1
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Pu H, Li W, Wang G, Zhou S. Effect of different shock conditions on mesenteric hemodynamics. Am J Med Sci 2024:S0002-9629(24)01410-1. [PMID: 39168406 DOI: 10.1016/j.amjms.2024.08.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 08/14/2024] [Indexed: 08/23/2024]
Abstract
BACKGROUND Reduced effective circulating blood volume and impaired peripheral tissue perfusion play an important role in the pathophysiology of shock. However, there have been no studies examining the relationship between Doppler ultrasound of the superior mesenteric artery (SMA) under different shock conditions. METHODS We evaluated a total of 85 patients, including 63 patients with different types of shock and 22 in the control group. we included patients who were diagnosed with shock upon admission or developed shock during their hospital stay. At the same time, patients with stable hemodynamics, no use of vasoactive drugs and normal lactate levels were used as a control group. We collected SMA Doppler ultrasound parameters, including Peak Systolic Velocity (PSV), End Diastolic Velocity (EDV), Resistance Index (RI), pulsatility index (PI), Time-Averaged Mean Velocity (TAMV), and Blood Flow (BF). RESULTS In the cardiac shock group, SMA PSV, TAMV, and BF were lower compared to the other groups. There was no significant difference in SMA RI and PI between the different types of shock groups, but both were significantly lower than the control group. Cardiac index (CI) is correlated with SMA PSV (r = 0.487, P = 0.000) and TAMV (r = 0.538, P = 0.000), whereas SVRI is not correlated with SMA RI and PI. Lactate levels was correlation with SMA RI (r = -0.307, P = 0.000) and PI (r = -0.287, P = 0.000). The area under the ROC curve of SMA RI and PI to predict hyperlactatemia was 0.85[0.78-0.91] and 0.83[0.76-0.90]. CONCLUSIONS The velocity parameters of SMA Doppler ultrasound such as TAMV and PSV can reflect cardiac function. The measurements of SMA RI and PI are correlated with lactate levels, having a positive predictive value for hyperlactatemia and provide guidance for fluid resuscitation in patients with shock in the future.
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Affiliation(s)
- Hao Pu
- Department of Critical Care Medicine, The Third Affiliated Hospital of Soochow University, No.185, Bureau Front Street, Changzhou, 213000, China
| | - Wen Li
- Department of Critical Care Medicine, The Third Affiliated Hospital of Soochow University, No.185, Bureau Front Street, Changzhou, 213000, China
| | - Gui Wang
- Department of Critical Care Medicine, The Third Affiliated Hospital of Soochow University, No.185, Bureau Front Street, Changzhou, 213000, China
| | - ShuJun Zhou
- Department of Critical Care Medicine, The Third Affiliated Hospital of Soochow University, No.185, Bureau Front Street, Changzhou, 213000, China.
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2
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Kupinski AM. Mesenteric and renal arterial duplex ultrasound: A review. Vasc Med 2023; 28:463-475. [PMID: 37259501 DOI: 10.1177/1358863x231172247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Duplex ultrasound examinations of the mesenteric and renal circulations are commonly used to detect disease as well as to follow up patients after open surgery or endovascular intervention. The aims of this review were to present essential elements of these duplex ultrasound examinations as well as conduct a literature review of diagnostic criteria. Documentation of appropriate images and data will aid in an accurate interpretation. Spectral Doppler waveforms from various segments of these arterial systems can contribute both direct and indirect evidence of the presence of disease. Various studies have validated the duplex ultrasound diagnostic criteria which more recently have expanded to include specific criteria for stented vessels. This review presents a summary of the fundamental exam components and diagnostic criteria utilized for mesenteric and renal duplex ultrasound.
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Affiliation(s)
- Ann Marie Kupinski
- North Country Vascular Diagnostics, Inc., Altamont, NY, USA
- Albany Medical College, Albany, NY, USA
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3
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Paulus LP, Wagner AL, Buehler A, Raming R, Jüngert J, Simon D, Tascilar K, Schnell A, Günther J, Rother U, Lang W, Hoerning A, Schett G, Neurath MF, Woelfle J, Waldner MJ, Knieling F, Regensburger AP. Multispectral optoacoustic tomography of the human intestine - temporal precision and the influence of postprandial gastrointestinal blood flow. PHOTOACOUSTICS 2023; 30:100457. [PMID: 36824387 PMCID: PMC9942118 DOI: 10.1016/j.pacs.2023.100457] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 01/29/2023] [Accepted: 02/01/2023] [Indexed: 06/18/2023]
Abstract
Multispectral optoacoustic tomography (MSOT) holds great promise as a non-invasive diagnostic tool for inflammatory bowel diseases. Yet, reliability and the impact of physiological processes during fasting and after food intake on optoacoustic signals have not been studied. In the present investigator initiated trial (NCT05160077) the intestines of ten healthy subjects were examined by MSOT at eight timepoints on two days, one fasting and one after food intake. While within-timepoint and within-day reproducibility were good for single wavelength 800 nm and total hemoglobin (ICC 0.722-0.956), between-day reproducibility was inferior (ICC -0.137 to 0.438). However, temporal variability was smaller than variation between individuals (coefficients of variation 8.9%-33.7% vs. 17.0%-48.5%). After food intake and consecutive increased intestinal circulation, indicated by reduced resistance index of simultaneous Doppler ultrasound, optoacoustic signals did not alter significantly. In summary, this study demonstrates high reliability and temporal stability of MSOT for imaging the human intestine during fasting and after food intake.
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Affiliation(s)
- Lars-Philip Paulus
- Department of Pediatrics and Adolescent Medicine, University Hospital Erlangen, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Erlangen, Germany
- Pediatric Experimental and Translational Imaging Laboratory (PETI-Lab), Department of Pediatrics and Adolescent Medicine, University Hospital Erlangen, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Erlangen, Germany
| | - Alexandra L. Wagner
- Department of Pediatrics and Adolescent Medicine, University Hospital Erlangen, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Erlangen, Germany
- Pediatric Experimental and Translational Imaging Laboratory (PETI-Lab), Department of Pediatrics and Adolescent Medicine, University Hospital Erlangen, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Erlangen, Germany
| | - Adrian Buehler
- Department of Pediatrics and Adolescent Medicine, University Hospital Erlangen, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Erlangen, Germany
- Pediatric Experimental and Translational Imaging Laboratory (PETI-Lab), Department of Pediatrics and Adolescent Medicine, University Hospital Erlangen, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Erlangen, Germany
| | - Roman Raming
- Department of Pediatrics and Adolescent Medicine, University Hospital Erlangen, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Erlangen, Germany
- Pediatric Experimental and Translational Imaging Laboratory (PETI-Lab), Department of Pediatrics and Adolescent Medicine, University Hospital Erlangen, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Erlangen, Germany
| | - Jörg Jüngert
- Department of Pediatrics and Adolescent Medicine, University Hospital Erlangen, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Erlangen, Germany
| | - David Simon
- Department of Medicine 3 and German Center Immunotherapy (DZI), University Hospital Erlangen, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Erlangen, Germany
| | - Koray Tascilar
- Department of Medicine 3 and German Center Immunotherapy (DZI), University Hospital Erlangen, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Erlangen, Germany
| | - Alexander Schnell
- Department of Pediatrics and Adolescent Medicine, University Hospital Erlangen, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Erlangen, Germany
| | - Josefine Günther
- Department of Vascular Surgery, University Hospital Erlangen, Friedrich-Alexander Universität (FAU) Erlangen-Nürnberg, Erlangen, Germany
| | - Ulrich Rother
- Department of Vascular Surgery, University Hospital Erlangen, Friedrich-Alexander Universität (FAU) Erlangen-Nürnberg, Erlangen, Germany
| | - Werner Lang
- Department of Vascular Surgery, University Hospital Erlangen, Friedrich-Alexander Universität (FAU) Erlangen-Nürnberg, Erlangen, Germany
| | - André Hoerning
- Department of Pediatrics and Adolescent Medicine, University Hospital Erlangen, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Erlangen, Germany
| | - Georg Schett
- Department of Medicine 3 and German Center Immunotherapy (DZI), University Hospital Erlangen, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Erlangen, Germany
| | - Markus F. Neurath
- Department of Medicine 1 and German Center Immunotherapy (DZI), University Hospital Erlangen, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Erlangen, Germany
| | - Joachim Woelfle
- Department of Pediatrics and Adolescent Medicine, University Hospital Erlangen, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Erlangen, Germany
| | - Maximilian J. Waldner
- Department of Medicine 1 and German Center Immunotherapy (DZI), University Hospital Erlangen, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Erlangen, Germany
| | - Ferdinand Knieling
- Department of Pediatrics and Adolescent Medicine, University Hospital Erlangen, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Erlangen, Germany
- Pediatric Experimental and Translational Imaging Laboratory (PETI-Lab), Department of Pediatrics and Adolescent Medicine, University Hospital Erlangen, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Erlangen, Germany
| | - Adrian P. Regensburger
- Department of Pediatrics and Adolescent Medicine, University Hospital Erlangen, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Erlangen, Germany
- Pediatric Experimental and Translational Imaging Laboratory (PETI-Lab), Department of Pediatrics and Adolescent Medicine, University Hospital Erlangen, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Erlangen, Germany
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4
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Terlouw LG, van Dijk LJ, van Noord D, Voogd T, Bakker BJ, Nikkessen S, Bruno MJ, Moelker A. MRI-based pre- and postprandial flow in the mesenteric vasculature of patients with suspected chronic mesenteric ischemia. Eur J Radiol 2022; 151:110316. [DOI: 10.1016/j.ejrad.2022.110316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 04/05/2022] [Accepted: 04/07/2022] [Indexed: 11/03/2022]
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5
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Yogic agnisara increases blood flow in the superior mesenteric artery. J Bodyw Mov Ther 2022; 31:97-101. [DOI: 10.1016/j.jbmt.2022.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 02/20/2022] [Accepted: 04/04/2022] [Indexed: 11/19/2022]
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6
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Revzin MV, Pellerito JS, Nezami N, Moshiri M. The radiologist's guide to duplex ultrasound assessment of chronic mesenteric ischemia. Abdom Radiol (NY) 2020; 45:2960-2979. [PMID: 31410506 DOI: 10.1007/s00261-019-02165-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE This article reviews the relevant anatomy and physiology of the mesenteric vasculature, familiarizes the radiologist with the accepted diagnostic criteria for mesenteric artery stenosis and its role in the diagnosis of chronic mesenteric ischemia, describes Doppler imaging techniques, and provides protocols for the assessment and surveillance of the mesenteric vasculature before and after revascularization. It also discusses expected changes following revascularization and reviews common post-procedural complications. RESULTS Duplex sonography plays an important role in the diagnosis and management of chronic mesenteric ischemia (CMI). Establishing a successful diagnosis is dependent upon knowledge of mesenteric arterial anatomy and physiology as well as sufficient expertise in image optimization and scanning techniques. Although there has been a trend toward utilization of other noninvasive [computed tomographic angiography (CTA), magnetic resonance angiography (MRA), and invasive (digital subtraction angiography (DSA)] imaging modalities for assessment of the mesenteric vasculature, a new era of "imaging wisely" raises legitimate concerns about the effects of ionizing radiation as well as potential effects of CT and MR contrast agents. These concerns are obviated by the use of ultrasound, and recently developed techniques, such as contrast-enhanced ultrasound and vascular applications focused on the evaluation of slow flow, have revealed the vast potential of vascular ultrasound in the evaluation of chronic mesenteric ischemia. CONCLUSION Duplex sonography is a cost-effective and powerful tool that can be utilized for the accurate assessment of mesenteric vascular pathology, specifically mesenteric arterial stenosis, and for the evaluation of mesenteric arterial system post revascularization.
