Obstruction Of Superior Mesenteric Artery Research Articles

Gut Microbial Metabolite Pravastatin Attenuates Intestinal Ischemia/Reperfusion Injury Through Promoting IL-13 Release From Type II Innate Lymphoid Cells via IL-33/ST2 Signaling.

Intestinal ischemia/reperfusion (I/R) injury is a grave condition with high morbidity and mortality. We previously confirmed that intestinal I/R induces intestinal flora disorders and changes in metabolites, but the role of different metabolites in intestinal I/R injury is currently unclear. Based on targeted metabolic sequencing, pravastatin (PA) was determined to be a metabolite of the gut microbiota. Further, intestinal I/R model mice were established through superior mesenteric artery obstruction. In addition, a co-culture model of small intestinal organoids and type II innate lymphoid cells (ILC2s) was subjected to hypoxia/reoxygenation (H/R) to simulate an intestinal I/R model. Moreover, correlation analysis between the PA level in preoperative feces of patients undergoing cardiopulmonary bypass and the indices of postoperative intestinal I/R injury was carried out. IL-33-deficient mice, ILC2-deleted mice, and anti-IL-13 neutralizing antibodies were also used to explore the potential mechanism through which PA attenuates intestinal I/R injury. We demonstrated that PA levels in the preoperative stool of patients undergoing cardiopulmonary bypass were negatively correlated with the indices of postoperative intestinal I/R injury. Furthermore, PA alleviated intestinal I/R injury and improved the survival of mice. We further showed that PA promotes IL-13 release from ILC2s by activating IL-33/ST2 signaling to attenuate intestinal I/R injury. In addition, IL-13 promoted the self-renewal of intestinal stem cells by activating Notch1 and Wnt signals. Overall, results indicated that the gut microbial metabolite PA can attenuate intestinal I/R injury by promoting the release of IL-13 from ILC2s via IL-33/ST2 signaling, revealing a novel mechanism of and therapeutic strategy for intestinal I/R injury.

Vagus nerve stimulation modulates arachidonic acid production in the mesenteric lymph following intestinal ischemia-reperfusion injury.

Inflammatory lipid mediators in mesenteric lymph (ML), including arachidonic acid (AA), are considered to play an important role in the pathogenesis of multiple-organ dysfunction after hemorrhagic shock. A previous study suggested that vagus nerve stimulation (VNS) could relieve shock-induced gut injury and abrogate ML toxicity, resulting in the prevention of multiple-organ dysfunction. However, the detailed mechanism of VNS in lymph toxicity remains unclear. The study aimed to investigate the relationship between VNS and inflammatory lipid mediators in ML. Male Sprague-Dawley rats underwent laparotomy and superior mesenteric artery obstruction (SMAO) for 60 minutes to induce intestinal ischemia followed by reperfusion and observation. The ML duct was cannulated, and ML samples were obtained both before and after SMAO. The distal ileum was removed at the end of the observation period. In one group of animals, VNS was performed from 10 minutes before 10 minutes after SMAO (5 V, 0.5 Hz). Liquid chromatography-electrospray ionization-tandem mass spectrometry analysis of AA was performed for each ML sample. The biological activity of ML was examined using a monocyte nuclear factor κ-light-chain-enhancer of activated B cells activation assay. Western blotting of phospholipase A2 group IIA (PLA2-IIA) was also performed for ML and ileum samples. Vagus nerve stimulation relieved the SMAO-induced histological gut injury. The concentration of AA and level of nuclear factor κ-light-chain-enhancer of activated B cells activation in ML increased significantly after SMAO, whereas VNS prevented these responses. Western blotting showed PLA2-IIA expression in the ML and ileum after SMAO; however, the appearance of PLA2-IIA band was remarkably decreased in the samples from VNS-treated animals. The results suggested that VNS could relieve gut injury induced by SMAO and decrease the production of AA in ML by altering PLA2-IIA expression in the gut and ML.

