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The off-the-shelf single fenestrated stent graft is based on the Cook Zenith fenestrated platform (Cook Medical Europe) with a premade 8-mm fenestration for the superior mesenteric artery (SMA). The device is suitable for emergency treatment of paravisceral aneurysms when combined with in situ laser fenestration for the renal arteries (and, if required, the celiac trunk). The presence of a premade SMA fenestration results in minimal visceral ischemia time. We present the case of a 69-year-old woman with a ruptured Crawford type I thoracoabdominal aortic aneurysm and a tandem abdominal aortic aneurysm that was treated successfully using the single fenestrated device with in situ laser fenes-tration for the renal arteries, with no SMA ischemia time. A 6-month computed tomography angiogram showed patent renovisceral stents without an endoleak.

The off-the-shelf single fenestrated stent graft is based on the Cook Zenith fenestrated platform (Cook Medical Europe) with a premade 8-mm fenestration for the superior mesenteric artery (SMA). The device is suitable for emergency treatment of paravisceral aneurysms when combined with in situ laser fenestration for the renal arteries (and, if required, the celiac trunk). The presence of a premade SMA fenestration results in minimal visceral ischemia time. We present the case of a 69-year-old woman with a ruptured Crawford type I thoracoabdominal aortic aneurysm and a tandem abdominal aortic aneurysm that was treated successfully using the single fenestrated device with in situ laser fenes-tration for the renal arteries, with no SMA ischemia time. A 6-month computed tomography angiogram showed patent renovisceral stents without an endoleak.

The off-the-shelf single fenestrated stent graft is based on the Cook Zenith fenestrated platform (Cook Medical Europe) with a premade 8-mm fenestration for the superior mesenteric artery (SMA). The device is suitable for emergency treatment of paravisceral aneurysms when combined with in situ laser fenestration for the renal arteries (and, if required, the celiac trunk). The presence of a premade SMA fenestration results in minimal visceral ischemia time. We present the case of a 69-year-old woman with a ruptured Crawford type I thoracoabdominal aortic aneurysm and a tandem abdominal aortic aneurysm that was treated successfully using the single fenestrated device with in situ laser fenestration for the renal arteries, with no SMA ischemia time. A 6-month computed tomography angiogram showed patent renovisceral stents without an endoleak.

The off-the-shelf single fenestrated stent graft is based on the Cook Zenith fenestrated platform (Cook Medical Europe) with a premade 8-mm fenestration for the superior mesenteric artery (SMA). The device is suitable for emergency treatment of paravisceral aneurysms when combined with in situ laser fenestration for the renal arteries (and, if required, the celiac trunk). The presence of a premade SMA fenestration results in minimal visceral ischemia time. We present the case of a 69-year-old woman with a ruptured Crawford type I thoracoabdominal aortic aneurysm and a tandem abdominal aortic aneurysm that was treated successfully using the single fenestrated device with in situ laser fenes-tration for the renal arteries, with no SMA ischemia time. A 6-month computed tomography angiogram showed patent renovisceral stents without an endoleak.

The off-the-shelf single fenestrated stent graft is based on the Cook Zenith fenestrated platform (Cook Medical Europe) with a premade 8-mm fenestration for the superior mesenteric artery (SMA). The device is suitable for emergency treatment of paravisceral aneurysms when combined with in situ laser fenestration for the renal arteries (and, if required, the celiac trunk). The presence of a premade SMA fenestration results in minimal visceral ischemia time. We present the case of a 69-year-old woman with a ruptured Crawford type I thoracoabdominal aortic aneurysm and a tandem abdominal aortic aneurysm that was treated successfully using the single fenestrated device with in situ laser fenes-tration for the renal arteries, with no SMA ischemia time. A 6-month computed tomography angiogram showed patent renovisceral stents without an endoleak.

The off-the-shelf single fenestrated stent graft is based on the Cook Zenith fenestrated platform (Cook Medical Europe) with a premade 8-mm fenestration for the superior mesenteric artery (SMA). The device is suitable for emergency treatment of paravisceral aneurysms when combined with in situ laser fenestration for the renal arteries (and, if required, the celiac trunk). The presence of a premade SMA fenestration results in minimal visceral ischemia time. We present the case of a 69-year-old woman with a ruptured Crawford type I thoracoabdominal aortic aneurysm and a tandem abdominal aortic aneurysm that was treated successfully using the single fenestrated device with in situ laser fenestration for the renal arteries, with no SMA ischemia time. A 6-month computed tomography angiogram showed patent renovisceral stents without an endoleak.

