Circulatory Compromise Research Articles

Antioxidant, In Vitro Cytotoxicity, and Anti-diabetic Attributes of a Drug-Free Guar Gum Nanoformulation as a Novel Candidate for Diabetic Wound Healing.

The escalating intersection of diabetes and impaired wound healing poses a substantial societal burden, marked by an increasing prevalence of chronic wounds. Diabetic individuals struggle with hindered recovery, attributed to compromised blood circulation and diminished immune function, resulting in prolonged healing periods and elevated healthcare expenditures. To address this challenge, we report here a drug-free novel guar gum (GG)-based nano-formulation which is effective against diabetic wound healing. Nanoparticles with an average particle size of 32.4nm display stability with negative zeta potential. Differential scanning calorimetry (DSC) and Fourier transform infrared (FTIR) analysis reveal alterations in thermal properties and molecular structures induced by the nano-particulation process. In vitro studies highlight the antioxidant potential of GGNP through concentration-dependent free radical scavenging activity in DPPH and ABTS assays. The nanoformulation also exhibits inhibitory effects on α-glucosidase and α-amylase enzymes. Cell viability studies have indicated moderate cytotoxicity in L929 cells and significant proliferation and migration in HaCaT cells, suggesting a positive impact on skin cells. In vitro enzymatic activity assessments under hyperglycaemic conditions reveal the potential of GGNP to modulate glutathione-S-transferase (GST), superoxide dismutase (SOD), and catalase activities as well as decreasing lipid peroxidation (LPO) levels, showcasing an antioxidant response. These results suggest GGNP as a promising candidate in diabetic wound healing.

First reported case of Acute Disseminated Encephalomyelitis in pregnancy in Sri Lanka

Acute Disseminated Encephalomyelitis (ADEM) complicating pregnancy is a rare occurrence, posing challenges to the management due to maternal and fetal risks including fetal loss, fetal anomalies, intrauterine fetal growth restriction (FGR) and preterm labour. We report a case of a 21-year-old primiparous woman who was diagnosed with ADEM during the second trimester. She was treated with high dose intravenous (IV) steroids as well as IV immunoglobulin. She made complete neurological recovery within two months, but there were fetal complications including oligohydramnios, intrauterine growth restriction and low birth weight. The baby was delivered via elective caesarean section due to suspicious cardiotocograph and abnormal fetal doppler studies indicative of compromised fetal circulation. The baby was given special baby care unit (SBCU) care. However, both the mother and baby were safely discharged following six days of special neonatal care. This is the first reported case of ADEM in pregnancy in Sri Lanka, and highlights the challenges in management.

The Association of Noninvasively Derived Tissue Perfusion Pressure With Acute Kidney Injury in Patients With Circulatory Compromise.

The Association of Noninvasively Derived Tissue Perfusion Pressure With Acute Kidney Injury in Patients With Circulatory Compromise.

Is NEWS of value for patients with acute stroke?

Patients with acute stroke are at risk of respiratory or circulatory compromise resulting in vital instability, which can be captured through the widely used aggregated National Early Warning Score (NEWS). We aimed to assess the relation between vital instability (defined as NEWS of five or higher) and death or dependency at 90 days after stroke. In this observational cohort study we studied 763 patients with ischaemic stroke (n = 400), intracerebral haemorrhage (ICH) (n = 146) or subarachnoid haemorrhage (SAH) (n = 217), hospitalized to a Dutch tertiary referral hospital from 1 January 2017 to 31 December 2018. We calculated NEWS for each 8 h time span during the first 72 h after hospitalization. We also decomposed NEWS into its three components respiration, circulation and consciousness. The primary outcome was death or dependency (modified Rankin Scale score ⩾3) at 90 days after stroke. The association of vital instability with functional dependency was examined using Poisson regression. Two hundred and twenty-seven (58%) patients with ischaemic stroke, 101 (69%) with ICH and 142 (65%) with SAH had at least one episode of vital instability. In patients with ischaemic stroke or SAH, vital instability was associated after adjustment for confounders with death or dependency (adjusted relative risk 1.55 ((95% CI) 1.25-1.93 and 2.13 (1.35-3.36), respectively)). This was mainly driven by impaired consciousness, which was associated with death or dependency in all types of stroke. Respiratory insufficiency and circulatory instability were associated with death or dependency only in SAH. Vital instability in the first 72 h of hospitalization for ischaemic stroke or SAH is associated with death or dependency at 90 days. Impaired consciousness was the main driver of this relationship. NEWS may not be appropriate for patients with acute stroke, mainly due to the dichotomous manner in which the level of consciousness is classified, and modification of NEWS should be considered for these patients.