SMA 閉塞を来したB 型急性大動脈解離に対して緊急TEVAR を行い治療した1 例

SMA 閉塞を来したB 型急性大動脈解離に対して緊急TEVAR を行い治療した1 例

Interpretation of Abdominal CT Findings in Patients Who Develop Acute on Chronic Mesenteric Ischemia

BackgroundWe studied whether ischemia-specific computed tomography (CT) findings are consistently detectable in patients who develop acute on chronic mesenteric ischemia (AOCMI), whereas absent in chronic mesenteric ischemia (CMI). MethodsConsecutive patients with symptomatic angiography-verified atherosclerotic obstruction of the superior mesenteric artery (SMA) were categorized as AOCMI (n = 27) or CMI (n = 20). Three experienced radiologists blindly evaluated the contrast-enhanced CTs for vascular and intestinal findings. Kappa statistics was used to test interobserver agreement. ResultsTwo observers had substantial agreement (k = 0.66) that two thirds of AOCMI patients showed ischemia-specific CT findings (decreased bowel wall enhancement, pneumatosis, or thrombotic SMA clot); the third observer agreed only fairly regarding pneumatosis and thrombosis (k = 0.3–0.4). All observers had substantial agreement (k = 0.65–0.71) that most patients with AOCMI had unspecific intestinal findings such as mesenteric fat stranding in up to 96 %, bowel lumen dilatation in 93 %, and bowel wall thickening in 70 %, while only few patients with CMI had such findings (due to chronic ischemic colitis) (P < 0.001). ConclusionOne third of AOCMI patients presented without any ischemia-specific CT signs. However, any intestinal abnormality in CT together with SMA obstruction should raise suspicion of intestinal ischemia. Furthermore, clinicians need to be aware of the interobserver variability in the CT interpretation.

Inferior mesenteric artery aneurysm: case report and literature review.

An inferior mesenteric artery (IMA) aneurysm is the rarest among visceral artery aneurysms. A 69-year-old man was referred to our hospital with an asymptomatic IMA aneurysm associated with occlusion of the superior mesenteric artery (SMA) and celiac artery (CA). After revascularization of the SMA with an 8-mm expanded polytetrafluoroethylene (ePTFE) graft, the aneurysm was resected, and the IMA was reconstructed. The "jet disorder" phenomenon has been thought to cause an IMA aneurysm in the case of CA and SMA obstruction. We consider it better to revascularize not only an IMA but also an SMA or CA for preventing that phenomenon.

Successful Management of Tachycardiac Atrial Fibrillation in a Septic Patient with Landiolol

To the Editor: In sepsis patients, management of tachycardia accompanied by hypotension is difficult. A 75-year-old man was admitted for urgent laparotomy because of septic peritonitis by superior mesenteric artery obstruction. General anesthesia was induced with propofol 60 mg, fentanyl 0.1 mg, and was maintained with supplementary fentanyl and sevoflurane. Although IV fluid administration and catecholamine infusion were continued from the admission, heart rate (HR) increased to 150 bpm, pulmonary artery pressure (PA) increased to 54 mm Hg, and systolic blood pressure (SBP) decreased to 90 mm Hg after the start of operation. Landiolol was started at the rate of 5 μg · kg−1 · min−1 for 15 min, and was maintained 2 to 3 μg · kg−1 · min−1. In 15 min after landiolol infusion, HR and PA decreased and stabilized at around 80 bpm, around 30 mm Hg, respectively (see Fig. 1 on page 295). SBP increased and stabilized at about 120 mm Hg. This case demonstrates that landiolol attenuated the tachycardia-induced low cardiac stroke volume and stabilized the hemodynamics in a patient with sepsis. Landiolol was reported to cause neither excessive hypotension nor cardiac decompression and is thought to be useful for treating tachycardia in sepsis patients (1,2). Yuko Yoshida, MD Takashi Hongo, MD Atsuhiro Sakamoto, MD Ryo Ogawa, MD Department of Anesthesiology Nippon Medical School Tokyo, Japan [email protected]

Superior mesenteric artery obstruction by intraaortic counterpulsation balloon simulating embolism: A case report

The use of intraaortic counterpulsation balloons has been lifesaving in patients with cardiogenic shock, and indications for its use have expanded in recent years. Several complications of catheter placement and use have been reported. We report what we believe is the first instance of simulated embolization of the superior mesenteric artery by a balloon that was intermittently occluding the vessel's origin.

Experimental studies of the splanchnic circulation of the rabbit after ligation of the superior mesenteric artery. II. Radionuclide tracer studies.

EXPERIMENTAL STUDIES OF THE SPLANCHNIC CIRCULATION OF THE RABBIT AFTER LIGATION OF THE SUPERIOR MESENTERIC ARTERY II: RADIONUCLIDE TRACER STUDIESFREDERICK J. BONTE, M.D., ROBERT W. PARKEY, M.D. and GEORGE C. CURRY, M.D.Audio Available | Share