Superior mesenteric artery syndrome (SMAS), also known as Wilkie syndrome, is a rare medical condition characterized by constriction of the third portion of the duodenum, which occurs due to compression exerted by the superior mesenteric artery and the abdominal aorta, generally associated with significant weight loss. We present the case of a 70-year-old woman with a two-year history of sporadic abdominal pain, significant weight loss, nausea and vomiting. After a thorough evaluation, including a CT scan, the patient was diagnosed with Wilkie syndrome. The patient underwent a gastrojejunostomy as part of the treatment, which relieved the symptoms; However, the subsequent development of anemia was attributed to the presence of an anastomotic ulcer and an infection caused by Helicobacter pylori. These underlying conditions were managed appropriately, leading to resolution of the anemia. Our case posed a challenge to the usual demographic patterns linked to this medical condition, which primarily affects younger people. This highlights the importance of taking into account different age-related factors for a more accurate diagnosis., El Síndrome de la arteria mesentérica superior (SAMS), también conocido como Síndrome de Wilkie, es una condición médica poco frecuente caracterizada por la constricción de la tercera porción del duodeno, que se produce debido a la compresión ejercida por la arteria mesentérica superior y la aorta abdominal, generalmente asociado a pérdida de peso significativa. Presentamos el caso de una mujer de 70 años con antecedentes de dos años de evolución de dolor abdominal esporádico, pérdida importante de peso, náuseas y vómitos. Después de una evaluación exhaustiva, incluida una tomografía computarizada, a la paciente se le diagnosticó síndrome de Wilkie. La paciente fue sometida a una gastroyeyunostomía como parte del tratamiento, la cual alivió los síntomas; sin embargo, el desarrollo posterior de anemia se atribuyó a la presencia de una úlcera anastomótica y una infección causada por Helicobacter pylori. Estas condiciones subyacentes se manejaron adecuadamente, lo que llevó a la resolución de la anemia. Nuestro caso planteó un desafío a los patrones demográficos habituales vinculados típicamente con esta condición médica, que afecta principalmente a personas más jóvenes. Esto resalta la importancia de tener en cuenta distintos factores relacionados con la edad para un diagnóstico más preciso.

Superior mesenteric artery syndrome (SAMS) or Wilkie syndrome is a rare clinical condition, the incidence of superior mesenteric syndrome reported in some previous studies can range from 0.013% to 0.78% but the true incidence is unknown. This syndrome is characterized by extrinsic constriction on the anterior surface of the duodenum by the superior mesenteric artery and the abdominal aorta, leading to the formation of an aortomesenteric angle < 25°, and a decrease in the normal distance between the aorta and the mesenteric artery to 2-8 mm. Objective: Therefore, the objective of the present study is to carry out a systematic review of the literature to describe the superior mesenteric artery syndrome. Methodology: This study is a systematic literature review, with a qualitative approach, with interpretation and analysis of the elements obtained. The research was carried out from the survey of scientific articles found in the main search platforms for scientific articles: ScienceDirect, PubMed, SciELO, Bireme, from 2017 to 2022. Results and discussion: For this review 15 articles were selected as the studies showed that the symptoms of Wilkie syndrome are confusing, epigastric pain, vomiting, heartburn may be signs of other gastrointestinal pathologies such as gastroesophageal reflux, as presented in the literature. In chronic patients, non-operative therapy is often prolonged due to the long period of hospitalization, with a low success rate ranging from 14 to 71%. Strong's operation, gastrojejunostomy, and duodenujejunostomy are treatment options for Wilkie syndrome. Final considerations: The diagnosis of Wilkie syndrome often depends on a high index of clinical exclusion of other diseases, resulting in ineffective symptomatic symptoms. For this reason, a detailed history should be taken and after careful endoscopic evaluation, CT images should be analyzed carefully and surgery should be considered in cases of longer duration with nutritional support, always emp

Superior mesenteric artery syndrome (SAMS) or Wilkie syndrome is a rare clinical condition, the incidence of superior mesenteric syndrome reported in some previous studies can range from 0.013% to 0.78% but the true incidence is unknown. This syndrome is characterized by extrinsic constriction on the anterior surface of the duodenum by the superior mesenteric artery and the abdominal aorta, leading to the formation of an aortomesenteric angle < 25°, and a decrease in the normal distance between the aorta and the mesenteric artery to 2-8 mm. Objective: Therefore, the objective of the present study is to carry out a systematic review of the literature to describe the superior mesenteric artery syndrome. Methodology: This study is a systematic literature review, with a qualitative approach, with interpretation and analysis of the elements obtained. The research was carried out from the survey of scientific articles found in the main search platforms for scientific articles: ScienceDirect, PubMed, SciELO, Bireme, from 2017 to 2022. Results and discussion: For this review 15 articles were selected as the studies showed that the symptoms of Wilkie syndrome are confusing, epigastric pain, vomiting, heartburn may be signs of other gastrointestinal pathologies such as gastroesophageal reflux, as presented in the literature. In chronic patients, non-operative therapy is often prolonged due to the long period of hospitalization, with a low success rate ranging from 14 to 71%. Strong's operation, gastrojejunostomy, and duodenujejunostomy are treatment options for Wilkie syndrome. Final considerations: The diagnosis of Wilkie syndrome often depends on a high index of clinical exclusion of other diseases, resulting in ineffective symptomatic symptoms. For this reason, a detailed history should be taken and after careful endoscopic evaluation, CT images should be analyzed carefully and surgery should be considered in cases of longer duration with nutritional support, always emp

The off-the-shelf single fenestrated stent graft is based on the Cook Zenith fenestrated platform (Cook Medical Europe) with a premade 8-mm fenestration for the superior mesenteric artery (SMA). The device is suitable for emergency treatment of paravisceral aneurysms when combined with in situ laser fenestration for the renal arteries (and, if required, the celiac trunk). The presence of a premade SMA fenestration results in minimal visceral ischemia time. We present the case of a 69-year-old woman with a ruptured Crawford type I thoracoabdominal aortic aneurysm and a tandem abdominal aortic aneurysm that was treated successfully using the single fenestrated device with in situ laser fenes-tration for the renal arteries, with no SMA ischemia time. A 6-month computed tomography angiogram showed patent renovisceral stents without an endoleak.

