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Scallan OH, Duncan AA. Current Approaches for Mesenteric Ischemia and Visceral Aneurysms. Surg Clin North Am 2023; 103:703-731. [PMID: 37455033 DOI: 10.1016/j.suc.2023.04.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Abstract
This article provides an overview of acute mesenteric ischemia, chronic mesenteric ischemia, and visceral aneurysms, with a focus on treatment. Acute mesenteric ischemia can be a challenging diagnosis. Early recognition and adequate revascularization are key to patient outcomes. Chronic mesenteric ischemia is a more insidious process, typically caused by atherosclerosis. Various options for revascularization exist, which must be tailored to each patient. Visceral aneurysms are rare and the natural history is not well defined. However, given the risk of rupture and high mortality, treatment may be complex.
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Affiliation(s)
- Oonagh H Scallan
- Division of Vascular and Endovascular Surgery, Western University, 800 Commissioners Road East, PO Box 5010, London, Ontario N6A 5W9, Canada
| | - Audra A Duncan
- Division of Vascular and Endovascular Surgery, Western University, 800 Commissioners Road East, PO Box 5010, London, Ontario N6A 5W9, Canada.
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Voth M, Verboket R, Henrich D, Marzi I. L-FABP and NGAL are novel biomarkers for detection of abdominal injury and hemorrhagic shock. Injury 2023; 54:1246-1256. [PMID: 36621362 DOI: 10.1016/j.injury.2023.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 12/15/2022] [Accepted: 01/01/2023] [Indexed: 01/04/2023]
Abstract
INTRODUCTION Delayed diagnosis of abdominal injuries and hemorrhagic shock leads to secondary complications and high late mortality in severely traumatized patients. The liver fatty acid-binding protein (L-FABP) is expressed in intestine, liver and kidney; the neutrophil gelatinase-associated lipocalin (NGAL) in colon and kidney. We hypothesized that l-FABP is an early biomarker for abdominal injury and hemorrhagic shock and that l-FABP and NGAL are specific markers for detection of liver and/or kidney injuries. PATIENTS AND METHODS Traumatized patients with an age ≥18 years and an abdominal injury (AISabd≥2), independently from Injury Severity Score (ISS), were prospectively included from 04/2018 to 05/2021. 68 patients had an abdominal injury ("Abd") and 10 patients had an abdominal injury with hemorrhagic shock ("HS Abd"). 41 patients without abdominal injury and hemorrhagic shock but with an ISS ≥ 25 ("noAbd") were included as control group. Four abdominal subgroups with isolated organ injuries were defined. Plasma l-FABP and NGAL levels were measured at admission (ER) and up to two days post-trauma. RESULTS All patient groups had a median ISS≥25. In ER, median l-FABP levels were significantly higher in "HS Abd" group (1209.2 ng/ml [IQR=575.2-1780.3]) compared to "noAbd" group (36.4 ng/ml [IQR=14.8-88.5]), and to "Abd" group (41.4 ng/ml [IQR=18.0-235.5]), p<0.001. In matched-pair-analysis l-FABP levels in the group "Abd" were significantly higher (108.3 ng/ml [IQR=31.4-540.9]) compared to "noAbd" (26.4 ng/ml [IQR=15.5-88.8]), p = 0.0016. l-FABP correlated significantly with clinical parameters of hemorrhagic shock; the optimal cut-off level of l-FABP for detection was 334.3 ng/ml (sensitivity: 90%, specificity: 78%). Median l-FABP-levels were significantly higher in patients with isolated liver or kidney injuries and correlated significantly with AST, ALT and creatinine value. Median NGAL levels in the ER were significantly higher in "HS Abd" group (115.9 ng/ml [IQR=90.6-163.8]) compared to "noAbd" group (58.5 ng/ml [IQR=41.0-89.6],p<0.001) and "Abd" group (70.5 ng/ml [IQR=53.3-115.5], p<0.05). The group "Abd" showed significant higher median NGAL levels compared to "noAbd", p = 0.019. NGAL levels correlated significantly with clinical parameters of hemorrhagic shock. CONCLUSION L-FABP and NGAL are novel biomarkers for detection of abdominal trauma and hemorrhagic shock. l-FABP may be a useful and promising parameter in diagnosis of liver and kidney injuries, NGAL failed to achieve the same.
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Affiliation(s)
- M Voth
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital, Goethe University Frankfurt, Frankfurt am Main, Germany.
| | - R Verboket
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - D Henrich
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - I Marzi
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital, Goethe University Frankfurt, Frankfurt am Main, Germany
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Update on biomarkers for early detection of intestinal ischaemia. ANGIOLOGIA 2023. [DOI: 10.20960/angiologia.00425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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4
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Conde Monroy DM, Girón Arango F, Rodríguez Moreno L, Rey Chaves CE, Donoso-Samper A, Nassar R, Isaza-Restrepo A. Succoring the challenging acute mesenteric ischemia: Feasibility of lactate dehydrogenase for evaluation of intestinal necrosis extension and mortality. Ann Med Surg (Lond) 2022; 84:104922. [DOI: 10.1016/j.amsu.2022.104922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Revised: 10/23/2022] [Accepted: 11/12/2022] [Indexed: 11/19/2022] Open
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Bala M, Catena F, Kashuk J, De Simone B, Gomes CA, Weber D, Sartelli M, Coccolini F, Kluger Y, Abu-Zidan FM, Picetti E, Ansaloni L, Augustin G, Biffl WL, Ceresoli M, Chiara O, Chiarugi M, Coimbra R, Cui Y, Damaskos D, Di Saverio S, Galante JM, Khokha V, Kirkpatrick AW, Inaba K, Leppäniemi A, Litvin A, Peitzman AB, Shelat VG, Sugrue M, Tolonen M, Rizoli S, Sall I, Beka SG, Di Carlo I, Ten Broek R, Mircea C, Tebala G, Pisano M, van Goor H, Maier RV, Jeekel H, Civil I, Hecker A, Tan E, Soreide K, Lee MJ, Wani I, Bonavina L, Malangoni MA, Koike K, Velmahos GC, Fraga GP, Fette A, de'Angelis N, Balogh ZJ, Scalea TM, Sganga G, Kelly MD, Khan J, Stahel PF, Moore EE. Acute mesenteric ischemia: updated guidelines of the World Society of Emergency Surgery. World J Emerg Surg 2022; 17:54. [PMID: 36261857 PMCID: PMC9580452 DOI: 10.1186/s13017-022-00443-x] [Citation(s) in RCA: 71] [Impact Index Per Article: 35.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Accepted: 06/17/2022] [Indexed: 02/08/2023] Open
Abstract
Acute mesenteric ischemia (AMI) is a group of diseases characterized by an interruption of the blood supply to varying portions of the intestine, leading to ischemia and secondary inflammatory changes. If untreated, this process may progress to life-threatening intestinal necrosis. The incidence is low, estimated at 0.09-0.2% of all acute surgical admissions, but increases with age. Although the entity is an uncommon cause of abdominal pain, diligence is required because if untreated, mortality remains in the range of 50%. Early diagnosis and timely surgical intervention are the cornerstones of modern treatment to reduce the high mortality associated with this entity. The advent of endovascular approaches in parallel with modern imaging techniques is evolving and provides new treatment options. Lastly, a focused multidisciplinary approach based on early diagnosis and individualized treatment is essential. Thus, we believe that updated guidelines from World Society of Emergency Surgery are warranted, in order to provide the most recent and practical recommendations for diagnosis and treatment of AMI.
