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Abstract
Neutrophils play a central role in innate immune defense. Advances in neutrophil biology have brought to light the capacity of neutrophils to release their decondensed chromatin and form large extracellular DNA networks called neutrophil extracellular traps (NETs). NETs are produced in response to many infectious and noninfectious stimuli and, together with fibrin, block the invasion of pathogens. However, their formation in inflamed blood vessels produces a scaffold that supports thrombosis, generates neo-antigens favoring autoimmunity, and aggravates damage in ischemia/reperfusion injury. NET formation can also be induced by cancer and promotes tumor progression. Formation of NETs within organs can be immediately detrimental, such as in lung alveoli, where they affect respiration, or they can be harmful over longer periods of time. For example, NETs initiate excessive deposition of collagen, resulting in fibrosis, thus likely contributing to heart failure. Here, we summarize the latest knowledge on NET generation and discuss how excessive NET formation mediates propagation of thrombosis and inflammation and, thereby, contributes to various diseases. There are many ways in which NET formation could be averted or NETs neutralized to prevent their detrimental consequences, and we will provide an overview of these possibilities.
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Affiliation(s)
- Nicoletta Sorvillo
- From the Program in Cellular and Molecular Medicine (N.S., D.C., D.D.W.), Boston Children's Hospital, MA
- Department of Pediatrics, Harvard Medical School, Boston, MA (N.S., D.C., D.D.W.)
| | - Deya Cherpokova
- From the Program in Cellular and Molecular Medicine (N.S., D.C., D.D.W.), Boston Children's Hospital, MA
- Department of Pediatrics, Harvard Medical School, Boston, MA (N.S., D.C., D.D.W.)
| | - Kimberly Martinod
- Laboratory for Thrombosis Research, KU Leuven Campus Kulak Kortrijk, Belgium (K.M.)
| | - Denisa D Wagner
- From the Program in Cellular and Molecular Medicine (N.S., D.C., D.D.W.), Boston Children's Hospital, MA
- Division of Hematology/Oncology (D.D.W.), Boston Children's Hospital, MA
- Department of Pediatrics, Harvard Medical School, Boston, MA (N.S., D.C., D.D.W.)
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352
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Wang X, Chu C, Sun S, Xie T, Duan Z, Wang K, Liu B, Fan X, Wu X, Ding W. Outcomes and clinical characteristics of transmural intestinal necrosis in acute mesenteric ischemia. Scand J Gastroenterol 2019; 54:953-959. [PMID: 31361977 DOI: 10.1080/00365521.2019.1646800] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Background: Acute mesenteric ischemia (AMI) is a rare life-threatening condition, especially for the patients with transmural intestinal necrosis (TIN). However, the optimal time for surgical intervention is controversial. As a series study, this study aimed to identify the outcomes and clinical characteristic of patients with TIN. Methods: Clinical data of 158 patients with AMI from January 2010 to December 2017 were retrospectively analyzed in a national gastrointestinal referral center in China to confirm the outcomes and identify predictors for TIN. Results: According to the results of pathological assessment and follow-up, 62 patients were TIN and 96 were non-TIN. Patients with TIN have a higher mortality and incidence of severe complications. The significant independent predictors for TIN were arterial lactate level (OR: 4.76 [2.29 ∼ 9.89]), free intraperitoneal fluid (OR: 9.49 [2.56 ∼ 35.24]) and pneumatosis intestinalis (OR: 7.08 [1.68 ∼ 29.82]) in computed tomography (CT) scan imaging. The overall area under the receiver operating characteristics (ROC) curve of the model was 0.934 (95% confidence interval: 0.893 ∼ 0.974). Using ROC curve, the cutoff value of arterial lactate level predicting the onset of TIN was 2.65 mmol/L. Conclusions: Patients concomitant with TIN manifest a higher risk of poor prognosis. The three predictors for TIN were arterial lactate level >2.65 mmol/L, free intraperitoneal fluid and pneumatosis intestinalis. Close monitoring these predictors would help identify AMI patients developed TIN and in urgent need for bowel resection.
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Affiliation(s)
- Xinyu Wang
- Research Institute of General Surgery, Jinling Hospital, Medical School of Nanjing University , Nanjing , China
| | - Chengnan Chu
- Research Institute of General Surgery, Jinling Hospital, Medical School of Nanjing University , Nanjing , China
| | - Shilong Sun
- Research Institute of General Surgery, Jinling Hospital, Medical School of Nanjing University , Nanjing , China
| | - Tian Xie
- Research Institute of General Surgery, Jinling Hospital, Medical School of Nanjing University , Nanjing , China
| | - Zehua Duan
- Research Institute of General Surgery, Jinling Hospital, Medical School of Nanjing University , Nanjing , China
| | - Kai Wang
- Research Institute of General Surgery, Jinling Hospital, Medical School of Nanjing University , Nanjing , China
| | - Baochen Liu
- Research Institute of General Surgery, Jinling Hospital, Medical School of Nanjing University , Nanjing , China
| | - Xinxin Fan
- Research Institute of General Surgery, Jinling Hospital, Medical School of Nanjing University , Nanjing , China
| | - Xingjiang Wu
- Research Institute of General Surgery, Jinling Hospital, Medical School of Nanjing University , Nanjing , China
| | - Weiwei Ding
- Research Institute of General Surgery, Jinling Hospital, Medical School of Nanjing University , Nanjing , China
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353
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Memet O, Zhang L, Shen J. Serological biomarkers for acute mesenteric ischemia. ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:394. [PMID: 31555708 DOI: 10.21037/atm.2019.07.51] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Acute mesenteric ischemia (AMI) defines a complex of conditions characterized by an interruption of the splanchnic circulation, leading to insufficient oxygen delivery or utilization to fill the metabolic needs of the visceral organs. Early diagnosis and immediate therapy are the cornerstones of early ischemia to reach a successful outcome and are necessary to reduce the high mortality. Although there is still lack of specific biomarkers to assist the diagnosis of AMI in clinical practice, there are several biomarkers with high specificity, may become a potential tools in early diagnosis of AMI, including intestinal fatty acid binding protein (I-FABP), a-glutathione S-transferase (a-GST), D-dimer, L- and D-lactate, citrulline, ischemia modified albumin, procalcitonin (PCT). However, they use in clinical limited duo to the many studies about these makers finished with small patient populations, and heterogeneous among these populations. This review describes the etiology of AMI, the current most studied promising biomarkers, the current research situation and future of biomarker research.
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Affiliation(s)
- Obulkasim Memet
- Center of Emergency & Intensive Care Unit, Medical Center of Chemical Injury, Jinshan Hospital, Fudan University, Shanghai 201508, China
| | - Lin Zhang
- Center of Emergency & Intensive Care Unit, Medical Center of Chemical Injury, Jinshan Hospital, Fudan University, Shanghai 201508, China
| | - Jie Shen
- Center of Emergency & Intensive Care Unit, Medical Center of Chemical Injury, Jinshan Hospital, Fudan University, Shanghai 201508, China
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354
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Four Subgroups of Blood Stasis Syndrome Are Identified by Manifestation Cluster Analysis in Males. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2019; 2019:2647525. [PMID: 31360206 PMCID: PMC6644214 DOI: 10.1155/2019/2647525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 05/23/2019] [Accepted: 06/23/2019] [Indexed: 11/17/2022]
Abstract
Blood stasis syndrome (BSS) is an important pathological condition in traditional East Asian medicine and is associated with ischemic heart disease, cerebral vascular accident, diabetes mellitus, chronic renal failure, severe traumatic injury, and dysmenorrhea. However, previous studies have been unable to reveal the clinical and biological characteristics or biological markers of BSS. We hypothesized that the heterogeneity among the manifestations of BSS or non-BSS could interfere with an analysis to describe the characteristics of BSS. In this study, male participants based on the severity of BSS-associated symptoms and signs were clustered and classified into four subgroups: BSS subgroups (1), (2), (3), and (4). Non-BSS core subgroup was redefined using manifestation cluster analysis. Biological characteristics of subgroups BSS(1) and BSS(2) belong to the range of the non-BSS core subgroup (1), whereas that of subgroups BSS(3) and BSS(4) are characterized by different biological parameters such as systemic inflammatory conditions and elevated D-dimer level. Our results suggested that patients in subgroups of BSS(3) and BSS(4) are more likely to be exposed in an inflammatory state than other BSS subgroups. We found the heterogeneity among the manifestations which could mask the characteristics of BSS and identified the clinical and biological profiles of the four BSS subgroups through comparisons of the redefined non-BSS and BSS subgroups. This finding could provide accurate diagnostic criteria and new approaches for BSS treatments in different subgroups.
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355
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Rather than Surgical Technique, Dedicated Stroke Centers Improve Bowel and Life Outcomes in Acute Mesenteric Ischemia. J Clin Gastroenterol 2019; 53:471-472. [PMID: 29206752 DOI: 10.1097/mcg.0000000000000970] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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356
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Xu X, Guo X, De Stefano V, Silva-Junior G, Goyal H, Bai Z, Zhao Q, Qi X. Nonselective beta-blockers and development of portal vein thrombosis in liver cirrhosis: a systematic review and meta-analysis. Hepatol Int 2019; 13:468-481. [PMID: 31175581 DOI: 10.1007/s12072-019-09951-6] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Accepted: 05/11/2019] [Indexed: 02/07/2023]
Abstract
Portal vein thrombosis (PVT), which is associated with reduced portal vein velocity, is considered to be an indicator for worse outcomes in liver cirrhosis. Nonselective beta-blockers (NSBBs), which are widely used for primary and secondary prophylaxis of esophageal variceal bleeding in liver cirrhosis, can significantly decrease the portal vein velocity. We proposed a hypothesis that the use of NSBBs might facilitate the development of PVT in cirrhotic patients. The PubMed, EMBASE, and Cochrane Library databases were searched. Major meeting abstracts and randomized-controlled trials regarding the use of NSBBs in liver cirrhosis were also hand-searched. The number of patients who developed PVT in groups treated with or without NSBBs was pooled. Odds ratios (ORs) or risk ratios (RRs) with 95% confidence intervals (CIs) were calculated. Subgroup meta-analyses were performed according to the type of studies, region, and study quality. Meta-regression and sensitivity analyses were performed to explore the source of heterogeneity. Nine of the 6416 retrieved papers were finally included. Overall, meta-analysis demonstrated that NSBBs were significantly associated with the development of PVT (OR 4.62, 95% CI 2.50-8.53; p < 0.00001). The heterogeneity was statistically significant (I2 = 80%; p < 0.00001). Subgroup meta-analyses still demonstrated a significantly positive association of NSBBs with the development of PVT in cohort studies (RR 2.57, 95% CI 1.46-4.51; p = 0.001) and case-control studies (OR 8.17, 95% CI 2.46-27.06; p = 0.0006). Sensitivity analyses based on subgroups find the source of heterogeneity. Based on the systematic review and meta-analysis, we found that the use of NSBBs increased a 4.62-fold risk of PVT in cirrhotic patients.
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Affiliation(s)
- Xiangbo Xu
- Liver Cirrhosis Study Group, Department of Gastroenterology, General Hospital of Northern Theater Command (Formerly Called General Hospital of Shenyang Military Area), No. 83 Wenhua Road, Shenyang, 110840, Liaoning, China
- Postgraduate College, Shenyang Pharmaceutical University, Shenyang, China
| | - Xiaozhong Guo
- Liver Cirrhosis Study Group, Department of Gastroenterology, General Hospital of Northern Theater Command (Formerly Called General Hospital of Shenyang Military Area), No. 83 Wenhua Road, Shenyang, 110840, Liaoning, China
| | - Valerio De Stefano
- Fondazione Policlinico A. Gemelli IRCCS, Istituto Di Ematologia, Università Cattolica, Rome, Italy
| | - Gilberto Silva-Junior
- Department of General Medicine and Hepatology, Quinta D'Or Hospital, Rio de Janeiro, Brazil
| | - Hemant Goyal
- Department of Internal Medicine, School of Medicine, Mercer University, Macon, GA, USA
| | - Zhaohui Bai
- Liver Cirrhosis Study Group, Department of Gastroenterology, General Hospital of Northern Theater Command (Formerly Called General Hospital of Shenyang Military Area), No. 83 Wenhua Road, Shenyang, 110840, Liaoning, China
- Postgraduate College, Shenyang Pharmaceutical University, Shenyang, China
| | - Qingchun Zhao
- Postgraduate College, Shenyang Pharmaceutical University, Shenyang, China
| | - Xingshun Qi
- Liver Cirrhosis Study Group, Department of Gastroenterology, General Hospital of Northern Theater Command (Formerly Called General Hospital of Shenyang Military Area), No. 83 Wenhua Road, Shenyang, 110840, Liaoning, China.
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357
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Sun H, Zuo HD, Lin Q, Yang DD, Zhou T, Tang MY, Wáng YXJ, Zhang XM. MR imaging for acute pancreatitis: the current status of clinical applications. ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:269. [PMID: 31355236 DOI: 10.21037/atm.2019.05.37] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Acute pancreatitis is a common clinical acute abdomen. Imaging examinations play an important role in the management of acute pancreatitis. MR imaging is a noninvasive examination with high tissue contrast and a variety of acquisition sequences that can help determine the diagnosis, complications and severity of acute pancreatitis. The acute pancreatitis classification working group modified the Atlanta classification in 2012 to improve clinical evaluations and standardize the radiologic nomenclature for acute pancreatitis. In particular, the redefinition of necrotizing pancreatitis offers a new understanding of this disease. In clinical practice, there is still a lack of unifying standards between radiologists and physicians, such as for the imaging features of pseudocysts, walled-off necrosis, peripancreatic necrosis and especially for the MR imaging features of acute pancreatitis. In this article, we review the 2012 revised Atlanta classification of acute pancreatitis and recent advances in the clinical applications of MR imaging (MRI) in acute pancreatitis by showing how MRI can provide more optimized information for clinical diagnosis and treatment plan.
