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Cirocchi R, Randolph J, Cheruiyot I, Davies RJ, Gioia S, Henry BM, Anania G, Donini A, Mingoli A, Sapienza P, Avenia S. Discontinuity of marginal artery at splenic flexure and rectosigmoid junction: A systematic review and meta-analysis. Colorectal Dis 2023. [PMID: 37317032 DOI: 10.1111/codi.16624] [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: 04/10/2022] [Revised: 02/08/2023] [Accepted: 04/02/2023] [Indexed: 06/16/2023]
Abstract
AIM The aim of this study was to provide comprehensive evidence-based assessment of the discontinuity of the marginal artery at the splenic flexure (SF) and the rectosigmoid junction (RSJ). METHOD A systematic review was conducted of literature published to 26 December 2022 in the electronic databases PubMed, SCOPUS and Web of Science to identify studies eligible for inclusion. Data were extracted and pooled into a meta-analysis using the Metafor package in R. The primary outcomes were the pooled PPEs of the marginal artery at the SF and the RSJ. The secondary outcome was the size of vascular anastomoses. RESULTS A total of 21 studies (n = 2,864 patients) were included. The marginal artery was present at the splenic flexure in 82% (95% CI: 62-95) of patients. Approximately 81% (95% CI: 63-94%) of patients had a large macroscopic anastomosis, while the remainder (19%) had small bridging ramifications forming the vessel. The marginal artery was present at the RSJ in 82% (95% CI: 70-91%) of patients. CONCLUSION The marginal artery may be absent at the SF and the RSJ in up to 18% of individuals, which may confer a higher risk of ischaemic colitis. As a result of high interstudy heterogeneity noted in our analysis, further well-powered studies to clarify the prevalence of the marginal artery at the SF and the RSJ, as well as its relationship with other complementary colonic collaterals (intermediate and central mesenteric), are warranted.
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Affiliation(s)
- Roberto Cirocchi
- Department of Medicine and Surgery, University of Perugia, Piazza dell' Universitá, Perugia, Italy
| | - Justus Randolph
- Georgia Baptist College of Nursing, Mercer University, Atlanta, USA
| | - Isaac Cheruiyot
- Department of Human Anatomy, University of Nairobi, Nairobi, Kenya
- International Evidence-Based Anatomy Working Group, Krakow, Poland
| | - R Justin Davies
- Cambridge Colorectal Unit, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
- University of Cambridge, Cambridge, UK
| | - Sara Gioia
- Section of Legal Medicine, Hospital of Terni, Terni, Italy
| | | | - Gabriele Anania
- Department of Medical Science, Sant'Anna Hospital, University of Ferrara, Ferrara, Italy
| | - Annibale Donini
- Department of Medicine and Surgery, University of Perugia, Piazza dell' Universitá, Perugia, Italy
| | - Andrea Mingoli
- Department of Surgery "Pietro Valdoni", "Sapienza" University of Rome, Rome, Italy
| | - Paolo Sapienza
- Department of Surgery "Pietro Valdoni", "Sapienza" University of Rome, Rome, Italy
| | - Stefano Avenia
- Department of Medicine and Surgery, University of Perugia, Piazza dell' Universitá, Perugia, Italy
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Katano K, Yoshimitsu Y, Haba Y, Maeda T. Mild nonocclusive mesenteric ischemia associated with syncope. Clin J Gastroenterol 2021; 14:776-781. [PMID: 33682023 DOI: 10.1007/s12328-021-01379-6] [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: 01/09/2021] [Accepted: 02/26/2021] [Indexed: 11/30/2022]
Abstract
Nonocclusive mesenteric ischemia (NOMI) is a life-threatening disease caused by a reduction in mesenteric blood supply without vascular occlusion. Early diagnosis of NOMI is often difficult because there are no specific findings suggesting NOMI. Here, we report a rare case of a very elderly patient with mild NOMI caused by dehydration due to short-term reduced oral intake and associated with syncope. A 90-year-old man was admitted to our hospital with syncope and melena. The syncope was thought to be caused by orthostatic hypotension due to dehydration owing to reduced oral intake for approximately 24 h. Abdominal computed tomography (CT) revealed marked bowel wall thickening with mesenteric stranding in the ileum and ascending colon, dilated small intestine with thinned bowel wall, collapsed superior mesenteric vein, hemorrhagic ascites, and absence of obvious vascular occlusion in the mesenteric vessels. Abdominal symptoms, laboratory abnormalities, and CT findings improved gradually with the correction of dehydration. Therefore, we diagnosed our patient with mild NOMI. NOMI can be associated with syncope and can occur even with dehydration due to short-term reduced oral intake. When examining elderly patients with hypovolemic signs, such as syncope, who exhibit abdominal symptoms, clinicians must keep in mind the possibility of NOMI.