The off-the-shelf single fenestrated stent graft is based on the Cook Zenith fenestrated platform (Cook Medical Europe) with a premade 8-mm fenestration for the superior mesenteric artery (SMA). The device is suitable for emergency treatment of paravisceral aneurysms when combined with in situ laser fenestration for the renal arteries (and, if required, the celiac trunk). The presence of a premade SMA fenestration results in minimal visceral ischemia time. We present the case of a 69-year-old woman with a ruptured Crawford type I thoracoabdominal aortic aneurysm and a tandem abdominal aortic aneurysm that was treated successfully using the single fenestrated device with in situ laser fenestration for the renal arteries, with no SMA ischemia time. A 6-month computed tomography angiogram showed patent renovisceral stents without an endoleak.

The off-the-shelf single fenestrated stent graft is based on the Cook Zenith fenestrated platform (Cook Medical Europe) with a premade 8-mm fenestration for the superior mesenteric artery (SMA). The device is suitable for emergency treatment of paravisceral aneurysms when combined with in situ laser fenestration for the renal arteries (and, if required, the celiac trunk). The presence of a premade SMA fenestration results in minimal visceral ischemia time. We present the case of a 69-year-old woman with a ruptured Crawford type I thoracoabdominal aortic aneurysm and a tandem abdominal aortic aneurysm that was treated successfully using the single fenestrated device with in situ laser fenestration for the renal arteries, with no SMA ischemia time. A 6-month computed tomography angiogram showed patent renovisceral stents without an endoleak.

Superior mesenteric artery syndrome (SAMS) or Wilkie syndrome is a rare clinical condition, the incidence of superior mesenteric syndrome reported in some previous studies can range from 0.013% to 0.78% but the true incidence is unknown. This syndrome is characterized by extrinsic constriction on the anterior surface of the duodenum by the superior mesenteric artery and the abdominal aorta, leading to the formation of an aortomesenteric angle < 25°, and a decrease in the normal distance between the aorta and the mesenteric artery to 2-8 mm. Objective: Therefore, the objective of the present study is to carry out a systematic review of the literature to describe the superior mesenteric artery syndrome. Methodology: This study is a systematic literature review, with a qualitative approach, with interpretation and analysis of the elements obtained. The research was carried out from the survey of scientific articles found in the main search platforms for scientific articles: ScienceDirect, PubMed, SciELO, Bireme, from 2017 to 2022. Results and discussion: For this review 15 articles were selected as the studies showed that the symptoms of Wilkie syndrome are confusing, epigastric pain, vomiting, heartburn may be signs of other gastrointestinal pathologies such as gastroesophageal reflux, as presented in the literature. In chronic patients, non-operative therapy is often prolonged due to the long period of hospitalization, with a low success rate ranging from 14 to 71%. Strong's operation, gastrojejunostomy, and duodenujejunostomy are treatment options for Wilkie syndrome. Final considerations: The diagnosis of Wilkie syndrome often depends on a high index of clinical exclusion of other diseases, resulting in ineffective symptomatic symptoms. For this reason, a detailed history should be taken and after careful endoscopic evaluation, CT images should be analyzed carefully and surgery should be considered in cases of longer duration with nutritional support, always emp

The concept of the superior mesenteric artery (SMA)-first approach has been widely accepted in pancreatoduodenectomy. However, few studies have reported surgical approaches to the SMA in robotic pancreatoduodenectomy (RPD). Herein, we present our surgical strategies to dissect around the SMA in RPD. Among the various approaches, our standard protocol for RPD included the right approach to the SMA, which can result in complete tumor resection in most cases. In patients with malignant diseases requiring lymphadenectomy around the SMA, we developed a novel approach by combining the left and right approaches in RPD. Using this approach, circumferential dissection around the SMA can be achieved through both the left and right sides. This approach can also be helpful in patients with obesity or intra-abdominal adhesions. The present study summarizes the advantages and disadvantages of both the approaches during RPD. To perform RPD safely, surgeons should understand the different surgical approaches and select the best approach or a combination of different approaches, depending on demographic, anatomical, and oncological factors.

The concept of the superior mesenteric artery (SMA)-first approach has been widely accepted in pancreatoduodenectomy. However, few studies have reported surgical approaches to the SMA in robotic pancreatoduodenectomy (RPD). Herein, we present our surgical strategies to dissect around the SMA in RPD. Among the various approaches, our standard protocol for RPD included the right approach to the SMA, which can result in complete tumor resection in most cases. In patients with malignant diseases requiring lymphadenectomy around the SMA, we developed a novel approach by combining the left and right approaches in RPD. Using this approach, circumferential dissection around the SMA can be achieved through both the left and right sides. This approach can also be helpful in patients with obesity or intra-abdominal adhesions. The present study summarizes the advantages and disadvantages of both the approaches during RPD. To perform RPD safely, surgeons should understand the different surgical approaches and select the best approach or a combination of different approaches, depending on demographic, anatomical, and oncological factors.