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Affiliation(s)
- Huan Sun
- Sichuan Key Laboratory of Medical Imaging, Department of Radiology, The Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, China
| | - Hou-Dong Zuo
- Sichuan Key Laboratory of Medical Imaging, Department of Radiology, The Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, China
| | - Qiao Lin
- Sichuan Key Laboratory of Medical Imaging, Department of Radiology, The Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, China
| | - Dan-Dan Yang
- Sichuan Key Laboratory of Medical Imaging, Department of Radiology, The Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, China
| | - Ting Zhou
- Sichuan Key Laboratory of Medical Imaging, Department of Radiology, The Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, China
| | - Meng-Yue Tang
- Sichuan Key Laboratory of Medical Imaging, Department of Radiology, The Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, China
| | - Yì Xiáng J Wáng
- Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, New Territories, Hong Kong, China
| | - Xiao-Ming Zhang
- Sichuan Key Laboratory of Medical Imaging, Department of Radiology, The Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, China
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358
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Rasmussen T, Stockinger Z, Antevil J, White C, Fernandez N, White J, White P. Wartime Vascular Injury. Mil Med 2019; 183:101-104. [PMID: 30189077 DOI: 10.1093/milmed/usy138] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Indexed: 11/13/2022] Open
Abstract
Wartime vascular injury can be particularly challenging due to the complexity of the case, concomitant injuries, resource limitations, and often lack of expertise of the operating surgeon. The proliferation of vascular shunting has been of particular importance as a damage control surgery technique to restore perfusion and temporize the immediate need for definitive repair necessary for limb salvage, particularly in austere locations. Diagnosis of vascular injury can be made using a variety of techniques, from physical examination to ankle-brachial indices to the use of CT angiography or invasive angiographic techniques. Operative planning and judgment are therefore critical in deciding both how and whether to operate. Surgeons likely to deploy should take every opportunity to practice vascular exposures and techniques through clinical practice and laboratory courses.
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Affiliation(s)
- Todd Rasmussen
- Joint Trauma System, 3698 Chambers Pass, Joint Base San Antonio, Fort Sam Houston, TX
| | - Zsolt Stockinger
- Joint Trauma System, 3698 Chambers Pass, Joint Base San Antonio, Fort Sam Houston, TX
| | - Jared Antevil
- Joint Trauma System, 3698 Chambers Pass, Joint Base San Antonio, Fort Sam Houston, TX
| | - Christopher White
- Joint Trauma System, 3698 Chambers Pass, Joint Base San Antonio, Fort Sam Houston, TX
| | - Nathaniel Fernandez
- Joint Trauma System, 3698 Chambers Pass, Joint Base San Antonio, Fort Sam Houston, TX
| | - Joseph White
- Joint Trauma System, 3698 Chambers Pass, Joint Base San Antonio, Fort Sam Houston, TX
| | - Paul White
- Joint Trauma System, 3698 Chambers Pass, Joint Base San Antonio, Fort Sam Houston, TX
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359
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Smalheiser NR. Mining Clinical Case Reports to Identify New Lines of Investigation in Alzheimer's Disease: The Curious Case of DNase I. J Alzheimers Dis Rep 2019; 3:71-76. [PMID: 31025031 PMCID: PMC6481472 DOI: 10.3233/adr-190100] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Mining the case report literature identified an intriguing, yet neglected finding: Deoxyribonuclease I (DNase I) as a possible treatment for Alzheimer’s disease. This finding is speculative, both because it is based on one patient, and because the underlying mechanism(s) of action remain obscure. However, further literature review revealed that there are several plausible mechanisms by which DNase I might affect the course of Alzheimer’s disease. Given that DNase I is an FDA-approved drug, with extensive studies in both animals and man in the context of other diseases, I suggest that investigation of DNAse I in Alzheimer’s disease is worthwhile.
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Affiliation(s)
- Neil R Smalheiser
- Department of Psychiatry, University of Illinois College of Medicine, Chicago, IL, USA
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360
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Luo X, Zhao M, Wang X, Jiang M, Yu J, Li X, Yang L. Long-term patency and clinical outcome of the transjugular intrahepatic portosystemic shunt using the expanded polytetrafluoroethylene stent-graft. PLoS One 2019; 14:e0212658. [PMID: 30811467 PMCID: PMC6392293 DOI: 10.1371/journal.pone.0212658] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Accepted: 02/08/2019] [Indexed: 02/05/2023] Open
Abstract
Background Transjugular intrahepatic portosystemic shunt (TIPS) creation is an established treatment option to management the complications of portal hypertension. Recent data on the long-term outcomes of TIPS are scarce. Materials and methods In this single-institution retrospective study, 495 patients underwent TIPS with the Fluency stent-grafts between December 2011 and June 2015 were evaluated. The cumulative rates of TIPS dysfunction, hepatic encephalopathy (HE), survival, and variceal rebleeding were determined using the Kaplan–Meier method. Cox regression analysis was used to assess the parameters on TIPS patency, occurrence of HE and all-cause mortality. Results Technical success was 98.2%. TIPS-related complications occurred in 67 patients (13.5%) during the index hospital stay. TIPS creation resulted in an immediate decrease in mean portosystemic pressure gradient from 23.4 ± 7.1 mmHg to 7.6 ± 3.5 mmHg. The median follow-up period was 649 days. Primary TIPS patency rates were 93%, and 75.9% at 1 and 3 years, respectively. Previous splenectomy was associated with a higher risk of TPS dysfunction. The cumulative survival rates were 93.4% and 77.2% at 1 and 3 years, respectively. The 1- and 3-year probability of remaining free of variceal bleeding rates were 94.2% and 71.4%, respectively. Conclusions This retrospective single-center experience with TIPS using the Fluency stent-grafts demonstrates good long-term patency and favorable good clinical results. Previous splenectomy strongly predicts shunt dysfunction.
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Affiliation(s)
- Xuefeng Luo
- Department of Gastroenterology and Hepatology, West China Hospital, Sichuan University, Chengdu, China
| | - Ming Zhao
- Department of Gastroenterology and Hepatology, West China Hospital, Sichuan University, Chengdu, China
| | - Xiaoze Wang
- Department of Gastroenterology and Hepatology, West China Hospital, Sichuan University, Chengdu, China
| | - Mingshan Jiang
- Department of Gastroenterology and Hepatology, West China Hospital, Sichuan University, Chengdu, China
| | - Jiaze Yu
- Department of Gastroenterology and Hepatology, West China Hospital, Sichuan University, Chengdu, China
| | - Xiao Li
- Department of interventional radiology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
- * E-mail: (XL); (LY)
| | - Li Yang
- Department of Gastroenterology and Hepatology, West China Hospital, Sichuan University, Chengdu, China
- * E-mail: (XL); (LY)
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361
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Bertino F, Hawkins CM, Shivaram G, Gill AE, Lungren MP, Reposar A, Sze DY, Hwang GL, Koo K, Monroe E. Technical Feasibility and Clinical Effectiveness of Transjugular Intrahepatic Portosystemic Shunt Creation in Pediatric and Adolescent Patients. J Vasc Interv Radiol 2019; 30:178-186.e5. [PMID: 30717948 DOI: 10.1016/j.jvir.2018.10.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 09/28/2018] [Accepted: 10/06/2018] [Indexed: 12/24/2022] Open
Abstract
PURPOSE To examine the technical feasibility and clinical efficacy of transjugular intrahepatic portosystemic shunt (TIPS) creation in children and adolescents. MATERIALS AND METHODS Retrospective review was performed of 59 patients (mean age 12.6 y [range, 1.5-20 y], mean weight 47.5 kg [range, 11.4-112.2 kg], mean Model for End-stage Liver Disease/Pediatric End-stage Liver Disease score 12.5 [range, 6-33]) who underwent 61 TIPS attempts at 3 tertiary children's hospitals from 2001 to 2017 for acute esophageal or gastroesophageal variceal bleeding, primary and secondary prevention of variceal bleeding, and refractory ascites. Pediatric liver disease etiologies included biliary atresia, cystic fibrosis, and ductal plate anomalies. Technical, hemodynamic, and clinical success and patency rates were reported at 1, 6, 12, and 24 months. Statistical analysis evaluated reasons for clinical failure. Kaplan-Meier analysis measured clinical success, patency, and transplant-free survival. RESULTS Technical success was 93.4% (57/61) in 59 consecutive patients. Most common TIPS indications were treating and preventing esophageal and gastroesophageal variceal bleeding (57/59; 96.6%). Hemodynamic success was 94% (47/50). Clinical success was 80.7% (45/56). Two-year clinical success for acute variceal bleeding and ascites was 94.1% and 100%, respectively. Overall patency at 1, 6, 12, and 24 months was 98.0%, 97.8%, 94.3%, and 91.3%. Two-year transplant-free survival was 88.8%. Overall and major complication rates were 21.2% (13/61) and 8.2% (5/61), with 3 mortalities. Gradient reduction < 12 mm Hg correlated with clinical success (P < .01). CONCLUSIONS TIPS creation in pediatric patients is technically feasible and clinically efficacious for treatment and prevention of esophageal and gastroesophageal variceal hemorrhage. High 2-year clinical success, patency, and survival rates should encourage providers to consider portosystemic shunts as a bridge to liver transplantation.
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Affiliation(s)
- Frederic Bertino
- Divisions of Pediatric Radiology and Interventional Radiology and Image Guided Medicine, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia; Children's Healthcare of Atlanta, Atlanta, Georgia.
| | - C Matthew Hawkins
- Divisions of Pediatric Radiology and Interventional Radiology and Image Guided Medicine, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia; Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Giri Shivaram
- Division of Interventional Radiology, Department of Radiology, University of Washington, Seattle, Washington; Seattle Children's Hospital, Seattle, Washington
| | - Anne E Gill
- Divisions of Pediatric Radiology and Interventional Radiology and Image Guided Medicine, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia; Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Matthew P Lungren
- Department of Radiology, Stanford University School of Medicine, Stanford, California
| | - Aaron Reposar
- Department of Radiology, Stanford University School of Medicine, Stanford, California
| | - Daniel Y Sze
- Department of Radiology, Stanford University School of Medicine, Stanford, California
| | - Gloria L Hwang
- Department of Radiology, Stanford University School of Medicine, Stanford, California
| | - Kevin Koo
- Division of Interventional Radiology, Department of Radiology, University of Washington, Seattle, Washington; Seattle Children's Hospital, Seattle, Washington
| | - Eric Monroe
- Division of Interventional Radiology, Department of Radiology, University of Washington, Seattle, Washington; Seattle Children's Hospital, Seattle, Washington
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362
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Li LN, Sun XY, Wang GC, Tian XG, Zhang MY, Jiang KT, Zhang CQ. Transjugular intrahepatic portosystemic shunt prevents rebleeding in cirrhotic patients having cavernous transformation of the portal vein without improving their survival. J Dig Dis 2019; 20:89-96. [PMID: 30629804 DOI: 10.1111/1751-2980.12702] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 12/18/2018] [Accepted: 12/20/2018] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To compare the efficacy of transjugular intrahepatic portosystemic shunts (TIPS) and endoscopic variceal ligations (EVL) plus propranolol in decreasing rebleeding and improving survival rates in cirrhotic patients with cavernous transformation of the portal vein (CTPV). METHODS Cirrhotic patients with CTPV and a history of variceal bleeding who were treated for recurrent variceal bleeding between June 2010 and July 2016 were identified and classified based on the treatment they received (TIPS or EVL plus propranolol). Their characteristics and clinical data were recorded. The rebleeding and long-term survival rates between the two groups were analyzed. RESULTS A total of 51 patients were included, of whom 25 were treated with TIPS and 26 with EVL plus propranolol. The mean duration of follow up was 21 months (range 1-47 months) in the former group and 27 months (range 6-73 months) in the latter group. The recurrent variceal bleeding-free rate increased remarkably in the TIPS group compared with the EVL + propranolol group (P = 0.047). Three (14.3%) patients died in the TIPS group, and one (3.8%) in the EVL plus propranolol group (P = 0.305). Hepatic encephalopathy occurred in 14.3% (3/21) of the patients in the TIPS group and in 3.8% (1/26) in the EVL + propranolol group (P = 0.202). CONCLUSION TIPS appeared to be more effective in preventing rebleeding in cirrhotic patients with CTPV compared with EVL plus propranolol, without improving survival.
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Affiliation(s)
- Lu Ning Li
- Department of Gastroenterology, Shandong Provincial Hospital affiliated to Shandong University, Jinan, Shandong Province, China.,Department of Gastroenterology, Linyi People's Hospital, Linyi, Shandong Province, China
| | - Xiao Yan Sun
- Department of Gastroenterology, Shandong Provincial Hospital affiliated to Shandong University, Jinan, Shandong Province, China
| | - Guang Chuan Wang
- Department of Gastroenterology, Shandong Provincial Hospital affiliated to Shandong University, Jinan, Shandong Province, China
| | - Xiang Guo Tian
- Department of Gastroenterology, Shandong Provincial Hospital affiliated to Shandong University, Jinan, Shandong Province, China
| | - Ming Yan Zhang
- Department of Gastroenterology, Shandong Provincial Hospital affiliated to Shandong University, Jinan, Shandong Province, China
| | - Kai Tong Jiang
- Department of Gastroenterology, Linyi People's Hospital, Linyi, Shandong Province, China
| | - Chun Qing Zhang
- Department of Gastroenterology, Shandong Provincial Hospital affiliated to Shandong University, Jinan, Shandong Province, China
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363
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Murthy P, Singhi AD, Ross MA, Loughran P, Paragomi P, Papachristou GI, Whitcomb DC, Zureikat AH, Lotze MT, Zeh Iii HJ, Boone BA. Enhanced Neutrophil Extracellular Trap Formation in Acute Pancreatitis Contributes to Disease Severity and Is Reduced by Chloroquine. Front Immunol 2019; 10:28. [PMID: 30733719 PMCID: PMC6353831 DOI: 10.3389/fimmu.2019.00028] [Citation(s) in RCA: 66] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Accepted: 01/08/2019] [Indexed: 12/12/2022] Open
Abstract
Background: Neutrophil extracellular traps (NETs) are generated when activated neutrophils, driven by PAD4, release their DNA, histones, HMGB1, and other intracellular granule components. NETs play a role in acute pancreatitis, worsening pancreatic inflammation, and promoting pancreatic duct obstruction. The autophagy inhibitor chloroquine (CQ) inhibits NET formation; therefore, we investigated the impact of CQ mediated NET inhibition in murine models of pancreatitis and human correlative studies. Methods: L-arginine and choline deficient ethionine supplemented (CDE) diet models of acute pancreatitis were studied in wild type and PAD4−/− mice, incapable of forming NETs. Isolated neutrophils were stimulated to induce NET formation and visualized with fluorescence microscopy. CQ treatment (0.5 mg/ml PO) was initiated after induction of pancreatitis. Biomarkers of NET formation, including cell-free DNA, citrullinated histone H3 (CitH3), and MPO-DNA conjugates were measured in murine serum and correlative human patient serum samples. Results: We first confirmed the role of NETs in the pathophysiology of acute pancreatitis by demonstrating that PAD4−/− mice had decreased pancreatitis severity and improved survival compared to wild-type controls. Furthermore, patients with severe acute pancreatitis had elevated levels of cell-free DNA and MPO-DNA conjugates, consistent with NET formation. Neutrophils from mice with pancreatitis were more prone to NET formation and CQ decreased this propensity to form NETs. CQ significantly reduced serum cell-free DNA and citrullinated histone H3 in murine models of pancreatitis, increasing survival in both models. Conclusions: Inhibition of NETs with CQ decreases the severity of acute pancreatitis and improves survival. Translating these findings into clinical trials of acute pancreatitis is warranted.