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Affiliation(s)
- Kaoru Katano
- Department of Surgery, Houju Memorial Hospital, 11-71 Midorigaoka, Nomi, Ishikawa, 923-1226, Japan.
| | - Yutaka Yoshimitsu
- Department of Surgery, Houju Memorial Hospital, 11-71 Midorigaoka, Nomi, Ishikawa, 923-1226, Japan
| | - Yusuke Haba
- Department of Surgery, Houju Memorial Hospital, 11-71 Midorigaoka, Nomi, Ishikawa, 923-1226, Japan
| | - Tsutomu Maeda
- Department of Surgery, Houju Memorial Hospital, 11-71 Midorigaoka, Nomi, Ishikawa, 923-1226, Japan
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Grant CJ, Huang SHS, McIntyre CW. Hepato-splanchnic circulatory stress: An important effect of hemodialysis. Semin Dial 2019; 32:237-242. [PMID: 30937954 DOI: 10.1111/sdi.12782] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The gastro-intestinal tract is being increasingly recognized as the site of key pathophysiological processes in the hemodialysis patient. Intestinal dysbiosis, increased intraluminal toxin production, and increased intestinal permeability are commonly observed processes which contribute to the pathogenesis of cardiovascular disease and thus elevated mortality. The acute circulatory effects of dialysis itself may contribute significantly to the development of gastrointestinal dysfunction as a result of both local and distant effects. Additionally, the liver, a relatively unknown entity in this process, has a substantial role as a functional barrier between the portal and systemic circulation and in the metabolism of pathogenic gut-derived uremic toxins. Here we summarize the evidence for acute gastro-intestinal and hepatic effects of hemodialysis and identify gaps in knowledge to date which require further study.
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Affiliation(s)
- Claire J Grant
- The Lilibeth Caberto Kidney Clinical Research Unit, Western University, London, Ontario, Canada
| | - Shih-Han S Huang
- The Lilibeth Caberto Kidney Clinical Research Unit, Western University, London, Ontario, Canada.,Department of Medical Biophysics, Western University, London, Ontario, Canada.,Division of Nephrology, London Health Sciences Centre, London, Ontario, Canada
| | - Chris W McIntyre
- The Lilibeth Caberto Kidney Clinical Research Unit, Western University, London, Ontario, Canada.,Department of Medical Biophysics, Western University, London, Ontario, Canada.,Division of Nephrology, London Health Sciences Centre, London, Ontario, Canada
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Seong EY, Zheng Y, Winkelmayer WC, Montez-Rath ME, Chang TI. The Relationship between Intradialytic Hypotension and Hospitalized Mesenteric Ischemia: A Case-Control Study. Clin J Am Soc Nephrol 2018; 13:1517-1525. [PMID: 30237215 PMCID: PMC6218836 DOI: 10.2215/cjn.13891217] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Accepted: 07/26/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND OBJECTIVES Mesenteric ischemia is a rare but devastating condition caused by insufficient blood supply to meet the demands of intestinal metabolism. In patients with ESKD, it can be difficult to diagnose and has a >70% mortality rate. Patients on hemodialysis have a high prevalence of predisposing conditions for mesenteric ischemia, but the contribution of intradialytic hypotension, a potential modifiable risk factor, has not been well described. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS We used data from the US Renal Data System to identify 626 patients on hemodialysis with a hospitalized mesenteric ischemia event (cases). We selected 2428 controls in up to a 1:4 ratio matched by age, sex, black race, incident dialysis year, diabetes mellitus, coronary artery disease, and peripheral artery disease. We used six different definitions of intradialytic hypotension on the basis of prior studies, and categorized patients as having had intradialytic hypotension if ≥30% of hemodialysis sessions in the 30 days before the event met the specified definition. RESULTS The proportion of patients with intradialytic hypotension varied depending on its definition: from 19% to 92% of cases and 11% to 94% of controls. Cases had a higher adjusted odds (1.82; 95% confidence interval, 1.47 to 2.26) of having had intradialytic hypotension in the preceding 30 days than controls when using nadir-based intradialytic hypotension definitions such as nadir systolic BP <90 mm Hg. To examine a potential dose-response association of intradialytic hypotension with hospitalized mesenteric ischemia, we categorized patients by the proportion of hemodialysis sessions having intradialytic hypotension, defined using the Nadir90 definition (0%, 1%-9%, 10%-29%, 30%-49%, and ≥50%), and found a direct association of proportion of intradialytic hypotension with hospitalized mesenteric ischemia (P-trend<0.001). CONCLUSIONS Patients with hospitalized mesenteric ischemia had significantly higher odds of having had intradialytic hypotension in the preceding 30 days than controls, as defined by nadir-based definitions.
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Affiliation(s)
- Eun Young Seong
- Division of Nephrology, Stanford University School of Medicine, Palo Alto, California
- Division of Nephrology, Pusan National University School of Medicine, Pusan, South Korea; and
| | - Yuanchao Zheng
- Division of Nephrology, Stanford University School of Medicine, Palo Alto, California
| | | | - Maria E. Montez-Rath
- Division of Nephrology, Stanford University School of Medicine, Palo Alto, California
| | - Tara I. Chang
- Division of Nephrology, Stanford University School of Medicine, Palo Alto, California
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Çakar E, Ersöz F, Bag M, Bayrak S, Çolak Ş, Bektaş H, Güneş ME, Çakar E. Isolated cecal necrosis: our surgical experience and a review of the literature. Turk J Surg 2014; 30:214-8. [PMID: 25931932 PMCID: PMC4379799 DOI: 10.5152/ucd.2014.2643] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2014] [Accepted: 04/05/2014] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Isolated cecal necrosis is a rare cause of ischemic colitis. Ischemic colitis is further divided into two groups: occlusive mesenteric ischemia and non-occlusive mesenteric ischemia. The aim of this study was to investigate the cause of isolated cecal necrosis. MATERIAL AND METHODS We operated on 3 male and 3 female patients with a mean age of 60.3±18.7 (38-85) years with a preliminary diagnosis of acute appendicitis between 2007 and 2012. Four of these patients were on hemodialysis, 1 patient had an aortofemoral bypass, and 1 patient had coronary artery disease with atrial fibrillation. RESULTS The diagnosis was made intraoperatively in all cases. Five patients died postoperatively. One patient survived. CONCLUSION In the case of right lower quadrant pain, the possibility of isolated cecal necrosis should be kept in mind, especially in patients on hemodialysis, elderly patients with diabetes, and heart disease; surgical strategies should be planned accordingly, and it should be understood that a high mortality rate will be inevitable.
