Vogt-Koyanagi-Harada syndrome and mesenteric ischemia: A case report

Vogt-Koyanagi-Harada (VKH) disease is a rare inflammatory ocular disorder that is characterized by bilateral granulomatous panuveitis, neuropathy, and aseptic meningitis, along with various extraocular manifestations. VKH disease has been reported to be associated with various immune disorders. In this report, a case of VKH disease is presented that is associated with mesenteric vascular disease and intestinal necrosis, with an emphasis on the fact that this is the first case documented in the literature of both diseases occurring simultaneously.     

Chronic mesenteric ischemia: stenting of mesenteric arteries

This article focuses on stent placement in mesenteric arteries in patients with the rare diagnosis of chronic mesenteric ischemia. We present a survey from the initial stage of recognition of this gastrointestinal disorder and its manifestations to treatment by stenting to avoid further ischemic episodes and bowel infarction and necrosis. The advantages of stent placement in splanchnic arteries are discussed in comparison to open surgical revascularization.     

肠系膜静脉血栓形成31例临床分析

目的 分析肠系膜静脉血栓形成的临床特点,探讨其早期诊断和治疗方法.方法回顾性分析31例肠系膜静脉血栓形成患者的临床资料.结果31例患者中,急性组19例,36.8%患者有肢体血栓性静脉炎或肺栓塞史,均以腹痛为首发症状,并进行性加重,57.9%患者出现腹膜刺激征,68.4%出现腹水征;13例患者经腹部CT或选择性血管造影检查确诊,CT检出率83.3%;93.3%患者血浆D-二聚体升高;手术治疗13例,抗凝治疗6例,病死率15.8%,复发率21.1%,2例死亡.慢性组12例,均无急腹症表现,经腹部CT检查确诊,66.7%患者出现上消化道出血.结论肠系膜静脉血栓形成是一种缺乏特异性临床表现、病死率高的疾病,腹部CT检查对早期诊断有重要价值,及时手术、抗凝治疗可以降低病死率.     

急性肠系膜动脉性缺血患者的术后护理

肠系膜动脉缺血性疾病是指由于肠系膜动脉的急性血循环障碍,导致肠管缺血坏死,临床上表现为血运性肠梗阻.其原因包括肠系膜上动脉栓塞及肠系膜上动脉血栓形成,其中以肠系膜上动脉栓塞较多见.临床起病急骤,病情发展迅速,误诊率及死亡率均较高.因此,护理干预对急性肠系膜动脉性缺血的康复非常重要.我科2008年1月～2011年6月对32例患有急性肠系膜动脉性缺血的术后患者进行护理干预,取得满意效果,现报告如下.     

Delta Opiates Increase Ischemic Tolerance in Isolated Rabbit Jejunum

Mammalian hibernation is mediated by humoral agonists of the delta opioid receptor (DOR). Moreover, transfer of either humoral or synthetic DOR agonists to non-hibernators reportedly induces a state of improved myocardial ischemic tolerance. OBJECTIVE: To determine whether the DOR agonist D-Ala 2, D-Leu 5, enkephalin (DADLE) similarly elicits protection in noncardiac-i.e., mesenteric-tissue. METHODS: In Protocols 1 and 2, the authors developed and characterized an in vitro model of mesenteric ischemia/reperfusion in isolated rabbit jejunum by documenting the effect of increasing ischemic duration (0 to 120 minutes) and the relative importance of glucose and/or oxygen deprivation on the evolution of jejunal injury. In Protocol 3, jejunal segments were randomized to receive either no treatment (controls) or 15 minutes of pretreatment with 1 microM DADLE, followed by 60 minutes of simulated ischemia and 30 minutes of reperfusion. Jejunal injury was quantified by repeated, time-matched assessment of peak contractile force evoked by 1 microM acetylcholine (all protocols) and delineation of tissue necrosis (Protocol 1). RESULTS: Development of significant jejunal injury required combined oxygen/glucose deprivation. Moreover, there was a direct relationship between ischemic duration and tissue injury, and a significant inverse correlation between reperfusion contractile force (% of baseline) and the extent of smooth muscle necrosis (r(2) = 0.87; p < 0.01). Most notably, mesenteric ischemia/reperfusion injury was attenuated by DADLE: reperfusion contractile force was 47 +/- 5% versus 36 +/- 5% in DADLE-treated versus control segments (p < 0.01). CONCLUSIONS: Treatment with the delta opioid agonist DADLE increases ischemic tolerance of isolated rabbit jejunum.     

