scholarly journals Prospects of Intraoperative Multimodal OCT Application in Patients With Acute Mesenteric Ischemia

2021 ◽  
Author(s):  
Elena Kiseleva ◽  
Maxim Ryabkov ◽  
Mikhail Baleev ◽  
Evgeniya Bederina ◽  
Pavel Shilyagin ◽  
...  
Keyword(s):  
Small Intestine ◽  
Mesenteric Ischemia ◽  
Acute Mesenteric Ischemia ◽  
Diagnostic Techniques ◽  
Intestinal Wall ◽  
Control Group ◽  
Serous Membrane ◽  
Non Invasive ◽  
Associated Conditions ◽  
Clinical Conditions

Introduction: Despite the introduction of increasingly multifaceted diagnostic techniques and the general progress of emergency abdominal and vascular surgery, the outcome of treatment of patients with acute impaired intestinal circulation remains unsatisfactory. The non-invasive and high-resolution technique of optical coherence tomography (OCT) can be used intraoperatively to assess intestine viability and associated conditions that frequently emerge under conditions of impaired blood circulation. This study aims to demonstrate the effectiveness of multimodal (MM) OCT for intraoperative diagnostics of both the microstructure (cross-polarization OCT mode) and microcirculation (OCT angiography mode) of the small intestine wall in patients with acute mesenteric ischemia (AMI). Methods and Participants: A total of 18 patients were enrolled in the study. Nine of them suffered from AMI in segments II-III of the superior mesenteric artery (AMI group), where the ischemic segments of the intestine were examined. Nine others were operated for adenocarcinoma of the colon (control group), thus allowing areas of their normal small intestine to be examined for comparison. Data on the microstructure and microcirculation in the walls of the small intestine were obtained intraoperatively from the side of the serous membrane using the MM OCT system (IAP RAS, Russia) before bowel resection. The MM OCT data were compared with the results of histological examination. Results: The study finds that MM OCT visualized the damage to serosa, muscularis externa, and blood vessels localized in these layers in 100% of AMI cases. It also visualized the submucosa in 33.3% of AMI cases. The MM OCT image of non-ischemic (control group), viable ischemic and necrotic small intestines (AMI group) differed significantly across stratification of the distinguishable layers, the severity of intermuscular fluid accumulations and the type and density of the vasculature. Conclusion: The MM OCT diagnostic procedure optimally meets the requirements of emergency surgery. Data on the microstructure and microcirculation of the intestinal wall can be obtained simultaneously in real time without requiring contrast agent injections. The depth of visualization of the intestinal wall from the side of the serous membrane is sufficient to assess the volume of the affected tissues. However, the methodology for obtaining MM OCT data needs to be improved to minimize the motion artefacts generated in actual clinical conditions.

scholarly journals Prospects of Intraoperative Multimodal OCT Application in Patients with Acute Mesenteric Ischemia

Diagnostics ◽  
2021 ◽  
Vol 11 (4) ◽  
pp. 705
Author(s):  
Elena Kiseleva ◽  
Maxim Ryabkov ◽  
Mikhail Baleev ◽  
Evgeniya Bederina ◽  
Pavel Shilyagin ◽  
...  
Keyword(s):  
Small Intestine ◽  
Mesenteric Ischemia ◽  
Acute Mesenteric Ischemia ◽  
Diagnostic Techniques ◽  
Intestinal Wall ◽  
Control Group ◽  
Serous Membrane ◽  
Non Invasive ◽  
Associated Conditions ◽  
Clinical Conditions