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7
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Smiljanec K, Mbakwe AU, Ramos-Gonzalez M, Pohlig RT, Lennon SL. Antioxidant cocktail following a high-sodium meal does not affect vascular function in young, healthy adult humans: a randomized controlled crossover trial. Nutr Res 2020; 79:13-22. [PMID: 32610254 DOI: 10.1016/j.nutres.2020.05.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 05/06/2020] [Accepted: 05/18/2020] [Indexed: 02/06/2023]
Abstract
Chronic high sodium intake is a risk factor for cardiovascular disease as it impairs vascular function through an increase in oxidative stress. The objective of this study was to investigate the acute effects of a high-sodium meal (HSM) and antioxidant (AO) cocktail on vascular function. We hypothesized that a HSM would impair endothelial function, and increase arterial stiffness and wave reflection, while ingestion of the AO cocktail would mitigate this response. Healthy adults ingested either an AO cocktail (vitamin C, E, alpha-lipoic acid) or placebo (PLA) followed by a HSM (1500 mg) in a randomized crossover blinded design. Blood pressure (BP), endothelial function (flow-mediated dilation; FMD) and measures of arterial stiffness (pulse wave velocity; PWV) and wave reflection (augmentation index; AIx) were made at baseline and 30, 60, 90, and 120 min after meal consumption. Forty-one participants (20M/21W; 24 ± 1 years; BMI 23.4 ± 0.4 kg/m2) completed the study. Mean BP increased at 120 min relative to 60 min (60 min: 79 ± 1; 120 min: 81 ± 1 mmHg; time effect P = .01) but was not different between treatments (treatment × time interaction P = .32). AIx decreased from baseline (time effect P < .001) but was not different between treatments (treatment × time interaction P = .31). PWV (treatment × time interaction, P = .91) and FMD (treatment × time interaction P = .65) were also not different between treatments. In conclusion, a HSM does not acutely impair vascular function suggesting young healthy adults can withstand the acute impact of sodium on the vasculature and therefore, the AO cocktail is not necessary to mitigate the response.
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Affiliation(s)
- Katarina Smiljanec
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, DE.
| | - Alexis U Mbakwe
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, DE.
| | | | - Ryan T Pohlig
- Biostatistics Core Facility, University of Delaware, STAR, Newark, DE.
| | - Shannon L Lennon
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, DE.
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8
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Burkart JM. Intermittent Severe Abdominal Pain with Normal Peritoneal Fluid Findings on Presentation. Perit Dial Int 2020. [DOI: 10.1177/089686080002000649] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- John M. Burkart
- Wake Forest University, Winston–Salem, North Carolina, U.S.A
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9
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Lee SK, Yoon S, Kim C, Choi J. Triple-phased mesenteric CT angiography using a test bolus technique for evaluation of the mesenteric vasculature and small intestinal wall contrast enhancement in dogs. Vet Radiol Ultrasound 2019; 60:493-501. [PMID: 31237070 DOI: 10.1111/vru.12781] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 04/09/2019] [Accepted: 04/27/2019] [Indexed: 12/26/2022] Open
Abstract
Computed tomography angiography is widely used for the assessment of various mesenteric vascular and bowel diseases in humans. However, there are only few studies that describe CT angiography application to mesenteric vessels in dogs. In this prospective, experimental, exploratory study, the mesenteric vasculature and enhancement pattern of the intestinal wall were evaluated on triple-phase CT angiography, and improvement of the visibility of vasculature was assessed on multiplanar reformation, maximum intensity projection, and volume rendering technique. After test bolus scanning at the level of the cranial mesenteric artery arising from the aorta, mesenteric CT angiography was performed in 10 healthy, male, Beagle dogs. Scan delay was set based on time-to-attenuation curves, drawn by placing the regions of interest over the aorta, intestinal wall, and cranial mesenteric vein. Visualization and enhancement of mesenteric arteries and veins were evaluated with multiplanar reformation, maximum intensity projection, and volume rendering techniques. The degree of intestinal wall enhancement was assessed on the transverse images in precontrast, arterial, intestinal, and venous phases. Pure arterial images were obtained in the arterial phase. Venous phase images allowed good portal vascular mapping. All CT angiography images were of high quality, allowing for excellent visualization of the anatomy of mesenteric vasculature including the small branches, particularly on maximum intensity projection and volume rendering technique. Distinct contrast enhancement of the intestinal wall was observed in both intestinal and venous phases. Findings indicated that this technique is feasible for the evaluation of mesenteric circulation in dogs.
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Affiliation(s)
- Sang-Kwon Lee
- College of Veterinary Medicine and BK21 Plus project team, Chonnam National University, Gwangju, 61186, Republic of Korea
| | - Sooa Yoon
- College of Veterinary Medicine and BK21 Plus project team, Chonnam National University, Gwangju, 61186, Republic of Korea
| | - Cheolhyun Kim
- College of Veterinary Medicine and BK21 Plus project team, Chonnam National University, Gwangju, 61186, Republic of Korea
| | - Jihye Choi
- College of Veterinary Medicine and BK21 Plus project team, Chonnam National University, Gwangju, 61186, Republic of Korea
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10
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Rose RH, Turner DB, Neuhoff S, Jamei M. Incorporation of the Time-Varying Postprandial Increase in Splanchnic Blood Flow into a PBPK Model to Predict the Effect of Food on the Pharmacokinetics of Orally Administered High-Extraction Drugs. AAPS JOURNAL 2017; 19:1205-1217. [PMID: 28526963 DOI: 10.1208/s12248-017-0099-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Accepted: 05/04/2017] [Indexed: 11/30/2022]
Abstract
Following a meal, a transient increase in splanchnic blood flow occurs that can result in increased exposure to orally administered high-extraction drugs. Typically, physiologically based pharmacokinetic (PBPK) models have incorporated this increase in blood flow as a time-invariant fed/fasted ratio, but this approach is unable to explain the extent of increased drug exposure. A model for the time-varying increase in splanchnic blood flow following a moderate- to high-calorie meal (TV-Q Splanch) was developed to describe the observed data for healthy individuals. This was integrated within a PBPK model and used to predict the contribution of increased splanchnic blood flow to the observed food effect for two orally administered high-extraction drugs, propranolol and ibrutinib. The model predicted geometric mean fed/fasted AUC and C max ratios of 1.24 and 1.29 for propranolol, which were within the range of published values (within 1.0-1.8-fold of values from eight clinical studies). For ibrutinib, the predicted geometric mean fed/fasted AUC and C max ratios were 2.0 and 1.84, respectively, which was within 1.1-fold of the reported fed/fasted AUC ratio but underestimated the reported C max ratio by up to 1.9-fold. For both drugs, the interindividual variability in fed/fasted AUC and C max ratios was underpredicted. This suggests that the postprandial change in splanchnic blood flow is a major mechanism of the food effect for propranolol and ibrutinib but is insufficient to fully explain the observations. The proposed model is anticipated to improve the prediction of food effect for high-extraction drugs, but should be considered with other mechanisms.