Differences in Systemic Pulse Waveform Between Individuals With Glaucoma, Glaucoma Suspects, and Healthy Controls.

It has been hypothesized that compromised ocular circulation in glaucoma may be concomitant of systemic changes. The purpose of this study is to test whether systemic blood flow pulse waveform patterns differ between individuals with glaucoma (GL), glaucoma suspects (GLS), and normal healthy controls (HC). The study included 35 bilateral GL, 67 bilateral GLS, 29 individuals with unilateral GL who were considered GLS in the other eye, and 44 healthy controls. Systemic pulsatile blood pressure waveforms were recorded using a finger cuff. A continuous 200Hz plethysmography recording is made to obtain a pulse waveform. Waveform parameters were extracted using custom software from an average of eight pulse cycles. These were compared between GL, GLS, and HC groups on a per-eye basis, using generalized estimating equation models to account for intereye correlations; and plotted against disease severity by visual field linearized mean deviation (MDlin) and retinal nerve fiber layer thickness (RNFLT). Averaged blood pressure was significantly lower in the HC group (mean ± standard deviation 91.7 ±11.7 mm Hg) than the GLS (102.4 ± 13.9) or GL (102.8 ± 13.7) groups, with P < 0.0001 (generalized estimating equation regression). Waveform parameters representing vascular resistance were higher in both GLS and GL groups than the HC group; and were correlated with RNFLT and MDlin (P ≤ 0.05). The shape of the systemic pulsatile waveform differs in individuals with GL/GLS suspects, compared to HC eyes. Blood pressure changes more rapidly in individuals with GL, which suggests higher arterial stiffness.

Flexor Tendon Continuity and Negative X-ray: The "Combo" Negative Features in Finger Subamputation.

Background: The subamputation of fingers with vascular compromise presents a surgical challenge. Although tissue continuity may be considered a favourable prognostic element, in our experience, we noticed that there is not always a direct correlation between soft tissue involvement, radiographic appearance and final outcome. Methods: We included, in our study, all cases of vascular pedicle injury in which finger salvage was attempted with microsurgical revascularisation. Exclusion criteria were: integrity of both vascular pedicles, pedicle lesion without global circulatory compromise and patients treated immediately with amputation. Results: Between May 2018 and July 2023, 27 male patients with finger subamputation injuries were treated at our institution. In 11 cases of injured fingers, the only intact tissue was the flexor digitorum profundus (FDP) or flexor pollicis longus (FPL). Our global failure rate was 49%; whereas, in the subgroup of the 11 cases with continuity of the FDP or FPL, the failure rate rose to 73% and when the fingers showed flexor tendon integrity and radiographs demonstrated minimal bone damage, revascularisation failure was observed in all cases (100%). Conclusions: The results of the study show that subamputations with devascularisation, clinically presented with the combination of flexor tendon as the only element of tissue continuity and dislocation or minimal bone/articular injury, have a worse prognosis because of their trauma mechanism. We propose to add them to the Kay-Adani Classification as a subset of the poorest prognostic injuries group (III), to help surgeons to make decisions about the management of subamputation finger injuries.

