Aneurysm arising from the branch of the superior mesenteric artery.

Superior mesenteric branch aneurysms are rare and usually become symptomatic at the time of rupture. Pain, gastrointestinal blood loss and intra-abdominal hemorrhage draw attention to the presence of aneurysms in 70% of the reported cases. We report on a 64-year-old male patient who had an emergent laparotomy for acute abdominal pain at a local hospital in Changhua in March of 1988. The operative finding was an unresectable mesentric mass, and the pathologic finding of the biopsy was a chronic abscess. Because of two episodes of tarry stools after the operation, the patient was referred to the National Taiwan University Hospital for further evaluation of the intra-abdominal mass. After admission in April of 1990, abdominal sonogram and CT examinations demonstrated the presence of a multilobulated mass which was suspected to be an aneurysm. Selective superior mesenteric arteriography confirmed this diagnosis and showed that the aneurysm arose from the origin of the ileocolic branch. At surgery, the aneurysm was found to have a fistula tract communicating with the terminal ileum. The aneurysm and the associated segment of the terminal ileum were successfully removed. We herein report this unusual case.     

Effect of caffeine on superior mesenteric artery blood flow velocities in preterm neonates

Objective: To investigate the effect of caffeine infusion on superior mesenteric artery (SMA) blood flow velocities (BFV) in preterm infants.

Methods: Prospective observational study on 38 preterm neonates 28–33⁺⁶ weeks gestation, who developed apnea on their first day of life, and caffeine citrate infusion was initiated at a loading dose of 20?mg/kg, followed by a maintenance dose of 5–10?mg/kg/day. Duplex ultrasound measurements of SMA BFV were recorded: peak systolic velocity (PSV), end diastolic velocity (EDV) and resistive index (RI), at 15?min before, 1-, 2- and 6-h after caffeine loading dose, and 2?h after two maintenance doses.

Results: There was a significant reduction in PSV 1-h (p?=?.008), a significant decrease in EDV 1- and 2-h (p?=?.000 and p?=?.005, respectively) and a significant increase in RI 1- and 2-h (p?=?.003 and p?=?.005, respectively) following caffeine loading dose, as compared to values before caffeine infusion. No significant effect of caffeine maintenance doses on SMA BFV was observed (p?>?.05).

Conclusion: Blood flow in SMA is significantly reduced after caffeine citrate infusion at a loading dose of 20?mg/kg. This effect continues for at least 2?h. Meanwhile, SMA BFV seems not affected by maintenance doses.     

Improvement of mesenteric superior artery Doppler velocimetry by amnio-infusion in fetal gastroschisis.

This study aimed to analyse the influence of amnio-infusion on superior mesenteric Doppler velocimetry and to correlate Doppler data with outcome in fetuses presenting with gastroschisis. Umbilical and intra- and extra-abdominal superior mesenteric artery Doppler velocimetry was measured prospectively before and after amnio-infusion in fetuses with gastroschisis. Doppler index values and changes were correlated with the following outcome parameters: importance of fibrous coating, duration of hospitalization in the neonatal intensive care unit, total duration of hospitalization, duration of parenteral feeding, duration of ventilatory assistance, and the interval to initiation of oral feeding. A significant improvement of diastolic flow was observed in the extra-abdominal superior mesenteric artery with amnio-infusion. No similar change was seen in the intra-abdominal superior mesenteric or in the umbilical artery. Pre-amnioinfusion extra-abdominal mesenteric Doppler index was correlated with maximal diameter of exteriorized bowel and slightly with duration of hospitalization in the neonatal intensive care unit, but no other relation between Doppler index and outcome parameter could be ascertained. Amnio-infusion induces modifications in the vascularization of exteriorized bowel in gastroschisis. This could partly explain the beneficial effect of this procedure on fetal gut.     

The hemodynamic effects of neonatal patent ductus arteriosus shunting on superior mesenteric artery blood flow.