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Affiliation(s)
- Rachel H Rose
- Simcyp (a Certara Company), Blades Enterprise Centre, John Street, S2 4SU, Sheffield, UK.
| | - David B Turner
- Simcyp (a Certara Company), Blades Enterprise Centre, John Street, S2 4SU, Sheffield, UK
| | - Sibylle Neuhoff
- Simcyp (a Certara Company), Blades Enterprise Centre, John Street, S2 4SU, Sheffield, UK
| | - Masoud Jamei
- Simcyp (a Certara Company), Blades Enterprise Centre, John Street, S2 4SU, Sheffield, UK
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11
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Seifert H, Jäger K. Diagnostic value of duplex scanning in peripheral vascular disease. ACTA ACUST UNITED AC 2017. [DOI: 10.1177/1358836x9000100103] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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12
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Sieber CC, Jaeger K. Duplex Scanning — A Useful Tool for Noninvasive Assessment of Visceral Blood Flow in Man. ACTA ACUST UNITED AC 2016. [DOI: 10.1177/1358863x9200300202] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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13
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Coskun AK, Halici Z, Oral A, Bayir Y, Deniz F, Caycı T, Mentes O, Oz BS, Harlak A, Yigit T, Kozak O, Peker Y. The value of combined elevation of D-dimer and neopterin as a predictive parameter for early stage acute mesenteric ischemia: An experimental study. Vascular 2016; 25:163-169. [PMID: 27278523 DOI: 10.1177/1708538116652267] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Background The diagnosis of acute mesenteric ischemia is variable. Early diagnosis is important for reducing the mortality and morbidity rates. Aim This experimental study aims to investigate the diagnostic utility of D-dimer and neopterin as a marker for the early stage of acute mesenteric ischemia caused by occlusion of superior mesenteric artery. Methods The levels of D-dimer and neopterin were measured using an animal acute mesenteric ischemia model in 21 male rabbits. Superior mesenteric artery occlusion (Group 1, n = 14) and control (Group 2, n = 7) groups were identified. Blood samples at different times are collected from each rabbits. Blood samples from superior mesenteric artery occlusion group were taken 30 min after anesthesia but before laparotomy, 1, 2, and 3 h after superior mesenteric artery ligation. Blood samples from control group were taken 1 h before, 1 and 3 h after anesthesia and laparotomy. The D-dimer and neopterin levels of each blood sample were measured. Results The probability of acute mesenteric ischemia was found to be 36 times higher when the D-dimer level was over 0.125 ng/L, whereas the probability was 19.2 times higher when the neopterin level was over 1.25 nmol/L. Conclusions In this experimental study, the combined elevation of two significant markers, D-dimer and neopterin, may be helpful for the early diagnosis of acute mesenteric ischemia.
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Affiliation(s)
| | - Zekai Halici
- Department of Pharmacology, Gulhane Medical School, Turkey
- Department of Pharmacology, Ataturk University, Turkey
| | - Akgun Oral
- Department of Pediatric Surgery, Gulhane Medical School, Turkey
- Department of Pediatric Surgery, Ataturk University, Turkey
| | - Yasin Bayir
- Faculty of Pharmacy, Ataturk University, Turkey
| | - Ferhat Deniz
- Department of Endocrinology, Gulhane Medical School, Turkey
| | - Tuncer Caycı
- Department of Biochemistry, Gulhane Medical School, Turkey
| | - Oner Mentes
- Department of General Surgery, Gulhane Medical School, Turkey
| | - Bilgehan Savas Oz
- Department of Cardiovascular Surgery, Gulhane Medical School, Turkey
| | - Ali Harlak
- Department of General Surgery, Gulhane Medical School, Turkey
| | - Taner Yigit
- Department of General Surgery, Gulhane Medical School, Turkey
| | - Orhan Kozak
- Department of General Surgery, Gulhane Medical School, Turkey
| | - Yusuf Peker
- Department of General Surgery, Gulhane Medical School, Turkey
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14
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Jayasinghe SU, Torres SJ, Fraser SF, Turner AI. Cortisol, blood pressure, and heart rate responses to food intake were independent of physical fitness levels in women. Appl Physiol Nutr Metab 2015; 40:1186-92. [PMID: 26499850 DOI: 10.1139/apnm-2015-0168] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
This research tested the hypothesis that women who had higher levels of physical fitness will have lower hypothalamo-pituitary-adrenal axis (cortisol) and sympatho-adrenal medullary system (blood pressure and heart rate) responses to food intake compared with women who had low levels of physical fitness. Lower fitness (n = 22; maximal oxygen consumption = 27.4 ± 1.0 mL∙kg(-1)·min(-1)) and higher fitness (n = 22; maximal oxygen consumption = 41.9 ± 1.6 mL∙kg(-1)·min(-1)) women (aged 30-50 years; in the follicular phase of the menstrual cycle) who participated in levels of physical activity that met (lower fitness = 2.7 ± 0.5 h/week) or considerably exceeded (higher fitness = 7.1 ± 1.4 h/week) physical activity guidelines made their own lunch using standardised ingredients at 1200 h. Concentrations of cortisol were measured in blood samples collected every 15 min from 1145-1400 h. Blood pressures and heart rate were also measured every 15 min between 1145 h and 1400 h. The meal consumed by the participants consisted of 20% protein, 61% carbohydrates, and 19% fat. There was a significant overall response to lunch in all of the parameters measured (time effect for all, p < 0.01). The cortisol response to lunch was not significantly different between the groups (time × treatment, p = 0.882). Overall, both groups showed the same pattern of cortisol secretion (treatment p = 0.839). Systolic blood pressure, diastolic blood pressure, mean arterial pressure, or heart rate responses (time × treatment, p = 0.726, 0.898, 0.713, and 0.620, respectively) were also similar between higher and lower fitness women. Results suggest that the physiological response to food intake in women is quite resistant to modification by elevated physical fitness levels.
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Affiliation(s)
- Sisitha U Jayasinghe
- Centre for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Burwood, Victoria 3125, Australia.,Centre for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Burwood, Victoria 3125, Australia
| | - Susan J Torres
- Centre for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Burwood, Victoria 3125, Australia.,Centre for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Burwood, Victoria 3125, Australia
| | - Steve F Fraser
- Centre for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Burwood, Victoria 3125, Australia.,Centre for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Burwood, Victoria 3125, Australia
| | - Anne I Turner
- Centre for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Burwood, Victoria 3125, Australia.,Centre for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Burwood, Victoria 3125, Australia
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15
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Jayasinghe SU, Torres SJ, Nowson CA, Tilbrook AJ, Turner AI. Cortisol, alpha amylase, blood pressure and heart rate responses to food intake in men aged 50–70 years: importance of adiposity. BMC OBESITY 2014. [DOI: 10.1186/s40608-014-0014-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Martins FP, Vilela EG, Ferrari MDLA, Torres HODG, Leite JB, Cunha ASD. Role of Doppler ultrasonography evaluation of superior mesenteric artery flow volume in the assessment of Crohn's disease activity. Radiol Bras 2013. [DOI: 10.1590/s0100-39842013000500003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Jun HJ. Isolated bypass to the superior mesenteric artery for chronic mesenteric ischemia. THE KOREAN JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2013; 46:146-9. [PMID: 23614103 PMCID: PMC3631791 DOI: 10.5090/kjtcs.2013.46.2.146] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/08/2012] [Revised: 11/29/2012] [Accepted: 12/03/2012] [Indexed: 11/16/2022]
Abstract
Mesenteric ischemic symptoms appear only when two of the three major splanchnic arteries from the abdominal aorta are involved. Recently, we encountered a case of chronic mesenteric ischemia in a 50-year-old female patient caused by atherosclerotic obstruction of the celiac trunk and superior mesenteric artery. She was treated with a retrograde bypass graft from the right common iliac artery to the superior mesenteric artery (SMA) in a C-loop configuration. Complete revascularization is recommended for treatment of intestinal ischemia. When the celiac trunk is a not suitable recipient vessel, bypass grafting to the SMA alone appears to be both an effective and durable procedure for treating intestinal ischemia.
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Affiliation(s)
- Hee Jae Jun
- Department of Thoracic and Cardiovascular Surgery, Haeundae Paik Hospital, Inje University College of Medicine, Korea
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Osada T. Physiological aspects of the determination of comprehensive arterial inflows in the lower abdomen assessed by Doppler ultrasound. Cardiovasc Ultrasound 2012; 10:13. [PMID: 22443486 PMCID: PMC3366871 DOI: 10.1186/1476-7120-10-13] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2011] [Accepted: 03/26/2012] [Indexed: 11/30/2022] Open
Abstract
Non-invasive measurement of splanchnic hemodynamics has been utilized in the clinical setting for diagnosis of gastro-intestinal disease, and for determining reserve blood flow (BF) distribution. However, previous studies that measured BF in a "single vessel with small size volume", such as the superior mesenteric and coeliac arteries, were concerned solely with the target organ in the gastrointestinal area, and therefore evaluation of alterations in these single arterial BFs under various states was sometimes limited to "small blood volumes", even though there was a relatively large change in flow. BF in the lower abdomen (BF(Ab)) is potentially a useful indicator of the influence of comprehensive BF redistribution in cardiovascular and hepato-gastrointestinal disease, in the postprandial period, and in relation to physical exercise. BF(Ab) can be determined theoretically using Doppler ultrasound by subtracting BF in the bilateral proximal femoral arteries (FAs) from BF in the upper abdominal aorta (Ao) above the coeliac trunk. Prior to acceptance of this method of determining a true BF(Ab) value, it is necessary to obtain validated normal physiological data that represent the hemodynamic relationship between the three arteries. In determining BF(Ab), relative reliability was acceptably high (range in intra-class correlation coefficient: 0.85-0.97) for three arterial hemodynamic parameters (blood velocity, vessel diameter, and BF) in three repeated measurements obtained over three different days. Bland-Altman analysis of the three repeated measurements revealed that day-to-day physiological variation (potentially including measurement error) was within the acceptable minimum range (95% of confidence interval), calculated as the difference in hemodynamics between two measurements. Mean BF (ml/min) was 2951 ± 767 in Ao, 316 ± 97 in left FA, 313 ± 83 in right FA, and 2323 ± 703 in BF(Ab), which is in agreement with a previous study that measured the sum of BF in the major part of the coeliac, mesenteric, and renal arteries. This review presents the methodological concept that underlies BF(Ab), and aspects of its day-to-day relative reliability in terms of the hemodynamics of the three target arteries, relationship with body surface area, respiratory effects, and potential clinical usefulness and application, in relation to data previously reported in original dedicated research.