Introduction: Despite the introduction of increasingly multifaceted diagnostic techniques and the general advances in emergency abdominal and vascular surgery, the outcome of treatment of patients with acute impaired intestinal circulation remains unsatisfactory. The non-invasive and high-resolution technique of optical coherence tomography (OCT) can be used intraoperatively to assess intestine viability and associated conditions that frequently emerge under conditions of impaired blood circulation. This study aims to demonstrate the effectiveness of multimodal (MM) OCT for intraoperative diagnostics of both the microstructure (cross—polarization OCT mode) and microcirculation (OCT angiography mode) of the small intestine wall in patients with acute mesenteric ischemia (AMI). Methods and Participants: A total of 18 patients were enrolled in the study. Nine of them suffered from AMI in segments II-III of the superior mesenteric artery (AMI group), whereby the ischemic segments of the intestine were examined. Nine others were operated on for adenocarcinoma of the colon (control group), thus allowing areas of their normal small intestine to be examined for comparison. Data on the microstructure and microcirculation in the walls of the small intestine were obtained intraoperatively from the side of the serous membrane using the MM OCT system (IAP RAS, Russia) before bowel resection. The MM OCT data were compared with the results of histological examination. Results: The study finds that MM OCT visualized the damage to serosa, muscularis externa, and blood vessels localized in these layers in 100% of AMI cases. It also visualized the submucosa in 33.3% of AMI cases. The MM OCT images of non-ischemic (control group), viable ischemic, and necrotic small intestines (AMI group) differed significantly across stratification of the distinguishable layers, the severity of intermuscular fluid accumulations, and the type and density of the vasculature. Conclusion: The MM OCT diagnostic procedure optimally meets the requirements of emergency surgery. Data on the microstructure and microcirculation of the intestinal wall can be obtained simultaneously in real time without requiring contrast agent injections. The depth of visualization of the intestinal wall from the side of the serous membrane is sufficient to assess the volume of the affected tissues. However, the methodology for obtaining MM OCT data needs to be improved to minimize the motion artefacts generated in actual clinical conditions.

scholarly journals A New Approach Using Manganese-Enhanced MRI to Diagnose Acute Mesenteric Ischemia in a Rabbit Model: Initial Experience

2015 ◽  
Vol 2015 ◽  
pp. 1-7 ◽  
Author(s):  
Da-wei Zhao ◽  
Cheng Cheng ◽  
Lian-qin Kuang ◽  
Yu-long Zhang ◽  
Hai-yun Cheng ◽  
...  
Keyword(s):  
Mesenteric Ischemia ◽  
Rabbit Model ◽  
Diagnostic Technique ◽  
Acute Mesenteric Ischemia ◽  
Intestinal Wall ◽  
Control Group ◽  
Enhanced Mri ◽  
Wide Range ◽  
Small Intestinal ◽  
Manganese Enhanced Mri

Purpose. Manganese-enhanced MRI (MEMRI) has been applied to a wide range of biological and disease research. The purpose of the study was to use MEMRI to diagnose the acute mesenteric ischemia (AMI).Methods. The institutional experimental animal ethics committee approved this study. To optimize the dose of Mn2+infusion, a dose-dependent curve was obtained using Mn2+-enhancedT1map MRI by an intravenous infusion 2.5–20 nmol/g body weight (BW) of 50 nmol/L MnCl2. The eighteen animals were divided into control, sham-operated, and AMI groups. AMI models were performed by ligating the superior mesenteric artery (SMA).T1values were measured onT1maps in regions of the small intestinal wall and relaxation rate (ΔR1) was calculated.Results. A nonlinear relationship between infused MnCl2solution dose and increase in small intestinal wall ΔR1was observed. Control animal exhibited significant Mn2+clearance over time at the dose of 15 nmol/g BW. In the AMI model, ΔR1values (0.95 ± 0.13) in the small intestinal wall were significantly lower than in control group (2.05 ± 0.19) after Mn2+infusion (P< 0.01).Conclusion. The data suggest that MEMRI shows potential as a diagnostic technique that is directly sensitive to the poor or absent perfusion in AMI.

Acute mesenteric ischemia with necrosis of entire small intestine

2019 ◽  
Vol 98 (4) ◽  
pp. 174-177
Keyword(s):  
Small Intestine ◽  
Mesenteric Ischemia ◽  
Severe Disease ◽  
Acute Mesenteric Ischemia ◽  
Diagnostic Methods ◽  
Entire Small Intestine ◽  
Common Etiology

The case study describes a case of a patient with acute mesenteric ischemia with necrosis of entire small intestine. In following text there is an overview of the incidence of acute mesenteric ischemia, its most common etiology, diagnostic methods and treatment of this severe disease.

scholarly journals Mean Platelet Volume: Is It a Predictive Parameter in Diagnosis of Acute Mesenteric Ischemia?