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Affiliation(s)
- Pranav Murthy
- Division of Surgical Oncology, Department of Surgery, University of Pittsburgh, Pittsburgh, PA, United States
| | - Aatur D Singhi
- Department of Pathology, University of Pittsburgh, Pittsburgh, PA, United States
| | - Mark A Ross
- Center for Biologic Imaging, University of Pittsburgh, Pittsburgh, PA, United States
| | - Patricia Loughran
- Center for Biologic Imaging, University of Pittsburgh, Pittsburgh, PA, United States
| | - Pedram Paragomi
- Division of Gastroenterology, Hepatology and Nutrition, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, United States
| | - Georgios I Papachristou
- Division of Gastroenterology, Hepatology and Nutrition, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, United States
| | - David C Whitcomb
- Division of Gastroenterology, Hepatology and Nutrition, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, United States
| | - Amer H Zureikat
- Division of Surgical Oncology, Department of Surgery, University of Pittsburgh, Pittsburgh, PA, United States
| | - Michael T Lotze
- Division of Surgical Oncology, Department of Surgery, University of Pittsburgh, Pittsburgh, PA, United States
| | - Herbert J Zeh Iii
- Division of Surgical Oncology, Department of Surgery, University of Pittsburgh, Pittsburgh, PA, United States.,Department of Surgery, UT Southwestern Medical Center, Dallas, TX, United States
| | - Brian A Boone
- Division of Surgical Oncology, Department of Surgery, University of Pittsburgh, Pittsburgh, PA, United States.,Department of Surgery, West Virginia University, Morgantown, WV, United States
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364
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Goodman RR, Jong MK, Davies JE. Concise review: The challenges and opportunities of employing mesenchymal stromal cells in the treatment of acute pancreatitis. Biotechnol Adv 2019; 42:107338. [PMID: 30639517 DOI: 10.1016/j.biotechadv.2019.01.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 01/02/2019] [Accepted: 01/07/2019] [Indexed: 02/08/2023]
Abstract
To date only small animal models have been employed to assess the effect of mesenchymal stromal cell (MSC) therapy on acute pancreatitis (AP), the most common cause of hospitalization for gastrointestinal diseases worldwide. We outline the challenges inherent in the small animal models of AP. We also point to specific benefits afforded by the adoption of larger animal models. The potential for MSC therapeutics in the treatment of AP was recognized over a decade ago. With sharper focus on the form of AP and development of new MSC delivery routes in larger animals, we believe the challenge can be engaged.
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Affiliation(s)
- Robbie R Goodman
- Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto M5S 3G9, Canada
| | - Madelaine K Jong
- Faculty of Dentistry, University of Toronto, Toronto M5G 1G6, Canada
| | - John E Davies
- Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto M5S 3G9, Canada; Faculty of Dentistry, University of Toronto, Toronto M5G 1G6, Canada.
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365
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Wang S, Xie T, Sun S, Wang K, Liu B, Wu X, Ding W. DNase-1 Treatment Exerts Protective Effects in a Rat Model of Intestinal Ischemia-Reperfusion Injury. Sci Rep 2018; 8:17788. [PMID: 30542063 PMCID: PMC6290768 DOI: 10.1038/s41598-018-36198-2] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Accepted: 11/01/2018] [Indexed: 12/12/2022] Open
Abstract
A growing number of studies have recently revealed a potential role for neutrophil extracellular traps (NETs) in the development of inflammation, coagulation and cell death. Deleterious consequences of NETs have been identified in ischemia-reperfusion (I/R)-induced organ damage, thrombosis and sepsis. And exogenous DNase-I has been suggested as a therapeutic strategy to attenuate ischemia-reperfusion (I/R) injuries in the kidney, brain and myocardium. Herein, we designed a study to investigate whether NETs contribute to the pathogenesis of intestinal I/R injury and evaluated the therapeutic value of DNase-1 in a rat model of intestinal I/R injury. In this rat model of intestinal I/R injury, we found that extracellular DNA was readily detectable in rat serum after 1 h of ischemia and 2 h of reperfusion. Treatment with DNase-1 significantly reduced the inflammatory response, restored intestinal barrier integrity and increased the expression of tight junction proteins. Our results indicate the existence of NETs in I/R-challenged intestinal tissues and firstly provide more evidence that DNase-1 may be an effective treatment for attenuating intestinal I/R injury.
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Affiliation(s)
- Shikai Wang
- Research Institute of General Surgery, Jinling Hospital, Nanjing University School of Medicine, Nanjing, 210002, Jiangsu Province, P.R. China
| | - Tian Xie
- Research Institute of General Surgery, Jinling Hospital, Nanjing University School of Medicine, Nanjing, 210002, Jiangsu Province, P.R. China
| | - Shilong Sun
- Research Institute of General Surgery, Jinling Hospital, Nanjing University School of Medicine, Nanjing, 210002, Jiangsu Province, P.R. China
| | - Kai Wang
- Research Institute of General Surgery, Jinling Hospital, Nanjing University School of Medicine, Nanjing, 210002, Jiangsu Province, P.R. China
| | - Baochen Liu
- Research Institute of General Surgery, Jinling Hospital, Nanjing University School of Medicine, Nanjing, 210002, Jiangsu Province, P.R. China
| | - Xingjiang Wu
- Research Institute of General Surgery, Jinling Hospital, Nanjing University School of Medicine, Nanjing, 210002, Jiangsu Province, P.R. China
| | - Weiwei Ding
- Research Institute of General Surgery, Jinling Hospital, Nanjing University School of Medicine, Nanjing, 210002, Jiangsu Province, P.R. China.
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366
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Postsplenectomy thrombosis of splenic, mesenteric, and portal vein (PST-SMPv): A single institutional series, comprehensive systematic review of a literature and suggested classification. Am J Surg 2018; 216:1192-1204. [DOI: 10.1016/j.amjsurg.2018.01.073] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Revised: 01/22/2018] [Accepted: 01/30/2018] [Indexed: 12/21/2022]
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367
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Wu W, Cai Z, Lin N, Yang W, Hong J, Lin L, Lin Z, Song J, Fang Y, Lin C, Zhang H, Chen D, Wang Y. A Novel Method of Damage Control for Multiple Discontinuous Intestinal Injuries with Hemorrhagic Shock: A Controlled Experiment. J INVEST SURG 2018; 33:412-421. [PMID: 30430887 DOI: 10.1080/08941939.2018.1527418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Aim: In this study, we examined the effects of branched silicon tube (BST) and temporary closed circle (TCC) in a Beagle dog model of multiple transection of small intestine and discontinuities suspected intestinal necrosis with hemorrhagic shock. Materials and Methods: Ten male Beagle dogs were randomly divided into two groups. Hemorrhagic shock was induced by bleeding. Intestine was severed. Suspected intestinal necrotic model by ligating the mesenteric vessels was established, with a small tertiary mesenteric vessel reserved. Fracted intestines were ligated (IL group, n = 5) or reconnected with BST (IR group, n = 5). The abdominal cavity was temporarily closed with TCC. Definitive surgery was conducted after 24 h. Results: There was no statistical difference between two groups in the weight of dogs, their blood loss, fluid resuscitation, operation time of early emergency treatment (EET). After definitive surgery, all dogs in IR group and 3 dogs in IL groups were alive. 18 (90%) suspicious necrotic intestinal segments in IL group became necrotic, but 20 (80%) segments in IR group didn't develop obvious changes (p < 0.01). From 2 h after EET, the endotoxin concentration in IL group was significantly higher than that in IR group (133.87 ± 43.73 vs. 56.31 ± 24.70 pg/ml, p < 0.01). Microscopic examination revealed that much more severe damage occurred in the suspicious necrotic intestinal segments in IL group. Conclusion: Both reconnecting intestine with BST and temporary abdominal closure with TCC are viable methods of damage control for multiple discontinuous intestinal injuries.
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Affiliation(s)
- Weihang Wu
- Department of General Surgery, Fuzhou General Hospital of the Chinese People's Liberation Army, Fuzhou, Fujian, China.,Department of General Surgery, Clinical Institute of Fuzhou General Hospital, Fujian Medical University, Fuzhou, Fujian, China.,Department of General Surgery, Dongfang Hospital, Xiamen University, Fuzhou, Fujian, China
| | - Zhicong Cai
- Department of Gastroenterological Surgery, Jinjiang Municipal Hospital, Quanzhou, Fujian, China
| | - Nan Lin
- Department of General Surgery, Fuzhou General Hospital of the Chinese People's Liberation Army, Fuzhou, Fujian, China.,Department of General Surgery, Clinical Institute of Fuzhou General Hospital, Fujian Medical University, Fuzhou, Fujian, China.,Department of General Surgery, Dongfang Hospital, Xiamen University, Fuzhou, Fujian, China
| | - Weijin Yang
- Department of General Surgery, Fuzhou General Hospital of the Chinese People's Liberation Army, Fuzhou, Fujian, China.,Department of General Surgery, Clinical Institute of Fuzhou General Hospital, Fujian Medical University, Fuzhou, Fujian, China.,Department of General Surgery, Dongfang Hospital, Xiamen University, Fuzhou, Fujian, China
| | - Jie Hong
- Department of General Surgery, Fuzhou General Hospital of the Chinese People's Liberation Army, Fuzhou, Fujian, China.,Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian, China
| | - Li Lin
- Department of General Surgery, Clinical Institute of Fuzhou General Hospital, Fujian Medical University, Fuzhou, Fujian, China
| | - Zhixiong Lin
- Department of General Surgery, Clinical Institute of Fuzhou General Hospital, Fujian Medical University, Fuzhou, Fujian, China
| | - Junchuan Song
- Department of General Surgery, Clinical Institute of Fuzhou General Hospital, Fujian Medical University, Fuzhou, Fujian, China
| | - Yongchao Fang
- Department of General Surgery, Clinical Institute of Fuzhou General Hospital, Fujian Medical University, Fuzhou, Fujian, China
| | - Chen Lin
- Department of General Surgery, Fuzhou General Hospital of the Chinese People's Liberation Army, Fuzhou, Fujian, China.,Department of General Surgery, Clinical Institute of Fuzhou General Hospital, Fujian Medical University, Fuzhou, Fujian, China.,Department of General Surgery, Dongfang Hospital, Xiamen University, Fuzhou, Fujian, China
| | - Hongwen Zhang
- Department of Radiology, Fuzhou General Hospital of the Chinese People's Liberation Army, Fuzhou, Fujian, China.,Department of Radiology, Clinical Institute of Fuzhou General Hospital, Fujian Medical University, Fuzhou, Fujian, China.,Department of Radiology, Dongfang Hospital, Xiamen University, Fuzhou, Fujian, China
| | - Dongsheng Chen
- Department of Anesthesiology, Fuzhou General Hospital of the Chinese People's Liberation Army, Fuzhou, Fujian, China.,Department of Anesthesiology, Clinical Institute of Fuzhou General Hospital, Fujian Medical University, Fuzhou, Fujian, China.,Department of Anesthesiology, Dongfang Hospital, Xiamen University, Fuzhou, Fujian, China
| | - Yu Wang
- Department of General Surgery, Fuzhou General Hospital of the Chinese People's Liberation Army, Fuzhou, Fujian, China.,Department of General Surgery, Clinical Institute of Fuzhou General Hospital, Fujian Medical University, Fuzhou, Fujian, China.,Department of General Surgery, Dongfang Hospital, Xiamen University, Fuzhou, Fujian, China
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368
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Li Y, Cong J, Fei F, Zhang Z, Yu Y, Xu C, Zhang X, Zhang S. Use of high-resolution colonic manometry to establish etiology and direct treatment in patients with constipation: Case series with correlation to histology. J Gastroenterol Hepatol 2018; 33:1864-1872. [PMID: 29791059 DOI: 10.1111/jgh.14287] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 04/09/2018] [Accepted: 04/29/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND AIM Different clinical treatments are available to treat patients with constipation. We aimed to study the etiology and direct treatment in a case series of patients with constipation by the use of high-resolution colonic manometry (HRCM). METHODS High-resolution colonic manometry was used to record the colorectal peristaltic contractions of the entire colon in patients. Based on the results of HRCM, 151 patients with constipation were classified into groups and received different clinical treatment such as a total or subtotal colectomy, local excision, or conservative treatment. Paraffin-embedded samples obtained after resection were studied using hematoxylin and eosin, as well as immunohistochemical staining. RESULTS All patients underwent HRCM over 24 h. Based on the amplitude, intensity, and trends in peristaltic contractions recorded by HRCM, we observed 117 patients with slow-transit constipation and 34 with functional outlet obstruction constipation. After an overall evaluation of the results of HRCM and anorectal function, 26, 23, 27, and 75 patients were treated with total colectomy, subtotal colectomy, local excision, and conservative treatment, respectively. Furthermore, histological examination of surgical samples showed vacuolar degeneration of nerve plexuses as well as of the muscularis propria, which also showed fibrosis in its outer layers in patients with constipation. CONCLUSION Different types of constipation showed different colonic motility patterns and morphological changes in the colonic wall. HRCM plays an important role in the diagnosis and classification of patients with constipation. Furthermore, HRCM can accurately identify the diseased colonic segments and help to choose the appropriate treatment.