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Affiliation(s)
- Takuya Osada
- Department of Sports Medicine for Health Promotion, Tokyo Medical University, Tokyo, Japan.
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Osada T, Nagata H, Murase N, Kime R, Katsumura T. Determination of comprehensive arterial blood inflow in abdominal-pelvic organs: impact of respiration and posture on organ perfusion. Med Sci Monit 2011; 17:CR57-66. [PMID: 21278689 PMCID: PMC3524711 DOI: 10.12659/msm.881388] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Background Arterial blood flow (BF) to all abdominal-pelvic organs (AP) shows potential for an indicator of comprehensive splanchnic organ circulation (reservoir of blood supply for redistribution) in cardiovascular disease, hepato-gastrointestinal disease or hemodynamic disorders. Our previous assessment of splanchnic hemodynamics, as magnitude of BFAP [measuring by subtracting BF in both femoral arteries (FAs) from the upper abdominal aorta (Ao) above the celiac trunk] using Doppler ultrasound, was reported as the relationship between Ao and FAs, day-to-day variability and response to exercise. For accurate determination of BFAP, it is important to consider the various factors that potentially influence BFAP. However, little information exists regarding the influence of respiration (interplay between inspiration and expiration) and posture on BFAP. Material/Methods Ten healthy males were evaluated in sitting/supine positions following a 12 hr fast. Magnitude of BFAP was determined as measurement of Ao and FAs hemodynamics (blood velocity and vessel diameter) using pulsed Doppler with spectral analysis during spontaneous 4-sec inspiration/4-sec expiration phases. Results BF/blood velocity in the Ao and FAs showed significant lower in inspiration than expiration. BFAP showed a significant (P<0.005) reduction of ~20% in inspiratory phase (sitting, 2213±222 ml/min; supine, 2059±215 ml/min) compared with expiratory phase (sitting, 2765±303 ml/min; supine, 2539±253 ml/min), with no difference between sitting and supine. Conclusions Respiratory-related to alterations in BFAP were observed. It may be speculated that changes in intra-abdominal pressure during breathing (thoracic-abdominal movement) is possibly reflecting transient changes in blood velocity in the Ao and FAs. Respiratory effects should be taken into account for evaluation of BFAP.
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Affiliation(s)
- Takuya Osada
- Department of Sports Medicine for Health Promotion, Tokyo Medical University, Tokyo, Japan.
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Rawat N, Gibbons CP. Surgical or Endovascular Treatment for Chronic Mesenteric Ischemia: A Multicenter Study. Ann Vasc Surg 2010; 24:935-45. [DOI: 10.1016/j.avsg.2010.05.007] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2009] [Revised: 03/28/2010] [Accepted: 05/16/2010] [Indexed: 01/31/2023]
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Altinyollar H, Boyabatli M, Berberoğlu U. D-dimer as a marker for early diagnosis of acute mesenteric ischemia. Thromb Res 2009; 117:463-7. [PMID: 15922412 DOI: 10.1016/j.thromres.2005.04.025] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2004] [Revised: 02/24/2005] [Accepted: 04/05/2005] [Indexed: 01/13/2023]
Abstract
INTRODUCTION Acute obstruction of mesenteric artery generally has an unfavorable prognosis because of late diagnosis. In this study we evaluated the diagnostic value of plasma D-dimer level as an early indicator in acute mesenteric ischemia in rats caused by ligation of superior mesenteric artery. MATERIALS AND METHODS Twenty-eight mature male Wistar rats were used in the study. These were divided into four groups, each consisting of seven rats. In group I, after performing a simple laparotomy, blood was sampled at minute 30. In group II, first the superior mesenteric artery was ligated, and blood samples were taken at the 30th minute. Group III consisted of rats undergoing a simple laparotomy and blood samples were taken 7 h later. From the subjects in group IV blood samples were obtained 7 h after the ligation of their superior mesenteric artery. RESULTS Plasma D-dimer levels of the ligated groups were significantly higher both at the 30th minute and the 7th hour compared to the levels of those having undergone simple laparotomies (p<0.002). Likewise, this level was higher in the 7th hour blood samples of the ligated group than in the 30th minute (p<0.008). CONCLUSIONS In rats undergoing acute mesenteric ischemia by ligation of superior mesenteric artery, plasma D-dimer levels increase with the duration of the intestinal ischemia period. This finding suggests that the measurement of the plasma D-dimer levels might be a useful tool for the early diagnosis of acute mesenteric obstruction.
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Affiliation(s)
- Hüseyin Altinyollar
- Ankara Oncology Education and Research Hospital, Department of General Surgery, Batikent-Ankara, Turkey.
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Abstract
BACKGROUND AND AIMS The splanchnic circulation has an important function in the body under both physiological and pathophysiological conditions. Despite its importance, no reliable noninvasive procedures for estimating splanchnic circulation have been established. The aim of this study was to evaluate MRI as a tool for assessing intra-abdominal blood flows of the aorta, portal vein (VPO) and the major intestinal and hepatic vessels. METHODS In nine healthy volunteers, the proximal aorta (AOP) and distal abdominal aorta (AOD), superior mesenteric artery (SAM), celiac trunk (CTR), hepatic arteries (common and proper hepatic arteries, AHC and AHP, respectively), and VPO were localized on contrast-enhanced magnetic resonance angiography images. Volumetric flow was measured using a two-dimensional cine echocardiogram-gated phase contrast technique. Measurements were taken before and 30 min after continuous intravenous infusion of somatostatin (250 microg/h) and were independently evaluated by two investigators. RESULTS Blood flow measured by MRI in the VPO, SAM, AOP, AHP, and CTR significantly decreased after drug infusion. Flows in the AOD and AHC showed a tendency to decrease (P>0.05). Interrater agreement on flows in MRI was very good for large vessels (VPO, AOP, and AOD), with a concordance correlation coefficient of 0.94, as well as for smaller vessels such as the CTR, AHC, AHP, and SAM (concordance correlation coefficient =0.78). CONCLUSION Somatostatin-induced blood flow changes in the splanchnic region were reliably detected by MRI. MRI may be useful for the noninvasive assessment of blood flow changes in the splanchnic region.
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Pellerito JS, Revzin MV, Tsang JC, Greben CR, Naidich JB. Doppler sonographic criteria for the diagnosis of inferior mesenteric artery stenosis. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2009; 28:641-650. [PMID: 19389903 DOI: 10.7863/jum.2009.28.5.641] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
OBJECTIVE The purpose of this study was to define the optimal Doppler criteria for the diagnosis of inferior mesenteric artery (IMA) stenosis in patients with suspected chronic mesenteric ischemia (CMI). METHODS A retrospective review of 205 dedicated color and pulsed Doppler sonographic studies of mesenteric arteries was performed in 205 patients. All studies were performed in patients with suspected CMI. Correlative angiography was available in 50 patients. RESULTS The IMA was visualized in 176 of 205 Doppler sonographic examinations (86%) and in 92% of the correlative studies. The visualization rate for the detection of a patent IMA by Doppler sonography in this series was 90%. The ranges of the peak systolic velocity (PSV), end-diastolic velocity (EDV), and mesenteric-aortic velocity ratio (MAR) in the nonstenotic IMA were 70 to 200 cm/s, 0 to 33 cm/s, and 0.7 to 3.7, respectively. The ranges of the PSV, EDV, and MAR in IMA stenosis were 200 to 485 cm/s, 0 to 177 cm/s, and 0.69 to 8.1. The threshold values for severe IMA stenosis by logistic regression analysis (n = 42) were as follows: PSV, greater than 200 cm/s; EDV, greater than 25 cm/s; and MAR, greater than 2.5, with sensitivities of 90%, 40%, and 80%; specificities of 97%, 91%, and 88%; positive predictive values (PPVs) of 90%, 57%, and 67%; negative predictive values (NPVs) of 97%, 83%, and 93%; and accuracy of 95%, 79%, and 86%, respectively. CONCLUSIONS We found that a PSV of greater than 200 cm/s was the best criterion for the diagnosis of IMA stenosis. The sensitivity, specificity, PPV, NPV, and accuracy for the PSV were 90%, 97%, 90%, 97%, and 95%, respectively.
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Affiliation(s)
- John S Pellerito
- Department of Radiology, North Shore University Hospital, Manhasset, NY 11030, USA.
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Papacci P, Giannantonio C, Cota F, Latella C, Semeraro CM, Fioretti M, Tesfagabir MG, Romagnoli C. Neonatal colour Doppler ultrasound study: normal values of abdominal blood flow velocities in the neonate during the first month of life. Pediatr Radiol 2009; 39:328-35. [PMID: 19189099 DOI: 10.1007/s00247-008-1112-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2008] [Revised: 09/25/2008] [Accepted: 10/20/2008] [Indexed: 11/25/2022]
Abstract
BACKGROUND Doppler US to measure abdominal blood flow velocities (ABFV) is increasingly used to investigate intestinal haemodynamics in several clinical conditions in neonates. Studies that provide reference values of ABFV during the entire neonatal period are currently lacking. OBJECTIVE To make available normal reference values of ABFV and Doppler indices in the coeliac trunk and superior mesenteric artery during the first month of life in term and healthy preterm infants. MATERIALS AND METHODS ABFV were obtained with colour Doppler US in 69 neonates (12 term, 57 preterm) divided into four gestational age groups (25-28 weeks, 29-32 weeks, 33-36 weeks, and 37-41 weeks). RESULTS ABFV increased with increasing gestational and postnatal age. We also provide normal reference values of ABFV and Doppler indices to compare with measurements of abdominal blood flow changes during the neonatal period for diagnostic, therapeutic and prognostic purposes. CONCLUSION These longitudinal reference values provide a useful tool for assessing possible alteration in ABFV secondary to neonatal pathologies.