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Affiliation(s)
- Miklosh Bala
- Director of Acute Care Surgery and Trauma Unit, Department of General Surgery, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem Kiriat Hadassah, POB 12000, 91120, Jerusalem, Israel.
| | - Fausto Catena
- General and Emergency Surgery Department, Bufalini Hospital, Cesena, Italy
| | - Jeffry Kashuk
- Tel Aviv Sackler School of Medicine, Tel Aviv, Israel
| | - Belinda De Simone
- Department of General, Digestive and Metabolic Minimally Invasive Surgery, Centre Hospitalier Intercommunal De Poissy/St Germain en Laye, Poissy, France
| | - Carlos Augusto Gomes
- Department of Surgery, Faculdade de Ciências Médicas e da Saúde de Juiz de Fora, Hospital Universitário Terezinha de Jesus, Juiz de Fora, Brazil
| | - Dieter Weber
- Department of General Surgery, Royal Perth Hospital, The University of Western Australia, Perth, Australia
| | | | - Federico Coccolini
- Department of General, Emergency and Trauma Surgery, Pisa University Hospital, Pisa, Italy
| | - Yoram Kluger
- Department of General Surgery, Rambam Health Care Campus, Haifa, Israel
| | - Fikri M Abu-Zidan
- Department of Surgery, College of Medicine and Health Sciences, United Arab Emirates University, Al-Ain, United Arab Emirates
| | - Edoardo Picetti
- Department of Anesthesia and Intensive Care, Azienda Ospedaliero-Universitaria Parma, Parma, Italy
| | - Luca Ansaloni
- Department of Surgery, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Goran Augustin
- Department of Surgery, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Walter L Biffl
- Division of Trauma/Acute Care Surgery, Scripps Clinic Medical Group, La Jolla, CA, USA
| | - Marco Ceresoli
- Emergency and General Surgery Department, School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Osvaldo Chiara
- Emergency Department, Niguarda Ca'Granda Hospital, Milan, Italy
| | - Massimo Chiarugi
- Department of General, Emergency and Trauma Surgery, Pisa University Hospital, Pisa, Italy
| | - Raul Coimbra
- CECORC Research Center, Riverside University Health System, Loma Linda University, Loma Linda, USA
| | - Yunfeng Cui
- Department of Surgery, Nankai Clinical School of Medicine, Tianjin Nankai Hospital, Tianjin Medical University, Tianjin, China
| | | | - Salomone Di Saverio
- General Surgery Department Hospital of San Benedetto del Tronto, Marche region, Italy
| | - Joseph M Galante
- Division of Trauma and Acute Care Surgery, Department of Surgery, University of California Davis, Sacramento, CA, USA
| | - Vladimir Khokha
- Department of Emergency Surgery, City Hospital, Mozyr, Belarus
| | - Andrew W Kirkpatrick
- General, Acute Care, Abdominal Wall Reconstruction, and Trauma Surgery, Foothills Medical Centre, Calgary, AB, Canada
| | - Kenji Inaba
- Division of Trauma and Surgical Critical Care, Department of Surgery, University of Southern California, Los Angeles, CA, USA
| | - Ari Leppäniemi
- Abdominal Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Andrey Litvin
- Department of Surgical Disciplines, Regional Clinical Hospital, Immanuel Kant Baltic Federal University, Kaliningrad, Russia
| | - Andrew B Peitzman
- Department of Surgery, University of Pittsburgh School of Medicine, UPMC-Presbyterian, Pittsburgh, USA
| | - Vishal G Shelat
- Department of General Surgery, Tan Tock Seng Hospital, Novena, Singapore
| | - Michael Sugrue
- Donegal Clinical Research Academy Emergency Surgery Outcome Project, Letterkenny University Hospital, Donegal, Ireland
| | - Matti Tolonen
- Abdominal Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Sandro Rizoli
- Surgery Department, Section of Trauma Surgery, Hamad General Hospital (HGH), Doha, Qatar
| | - Ibrahima Sall
- General Surgery Department, Military Teaching Hospital, Dakar, Senegal
| | | | - Isidoro Di Carlo
- Department of Surgical Sciences and Advanced Technologies, General Surgery Cannizzaro Hospital, University of Catania, Catania, Italy
| | - Richard Ten Broek
- Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Chirika Mircea
- Centre Hospitalier Universitaire Grenoble Alpes, Grenoble, France
| | - Giovanni Tebala
- Department of Digestive and Emergency Surgery, S.Maria Hospital Trust, Terni, Italy
| | - Michele Pisano
- General and Emergency Surgery, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Harry van Goor
- Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Ronald V Maier
- Harborview Medical Center, University of Washington School of Medicine, Seattle, WA, USA
| | - Hans Jeekel
- Department of Surgery, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Ian Civil
- Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Andreas Hecker
- Emergency Medicine Department of General and Thoracic Surgery, University Hospital of Giessen, Giessen, Germany
| | - Edward Tan
- Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Kjetil Soreide
- HPB Unit, Department of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger, Norway
| | - Matthew J Lee
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
| | | | - Luigi Bonavina
- Department of Surgery, IRCCS Policlinico San Donato, University of Milano, Milano, Italy
| | - Mark A Malangoni
- Case Western Reserve University School of Medicine, Cleveland, USA
| | | | - George C Velmahos
- Division of Trauma, Emergency Surgery and Surgical Critical Care, Massachusetts General Hospital, Boston, PA, USA
| | - Gustavo P Fraga
- Division of Trauma Surgery, School of Medical Sciences, University of Campinas (Unicamp), Campinas, Brazil
| | - Andreas Fette
- Pediatric Surgery, Children's Care Center, SRH Klinikum Suhl, Suhl, Thueringen, Germany
| | - Nicola de'Angelis
- Unit of Digestive and HPB Surgery, Faculty of Medicine, University of Paris, Paris, France
| | - Zsolt J Balogh
- John Hunter Hospital and University of Newcastle, Newcastle, NSW, Australia
| | - Thomas M Scalea
- Cowley Shock Trauma Center at the University of Maryland, Baltimore, MD, USA
| | - Gabriele Sganga
- Emergency Surgery and Trauma, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Michael D Kelly
- Department of General Surgery, Albury Hospital, Albury, Australia
| | - Jim Khan
- University of Portsmouth, Portsmouth Hospitals University NHS Trust, Portsmouth, UK
| | - Philip F Stahel
- College of Osteopathic Medicine, Rocky Vista University, Parker, CO, USA
| | - Ernest E Moore
- Ernest E Moore Shock Trauma Center at Denver Health, University of Colorado, Denver, CO, USA
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Qin L, Zhang XX, Jin X, Cui CH, Tang CZ. The Effect of Acupuncture on Enteral Nutrition and Gastrointestinal Dynamics in Patients Who Have Suffered a Severe Stroke. Curr Neurovasc Res 2022; 19:275-281. [PMID: 35996236 DOI: 10.2174/1567202619666220822123023] [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: 06/20/2022] [Revised: 07/10/2022] [Accepted: 07/19/2022] [Indexed: 11/22/2022]
Abstract
OBJECTIVE This study aimed to explore and analyze the effect of acupuncture on improving the enteral nutrition level and gastrointestinal dynamics in patients who had suffered a severe stroke. METHODS A total of 122 patients who experienced a severe stroke who were treated in the intensive care unit of the Affiliated Hospital of Hebei University (China) between September 2021 and March 2022 were randomly divided into two groups as follows: 1) the observation group, the participants of which received acupuncture combined with early enteral nutrition (61 cases); 2) the control group, the participants of which received early enteral nutrition (61 cases). Following treatment, the hemoglobin, neutrophil count, blood glucose, albumin, pre-albumin, immediate postprandial antral area, antral contraction frequency (at 2 min), and antral motility index on days 1 and 7 of treatment were compared between the two groups. RESULTS The total clinical effective rate was 96.72% in the observation group and 77.05% in the control group. The curative effect comparison between the two groups after seven days of treatment showed a lower probability of gastrointestinal bleeding, faster recovery of gastrointestinal motility, and a higher level of nutrient absorption in the observation group. Serum albumin, pre-albumin, hemoglobin, total lymphocyte count, immediate postprandial maximum (max) and minimum (mix) area of the gastric antrum, antral contraction frequency (at 2 min), and antral motility index were higher in the observation group than in the control group (P < 0.05). The difference in blood glucose levels between the two groups was not statistically significant (P > 0.05). CONCLUSION Acupuncture improved the enteral nutrition status of patients who had suffered a severe stroke and promoted gastrointestinal motility. The combination of acupuncture and early enteral nutrition could reduce damage to the gastrointestinal mucosal barrier caused by stress, changes in metabolism, and improved gastrointestinal function.
