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At least 1,531 records · Page 85Linked to original sources
PubMed2000

[The value of intraoperative ultrasonography during surgery for pancreatitis related changes of the pancreas].

The main purpose of this work was to examine the value of intraoperative ultrasonography (IOS) for decision-making in patients with complications of chronic pancreatitis and pancreatic adenocarcinoma. High-resolution intraoperative ultrasound scanning using B-mode real time (Capasee SSA-220A, Toshiba, Tokyo, Japan) and 7.5 MHz T-type transducer was performed in 48 patients (18 women and 30 men) treated at the Second Department of General Surgery between 1996 and 1998. The size, echogenicity and location of pancreatic lesions was studied, as well as the structure of liver, bile ducts and regional lymph nodes. The value of IOS was assigned to one of three categories: 1) very helpful--the scheduled operative procedure was modified in the light of IOS findings; 2) helpful--the operative procedure was carried out under IOS guidance; and 3) not helpful. The patients were divided into three groups basing on the histologic changes: Group I--26 patients operated for pancreatic carcinoma; group II--19 patients with cystic lesions and inflammatory tumors of the pancreas; group III--3 patients operated for preoperatively diagnosed pancreatic carcinoma not confirmed during surgery. In group I eight resections were performed, including five Whipple duodenopancreatectomies, two pancreatectomies, and one subtotal pancreatectomy. Very helpful information was obtained from IOS in four (16%) patients, helpful information in 11 (42%), not helpful in 11 (42%). Two nonpalpable masses were revealed by ultrasonography. In all cases the spread of the carcinoma to peripancreatic vessels: portal vein, superior mesenteric artery and inferior caval vein was correctly assessed (Figs. 1, 2). IOS provided mainly topographic information in group II, with very helpful and helpful data for 89% of the operations. Three cystic lesions in the inflammatory infiltrate and three hitherto undetected minor cysts were found. IOS facilitated drainage in 11 cases by reducing tissue trauma and operative time (Fig. 3). In six patients with suspected inflammatory lesions ultrasound served to guide needle biopsy. In group III the information was of diagnostic value. All patients in this group were intraoperatively diagnosed with extrapancreatic primary neoplasm spreading to the hepatoduodenal ligament. IOS served to inert a prosthesis of the common bile duct in one patient. Overall, IOS was very helpful for decision-making in 22.9% and helpful in 50% of the procedures (Tab. 1).

Adenocarcinoma↗
PubMedDate not supplied

[Endovascular treatment: peripheral vascular disease].

Peripheral arterial disease comprises those entities that result in obstruction to blood flow in the supra-aortic, mesenteric, renal and infrainguinal vessels. This review focuses on the endovascular treatment of extracranial internal carotid obstructive lesions, descending thoracic aorta aneurysms, and reconstruction of the aortoiliac bifurcation. The utilization of carotid artery stenting as a less invasive alternative to the surgical treatment for the extracranial internal carotid artery stenosis has progressively increased. Preliminary reports of carotid stenting with distal protection have shown a favorable reduction in the adverse event rates; but, the advantage of the endovascular approach has to be established in comparative and randomized trials. Transluminal endovascular stent grafting is rapidly emerging as a modality to repair descending thoracic aorta aneurysms. Preliminary experience has demonstrated the feasibility and safety of endovascular stent-graft treatment. However, further long-term follow-up is mandatory. Reconstruction of the aortoiliac bifurcation is not usually considered an indication for percutaneous treatment. Although there is limited experience, the results are encouraging with > 90% technical success and high primary patency at 3 years. Endovascular intervention has the potential benefit to reduce the cardiopulmonary and neurological complications and to be applicable to most traditional vascular operations.

Angioplasty↗
PubMed1975

The clinical use of dopamine in the treatment of shock.