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Affiliation(s)
- Ekrem Çakar
- Clinic of General Surgery, İstanbul Training and Research Hospital, İstanbul, Turkey
| | - Feyzullah Ersöz
- Clinic of General Surgery, İstanbul Training and Research Hospital, İstanbul, Turkey
| | - Murat Bag
- Clinic of General Surgery, Kocaeli State Hospital, Kocaeli, Turkey
| | - Savaş Bayrak
- Clinic of General Surgery, İstanbul Training and Research Hospital, İstanbul, Turkey
| | - Şükrü Çolak
- Clinic of General Surgery, İstanbul Training and Research Hospital, İstanbul, Turkey
| | - Hasan Bektaş
- Clinic of General Surgery, İstanbul Training and Research Hospital, İstanbul, Turkey
| | - M. Emin Güneş
- Clinic of General Surgery, İstanbul Training and Research Hospital, İstanbul, Turkey
| | - Emel Çakar
- Department of Nursing, İstanbul Gelişim University, İstanbul, Turkey
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Mostovaya IM, Blankestijn PJ, Bots ML, Covic A, Davenport A, Grooteman MP, Hegbrant J, Locatelli F, Vanholder R, Nubé MJ. Clinical Evidence on Hemodiafiltration: A Systematic Review and a Meta-analysis. Semin Dial 2014; 27:119-27. [DOI: 10.1111/sdi.12200] [Citation(s) in RCA: 96] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Ira M. Mostovaya
- Department of Nephrology; University Medical Center Utrecht; Utrecht The Netherlands
| | - Peter J. Blankestijn
- Department of Nephrology; University Medical Center Utrecht; Utrecht The Netherlands
| | - Michiel L. Bots
- Julius Center for Health Sciences and Primary Care; University Medical Center Utrecht; Utrecht The Netherlands
| | - Adrian Covic
- Nephrology Clinic, Dialysis and Renal Transplant Center; C.I. Parhon University Hospital; Gr. T. Popa University of Medicine and Pharmacy; Iasi Romania
| | - Andrew Davenport
- UCL Centre for Nephrology; Royal Free Hospital; University College London Medical School; London United Kingdom
| | - Muriel P.C. Grooteman
- Department of Nephrology; VU University Medical Center; Amsterdam The Netherlands
- Institute for Cardiovascular Research VU Medical Center (ICaR-VU); VU University Medical Center; Amsterdam The Netherlands
| | | | - Francesco Locatelli
- Department of Nephrology Dialysis and Renal Transplantation; Alessandro Manzoni Hospital; Lecco Italy
| | - Raymond Vanholder
- Nephrology Section; Department of Internal Medicine; University Hospital; Ghent Belgium
| | - Menso J. Nubé
- Department of Nephrology; VU University Medical Center; Amsterdam The Netherlands
- Institute for Cardiovascular Research VU Medical Center (ICaR-VU); VU University Medical Center; Amsterdam The Netherlands
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Nakamura Y, Urashima M, Toyota N, Ono C, Iida M, Fukumoto W, Kaichi Y, Tani C, Honda Y, Komoto D, Tatsugami F, Kakizawa H, Date S, Awai K. Non-occlusive mesenteric ischemia (NOMI): utility of measuring the diameters of the superior mesenteric artery and superior mesenteric vein at multidetector CT. Jpn J Radiol 2013; 31:737-743. [PMID: 24022230 DOI: 10.1007/s11604-013-0245-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2013] [Accepted: 08/26/2013] [Indexed: 01/16/2023]
Abstract
OBJECTIVE To investigate the diagnostic capability of multidetector computed tomography for detecting non-occlusive mesenteric ischemia (NOMI). METHODS We studied 11 NOMI patients and 44 controls. Radiologists evaluated the CT images for the presence of bowel ischemia and measured the diameters of the superior mesenteric artery and the superior mesenteric vein (D SMA and D SMV). We also performed linear discriminant analysis (LDA) using D SMA and D SMV. RESULTS All NOMI patients presented with more than 2 CT findings of bowel ischemia. D SMA and D SMV were significantly smaller in NOMI patients than in the controls (p < 0.01). At the optimal cut-off values for D SMA (6.5 mm), D SMV (9.0 mm), and the Z value in LDA (0.93), sensitivity and specificity were 81.8 and 81.8; 81.8 and 88.6; and 81.8 and 97.7 %, respectively. CONCLUSIONS D SMA and D SMV were significantly smaller in NOMI patients than in the controls and D SMV is a more significant parameter than D SMA.