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Affiliation(s)
- Yuwei Li
- Department of Colorectal Surgery, Tianjin Union Medical Center, Tianjin, China
| | - Jiying Cong
- Department of Colorectal Surgery, Tianjin Union Medical Center, Tianjin, China
| | - Fei Fei
- Department of Pathology, Tianjin Union Medical Center, Tianjin, China
| | - Zhao Zhang
- Department of Colorectal Surgery, Tianjin Union Medical Center, Tianjin, China
| | - Yongjun Yu
- Department of Colorectal Surgery, Tianjin Union Medical Center, Tianjin, China
| | - Chen Xu
- Department of Pathology, Tianjin Union Medical Center, Tianjin, China
| | - Xipeng Zhang
- Department of Colorectal Surgery, Tianjin Union Medical Center, Tianjin, China
| | - Shiwu Zhang
- Department of Pathology, Tianjin Union Medical Center, Tianjin, China
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369
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Xu ZG, Tang L, Zhao YB, Gao MF, Yang SM. Catheter-directed thrombolysis combined with anticoagulation for acute extensive portal vein thrombosis: Our experience. J Dig Dis 2018; 19:635-640. [PMID: 30039602 DOI: 10.1111/1751-2980.12649] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Revised: 07/18/2018] [Accepted: 07/19/2018] [Indexed: 12/17/2022]
Affiliation(s)
- Zheng Guo Xu
- Department of Gastroenterology, Xinqiao Hospital, Third Military Medical University, Chongqing, China
| | - Li Tang
- Department of Gastroenterology, Xinqiao Hospital, Third Military Medical University, Chongqing, China
| | - Yong Bing Zhao
- Department of Gastroenterology, Xinqiao Hospital, Third Military Medical University, Chongqing, China
| | - Ming Fa Gao
- Department of Hepatobiliary Surgery, Xinqiao Hospital, Third Military Medical University, Chongqing, China
| | - Shi Ming Yang
- Department of Gastroenterology, Xinqiao Hospital, Third Military Medical University, Chongqing, China
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370
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Gu L, Yang B, Zhang X, Ding C, Tian H, Zhu W, Li J, Li N. Fluoroscopy-guided trans-anal decompression tube placement in the treatment of acute colonic pseudo-obstruction: a single center experience. Abdom Radiol (NY) 2018; 43:2643-2650. [PMID: 29470625 DOI: 10.1007/s00261-018-1509-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
PURPOSE Acute colonic pseudo-obstruction (ACPO or Ogilvie's syndrome) is a rare but often fatal disease; timely colonic decompression may be essential for successful treatment. This study describes a technique of placing a trans-anal tube via fluoroscopy-guiding and investigates the effect of colon decompression on ACPO. METHODS Patients undergoing colonic decompression via fluoroscopy-guided trans-anal tube placement from April 2015 to May 2017 were included. The technical and clinical successes of this procedure were evaluated. Clinical features and long-term outcomes are described. RESULTS Decompression was successful in 72.73% (16/22) of the patients; the procedure was considered a clinical success in 50% (11/22) of the patients. 31.82% (7/22) of the patients underwent elective surgery, and only 18.19% (4/22) of the patients need emergency surgery. CONCLUSIONS Fluoroscopy-guided trans-anal decompression tube placement was an easy and efficient method for treating ACPO. Additionally, ACPO once required emergency surgery, but now may only require elective surgery in certain instances.
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371
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Montagnana M, Danese E, Lippi G. Biochemical markers of acute intestinal ischemia: possibilities and limitations. ANNALS OF TRANSLATIONAL MEDICINE 2018; 6:341. [PMID: 30306080 DOI: 10.21037/atm.2018.07.22] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Acute intestinal ischemia is a relative rare abdominal emergency, associated with considerably high morbidity and mortality rates. Although the conventional diagnostic approach to acute intestinal ischemia entails a preliminary evaluation of signs and symptoms, followed by radiological and laboratory investigations, a definitive diagnosis is can usually be made after laparotomy, which still remains the gold standard diagnostic (and therapeutic) procedure. Several potential laboratory biomarkers have been investigated over the past decades, but none of these seems to reach a suitable diagnostic accuracy for an early and reliable diagnosis of intestinal ischemia. The aim of this narrative review is to provide an overview on traditional laboratory tests for diagnosing acute intestinal ischemia (i.e., complete blood count, D-dimer, blood gas analysis, total lactic acid, C-reactive protein and procalcitonin), and summarize current evidence regarding some emerging and potentially useful biomarkers such as D-lactate, intestinal fatty acid-binding protein (I-FABP), ischemia modified albumin (IMA), α-glutathione S-transferase (α-GST), interleukin-6 (IL-6), citrulline and smooth muscle protein of 22 kDa (SM22). Among the various tests, D-lactate, IMA and I-FABP are perhaps the most promising, since they are characterized by optimal sensitivity and relatively good specificity, early kinetics, and can be measured with assays suited for a rapid diagnosis.
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Affiliation(s)
- Martina Montagnana
- Clinical Biochemistry Section, University Hospital of Verona, Verona, Italy
| | - Elisa Danese
- Clinical Biochemistry Section, University Hospital of Verona, Verona, Italy
| | - Giuseppe Lippi
- Clinical Biochemistry Section, University Hospital of Verona, Verona, Italy
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372
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Wei Y, Chen X, Shen H, Wu W, Cao G, Chen W, Wang Y, Shen H, Yu S, Zhang J. P-Selectin Level at First and Third Day After Portal Hypertensive Splenectomy for Early Prediction of Portal Vein Thrombosis in Patients With Cirrhosis. Clin Appl Thromb Hemost 2018; 24:76S-83S. [PMID: 30033741 PMCID: PMC6714827 DOI: 10.1177/1076029618788180] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
We aimed to investigate the changes in p-selectin (p-sel), thrombus precursor protein, and D-dimer (D-D) in patients with cirrhosis after portal hypertensive splenectomy and explore its values on the prediction of postoperative portal vein thrombosis (PVT) formation. A total of 144 patients with cirrhosis with portal hypertension who underwent portal hypertensive splenectomy from January 2009 to December 2016 were enrolled in this study and divided into the thrombus and nonthrombus groups. The levels of p-sel, thrombus precursor protein (TpP), and D-D were measured by flow cytometry, enzyme-linked immunosorbent assay, and immunoturbidimetry, respectively. Sensitivity, specificity, and other values for p-sel, TpP, and D-D were calculated. The linear discriminant, logistic regression, and decision tree methods were used to analyze the p-sel value on the prediction of PVT formation. Seventy-nine patients were confirmed having postoperative PVT, with the incidence rate of 54.86%. No significant differences were observed in the p-sel, TpP, and D-D between the thrombus and nonthrombus groups before surgery, but these 3 indexes were obviously elevated in the thrombus group after operation (P < .01). P-selectin level on first day showed the highest positive predictive value (91.0%) and diagnostic coincidence rate (83.3%), while negative expected value (76.6%) was lower than those of TpP and D-D. Multiple analyses showed the prediction accuracy of PVT was 61.1% (P = .023), 97.2% (P < .001), and 97.2% (P < .001), respectively. P-selectin has a significant value in predicting PVT. P-selectin level on first and third day is valuable and feasible for the early prediction of PVT.
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Affiliation(s)
- Yunhai Wei
- Surgical Department, Huzhou Central Hospital, Zhejiang University Huzhou Hospital, Huzhou, People's Republic of China
| | - Xuedong Chen
- School of Science, Huzhou University, Huzhou, People's Republic of China
| | - Huaping Shen
- Surgical Department, Huzhou Central Hospital, Zhejiang University Huzhou Hospital, Huzhou, People's Republic of China
| | - Wanbo Wu
- Surgical Department, Huzhou Central Hospital, Zhejiang University Huzhou Hospital, Huzhou, People's Republic of China
| | - Guoliang Cao
- Surgical Department, Huzhou Central Hospital, Zhejiang University Huzhou Hospital, Huzhou, People's Republic of China
| | - Wenxian Chen
- Surgical Department, Huzhou Central Hospital, Zhejiang University Huzhou Hospital, Huzhou, People's Republic of China
| | - Yan Wang
- Surgical Department, Huzhou Central Hospital, Zhejiang University Huzhou Hospital, Huzhou, People's Republic of China
| | - Hua Shen
- Surgical Department, Huzhou Central Hospital, Zhejiang University Huzhou Hospital, Huzhou, People's Republic of China
| | - Sheng Yu
- Surgical Department, Huzhou Central Hospital, Zhejiang University Huzhou Hospital, Huzhou, People's Republic of China
| | - Jinyu Zhang
- Surgical Department, Huzhou Central Hospital, Zhejiang University Huzhou Hospital, Huzhou, People's Republic of China
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373
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Patient-Reported Outcome After Ostomy Surgery for Chronic Constipation. J Wound Ostomy Continence Nurs 2018; 45:319-325. [DOI: 10.1097/won.0000000000000445] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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374
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Scali ST, Ayo D, Giles KA, Gray S, Kubilis P, Back M, Fatima J, Arnaoutakis D, Berceli SA, Beck AW, Upchurch GJ, Feezor RJ, Huber TS. Outcomes of antegrade and retrograde open mesenteric bypass for acute mesenteric ischemia. J Vasc Surg 2018; 69:129-140. [PMID: 30580778 DOI: 10.1016/j.jvs.2018.04.063] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Accepted: 04/28/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND Acute mesenteric ischemia (AMI) is a challenging clinical problem associated with significant morbidity and mortality. Few contemporary reports focus specifically on patients undergoing open mesenteric bypass (OMB) or delineate outcome differences based on bypass configuration. This is notable, because there is a subset of patients who are poor candidates for endovascular intervention including those with flush mesenteric vessel occlusion, long segment occlusive disease, and a thrombosed mesenteric stent and/or bypass. This analysis reviewed our experience with OMB in the treatment of AMI and compared outcomes between patients undergoing either antegrade or retrograde bypass. METHODS A single-center, retrospective review was performed to identify all patients who underwent OMB for AMI from 2002 to 2016. A preoperative history of mesenteric revascularization, demographics, comorbidities, operative details, and outcomes were abstracted. The primary end point was in-hospital mortality. Secondary end points included complications, reintervention, and overall survival. Kaplan-Meier estimation and Cox proportional hazards regression were used to analyze all end points. RESULTS Eighty-two patients (female 54%; age 63 ± 12 years) underwent aortomesenteric bypass (aortoceliac/superior mesenteric, n = 44; aortomesenteric, n = 38) for AMI. A history of prior stent/bypass was present in 20% (n = 16). A majority (76%; n = 62) underwent antegrade bypass and the remainder received retrograde infrarenal aortoiliac inflow. Patients receiving antegrade OMB were more likely to be male (53% vs 25%; P = .02), have coronary artery disease (48% vs 25%; P = .06), chronic obstructive pulmonary disease (52% vs 25%; P = .03), and peripheral arterial disease (60% vs 35%; P = .05). Concurrent bowel resection was evenly distributed (antegrade, 45%; retrograde, 45%; P = .9) and 37% (n = 30) underwent subsequent resection during second look operations. The median duration of stay was 16 days (interquartile range, 9-35 days) and 78% (n = 64) experienced at least one major complication with no difference in rates between antegrade/retrograde configurations. In-hospital mortality was 37% (n = 30; multiple organ dysfunction, 22; bowel infarction, 4; hemorrhage/anemia, 2; arrhythmia, 1; stroke, 1; 30-day mortality, 26%). The median follow-up was 8 months (interquartile range, 1-26 months). The 1- and 3-year primary patency rates were both 82% ± 6% (95% confidence interval, 71%-95%), with 10 patients requiring reintervention. Estimated survival at 1 and 5 years was 57% ± 6% and 50% ± 6%, respectively. Bypass configuration was not associated with complication rates (P > .10), in-hospital mortality (log-rank, P = .3), or overall survival (log-rank, P = .9). However, a higher risk of reintervention was observed in patients undergoing retrograde bypass (hazard ratio, 3.0; 95% confidence interval, 0.9-11.0; P = .08). CONCLUSIONS OMB for AMI results in significant morbidity and mortality, irrespective of bypass configuration. Antegrade OMB is associated with comparable outcomes as retrograde OMB. The bypass configuration choice should be predicated on patient presentation, anatomy, physiology, and surgeon preference; however, an antegrade configuration may provide a lower risk of reintervention.
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Affiliation(s)
- Salvatore T Scali
- Division of Vascular Surgery & Endovascular Therapy, University of Florida, Gainesville, Fla.
| | - Diego Ayo
- Division of Vascular Surgery & Endovascular Therapy, University of Florida, Gainesville, Fla
| | - Kristina A Giles
- Division of Vascular Surgery & Endovascular Therapy, University of Florida, Gainesville, Fla
| | - Sarah Gray
- Division of Vascular Surgery & Endovascular Therapy, University of Florida, Gainesville, Fla
| | - Paul Kubilis
- Division of Vascular Surgery & Endovascular Therapy, University of Florida, Gainesville, Fla
| | - Martin Back
- Division of Vascular Surgery & Endovascular Therapy, University of Florida, Gainesville, Fla
| | - Javairiah Fatima
- Division of Vascular Surgery & Endovascular Therapy, University of Florida, Gainesville, Fla
| | - Dean Arnaoutakis
- Division of Vascular Surgery & Endovascular Therapy, University of Florida, Gainesville, Fla
| | - Scott A Berceli
- Division of Vascular Surgery & Endovascular Therapy, University of Florida, Gainesville, Fla
| | - Adam W Beck
- Division of Vascular Surgery & Endovascular Therapy, University of Alabama-Birmingham, Birmingham, Ala
| | - Gilbert J Upchurch
- Division of Vascular Surgery & Endovascular Therapy, University of Florida, Gainesville, Fla
| | - Robert J Feezor
- Division of Vascular Surgery & Endovascular Therapy, University of Florida, Gainesville, Fla
| | - Thomas S Huber
- Division of Vascular Surgery & Endovascular Therapy, University of Florida, Gainesville, Fla
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Kennoki N, Saguchi T, Sano T, Moriya T, Shirota N, Otaka J, Suzuki K, Tomita K, Chiba N, Kawachi S, Koizumi K, Tokuuye K. Successful recanalization of acute extensive portal vein thrombosis by aspiration thrombectomy and thrombolysis via an operatively placed mesenteric catheter: a case report. BJR Case Rep 2018; 4:20180024. [PMID: 30931140 PMCID: PMC6438407 DOI: 10.1259/bjrcr.20180022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2018] [Revised: 04/26/2018] [Accepted: 04/30/2018] [Indexed: 12/29/2022] Open
Abstract
Portal vein thrombosis (PVT) after hepatobiliary surgery is rare but can cause lethal and severe complications. If early diagnosis and recanalization can be achieved, the PVT is expected to be eliminated. A 70-year-old male was diagnosed as having hepatocellular carcinoma occupying the right lobe of the liver. As oligometastatic lung tumors were simultaneously detected on contrast-enhanced CT (CECT), hepatectomy was not indicated. However, the primary tumor was very large, and as large tumor size can be associated with an unfavorable prognosis, and owing to the strong desire of the patient, he underwent right lobe hepatectomy. Jaundice appeared on post-operative Day (POD) 2 and CECT displayed slight intraheptatic bile duct dilation. However, a PVT did not exist at this time. Percutaneous transhepatic biliary drainage was performed and Doppler echo displayed intrahepatic and extrahepatic PVT on post-operative Day 5. Emergent thrombectomy was performed using a Vasplyser PlusTM thrombus aspiration catheter (Johnson & Johnson K.K. Medical Company, Tokyo, Japan) via the ileocolic vein under laparotomy. The mesenteric catheter was placed at the distal point of the residual PVT. Thrombolysis and anticoagulant therapy were performed using heparin and urokinase. In the CECT performed 16 days after the additional operation, the PVT had disappeared and the portal vein was completely recanalized. The mesenteric catheter was removed on the same day and oral anticoagulant therapy was continued. At the time of writing, 14 months have passed with no recurrence of PVT. Early diagnosis of PVT enables treatment with emergent thrombectomy, thrombolysis, and anticoagulant therapy. These treatments result in the improvement of portal vein flow and the complete disappearance of PVT.
