Treatment Of Intestinal Ischemia Research Articles

When is the right time to take an emergency surgery decision in Mechanical Intestinal Obstruction?

Background/Objective: Ischemia is a leading cause of morbidity in Mechanical Intestinal Obstruction (MIO) in which the timing of decisions of whether to proceed to surgical or conservative treatment is critical in emergency departments (ED). While advanced technological options are available, patients may be negatively affected by the application of contrast agents or radiation. The use of ultrasound is limited because of the air in the intestines does not allow a good field of vision. While biomarkers can be considered as a good alternative option at this point. In the present study we examine the effect of hemogram and blood gas parameters on early surgical decision-making in MIO patients. MethodInvolved in this observational prospective study were 264 patients diagnosed with MIO who presented to the Department of Emergency Medicine, Ataturk Research and Training Hospital, Katip Celebi University between February 2018 and February 2019. Contrast-enhanced tomography (CECT) and laboratory results of the patients were recorded. Pathology reports of the patients who underwent surgery were collected. Laboratory data were analyzed by comparing CECT and pathology reports. ResultsIn a ROC analysis of the laboratory values of the patients who were diagnosed with ileus, the sensitivity was calculated as 80% and the specificity was 57.7 in values above WBC>10.75 (109/L), 96.6%, and the specificity was 31.1% in N/L > 2.9. For intestinal ischemia, the cut-off values were WBC> 12.6 and N/L > 3.2, Lactate >2.8 mmol/L and B.E < -3.6 mmol/L. ConclusionDiagnoses of ileus are based on the results examinations and imaging methods. More data are needed to support decisions on the timing of surgery in ED. WBC, N/L, Lactate and Base Excess indicate an ischemic segment. When the parameters are evaluated together, they strongly support early surgical decision-making regarding the treatment of intestinal ischemia.

Plant histaminase as an investigational drug in splanchnic artery occlusion and reperfusion

Background: Amine oxidases are ubiquitous enzymes involved in the metabolism of biogenic amines. Copper amine oxidases catalyze the oxidative deamination of primary amine groups of several biogenic amines, such as putrescine, cadaverine and histamine. Objective: In the present review the effects of a plant amine oxidase (histaminase, EC1.4.3.6), purified from pea seedlings, in the prevention of splanchnic postischemic reperfusion damage are reported. Conclusion: Various studies have clearly indicated that the use of histaminase will offer a good perspective for a novel therapeutic approach in the medical treatment of intestinal ischemia.

Influence of anti-inflammatory drugs and free radical scavengers on intestinal ischemia induced oxidative tissue damage.

The influence of oxygen free radical scavengers and anti-inflammatory drugs on postischemic lipid peroxidation and myeloperoxidase activity was shown. The best results were obtained from vitamin E and the antiinflammatory treatment with CP and SUL, whereas an iron elimination only showed slight effects on myeloperoxidase activity above all. In experiments without therapy a linear increase of lipid peroxides dependent on reperfusion durance was found, whereas myeloperoxidase already showed a remarkable increase during ischemia and early reperfusion. This difference can be interpreted by scavenging mechanisms, which are overcharged after an appointed durance of reperfusion.