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Affiliation(s)
- Liang Qin
- Acupuncture Rehabilitation Clinical Medical College, Guangzhou University of Traditional Chinese Medicine, Guangzhou, 510006, China.,Department of Rehabilitation Medicine, Affiliated Hospital of Hebei University, Baoding, 071000, China
| | - Xin-Xin Zhang
- Department of Emergency Medicine, Affiliated Hospital of Hebei University, Baoding, 071000, China
| | - Xin Jin
- Department of Neurology, Intensive Care Unit of Affiliated Hospital of Hebei University, Baoding, 071000, China
| | - Cai-Hong Cui
- Department of Rehabilitation Medicine, Affiliated Hospital of Hebei University, Baoding, 071000, China
| | - Chun-Zhi Tang
- Acupuncture Rehabilitation Clinical Medical College, Guangzhou University of Traditional Chinese Medicine, Guangzhou, 510006, China
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Xu WX, Zhong QH, Cai Y, Zhan CH, Chen S, Wang H, Lin L, Geng YQ, Hou P, Chen XQ, Zhang JR. Prediction and management of strangulated bowel obstruction: a multi-dimensional model analysis. BMC Gastroenterol 2022; 22:304. [PMID: 35733109 PMCID: PMC9219133 DOI: 10.1186/s12876-022-02363-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Accepted: 05/30/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Distinguishing strangulated bowel obstruction (StBO) from simple bowel obstruction (SiBO) still poses a challenge for emergency surgeons. We aimed to construct a predictive model that could distinctly discriminate StBO from SiBO based on the degree of bowel ischemia. METHODS The patients diagnosed with intestinal obstruction were enrolled and divided into SiBO group and StBO group. Binary logistic regression was applied to identify independent risk factors, and then predictive models based on radiological and multi-dimensional models were constructed. Receiver operating characteristic (ROC) curves and the area under the curve (AUC) were calculated to assess the accuracy of the predicted models. Via stratification analysis, we validated the multi-dimensional model in the prediction of transmural necrosis both in the training set and validation set. RESULTS Of the 281 patients with SBO, 45 (16.0%) were found to have StBO, while 236(84.0%) with SiBO. The AUC of the radiological model was 0.706 (95%CI, 0.617-0.795). In the multivariate analysis, seven risk factors including pain duration ≤ 3 days (OR = 3.775), rebound tenderness (OR = 5.201), low-to-absent bowel sounds (OR = 5.006), low levels of potassium (OR = 3.696) and sodium (OR = 3.753), high levels of BUN (OR = 4.349), high radiological score (OR = 11.264) were identified. The AUC of the multi-dimensional model was 0.857(95%CI, 0.793-0.920). In the stratification analysis, the proportion of patients with transmural necrosis was significantly greater in the high-risk group (24%) than in the medium-risk group (3%). No transmural necrosis was found in the low-risk group. The AUC of the validation set was 0.910 (95%CI, 0.843-0.976). None of patients in the low-risk and medium-risk score group suffered with StBO. However, all patients with bowel ischemia (12%) and necrosis (24%) were resorted into high-risk score group. CONCLUSION The novel multi-dimensional model offers a useful tool for predicting StBO. Clinical management could be performed according to the multivariate score.
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Affiliation(s)
- Wei-Xuan Xu
- Fujian Medical University, No.1 Xuefu bei Road, Fuzhou, 350122, Fujian Province, China
| | - Qi-Hong Zhong
- Fujian Medical University, No.1 Xuefu bei Road, Fuzhou, 350122, Fujian Province, China
| | - Yong Cai
- Fujian Medical University, No.1 Xuefu bei Road, Fuzhou, 350122, Fujian Province, China
| | - Can-Hong Zhan
- Fujian Medical University, No.1 Xuefu bei Road, Fuzhou, 350122, Fujian Province, China
| | - Shuai Chen
- Department of General Surgery (Emergency Surgery), Fujian Medical University Union Hospital, No.29 Xinquan Road, Fuzhou, 350001, Fujian Province, China
| | - Hui Wang
- Department of General Surgery (Emergency Surgery), Fujian Medical University Union Hospital, No.29 Xinquan Road, Fuzhou, 350001, Fujian Province, China
| | - Lin Lin
- Department of Radiology, Fujian Medical University Union Hospital, No.29 Xinquan Road, Fuzhou, 350001, Fujian Province, China
| | - Ying-Qian Geng
- Department of Radiology, Fujian Medical University Union Hospital, No.29 Xinquan Road, Fuzhou, 350001, Fujian Province, China
| | - Ping Hou
- Fujian Medical University, No.1 Xuefu bei Road, Fuzhou, 350122, Fujian Province, China.,Immunotherapy Institute, Fujian Medical University, No.1 Xuefu bei Road, Fuzhou, 350122, Fujian Province, China
| | - Xian-Qiang Chen
- Fujian Medical University, No.1 Xuefu bei Road, Fuzhou, 350122, Fujian Province, China. .,Department of General Surgery (Emergency Surgery), Fujian Medical University Union Hospital, No.29 Xinquan Road, Fuzhou, 350001, Fujian Province, China.
| | - Jun-Rong Zhang
- Fujian Medical University, No.1 Xuefu bei Road, Fuzhou, 350122, Fujian Province, China. .,Department of General Surgery (Emergency Surgery), Fujian Medical University Union Hospital, No.29 Xinquan Road, Fuzhou, 350001, Fujian Province, China.
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Miller AS, Boyce K, Box B, Clarke MD, Duff SE, Foley NM, Guy RJ, Massey LH, Ramsay G, Slade DAJ, Stephenson JA, Tozer PJ, Wright D. The Association of Coloproctology of Great Britain and Ireland consensus guidelines in emergency colorectal surgery. Colorectal Dis 2021; 23:476-547. [PMID: 33470518 PMCID: PMC9291558 DOI: 10.1111/codi.15503] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Revised: 12/08/2020] [Accepted: 12/12/2020] [Indexed: 12/15/2022]
Abstract
AIM There is a requirement for an expansive and up to date review of the management of emergency colorectal conditions seen in adults. The primary objective is to provide detailed evidence-based guidelines for the target audience of general and colorectal surgeons who are responsible for an adult population and who practise in Great Britain and Ireland. METHODS Surgeons who are elected members of the Association of Coloproctology of Great Britain and Ireland Emergency Surgery Subcommittee were invited to contribute various sections to the guidelines. They were directed to produce a pathology-based document using literature searches that were systematic, comprehensible, transparent and reproducible. Levels of evidence were graded. Each author was asked to provide a set of recommendations which were evidence-based and unambiguous. These recommendations were submitted to the whole guideline group and scored. They were then refined and submitted to a second vote. Only those that achieved >80% consensus at level 5 (strongly agree) or level 4 (agree) after two votes were included in the guidelines. RESULTS All aspects of care (excluding abdominal trauma) for emergency colorectal conditions have been included along with 122 recommendations for management. CONCLUSION These guidelines provide an up to date and evidence-based summary of the current surgical knowledge in the management of emergency colorectal conditions and should serve as practical text for clinicians managing colorectal conditions in the emergency setting.
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Affiliation(s)
- Andrew S. Miller
- Leicester Royal InfirmaryUniversity Hospitals of Leicester NHS TrustLeicesterUK
| | | | - Benjamin Box
- Northumbria Healthcare Foundation NHS TrustNorth ShieldsUK
| | | | - Sarah E. Duff
- Manchester University NHS Foundation TrustManchesterUK
| | | | | | | | | | | | | | - Phil J. Tozer
- St Mark’s Hospital and Imperial College LondonHarrowUK
| | - Danette Wright
- Western Sydney Local Health DistrictSydneyNew South WalesAustralia
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Zhang X, Wu J, Liu Q, Li X, Li S, Chen J, Hong Z, Wu X, Zhao Y, Ren J. mtDNA-STING pathway promotes necroptosis-dependent enterocyte injury in intestinal ischemia reperfusion. Cell Death Dis 2020; 11:1050. [PMID: 33311495 PMCID: PMC7732985 DOI: 10.1038/s41419-020-03239-6] [Citation(s) in RCA: 70] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Revised: 11/11/2020] [Accepted: 11/12/2020] [Indexed: 12/13/2022]
Abstract
Intestinal ischemia reperfusion (I/R) injury is the important pathogenesis for acute intestinal barrier disruption. The STING signaling is associated with gut homeostasis and barrier integrity. However, the biological function and regulation of STING signaling in intestinal I/R injury are not yet fully understood. As the ligand of STING signaling, the mitochondrial DNA (mtDNA) has been found to be associated with necroptosis. It still remains unknown whether mtDNA-STING signaling triggers intestinal necroptosis in intestinal I/R injury. We found that circulating RIPK3 was significantly increased and had a positive correlation with markers of enterocyte injury in critically ill patients with intestinal injury. Moreover, the levels of circulating mtDNA were also associated with the levels of circulating RIPK3. To explore the relationship between mtDNA and intestinal necroptosis, mice were treated with the intraperitoneal injection of mtDNA, and necroptosis signaling was remarkably activated and the inhibition of necroptosis alleviated mtDNA-induced intestinal injury. Furthermore, STING knockout mice showed an alleviated intestinal necroptosis. In intestinal I/R injury, mtDNA was released from IECs and necroptosis was also triggered, companied with a significant decrease of RIPK3 in the intestine. STING knockout mice markedly attenuated intestinal necroptosis and intestinal I/R injury. Finally, we found that mtDNA-mediated STING signaling triggered necroptosis through synergistic IFN and TNF-α signaling in primary IECs. Our results indicated that mtDNA-STING signaling can contribute to intestinal I/R injury by promoting IEC necroptosis. STING-mediated both IFN and TNF-α signaling can trigger intestinal nercroptosis.
