Effects of Hemorrhagic Shock and Resuscitation on Mesenteric Circulation

Vascular beds may be variably affected by hemorrhage, which may have implications for resuscitation. The vascular anatomy of swine has been described with focus on its use for vascular and endovascular research; however, current research has predominantly focused on anatomy. (1,2) There is a lack of research regarding the physiology of mesenteric circulation at baseline physiology, as well as during hemorrhagic shock and resuscitation. The aim of this study was to develop a large animal model to characterize the implications of hemorrhage on mesenteric circulation and reperfusion. We constructed a surgical protocol to measure intestinal perfusion, as well as pressure and flow data of the superior mesenteric artery (SMA), portal vein, inferior vena cava (IVC), and aorta.

Wide-ranging clinical spectrum of paradoxical embolism

The purpose of this review is to raise the index of suspicion for paradoxical embolism among generalists. The review is based solely on anecdotal reports compiled from EMBASE, MEDLINE, Googlescholar and Pubmed. Search terms were ‘paradoxical embolism’, ‘pulmonary embolism’ and ‘pulmonary arteriovenous malformations’. What emerged was that right-to-left paradoxical embolism could occur with or without concurrent pulmonary embolism, and also with and without proof of the presence of an ‘embolus-in-transit’. Potential sites of single or multiple systemic involvement included the central nervous system, the coronary circulation, renal arterial circulation, splenic circulation, the mesenteric circulation and the limbs. In many cases, the deep veins of the lower limbs were the source of thromboembolism. In other cases, thrombi originated from an atrial septal aneurysm, from a central venous line, from a haemodialysis-related arterio-venous shunt, from a popliteal vein aneurysm, internal jugular vein, superior vena cava, from a pulmonary arteriovenous malformation, from tricuspid valve endocarditis (with and without pulmonary embolism) and from the right atrium, respectively. Stroke was by far the commonest systemic manifestation of paradoxical embolism. Some strokes were attributable to pulmonary arteriovenous malformations with or without coexistence of intracardiac shunts. Clinicians should have a high index of suspicion for paradoxical embolism because of its time-sensitive dimension when it occurs in the context of involvement of the intracranial circulation, coronary circulation, mesenteric circulation, and peripheral limb circulation.

Vascular anomalies in the mesenteric circulation of patients with Crohn’s disease: a pilot study

Crohn’s disease (CD) is a chronic inflammatory bowel disease and its pathogenesis is still not well understood. Previous studies suggested the possibility of the involvement of vascular system, but, todate, the mesenteric circulation has poor been investigated, especially in complicated CD cases requiring colectomy. We investigated the mesenteric circulation in a case-control pilot study, including 19 controls and 7 patients affected by complicated cases of CD. Cases and controls underwent selective angiography of both superior and inferior mesenteric district. Transit time was found either significantly shortened in 2/7 cases (29%), or prolonged 5/7 (71%) (P=0.0034 in the superior mesenteric district; P=0.0079 in the inferior mesenteric district), respectively due to the presence of A-V malformations and of a miscellaneous of venous abnormalities, which included thrombosis, hypoplasia and extra-truncular venous malformations. Our study demonstrates the presence of congenital or acquired vascular anomalies in a small sample of CD patients not responder to current treatment and with severe complications. The present pilot study warrants further investigations.

Ways to Improve the Results of Treatment of Patients with Acute Mesenteric Circulation

Целью нашего исследования явилось улучшение результатов обширной резекции тонкой кишки у больных с острым нарушением мезентериального кровообращения за счет рационального выбора способа завершения данной операции. Материалы и методы. В исследование включены 44 пациента с острым нарушением мезентериального кровообращения, которым была выполнена обширная резекция тонкой кишки на фоне распространенного гнойного перитонита. Резекция завешалась формированием временной концевой еюностомы либо еюностомией по Майдлю. Выявлены факторы, оказывающие статистически значимое влияние на летальность у этой группы больных (значения по интегральным шкалам MIP и SAPS). Результаты и их обсуждение. Установлено, что длина остающейся части тонкой кишки не может быть фактором, сдерживающим формирование временной концевой еюностомы. На основании полученных результатов разработан хирургический алгоритм, успешно примененный у 28 пациентов основной группы, что позволило снизить летальность с 86,4% до 68%.Заключение. После резекции тонкой кишки у больных с перитонитом вследствие острого нарушения мезентериального кровообращения предпочтение следует отдать временной концевой еюностоме.