Intermittent ischemia potentiates intestinal reperfusion injury

We hypothesized that even brief periods of reperfusion interjected between ischemic episodes would increase tissue injury. Studies were performed in a rat small intestine preparation in which metabolic, hemodynamic, and histologic responses to ischemia have been well characterized. Animals were subjected to a total of 30 or 45 minutes of complete intestinal ischemia. Flow interruption was continuous (C, single episode) or intermittent (I, two or three episodes of 15-minute ischemia separated by 5 minutes of reperfusion). In some experiments 5-minute reperfusions were performed with arterial blood depleted of leukocytes (IL). This additional perturbation was included to determine the role of neutrophils that have been strongly implicated in reperfusion injury. In all three protocols histologic sections were obtained after each ischemic insult and after 1 hour of reperfusion with arterial blood. Villous histology was graded in a blinded fashion with 1 = normal and 5 = severe injury. No significant differences were found between groups in immediate postischemic histologies before reperfusion. After 1 hour of reperfusion, intermittent episodes of ischemia were associated with significantly worse histologic injury than that seen with comparable durations of continuous ischemia (30 min: I, 4.4 ± 0.5 vs C, 2.7 ± 0.4; 45 min: I, 4.9 ± 0.2 vs C, 2.8 ± 0.3). However, if 5-minute reperfusions were with leukopenic blood, this effect was markedly reduced (30 min IL, 3.4 ± 0.3; 45 min IL, 3.6 ± 0.2). Even short periods of reperfusion during an ischemic insult greatly increased mucosal injury. This likely resulted from increased access of leukocytes to ischemic tissues during the brief reperfusion periods, since decreasing leukocyte availability by transiently reperfusing with leukopenic blood attenuated the damage. Maneuvers designed to limit leukocyte adherence to endothelial cells should be considered in the treatment of intestinal ischemia, particularly in patients at risk for repeated episodes of flow interruption.

Treatment of Intestinal Ischemia with Oxygenated Intraluminal Perfluorocarbons

Liquid perfluorocarbons are biologically inert compounds capable of dissolving up to 40 percent oxygen by volume. This remarkable and reversible oxygen solubility has encouraged investigations into therapeutic application in situations where tissue oxygen delivery is impaired. One such setting is intestinal ischemia. Identically prepared devascularized segments of rat intestine were treated with either intraluminal oxygenated perfluorocarbon (perfluorotributylamine) or physiologic saline solution. After timed sacrifice, blinded quantitative histologic evaluation for ischemic injury was performed. The perfluorotributylamine treatment groups had histologic scores indicative of less severe injury between 1 and 4 hours. These scores achieved statistical significance (p less than 0.05). We conclude that intraluminal oxygenated perfluorocarbons have a significant protective effect in this model of intestinal ischemia. This quantitative analysis is unique and is an important aspect of the preclinical evaluation of the perfluorocarbon preparations.

Treatment of intestinal ischemia with oxygenated intraluminal perfluorocarbons

Liquid perfluorocarbons are biologically inert compounds capable of dissolving up to 40 percent oxygen by volume. This remarkable and reversible oxygen solubility has encouraged investigations into therapeutic application in situations where tissue oxygen delivery is impaired. One such setting is intestinal ischemia. Identically prepared devascularized segments of rat intestine were treated with either intraluminal oxygenated perfluorocarbon (perfluorotributylamine) or physiologic saline solution. After timed sacrifice, blinded quantitative histologic evaluation for ischemic injury was performed. The perfluorotributylamine treatment groups had histologic scores indicative of less severe injury between 1 and 4 hours. These scores achieved statistical significance (p < 0.05). We conclude that intraluminal oxygenated perfluorocarbons have a significant protective effect in this model of intestinal ischemia. This quantitative analysis is unique and is an important aspect of the preclinical evaluation of the perfluorocarbon preparations.

Adenosine and Diltiazem

To determine the therapeutic effect of two vasodilators, adenosine and diltiazem, in mesenteric ischemia, 13 dogs were treated with an intra-arterial perfusion of the drugs after digitalis intoxication. Blood flow was restored to the control value after a dose of 2 micrograms/kg/minute adenosine or 5 micrograms/kg/minute diltiazem. The advantage of adenosine is that its effect begins and ends very rapidly, but because doses of more than 2 micrograms/kg/minute may cause a drop in blood pressure, strict pressure control is mandatory when the drug is applied clinically. Its limited use is appropriate, for example, when operative measures cannot be excluded. Diltiazem can be used for long-term therapy with a reduced risk of a drop in blood pressure.

Recognition and Treatment of Intestinal Ischemia

Recognition and Treatment of Intestinal Ischemia