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Affiliation(s)
- Yuko Nakamura
- Diagnostic Radiology, Graduate School of Biomedical Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, Japan,
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Affiliation(s)
- Andrew A House
- Department of Medicine, Division of Nephrology, London Health Sciences Centre, University of Western Ontario, London, Ontario, Canada.
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9
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Mitsuyoshi A, Obama K, Shinkura N, Ito T, Zaima M. Survival in nonocclusive mesenteric ischemia: early diagnosis by multidetector row computed tomography and early treatment with continuous intravenous high-dose prostaglandin E(1). Ann Surg 2007; 246:229-35. [PMID: 17667501 PMCID: PMC1933563 DOI: 10.1097/01.sla.0000263157.59422.76] [Citation(s) in RCA: 104] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVES The aim of the study was to establish a procedure for early diagnosis and treatment of nonocclusive mesenteric ischemia (NOMI). BACKGROUND NOMI has a high mortality rate, and early diagnosis and treatment are important for improving survival in patients with this condition. METHODS The subjects were 22 patients treated at our hospital over 13 years. Diagnostic criteria for NOMI were established based on the first 13 cases. In the 9 more recent cases, we performed abdominal contrast multidetector row computed tomography (MDCT) upon suspicion of NOMI based on these criteria. Imaging allowed definite diagnosis of NOMI, and continuous intravenous high-dose PGE1 administration was initiated immediately after diagnosis (dose, 0.01-0.03 microg/kg per min; mean administration period, 4.8 days). RESULTS Nine of the first 13 patients died of multiple organ failure associated with multiple intestinal necrosis. These cases suggested that NOMI may develop when 3 of the following 4 criteria are met after cardiovascular surgery or maintenance dialysis in elderly patients: symptoms of the ileus develop slowly from abdominal symptoms, such as an unpleasant abdominal feeling or pain; a requirement for catecholamine treatment; an episode of hypotension; and slow elevation of the serum transaminase level. In the 9 recent cases, definite diagnosis was made from spasm of the principal arteries in arterial volume rendering and curved planar reformation MDCT images. Early treatment with PGE1 prevented acute-stage NOMI in 8 of the 9 cases. CONCLUSIONS Early diagnosis of NOMI is possible using the above criteria and MDCT, and initiation of PGE1 treatment may increase survival in patients with NOMI.
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Affiliation(s)
- Akira Mitsuyoshi
- Department of Surgery, Mitsubishi Kyoto Hospital, Nishikyo-ku, Kyoto 615-8087, Japan.
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Ushiroyama T, Sakuma K, Nosaka S. Comparison of effects of vitamin E and wen-jing-tang (unkei-to), an herbal medicine, on peripheral blood flow in post-menopausal women with chilly sensation in the lower extremities: a randomized prospective study. THE AMERICAN JOURNAL OF CHINESE MEDICINE 2007; 34:969-79. [PMID: 17163586 DOI: 10.1142/s0192415x06004442] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
We examined the association between blood flow and chilly sensation in the lower extremities, comparing the changes in blood flow induced by the vitamin E and herbal therapy (Wen-jing-tang) in perimenopausal women with chilly sensation. One hundred sixty-one perimenopausal women aged 42-61 years (mean: 50.4 +/- 3.8 years) with chilly sensation in the lower extremities participated in the study. The participants were randomized for treatment with Wen-jing-tang or a vitamin E preparation containing 600 mg tocopherol nictinate per day for 8 weeks. Blood flow measurement was performed by laser Doppler fluxmetry to determine tissue under the jaw, in the middle finger, and in the third toe. Wen-jing-tang significantly increased the peripheral blood flow in the skin surface in the tiptoe (12.8 +/- 8.8, p = 0.0068) from basal levels (6.0 +/- 5.1), although no significant change was observed in the blood flow in fingertip or under the jaw during treatment. The rate of increase of blood flow in the skin surface of in the lower extremities was significantly higher in the Wen-jing-tang treating group (116.4 +/- 46.5%) than in the vitamin E group (39.8 +/- 21.3%) (p < 0.0001). When the effects of herbal treatment and vitamin E treatment were compared in the subjects with baseline upper extremity blood flow above the mean + 1.5 SD, mean blood flow through the upper extremities was found to have been significantly decreased after Wen-jing-tang treatment (from 57.7 +/- 4.8 to 43.1 +/- 4.2, p = 0.0277), whereas it remained unchanged after treatment with vitamin E. Classical monographs described Wen-jing-tang as being particularly useful in curing chilly sensation in lower extremities. The present study using a laser Doppler fluxmeter demonstrated that treatment with this herbal medicine significantly increased blood flow through the periphery of lower extremities in patients with chilly sensation. It also showed that this herbal medicine suppresses excessive blood flow through the upper half of the body and thus stimulates restoration of physiological distribution of blood flow throughout the entire body.