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Affiliation(s)
- Norifumi Kennoki
- Department of Radiology, Tokyo Medical University Hospital, Tokyo, Japan
| | - Toru Saguchi
- Department of Radiology, Tokyo Medical University Hospital, Tokyo, Japan
| | - Toru Sano
- Department of Digestive and Transplantation Surgery, Tokyo Medical University Hachioji Medical Center, Tokyo, Japan
| | - Tomohisa Moriya
- Department of Radiology, Tokyo Medical University Hospital, Tokyo, Japan
| | - Natsuhiko Shirota
- Department of Radiology, Tokyo Medical University Hachioji Medical Center, Tokyo, Japan
| | - Jun Otaka
- Department of Radiology, Tokyo Medical University Hospital, Tokyo, Japan
| | - Kunihito Suzuki
- Department of Radiology, Tokyo Medical University Hachioji Medical Center, Tokyo, Japan
| | - Koichi Tomita
- Department of Digestive and Transplantation Surgery, Tokyo Medical University Hachioji Medical Center, Tokyo, Japan
| | - Naokazu Chiba
- Department of Digestive and Transplantation Surgery, Tokyo Medical University Hachioji Medical Center, Tokyo, Japan
| | - Shigeyuki Kawachi
- Department of Digestive and Transplantation Surgery, Tokyo Medical University Hachioji Medical Center, Tokyo, Japan
| | - Kiyoshi Koizumi
- Department of Radiology, Tokyo Medical University Hachioji Medical Center, Tokyo, Japan
| | - Koichi Tokuuye
- Department of Radiology, Tokyo Medical University Hospital, Tokyo, Japan
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376
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Párraga Ros E, Correa-Martín L, Sánchez-Margallo FM, Candanosa-Aranda IE, Malbrain MLNG, Wise R, Latorre R, López Albors O, Castellanos G. Intestinal histopathological changes in a porcine model of pneumoperitoneum-induced intra-abdominal hypertension. Surg Endosc 2018; 32:3989-4002. [PMID: 29777353 DOI: 10.1007/s00464-018-6142-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Accepted: 03/06/2018] [Indexed: 01/02/2023]
Abstract
BACKGROUND Low splanchnic perfusion is an immediate effect of pneumoperitoneum-induced intra-abdominal hypertension (IAH). Anatomical structure results in the intestinal mucosa being the area most sensitive to hypoperfusion. The relationship between intestinal injury and clinical parameters of tissue perfusion [abdominal perfusion pressure (APP), gastric intramucosal pH (pHi) and lactic acid (Lc)] has not been previously studied. This study aimed to monitorize intestinal pathogenesis through sequential ileal biopsies and to measure APP, pHi, and Lc levels at different pneumoperitoneum-induced intra-abdominal pressures (20, 30, and 40 mmHg) to evaluate the potential relationships between them. MATERIALS AND METHODS Fifty pigs were divided into four groups; a control group (C) and three experimental groups with different pneumoperitoneum-induced levels [20 mmHg (G20), 30 mmHg (G30), and 40 mmHg (G40)], that were maintained for 3 and 5 h. APP, pHi, and Lc were measured and ileal biopsies taken laparoscopically every 30 min. The mucosal damage was graded using the standardized Park's Score and animals were classified as injured (I+) or uninjured (I-). RESULTS Different histopathological lesions were observed in groups G20, G30, and G40 but no damage observed in group C. A 33.3% of animals in G20 and G30 were I+ after 3 h, while 93.3% were injured in G40. After 5 h, histopathological lesions were no longer seen in some animals in G20 and only 10% were I+. Conversely, in G30 I+ pigs increased to 80% while those in G40 remained at 93.3% I+. The I+ animals had significantly lower APP and pHi than those I-. Lc was the clinical parameter that showed the earliest differences, with significantly higher figures in I+ animals. CONCLUSIONS The evolution of intestinal injuries from pneumoperitoneum-induced IAH depends on the degree of IAP. These damages may be associated with decreases in APP and pHi, and increases in Lc.
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Affiliation(s)
- Ester Párraga Ros
- Department of Anatomy and Comparative Pathology, Veterinary Faculty, University of Murcia, 30100, Murcia, Spain.
| | - Laura Correa-Martín
- Laparoscopy Department, Jesús Usón Minimally Invasive Surgery Centre (JUMISC), Cáceres, Spain
| | | | - Irma Eugenia Candanosa-Aranda
- Highlands Teaching and Research Farm (CEIEPAA), Faculty of Veterinary Medicine, National Autonomous University of México, Querétaro, Mexico
| | - Manu L N G Malbrain
- Medical and Surgical ICU and High Care Burn Unit, Ziekenhuis Netwerk Antwerpen, ZNA Stuivenberg/St-Erasmus, Lange Beeldekensstraat 267, 2060, Antwerp, Belgium
| | - Robert Wise
- Pietermaritzburg Metropolitan Department of Anaesthetics, Critical Care and Pain Management, Pietermaritzburg, South Africa.,Clinical Unit, Critical Care, Edendale Hospital, Pietermaritzburg, South Africa.,Discipline of Anaesthesiology and Critical Care, School of Clinical Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Rafael Latorre
- Department of Anatomy and Comparative Pathology, Veterinary Faculty, University of Murcia, 30100, Murcia, Spain
| | - Octavio López Albors
- Department of Anatomy and Comparative Pathology, Veterinary Faculty, University of Murcia, 30100, Murcia, Spain
| | - Gregorio Castellanos
- Department of General Surgery, Virgen de la Arrixaca General University Hospital, Murcia, Spain
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377
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Neutrophils and neutrophil extracellular traps in the liver and gastrointestinal system. Nat Rev Gastroenterol Hepatol 2018; 15:206-221. [PMID: 29382950 DOI: 10.1038/nrgastro.2017.183] [Citation(s) in RCA: 147] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Neutrophil extracellular traps (NETs) have an important role during infection by helping neutrophils to capture and kill pathogens. However, evidence is accumulating that uncontrolled or excessive production of NETs is related to the exacerbation of inflammation and the development of autoimmunity, cancer metastasis and inappropriate thrombosis. In this Review, we focus on the role of NETs in the liver and gastrointestinal system, outlining their protective and pathological effects. The latest mechanistic insights in NET formation, interactions between microorganisms and NETs and the relationship between neutrophil subtypes and their functions are also discussed. Additionally, we describe the potential importance of NET-related molecules, including cell-free DNA and hypercitrullinated histones, as biomarkers and targets for therapeutic intervention in gastrointestinal diseases.
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378
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Pressure Distribution during Negative Pressure Wound Therapy of Experimental Abdominal Compartment Syndrome in a Porcine Model. SENSORS 2018; 18:s18030897. [PMID: 29562626 PMCID: PMC5876758 DOI: 10.3390/s18030897] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Revised: 03/13/2018] [Accepted: 03/15/2018] [Indexed: 12/14/2022]
Abstract
(1) Introduction: Negative pressure wound therapy (NPWT) is a frequently applied open abdomen (OA) treatment. There are only a few experimental data supporting this method and describing the optimal settings and pressure distribution in the abdominal cavity during this procedure. The aim of our study was to evaluate pressure values at different points in the abdominal cavity during NPWT in experimental abdominal compartment syndrome (ACS) animal model; (2) Methods: In this study (permission Nr. 13/2014/UDCAW), 27 Hungahib pigs (15.4-20.2 kg) were operated on. ACS was generated by implanting a plastic bag in the abdomen through mini-laparotomy and filled with 2100-3300 mL saline solution (37 °C) to an intraabdominal pressure (IAP) of 30 mmHg. After 3 h, NPWT (Vivano Med® Abdominal Kit, Paul Hartmann AG, Germany) or a Bogota bag was applied. The NPWT group was divided into -50, -100 and -150 mmHg suction groups. Pressure distribution to the abdominal cavity was monitored at 6 different points of the abdomen via a multichannel pressure monitoring system; (3) Results: The absolute pressure levels were significantly higher above than below the protective layer. The values of the pressure were similar in the midline and laterally. Amongst the bowels, the pressure values changed periodically between 0 and -12 mmHg which might be caused by peristaltic movements; (4) Conclusions: The porcine model of the present study seems to be well applicable for investigating ACS and NPWT. It was possible to provide valuable information for clinicians. The pressure was well distributed by the protective layer to the lateral parts of the abdomen and this phenomenon did not change considerably during the therapy.
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379
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Soh AYS, Kang JY, Siah KTH, Scarpignato C, Gwee KA. Searching for a definition for pharmacologically refractory constipation: A systematic review. J Gastroenterol Hepatol 2018; 33:564-575. [PMID: 28960557 DOI: 10.1111/jgh.13998] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Revised: 08/24/2017] [Accepted: 09/13/2017] [Indexed: 12/17/2022]
Abstract
BACKGROUND AND AIM Surgery and other non-pharmacological treatments such as sacral nerve stimulation are used for the treatment of difficult-to-treat chronic constipation. Novel pharmacological therapeutic agents are also being introduced. To evaluate the efficacy of these treatments, it is imperative to have a consistent definition of pharmacologically refractory constipation. A systematic review of studies on refractory, difficult-to-treat or surgically treated constipation was carried out to determine the criteria that various authors used to define this group of patients. METHODS A systematic review was performed for literature published from June 2005 to June 2015 using PubMed, Cochrane, and Scopus databases, as well as manual searches. Studies on patients with refractory or intractable constipation were extracted. Criteria used for defining refractory constipation, as well as pharmacological agents tried including dosage, frequency, and duration, were reviewed. RESULTS Sixty-one studies were included in this review. Forty-eight involved surgical treatment of constipation, while 13 examined non-surgical therapies for refractory constipation. There is no generally accepted definition of refractory constipation. Authors consider constipation to be refractory when response to management is suboptimal, but there is no consensus on the choice of drug, order of usage, and dosage or treatment duration. Prior medical therapy was not mentioned at all in five studies. CONCLUSIONS There is need for a detailed definition of pharmacologically refractory constipation before submitting patients to invasive treatments and to evaluate new pharmacological agents.
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Affiliation(s)
- Alex Yu Sen Soh
- Department of Gastroenterology and Hepatology, National University Hospital, Singapore
| | - Jin-Yong Kang
- Department of Gastroenterology, St George's Hospital, London, UK.,Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Kewin Tien Ho Siah
- Department of Gastroenterology and Hepatology, National University Hospital, Singapore
| | - Carmelo Scarpignato
- Clinical Pharmacology and Digestive Pathophysiology Unit, Department of Clinical and Experimental Medicine, University of Parma, Parma, Italy
| | - Kok-Ann Gwee
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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380
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Wang S, Liu H, Wang Q, Cheng Z, Sun S, Zhang Y, Sun X, Wang Z, Ren L. Neutrophil-to-Lymphocyte Ratio and Platelet-to-Lymphocyte Ratio Are Effective Predictors of Prognosis in Patients with Acute Mesenteric Arterial Embolism and Thrombosis. Ann Vasc Surg 2018; 49:115-122. [PMID: 29428537 DOI: 10.1016/j.avsg.2018.01.059] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2016] [Revised: 12/14/2017] [Accepted: 01/29/2018] [Indexed: 01/04/2023]
Abstract
BACKGROUND The neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) have been shown to be valuable prognostic markers for a variety of pathological conditions including solid tumors, sepsis, and others. However, the prognostic values of the NLR and PLR in patients with acute mesenteric arterial embolism (AMAE) and acute mesenteric arterial thrombosis (AMAT) have not been elucidated. The aim of this study was to determine the predictive value of the NLR and PLR for poor prognosis in patients with AMAE and AMAT. METHODS A total of 137 patients with AMAE (n = 77) or AMAT (n = 60) were divided into a poor outcome group (cases of intestinal necrosis or death) and a better outcome group (cases without intestinal necrosis who survived successfully), according to prognosis. Neutrophil, platelet, and lymphocyte counts were recorded before pharmacotherapy or surgery. The NLR and PLR were calculated, and logistic regression analysis was performed to test their prognostic values. RESULTS The cutoff values for NLR and PLR were 11.05 and 156.26, respectively. The PLR was linearly associated with the NLR (R = 0.769, P < 0.001). NLR (odds ratio [OR] = 6.835, 95% confidence interval [CI] = 2.282-20.469, P = 0.001), PLR (OR = 4.871, 95% CI = 1.627-14.587, P = 0.005), and coronary heart disease (OR = 3.388, 95% CI = 1.156-9.929, P = 0.026) were found to be independent prognostic factors for the patients. CONCLUSIONS NLR ≥ 11.05, PLR ≥ 156.26, and coronary heart disease were shown to be risk factors for poor prognosis in patients with AMAE and AMAT. According to these factors, patients can be divided into 3 prognostic groups: good, NLR < 11.05 with PLR < 156.26; moderate, NLR < 11.05 with PLR ≥ 156.26 or NLR ≥ 11.05 with PLR < 156.26; and poor, NLR ≥ 11.05 with PLR ≥ 156.26.
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Affiliation(s)
- Shuai Wang
- Department of Experimental Pharmacology and Toxicology, School of Pharmaceutical Science, Jilin University, Changchun, Jilin, China; Department of Vascular Surgery, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Han Liu
- Department of Respiration, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Qi Wang
- Department of Vascular Surgery, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Zhihua Cheng
- Department of Vascular Surgery, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Siqiao Sun
- Department of Vascular Surgery, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Yang Zhang
- Department of Vascular Surgery, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Xiwei Sun
- Department of Vascular Surgery, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Zhongying Wang
- Department of Vascular Surgery, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Liqun Ren
- Department of Experimental Pharmacology and Toxicology, School of Pharmaceutical Science, Jilin University, Changchun, Jilin, China.