OBJECTIVE: To determine if the ratio of the pulsatility index (PI) of the left pulmonary artery to the PI of the descending aorta, the Rp/Rs index, correlates with the degree of ductal steal from the intestine in neonates with a patent ductus arteriosus (PDA). STUDY DESIGN: Echocardiograms and Doppler studies of the superior mesenteric artery (SMA) were performed in 41 neonates less than 35 weeks gestational age with a hemodynamically significant PDA (hsPDA). RESULTS: There was a significant negative correlation between the Rp/Rs index and the SMA PI after controlling for ductal size (r=-0.476, p<0.008). CONCLUSIONS: The Rp/Rs index can be used as an indicator of ductal steal on intestinal blood flow. The Rp/Rs index may be a useful adjunct to existing and new techniques for improving early assessment and treatment of hsPDA, and for evaluating the effects of hsPDA on systemic organs.     

A simplified technique for revascularization of homografts of the liver with a variant right hepatic artery from the superior mesenteric artery

A simplified technique for conversion of a complex hepatic arterial supply into a common channel is described. This technique permits single vessel anastomosis in the recipient of a liver transplant.     

Physiological changes in blood flow velocities in the superior mesenteric and coeliac artery in healthy term fetuses and newborns during perinatal period

Objective.?The aim was to describe the course of physiological changes in coeliac artery (CA) and superior mesenteric artery (SMA) blood flow velocities (BFVs) during the perinatal period in healthy term fetuses and infants as it has not been studied in detail so far.

Methods.?This prospective Doppler ultrasound study included 50 infants. The examinations were performed in a fetus after the completion of 36.0 gestation weeks before the onset of labor and in infants postnatally at the ages of 2, 24, and 72?h.

Results.?The end-diastolic velocity (EDV) in the CA was generally higher than in the SMA (p?<?0.001). The EDV in the SMA decreased postnatally (8.4 vs.??7.2, p?<?0.001) and showed negative values in 92% of infants. By 24?h of postnatal age, EDV in the SMA had become positive in all of the infants (mean 13.8 cm/s, p?<?0.001). The EDV in CA had only positive values. The changes in EDV in both vessels were reflected by changes in the resistance index in inverse manner.

Conclusions.?BFV in the CA and SMA changed dramatically in the perinatal period; the most remarkable changes occurred within the first 24?h of life.     

Prediction of feed intolerance and necrotizing enterocolitis in neonates with absent end diastolic flow in umbilical artery and the correlation of feed intolerance with postnatal superior mesenteric artery flow

Objectives.?To evaluate the role of postnatal superior mesenteric artery (SMA) flow in predicting feed intolerance and NEC in the babies who had AEDF in comparison with gestation matched SGA and AGA with normal flow.

Design.?This was a prospective cohort study conducted in 62 eligible babies admitted in NICU. Babies were enrolled in 3 groups. Group 1 (n = 23) was SGA and AEDF, group 2 (n = 20) was SGA and group 3 (n = 19) was AGA and both with normal UA flow. In all babies baseline SMA flow was measured before test feed (0.5 ml) and repeated every 15 minutes for 1 hour after the feed.

Results.?Feed intolerance was seen in 69.5% of babies in group1 (p = <0.001) as compared to 20% and 17.5% in group 2 and 3. Four (17.3%) babies developed NEC in group1 (p = 0.02) but none in other 2 groups. Baseline peak systolic velocity (PSV) and time average mean velocity (TAMV) at 60 min post feed were significantly (p = 0.01 and 0.028 respectively) lower in group1 than group3. TAMV and PSV at 60 min post feed were significantly lower (p = 0.028 and 0.03) in babies with feed intolerance as compared to no feed intolerance group. Absent end diastolic flow and hypoglycemia were independent risk factors for feed intolerance.

Conclusion.?SGA babies with AEDF had higher incidence of feed intolerance and NEC. Serial SMA flow studies specially the 60 min post feed study may help in differentiating which babies are likely to develop feed intolerance.     