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Affiliation(s)
- Patrizia Papacci
- Department of Paediatrics, Division of Neonatology, Sacro Cuore Catholic University, Rome, Italy.
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Harthoorn LF, Dransfield E. Periprandial changes of the sympathetic-parasympathetic balance related to perceived satiety in humans. Eur J Appl Physiol 2007; 102:601-8. [PMID: 18092177 PMCID: PMC2225999 DOI: 10.1007/s00421-007-0622-5] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/13/2007] [Indexed: 11/25/2022]
Abstract
Food intake regulation involves various central and peripheral mechanisms. In this study the relevance of physiological responses reflecting the autonomic nervous system were evaluated in relation to perceived satiety. Subjects were exposed to a lunch-induced hunger-satiety shift, while profiling diverse sensory, physiological, and biochemical characteristics at 15 min intervals. Sensory ratings comprised questionnaires with visual analogues scales about their feeling of satiety, desire to eat, fullness, and hunger. Physiological characteristics included heart rate, heart rate variability, and blood pressure, while biochemical markers such as cortisol levels and α-amylase activity were monitored in saliva. The four sensory ratings correlated with heart rate and salivary α-amylase suggesting a higher sympathetic tone during satiety. Furthermore, heart rate variability was associated with age and waist-to-hip ratio and cortisol levels negatively correlated with body mass index. Finally, neither chewing nor swallowing contributed to a heart rate increase at food consumption, but orosensory stimulation, as tested with modified sham feeding, caused a partial increase of heart rate. In conclusion, after meal ingestion critical physiological alterations reveal a elevated sympathetic tone, which is a potential measure of satiety.
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Pourhassan S, Grotemeyer D, Fürst G, Sandmann W. Das chronisch viszerale Ischämiesyndrom. GEFÄSSCHIRURGIE 2006. [DOI: 10.1007/s00772-006-0467-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Lam EY, Moneta GL. Clinical Evaluation. Vasc Med 2006. [DOI: 10.1016/b978-0-7216-0284-4.50032-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Sheehan M, Labropoulos N, Baker W. Mesenteric steal and carotid stenosis relief of symptoms with carotid endarterectomy. Ann Vasc Surg 2005; 19:731-3. [PMID: 16078007 DOI: 10.1007/s10016-005-6616-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
This is a case report of a patient with mesenteric steal, severe carotid stenosis, and cerebral symptoms that occurred with eating. Symptoms occurred when carotid flows were documented to be decreased. Carotid endarterectomy stabilized carotid flows and ameliorated symptoms.
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Affiliation(s)
- Maureen Sheehan
- Division of Peripheral Vascular Surgery, Department of Surgery, Loyola University Medical Center, Maywood, IL, USA.
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Gaschen L, Kircher P, Lang J, Gaschen F, Allenspach K, Gröne A. Pattern recognition and feature extraction of canine celiac and cranial mesenteric arterial waveforms: normal versus chronic enteropathy--a pilot study. Vet J 2005; 169:242-50. [PMID: 15727916 DOI: 10.1016/j.tvjl.2004.01.028] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/28/2004] [Indexed: 10/26/2022]
Abstract
In this pilot study, we hypothesize that waveform patterns of the celiac and cranial mesenteric arteries differ pre- and post-prandially in normal dogs compared to those with chronic enteropathy. We further suggest that it is possible to classify these findings according to the type of disease present. Eleven dogs with chronic enteropathy and eight normal dogs were examined. Doppler examinations were performed at times 0 (fasted), and at 20, 40, 60 and 90 min post-prandially. The waveform shapes were described and the following features were extracted: resistive and pulsatility index, mean maximum velocity, mean diastolic velocity, peak systolic velocity, early diastolic notch ratio and the deceleration time interval. Dogs with inflammatory bowel disease had either lower or absent flow at fasting in early diastole compared to the other groups. Resistive and pulsatility indices decreased during digestion in all groups except those with protein losing enteropathy. The increase in mean diastolic flow during digestion in affected dogs was either lacking (protein-losing enteropathy) or significantly lower (inflammatory bowel disease, P<0.05) compared to normal dogs. Dogs with chronic enteropathies had abnormal arterial waveform shapes and suboptimal increases in diastolic blood flow during digestion and these findings worsened with the severity of the histological lesions present. Doppler ultrasound of the celiac and mesenteric arteries has great potential to enhance our understanding of intestinal disease in conscious dogs.
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Affiliation(s)
- Lorrie Gaschen
- Department of Clinical Veterinary Medicine, Division of Radiology, University of Bern, Bern, Switzerland.
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Unal B, Bilgili MYK, Yilmaz S, Caglayan O, Kara S. Smoking prevents the expected postprandial increase in intestinal blood flow: a Doppler sonographic study. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2004; 23:647-653. [PMID: 15154531 DOI: 10.7863/jum.2004.23.5.647] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
OBJECTIVE To assess whether cigarette smoking had an effect on superior mesenteric artery postprandial blood flow. METHODS Forty-six subjects were studied in 3 groups with Doppler sonography. Group A consisted of nonsmokers; groups B and C consisted of smokers. In group B, subjects were allowed to smoke cigarettes postprandially, whereas in group C, postprandial smoking was prohibited. A baseline Doppler evaluation was performed in the fasting state, and consecutive Doppler evaluations were performed postprandially with 30-min intervals for 120 minutes. Doppler sonographic measurements of the superior mesenteric artery, including peak systolic and end-diastolic velocities, resistive index, and diameter, were calculated. Statistical analysis was performed by analysis of variance. RESULTS All groups showed significant changes with time for all parameters (P < .001 for all). The changes in time were significantly different at 90 and 120 minutes for peak systolic velocity, at 90 minutes for end-diastolic velocity, and at 120 minutes for diameter between groups. Group B had the greatest differences. Compared with group A, changes in peak systolic velocity at 90 to 120 minutes were significantly lower in group B (P = .007 and .006, respectively), and compared with groups A and C, changes in end-diastolic velocity at 90 minutes (P = .006 and .004, respectively) and diameter at 120 minutes (P = .007 and .011, respectively) were significantly lower in group B. CONCLUSIONS Smoking immediately after meals was associated with a superior mesenteric artery blood flow increase that was lower than expected, which may explain the belief that smoking reduces body weight. Postprandial smoking may have undesired results in patients with chronic intestinal ischemia.
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Affiliation(s)
- Birsen Unal
- Department of Radiology, Kirikkale University School of Medicine, Suleyman Demirel Hospital, Kirikkale, Turkey.
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Kircher P, Lang J, Blum J, Gaschen F, Doherr M, Sieber C, Gaschen L. Influence of food composition on splanchnic blood flow during digestion in unsedated normal dogs: a Doppler study. Vet J 2003; 166:265-72. [PMID: 14550739 DOI: 10.1016/s1090-0233(03)00049-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The effect of dietary components in gastrointestinal blood flow was investigated non-invasively in dogs. Doppler ultrasound (US) waveform analysis of the celiac artery (CA) and the cranial mesenteric artery (CMA) of eight healthy dogs was performed both in the fasting state and at 20, 40, 60 and 90 min after feeding maintenance, high protein, high carbohydrate and high fat diets. Resistive index (RI), pulsatility index (PI) and the percentage differences between measurements were calculated. In fasted dogs, the CA showed significantly (p<0.05) lower resistance than the CMA. With all diets, post-prandial RI and PI values decreased significantly in both vessels (CA: RI=-12-13%; PI=-25-29%; CMA: RI=-13-15%; PI=-27-29% [p<0.05]), and in all cases significantly earlier in the CA than in the CMA (p<0.05). With all diets except high fat the maximum decrease in RI and PI was reached in the CA at 40 min and in the CMA at 60 min. High fat diets were unique in that the maximum decrease in RI and PI in the CMA occurred earlier (at 20 min) and values were slower to return to normal (p<0.05). We conclude that Doppler US can be used in dogs to quantify significant differences in the response of splanchnic blood flow to different dietary components.
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Affiliation(s)
- P Kircher
- Division of Clinical Radiology, Department of Clinical Veterinary Medicine, University of Berne, Laenggassstrasse 128, 3012 Berne, Switzerland.
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Blebea J, Volteas N, Neumyer M, Ingraham J, Dawson K, Assadnia S, Anderson KM, Atnip RG. Contrast enhanced duplex ultrasound imaging of the mesenteric arteries. Ann Vasc Surg 2002; 16:77-83. [PMID: 11904809 DOI: 10.1007/s10016-001-0144-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Duplex ultrasound of the visceral arteries is a technically challenging procedure. We examined the clinical usefulness of perflutren intravenous ultrasound contrast to improve the diagnostic accuracy of such studies. Seventeen patients were prospectively studied. A color duplex imaging study of the visceral vasculature was performed with and without the contrast agent. Vessels were imaged and peak systolic velocity and Doppler waveforms of the aorta, celiac artery, superior mesenteric artery, and the inferior mesenteric artery were examined. These results were independently compared to those of contrast angiography. From this analysis we concluded contrast-enhanced duplex imaging of the mesenteric arteries is safe but not routinely required when performed by an experienced sonographer. Ultrasound contrast may be helpful in difficult patients when the vessels are not initially successfully visualized.
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Affiliation(s)
- John Blebea
- Division of Vascular Surgery, The Pennsylvania State University College of Medicine, Hershey 17033-0850, USA.