We report a rare variant of the hepatic arterial supply observed during liver procurement from a 71-year-old female donor for whom an ischemic stroke caused brain death. Preoperative computed tomography showed a partially obliterated celiac trunk and an atypical arterial branch that coursed in a retropancreatic plane away from its origin at the superior mesenteric artery to anastomose with the common hepatic artery at the origin of the proper hepatic artery. The gastroduodenal artery and the dorsal pancreatic artery are the 2 conventional anastomotic arcades between the celiac trunk and the superior mesenteric artery. However, another potential anastomotic route is a rare physiological phenomenon known as the arc of Bühler, which, if present, connects the superior mesenteric artery with the celiac trunk or one of its branches. Although the arc of Bühler is known to occur in less than 3% of the general population, it could serve as a crucial anastomotic option in the case of median arcuate ligament syndrome or atheromatous obliteration of the celiac trunk. In our case, we were able to dissect and preserve the entire anastomotic arc from the donor. For arterial reconstruction during liver transplant, we anastomosed the arc of Bühler to the recipient’s hepatic artery at the origin of the gastroduodenal artery. The postoperative course was uneventful, and the recipient was in good health at the 6-month follow-up. The arc of Bühler, when present, is an important anastomotic option in hepatobiliary surgery to avoid potential damage to the arterial supply of the liver.

Familial hypercholesterolemia (FH) is a common hereditary lipid disorder associated with substantial risk of premature atherosclerotic cardiovascular disease. We report an interesting newly diagnosed index case of FH in a 31-year-old man who presented to the hospital with an ST-elevated myocardial infarction. He had a background of inadequately treated hypertension and hypercholesterolemia. Further investigations raised the possibility of secondary hypertension after the identification of renal artery stenosis, in addition to other areas of mesenteric arterial stenoses. Our patient's case highlights that early-onset hypertension and hypercholesterolemia in a young individual may be an early manifestation of FH requiring high clinical vigilance and awareness.Copyright © American Journal of Hypertension, Ltd 2019. All rights reserved.

The feasibility and effectiveness of superior mesenteric artery Doppler ultrasonography in the diagnosis of necrotizing enterocolitis and other gastrointestinal pathologies in newborns were evaluated in this article. It was found that with in necrotizing enterocolitis presence in newborn indices of hemodynamics are outgoing of the bounds of norm and are typical for ischemic lesions of gastro - intestinal tract (elevated levels of PI and RI, Vps growth and Ved decrease). When functional gastrointestinal disorders are present the hemodynamic disorders are absent or temporary and insignificant. Authors concluded that the use of Doppler ultrasonography of superior mesenteric artery in infants with gastrointestinal pathology allows to establish the timely diagnosis of necrotizing enterocolitis and to prescribe adequate treatment., В работе оценена возможность и эффективность допплерографической ультрасонографии верхней брыжеечной артерии при диагностике некротического энтероколита и другой гастроинтестинальной патологии у новорожденных. Установлено, что при некротическом энтероколите у новорожденных показатели гемодинамики выходят за пределы нормы и являются типичными для ишемических поражений желудочно-кишечного тракта (повышенные уровни PI и RI, рост Vps и снижение Ved). При функциональных гастроинтестинальных расстройствах нарушения гемодинамики отсутствуют или являются временными и незначительными. Сделан вывод, что использование допплерографической ультрасонографии верхней брыжеечной артерии у новорожденных с гастроинтестинальной патологией позволяет своевременно установить диагноз некротического энтероколита и назначить адекватное лечение., У роботі оцінена можливість і ефективність допплерографічної ультрасонографії верхньої брижової артерії при діагностиці некротичного ентероколіту та іншої гастроінтестинальної патології у новонароджених. Встановлено, що при некротичному ентероколіті у новонароджених показники гемодинаміки виходять за межі норми і є типовими для ішемічних уражень шлунково-кишкового тракту (підвищені рівні PI і RI, зростання Vps та зниження Ved). При функціональних гастроінтестинальних розладах порушення гемодинаміки є відсутніми або тимчасовими і незначними. Зроблено висновок, що використання допплерографічної ультрасонографії верхньої брижової артерії у новонароджених з гастроінтестинальною патологією дає змогу своєчасно встановити діагноз некротичного ентероколіту та призначити адекватне лікування.

Background and objective: The objective of this article is to externally validate and update a recently published score chart for chronic mesenteric ischemia (CMI). Methods: A multicenter prospective cohort analysis was conducted of 666 CMI-suspected patients referred to two Dutch specialized CMI centers. Multidisciplinary consultation resulted in expert-based consensus diagnosis after which CMI consensus patients were treated. A definitive diagnosis of CMI was established if successful treatment resulted in durable symptom relief. The absolute CMI risk was calculated and discriminative ability of the original chart was assessed by the c-statistic in the validation cohort. Thereafter the original score chart was updated based on the performance in the combined original and validation cohort with inclusion of celiac artery (CA) stenosis cause. Results: In 8% of low-risk patients, 39% of intermediate-risk patients and 94% of high-risk patients of the validation cohort, CMI was diagnosed. Discriminative ability of the original model was acceptable (c-statistic 0.79). The total score of the updated chart ranged from 0 to 28 points (low risk 19% absolute CMI risk, intermediate risk 45%, and high risk 92%). The discriminative ability of the updated chart was slightly better (c-statistic 0.80). Conclusion: The CMI prediction model performs and discriminates well in the validation cohort. The updated score chart has excellent discriminative ability and is useful in clinical decision making.