Dopamine is a direct-acting catecholamine with a short half-life that has many advantages in treating visceral hypoperfusion states such as shock and refractory heart failure. Unlike other inotropic drugs, dopamine directly dilates the mesenteric, renal, and cerebral vessels and redirects blood flow to essential viscera. This dopaminergic effect is prominent with doses of 100-700 mug/min in adults and is attenuated by phenothiazines and haloperidol. At doses of 700-1400 mug/min, dopamine also has a significant beta-adrenergic, inotropic effect, increasing myocardial contractility. The inotropic effect is equivalent to that of isoproterenol, epinephrine, and norepinephrine, but tachycardia, tachyarrhythmias, and angina may be less frequent with dopamine. In doses greater than 1400 mug/min, dopamine is a vasoconstrictor with pressor effects usually equivalent to that of norepinephrine. Dopamine dilates pupils, does not dilate bronchi, and does not shunt blood from viscera to skeletal muscles as does isoproterenol. Because dopamine increases myocardial contractility, selectively redistributes perfusion to essential viscera and allows a pharmacologic titration of effect, it is a logical first-choice catecholamine for treatment of shock and refractory heart failure.

Adrenergic alpha-Agonists↗
PubMed1988

Intrarenal dopamine-1 receptors control renal function.

Dopamine receptors are classified to DA-1 and DA-2 and are characterized in renal tissue by radioligand binding and by the response of renal adenylate cyclase to dopaminergic agonists and antagonists. DA-1 receptors are localized in the renal tubules, the medial layer of renal microvessels, and the juxtaglomerular apparatus. DA-1 receptor stimulation causes dilation of renal, mesenteric, coronary, and cerebral vessels. In the present study, we tested the hypothesis that dopamine is a paracrine substance in the control of renal function. We employed a potent specific DA-1 receptor antagonist, SCH, to evaluate the role of intrarenal DA-1 receptor in the maintenance of renal function. Intrarenal DA-1 receptor blockade with SCH caused a highly significant dose-dependent antidiuresis and antinatriuresis, and decreased FENa. A rebound diuresis and natriuresis above control values were observed after cessation of DA-1 receptor blockade. There were no changes in renal hemodynamic function during DA-1 receptor blockade. These results strongly suggest that the antinatriuresis and antidiuresis induced by DA-1 receptor blockade are mediated by an action at the renal tubule. The infusion rate of SCH administered intrarenally was sufficiently low to produce no measurable systemic effects including PRA, PAC, and MAP. Thus, these results can be interpreted as due to intrarenal DA-1 blockade. In summary, we have demonstrated that renal excretory function is highly sensitive to DA-1 receptor blockade within the kidney and appears to be mediated by renal tubular events. This study provides strong evidence that DA-1 receptors play a physiological role in the control of renal function.

Animals↗
PubMed1988

Lymphocytic enteritis in a filly.

A yearling Hanoverian filly had intermittent colic for 6 weeks, chylous peritoneal effusion, and a firm mass palpable per rectum. Exploratory laparotomy revealed mesenteric lymphadenopathy, adhesion of the mesenteric root to the duodenum and jejunum, distention of the mesenteric veins and lymphatic vessels, and increased jejunal venous pressure. Lesions in the duodenum, jejunum, and colon included infiltration of lymphocytes and plasma cells in the lamina propria.

Animals↗
PubMed1979

[Polyarteritis nodosa: evolution of the angiographic findings and uncommon localizations (author's transl)].

A series of 10 patients with polyarteritis nodosa have been studied by means of angiographic investigations with selective arteriography of the different visceral districts. The attention is focused on some unusual localizations of the typical lesions such as aneurysms of the supra-renal artery of the coronary artery and of the femoral artery. Up to now these localizations have been described only in post mortem examinations. Such localizations should be considered as a demonstration of the multicentric spread of the disease, independently from its degree of development. On the other hand a correlation seems to exist between the evolution of the disease in the increase in size of the aneurysmatic lesions as well as with the simultaneous presence of all the angiographic signs.