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Byrne MF, Farrell MA, Abass S, Fitzgerald A, Varghese JC, Thornton F, Murray FE, Lee MJ. Assessment of Crohn's disease activity by Doppler sonography of the superior mesenteric artery, clinical evaluation and the Crohn's disease activity index: a prospective study. Clin Radiol 2001; 56:973-8. [PMID: 11795926 DOI: 10.1053/crad.2001.0794] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
AIM Recent data have shown that superior mesenteric artery (SMA) flow rates are significantly increased in active Crohn's disease, suggesting that SMA flow may be a useful, non-invasive index of disease activity. The aim of this prospective study was to evaluate the use of SMA Doppler sonography as an indicator of Crohn's disease activity and to compare with clinical evaluation and the Crohn's disease activity index (CDAI). MATERIALS AND METHODS Patients with active Crohn's (n = 19), inactive Crohn's (n = 17) and control subjects (n = 17) were evaluated. Categorization of disease activity was based on a reference standard. CDAI scores were also calculated independently. The SMA flow parameters evaluated were resistive index, pulsatility index, end diastolic velocity, peak systolic velocity, time averaged maximum velocity, cross-sectional area and maximum flow volume. RESULTS Using a three-group ANOVA for each of peak systolic velocity (PSV) (P = 0.01), end-diastolic velocity (EDV) (P = 0.04), pulsatility index (PI) (P = 0.003), time-averaged maximum velocity (TAMV) (P = 0.05), and maximum flow volume (TAMV.CSA) (P = 0.01), there was a significant effect of group. Using post-hoc tests, only EDV (P = 0.01), TAMV (P = 0.02) and TAMV.CSA (P = 0.003) were significantly different between active and inactive Crohn's disease, though with considerable overlap of values for EDV and TAMV. The mean CDAI scores were significantly different between patients with active Crohn's (287) and inactive Crohn's (71) (P = 0.0001) and correlated well with the reference standard. CONCLUSION Only three of several parameters previously described as allowing Crohn's disease activity assessment actually did so in our study. However, for two of these parameters (EDV, TAMV), there was overlap between the measurements in the active and inactive groups, thus limiting the ability to discriminate disease activity in practice. The degree of overlap for maximum flow volume (TAMV.CSA) between active and inactive disease was considerably less and this parameter may be more discriminatory of disease activity. On the other hand, we found CDAI scores to be accurate in disease categorization. We agree that there appear to be hyperdynamic changes in active Crohn's disease but suggest that Doppler ultrasound assessment does not reliably assess disease activity in routine clinical practice.
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Affiliation(s)
- M F Byrne
- Department of Gastroenterology, Beaumont Hospital, Dublin, Ireland.
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Carlos RC, Stanley JC, Stafford-Johnson D, Prince MR. Interobserver variability in the evaluation of chronic mesenteric ischemia with gadolinium-enhanced MR angiography. Acad Radiol 2001; 8:879-87. [PMID: 11724043 DOI: 10.1016/s1076-6332(03)80767-5] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
RATIONALE AND OBJECTIVES The purpose of this study was to assess interobserver variability in the interpretation of gadolinium-enhanced magnetic resonance (MR) angiograms of splanchnic vessels in patients suspected of having chronic mesenteric ischemia (CMI). MATERIALS AND METHODS Two readers blinded to the initial interpretation retrospectively reviewed gadolinium-enhanced MR angiograms obtained for suspected CMI in 26 patients (20 women and six men; age range, 23-77 years; mean age, 61 years) who also underwent conventional angiography. Each reader graded the degree of stenosis based on the percentage diameter reduction of the celiac artery (CA), superior mesenteric artery (SMA), and inferior mesenteric artery (IMA) by using a five-point ordinal scale: 0, no stenosis: 1, mild stenosis (<50%); 2, moderate stenosis (50%-75%); 3, severe stenosis (>75%); 4, occluded artery. Using the conventional angiogram as a reference standard, authors determined sensitivity and specificity for each observer, assigning two thresholds (grades 2 and 3) as significant stenoses. A kappa statistic (kappa) measured interobserver agreement. RESULTS With grade 2 stenosis used as a threshold, cumulative accuracies for detecting significant stenosis were 0.95 (95% confidence interval, 0.86-0.99) for reader A and 0.97 (0.88-1.0) for reader B. Interobserver agreement for grading proximal splanchnic stenosis was 0.90 for CA, 0.92 for SMA, and 0.48 for IMA. CONCLUSION Gadolinium-enhanced MR angiography is reproducibly accurate for detection of proximal splanchnic artery stenosis, with good to excellent interobserver agreement.
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Affiliation(s)
- R C Carlos
- Department of Radiology, University of Michigan, Ann Arbor 48109-0030, USA
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Gerrits HL, de Haan A, Sargeant AJ, van Langen H, Hopman MT. Peripheral vascular changes after electrically stimulated cycle training in people with spinal cord injury. Arch Phys Med Rehabil 2001; 82:832-9. [PMID: 11387591 DOI: 10.1053/apmr.2001.23305] [Citation(s) in RCA: 81] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To test whether a short period of training leads to adaptations in the cross-sectional area of large conduit arteries and improved blood flow to the paralyzed legs of individuals with spinal cord injury (SCI). DESIGN Before-after trial. SETTING Rehabilitation center, academic medical center. PARTICIPANTS Nine men with spinal cord lesions. INTERVENTION Six weeks of cycling using a functional electrically stimulated leg cycle ergometer (FES-LCE). MAIN OUTCOME MEASURES Longitudinal images and simultaneous velocity spectra were measured in the common carotid (CA) and femoral (FA) arteries using quantitative duplex Doppler ultrasound examination. Arterial diameters, peak systolic inflow volumes (PSIVs), mean inflow volumes (MIVs), and a velocity index (VI), representing the peripheral resistance, were obtained at rest. PSIVs and VI were obtained during 3 minutes of hyperemia following 20 minutes of FA occlusion. RESULTS Training resulted in significant increases in diameter (p < .01), PSIVs (p < .01), and MIVs (p < .05), and reduced VI (p < .01) of the FA, whereas values in the CA remained unchanged. Postocclusive hyperemic responses were augmented, indicated by significantly higher PSIVs (p <.01) and a trend toward lower VI. CONCLUSION Six weeks of FES-LCE training increased the cross-sectional area of large conduit arteries and improved blood flow to the paralyzed legs of individuals with SCI.
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Affiliation(s)
- H L Gerrits
- Institute for Fundamental and Clinical Human Movement Sciences, Vrije University Amsterdam, Amsterdam, the Netherlands.
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Perko MJ. Duplex ultrasound for assessment of superior mesenteric artery blood flow. Eur J Vasc Endovasc Surg 2001; 21:106-17. [PMID: 11237782 DOI: 10.1053/ejvs.2001.1313] [Citation(s) in RCA: 86] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Duplex ultrasound (DU) is recognised as a valuable tool for the assessment of blood flow in many vascular territories. The application of this technique to the superior mesenteric artery (SMA) has increased rapidly throughout the last decade. The purpose of this review is to collate currently available information on the utility of SMA DU, both in terms of research and clinical practice. Research investigations have revealed low intra- and interobserver variability in the estimation of Doppler variables, while reliable evaluation of B-mode dimensions requires repeated measurements. SMA blood flow velocity has been found to be dependent upon changes in central haemodynamics and in peripheral resistance, which was documented in studies with hypotension, medication and post-prandially. Food intake induces mesenteric vasorelaxation reflected by a 10-fold increase in the diastolic velocity. This feature has been utilised in studies on mesenteric physiology, which confirmed parasympathetic activity during hypovolaemia, and showed that exercise increases splanchnic resistance and reduces its blood flow following a 50% reduction in the hepato-splenic and a 25% reduction in the mesenteric blood flow. Clinical studies have documented high sensitivity and specificity of DU in detection of disease in splanchnic arteries. Diastolic velocity was found to be the most accurate indicator of SMA stenosis, while an absent Doppler signal from a well visualised vessel has been found to be a reliable predictor of occlusion. The high predictive value of DU in the detection of mesenteric artery disease, together with its simplicity and non-invasiveness, suggests that DU should take precedence over arteriography in both clinical practice and laboratory investigations.
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Affiliation(s)
- M J Perko
- Department of Vascular Surgery and Cardiothoracic Surgery, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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Houghton AR, Harrison M, Cowley AJ, Hampton JR. Combined treatment with losartan and an ACE inhibitor in mild to moderate heart failure: results of a double-blind, randomized, placebo-controlled trial. Am Heart J 2000; 140:e25. [PMID: 11054627 DOI: 10.1067/mhj.2000.110283] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Although the beneficial effects of angiotensin-converting enzyme (ACE) inhibitors in patients with heart failure are well recognized, there are theoretical advantages in combining ACE inhibition with angiotensin (AT)1 receptor antagonism. METHODS Twenty patients with mild to moderate heart failure and maximally treated with an ACE inhibitor were randomly assigned to losartan or placebo. Patients underwent repeated assessment of exercise tolerance, quality of life, central and regional hemodynamics, and neurohumoral and biochemical parameters over a period of 12 weeks. RESULTS Losartan treatment was well tolerated in terms of adverse events, heart rate, and blood pressure response, and there were no significant changes in serum creatinine or potassium. After 12 weeks of treatment, no significant differences were observed between the losartan and placebo groups in exercise tolerance, quality of life, central and regional hemodynamics, or neurohumoral parameters. CONCLUSIONS In patients with mild to moderate heart failure already maximally treated with an ACE inhibitor, additional treatment with losartan is well tolerated, but we have not observed any significant improvement in exercise capacity, quality of life, central and regional hemodynamics, or neurohormones. Our data suggest that the combination of losartan with an ACE inhibitor does not offer any substantial advantages over treatment with an ACE inhibitor alone in these patients.
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Affiliation(s)
- A R Houghton
- Department of Cardiovascular Medicine, University Hospital, Queen's Medical Centre, Nottingham, United Kingdom.