2015 ◽  
Vol 100 (5) ◽  
pp. 962-965 ◽  
Author(s):  
Ahmet Türkoğlu ◽  
Mesut Gül ◽  
Abdullah Oğuz ◽  
Zübeyir Bozdağ ◽  
Burak Veli Ülger ◽  
...  
Keyword(s):  
Early Diagnosis ◽  
Mean Platelet Volume ◽  
Mesenteric Ischemia ◽  
Area Under The Curve ◽  
Acute Mesenteric Ischemia ◽  
The Elderly ◽  
Control Group ◽  
Characteristic Analysis ◽  
Platelet Volume ◽  
Cell Counts

Our objective for this study was to discuss the usability of mean platelet volume, which is associated with numerous vascular pathologies, in the early diagnosis of acute mesenteric ischemia. Acute mesenteric ischemia is an uncommon, life-threatening clinical condition mostly seen in the elderly. Early diagnosis of acute mesenteric ischemia and correction of blood circulation before necrosis occurs are important factors affecting prognosis. A total of 95 patients who underwent emergency surgery for acute mesenteric ischemia and 90 healthy volunteers as control group were included in this study. Age, gender, hemoglobin values, white blood cell counts, mean platelet volume, and platelet counts are recorded for evaluation. The mean platelet volume values were significantly higher in patients with acute mesenteric ischemia than in the controls (9.4 ± 1.1 fL and 7.4 ± 1.4 fL, respectively; P &lt; 0.001). Receiver-operating characteristic analysis demonstrated a cutoff value of mean platelet volume as 8.1 fL (area under the curve, 0.862), a sensitivity of 83.2%, and a specificity of 80%. As a result, in the patients who are admitted to the hospital with acute nonspecific abdominal pain and suspected of having acute mesenteric ischemia, high mean platelet volume values in routine hemograms support the diagnosis of acute mesenteric ischemia.

Non-invasive Point-of-Care Device To Diagnose Acute Mesenteric Ischemia

ACS Sensors ◽  
2018 ◽  
Vol 3 (11) ◽  
pp. 2296-2302 ◽  
Author(s):  
Gaser N. Abdelrasoul ◽  
Scott MacKay ◽  
Saad Y. Salim ◽  
Kathleen P. Ismond ◽  
Marcus Tamura ◽  
...  
Keyword(s):  
Mesenteric Ischemia ◽  
Point Of Care ◽  
Acute Mesenteric Ischemia ◽  
Non Invasive

ROLE OF LABORATORY METHODS IN INTEGRATED DIAGNOSTICS OF ACUTE MESENTERIAL ISCHEMIA

2019 ◽  
Vol 25 (5-6) ◽  
pp. 316-323
Author(s):  
Dmitry V. Belov ◽  
D. V Garbuzenko ◽  
O. P Lukin ◽  
S. S Anufrieva
Keyword(s):  
Blood Flow ◽  
Mesenteric Ischemia ◽  
Acute Mesenteric Ischemia ◽  
Intestinal Wall ◽  
Mesenteric Blood Flow ◽  
Scientific Publications ◽  
Laboratory Methods ◽  
Diagnostic Measures ◽  
Pubmed Database

The aim of the review: to present literature data on the role of laboratory methods in the complex diagnosis of acute mesenteric ischemia. The main provisions. To search for scientific publications, we used the PubMed database, the RSCI, the Google Scholar search engine, as well as cited references. Articles relevant to the purpose of the review were selected for the period from 1999 to 2019 in the following terms: “acute mesenteric ischemia”, “pathogenesis”, “diagnosis”, “biomarkers”. Inclusion criteria were limited to acute arterial mesenteric ischemia. Acute mesenteric ischemia is an emergency condition caused by a sudden violation of the blood flow through the mesenteric vessels, which rapidly progresses to a heart attack of the intestinal wall and is accompanied by high mortality. Four main mechanisms of OMI are distinguished: embolism from the left parts of the heart or aorta, thrombosis of arteries or veins of the intestine, non-occlusive acute mesenteric ischemia (NOMI), due to vascular spasm. In this case, destructive disorders occur in the intestinal wall, starting from the mucous membrane to the serous, which leads to bacterial translocation and the development of a systemic inflammatory response syndrome. Early bowel revascularization is a key factor in reducing complications and mortality associated with it. However, in the initial stages of the disease has no specific signs, which complicate its diagnosis. The only way to detect mesenteric blood flow disorders is MSCT with angiography, and with non-occlusive lesions, mesenteric angiography, which in normal clinical practice is not always possible. Conclusion. It can be assumed that the use of laboratory methods will expand the range of diagnostic measures and will make it possible to conduct timely treatment aimed at restoring the mesenteric blood flow and improve the prognosis in patients with acute mesenteric ischemia.