Familial hypercholesterolemia (FH) is a common hereditary lipid disorder associated with substantial risk of premature atherosclerotic cardiovascular disease. We report an interesting newly diagnosed index case of FH in a 31-year-old man who presented to the hospital with an ST-elevated myocardial infarction. He had a background of inadequately treated hypertension and hypercholesterolemia. Further investigations raised the possibility of secondary hypertension after the identification of renal artery stenosis, in addition to other areas of mesenteric arterial stenoses. Our patient's case highlights that early-onset hypertension and hypercholesterolemia in a young individual may be an early manifestation of FH requiring high clinical vigilance and awareness.Copyright © American Journal of Hypertension, Ltd 2019. All rights reserved.

Wilkie syndrome is a disease characterized by an extrinsic compression of the third portion of the duodenum by the superior mesenteric artery and the aorta. It is of gradual evolution producing long-term high intestinal obstructive symptoms. The diagnostic method of choice is the CT scan being the most effective and least invasive. The treatment of choice in the absence of a good response with conservative treatment, is surgical through a duodenoyeyunostomy relieving duodenal and gastric symptoms. The article presents a case of Superior Mesenteric Artery Syndrome that develops in a 45-year-old woman. The patient presents a clinical picture of colic pain in epigastrium, nausea and vomiting for several occasions, weight loss of approximately 10 Kg, upper digestive endoscopy, it is concluded as a pseudo intestinal obstruction. Abdominal tomography suggests aortomesenteric clamping of the Treitz angle (Wilkie syndrome). The patient does not improve conservative management, so duodenoyeyuno anastomosis is performed in Y of Roux and is discharged 4 days after the intervention with good oral tolerance and weight gain is evidenced by the controls. Esophagogastricoduodenal transit does not reveal areas of stenosis or dilation. It is concluded that Wilkie syndrome is an uncommon pathology of low incidence, so it is underdiagnosed, although its clinic is not easy to differentiate since it can be confused with several pathologies so that its diagnosis is made late, being the diagnostic tool more useful the TAC. Among the surgical techniques of choice, the most appropriate would be the duodenoyeyunostomy with a higher success rate and fewer complications., El síndrome de Wilkie es una enfermedad que se caracteriza por una compresión extrínseca de la tercera porción del duodeno por la arteria mesentérica superior y la aorta. Es de evolución gradual produciendo síntomas obstructivos intestinales altos a largo plazo. El método diagnóstico de elección es la TAC siendo la más efectiva y menos invasiva. El tratamiento de elección al no existir una buena respuesta con el tratamiento conservador, es quirúrgico por medio de una duodenoyeyunostomia aliviando síntomas duodenales y gástricos. El artículo presenta un caso del Síndrome de Arteria Mesentérica Superior que se desarrolla en una mujer de 45 años de edad. La paciente presenta un cuadro clínico de dolor cólico en epigastrio, náuseas y vómitos por varias ocasiones, pérdida de peso de aproximadamente 10 Kg, endoscopia digestiva alta, se concluye como pseudo obstrucción intestinal. La Tomografía de abdomen sugiere pinzamiento aortomesenterico del ángulo de Treitz (Síndrome de Wilkie). La paciente no mejora al manejo conservador, por lo que se realiza duodenoyeyuno anastomosis en Y de Roux y se da de alta a los 4 días de la intervención con buena tolerancia oral y a los controles se evidencia ganancia de peso. Transito esofagogastricoduodenal no revela áreas de estenosis o dilatación. Se concluye que el síndrome de Wilkie es una patología infrecuente de baja incidencia, por lo cual es subdiagnosticada, aunque su clínica no es fácil de diferenciar ya que puede confundirse con varias patologías por lo que su diagnóstico se lo realiza tardíamente, siendo la herramienta diagnostica más útil la TAC. Entre las técnicas quirúrgicas de elección, la más apropiada vendría a ser la duodenoyeyunostomia con una mayor tasa de éxito y menor complicaciones.