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Foley MI, Moneta GL, Abou-Zamzam AM, Edwards JM, Taylor LM, Yeager RA, Porter JM. Revascularization of the superior mesenteric artery alone for treatment of intestinal ischemia. J Vasc Surg 2000; 32:37-47. [PMID: 10876205 DOI: 10.1067/mva.2000.107314] [Citation(s) in RCA: 143] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Complete revascularization is recommended by many authors for treatment of intestinal ischemia. The observation that postprandial intestinal hyperemia is limited to the superior mesenteric artery (SMA) has suggested to us that SMA revascularization alone should be adequate treatment. We preferentially manage intestinal ischemia with a single bypass graft to the SMA and herein update our results using this approach. METHODS Patients were identified from a prospectively established vascular surgical registry. Each patient was assessed for acute versus chronic intestinal ischemia, preoperative angiographic findings, operation used, perioperative morbidity and mortality, late symptomatic relief, cause of death, and life table-determined survival and graft patency. Graft patency was determined by follow-up angiography or duplex scanning. RESULTS Fifty bypass grafts to the SMA alone were performed in 49 patients (31 women, 18 men; mean age, 62 years) for treatment of intestinal ischemia. In all patients additional splanchnic arteries were available for bypass grafting. Operative indications were acute symptoms in 21 patients, 14 of whom had bowel infarction; chronic symptoms in 26 patients; and prophylaxis in conjunction with infrarenal aortic surgery in 3 patients. Thirty-two grafts originated from the aorta or an iliac artery, and 18 originated from an aortic graft. There were 40 prosthetic and 10 autogenous conduits. Perioperative mortality was 3% in patients with chronic symptoms and 12% overall. All survivors were symptomatically improved. Mean follow-up was 44 months. Nine-year assisted primary graft patency was 79%, and 5-year patient survival was 61%. Two late deaths occurred in patients with recurrent intestinal ischemia resulting from graft occlusions. CONCLUSIONS Bypass grafting to the SMA alone appears to be both an effective and durable procedure for treatment of intestinal ischemia. Our results appear equal to those reported for "complete" revascularization for intestinal ischemia. When the SMA is a suitable recipient vessel, multiple bypass grafts to other splanchnic vessels are unnecessary in the treatment of intestinal ischemia.
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Affiliation(s)
- M I Foley
- Division of Vascular Surgery, Oregon Health Sciences University, Portland, OR 97201-3098, USA
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Houghton AR, Harrison M, Cowley AJ. Haemodynamic, neurohumoral and exercise effects of losartan vs. captopril in chronic heart failure: results of an ELITE trial substudy. Evaluation of Losartan in the Elderly. Eur J Heart Fail 1999; 1:385-93. [PMID: 10937952 DOI: 10.1016/s1388-9842(99)00038-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND The AT1 receptor antagonists differ from the angiotensin converting enzyme inhibitors by achieving a more complete blockade of angiotensin II's actions and by not affecting bradykinin metabolism. There is little information on whether this causes clinically significant differences in haemodynamics, neurohormones and exercise tolerance in heart failure. AIMS To compare the effects of losartan and captopril upon central and regional haemodynamics, neurohormones and exercise capacity in heart failure. METHODS In a double-blind, randomised trial 18 patients aged > or =65 years with symptomatic heart failure were allocated to treatment with losartan (10 patients) or captopril (eight patients). Patients underwent assessment at baseline, after the first dose, at 12 weeks and at 24 weeks. RESULTS Systolic blood pressure fell by - 10.7% 1 h after captopril 6.25 mg (P = 0.007) and by - 4.8% 3 h after losartan 12.5 mg (P = 0.02). The blood pressure reduction was sustained with losartan at 12 and 24 weeks. Systemic vascular resistance fell acutely after captopril (-16.4%, P = 0.01). Captopril caused an acute and sustained rise in superior mesenteric artery blood flow (+ 22.9%, P = 0.04), and a slower rise in renal artery blood flow (+31.7%, P = 0.01). Losartan had no acute effects on regional haemodynamics but had increased superior mesenteric artery blood flow by 38.1% at 12 weeks (P = 0.02). There were no substantial differences between losartan and captopril, and no changes occurred in neurohormones or exercise capacity. CONCLUSION No substantial differences were observed between losartan and captopril on central or regional haemodynamics, neurohormones or exercise capacity in elderly patients with stable symptomatic heart failure.
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Affiliation(s)
- A R Houghton
- Department of Cardiovascular Medicine, University Hospital, Queen's Medical Centre, Nottingham, UK.
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Li KC, Dalman RL, Wright GA. In vivo flow-independent T2 measurements of superior mesenteric vein blood in diagnosis of chronic mesenteric ischemia: a preliminary evaluation. Acad Radiol 1999; 6:530-4. [PMID: 10894061 DOI: 10.1016/s1076-6332(99)80430-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
RATIONALE AND OBJECTIVES The authors attempted to determine whether the T2 relaxation time of superior mesenteric vein (SMV) blood would decrease in patients with chronic mesenteric ischemia after a meal. MATERIALS AND METHODS Thirty-two patients without chronic mesenteric ischemia and eight patients with symptomatic chronic mesenteric ischemia underwent magnetic resonance (MR) imaging. All examinations were performed with a 1.5-T unit, a modified Carr-Purcell-Meiboom-Gill sequence, final section-selective pulse of 180 degrees, and spiral readout gradients. Measurements of SMV blood T2 were obtained after at least 6 hours of fasting and 15 and 35 minutes after ingestion of 240 mL of a liquid nutritional supplement. Maximal change of the SMV blood T2 was expressed as a percentage of the fasting T2 in all patients. RESULTS In control patients, SMV blood T2 increased postprandially by 9.4% +/- 1.3 (95% confidence level; range, 6.8%-11.9%) (data range, -7.3% to 25.6%) compared with fasting T2. In symptomatic patients, SMV blood T2 decreased postprandially by 15.8% +/- 2.2 (95% confidence level; range, -20.1% to -10.7%) (data range, -7.9% to -25.3%). The difference between the two groups was statistically significant (P < .0001 by Student unpaired t test). CONCLUSION Measurement of SMV blood T2 is a promising test for chronic mesenteric ischemia diagnosis. Therefore, conversion of T2 measurements to estimate oxygen saturation may not be necessary for all cases of this clinical indication.
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Affiliation(s)
- K C Li
- Department of Radiology, Stanford University School of Medicine, Calif, USA
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Barbaro B, Palazzoni G, Prudenzano R, Cina A, Manfredi R, Marano P. Doppler sonographic assessment of functional response of the right and left portal venous branches to a meal. JOURNAL OF CLINICAL ULTRASOUND : JCU 1999; 27:75-80. [PMID: 9932252 DOI: 10.1002/(sici)1097-0096(199902)27:2<75::aid-jcu5>3.0.co;2-f] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
PURPOSE The aim of our study was to quantitate by Doppler sonography the blood flow in the right and left portal vein branches before and after a standard meal. We also assessed the functional response of the right and left lobes of the liver. METHODS Portal blood flow was measured by Doppler sonography in the left and right portal vein branches and main portal trunk in 20 healthy volunteers in both fasting and postprandial states. The ratio between portal blood flow and liver volume (determined by MRI) was the portal flow index (PFI). RESULTS Before the meal, a statistically significant difference in portal blood flow volume was observed between the right and left portal branches (p < 0.01). The right PFI (0.83 ml/minute/cm3) and left PFI (1.1 ml/minute/cm3) were also significantly different (p < 0.01). The increase in portal venous blood flow after a meal was found to be greater in the left portal branch (128%) than in the right portal branch (78%). The postprandial PFI also differed significantly (right, 1.54 ml/minute/cm3; left, 2.5 ml/minute/cm3). CONCLUSIONS These findings suggest that the left lobe of the liver has a better postprandial compliance than the right lobe has.
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Affiliation(s)
- B Barbaro
- Istituto di Radiologia, Università Cattolica del Sacro Cuore, Policlinico A. Gemelli, Rome, Italy
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Osada T, Katsumura T, Hamaoka T, Inoue S, Esaki K, Sakamoto A, Murase N, Kajiyama J, Shimomitsu T, Iwane H. Reduced blood flow in abdominal viscera measured by Doppler ultrasound during one-legged knee extension. J Appl Physiol (1985) 1999; 86:709-19. [PMID: 9931212 DOI: 10.1152/jappl.1999.86.2.709] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The redistribution of blood flow (BF) in the abdominal viscera during right-legged knee extension-flexion exercise at very low intensity [peak heart rate (HR), 76 beats/min] was examined by using Doppler ultrasound. While sitting, subjects performed a right-legged knee extension-flexion exercise every 6 s for 20 min. BF was measured in the upper abdominal aorta (Ao), right common femoral artery (RCFA), and left common femoral artery (LCFA). Visceral BF (BFVis) was determined by the equation [BFAo - (BFRCFA + BFLCFA)]. A comparison with the change in BF (DeltaBF) preexercise showed a greater increase in DeltaBFRCFA than in DeltaBFAo during exercise. This resulted in a reduction of BFVis to 56% of its preexercise value or a decrease in flow by 1,147 +/- 293 (+/-SE) ml/min at the peak workload. Oxygen consumption correlated positively with DeltaBFAo, DeltaBFRCFA, and DeltaBFLCFA but inversely with DeltaBFVis during exercise and recovery. Furthermore, BFVis (% of preexercise value) correlated inversely with both an increase in HR (r = -0.89), and percent peak oxygen consumption (r = -0.99). This study demonstrated that, even during very-low-intensity exercise (HR <90 beats/min), there was a significant shift in BF from the viscera to the exercising muscles.