scholarly journals Serum Lactate and Acute Mesenteric Ischemia: An Observational, Controlled Multicenter Study

2021 ◽  
Author(s):  
Olivier Collange ◽  
Marc LOPEZ ◽  
Anne LEJAY ◽  
Patrick PESSAUX ◽  
Alexandre OUATTARA ◽  
...  
Keyword(s):  
Multicenter Study ◽  
Mesenteric Ischemia ◽  
Acute Mesenteric Ischemia ◽  
Serum Lactate ◽  
Control Group ◽  
Adult Intensive Care Unit ◽  
Diagnosis And Prognosis ◽  
Significant Difference ◽  
Lactate Levels ◽  
Matching Criteria

Abstract Purpose Early diagnosis of acute mesenteric ischemia (AMI) is key to survival but remains extremely difficult, as the symptoms are vague and non-specific. Although international guidelines recommend that serum lactate is not used for AMI diagnosis, this parameter is still specifically taken into account for the diagnosis and prognosis of AMI. Our hypothesis was that serum lactate levels cannot be used to diagnose AMI or predict its outcome. Methods This was an ancillary, retrospective, observational, controlled multicenter study, approved by an Ethics Committee. Patients with AMI at adult intensive care unit (ICU) admission were included (AMI group) and matched to ICU patients without AMI (control group). Matching criteria were center, period, gender, age, and severity. Serum lactate levels were measured on day 0 (D0) and day 1 (D1) and the lactate difference (D0-D1) was calculated. Results Two hundred and seventy-four patients were included. Serum lactate levels were elevated in both groups at D0 and D1 but there was no significant difference between groups at D0 (2.7 [1.3; 5.5] vs 3.4 [1.9; 6.1] mmol/L; p = 0.284), D1 (1.8 [1.2; 3.1] vs 2.4 [1.5; 4.6] mmol/L, p = 0.547; respectively for control and AMI groups) or D0-D1. Thus, the performance of serum lactate for AMI diagnosis was poor. Concerning AMI outcome, serum lactate levels predicted ICU death in both groups at D0 and D1. Conclusions no specific association was observed between serum lactate levels and AMI. Serum lactate should not be used for the diagnosis of AMI but may help assess disease severity.

scholarly journals Retrospective study of mesenteric ischemia

2020 ◽  
Vol 7 (8) ◽  
pp. 2544
Author(s):  
Mallikarjuna Reddy Mandapati ◽  
Sanjeev Kumar Jukuri ◽  
Nageswara Rao Nasika ◽  
Haleema Neshat
Keyword(s):  
Risk Factors ◽  
Small Intestine ◽  
Retrospective Study ◽  
Mesenteric Ischemia ◽  
Acute Mesenteric Ischemia ◽  
Delay Group ◽  
Late Mortality ◽  
Intestinal Necrosis ◽  
Life Threatening ◽  
Overall Mortality

Background: 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.Methods: A monocentric retrospective study was conducted between 01 August 2013 and 31 December 2019; 24 AMI patients underwent surgery (17 men and 7 women). Retrospectively, the risk factors, management until diagnosis and mortality were evaluated.Results: Patients present with an acute pain of the abdomen. Diagnosis was provided by CT with contrast medium. The 30-day mortality was 45.8%, the late mortality was 25% and the overall mortality was 70.8%. For the <12 hours delay group, the mortality was 33.3%, and the mortality in the group with 12-24 hours delay was 80% and was 87.5% in the >24 hours after admission group.Conclusions: If untreated, this process will eventuate in life threatening intestinal necrosis. The incidence is low, estimated at 0.09-0.21% of all acute surgical admissions.