Extracellular pH is an important physiological determinant of vascular tone that is normally maintained within 7.35-7.45. Any change outside this range leads to severe pathological repercussions. We investigated the unknown effects of extracellular acidosis on relaxation in the superior mesenteric artery (SMA) of goat. SMA rings were employed to maintain isometric contractions at extracellular pH (pH

Nitric oxide produced by inducible nitric oxide synthase (iNOS) regulates sepsis-induced hypotension. During septic shock, interleukin (IL)-1β is synthesized in endothelial cells and smooth muscle cells by endotoxin. Ethanol (EtOH) suppresses endotoxin-induced hypotension. The present study aimed to elucidate the effect of EtOH on gradual relaxation and iNOS expression induced by IL-1β in isolated rat superior mesenteric arteries (SMAs). Exposure to IL-1β–induced contraction in SMA rings, followed by a gradual relaxation of phenylephrine precontracted tone. Contraction was abolished by indomethacin (IM), cycloheximide (Chx), and endothelium denudation. In contrast, the gradual relaxation was abolished by NOS inhibitors, Chx, endothelium denudation, and inhibited by EtOH (50 and 100 mM). However, IM had no effect on relaxation. Western blot analysis demonstrated that iNOS expression was induced by IL-1β and was inhibited by EtOH and endothelium denudation. Furthermore, messenger RNA expression of iNOS, but not endothelial NOS, was inhibited by EtOH. These data suggest that IL-1β–induced contraction is mediated by thromboxane A2, whereas IL-1β–induced relaxation occurs via NO derived from iNOS. The endothelium plays an important role in vasorelaxation. Taken together, EtOH inhibits IL-1β–mediated vasorelaxation by suppressing endothelium iNOS expression. This study provides the first evidence of EtOH -induced inhibition of IL-1β–mediated vasorelaxation., 博士（医学）・甲第647号・平成28年3月15日, © The Author(s), Copyright © 2016 by SAGE Publications, The definitive version is available at " http://dx.doi.org/10.1177/0960327115611944 "

Nitric oxide produced by inducible nitric oxide synthase (iNOS) regulates sepsis-induced hypotension. During septic shock, interleukin (IL)-1β is synthesized in endothelial cells and smooth muscle cells by endotoxin. Ethanol (EtOH) suppresses endotoxin-induced hypotension. The present study aimed to elucidate the effect of EtOH on gradual relaxation and iNOS expression induced by IL-1β in isolated rat superior mesenteric arteries (SMAs). Exposure to IL-1β–induced contraction in SMA rings, followed by a gradual relaxation of phenylephrine precontracted tone. Contraction was abolished by indomethacin (IM), cycloheximide (Chx), and endothelium denudation. In contrast, the gradual relaxation was abolished by NOS inhibitors, Chx, endothelium denudation, and inhibited by EtOH (50 and 100 mM). However, IM had no effect on relaxation. Western blot analysis demonstrated that iNOS expression was induced by IL-1β and was inhibited by EtOH and endothelium denudation. Furthermore, messenger RNA expression of iNOS, but not endothelial NOS, was inhibited by EtOH. These data suggest that IL-1β–induced contraction is mediated by thromboxane A2, whereas IL-1β–induced relaxation occurs via NO derived from iNOS. The endothelium plays an important role in vasorelaxation. Taken together, EtOH inhibits IL-1β–mediated vasorelaxation by suppressing endothelium iNOS expression. This study provides the first evidence of EtOH -induced inhibition of IL-1β–mediated vasorelaxation., 博士（医学）・甲第647号・平成28年3月15日, © The Author(s), Copyright © 2016 by SAGE Publications, The definitive version is available at " http://dx.doi.org/10.1177/0960327115611944 "

Introduction: As the field of intestinal surgery advanced over the recent century, challenge of performing more complex resection and anastomoses highlighted the presence of vascular variants. The current clinical interest of these anatomic finding is to laparoscopic colon surgeon. Material and method: The study was conducted on a 50 embalmed human cadavers in the Anatomy dissection hall .We performed detailed dissection to measure length and to note a branching pattern of Superior mesenteric artery and its branches. Results: In all 50 cases Superior Mesenteric Artery (SMA) was originated from abdominal aorta, separated from celiac trunk by 0.9cm + 0.29. All five branches were seen in all samples with 2% showed additional branches. A common trunk of Right Colic artery (RCA) and Middle Colic artery (MCA) was noted in 42%. The numbers of Jejuno-Ilel branches were 7-13 in number with most common was 9 (26%). Additional branch from jejunal artery to other viscera was present in 4%. Mean length of MCA, RCA and Ileo-colic was 3.23 + 1.51, 3.42 + 1.17, and 4.57+ 0.98 respectively. Pattern of distribution noted was Type A 58%, Type B 32%, Type C 10%. Conclusion: A normal pattern of colonic vasculature as accepted by most of medical textbook was not seen in all of the cases. The interest in these anatomical concepts was not simply to Anatomist but also to surgeons while performing a safe and efficient laparoscopic or conventional colon surgery.

Introduction: As the field of intestinal surgery advanced over the recent century, challenge of performing more complex resection and anastomoses highlighted the presence of vascular variants. The current clinical interest of these anatomic finding is to laparoscopic colon surgeon. Material and method: The study was conducted on a 50 embalmed human cadavers in the Anatomy dissection hall .We performed detailed dissection to measure length and to note a branching pattern of Superior mesenteric artery and its branches. Results: In all 50 cases Superior Mesenteric Artery (SMA) was originated from abdominal aorta, separated from celiac trunk by 0.9cm + 0.29. All five branches were seen in all samples with 2% showed additional branches. A common trunk of Right Colic artery (RCA) and Middle Colic artery (MCA) was noted in 42%. The numbers of Jejuno-Ilel branches were 7-13 in number with most common was 9 (26%). Additional branch from jejunal artery to other viscera was present in 4%. Mean length of MCA, RCA and Ileo-colic was 3.23 + 1.51, 3.42 + 1.17, and 4.57+ 0.98 respectively. Pattern of distribution noted was Type A 58%, Type B 32%, Type C 10%. Conclusion: A normal pattern of colonic vasculature as accepted by most of medical textbook was not seen in all of the cases. The interest in these anatomical concepts was not simply to Anatomist but also to surgeons while performing a safe and efficient laparoscopic or conventional colon surgery.