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381
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Béliard A, Verreth L, Grandjean P. Oral contraceptive and acute intestinal ischemia with mesenteric venous thrombosis: a case report. Open Access J Contracept 2018; 8:9-11. [PMID: 29386950 PMCID: PMC5774556 DOI: 10.2147/oajc.s124625] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Venous thrombosis is a serious complication of combined contraceptive usage. However, mesenteric venous thrombosis and intestinal necrosis are infrequently seen in women using oral contraceptives, and in such cases diagnosis is often delayed. Case presentation We report the case of a 38-year-old obese female patient who presented with acute abdominal pain. A bowel infection was first diagnosed and treated with antibiotics. Contrast-enhanced tomography of the abdomen revealed diffuse ischemia of the small intestine with superior mesenteric thrombosis. Laparotomy with segmental resection of both small and large bowel was performed. No predisposing factor of mesenteric venous thrombosis was demonstrated except association of the combined contraceptive with obesity. Conclusion This report highlights the need for clinicians to suspect venous mesenteric thrombosis in women of reproductive age with acute abdominal pain and poor physical findings. Detailed personal history including prescriptions should help to quickly and accurately determine the problem.
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Affiliation(s)
- Aude Béliard
- Department of Obstetrics and Gynaecology, Centre Hospitalier du Bois de l'Abbaye (CHBA), Liege, Belgium
| | - Lucie Verreth
- Department of Obstetrics and Gynaecology, Centre Hospitalier Régional (CHR) Mons Hainaut, Mons, Belgium
| | - Pascale Grandjean
- Department of Obstetrics and Gynaecology, Centre Hospitalier Régional (CHR) Mons Hainaut, Mons, Belgium
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382
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Li Y, Yu Y, Li S, Zhang M, Zhang Z, Zhang X, Shi Y, Zhang S. Isobaric tags for relative and absolute quantification-based proteomic analysis that reveals the roles of progesterone receptor, inflammation, and fibrosis for slow-transit constipation. J Gastroenterol Hepatol 2018; 33:385-392. [PMID: 28699285 DOI: 10.1111/jgh.13873] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Revised: 06/14/2017] [Accepted: 07/08/2017] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND AIM Progesterone receptor, inflammation, neurotransmitter expression, and fibrosis are involved in slow-transit constipation. The aim of the present study was to examine whether patients with slow-transit constipation have an overexpression of progesterone receptor and serotonin, which may impair the fibrosis of muscularis propria in colorectal wall. METHODS High-resolution colon manometry was used to record the colorectal peristaltic contractions of the proximal ascending and sigmoid colon in patients. Protein samples prepared from frozen sigmoid colon tissue and the proximal margin of the ascending colon of four female patients were compared using isobaric tags for relative and absolute quantification labeling technique coupled to 2D liquid chromatography-tandem mass spectrometry analysis. Immunohistochemical staining of progesterone receptor, serotonin, and fibronectin was performed in paraffin-embedded sigmoid colon tissues and the proximal margin of the ascending colon or ileum from 43 patients with slow-transit constipation. RESULTS Among these differentially regulated proteins based on isobaric tags for relative and absolute quantification and liquid chromatography-tandem mass spectrometry analysis, 56 proteins involved in the response to progesterone, inflammation, matrix remodeling, fibrosis, and muscle metabolism. Immunohistochemical staining confirmed that there was significantly higher expression of progesterone receptor (t = 19.19, P = 0.000) and serotonin (t = 13.52, P = 0.004) in sigmoid colon than in the proximal margin of the ascending colon and ileum. Progesterone receptor and fibronectin expression in the outer layer of muscularis propria were higher than in the middle layer. CONCLUSIONS These results demonstrate that progesterone receptor, along with inflammation and fibrosis, may take part in slow-transit constipation development.
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Affiliation(s)
- Yuwei Li
- Department of Colorectal Surgery, Tianjin Union Medical Center, Tianjin, China
| | - Yongjun Yu
- Department of Colorectal Surgery, Tianjin Union Medical Center, Tianjin, China
| | - Shuyuan Li
- Department of Colorectal Surgery, Tianjin Union Medical Center, Tianjin, China
| | - Mingqing Zhang
- Department of Colorectal Surgery, Tianjin Union Medical Center, Tianjin, China
| | - Zhao Zhang
- Department of Colorectal Surgery, Tianjin Union Medical Center, Tianjin, China
| | - Xipeng Zhang
- Department of Colorectal Surgery, Tianjin Union Medical Center, Tianjin, China
| | - Yang Shi
- Department of Colorectal Surgery, Tianjin Union Medical Center, Tianjin, China
| | - Shiwu Zhang
- Department of Pathology, Tianjin Union Medical Center, Tianjin, China
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383
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Time-course evaluation of intestinal structural disorders in a porcine model of intra-abdominal hypertension by mechanical intestinal obstruction. PLoS One 2018; 13:e0191420. [PMID: 29357386 PMCID: PMC5777654 DOI: 10.1371/journal.pone.0191420] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2017] [Accepted: 01/04/2018] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND A mechanical intestinal obstruction (MIO) can generate intraabdominal hypertension (IAH) that is life threatening. The intestines are very sensitive to IAH since the low splanchnic perfusion causes intestinal hypoxia, local acidosis and bacterial translocations. This may lead to acute intestinal distress syndrome (AIDS). The identification of intestinal injuries during IAH and its correlation with clinical parameters as the abdominal perfusion pressure (APP), the gastric intramucosal pH (pHi) and lactic acid (Lc) are still unknown. This study aimed to evaluate the sequence of intestinal histopathological findings in an MIO model and to analyze potential relationships with parameters currently used in clinical practice (APP, pHi and Lc). MATERIAL AND METHODS Twenty pigs were divided into three groups: a control group (n = 5) and two experimental groups with 20 mmHg (G1, n = 10) and 30 mmHg (G2, n = 5) of IAH by MIO. The pressures were maintained for 3 hours, except in 5 animals in G1 where it was maintained for 5 hours. The APP, pHi and LA were recorded and biopsies of the terminal ileum were taken every 30 minutes in all groups. The intestinal damage was graded according to the Park Score. RESULTS Intestinal injuries were found in 42.9% of pigs in the experimental groups. The lesions were independent of the level and duration of IAH. Although APP and pHi were slightly lower in injured animals (I +) of G1 and G2, there were no significant differences among those uninjured (I-). Lc was significantly increased in all I+ pigs from the onset of IAH. CONCLUSION The IAH by MIO causes intestinal lesions from the first 30 minutes with concurrent decreases in APP and pHi and increases in Lc. Lc could be the best clinical parameter related to intestinal damages with a clear difference between I + and I- animals.
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384
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Triantafyllou T, Aggarwal P, Gupta E, Svetanoff WJ, Bhirud DP, Singhal S. Polytetrafluoroethylene-Covered Stent Graft Versus Bare Stent in Transjugular Intrahepatic Portosystemic Shunt: Systematic Review and Meta-Analysis. J Laparoendosc Adv Surg Tech A 2018; 28:867-879. [PMID: 29356589 DOI: 10.1089/lap.2017.0560] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND & AIMS Transjugular Intrahepatic Portosystemic Shunt (TIPS) is used to control refractory variceal bleeding secondary to portal hypertension. This meta-analysis was conducted to systematically review polytetrafluoroethylene-covered stent grafts (CS) versus bare stents (BS) in TIPS procedure. METHODS Systematic search of literature databases was done from January-1990 till April-2017, using predecided keywords. Outcome measures studied were (1) primary-patency (PP) at 1 year (defined as absence of shunt insufficiency at 1 year), (2) rebleeding (RE) (3) new-onset hepatic encephalopathy ([HE] new-onset or worsening encephalopathy following the procedure), and (4) survival at 1 year (SU). Odds ratio (OR) was calculated for each outcome variable. Between-study heterogeneity was assessed by the I2 statistics and χ2 Q-test. RESULTS Fourteen studies (4 RCTs, 2 prospective nonrandomized, and 8 retrospective) were included with 2519 patients (1548 patients in BS group and 971 patients in CS group). Three-quarter outcome measures showed significantly better results with CS. PP was pooled from 13 studies and showed an OR = 4.75 (95% confidence interval [CI] = 3.32-6.79; P < .00001; I2 = 44%) in favor of CS. RE was pooled from six studies with odds ratio (OR) = 0.37(95% CI = 0.24-0.56; P < .00001; I2 = 0%) in favor of CS. SU was pooled from 11 studies with OR = 1.85 (95% CI = 1.44-2.38; P < .00001; I2 = 0%) in favor of CS. On subset analysis for RCTs, three outcome variables favored CS with minimal heterogeneity [PP: OR = 4.18 (95% CI = 2.66-6.55; P < .00001; I2 = 0%). RE: OR = 0.43 (95% CI = 0.25-0.72; P < .001; I2 = 0%). SU: OR = 1.85 (95% CI = 1.44-2.38, P < .00001; I2 = 0%)]. HE showed no difference between two stents on the overall and subset pooled analysis. Overall: OR = 0.86 (95% CI = 0.68-1.08; P = .19; I2 = 4%). Only RCTs: OR = 0.91 (95% CI = 0.63-1.32, P = .63; I2 = 0%). CONCLUSIONS CS is associated with better primary patency and survival and lesser rate of rebleeding than BS in patients undergoing TIPS procedure. There is no difference in new-onset hepatic encephalopathy.
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Affiliation(s)
| | - Piyush Aggarwal
- 2 All India Institute of Medical Sciences , New Delhi, India
| | - Ekansh Gupta
- 2 All India Institute of Medical Sciences , New Delhi, India
| | - Wendy Jo Svetanoff
- 3 Boston Children's Hospital , Harvard Medical School, Boston, Massachusetts
| | | | - Saurabh Singhal
- 5 St. Joseph's Hospital and Medical Centre , Phoenix, Arizona
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385
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Björck M, Koelemay M, Acosta S, Bastos Goncalves F, Kölbel T, Kolkman JJ, Lees T, Lefevre JH, Menyhei G, Oderich G, Kolh P, de Borst GJ, Chakfe N, Debus S, Hinchliffe R, Kakkos S, Koncar I, Sanddal Lindholt J, Vega de Ceniga M, Vermassen F, Verzini F, Geelkerken B, Gloviczki P, Huber T, Naylor R. Editor's Choice - Management of the Diseases of Mesenteric Arteries and Veins: Clinical Practice Guidelines of the European Society of Vascular Surgery (ESVS). Eur J Vasc Endovasc Surg 2018; 53:460-510. [PMID: 28359440 DOI: 10.1016/j.ejvs.2017.01.010] [Citation(s) in RCA: 351] [Impact Index Per Article: 58.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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386
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Time course study of intestinal epithelial barrier disruption in acute mesenteric venous thrombosis. J Surg Res 2018; 224:222-232. [PMID: 29506844 DOI: 10.1016/j.jss.2017.12.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Revised: 10/29/2017] [Accepted: 12/13/2017] [Indexed: 01/16/2023]
Abstract
BACKGROUND Acute superior mesenteric venous thrombosis (ASMVT) is an abdominal vascular condition. Early recanalization is essential to successful treatment. The aim of the study was to establish rabbit models of ASMVT and assess the time course of intestinal epithelial barrier disruption. METHODS After surgical exposure of superior mesenteric vein (Sham group), large-vessel (L-group) and small-vessel (S-group) models were established by endothelium damage, stenosis creation, and thrombin injection. At baseline, 6, 9, and 12 h, hemodynamic and serum parameters were tested. Serum from ASMVT patients diagnosed at 24, 36, 48, and 60 h from symptom onset was collected. Intestinal barrier disruption was assessed by tight junction (TJ) protein expression, morphology changes, and bacterial translocation. Mesenteric arteriospasm was measured by flow velocity and intestinal wet/dry weight ratio. The serum level of intestinal fatty acid-binding protein and endotoxin in patients was also measured as an indicator for intestinal barrier function. RESULTS Severe acidosis and lacticemia were observed in both the groups. The L-group experienced greater hemodynamic alteration than the S-group. Intestinal barrier disruption was detected by significantly decreased TJ protein expression, histology and ultrastructure injury of TJ, increased permeability, and bacterial translocation, at 9 h in the S-group and 12 h in the L-group. Secondary mesenteric arteriospasm occurred at the same time of complete intestinal barrier disruption and could be a significant cause of bowel necrosis. Significant increased level of intestinal fatty acid-binding protein and endotoxin was found in patients at 48 h in the S-group type and 60 h in the L-group type. CONCLUSIONS The ASMVT animal models of both the types were first established. The loss of intestinal barrier function occurred at 6 h in the S-group model and 9 h in the L-group model. For clinical patients, the time window extended to 36 h in the S-group type and 48 h in the L-group type.