Effect of normal pregnancy upon the glycosylated haemoglobins.

In this cross-sectional study total glycosylated haemoglobin (Hb AIa+b+c) has been measured in 20 healthy non-pregnant women and in five groups of 20 healthy women at various times during pregnancy. A statistically significant decrease occurs in these minor haemoglobin fractions by about 20 weeks gestation and this reduced level is maintained throughout the rest of pregnancy. If diabetic patients are to have their control assessed during pregnancy by determination of these fractions this fact might be relevant.     

Effect of albumin on transplacental transfer and distribution of rosiglitazone and glyburide.

OBJECTIVE: The aims of this investigation were (i) to determine the rate and extent of rosiglitazone transfer across term human placenta, and (ii) to determine the effect of human serum albumin (HSA) on rosiglitazone and glyburide transfer and distribution. METHODS: These aims were achieved by utilizing the technique of dual perfusion of placental lobule (DPPL). Each hypoglycemic drug was coperfused with the marker compound antipyrine (AP). In each experiment, the [3H]-isotope of the hypoglycemic drug and the [14C]-isotope of AP were added to enhance the detection limits of each drug. Human serum albumin (HSA) was added to both the maternal and fetal circuits in the experiments in which it was investigated. RESULTS: Transplacental transfer of rosiglitazone and glyburide from the maternal to fetal circuits in media devoid of HSA was similar. However, the addition of HSA to the maternal and fetal circuits had different effects on the transfer and distribution of the two drugs, though their binding to HSA (99.8%) was almost identical. HSA increased the maternal (M) to fetal (F) transfer of rosiglitazone, as revealed by an increase in its F/M concentration ratio from 0.17 +/- 0.01 (in the absence of albumin) to 0.33 +/- 0.07 (p < 0.001). Moreover, the addition of albumin decreased the amount of rosiglitazone retained by placental tissue from 539 +/- 148 to 60 +/- 8 ng/g (p < 0.001). Conversely, the addition of HSA to the perfusion media resulted in a decrease in glyburide transfer, as revealed by the change of its F/M concentration ratio from 0.09 +/- 0.02 (in the absence of albumin) to 0.03 +/- 0.01 (p < 0.01). However, similar to rosiglitazone, glyburide retention by the tissue decreased from 103 +/- 26 to 19 +/- 6 ng/g (p < 0.001). CONCLUSIONS: These data indicate that the binding of the two drugs to albumin, though similar, is only one of the factors that could affect their placental transfer and distribution.     

Acute pseudo-obstruction of the colon following partial splenic artery embolization: report of a case.

This is a case of a 45-year-old woman suffering from liver cirrhosis with hypersplenism who received a partial splenic artery embolization with gelfoam pieces. Thrombocytopenia and leukopenia improved immediately after treatment. Marked abdominal distention, metallic bowel sounds and combined small and large bowel distension with air-fluid levels as shown on a plain abdominal X ray were noted on the fifth day after the embolization procedure. Laparotomy was performed. No mechanical obstruction was found during surgery. Acute pseudo-obstruction of the colon (Ogilvie's syndrome) was diagnosed. This condition was considered to be a complication of the partial splenic artery embolization and has not hitherto been reported.     

Effect of exogenous dehydroepiandrosterone upon the fetoplacental biosynthesis of estrogens and its effect upon uterine blood flow in the term pregnant ewe.

The fetoplacental unit of the ewe is capable of increasing the biosynthesis of estrogens following the exogenous administration of DHEA to the fetus. The maximum concentrations of estrogens appeared approximately 30 minutes after the administration of DHEA. Uterine blood flow in the pregnant ewe increased approximately 90 minutes after the maximum concentrations of estrogens were noted. The administration of DHEA to the nonpregnant, ovariectomized ewe did not elicit estrogen biosynthesis or changes in uterine blood flow. Isotope experiments in the pregnant ewe demonstrated the incorporation of DHEA into urinary estradiol.