Aneurysm↗
PubMed1993

[Synthesis of (+/-) demethoxy-eleutherol and (+/-) demethoxy-eleutherin].

(+/-) Demethoxy-eleutherol and (+/-) demethoxy-eleutherin were synthesized for studying the relationship between structure and coronary dilation activity. The structures of the two compounds and intermediates were confirmed by means of IR, MS and 1HNMR. Preliminary pharmacological experiments showed no activity for the two compounds.

Animals↗
PubMed1993

L-propionylcarnitine and synchronization of spontaneous activity in rat isolated portal vein.

The effects of L-propionylcarnitine (LPC) on spontaneous mechanical and electrical activity of rat portal vein have been studied "in vitro" by means of an isometric technique. Mechanical activity in normal Krebs solution consisted, in the majority of cases, in phasic contractions with variable amplitude, duration and frequency, while electrical activity showed both slow and fast spike potential components. By adding LPC to the medium at doses ranging from 10(-5) M to 10(-3) M, no effect has been observed while at concentrations from 2 x 10(-3) M to 8 x 10(-3) M, after an initial period of total inhibition, a dose-dependent increase in amplitude associated with a parallel decrease in frequency of contraction waves have been observed. The pattern of electrical activity was characterized by a regular slow wave component with the same frequency of the mechanical waves, and by an increase in number, amplitude and frequency of spike potentials. Experiments on synchronization of contractile activity showed that, in presence of LPC, hepatic and mesenteric regions of the vessel contract in close synchronism. These results suggest that LPC synchronizes spontaneous activity of rat portal vein by means of a mechanism which is at the present unknown.

Animals↗
PubMed1993

[Evaluation of intra-arterial infusion chemotherapy and radical pancreatectomy in patients with locally advanced pancreatic cancer].

This is a retrospective study to evaluate arterial infusion chemotherapy and resection for locally advanced pancreatic cancer involving retro-peritoneal organs or large vessels such as superior mesenteric artery or celiac trunks. Intra-arterial chemotherapy was performed for 19 patients, and 15 underwent pancreatectomy. Patients in the intra-arterial chemotherapy group could live 11 months out of the hospital, against 4 months in the resected cases (p < 0.05). The period of over 2nd degree in performance status was 11 months in the arterial chemotherapy group and 3 months in resected groups (p < 0.05). The survival rates were 53, 18 and 9% at 1, 2 and 3 years in the patients with arterial chemotherapy, respectively, against 22, 15 and 15% in the resected patients (p < 0.05). These results suggested that intra-arterial chemotherapy was significantly effective in prolonging the survival period with a better quality of life.

Angiotensin II↗
PubMed1995

[Is it permissible to operate on an asymptomatic aneurysm of the abdominal aorta after the age of 80?].

Whether or not to operate an asymptomatic aneurysm of the aorta in a patient over 80 years of age is a question increasingly facing the surgeon: longer life span (about 7 years), aneurysm discovered on a sonogram or scan ordered for digestive, urologic or pelvic disorders. This discussion is based on a personal retrospective series of 800 patients who underwent elective operation for non-ruptured aneurysms of the subrenal abdominal aorta between January 1985 and June 1990. For the 732 patients under 80, mortality was 1.9% and for the 68 patients over 80, it was 8.8%, emphasising that in this group survival at 6 months was reduced by 10%. The operative risk, as for younger subjects, results from coronary risk (reversible ischaemia), the quality of the heart muscle (ejection fraction < 35%), respiratory and renal function. Increased age raises mortality when one of these factors is severely jeopardized but associated lesions, such as digestive disorders or arterial lesions (severe occlusion of the downstream vessels, occlusion of the mesenteric and hypogastric arteries increases the risk of acute ischaemia of a limb or the intestine), should also be taken into consideration. Indications for operation should be discussed in light of these factors in patients at risk (large aneurysm > 60 mm or increasing in size, "images" suggesting risk of rupture: bleb or bubble ectasia, flotting mural thrombus, "digitiform" lysis of a mural thrombus, rupture of the calcified shell or covered rupture). When there is a high risk of lesion and the operative risk prohibits conventional surgery, other procedures can be discussed: axillo-bifemoral bypass with exclusion of the iliac and secondary embolization or subrenal exclusion, substitution with an endoaortic prosthesis allowing wider indications.