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387
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Khripun AI, Shurygin SN, Mironkov AB, Pryamikov AD. [Venous acute disturbance of mesenteric circulation: diagnosis and treatment]. Khirurgiia (Mosk) 2017:95-102. [PMID: 29286040 DOI: 10.17116/hirurgia20171295-102] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- A I Khripun
- Chair of surgery and endoscopy of the Department of advanced medical training of the N.I. Pirogov's Russian National Research Medical University, Moscow
| | - S N Shurygin
- Chair of surgery and endoscopy of the Department of advanced medical training of the N.I. Pirogov's Russian National Research Medical University, Moscow
| | - A B Mironkov
- Chair of surgery and endoscopy of the Department of advanced medical training of the N.I. Pirogov's Russian National Research Medical University, Moscow; V.M. Buyanov's City Clinical Hospital, Moscow, Russia
| | - A D Pryamikov
- Chair of surgery and endoscopy of the Department of advanced medical training of the N.I. Pirogov's Russian National Research Medical University, Moscow; V.M. Buyanov's City Clinical Hospital, Moscow, Russia
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388
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Talving P, Chouliaras K, Eastman A, Lauerman M, Teixeira PG, DuBose J, Minei J, Scalea T, Demetriades D. Discontinuity of the Bowel Following Damage Control Operation Revisited: A Multi-institutional Study. World J Surg 2017; 41:146-151. [PMID: 27541027 DOI: 10.1007/s00268-016-3685-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Discontinuity of the bowel following intestinal injury and resection is a common practice in damage control procedures for severe abdominal trauma. However, there are concerns that complete occlusion of the bowel, especially in the presence of hypotension or edema that may result in ischemic bowel changes or increase bacterial or toxin translocation. METHODS This was a retrospective study from three Level-1 trauma centers. Included were trauma patients who required bowel resection and damage control. The study population was stratified into two groups based on the management for bowel injury: bowel discontinuity versus primary anastomosis. Outcomes included anastomotic leak, organ space infection, bowel ischemia, and mortality. RESULTS A total of 167 cases were included. In 84 cases, continuity of the bowel was established, and in 83, the bowel was left in discontinuity. The epidemiological, admission, and intraoperative physiological characteristics, the abdominal Abbreviated Injury Scale, type of intra-abdominal injury, and transfusion requirements were similar in the two study groups. The mortality was 8.3 % in the continuity group and 16.9 % for the discontinuity group (p = 0.096). On the crude bivariate and adjusted regression analyses, there was a higher rate of bowel ischemia at the take-back operation in the discontinuity group (p = 0.003 for the crude and p = 0.034 for the adjusted). The organ space infection and anastomotic leak rate were not significantly different between the study groups. CONCLUSIONS Discontinuity of the bowel following damage control operation is associated with a higher risk of bowel ischemia than in patients with anastomosis. Further prospective observational and randomized studies are warranted. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Peep Talving
- Division of Acute Care Surgery Trauma, Emergency Surgery and Surgical Critical Care), Department of Surgery, Keck School of Medicine, Los Angeles County + University of Southern California Medical Center, IPT-C5L100, 2051 Marengo Str. 90033, Los Angeles, CA, USA
| | - Konstantinos Chouliaras
- Division of Acute Care Surgery Trauma, Emergency Surgery and Surgical Critical Care), Department of Surgery, Keck School of Medicine, Los Angeles County + University of Southern California Medical Center, IPT-C5L100, 2051 Marengo Str. 90033, Los Angeles, CA, USA
| | - Alexander Eastman
- Division of Burn/Trauma/Critical Care at UT Southwestern Medical Center, The Trauma Center at Parkland, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Margaret Lauerman
- R Adams Cowley Shock Trauma Center, University of Maryland Medical Center, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Pedro G Teixeira
- Division of Acute Care Surgery Trauma, Emergency Surgery and Surgical Critical Care), Department of Surgery, Keck School of Medicine, Los Angeles County + University of Southern California Medical Center, IPT-C5L100, 2051 Marengo Str. 90033, Los Angeles, CA, USA
| | - Joseph DuBose
- R Adams Cowley Shock Trauma Center, University of Maryland Medical Center, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Joseph Minei
- Division of Burn/Trauma/Critical Care at UT Southwestern Medical Center, The Trauma Center at Parkland, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Thomas Scalea
- R Adams Cowley Shock Trauma Center, University of Maryland Medical Center, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Demetrios Demetriades
- Division of Acute Care Surgery Trauma, Emergency Surgery and Surgical Critical Care), Department of Surgery, Keck School of Medicine, Los Angeles County + University of Southern California Medical Center, IPT-C5L100, 2051 Marengo Str. 90033, Los Angeles, CA, USA.
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389
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Lim KH, Jang J, Yoon HY, Park J. Acute superior mesenteric vein thrombosis associated with abdominal trauma: A rare case report and literature review. Medicine (Baltimore) 2017; 96:e8863. [PMID: 29382004 PMCID: PMC5709003 DOI: 10.1097/md.0000000000008863] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
RATIONALE Acute mesenteric vein thrombosis (MVT) is defined as new-onset thrombosis of the mesenteric vein without evidence of collateralization, finally resulting in extensive intestinal infarction. MVT may be idiopathic or be caused by conditions responsible for thrombophilia and acquired risk factors. To date, there have been few reports of MVT after trauma. Herein we describe our experiences treating three patients with MVT. PATIENT CONCERNS Case 1 was a 44-year-old man with transverse colon mesenteric hematoma after blunt abdominal trauma. Case 2 was a 55-year-old man with jejunal transection after a traffic accident. Case 3 was a 26-year-old man presented with multiple abdominal stab bowel injury. DIAGNOSES A 1-week follow-up abdominal computed tomography scan showed superior mesenteric vein thrombosis in all of three patients. INTERVENTIONS All patients were treated with anticoagulant for 3 or 6 months. OUTCOMES MVTs were completely resolved without any complications. LESSONS If early diagnosis and treatment could be available, anticoagulation alone might be adequate for the treatment of SMVT associated with trauma. Early anticoagulation in patients with acute SMVT may avoid the grave prognosis observed in patients with arterial thrombosis.
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390
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Open Abdomen Improves Survival in Patients With Peritonitis Secondary to Acute Superior Mesenteric Artery Occlusion. J Clin Gastroenterol 2017; 51:e77-e82. [PMID: 28877534 DOI: 10.1097/mcg.0000000000000799] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Damage control surgery and open abdomen (OA) have been extensively used in the severe traumatic patients. However, there was little information when extended to a nontrauma setting. The purpose of this study was to evaluate whether the liberal use of OA as a damage control surgery adjunct improved the clinical outcome in acute superior mesenteric artery occlusion patients. STUDY DESIGN A single-center, retrospective cohort review was performed in a national tertiary surgical referral center. RESULTS Forty-four patients received OA (OA group) and 65 patients had a primary fascial closure (non-OA group) after diagnosed as peritonitis secondary to acute superior mesenteric artery occlusion from January, 2005 to June, 2016. Revascularization was achieved through endovascular aspiration embolectomy, open embolectomy, or percutaneous stent. No difference of bowel resection length was found between groups in the first emergency surgery. However, more non-OA patients (35.4%) required a second-look enterectomy to remove the residual bowel ischemia than OA patients (13.6%, P<0.05). OA was closed within a median of 7 days (4 to 15 d). There was a mean of 134 cm residual alive bowel in OA, whereas 96 cm in non-OA. More non-OA patients suffered from intra-abdominal sepsis (23.1% vs. 6.8%, P<0.01), intra-abdominal hypertension (31% vs. 0, P<0.01), and acute renal failure (53.8% vs. 31.8%, P<0.05) than OA group after surgery. Short-bowel syndrome occurred infrequently in OA than non-OA patients (9.1% vs. 36.9%, P<0.01). OA significantly decreased the 30-day (27.3% vs. 52.3%, P<0.01) and 1-year mortality rate (31.8 % vs. 61.5%, P<0.01) compared with non-OA group. CONCLUSIONS Liberal use of OA, as a damage control adjunct avoided the development of intra-abdominal hypertension, reduced sepsis-related complication, and improved the clinical outcomes in peritonitis secondary to acute SMA occlusion.
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391
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Comparison of direct site endovascular repair utilizing expandable polytetrafluoroethylene stent grafts versus standard vascular shunts in a porcine (Sus scrofa) model. J Trauma Acute Care Surg 2017; 83:457-463. [PMID: 28846579 DOI: 10.1097/ta.0000000000001614] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION The small diameter of temporary vascular shunts for vascular trauma management may restrict flow and result in ischemia or early thrombosis. We have previously reported a clinical experience with direct, open surgical reconstruction using expandable polytetrafluoroethylene stent grafts to create a "sutureless" anastomosis as an alternative to standard temporary vascular shunts. We sought to characterize patency and flow characteristics of these grafts compared with standard shunts in a survival model of porcine vascular injury. METHODS Twelve Yorkshire-cross swine received a 2-cm-long near-circumferential defect in the bilateral iliac arteries. A 14 Fr Argyle shunt was inserted into one randomly assigned artery, with a self-expanding expandable polytetrafluoroethylene stent deployed in the other. At 72 hours, conduit patency was evaluated by angiography. Arterial flow measurements were obtained at baseline, immediately after intervention, and after 72 hours via direct measurement with perivascular flow meters. Blood pressure proximal and distal to the conduits and arterial samples for histopathology were obtained during the terminal procedure. RESULTS Angiography revealed no difference in patency at 72 hours (p = 1.0). While there was no difference in baseline arterial flow between arteries (p = 0.63), the stent grafts demonstrated significantly improved blood flow compared with shunts both immediately after intervention (390 ± 36 mL/min vs. 265 ± 25 mL/min, p = 0.002) and at 72 hours (261 ± 29 mL/min vs. 170 ± 36 mL/min, p = 0.005). The pressure gradient across the shunts was greater than that of the stent grafts (11.5 mm Hg [interquartile range, 3-19 mm Hg] vs. 3 mm Hg [interquartile range, 3-5 mm Hg], p = 0.013). The speed of deployment was similar between the two devices. CONCLUSIONS Open "sutureless" direct site repair using commercially available stent grafts to treat vascular injury is a technically feasible strategy for damage control management of peripheral vascular injury and offers increased blood flow when compared with temporary shunts. Furthermore, stent grafts may offer improved durability to extend the window until definitive vascular repair. The combination of these traits may improve outcomes after vascular injury. LEVEL OF EVIDENCE Epidemiologic/Prognostic, level III.
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392
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Ke J, Wu W, Lin N, Yang W, Cai Z, Wu W, Chen D, Wang Y. A novel method for multiple bowel injuries: a pilot canine experiment. World J Emerg Surg 2017; 12:44. [PMID: 28932257 PMCID: PMC5602872 DOI: 10.1186/s13017-017-0155-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2017] [Accepted: 08/29/2017] [Indexed: 12/30/2022] Open
Abstract
Background Intestinal ligation is the cornerstone for damage control in abdominal emergency, yet it may lead to bowel ischemia. Although intestinal ligation avoids further peritoneal cavity pollution, it may lead to an increased pressure within the bowel segments and rapid bacterial translocation. In this study, we showed that severed intestine could be readily reconnected by using silicon tubes and be secured by using rubber bands in a canine model. Methods Adult Beagle dogs, subject to multiple intestinal transections and hemorrhagic shock by exsanguination, randomly received conventional ligation vs. silicon tubes reconnecting (n = 5 per group). Intestinal transections were carried out under general anesthesia after 24-h fasting. The abdomen was opened with a midline incision. The small intestine was severed at 50, 100, and 150 cm below the Treitz ligament. Hemorrhagic shock was established by streaming blood from the left carotid artery until the mean arterial pressure reached 40 mmHg in 20 min. Fluid resuscitation and surgery began 30 min after the establishment of hemorrhagic shock. Severed intestines were ligated or connected with silicon tubes. Definitive repair was conducted in subjects surviving for at least 48 h. Results Operation time was comparable between the two groups (39.6 ± 8.9 vs. 36.6 ± 7.8 min in ligation and reconnecting groups, respectively; p = 0.56). The time spent in managing each resection was also comparable (4.6 ± 1.1 vs. 3.8 ± 0.84 min; p = 0.24). Blood loss (341.2 ± 28.6 vs. 333.8 ± 34.6 ml; p = 0.48), and fluid resuscitation within the first 24 h (1676 ± 200.6 vs. 1594 ± 156.5 ml; p = 0.46) were similar. One subject in the ligation group was sacrificed at 36-h due to severe vomiting that led to aspiration. Four remaining dogs in the ligation group received definitive surgery, but two out of four had to be sacrificed at 24-h after definitive repair due to imminent death. All five dogs in the reconnecting group survived for at least a week. Radiographic examination confirmed the integrity of the GI tract in the reconnecting group. In both groups, plasma endotoxin concentration increased after damage control surgery, but the increase was much more pronounced in the ligation group. Microscopic examination of the involved segment of the intestine revealed much more severe pathology in the ligation group. Conclusion The current study showed that the reconnecting resected intestine by using silicon tubes is feasible under emergency. Such a method could decrease short-term mortality and minimize endotoxin translocation.
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Affiliation(s)
- Jun Ke
- Department of Gastroenterology, Dongfang Hospital, Xiamen University, Fuzhou, Fujian 350025 China
| | - Weihang Wu
- Department of General Surgery, Dongfang Hospital, Xiamen University, Fuzhou, Fujian 350025 China
| | - Nan Lin
- Department of General Surgery, Dongfang Hospital, Xiamen University, Fuzhou, Fujian 350025 China
| | - Weijin Yang
- Department of General Surgery, Dongfang Hospital, Xiamen University, Fuzhou, Fujian 350025 China
| | - Zhicong Cai
- Department of General Surgery, Dongfang Hospital, Xiamen University, Fuzhou, Fujian 350025 China
| | - Wei Wu
- Department of General Surgery, Dongfang Hospital, Xiamen University, Fuzhou, Fujian 350025 China
| | - Dongsheng Chen
- Department of Anesthesiology, Dongfang Hospital, Xiamen University, Fuzhou, Fujian 350025 China
| | - Yu Wang
- Department of General Surgery, Dongfang Hospital, Xiamen University, Fuzhou, Fujian 350025 China
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393
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Trauma to the Superior Mesenteric Artery and Superior Mesenteric Vein: A Narrative Review of Rare but Lethal Injuries. World J Surg 2017; 42:713-726. [DOI: 10.1007/s00268-017-4212-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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394
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Lauková L, Konečná B, Bábíčková J, Wagnerová A, Melišková V, Vlková B, Celec P. Exogenous deoxyribonuclease has a protective effect in a mouse model of sepsis. Biomed Pharmacother 2017. [DOI: 10.1016/j.biopha.2017.06.009] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
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395
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Knowles CH, Grossi U, Chapman M, Mason J. Surgery for constipation: systematic review and practice recommendations: Results I: Colonic resection. Colorectal Dis 2017; 19 Suppl 3:17-36. [PMID: 28960923 DOI: 10.1111/codi.13779] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
AIM To assess the outcomes of colectomy in adults with chronic constipation (CC). METHOD Standardised methods and reporting of benefits and harms were used for all CapaCiTY reviews that closely adhered to PRISMA 2016 guidance. Main conclusions were presented as summary evidence statements (SES) with a summative Oxford Centre for Evidence-Based Medicine (2009) level. RESULTS Forty articles were identified, providing data on outcomes in 2045 patients. Evidence was derived almost exclusively from observational studies, the majority of which concerned colectomy and ileorectal anastomosis (CIRA) rather than other procedural variations. Average length of stay (LOS) ranged between 7-15 days. Although inconsistent, laparoscopic surgery may be associated with longer mean operating times (210 vs 167 min) and modest decreases in LOS (10-8 days). Complications occurred in approximately 24% of patients. Six (0.4%) procedure-related deaths were observed. Recurrent episodes of small bowel obstruction occurred in about 15% (95%CI: 10-21%) of patients in the long-term, with significant burden of re-hospitalisation and frequent recourse to surgery. Most patients reported a satisfactory or good outcome after colectomy but negative long-term functional outcomes persist in a minority of patients. The influence of resection extent, anastomotic configuration and method of access on complication rates remains uncertain. Available evidence weakly supports selection of patients with an isolated slow-transit phenotype. CONCLUSION Colectomy for CC may benefit some patients but at the cost of substantial short- and long-term morbidity. Current evidence is insufficient to guide patient or procedural selection.