肠系膜静脉血栓形成8例临床分析

目的 探论肠系膜静脉血栓的诊治方法.方法 回顾性分析北京医院2003～2005年收治的8例肠系膜静脉血栓病例.结果 5例患者康复出院;2例术后短肠综合征,出院后未访;1例术后死亡.结论 腹部手术史(37.5%)和肝硬化(25.0%)是肠系膜静脉血栓的明确诱因;D二聚体(D-dimer)和磁共振成像(MRI)是有效的检查手段;坏死肠段切除术后严格抗凝、祛聚治疗效果满意.     

Technique profile: mesenteric reconstructions for occlusive disease

Visceral ischemic syndromes are rare but catastrophic disorders. In acute presentations, treatment modalities include thrombolytic therapy, open surgical revascularization and percutaneous endovascular therapy. Endovascular therapy has become the most commonly utilized treatment option for chronic mesenteric ischemia and should be considered the first line of therapy for patients with anatomically suitable lesions or excessive open surgical risk. Open surgical revascularization has been associated with outstanding long-term outcomes. The various surgical and endovascular techniques and their associated outcomes for the treatment of mesenteric ischemic syndromes are reviewed in detail.     

Idiopathic inferior mesenteric venous thrombosis demonstrated by angiography

Idiopathic thrombosis of the inferior mesenteric vein, not associated with portal vein thrombosis, is an uncommonly diagnosed lesion. We are reporting a case of inferior mesenteric vein thrombosis diagnosed preoperatively by angiography. We believe this to be the first case in the literature of this particular lesion demonstrated conclusively by angiography before surgery.     

急诊疑似肠系膜动脉缺血患者血浆D-二聚体的检测及临床意义

目的探讨血浆D-二聚体检测在急性肠系膜动脉缺血(AMAI)中的应用价值。方法对124例疑诊为AMAI急腹症患者进行前瞻性研究。疼痛发作24h内抽血检测D-二聚体、纤维蛋白原、活化部分凝血活酶时间、凝血酶原时间、凝血酶时间。用阳性似然比评价D-二聚体水平在诊断急性肠系膜动脉缺血中的价值。结果9例确诊为AMAI中,D-二聚体中位数为1.6(0.4-5.6)mg/L,明显高于39例炎性疾病患者(P<0.01),高于22例肠痉挛患者(P<0.05)。D-二聚体水平>1.5mg/L结合心房颤动、女性等临床特征,计算阳性似然比为14.9。急性肠系膜动脉缺血患者中无一例D-二聚体水平<0.3mg/L。结论D-二聚体水平检测在急腹症诊断中对排除急性肠系膜动脉缺血性疾病有重要价值。     

Doppler ultrasound in the diagnosis of intestinal ischemia

Conventional ultrasound is unreliable in detecting narrowing of the visceral arteries. Two cases are reported in which duplex Doppler ultrasound correctly identified severe narrowing of the celiac artery. Doppler ultrasound promises to be more accurate than conventional ultrasound in the diagnosis of visceral ischemia and may help to identify those patients who may require angiography.     

Computed tomographic findings in bowel ischemia

Computed tomography (CT) has been used in the evaluation of 11 patients with ischemic bowel lesions before confirmation of the disease with surgery or autopsy. The CT abnormalities were thickened bowel wall (10 patients) with post-contrast enhancement (9 patients), dilated fluid-filled bowel (9 patients), intramural low attenuation zones (5 patients), intramural gas (8 patients), and focal or diffuse free intraperitoneal fluid (5 patients). The diagnosis of bowel ischemia should be considered when performing CT in patients with abdominal pain of unknown etiology.     