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Affiliation(s)
- Xufei Zhang
- Research Institute of General Surgery, Jinling Hospital, Nanjing Medical University, Nanjing, 210002, PR China
| | - Jie Wu
- Research Institute of General Surgery, Jinling Hospital, Nanjing Medical University, Nanjing, 210002, PR China.,Research Center of Surgery, BenQ Medical Center, the Affiliated BenQ Hospital of Nanjing Medical University, Nanjing, 210021, PR China
| | - Qinjie Liu
- Research Institute of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, 210002, PR China
| | - Xuanheng Li
- Research Institute of General Surgery, Jinling Hospital, Nanjing Medical University, Nanjing, 210002, PR China
| | - Sicheng Li
- Research Institute of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, 210002, PR China
| | - Jun Chen
- Research Institute of General Surgery, Jinling Hospital, Nanjing Medical University, Nanjing, 210002, PR China.,Research Institute of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, 210002, PR China
| | - Zhiwu Hong
- Research Institute of General Surgery, Jinling Hospital, Nanjing Medical University, Nanjing, 210002, PR China.,Research Institute of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, 210002, PR China
| | - Xiuwen Wu
- Research Institute of General Surgery, Jinling Hospital, Nanjing Medical University, Nanjing, 210002, PR China. .,Research Institute of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, 210002, PR China.
| | - Yun Zhao
- Research Center of Surgery, BenQ Medical Center, the Affiliated BenQ Hospital of Nanjing Medical University, Nanjing, 210021, PR China.
| | - Jianan Ren
- Research Institute of General Surgery, Jinling Hospital, Nanjing Medical University, Nanjing, 210002, PR China. .,Research Institute of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, 210002, PR China.
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10
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Nuzzo A, Joly F, Ronot M, Castier Y, Huguet A, Paugam-Burtz C, Cazals-Hatem D, Tran-Dinh A, Becq A, Panis Y, Bouhnik Y, Maggiori L, Corcos O. Normal Lactate and Unenhanced CT-Scan Result in Delayed Diagnosis of Acute Mesenteric Ischemia. Am J Gastroenterol 2020; 115:1902-1905. [PMID: 33156109 DOI: 10.14309/ajg.0000000000000836] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
INTRODUCTION To investigate the factors associated with a delayed diagnosis (DD) of acute mesenteric ischemia (AMI). METHODS An observational cohort study from an intestinal failure center. The primary outcome was DD >24 hours. RESULTS Between 2006 and 2015, 74 patients with AMI were included and 39 (53%) had a DD. Plasma lactate <2 mmol/L (odd ratio: 3.2; 95% confidence interval: 1.1-9.1; P = 0.03) and unenhanced computed tomography scan (odds ratio: 5.9; 95% confidence interval: 1.4-25.8; P = 0.01) were independently associated with DD. DISCUSSION Suspicion of AMI should no longer be affected by normal plasma lactate levels and should prompt evaluation by a contrast-enhanced computed tomography-scan.
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Affiliation(s)
- Alexandre Nuzzo
- APHP, Deparment of Gastroenterology, IBD and Intestinal Failure, Beaujon Hospital, Clichy, France
- University of Paris, Paris, France
| | - Francisca Joly
- APHP, Deparment of Gastroenterology, IBD and Intestinal Failure, Beaujon Hospital, Clichy, France
- University of Paris, Paris, France
| | - Maxime Ronot
- University of Paris, Paris, France
- APHP, Department of Radiology, Beaujon Hospital, Clichy, France
| | - Yves Castier
- APHP, Department of Vascular Surgery, Bichat Hospital, Paris, France
| | - Audrey Huguet
- APHP, Deparment of Gastroenterology, IBD and Intestinal Failure, Beaujon Hospital, Clichy, France
- University of Paris, Paris, France
| | - Catherine Paugam-Burtz
- University of Paris, Paris, France
- APHP, Department of Anesthesia and Intensive Care, Beaujon Hospital, Clichy, France
| | - Dominique Cazals-Hatem
- University of Paris, Paris, France
- APHP, Department of Pathology, Beaujon Hospital, Clichy, France
| | - Alexy Tran-Dinh
- University of Paris, Paris, France
- APHP, Department of Anesthesia and Intensive Care, Bichat Hospital, Paris, France
| | - Aymeric Becq
- APHP, Deparment of Gastroenterology, IBD and Intestinal Failure, Beaujon Hospital, Clichy, France
- University of Paris, Paris, France
| | - Yves Panis
- University of Paris, Paris, France
- APHP, Department of Colorectal Surgery, Beaujon Hospital, Clichy, France
| | - Yoram Bouhnik
- APHP, Deparment of Gastroenterology, IBD and Intestinal Failure, Beaujon Hospital, Clichy, France
- University of Paris, Paris, France
| | - Leon Maggiori
- University of Paris, Paris, France
- APHP, Department of Colorectal Surgery, Beaujon Hospital, Clichy, France
| | - Olivier Corcos
- APHP, Deparment of Gastroenterology, IBD and Intestinal Failure, Beaujon Hospital, Clichy, France
- University of Paris, Paris, France
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11
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Zhang L, Zhang X, Chang P, Yang J, Zheng D, Zhang D, Wen S, Jing S. A Novel Approach for Repairing Superior Mesenteric Artery Injury During Left Nephrectomy-6-year Follow-up. Urology 2020; 144:241-244. [PMID: 32717246 DOI: 10.1016/j.urology.2020.07.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 06/27/2020] [Accepted: 07/12/2020] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To describe a novel approach for reconstructing the superior mesenteric artery (SMA) during left nephrectomy and review the literature. MATERIALS AND METHODS The patient was a 57-year-old man with left back pain from an unknown cause for more than 3 hours. A computed tomography scan showed a 12- × 15-cm firm mass and a subcapsular hematoma in the left kidney. It was considered to be bleeding and rupture of the solid renal mass, and because of persistent pain and no documented distant metastatic disease, a transperitoneal laparoscopic nephrectomy was elected, but the procedure was converted to open surgery for SMA injury. We reconstructed the SMA with end-to-end anastomosis between the SMA and the left renal artery stump. RESULTS At the 6-year follow-up, the patient had no intestine-related sequelae. CONCLUSION Our novel approach of an end-to-end anastomosis between the SMA and the left renal artery stump is an option for SMA injury, especially when orthotopic anastomosis or repair of the SMA is not indicated.
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Affiliation(s)
- Liyuan Zhang
- Department of Urology, the first hospital of Lanzhou university, Lanzhou, China
| | - Xiaokang Zhang
- Department of Urology, the first hospital of Lanzhou university, Lanzhou, China
| | - Pengcheng Chang
- Department of Urology, the first hospital of Lanzhou university, Lanzhou, China
| | - Jie Yang
- Department of Urology, the first hospital of Lanzhou university, Lanzhou, China
| | - Duo Zheng
- Department of Urology, the first hospital of Lanzhou university, Lanzhou, China
| | - Deng Zhang
- Jinchang hospital of integrated traditional Chinese and western medicine, Jinchang, China
| | - Siqi Wen
- The art academy of Lanzhou university, Lanzhou, China
| | - Suoshi Jing
- Department of Urology, the first hospital of Lanzhou university, Lanzhou, China.