Aged↗
PubMed1981

Diameter, wall tension, and flow in mesenteric arterioles during autoregulation.

The effect of arterial pressure on vessel diameter, blood velocity, and intravascular pressure was examined in cat mesenteric arterioles in the arterial pressure range of 120--40 mmHg. Circumferential wall tension and volume flow in individual vessels were calculated. Twenty-nine arterioles with an average diameter of 25.1 micrometers were studied. Twenty-six reactive vessels dilated by an average of 6.5 micrometers with arterial pressure reduction, whereas three nonreactive arterioles narrowed by an average of 5.9 micrometers. When pressure was reduced, circumferential wall tension in reactive arterioles tended to be maintained, whereas in nonreactive vessels tension decreased more than pressure. Data from 25 of 26 reactive arterioles were consistent with the hypothesis that regulation of wall tension accounts for the autoregulatory response; however, in 18 of these vessels a flow-dependent mechanism could also account for the response. Thus the hypothesis that wall tension is a controlled variable responsible for autoregulation is supported, but an important role for flow regulation in local control is also supported.

Animals↗
PubMed2005

Mesenteric involvement of acute-stage Buerger's disease as the initial clinical manifestation: report of a case.

Buerger's disease is almost always a disease of the blood vessels in the extremities. Conversely, mesenteric involvement of Buerger's disease is rare, and no true series have been reported. We report the case of a 37-year-old man with clinical symptoms of upper extremity Buerger's disease, who underwent surgery for extensive small bowel infarction. Histopathologic findings revealed that the mesenteric arteries were swollen and infiltrated with neutrophils, but not associated with fibrinoid necrosis. The lumen was occluded by a highly cellular thrombus with the appearance of a microabscess. These findings were compatible with acute-stage mesenteric Buerger's disease and postoperative studies revealed multiple occluded segments in the small and medium-sized arteries of both legs and the left arm, suggestive of Buerger's disease in the extremities.

Acute Disease↗
PubMed2000

Novel inhibitors of nucleoside triphosphate diphosphohydrolases: chemical synthesis and biochemical and pharmacological characterizations.

To elucidate the physiological role played by nucleoside triphosphate diphosphohydrolase (NTPDase; EC 3.6.1.5), adenine nucleotide analogues, modified on the purine ring, have been synthesized and tested as potential inhibitors. Resistance of ATP analogues to hydrolysis and their potency as NTPDase inhibitors were evaluated. For this purpose, a particulate fraction isolated from bovine spleen was used as the enzyme source. Among the synthesized analogues, 8-thiobutyladenosine 5'-triphosphate (8-BuS-ATP) was found to be the most effective nonhydrolyzable competitive inhibitor, with an estimated K(i) of 10 microM. This nonhydrolyzable analogue did not exert any P2X-receptor-mediated effect on endothelium-denuded blood vessels, from the guinea pig mesenteric bed. In agreement with this observation, infusion of the analogue did not cause any significant blood pressure variations of the precontracted vessel. Because in previous studies on isolated turkey erythrocytes and rat astrocytes 8-BuS-ATP was not able to trigger any P2Y(1)-receptor-mediated effect, it therefore appears that this NTPDase inhibitor does not interfere with purinergic receptors.

Adenosine Triphosphate↗
PubMed1993

Inferior mesenteric and hypogastric artery reconstruction to prevent colonic ischaemia following abdominal aortic aneurysmectomy.