Innovative techniques in the treatment of penile strangulation: a case report

Introduction and importance: Penile strangulation is a medical emergency characterized by the encirclement of the penis by an external object, resulting in circulatory compromise. Case presentation: A 35-year-old male presented with penile pain and urinary obstruction due to the inability to remove the ring. Upon examination, the ring was firmly lodged at the base of the penis, causing significant swelling and discoloration in the distal region. Interventions and outcomes: Initial attempts to cut the ring using standard tools were unsuccessful, leading to the engagement of a rescue team equipped with an air cutter. The cutting procedure, complicated by the ring’s thickness and hardness and the significant edema, took ~90 min. Safety measures, including the use of a surgical brain spatula and forceps, were employed to protect the penile skin from damage during the operation. Relevance and impact: This case underscores the necessity for timely intervention in penile strangulation cases and highlights the effectiveness of collaboration with specialized rescue teams equipped with appropriate cutting tools. It also emphasizes the importance of safety considerations when employing nonmedical devices in medical emergencies. The patient experienced a favorable outcome, with significant improvement in swelling and discoloration postprocedure, and no complications during follow-up. This report contributes to the limited but crucial literature on managing penile strangulation, particularly regarding the methods and timeframes for safely removing constricting objects.

Quadruple (1440 degrees) intestinal volvulus

Key Clinical MessageA whirl sign on contrast‐enhanced abdominal CT scan is indicative of intestine twisted around the mesenteric vessels, and is observed in cases of strangulated obstruction, signaling compromised intestinal circulation. In cases of intestinal volvulus, surgery is necessary to untwist the affected bowel, and resection is necessary if necrosis is present.AbstractA 31‐year‐old Japanese man presented with acute lower abdominal pain and vomiting. Contrast‐enhanced abdominal computed tomography (CT) revealed a 1440‐degree clockwise torsion of superior mesenteric artery and a whirl sign. Intestinal volvulus in adulthood with a background of malrotation is extremely rare. Contrast‐enhanced CT is effective for diagnosis.

#2812 Continuous blood pressure monitoring with a finger cuff is unreliable in chronic hemodialysis patients

Abstract Background and Aims Intradialytic hypotension (IDH) is the most common complication of hemodialysis (HD), which is often related to ultrafiltration. Due to the high prevalence of cardiovascular disease (CVD), compensatory mechanisms often fail. In clinical practice, BP is measured 2x/hour, while additional readings are only performed when symptoms arise. However, since IDH defined by a nadir systolic BP (SBP)&amp;lt;90 mmHg or &amp;lt;100 mmHg (depending on pre-dialysis SBP), regardless of symptoms, is most strongly associated with mortality, current BP measurement frequency may severely underestimate the true incidence of IDH. Continuous BP-monitoring may offer a solution to this issue. The Clearsight device (CSD) is a non-invasive continuous BP-monitoring system that measures arterial pressure and waveforms through a finger cuff by photoplethysmography. Yet, a compromised peripheral circulation may hamper its reliability in HD patients. This study aims to assess the agreement between intradialytic CSD-monitoring and standard oscillometric brachial arterial pressure (oBAP) assessment. Methods 40 Chronic HD patients were cross-over randomized to 4 modalities, each for 2 weeks: [standard HD (S-HD), cool HD (C-HD), low volume hemodiafiltration (LV-HDF) and high-volume HDF (HV-HDF)]. During one session of each second week, BP and heart rate (HR) were continuously recorded with the CSD (BMEYE/Edwards Lifesciences) and every 15 minutes with a brachial arterial cuff (contralateral of the fistula or graft, if applicable). Simultaneous measurements of SBP, diastolic BP (DBP) and HR were compared with descriptive statistics (mean difference [bias, BAP minus CSD], standard deviation (SD) and range) and Bland-Altman analysis. Bias was defined as the mean difference between oBAP and CSD, and 95% limits of agreement (LA) as the mean difference ±1.96 SD. Post-hoc, patients were stratified into tertiles of unexplained missing CSD-readings, to explore whether specific patient characteristics explain failed readings. Results 75% of patients was male, with a mean age 69.7 (±13.5 years) and median dialysis vintage 3.0 years (IQR 1.0-5.8). Diabetes mellitus and CVD were present in 48% and 73%, resp. Of the 2720 paired BP-measurements, 42% CSD and 6% of oBAP-readings were missing, leaving 36% of absent CSD-readings unexplained. Bland-Altman analysis, comparing oBAP and CSD-measurements, revealed a mean bias ± LA of 13.3 ± 44.5 mmHg for SBP, a mean bias ± LA of 13.3 ± 25.5 for DBP, and a mean bias ± LA of −0.03 ± 22.9 for HR. Surprisingly, the group with a high (&amp;gt;38%) proportion of unexplained missing CSD-values was significantly younger compared to the low (&amp;lt;21%) and intermediate group (21-38%) (p = 0.015), whereas no significant differences were observed with respect to dialysis vintage, diabetes mellitus or CVD. Conclusions 1) Compared to the oBAP method, finger cuff-monitoring shows poor precision and accuracy in BP-measurements, but good accuracy and poor precision in HR-readings; 2) 1/3 of readings failed for unknown reasons. Thus, CSD-monitoring is unsuitable for intradialytic hemodynamic monitoring in chronic HD patients.