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12
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Bertoglio L, Loschi D, Grandi A, Melloni A, Bilman V, Melissano G, Chiesa R. Early Limb Reperfusion Using Routinely Preloaded Fenestrated Stent-graft Designs for Complex Endovascular Aortic Procedures. Cardiovasc Intervent Radiol 2020; 43:1868-1880. [DOI: 10.1007/s00270-020-02596-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 07/04/2020] [Indexed: 12/17/2022]
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13
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Voth M, Lustenberger T, Relja B, Marzi I. Is I-FABP not only a marker for the detection abdominal injury but also of hemorrhagic shock in severely injured trauma patients? World J Emerg Surg 2019; 14:49. [PMID: 31832083 PMCID: PMC6868704 DOI: 10.1186/s13017-019-0267-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 09/26/2019] [Indexed: 12/18/2022] Open
Abstract
Background Hemorrhagic shock can lead to intestinal damage with subsequent hyperinflammation and multiple organ dysfunction syndrome (MODS). The intestinal fatty acid-binding protein (I-FABP) is solely expressed in the intestine and is released extracellulary after tissue damage. This study evaluates the validity of I-FABP as an early biomarker to detect hemorrhagic shock and abdominal injury. Patients and methods Severely injured patients with an Injury Severity Score (ISS) ≥ 16 points and an age ≥ 18 years, admitted from January 2010 to December 2016, were included. Overall, 26 patients retrospectively presented with hemorrhagic shock to the emergency room (ER): 8 patients without abdominal injury ("HS noAbd") and 18 patients with abdominal injury ("HS Abd"). Furthermore, 16 severely injured patients without hemorrhagic shock and without abdominal injury ("noHS noAbd") were retrospectively selected as controls. Plasma I-FABP levels were measured at admission to the ER and up to 3 days posttraumatic (d1-d3). Results Median I-FABP levels were significantly higher in the "HS Abd" group compared with the "HS noAbd" group (28,637.0 pg/ml [IQR = 6372.4-55,550.0] vs. 7292.3 pg/ml [IQR = 1282.5-11,159.5], p < 0.05). Furthermore, I-FABP levels of both hemorrhagic shock groups were significantly higher compared with the "noHS noAbd" group (844.4 pg/ml [IQR = 530.0-1432.9], p < 0.05). The time course of I-FABP levels showed a peak on the day of admission with a subsequent decline in the post-traumatic course. Furthermore, significant correlations between I-FABP levels and clinical parameters of hemorrhagic shock, such as hemoglobin, lactate value, systolic blood pressure (SBP), and shock index, were found.The optimal cut-off level of I-FABP for detection of hemorrhagic shock was 1761.9 pg/ml with a sensitivity of 85% and a specificity of 81%. Conclusion This study confirmed our previous observation that I-FABP might be used as a suitable early biomarker for the detection of abdominal injuries in general. In addition, I-FABP may also be a useful and a promising parameter in the diagnosis of hemorrhagic shock, because of reflecting low intestinal perfusion.
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Affiliation(s)
- Maika Voth
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital, Goethe University Frankfurt, Theodor-Stern-Kai 7, D-60590 Frankfurt, Main, Germany
| | - Thomas Lustenberger
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital, Goethe University Frankfurt, Theodor-Stern-Kai 7, D-60590 Frankfurt, Main, Germany
| | - Borna Relja
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital, Goethe University Frankfurt, Theodor-Stern-Kai 7, D-60590 Frankfurt, Main, Germany
| | - Ingo Marzi
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital, Goethe University Frankfurt, Theodor-Stern-Kai 7, D-60590 Frankfurt, Main, Germany
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14
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Matthaei H, Klein A, Branchi V, Kalff JC, Koscielny A. Acute mesenteric ischemia (AMI): absence of renal insufficiency and performance of early bowel resection may indicate improved outcomes. Int J Colorectal Dis 2019; 34:1781-1790. [PMID: 31512020 DOI: 10.1007/s00384-019-03388-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/01/2019] [Indexed: 02/06/2023]
Abstract
PURPOSE Acute mesenteric ischemia (AMI) is still associated with very high morbidity and mortality while the rareness and heterogeneity hamper the establishment of evidence-based guidelines. We sought to help standardize contemporary treatment by a cohort study at our tertiary center in the rising endovascular age. METHODS A retrospective cohort study was conducted from 2005 to 2015. Patients with occlusive (OMI), non-occlusive (NOMI), and venous mesenteric ischemia (VMI) were compared with respect to clinical and treatment parameters as well as outcome. RESULTS The study cohort consisted of 48 patients composed of 27 males and 21 females with an average age of 63 years and an average BMI of 25.1 kg/m2. In 48% of patients (N=23), an acute arterial OMI had occurred while NOMI was present in 31% (N=15) and VMI in 21% (N=10). Interventional and intraoperative recanalizations were significantly more often required in OMI patients compared with other entities (p=0.003). Patients with venous mesenteric ischemia had a significant better overall survival than patients with OMI or NOMI in the univariate analysis (p=0.027). Patients with renal failure had a 14.7-fold higher relative risk (Cox p=0.013) and patients without bowel resection during primary surgery had a 17.8-fold higher relative risk (Cox p=0.047) to die of AMI in the postoperative course. CONCLUSIONS AMI remains a rare but oftentimes fatal disease. Our study provides evidence that outcome may depend on the AMI subtype, presence of renal insufficiency, and early bowel resection. Further research should help individualize treatment for optimized outcomes.
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Affiliation(s)
- Hanno Matthaei
- Department of General, Visceral, Thoracic and Vascular Surgery, University Hospital Bonn, Sigmund-Freud-Strasse 25, 53127, Bonn, Germany
| | - Alina Klein
- Department of General, Visceral, Thoracic and Vascular Surgery, University Hospital Bonn, Sigmund-Freud-Strasse 25, 53127, Bonn, Germany
| | - Vittorio Branchi
- Department of General, Visceral, Thoracic and Vascular Surgery, University Hospital Bonn, Sigmund-Freud-Strasse 25, 53127, Bonn, Germany
| | - Jörg C Kalff
- Department of General, Visceral, Thoracic and Vascular Surgery, University Hospital Bonn, Sigmund-Freud-Strasse 25, 53127, Bonn, Germany
| | - Arne Koscielny
- Department of General, Visceral, Thoracic and Vascular Surgery, University Hospital Bonn, Sigmund-Freud-Strasse 25, 53127, Bonn, Germany.
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15
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Otsuka H, Uehata A, Sakurai K, Sato T, Aoki H, Nakagawa Y. Necessity of revascularization for acute mesenteric ischemia in symptomatic patients with spontaneous isolated dissection of the superior mesenteric artery. Vascular 2019; 28:109-114. [PMID: 31446850 DOI: 10.1177/1708538119872403] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Objectives We evaluated the necessity of revascularization for acute mesenteric ischemia in symptomatic patients with spontaneous isolated dissection of the superior mesenteric artery. Methods This retrospective study included 28 consecutive, symptomatic patients with spontaneous isolated dissection of the superior mesenteric artery treated at our hospital between December 2005 and December 2017. Patients with concomitant aortic dissection were excluded. We reviewed the patients’ clinical presentation; laboratory evaluations; computed tomography findings, including the true lumen residual ratio (i.e., the minimum true lumen size compared to the diameter of the transverse section of the dissected artery) at the time of admission; the number of patients who were suspected of having bowel ischemia; and the number of patients who required surgical or endovascular treatment and their outcomes. Additionally, to evaluate the true lumen residual ratio in symptomatic patients with bowel ischemia, the true lumen residual ratio in those with abnormal laboratory data were compared with that in those without abnormal laboratory data. Initial true lumen residual ratio values were also compared with final values. Furthermore, we assessed the clinical details of patients who had bowel necrosis. Categorical variables were compared using the χ2 test or Fisher’s exact test, and continuous values were presented as either the mean ± standard deviation or median (interquartile range 25–75%). Variables were analyzed using Student’s t-test or the Mann–Whitney U test. Results The patients’ age ranged between 41 and 85 years, and 25 were men. Although nine patients were suspected of having acute mesenteric ischemia, only one underwent bowel resection. None of the patients had an indication for revascularization. The true lumen residual ratio of the nine patients with abnormal laboratory data were significantly lower than those of the 19 without abnormal laboratory data (10 [0–25]% vs. 40 [20–50]%, p = 0.005). The patient who underwent bowel resection had a true lumen residual ratio of 10%; however, there was no obvious abnormal laboratory data suggestive of bowel necrosis. Dissections were managed conservatively in all patients. True lumen residual ratio increased from initial value of 30 (10–48)% to 98 (60-100)%at the final imaging study ( p < 0.0001). There were no adverse events related to the mesenteric circulation during the follow-up period of 2–11 years. Conclusions Reintervention is rarely required for spontaneous isolated dissection of the superior mesenteric artery, even in symptomatic patients, and spontaneous resolution of the luminal compromise is the rule.