Acute mesenteric ischemia: endovascular therapy

Acute mesenteric ischemia (AMI) is an abdominal emergency with a high mortality. Prompt revascularization can prevent intestinal infarction and reduce mortality. We report three cases of acute occlusive mesenteric ischemia without signs of intestinal necrosis, which were successfully managed with endovascular interventions. Mechanical thrombus fragmentation was performed and underlying chronic stenoses were treated with stent implantation. All the patients had pain relief immediately after the procedure, and none of them required surgery for bowel resection. The patients remained symptom free during a follow-up of 12–16 months. We suggest that endovascular treatment is a feasible option in patients with AMI and can prevent intestinal infarction.     

肠系膜上静脉血栓形成诊疗应注意的问题

肠系膜上静脉血栓形成(superior mesenteric vein thrombosis,SMVT)是肠缺血疾病中的一种,临床上较为少见,然而通常是致命性的。由于SMVT发病率较低及临床表现缺乏特异性,早期诊断难度较大,病死率较高。影像学检查的进展使得SMVT早期诊断成为可能,其中CT由于具有较高的敏感性及特异性,应作为临床首选检查手段。SMVT一经诊断,应立即予以抗凝治疗,以抗凝治疗为基础的保守治疗无效时,可考虑进一步行腔内治疗及手术治疗。任何时候,一旦出现疑似肠坏死的情况,应立即予以外科手术治疗。     

Evaluation of acute mesenteric ischemia: accuracy of biphasic mesenteric multi-detector CT angiography

The purpose of this study was to explore the accuracy of multi-detector row helical CT (MDCT), using a biphasic mesenteric angiography protocol for evaluation of acute mesenteric ischemia (AMI). In total, 79 consecutive patients with clinical signs of AMI underwent contrast enhanced 16- or 40-channel MDCT. MDCT findings were correlated with surgery, endoscopy and clinical outcome. Sensitivity, specificity, and positive and negative predictive values were calculated using the patients in which AMI had been excluded as a control group. In 28 patients the final diagnosis was AMI. In 27 patients (96.4%) MDCT correctly diagnosed AMI (specificity of 97.9%). A sensitivity of 93%, specificity of 100%, and positive and negative predictive values of 100% and 94%, respectively were achieved for the CT findings of visceral artery occlusion, intestinal pneumatosis, portomesenteric venous gas or bowel wall thickening in combination with either portomesenteric thrombosis or solid organ infarction. Our findings suggest that mesenteric MDCT angiography is an accurate tool for fast diagnostic work-up of patients with suspected AMI.     

急性肠系膜静脉血栓形成早期诊治分析

目的:探讨急性肠系膜静脉血栓形成(AMVT)的临床特征及早期诊断与治疗方法。方法:对1996-01-2009-10收治的13例AMVT患者的临床资料进行回顾性分析。结果:手术前确诊4例,其中2例保守治疗成功。11例手术治疗,平均切除肠管240cm。10例治愈,3例死亡。结论:厌食、腹部饱胀不适,症状和体征不符的腹痛和可能存在的高凝状态是早期诊断的线索,彩色多普勒及CT扫描血管重建检查对早期诊断有重要意义。     

双源CT血管成像诊断急性肠系膜缺血价值

目的探讨双源CT血管成像（dual—sourceCTangiography,DSCTA）在急性肠系膜缺血（acutemesentericischemia,AMI）诊断中的价值。方法回顾性分析14例经手术或介入治疗证实AMI患者的DSCTA影像资料。结果14例患者中肠系膜上动脉栓塞2例,肠系膜上动脉血栓形成6例,肠系膜上静脉血栓形成3例（1例合并门静脉血栓）,肠系膜上动脉重度狭窄1例,表现为血管突然中断,管腔内充盈缺损,管壁增厚,管腔变小,钙化影;肠系膜上动脉夹层2例,显示为真假双腔,内膜片清晰。间接征象为不同程度肠腔扩张,肠管内气液平,肠壁增厚或变薄,腹腔积液。增强扫描时肠壁不强化或强化延迟、减弱。结论DSCTA可准确显示AMI直接征象,是较理想的影像学检查方法。