Objectives: To assess the efficacy of fine focal spot imaging in calcification beam-hardening artefact reduction and vessel clarity on CT abdominal angiography (CTAA). Methods: Adult patients of any age and gender who presented for CTAA were included. Thirty-nine patients were examined with a standard focal spot size (SFSS) of 1 x 1 mm in the first 3 months while 31 consecutive patients were examined with a fine focal spot size (FFSS) of 1 x 0.5 mm in the following 3 months. Vessel clarity and calcification beam-hardening artefacts of the abdominal aorta, celiac axis, superior mesenteric artery, inferior mesenteric artery, renal arteries, and iliac arteries were assessed using a 5-point grading scale by two blinded radiologists randomly. Results: Cohen's Kappa test indicated that on average, there was substantial agreement among reviewers for vessel wall clarity and calcification artefact grading. Mann-Whitney test showed that there was a significant difference between the two groups, with FFSS performing significantly better for vessel clarity (U, 6481.50; p < 0.001; r, 0.73) and calcification artefact reduction (U, 1916; p < 0.001; r, 0.77). Conclusion: Fine focus CT angiography produces images with better vessel wall clarity and less vessel calcification beam-hardening artefact. Key Points: * Focal spot size affects the spatial resolution of a CT system. * Fine focus CTAA produces images with improved vessel wall clarity. * Fine focus CTAA is associated with fewer calcification beam-hardening artefacts. * Fine focus CTAA may improve accuracy in assessment of luminal stenosis.Copyright © 2014, European Society of Radiology.

Patent ductus arteriosus in extremely premature babies is associated with major neonatal morbidities, such as necrotizing enterocolitis and intraventricular hemorrhage. This may be attributable, at least in part, to systemic hypoperfusion secondary to ductal steal. A hemodynamically significant ductus arteriosus (HSDA) is known to be associated with altered systemic blood flow and end-organ hypoperfusion. Although descending aorta blood flow profiles may show abnormal diastolic retrograde flow, Doppler studies of blood flow in the systemic arteries may help improve our understanding of the relationship of a HSDA with these morbidities. In this article, we discuss aspects of diastolic blood flow reversal in the systemic arteries in premature infants with a hemodynamically significant duct. Whether these hemodynamic effects are significant enough to form the basis for initiating treatment is still unclear; these should form the basis for prospective studies. © 2011 Nature America, Inc. All rights reserved.

Patent ductus arteriosus in extremely premature babies is associated with major neonatal morbidities, such as necrotizing enterocolitis and intraventricular hemorrhage. This may be attributable, at least in part, to systemic hypoperfusion secondary to ductal steal. A hemodynamically significant ductus arteriosus (HSDA) is known to be associated with altered systemic blood flow and end-organ hypoperfusion. Although descending aorta blood flow profiles may show abnormal diastolic retrograde flow, Doppler studies of blood flow in the systemic arteries may help improve our understanding of the relationship of a HSDA with these morbidities. In this article, we discuss aspects of diastolic blood flow reversal in the systemic arteries in premature infants with a hemodynamically significant duct. Whether these hemodynamic effects are significant enough to form the basis for initiating treatment is still unclear; these should form the basis for prospective studies. © 2011 Nature America, Inc. All rights reserved.

Introduction: mRNA changes in the small intestine in response to acute mesenteric ischaemia (AMI) could offer novel diagnostic possibilities, but have not been described. The aim was to characterize the mRNA response to experimental AMI. Materials and methods: Twelve pigs underwent catheterization of the superior mesenteric artery with injection of polivinylalcohol embolization particles or sodium chloride. Laparotomy and intestinal tissue sampling was performed. Microarray analysis was performed using the GeneChip® whole porcine genome array. Results: Seven down-regulated cellular pathways were associated with protein, lipid and carbohydrate metabolism. Seventeen up-regulated pathways were associated with inflammatory and immunological activity, regulation of extracellular matrix and decreased cellular proliferation. Thrombospondin(THS), Monocyte Chemoattractant Protein 1(MCP-1) and Gap Junction Alpha 1(GJA-1) were consistently up-regulated in all embolized pigs. Genes encoding earlier proposed biomarkers for AMI were up-regulated, such as lactate dehydrogenase and creatine kinase, or down-regulated, such as intestinal fatty acid binding protein and glutathione S-transferase. Conclusion: This study describes the intestinal tissue response on a gene expression level to AMI. THS, MCP-1 and GJA-1 were consistently up-regulated by ischemia, whereas earlier proposed biomarkers for AMI were not. Gene expression may not be directly linked to the use of the corresponding proteins as potential clinical biomarkers.