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Abstract
Ischemic injury to the gastrointestinal tract can threaten bowel viability with potential catastrophic consequences, including intestinal necrosis and gangrene. The presenting symptoms and signs are relatively nonspecific and diagnosis requires a high index of clinical suspicion. AMI often results from an embolus or thrombus within the SMA, although a low-flow state through an area of profound atherosclerosis may also induce severe ischemia. Because most laboratory and radiologic studies are nonspecific in early ischemia an aggressive approach to diagnosis with imaging of the splanchnic vasculature by mesenteric angiography is advocated. Various therapeutic approaches, including the infusion of vasodilators and thrombolytics, may then be used. Proper diagnosis and management of patients with AMI requires vigilance and a readiness to pursue an aggressive course of action.
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Affiliation(s)
- Bryan J Burns
- Division of Gastroenterology, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, 111 East 210th Street, Bronx, NY 10467, USA
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Abstract
Intradialytic hypotension (IDH) occurs during 25% to 50% of end-stage renal disease (ESRD) hemodialysis (HD) treatments. The development of IDH signals both technology- and patient-dependent limitations expressed across a broad range of symptoms, from nausea and muscle cramps to ischemic injury. While traditional thinking has emphasized the link between hypertension and cardio-cerebrovascular injury, more recent studies of ESRD patients have stimulated significant interest in hypotension and poor outcomes. Theoretically, hypotension can contribute to the increased relative risk of death in ESRD by several mechanisms, which include acute coronary syndrome, autoregulation dysfunction, ischemia, and arrhythmogenicity. Endothelial abnormalities (increased procoagulation, thrombogenecity risk, and alterations in coronary flow reserve) and altered vascular distribution within the myocardium provide an environment for vascular injury. The current symposia will examine the pathophysiology of IDH, the specific HD prescription modifications to prevent IDH, and newer pharmacologic interventions to treat IDH and will highlight the approach to several clinical cases based on the information presented. It is becoming increasingly important to identify patients at "high risk" for IDH, to customize the HD prescription to the individual patient, to use drug therapy to prevent IDH events, and to track the prevalence of chronic hypotension and the incidence of IDH complications in the dialysis unit.
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Affiliation(s)
- M J Schreiber
- Department of Nephrology and Hypertension, Cleveland Clinic Foundation, Cleveland, OH 44195, USA.
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Abstract
The ischemic bowel diseases are a heterogeneous group of disorders usually seen in elderly individuals. They represent ischemic damage to different portions [figure: see text] of the bowel and produce a variety of clinical syndromes and outcomes. Colonic ischemia is the commonest of these disorders and has a favorable prognosis in most cases. In contrast, acute mesenteric ischemia, most commonly caused by a superior mesenteric artery embolus, is a disease with a poor prognosis. Acute mesenteric ischemia secondary to nonocclusive mesenteric ischemia usually is a [figure: see text] catastrophic complication of other severe medical illnesses, most notably atherosclerosis. Proper diagnosis and management of patients with ischemic bowel disease requires vigilance on the part of the physician and a willingness to embark on an aggressive plan of diagnosis and management in the appropriate setting.
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Affiliation(s)
- D A Greenwald
- Division of Gastroenterology, Department of Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York, USA.
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