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Affiliation(s)
- Hiroyuki Otsuka
- Department of Emergency and Critical Care Medicine, Tokai University School of Medicine, Isehara City, Kanagawa Prefecture, Japan
| | - Atsushi Uehata
- Department of Emergency and Critical Care Medicine, Tokai University School of Medicine, Isehara City, Kanagawa Prefecture, Japan
| | - Keiji Sakurai
- Department of Emergency and Critical Care Medicine, Tokai University School of Medicine, Isehara City, Kanagawa Prefecture, Japan
| | - Toshiki Sato
- Department of Emergency and Critical Care Medicine, Tokai University School of Medicine, Isehara City, Kanagawa Prefecture, Japan
| | - Hiromichi Aoki
- Department of Emergency and Critical Care Medicine, Tokai University School of Medicine, Isehara City, Kanagawa Prefecture, Japan
| | - Yoshihide Nakagawa
- Department of Emergency and Critical Care Medicine, Tokai University School of Medicine, Isehara City, Kanagawa Prefecture, Japan
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16
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Memet O, Zhang L, Shen J. Serological biomarkers for acute mesenteric ischemia. ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:394. [PMID: 31555708 DOI: 10.21037/atm.2019.07.51] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Acute mesenteric ischemia (AMI) defines a complex of conditions characterized by an interruption of the splanchnic circulation, leading to insufficient oxygen delivery or utilization to fill the metabolic needs of the visceral organs. Early diagnosis and immediate therapy are the cornerstones of early ischemia to reach a successful outcome and are necessary to reduce the high mortality. Although there is still lack of specific biomarkers to assist the diagnosis of AMI in clinical practice, there are several biomarkers with high specificity, may become a potential tools in early diagnosis of AMI, including intestinal fatty acid binding protein (I-FABP), a-glutathione S-transferase (a-GST), D-dimer, L- and D-lactate, citrulline, ischemia modified albumin, procalcitonin (PCT). However, they use in clinical limited duo to the many studies about these makers finished with small patient populations, and heterogeneous among these populations. This review describes the etiology of AMI, the current most studied promising biomarkers, the current research situation and future of biomarker research.
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Affiliation(s)
- Obulkasim Memet
- Center of Emergency & Intensive Care Unit, Medical Center of Chemical Injury, Jinshan Hospital, Fudan University, Shanghai 201508, China
| | - Lin Zhang
- Center of Emergency & Intensive Care Unit, Medical Center of Chemical Injury, Jinshan Hospital, Fudan University, Shanghai 201508, China
| | - Jie Shen
- Center of Emergency & Intensive Care Unit, Medical Center of Chemical Injury, Jinshan Hospital, Fudan University, Shanghai 201508, China
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17
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Kong C, Li SM, Yang H, Xiao WD, Cen YY, Wu Y, Li WM, Sun DL, Xu PY. Screening and combining serum biomarkers to improve their diagnostic performance in the detection of intestinal barrier dysfunction in patients after major abdominal surgery. ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:388. [PMID: 31555702 DOI: 10.21037/atm.2019.07.102] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Background The aim of this prospective study was to screen and combine effective biomarkers to improve their diagnostic performance in detecting intestinal barrier dysfunction in patients after major abdominal surgery. Methods Patients undergoing major abdominal surgery were enrolled after signing informed consent in this study. The serum concentrations of α-GST, DAO, D-lactate, citrulline and I-FABP were detected 24 hours before and after surgery. The diagnostic performance of five biomarkers on intestinal barrier dysfunction was assessed using logistic regression models and receiver operating characteristic (ROC) curve analyses. Results Thirty-nine patients with major abdominal surgery were enrolled in and successfully completed this study. ROC analysis revealed that the sensitivities of D-lactate, citrulline and I-FABP were very high (0.91, 0.91 and 1.00, respectively), but the specificities of these biomarkers were less than 0.70. The sensitivity of DAO was very low [0.25; 95% confidence interval (CI), 0.05-0.57], but its specificity was high (0.92; 95% CI, 0.75-0.99). The accuracies of D-lactate and I-FABP were very high, and the areas under the curves (AUCs) of the biomarkers were 0.84 (95% CI, 0.68-0.93) and 0.81 (95% CI, 0.65-0.92), respectively. Different combinations of five biomarkers were also analysed. The sensitivity, specificity and AUC values of the combination of I-FABP, citrulline and D-lactate were 1.00, 0.74 and 0.89, respectively. These results were similar to those derived from the combination of α-GST, DAO, D-lactate, citrulline and I-FABP (P=1.000). Conclusions The combination of serum D-lactic acid, citrulline and I-FABP greatly improved the diagnostic performance for identifying intestinal barrier dysfunction in patients after major abdominal surgery.
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Affiliation(s)
- Can Kong
- Department of Gastrointestinal Surgery, Second Affiliated Hospital of Kunming Medical University, Kunming 650101, China.,Research Center for Surgical Clinical Nutrition in Yun-Nan Province, Kunming 650101, China.,Professor Yang Hua Research Station in Yun-Nan Province, Kunming 650101, China
| | - Shu-Min Li
- Department of Gastrointestinal Surgery, Second Affiliated Hospital of Kunming Medical University, Kunming 650101, China.,Research Center for Surgical Clinical Nutrition in Yun-Nan Province, Kunming 650101, China.,Professor Yang Hua Research Station in Yun-Nan Province, Kunming 650101, China
| | - Hua Yang
- Department of General Surgery, Xinqiao Hospital, Third Military Medical University, Chongqing 400037, China
| | - Wei-Dong Xiao
- Department of General Surgery, Xinqiao Hospital, Third Military Medical University, Chongqing 400037, China
| | - Yun-Yun Cen
- Department of Gastrointestinal Surgery, Second Affiliated Hospital of Kunming Medical University, Kunming 650101, China.,Research Center for Surgical Clinical Nutrition in Yun-Nan Province, Kunming 650101, China.,Professor Yang Hua Research Station in Yun-Nan Province, Kunming 650101, China
| | - Yi Wu
- Experimental Center for Medical Science Research of Kunming Medical University, Kunming 650101, China
| | - Wei-Ming Li
- Department of Gastrointestinal Surgery, Second Affiliated Hospital of Kunming Medical University, Kunming 650101, China.,Research Center for Surgical Clinical Nutrition in Yun-Nan Province, Kunming 650101, China.,Professor Yang Hua Research Station in Yun-Nan Province, Kunming 650101, China
| | - Da-Li Sun
- Department of Gastrointestinal Surgery, Second Affiliated Hospital of Kunming Medical University, Kunming 650101, China.,Research Center for Surgical Clinical Nutrition in Yun-Nan Province, Kunming 650101, China.,Professor Yang Hua Research Station in Yun-Nan Province, Kunming 650101, China
| | - Peng-Yuan Xu
- Department of Gastrointestinal Surgery, Second Affiliated Hospital of Kunming Medical University, Kunming 650101, China.,Research Center for Surgical Clinical Nutrition in Yun-Nan Province, Kunming 650101, China.,Professor Yang Hua Research Station in Yun-Nan Province, Kunming 650101, China
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18
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Abdelrasoul GN, MacKay S, Salim SY, Ismond KP, Tamura M, Khalifa C, Mannan E, Lin D, Mandal T, Montgomery RR, Wishart DS, Chen J, Khadaroo RG. Non-invasive Point-of-Care Device To Diagnose Acute Mesenteric Ischemia. ACS Sens 2018; 3:2296-2302. [PMID: 30335977 DOI: 10.1021/acssensors.8b00558] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Inadequate blood supply to the intestine can lead to acute mesenteric ischemia (AMI), with a mortality rate ranging from 60% to 90%. This high mortality rate is partially due to late detection and the lack of efficient early diagnostic tests. There is an urgent need for a point-of-care tool for immediate bedside diagnosis. Here we present for the first time a rapid and non-invasive electrochemical biosensor device based on non-faradic impedance spectroscopy to detect intestinal fatty-acid binding protein (I-FABP) as an indication of AMI. The electrochemical biosensors consist of gold interdigitated electrodes that were fabricated using photolithographic techniques on top of silicon dioxide substrates. The electrode surfaces were functionalized with an I-FABP capture antibody (CAnB) to entice the target protein, while gold nanoparticles (GNPs) functionalized with detection antibodies (DAnB-GNPs) were utilized as a novel mechanism to enhance the detection signal. Quantification of the I-FABP concentration in the medium depended on its attachment to CAnB and DAnB-GNPs in a sandwich manner, where the latter boosts the impedance signal through its binding to the I-FABP. This non-invasive non-faradic electric biosensor device demonstrates the potential for bench-to-bedside translation with the goal of decreasing morbidity and mortality from AMI.