Below Elbow Amputation Due to Ischemic Complications after Radial Artery Cannulation: A Case Report

The patient is a 57 year old male with peripheral vascular disease and a non-healing thumb wound. After radial artery catheterization (RAC), he developed pain and numbness in the radial-sided 3.5 fingers and pulse oximetry readings &lt;80%. With a possible diagnosis of carpal tunnel syndrome due to increased pressure, the patient underwent a carpal tunnel release (CTR) one week after the catheterization and reported immediate pain relief. Unfortunately, his wound failed to heal, and his pain returned one week later. Another operation was performed to decompress the carpal tunnel; however, the pain worsened, and fingertip necrosis progressed, including the thumb, index, and middle fingers. An angiogram showed arterial calcifications, ruling out reperfusion of the hand. A trans-forearm amputation was performed. This case highlights overlapping symptoms of ischemia and median nerve compression as well as the risk of hand ischemia after RAC in those with circulatory compromise.

Fulminant Myocarditis and Venoarterial Extracorporeal Membrane Oxygenation: A Systematic Review.

This systematic review aimed to look at the effectiveness of venoarterial extracorporeal membrane oxygenation (VA-ECMO) therapy in treating fulminant myocarditis and evaluating the optimal length of time a patient should be placed on VA-ECMO. Fulminant myocarditis is a potentially life-threatening medical conditionmost commonly brought on by cardiogenic shock, which often progresses to severe circulatory compromise, requiring the patient to be placed on some form of mechanical circulatory assistanceto maintain adequate tissue perfusion. Medical centers have multiple mechanical assistive devices available for treatment at their disposal, but our area of focus was placed on one system in particular: VA-ECMO therapy. Although the technology has been around for more than 30 years, there is limited information on how effective VA-ECMO is regarding the treatment of fulminant myocarditis. Due to the lack of data regarding the treatment administration of VA-ECMO for fulminant myocarditis, standard treatment duration guidelines do not exist, resulting in a wide variation of treatment administrations among medical centers.In regardto short-term outcomes, VA-ECMO has shown to be effective in treating fulminant myocarditis, with a one-year post-hospital survival rate ranging from 57.1% to 78% at discharge. For long-term health and survival, the studies that recorded long-term survival ranged from 65% to 94.1%. However, given the small number of studies that pursue this, more research is needed to prove the efficacy of VA-ECMO for thetreatment of fulminant myocarditis.

Intussuscepção cecocecal após administração do dipropionato de imidocarb em equino - relato de caso

ABSTRACT The intussusception of the large intestine in adult horses has been poorly reported. The aim of this study is to report a case of an acute abdomen due to cecocolic intussusception in a Brazilian Sport Horse mare, aged eight, after the administration of imidocarb dipropionate. The drug used for the treatment of piroplasmosis caused a state of dysmotility in the large intestine and subsequent abdominal discomfort. Surgical intervention was necessary, performed through a median celiotomy, opting for partial typhlectomy due to tissue and circulatory compromise. The postoperative evolution was satisfactory and without serious complications, with a good short- and long-term prognosis, as the patient continued to perform its athletic functions.