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Affiliation(s)
- C H Knowles
- National Bowel Research Centre, Blizard Institute, Queen Mary University London, London, UK
| | - U Grossi
- National Bowel Research Centre, Blizard Institute, Queen Mary University London, London, UK
| | - M Chapman
- Good Hope Hospital, Heart of England NHS Trust, Birmingham, UK
| | - J Mason
- University of Warwick, Coventry, UK
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- National Institute for Health Research: Chronic Constipation Treatment Pathway
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- Affiliate section of the Association of Coloproctology of Great Britain and Ireland
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396
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Affiliation(s)
- B V Boldin
- Department of Faculty Surgery # 2, Medical Faculty of Pirogov Russian National Medical Research University, Moscow, Russia
| | - S A Ponomar
- Department of Faculty Surgery # 2, Medical Faculty of Pirogov Russian National Medical Research University, Moscow, Russia
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397
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Abou Ali AN, Salem KM, Alarcon LH, Bauza G, Pikoulis E, Chaer RA, Avgerinos ED. Vascular Shunts in Civilian Trauma. Front Surg 2017; 4:39. [PMID: 28775985 PMCID: PMC5517780 DOI: 10.3389/fsurg.2017.00039] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Accepted: 07/05/2017] [Indexed: 11/25/2022] Open
Abstract
Experience with temporary intravascular shunts (TIVS) for vessel injury comes from the military sector and while the indications might be clear in geographically isolated and under resourced war zones, this may be an uncommon scenario in civilian trauma. Data supporting TIVS use in civilian trauma have been extrapolated from the military literature where it demonstrated improved life and limb salvage. Few non-comparative studies from the civilian literature have also revealed similar favorable outcomes. Still, TIVS placement in civilian vascular injuries is uncommon and by some debatable given the absence of clear indications for placement, the potential for TIVS-related complications, the widespread resources for immediate and definitive vascular repair, and the need for curtailing costs and optimizing resources. This article reviews the current evidence and the role of TIVS in contemporary civilian trauma management.
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Affiliation(s)
- Adham N Abou Ali
- Division of Vascular Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, United States
| | - Karim M Salem
- Division of Vascular Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, United States
| | - Louis H Alarcon
- Division of Trauma and General Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, United States
| | - Graciela Bauza
- Division of Trauma and General Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, United States
| | - Emmanuel Pikoulis
- Uniformed Services University of Health Sciences, Bethesda, MD, United States
| | - Rabih A Chaer
- Division of Vascular Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, United States
| | - Efthymios D Avgerinos
- Division of Vascular Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, United States
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Abstract
BACKGROUND Arterial shunting is a well-described method to control hemorrhage and rapidly reestablish flow, but optimal shunt dwell times remain controversial. We hypothesized that prolonged shunt dwell times of more than 6 hours are related to adverse outcomes after major arterial injury. METHODS A review (2005-2013) of all patients with arterial shunts placed after traumatic injury at our urban Level I trauma center was undertaken. Patients who died prior to shunt removal (n = 7) were excluded. Shunt complications were defined as dislodgement, thrombosis, and distal ischemia. Patients were compared on the basis of shunt complications with respect to clinical parameters. RESULTS The 42 patients who underwent arterial shunting after major vascular injury were primarily young (median, 26 years; interquartile range [IQR], 22-31 years) males (97.6%), severely injured (Injury Severity Score, 17.5 [IQR, 14-29]; shunted vessel Abbreviated Injury Scale score, 4 [IQR, 3-4]) by gunshot (85.7%) requiring neck/torso (33.3%) or upper-extremity (19.1%) or lower-extremity (47.6%) shunts. Thirty-five patients survived until shunt removal, and 5 (14.3%) of 35 developed shunt complications. Demographics and clinical characteristics were compared between those with shunt dwell times of less than 6 hours (n = 19) and more than 6 hours (n = 16). While patients appeared to have a greater injury burden overall in the group with dwell times of more than 6 hours, there were no statistical differences between groups with respect to age, gender, initial systolic blood pressure or hemodynamics during the shunt dwell period, use of vasopressors, Abbreviated Injury Scale score of the shunted vessel, Injury Severity Score, or outcomes including limb amputation or mortality. No patients (0/19) with shunt dwell times of less than 6 hours developed complications, whereas 5 (31.3%) of 16 patients with dwell times of more than 6 hours developed shunt complications (p = 0.05). CONCLUSIONS In this civilian series, 14% of patients with arterial shunts developed shunt complications. Our data suggest that limiting shunt dwell times to less than 6 hours when clinically feasible may decrease adverse outcomes. LEVEL OF EVIDENCE Therapeutic/care management study, level IV.
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399
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Wan B, Zhang H, Yin J, Fu H, Chen Y, Yang L, Liu D, Lv T, Song Y. Rhubarb vs. glycerin enema for treatment of critically ill patients with intra-abdominal hypertension. Exp Ther Med 2017; 14:855-861. [PMID: 28673010 DOI: 10.3892/etm.2017.4556] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Accepted: 02/17/2017] [Indexed: 01/31/2023] Open
Abstract
Rhubarb has been used as an evacuant for thousands of years. However, recent research has indicated that rhubarb inhibits inflammation and protects organ function. In the current study, the use of rhubarb was investigated in patients with intra-abdominal hypertension (IAH). Specifically, its dual role in attenuating lung and bowel injury by catharsis and inhibiting inflammation was evaluated. Patients in the glycerin group (n=56) received 110 ml of glycerin enema by coloclysis once daily for 7 to 9 days. Patients in the rhubarb group (n=56) were treated with a mixture of 0.3 g/kg body weight rhubarb powder in 100 ml warm water. The Acute Physiology and Chronic Health Evaluation II (APACHE II), Sepsis-Related Organ Failure Assessment (SOFA), intra-abdominal pressure, procalcitonin (PCT), C-reactive protein (CRP), tumor necrosis factor-α (TNF-α) and interleukin (IL)-6 levels were recorded. The duration of mechanical ventilation (MV), respiratory parameters, first day of enteral nutrition (EN), intensive care unit (ICU) hospital stay and 30-day mortality were also recorded. The APACHE II scores were significantly lower in the rhubarb group compared with the glycerin group from day 3 to 9 (P<0.05 at day 3 and 4; P<0.01 at day 5, 7 and 9). The SOFA scores were significantly lower in the rhubarb group compared with the glycerin group from day 5 to 9 (P<0.05). PCT levels were significantly lower from day 4 to 9 (P<0.05) and the CRP level was significantly lower from day 3 to 9 (P<0.05) in the rhubarb group compared with the glycerin group. The TNF-α and IL-6 were significantly lower in the rhubarb group compared with the glycerin group from day 3 to 9 (P<0.05 at day 3 and 4, P<0.01 at day 5, 7 and 9). The positive end-expiratory pressure and peak inspiratory pressure were significantly lower in the rhubarb group compared with the glycerin group at day 3, 5 and 7 (P<0.05 at day 3 and 5, P<0.01 at day 7), while the oxygenation index (P<0.05) and alveolar-arterial partial pressure of oxygen (P<0.05 at day 3 and 5, P<0.01 at day 7) were significantly improved. Significantly shorter durations of MV and ICU hospital stay, and earlier EN, were observed in the rhubarb group compared with the glycerin group (all P<0.05). Rhubarb treatment was indicated to be beneficial in IAH, by inhibiting inflammation and restoring intestinal function.
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Affiliation(s)
- Bing Wan
- Department of Respiratory and Critical Medicine, Jinling Hospital, Nanjing Clinical School of Southern Medical University, Nanjing, Jiangsu 210002, P.R. China.,Department of ICU, Affiliated Hospital of Jiangsu University, Zhenjiang, Jiangsu 212001, P.R. China
| | - Hao Zhang
- Emergency Medicine Center, Affiliated Hospital of Jiangsu University, Zhenjiang, Jiangsu 212001, P.R. China
| | - Jiangtao Yin
- Department of ICU, Affiliated Hospital of Jiangsu University, Zhenjiang, Jiangsu 212001, P.R. China
| | - Haiyan Fu
- Department of General Surgery, Affiliated Hospital of Jiangsu University, Zhenjiang, Jiangsu 212001, P.R. China
| | - Yikun Chen
- Emergency Medicine Center, Affiliated Hospital of Jiangsu University, Zhenjiang, Jiangsu 212001, P.R. China
| | - Liping Yang
- Emergency Medicine Center, Affiliated Hospital of Jiangsu University, Zhenjiang, Jiangsu 212001, P.R. China
| | - Dadong Liu
- Department of ICU, Affiliated Hospital of Jiangsu University, Zhenjiang, Jiangsu 212001, P.R. China
| | - Tangfeng Lv
- Department of Respiratory and Critical Medicine, Jinling Hospital, Nanjing Clinical School of Southern Medical University, Nanjing, Jiangsu 210002, P.R. China
| | - Yong Song
- Department of Respiratory and Critical Medicine, Jinling Hospital, Nanjing Clinical School of Southern Medical University, Nanjing, Jiangsu 210002, P.R. China
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Ierardi AM, Tsetis D, Sbaraini S, Angileri SA, Galanakis N, Petrillo M, Patella F, Panella S, Balestra F, Lucchina N, Carrafiello G. The role of endovascular therapy in acute mesenteric ischemia. Ann Gastroenterol 2017; 30:526-533. [PMID: 28845108 PMCID: PMC5566773 DOI: 10.20524/aog.2017.0164] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2016] [Accepted: 04/24/2017] [Indexed: 12/23/2022] Open
Abstract
Background Endovascular therapy, including aspiration thrombectomy and local thrombolytic therapy, often associated with angioplasty and stent placement, has been described in the literature. The purpose of this study was to review case series of patients with acute mesenteric ischemia treated with endovascular therapy and evaluate their outcomes. Methods An online review using PubMed was carried out to identify all English articles about this topic in the time interval from 2005 to 2016. The following variables were extracted number of patients, cause of occlusion, symptoms, arteries involved, number of sessions of treatment, technical success, clinical success, recurrence rate, complications, mortality rate, number of patients who underwent diagnostic laparoscopy or surgical resection of ischemic bowel. Results Eighteen papers met the inclusion criteria and were included. Among the patients with arterial mesenteric ischemia treated with endovascular approach, the technical success rate was high (up to 100%) and data regarding clinical success are encouraging, even though they are few and heterogeneous. Technical success rate and clinical success of patients with acute venous mesenteric ischemia approached with endovascular treatment was 74-100% and 87.5-100% respectively. Conclusions Current advances in endovascular therapies have made these treatments feasible for mesenteric ischemia.
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Affiliation(s)
- Anna Maria Ierardi
- Department of Diagnostic and Interventional Radiology, University of Milan, San Paolo Hospital, Milan, Italy (Anna Maria Ierardi, Sara Sbaraini, Salvatore Alessio Angileri, Mario Petrillo, Francesca Patella, Silvia Panella, Federica Balestra, Gianpaolo Carrafiello)
| | - Dimitrios Tsetis
- Interventional Radiology Unit, Department of Medical Imaging, University Hospital of Heraklion, School of Medicine, University of Crete, Greece (Dimitrios Tsetis, Nikolaos Galanakis)
| | - Sara Sbaraini
- Department of Diagnostic and Interventional Radiology, University of Milan, San Paolo Hospital, Milan, Italy (Anna Maria Ierardi, Sara Sbaraini, Salvatore Alessio Angileri, Mario Petrillo, Francesca Patella, Silvia Panella, Federica Balestra, Gianpaolo Carrafiello)
| | - Salvatore Alessio Angileri
- Department of Diagnostic and Interventional Radiology, University of Milan, San Paolo Hospital, Milan, Italy (Anna Maria Ierardi, Sara Sbaraini, Salvatore Alessio Angileri, Mario Petrillo, Francesca Patella, Silvia Panella, Federica Balestra, Gianpaolo Carrafiello)
| | - Nikolaos Galanakis
- Interventional Radiology Unit, Department of Medical Imaging, University Hospital of Heraklion, School of Medicine, University of Crete, Greece (Dimitrios Tsetis, Nikolaos Galanakis)
| | - Mario Petrillo
- Department of Diagnostic and Interventional Radiology, University of Milan, San Paolo Hospital, Milan, Italy (Anna Maria Ierardi, Sara Sbaraini, Salvatore Alessio Angileri, Mario Petrillo, Francesca Patella, Silvia Panella, Federica Balestra, Gianpaolo Carrafiello)
| | - Francesca Patella
- Department of Diagnostic and Interventional Radiology, University of Milan, San Paolo Hospital, Milan, Italy (Anna Maria Ierardi, Sara Sbaraini, Salvatore Alessio Angileri, Mario Petrillo, Francesca Patella, Silvia Panella, Federica Balestra, Gianpaolo Carrafiello)
| | - Silvia Panella
- Department of Diagnostic and Interventional Radiology, University of Milan, San Paolo Hospital, Milan, Italy (Anna Maria Ierardi, Sara Sbaraini, Salvatore Alessio Angileri, Mario Petrillo, Francesca Patella, Silvia Panella, Federica Balestra, Gianpaolo Carrafiello)
| | - Federica Balestra
- Department of Diagnostic and Interventional Radiology, University of Milan, San Paolo Hospital, Milan, Italy (Anna Maria Ierardi, Sara Sbaraini, Salvatore Alessio Angileri, Mario Petrillo, Francesca Patella, Silvia Panella, Federica Balestra, Gianpaolo Carrafiello)
| | - Natalie Lucchina
- Unit of Interventional Radiology, Department of Radiology, University of Insubria, Varese, Italy (Natalie Lucchina)
| | - Gianpaolo Carrafiello
- Department of Diagnostic and Interventional Radiology, University of Milan, San Paolo Hospital, Milan, Italy (Anna Maria Ierardi, Sara Sbaraini, Salvatore Alessio Angileri, Mario Petrillo, Francesca Patella, Silvia Panella, Federica Balestra, Gianpaolo Carrafiello)
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