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Affiliation(s)
- Gaser N. Abdelrasoul
- Department of Electrical and Computer Engineering, University of Alberta, Edmonton, Alberta T6G 1H9, Canada
| | - Scott MacKay
- Department of Electrical and Computer Engineering, University of Alberta, Edmonton, Alberta T6G 1H9, Canada
| | - Saad Y. Salim
- Department of Surgery, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta T6G 2B7, Canada
| | - Kathleen P. Ismond
- Department of Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta T6G 2G3, Canada
| | - Marcus Tamura
- Department of Electrical and Computer Engineering, University of Alberta, Edmonton, Alberta T6G 1H9, Canada
| | - Charfeddine Khalifa
- Department of Electrical and Computer Engineering, University of Alberta, Edmonton, Alberta T6G 1H9, Canada
| | - Emma Mannan
- Department of Electrical and Computer Engineering, University of Alberta, Edmonton, Alberta T6G 1H9, Canada
| | - Donghai Lin
- Department of Electrical and Computer Engineering, University of Alberta, Edmonton, Alberta T6G 1H9, Canada
| | - Tanushree Mandal
- Department of Electrical and Computer Engineering, University of Alberta, Edmonton, Alberta T6G 1H9, Canada
| | - Ruth R. Montgomery
- Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut 06510, United States
| | - David S. Wishart
- Department of Biological Sciences, University of Alberta, Edmonton, Alberta T6G 2E9, Canada
- Department of Computing Science, University of Alberta, Edmonton, Alberta T6G 2E8, Canada
| | - Jie Chen
- Department of Electrical and Computer Engineering, University of Alberta, Edmonton, Alberta T6G 1H9, Canada
| | - Rachel G. Khadaroo
- Department of Surgery, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta T6G 2B7, Canada
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19
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Montagnana M, Danese E, Lippi G. Biochemical markers of acute intestinal ischemia: possibilities and limitations. ANNALS OF TRANSLATIONAL MEDICINE 2018; 6:341. [PMID: 30306080 DOI: 10.21037/atm.2018.07.22] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Acute intestinal ischemia is a relative rare abdominal emergency, associated with considerably high morbidity and mortality rates. Although the conventional diagnostic approach to acute intestinal ischemia entails a preliminary evaluation of signs and symptoms, followed by radiological and laboratory investigations, a definitive diagnosis is can usually be made after laparotomy, which still remains the gold standard diagnostic (and therapeutic) procedure. Several potential laboratory biomarkers have been investigated over the past decades, but none of these seems to reach a suitable diagnostic accuracy for an early and reliable diagnosis of intestinal ischemia. The aim of this narrative review is to provide an overview on traditional laboratory tests for diagnosing acute intestinal ischemia (i.e., complete blood count, D-dimer, blood gas analysis, total lactic acid, C-reactive protein and procalcitonin), and summarize current evidence regarding some emerging and potentially useful biomarkers such as D-lactate, intestinal fatty acid-binding protein (I-FABP), ischemia modified albumin (IMA), α-glutathione S-transferase (α-GST), interleukin-6 (IL-6), citrulline and smooth muscle protein of 22 kDa (SM22). Among the various tests, D-lactate, IMA and I-FABP are perhaps the most promising, since they are characterized by optimal sensitivity and relatively good specificity, early kinetics, and can be measured with assays suited for a rapid diagnosis.
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Affiliation(s)
- Martina Montagnana
- Clinical Biochemistry Section, University Hospital of Verona, Verona, Italy
| | - Elisa Danese
- Clinical Biochemistry Section, University Hospital of Verona, Verona, Italy
| | - Giuseppe Lippi
- Clinical Biochemistry Section, University Hospital of Verona, Verona, Italy
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20
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Tomečková V, Tóth Š, Tóth T, Komanický V, Krajčíková K, Široká M, Glinská G, Pella D, Mašlanková J, Tomečko M, Hakim T, Štefanič P. Analysis of Bowel Diseases from Blood Serum by Autofluorescence and Atomic Force Microscopy Techniques. OPEN CHEM 2018. [DOI: 10.1515/chem-2018-0024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
AbstractDiagnosis of bowel diseases is often difficult and time consuming since it is not always possible to obtain adequate information by the conventional diagnostic methods to set up a diagnosis and exclude nongastrointestinal causes of symptoms. The aim of this study was to investigate the structure of blood serum samples of patients with selected intestinal diseases. The blood serum samples of patients (N=35) with selected diagnoses (mesenteric thrombosis, inflammatory bowel disease, duodenal ulcers, sepsis, enterorrhagia, sigmoid colon resection, small intestine cancer) and of healthy subjects were evaluated by synchronous fluorescence fingerprint and atomic force microscopy. Autofluorescence of blood serum studied at λex = 280 nm showed significant decrease of fluorescence intensity in patients with all types of diseases affecting bowels in comparison with the healthy control patients. The blood serum surface of ill patients showed significant differences in comparison with control group samples after atomic force microscopy evaluation as well. Irregularly placed small globular units of irregular shape in small amounts are possible to observe in patients with intestine ischemia. Fluorescence analysis and atomic force microscopy showed the ability to rapidly reflect qualitative and quantitative changes of proteins in blood serum samples of patients. These sensitive methods could be beneficial for monitoring the progression of both acute or chronic bowel diseases.
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Affiliation(s)
- Vladimíra Tomečková
- Department of Medical and Clinical Biochemistry, Faculty of Medicine, Pavol Jozef Šafárik University in Košice, Košice, Slovak Republic
| | - Štefan Tóth
- 1st Department of Internal Medicine, Faculty of Medicine, Pavol Jozef Šafárik University in Košice, Košice, Slovak Republic
| | - Tímea Tóth
- 1st Department of Internal Medicine, Faculty of Medicine, Pavol Jozef Šafárik University in Košice, Košice, Slovak Republic
| | - Vladimír Komanický
- Institute of Physics, Faculty of Science, Pavol Jozef Šafárik University in Košice, Košice, Slovak Republic
| | - Kristína Krajčíková
- Department of Medical and Clinical Biochemistry, Faculty of Medicine, Pavol Jozef Šafárik University in Košice, Košice, Slovak Republic
| | - Monika Široká
- Department of Medical and Clinical Biochemistry, Faculty of Medicine, Pavol Jozef Šafárik University in Košice, Košice, Slovak Republic
| | - Gabriela Glinská
- Department of Medical and Clinical Biochemistry, Faculty of Medicine, Pavol Jozef Šafárik University in Košice, Košice, Slovak Republic
| | - Dominik Pella
- Department of Cardiology, East Slovak Institute of Cardiovascular Disease in Košice, Košice, Slovak Republic
| | - Jana Mašlanková
- Department of Medical and Clinical Biochemistry, Faculty of Medicine, Pavol Jozef Šafárik University in Košice, Košice, Slovak Republic
| | - Marián Tomečko
- Department of Vascular Surgery, East Slovak Institute of Cardiovascular Disease in Košice, Košice, Slovak Republic
| | - Tamer Hakim
- 1st Department of Internal Medicine, Faculty of Medicine, Pavol Jozef Šafárik University in Košice, Košice, Slovak Republic
| | - Peter Štefanič
- Department of Vascular Surgery, East Slovak Institute of Cardiovascular Disease in Košice, Košice, Slovak Republic
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21
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Richards C, Ishihara K, Grayson C, Lustik M, Yheulon C. Serum lactate predicts resource utilization, but not surgical need, in the emergency department. J Surg Res 2018; 226:89-93. [PMID: 29661294 DOI: 10.1016/j.jss.2018.01.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Revised: 12/29/2017] [Accepted: 01/12/2018] [Indexed: 12/19/2022]
Abstract
BACKGROUND Serum lactate is frequently tested in the emergency department (ED) setting to diagnose visceral ischemia and as a marker of end-organ perfusion. It is highly nonspecific, and levels can be affected by both kidney and liver function. In this retrospective chart review, we aim to demonstrate that serum lactate is overused in the ED setting and predicts resource utilization but not the need for surgical intervention. METHODS ED records with a chief complaint of "abdominal pain" were queried for the preceding 12 mo. We excluded pregnant patients, patients aged less than 18 years, and patients for whom a blood count and chemistry were not obtained. Vital signs, laboratory values, resource utilization, and outcome of the visit were obtained. Logistic regression models were developed to correct for confounding associations. RESULTS A total of 1003 records were obtained initially with 753 patients (75%) included in the study. Serum lactate was drawn in 118 patients (15%) and was elevated in 19 patients (16% of those drawn). Utilization of computed tomography imaging was associated with lactate utilization (P < 0.001). Patients in whom lactate was drawn were more likely to have a general surgery consult (51% versus 34%, P < 0.001) and to be admitted to the hospital (P < 0.001). CONCLUSIONS The use of serum lactate in the workup of patients with abdominal pain should be targeted at patients who have signs of sepsis and based on the index of suspicion for specific disease processes such as mesenteric ischemia.