scholarly journals Could Mean Platelet Volume Be a Reliable Indicator for Acute Mesenteric Ischemia Diagnosis? A Case-Control Study

2016 ◽  
Vol 2016 ◽  
pp. 1-5 ◽  
Author(s):  
Vermi Degerli ◽  
Isil Ergin ◽  
Fulya Yilmaz Duran ◽  
Mehmet Akif Ustuner ◽  
Ozgur Duran
Keyword(s):  
Mean Platelet Volume ◽  
Mesenteric Ischemia ◽  
Acute Mesenteric Ischemia ◽  
Reliable Indicator ◽  
Control Group ◽  
Concomitant Disease ◽  
Control Groups ◽  
Platelet Volume ◽  
Group I ◽  
Group Ii

Objective. Acute mesenteric ischemia (AMI) is a disease, usually seen in elderly people and accompanied by comorbid diseases. Mean platelet volume (MPV), the significant indicator of platelet activation and function, is associated with AMI. In this study, we considered that we can use MPV as a reliable indicator in the diagnosis of AMI.Methods. This study was conducted among AMI patients with two control groups. Age, gender, MPV, platelet count, concomitant diseases, abdominal computed tomography, and patient outcomes were recorded for evaluation. Control group I contained 41 healthy patients whose ages-genders were matched. Control group II contained 41 patients with no AMI, whose ages-genders-concomitant diseases were matched.Results. Of the total 41 AMI patients, 22 were female and 19 were male. The average age of them was72.12±13.2(44–91) years. MPV was significantly increased in the AMI (p=0.001) and control group II (p<0.001) in comparison with healthy control groups. In the comparison of the AMI patients with their matched controls for concomitant diseases, no statistical difference was found in the MPV values.Conclusion. MPV may be used as an indicator of AMI only if the patient has no concomitant diseases. The existence of a concomitant disease brings into question the reliability of high MPV values as a suitable indicator.

The value of combined elevation of D-dimer and neopterin as a predictive parameter for early stage acute mesenteric ischemia: An experimental study

Vascular ◽  
2016 ◽  
Vol 25 (2) ◽  
pp. 163-169 ◽  
Author(s):  
Ali Kagan Coskun ◽  
Zekai Halici ◽  
Akgun Oral ◽  
Yasin Bayir ◽  
Ferhat Deniz ◽  
...  
Keyword(s):  
Experimental Study ◽  
Superior Mesenteric Artery ◽  
Mesenteric Artery ◽  
Mesenteric Ischemia ◽  
Early Stage ◽  
Acute Mesenteric Ischemia ◽  
Artery Occlusion ◽  
Control Group ◽  
Blood Samples ◽  
D Dimer

Background The diagnosis of acute mesenteric ischemia is variable. Early diagnosis is important for reducing the mortality and morbidity rates. Aim This experimental study aims to investigate the diagnostic utility of D-dimer and neopterin as a marker for the early stage of acute mesenteric ischemia caused by occlusion of superior mesenteric artery. Methods The levels of D-dimer and neopterin were measured using an animal acute mesenteric ischemia model in 21 male rabbits. Superior mesenteric artery occlusion (Group 1, n = 14) and control (Group 2, n = 7) groups were identified. Blood samples at different times are collected from each rabbits. Blood samples from superior mesenteric artery occlusion group were taken 30 min after anesthesia but before laparotomy, 1, 2, and 3 h after superior mesenteric artery ligation. Blood samples from control group were taken 1 h before, 1 and 3 h after anesthesia and laparotomy. The D-dimer and neopterin levels of each blood sample were measured. Results The probability of acute mesenteric ischemia was found to be 36 times higher when the D-dimer level was over 0.125 ng/L, whereas the probability was 19.2 times higher when the neopterin level was over 1.25 nmol/L. Conclusions In this experimental study, the combined elevation of two significant markers, D-dimer and neopterin, may be helpful for the early diagnosis of acute mesenteric ischemia.

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