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Affiliation(s)
- T Osada
- Department of Preventive Medicine and Public Health, Tokyo Medical University, Tokyo 160-8402, Japan.
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Mottet C, Sieber CC, Nauer A, Drewe J, Fried R, Larsen F, Beglinger C. Hemodynamic effects of the somatostatin analog lanreotide in humans: placebo-controlled, cross-over dose-ranging Echo-Doppler study. Hepatology 1998; 27:920-5. [PMID: 9537429 DOI: 10.1002/hep.510270405] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/07/2022]
Abstract
Because of their vasoactive effects, somatostatin and its analogs are increasingly used in the management of complications of chronic liver diseases such as variceal bleeding. Postprandial hyperemia augments splanchnic blood flow, subsequently increasing portal pressure. The aim of this study was to explore effects of the somatostatin analog, lanreotide, on food-stimulated hemodynamic parameters in healthy human subjects. A dose-response curve was constructed in eight healthy male subjects in a placebo-controlled cross-over study. On 4 different days, either 0 (placebo), 50, 100, or 200 microg/h of lanreotide was infused intravenously in random order, starting at 45 minutes for 7 hours. On each day, a liquid test meal (Ensure plus, 1.5 kcal/mL) was perfused intraduodenally at a rate of 3 mL/min over 7 hours after a 45-minute basal period. Diastolic arterial pressure (dBP), heart rate (HR), superior mesenteric arterial (SMA) average flow velocity (SMA-V), SMA pulsatility index (SMA-PI), portal venous volume flow (PV-F), and renal artery (RA) resistance index (RA-RI) were measured on regular intervals (flows using Echo-Doppler technology). Lanreotide at all doses abolished food-stimulated splanchnic hyperemia both in the SMA and PV over 7 hours. The fall in dBP and increase in HR after food perfusion were blunted under lanreotide. Food as well as lanreotide did not modify RA-RI. In summary: 1) lanreotide inhibits food-induced splanchnic hyperemia in normal subjects; 2) in parallel, systemic hemodynamic alterations to food stimulation are abolished with lanreotide; and 3) renal vascular resistance is unchanged. Because of its persistent splanchnic vasoconstrictive effect, lanreotide should be tested in patients with portal hypertension.
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Affiliation(s)
- C Mottet
- Division of Gastroenterology, University Hospital, Basel, Switzerland
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Affiliation(s)
- R A Montgomery
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Iwao T, Oho K, Sakai T, Tayama C, Sato M, Nakano R, Yamawaki M, Toyonaga A, Tanikawa K. Splanchnic and extrasplanchnic arterial hemodynamics in patients with cirrhosis. J Hepatol 1997; 27:817-23. [PMID: 9382968 DOI: 10.1016/s0168-8278(97)80318-2] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND/AIMS This study was designed to assess the contribution of splanchnic and extrasplanchnic vascular hemodynamics to the hyperdynamic circulation in patients with cirrhosis. METHODS Cardiac index and flow volume index and pulsatility index (PI) of superior mesenteric artery (SMA) and femoral artery (FA) were measured with Doppler ultrasonography in 40 controls and 86 patients with cirrhosis (Child-Pugh grade A=41, grade B=30, and grade C=15). Mean arterial pressure was also recorded to calculate systemic vascular resistance index. RESULTS Systemic vascular resistance index was significantly lower in each Child-Pugh group than in controls. SMA blood flow index was significantly higher in each Child-Pugh group than in controls and the increase in SMA blood flow index paralleled the degree of liver dysfunction. SMA-PI was significantly lower in each Child-Pugh group than in controls and the decrease in SMA-PI paralleled the degree of liver dysfunction. FA blood flow index was slightly higher in Child-Pugh grade A patients and significantly higher in grade B patients than in controls, whereas grade C patients had normal FA blood flow index. FA-PI was significantly lower in grade A and grade B patients than in controls, whereas grade C patients had normal FA-PI. When all patients were examined together, SMA-PI significantly correlated with systemic vascular resistance index (r=0.69, p<0.01). In contrast, FA-PI did not significantly correlate with systemic vascular resistance index (r=0.15, p=0.18). CONCLUSIONS Splanchnic arterial vasodilatation plays an important role in the pathogenesis of decreased systemic vascular resistance seen in patients with cirrhosis.
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Affiliation(s)
- T Iwao
- Department of Medicine II, Kurume University School of Medicine, Japan
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Nicoloff AD, Williamson WK, Moneta GL, Taylor LM, Porter JM. Duplex ultrasonography in evaluation of splanchnic artery stenosis. Surg Clin North Am 1997; 77:339-55. [PMID: 9146717 DOI: 10.1016/s0039-6109(05)70553-3] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Duplex ultrasonography accurately identifies high-grade stenoses in the SMA. Analysis of velocity data reveals few false positives and virtually no false negatives in the determination of high-grade SMA stenosis by duplex scanning. We therefore utilize duplex scanning to perform early screening studies of patients with symptoms suggestive of chronic visceral ischemia. If the duplex findings are negative, we recommend evaluating for other sources of abdominal pain. If the findings are positive, prompt angiography is indicated. It is important to remember that although duplex scanning can identify mesenteric artery stenosis, it cannot diagnose intestinal ischemia. By establishing duplex scanning as a useful and accessible noninvasive screening tool, it is hoped that the time between onset of visceral ischemic symptoms and diagnosis of chronic visceral ischemia will be shortened significantly, potentially reducing the morbidity and mortality of the disease.
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Affiliation(s)
- A D Nicoloff
- Division of Vascular Surgery, Oregon Health Sciences University, Portland, USA
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Perko MJ, Perko G, Just S, Secher NH, Schroeder TV. Changes in superior mesenteric artery Doppler waveform during reduction of cardiac stroke volume and hypotension. ULTRASOUND IN MEDICINE & BIOLOGY 1996; 22:11-18. [PMID: 8928308 DOI: 10.1016/0301-5629(95)02037-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
Influence of stroke volume reduction and hypotension on the superior mesenteric artery (SMA) Doppler waveform was evaluated during head-up tilt-induced central hypovolemia in 11 healthy volunteers. During normotensive reduction in stroke volume, peak systolic velocity (pV), mean velocity, pulsatility and resistivity indices decreased, while diastolic velocities increased. During hypotension, a further decrease in pV was accompanied by maintained elevation of diastolic velocities and reduction in pulsatility and resistivity indices. Power of backscattered Doppler wave was elevated throughout the hypovolemia. Alterations in pV and pulsatility indices were closely related to changes in stroke volume, and a negative correlation was found between diastolic velocities and stroke volume. regression analysis showed no significant relation between variations in velocity parameters and blood pressure. Results of the study indicate that alterations in stroke volume induce consequential changes in the SMA Doppler waveform. These changes originate from both direct influence of stroke volume and/or pressure on blood flow velocity, and alterations in SMA peripheral resistance that follow variations in stroke volume. Presented interdependencies should be taken into consideration while studying mesenteric physiology with the use of Doppler technique and while interpreting the duplex results in patients suffering from diseases that may influence flow velocity and mimic or obscure Doppler effects of the SMA stenosis.
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Affiliation(s)
- M J Perko
- Department of Vascular Surgery, National University of Copenhagen, Denmark
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Duprez D, Voet D, De Buyzere M, Drieghe B, Vyncke B, Mareels S, Afschrift M, Clement DL. Influence of central command and ergoreceptors on the splanchnic circulation during isometric exercise. EUROPEAN JOURNAL OF APPLIED PHYSIOLOGY AND OCCUPATIONAL PHYSIOLOGY 1995; 71:459-63. [PMID: 8565979 DOI: 10.1007/bf00635881] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
The splanchnic circulation can make a major contribution to blood flow changes. However, the role of the splanchnic circulation in the reflex adjustments to the blood pressure increased during isometric exercise is not well documented. The central command and the muscle chemoreflex are the two major mechanisms involved in the blood pressure response to isometric exercise. This study aimed to examine the behaviour of the superior mesenteric artery during isometric handgrip (IHG) at 30% maximal voluntary contraction (MVC). The pulsatility index (PI) of the blood velocity waveform of the superior mesenteric artery was taken as the study parameter. A total of ten healthy subjects [mean age, 21.1 (SEM 0.3) years] performed an IHG at 30% MVC for 90 s. At 5 s prior to the end of the exercise, muscle circulation was arrested for 90 s to study the effect of the muscle chemoreflex (post exercise arterial occlusion, PEAO). The IHG at 30% MVC caused a decrease in superior mesenteric artery PI, from 4.84 (SEM 1.57) at control level to 3.90 (SEM 1.07) (P = 0.015). The PI further decreased to 3.17 (SEM 0.70) (P = 0.01) during PEAO. Our results indicated that ergoreceptors may be involved in the superior mesenteric artery vasodilatation during isometric exercise.
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Affiliation(s)
- D Duprez
- Department of Cardiology and Angiology, University Hospital, Gent, Belgium
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Nichols S, Windeler H. Duplex Scanning in Diagnosis of Mesenteric Insufciency. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 1995. [DOI: 10.1177/875647939501100302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Chronic mesenteric insufficiency presents clinically in a subtle fashion, yet has a devastating effect on the patient over time and may require surgical intervention. Duplex Doppler can be used to detect chronic mesenteric insufficiency and to follow up on surgical revascularization. Key parameters in diagnosing mesenteric insufficiency are reported to be decreased peak systolic and end-diastolic velocities from preto postprandial. More information about normal and abnormal velocity ranges is still needed. A literature review of the noninvasive diagnostic role for duplex sonography in mesenteric circulation and a description of current preand postprandial scanning techniques are discussed.
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Affiliation(s)
- Shawn Nichols
- Bellevue Community College, Bellevue, Washington; 416-156th Place NE, Bellevue, WA 98008
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