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Affiliation(s)
- Carly Richards
- Department of Surgery, Tripler Army Medical Center, Honolulu, Hawaii.
| | - Kelli Ishihara
- Department of Surgery, Tripler Army Medical Center, Honolulu, Hawaii
| | - Cary Grayson
- Department of Surgery, Tripler Army Medical Center, Honolulu, Hawaii
| | - Michael Lustik
- Department of Clinical Investigation, Tripler Army Medical Center, Honolulu, Hawaii
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22
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Bala M, Kashuk J, Moore EE, Kluger Y, Biffl W, Gomes CA, Ben-Ishay O, Rubinstein C, Balogh ZJ, Civil I, Coccolini F, Leppaniemi A, Peitzman A, Ansaloni L, Sugrue M, Sartelli M, Di Saverio S, Fraga GP, Catena F. Acute mesenteric ischemia: guidelines of the World Society of Emergency Surgery. World J Emerg Surg 2017; 12:38. [PMID: 28794797 PMCID: PMC5545843 DOI: 10.1186/s13017-017-0150-5] [Citation(s) in RCA: 274] [Impact Index Per Article: 39.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Accepted: 08/01/2017] [Indexed: 02/07/2023] Open
Abstract
Acute mesenteric ischemia (AMI) is typically defined as a group of diseases characterized by an interruption of the blood supply to varying portions of the small intestine, leading to ischemia and secondary inflammatory changes. If untreated, this process will eventuate in life threatening intestinal necrosis. The incidence is low, estimated at 0.09–0.2% of all acute surgical admissions. Therefore, although the entity is an uncommon cause of abdominal pain, diligence is always required because if untreated, mortality has consistently been reported in the range of 50%. Early diagnosis and timely surgical intervention are the cornerstones of modern treatment and are essential to reduce the high mortality associated with this entity. The advent of endovascular approaches in parallel with modern imaging techniques may provide new options. Thus, we believe that a current position paper from World Society of Emergency Surgery (WSES) is warranted, in order to put forth the most recent and practical recommendations for diagnosis and treatment of AMI. This review will address the concepts of AMI with the aim of focusing on specific areas where early diagnosis and management hold the strongest potential for improving outcomes in this disease process. Some of the key points include the prompt use of CT angiography to establish the diagnosis, evaluation of the potential for revascularization to re-establish blood flow to ischemic bowel, resection of necrotic intestine, and use of damage control techniques when appropriate to allow for re-assessment of bowel viability prior to definitive anastomosis and abdominal closure.
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Affiliation(s)
- Miklosh Bala
- Acute Care Surgery and Trauma Unit, General Surgery Department, Hadassah - Hebrew University Medical Center, Kiriat Hadassah, POB 12000, 91120 Jerusalem, Israel
| | - Jeffry Kashuk
- Assia Medical Group, Tel Aviv University Sackler School of Medicine, Tel Aviv, Israel
| | - Ernest E Moore
- Department of Surgery, Denver Health Medical Center, University of Colorado, Denver, USA
| | - Yoram Kluger
- Department of General Surgery, Rambam Health Care Campus, Haifa, Israel
| | - Walter Biffl
- Department of Surgery, Queens Medical Center, Honolulu, Hi USA
| | - Carlos Augusto Gomes
- Faculdade de Ciências Médicas e da Saúde de Juiz de Fora (SUPREMA), Federal University of Juiz de Fora (UFJF), Juiz de Fora, MG Brazil
| | - Offir Ben-Ishay
- Department of General Surgery, Rambam Health Care Campus, Haifa, Israel
| | - Chen Rubinstein
- Department of Vascular Surgery, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Zsolt J Balogh
- Department of Traumatology, John Hunter Hospital and University of Newcastle, Newcastle, NSW Australia
| | - Ian Civil
- Department of Surgery, Auckland City Hospital, Auckland, New Zealand
| | | | - Ari Leppaniemi
- Abdominal Center, University Hospital Meilahti, Helsinki, Finland
| | - Andrew Peitzman
- Department of Surgery, UPMC, University of Pittsburgh School of Medicine, Pittsburgh, PA USA
| | - Luca Ansaloni
- General Surgery I, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Michael Sugrue
- Donegal Clinical Research Academy, Letterkenny University Hospital, Letterkenny, Ireland
| | | | | | - Gustavo P Fraga
- Division of Trauma Surgery, Hospital de Clinica, School of Medical Sciences, University of Campinas, Campinas, Brazil
| | - Fausto Catena
- Emergency Department, Maggiore University Hospital, Parma, Italy
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23
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Salim SY, Young PY, Churchill TA, Khadaroo RG. Urine intestinal fatty acid-binding protein predicts acute mesenteric ischemia in patients. J Surg Res 2016; 209:258-265. [PMID: 27555111 DOI: 10.1016/j.jss.2016.07.017] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Revised: 05/25/2016] [Accepted: 07/08/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND Acute mesenteric ischemia (AMI) has a high morbidity and mortality and often presents as a diagnostic challenge. Currently, there is no blood, urine, or radiologic tests that provide a definitive diagnosis of AMI. The aim of this study was to evaluate the clinical accuracy of urine intestinal fatty acid-binding protein (I-FABP) to diagnosis AMI. MATERIALS AND METHODS Twenty patients referred to the Acute Care Surgery service at University of Alberta Hospital with suspected AMI taken to the operating room for definitive diagnosis were recruited. Pathologic findings from surgical specimens confirmed a gold standard diagnosis for intestinal ischemia. The patients found to be nonischemic became the internal controls. Conventional clinical markers were examined in blood including white blood cell count, lactate, and creatinine. Blood was also examined by enzyme-linked immunosorbent assays (ELISAs) for I-FABP and interleukin-6. Urine was examined preoperatively and 6 and 24 h postoperatively for I-FABP. RESULTS Thirteen patients were pathologically diagnosed with AMI while five patients were nonischemic; two were excluded due to missing biologic specimens. There was no difference in age or gender between ischemic and nonischemic patients (56 ± 5 versus 66 ± 11 years old, respectively; six females with ischemic and three females in the nonischemic group). There was no difference in serum lactate and creatinine between the two groups. Serum interleukin-6 levels in patients with AMI were significantly higher than nonischemic controls (0.4 ± 0.2 ng/mL versus 0.2 ± 0.07 ng/mL, respectively, P = 0.03). There was a nonstatistically significant increase in serum I-FABP in AMI patients compared to internal controls (9 ± 3 ng/mL versus 2.4 ± 0.9 ng/mL, respectively, P = 0.2). Urine I-FABP was significantly higher in patients diagnosed with AMI than in controls (7 ± 1 ng/mL versus 2 ± 1 ng/mL, respectively, P = 0.007). The receiver operating characteristic curve illustrated that urine I-FABP discriminates significantly between patients with AMI and controls (area under receiver operating characteristic = 0.88, P = 0.03). CONCLUSIONS The traditional clinical markers lactate and white blood cell count were not able to differentiate AMI from nonischemic bowel. However, we found that urine I-FABP was a noninvasive biomarker with high specificity and sensitivity for accurately diagnosing AMI in patients. A noninvasive accurate tool for AMI would facilitate for a rapid treatment, while preventing unnecessary surgical interventions in high-risk patient populations.
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Affiliation(s)
- Saad Y Salim
- Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Pang Y Young
- Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | | | - Rachel G Khadaroo
- Department of Surgery, University of Alberta, Edmonton, Alberta, Canada; Department of Critical Care Medicine, University of Alberta, Edmonton, Alberta, Canada.
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24
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Periarrest intestinal bacterial translocation and resuscitation outcome. J Crit Care 2015; 31:217-20. [PMID: 26481507 DOI: 10.1016/j.jcrc.2015.09.015] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2015] [Revised: 08/21/2015] [Accepted: 09/12/2015] [Indexed: 12/21/2022]
Abstract
During the periarrest period, intestinal ischemia may result in barrier dysfunction and bacterial translocation, which has clear mechanistic links to inflammation and cascade stimulation, especially in patients who are treated with therapeutic hypothermia. Despite optimal management, periarrest bacterial translocation may worsen the outcome of cardiac arrest victims.
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