Clinical characteristics of pituitary hormone deficiency in children: A single centre experience

Background: The clinical presentation of hypopituitarism varies from asymptomatic to circulatory compromise. The late diagnosis may cause significant mortality and morbidity. There is scant data on the clinical profile.Method: A cross-sectional descriptive analysis was carried out on diagnosed children with hypopituitarism at the endocrinology unit of Lady Ridgeway Hospital for Children, Sri Lanka, from 2013-2021. The presence and progression of pituitary hormonal deficiency were ascertained.Results: Out of the total 94 children with hypopituitarism, 52 had congenital hypopituitarism with a median presenting age of 5.86 years (IQR 3-9). Short stature was the commonest presentation (59.6%). Multiple pituitary hormone deficiency (MPHD) was seen in 27 (51.91%). MPHD was associated with the presence of postnatal risk factors (OR 2.036, 95% CI 1.94-3.786) and MRI Imaging abnormalities in hypothalamic-pituitary morphogenesis (OR 1.768, 95% CI 1.087-2.874). 90.4% with GHD, 46.2% with ACTH deficiency, and 40.4% with TSH deficiency had the mean age of presentation 6.54 years, 6.11 years, and 5.56 years respectively. Of the children above 13 years, 57% showed hypogonadism. Hypoplastic anterior pituitary (40.4%) was the commonest MRI abnormality. Out of the 42 children with brain tumours, 25 (59.52%) had craniopharyngioma, and 13 (31%) had Medulloblastoma, while MPHD was seen in 32 (76.2%). Hormone deficiency at the presentation was seen in 57.1%.Conclusion: Comprehensive evaluation and periodic screening are mandatory for the timely diagnosis of MPHD.

Heart function by M-mode and tissue Doppler in the early neonatal period in neonates with fetal growth restriction

BackgroundFetal growth restricted (FGR) neonates have increased risk of circulatory compromise due to failure of normal transition of circulation after birth. AimEchocardiographic assessment of heart function in FGR neonates first three days after birth. Study designProspective observational study. SubjectsFGR- and non-FGR neonates. Outcome measuresM-mode excursions and pulsed-wave tissue Doppler velocities normalised for heart size and E/e′ of the atrioventricular plane day one, two and three after birth. ResultsCompared with controls (non-FGR of comparable gestational age, n = 41), late-FGR (gestational age ≥ 32 weeks, n = 21) exhibited higher septal excursion (15.9 (0.6) vs. 14.0 (0.4) %, p = 0.021) (mean (SEM)) and left E/e′ (17.3 (1.9) vs.11.5 (1.3), p = 0.019). Relative to day three, indexes on day one were higher for left excursion (21 (6) % higher on day one, p = 0.002), right excursion (12 (5) %, p = 0.025), left e′ (15 (7) %, p = 0.049), right a′ (18 (6) %, p = 0.001), left E/e′ (25 (10) %, p = 0.015) and right E/e′ (17 (7) %, p = 0.013), whereas no index changed from day two to day three. Late-FGR had no impact on changes from day one and two to day three. No measurements differed between early-FGR (n = 7) and late-FGR. ConclusionsFGR impacted neonatal heart function the early transitional days after birth. Late-FGR hearts had increased septal contraction and reduced left diastolic function compared with controls. The dynamic changes in heart function between first three days were most evident in lateral walls, with similar pattern in late-FGR and non-FGR. Early-FGR and late-FGR exhibited similar heart function.