In 179 patients receiving prosthetic grafts for abdominal aortic aneurysmectomy, an attempt was made to preserve or restore continuity of at least two vessels, including the patent inferior mesenteric artery (IMA) and bilateral hypogastric arteries (HGAs), so as to prevent colorectal ischaemia. Adjunctive reconstruction of the IMA and/or HGAs was performed in 60 patients; a total of 40 HGAs and 31 IMAs were reconstructed. The hospital mortality rates of patients with elective and ruptured aneurysm repair were 3.9 and 22% respectively. There were no deaths related to colorectal ischaemia. The mean(s.d.) IMA stump blood pressure was 66(18) mmHg and the mean(s.d.) IMA stump pressure index (the ratio of mean peak systolic IMA pressure to mean systolic systemic pressure) was 0.58(0.15). The IMA was revascularized in all patients whose stump pressure was < 40 mmHg and whose index was < 0.4. Postoperative angiography revealed a 94% patency rate for the IMA and 92% for the HGAs. Colorectal ischaemia did not develop in any patient in whom aneurysmectomy was performed electively or in any who had colonoscopy because of watery diarrhoea after surgery. These results indicate the significance of adjunctive reconstruction of the IMA and HGA during abdominal aortic aneurysmectomy.

Adult↗
PubMed1998

Acute mesenteric ischemia after open heart surgery.

Acute mesenteric ischemia is a rare but severe complication after open heart surgery. Its incidence (0.2-0.4%) is quite low, but mortality rates are ranging between 70% and 100%. From October 1992 to December 1996, 4,640 patients underwent open heart surgery with cardiopulmonary bypass: 74.6% coronary artery bypass graft (CABG) operations, 23.2% valve replacement including aortic repairs, and 2.2% corrections of congenital heart diseases or tumors of the heart. The overall mortality rate (30 days) was 3.4%, and after CABG, 2.9%. Twelve patients (0.26%), following CABG (one combined with aortic valve replacement, one with mitral reconstruction, and one with carotid disobliteration) developed signs of acute mesenteric ischemia in the early postoperative period (day 1 to 5). In all patients various abdominal symptoms, leukocytosis, acidosis, hyperlactatemia, hyperosmolality, renal failure, and, finally, hemodynamic instability were observed. Eleven patients underwent emergency laparotomy. Mesenteric angiography was done if possible in still stable patients (n=7); it showed severe stenosis or occlusion prior to the operation in each case. Other diagnostic methods were not reliable. In six patients (55%) during the first look, extensive bowel necrosis was found and in five patients an ischemic intestine but no necrosis was detected. Of these, three patients were affected by extensive bowel gangrene at the second look. In the fourth patient a disseminated peripheral ischemia of the entire small intestine was found intraoperatively. After mechanical release and stimulation normal bowel function could be reestablished. One patient underwent percutaneous transluminal angioplasty prior to the laparotomy. Bowel perfusion was still deteriorated but no necrosis was found intraoperatively. These patients were the only survivors in the investigated group; 10 of 12 patients (83.3%) died in the early postoperative period (day 1 to day 6). Predisposing factors for mesenteric ischemia are: arteriosclerotic patients after CABG (100%), age >70 years (91.7%), hyperosmotic dehydration (100%), and cardiac ischemia in 25%. Mesenteric ischemia is a fatal complication with high mortality rates after open heart surgery, especially in older, dehydrated patients with generalized atherosclerotic vessel disease. As the acute mesenteric ischemia usually starts during anesthesia or in the early postoperative period, setting of immediate diagnosis is very difficult. With the occurrence of typical symptoms diagnostic and therapeutic procedures (angiography and laparotomy) must be done very urgently owing to the life-threatening mesenteric process. When mesenteric gangrene already has taken place, the prognosis is very poor, despite extensive resection. Prevention can be exercised by avoiding perioperative hyperosmotic dehydration of patients at high risk.

Acidosis↗