АНАЛИЗ ОСЛОЖНЕНИЙ ПОСЛЕ АУТОТРАНСПЛАНТАЦИИ ПРИ ПОСЛЕДСТВИЯХ ТЯЖЁЛОЙ ТРАВМЫ ВЕРХНЕЙ КОНЕЧНОСТИ

Objective: To analyze the complications after transplantation of vascularized autografts in upper limb injuries and develop a set of measures to eliminate them. Methods: Surgical treatment outcomes of 159 patients with severe upper limb injury sequelae were analyzed. The study population comprised 102 (64.1%) males, 57 (35.8%) females, and 49.6% of the patients were under 18. In forearm and hand injuries sequelae, 159 vascularized skin fascia and skin-bone composite autograft flaps were used. Of the 159 grafts, free flaps grafting and pedicled flaps grafting were performed in 30 (18.8%) and 129 (81.2%), respectively. Results: Of 30 free flaps, circulatory compromise was observed in 4 (13.3%) cases in the early postoperative period. Out of the total 159 grafts used, the percentage was 2.5%. In evaluating complications, it was revealed that the flap circulatory compromise of 4 patients was noted in the following grafting types: radial osseocutaneous (1), radial fasciocutaneous (1), fibula transplant (1), and inguinal fasciocutaneous (1). Of the 129 reverse and transposition flaps, a circulatory compromise was noted in 10 (7.7%) cases. Out of the total 159 flaps, the percentage of circulatory compromise was 6.3%. Of the total 159 free and pedicled flaps, necrosis with flap loss was observed in 6.9%. Conclusion: Timely diagnosis of complications based on clinical and axillary investigations data facilitated conducting appropriate conservative measures or surgical revision, which helped to achieve engraftment of transplanted autografts in 93.1% of cases. Keywords: Upper limb injury, injury sequelae, autotransplantation, flap engraftment, flap necrosis.

Preliminary Evaluation of Hemodynamic Effects of Fontan Palliation on Renal Artery Using Computational Fluid Dynamics

Background: The assessment of renal function is important to the prognosis of patients needing Fontan palliation due to the reconstructed compromised circulation. To know the relationship between the kidney perfusion and hemodynamic characteristics during surgical design could reduce the risk of acute kidney injury (AKI) and the postoperative complications. However, the issue is still unsolved because the current clinical evaluation methods are unable to predict the hemodynamic changes in renal artery (RA). Methods: We reconstructed a three-dimensional (3D) vascular model of a patient requiring Fontan palliation. The technique of computational fluid dynamics (CFD) was utilized to explore the changes of RA hemodynamics under different possible blood flow rates. The relationship between the kidney perfusion and hemodynamic characteristics was investigated. Results: The calculated results indicated the declined tendency of the pressure and pressure drop as the flow rate decreased. When the flow rate decreased to two-thirds of its baseline, both the pressure of left renal artery (LRA) and the pressure of right renal artery (RRA) dipped below 50%, and the pressure of RRA fell more quickly than that of LRA. Uneven distribution of WSS was observed on the trunk of RA, and the lowest WSS was found at the distal of RA. The average WSS in RA dropped to around 50% as the flow rate reached one-third of its baseline. Conclusions: As a promising approach, CFD can be utilized to quantitatively evaluate the hemodynamic characteristics of RA and contribute to offsetting the drawbacks of clinical assessments of renal function, to help realize better prognosis for the patients with Fontan palliation.

The association of subcortical brain injury and abusive head trauma

BackgroundAbusive head trauma (AHT) remains a major pediatric problem with diagnostic challenges. A small pilot study previously associated subcortical brain injury with AHT. ObjectivesTo investigate the association of subcortical injury on neuroimaging with the diagnosis of AHT. Participants and settingChildren <3 years with acute TBI admitted to 18 PICUs between 2011 and 2021. MethodsSecondary analysis of existing, combined, de-identified, cross-sectional dataset. ResultsDeepest location of visible injury was characterized as scalp/skull/epidural (n = 170), subarachnoid/subdural (n = 386), cortical brain (n = 170), or subcortical brain (n = 247) (total n = 973). Subcortical injury was significantly associated with AHT using both physicians' diagnostic impression (OR: 8.41 [95 % CI: 5.82–12.44]) and a priori definitional criteria (OR: 5.99 [95 % CI: 4.31–8.43]). Caregiver reports consistent with the child's gross motor skills and historically consistent with repetition decreased as deepest location of injury increased, p < 0.001. Patients with subcortical injuries were significantly more likely to have traumatic extracranial injuries such as rib fractures (OR 3.36, 95 % CI 2.30–4.92) or retinal hemorrhages (OR 5.97, 95 % CI 4.35–8.24), respiratory compromise (OR 12.12, 95 % CI 8.49–17.62), circulatory compromise (OR 6.71, 95 % CI 4.87–9.29), seizures (OR 3.18, 95 % CI 2.35–4.29), and acute encephalopathy (OR 12.44, 95 % CI 8.16–19.68). ConclusionsSubcortical injury is associated with a diagnosis of AHT, historical inaccuracies concerning for abuse, traumatic extracranial injuries, and increased severity of illness including respiratory and circulatory compromise, seizures, and prolonged loss of consciousness. Presence of subcortical injury should be considered as one component of the complex AHT diagnostic process.

Acute abdominal pain due to sigmoid volvulus with persistent descending mesocolon: a case report

BackgroundPersistent descending mesocolon, an anomaly of fixation of the mesentery of the descending colon, can sometimes cause complications such as intestinal obstruction and intussusception. We present the first reported case of sigmoid volvulus with persistent descending mesocolon.Case presentationAn 82-year-old Japanese man had intermittent lower abdominal pain. Abdominal computed tomography showed dilation and a shift to the right side of the sigmoid colon, but no findings of volvulus. The next day, he presented continuous lower abdominal pain with bloody stool. A second abdominal computed tomography showed strangulation and dilation of the sigmoid colon, with shift from the right side of the abdominal cavity to the pelvic space. This suggested the descending colon was running to the medial side with sigmoid volvulus. Emergency surgery was performed for volvulus with persistent descending mesocolon. Operative findings revealed dilation of the sigmoid colon with a partial poorly colored region and strangulation that caused volvulus. After releasing the strangulation of the sigmoid colon, the descending colon was revealed to be running more to the medial side, with adherence to small intestinal mesentery. There was no Toldt’s fusion fascia at the descending colon. Persistent descending mesocolon was therefore diagnosed due to abnormality of fixation of the descending colon. The sigmoid colon, including the poorly colored region, was resected and reconstructed, while the inferior mesenteric and left colonic arteries were preserved because of the complexity of the vascular system running around the descending and sigmoid colon due to the shortened mesentery. These findings were pathologically compatible with circulatory compromise and intestinal degeneration due to sigmoid volvulus. The patient had no complications after discharge, including in relation to defecation.ConclusionPersistent descending mesocolon can occasionally cause acute abdominal symptoms requiring immediate treatment. A computed tomography finding of the descending colon running more to the medial side than ordinary cases can aid diagnosis of persistent descending mesocolon.

ACUTE PULMONARY HYPERTENSION AFTER BORTEZOMIB THERAPY

ACUTE PULMONARY HYPERTENSION AFTER BORTEZOMIB THERAPY

Cardiorespiratory function, resting metabolic rate and heart rate variability in coal miners exposed to hypobaric hypoxia in highland workplace.

BackgroundOwing to intermittent/acute exposure to hypobaric hypoxia, highland miners may often suffer, the physiological characteristics between highland and lowland miners, however, are rarely reported. The objective of this study was to compare the physiological characteristics of coal miners working at disparate altitudes.MethodsTwenty-three male coal mining workers acclimating to high altitude for 30 ± 6 days in Tibet (highland group; approx. 4500 m above sea level; 628.39 millibar), and 22 male coal mining workers in Hebei (lowland group; less than 100 m above sea level; 1021.82 millibar) were recruited. Tests were conducted to compare ventilatory parameters, circulation parameters, resting metabolic rate (RMR), and heart rate variability (HRV) indices between the two groups in resting state.ResultsVentilation volume per minute (VE) of the highland group was markedly raised compared to that of the lowland group (11.70 ± 1.57 vs. 8.94 ± 1.97 L/min, p = 0.000). In the meanwhile, O2 intake per heart beat (VO2/HR) was strikingly decreased (3.54 ± 0.54 vs. 4.36 ± 0.69 ml/beat, p = 0.000). Resting metabolic rate relevant to body surface area (RMR/BSA) was found no significant difference between the two groups. Evident reduction in standard deviation of NN intervals (SDNN) and remarkable increase in ratio of low- and high- frequency bands (LF/HF) were manifest in highland miners compared to that of lowland ones (110.82 ± 33.34 vs. 141.44 ± 40.38, p = 0.008 and 858.86 ± 699.24 vs. 371.33 ± 171.46, p = 0.003; respectively).ConclusionsThese results implicate that long-term intermittent exposure to high altitude can lead miners to an intensified respiration, a compromised circulation and a profound sympathetic-parasympathetic imbalance, whereas the RMR in highland miners does not distinctly decline.