The present report describes two anomalous cases involving hepato-lieno-mesenteric trunk at the dissection for education of medical students in 1992. The first case (A) was found in a 53-year-old Japanese woman and the second case (B) in a 79-year-old Japanese man. The left gastric artery arises directly from the abdominal aorta and then gives off the inferior phrenic artery. The splenic, common hepatic and superior mesenteric arteries form a so-called hepato-lieno-mesenteric trunk. In the first case (A), the three arteries arise from the hepato-lieno-mesenteric trunk in the order of superior mesenteric, splenic and common hepatic arteries. In the second case (B), the hepato-lieno-mesenteric trunk divides into superior mesenteric artery and hepato-splenic trunk, which joins into the common hepatic and splenic arteries. These two cases belong to Type Ⅲ of Adachi's classification (1928), and to Type Ⅱ' of Morita's classification (1953).

The present report describes two anomalous cases involving hepato-lieno-mesenteric trunk at the dissection for education of medical students in 1992. The first case (A) was found in a 53-year-old Japanese woman and the second case (B) in a 79-year-old Japanese man. The left gastric artery arises directly from the abdominal aorta and then gives off the inferior phrenic artery. The splenic, common hepatic and superior mesenteric arteries form a so-called hepato-lieno-mesenteric trunk. In the first case (A), the three arteries arise from the hepato-lieno-mesenteric trunk in the order of superior mesenteric, splenic and common hepatic arteries. In the second case (B), the hepato-lieno-mesenteric trunk divides into superior mesenteric artery and hepato-splenic trunk, which joins into the common hepatic and splenic arteries. These two cases belong to Type Ⅲ of Adachi's classification (1928), and to Type Ⅱ' of Morita's classification (1953).

Acute occlusion of the superior mesenteric artery (SMA) is a condition associated with high mortality and morbidity. The aim of this thesis is to evaluate diagnostic and therapeutic approaches for acute SMA occlusion. In a prospective study of patients with suspected intestinal ischemia, no biomarker was sufficiently accurate to detect this condition. In a second retrospective study, pancreatic amylase and troponin-I were elevated in a substantial proportion of patients with verified SMA occlusion. In an experimental animal model of acute SMA occlusion, microarray studies of ischemic small bowel wall were used to characterize the mRNA response to ischemia. Thrombospondin, Monocyte Chemoattractant Protein 1 and Gap Junction Alpha 1 were consistently up-regulated in all pigs with intestinal ischemia. Genes encoding previously proposed biomarkers for intestinal ischemia were either up-regulated, such as lactate dehydrogenase and creatine kinase, or down-regulated, such as intestinal fatty acid binding protein and glutathione S-transferase. In a study of the role of computed tomography in the diagnosis of SMA occlusion, it was shown that computed tomography with intravenous contrast was associated with improved survival. A retrospective analysis of all acute SMA revascularizations in Sweden 1999-2006 revealed that D-dimer was elevated in all 35 measured cases. Endovascular surgery was associated with better outcome than open surgery, both in short and in long term. The presence of postoperative short bowel syndrome was a strong independent risk-factor for decreased long-term survival. Conclusions: Data affirm that D-dimer may serve as an exclusion test for acute SMA occlusion, whereas elevated troponin-I and pancreatic amylase are potential diagnostic pitfalls. Contrast-enhanced computed tomography of the visceral arteries seems to be the best diagnostic method. Endovascular surgery is an option to open surgery in selected cases, and was associated with favourable outc

Acute occlusion of the superior mesenteric artery (SMA) is a condition associated with high mortality and morbidity. The aim of this thesis is to evaluate diagnostic and therapeutic approaches for acute SMA occlusion. In a prospective study of patients with suspected intestinal ischemia, no biomarker was sufficiently accurate to detect this condition. In a second retrospective study, pancreatic amylase and troponin-I were elevated in a substantial proportion of patients with verified SMA occlusion. In an experimental animal model of acute SMA occlusion, microarray studies of ischemic small bowel wall were used to characterize the mRNA response to ischemia. Thrombospondin, Monocyte Chemoattractant Protein 1 and Gap Junction Alpha 1 were consistently up-regulated in all pigs with intestinal ischemia. Genes encoding previously proposed biomarkers for intestinal ischemia were either up-regulated, such as lactate dehydrogenase and creatine kinase, or down-regulated, such as intestinal fatty acid binding protein and glutathione S-transferase. In a study of the role of computed tomography in the diagnosis of SMA occlusion, it was shown that computed tomography with intravenous contrast was associated with improved survival. A retrospective analysis of all acute SMA revascularizations in Sweden 1999-2006 revealed that D-dimer was elevated in all 35 measured cases. Endovascular surgery was associated with better outcome than open surgery, both in short and in long term. The presence of postoperative short bowel syndrome was a strong independent risk-factor for decreased long-term survival. Conclusions: Data affirm that D-dimer may serve as an exclusion test for acute SMA occlusion, whereas elevated troponin-I and pancreatic amylase are potential diagnostic pitfalls. Contrast-enhanced computed tomography of the visceral arteries seems to be the best diagnostic method. Endovascular surgery is an option to open surgery in selected cases, and was associated with favourable outc

Acute occlusion of the superior mesenteric artery (SMA) is a condition associated with high mortality and morbidity. The aim of this thesis is to evaluate diagnostic and therapeutic approaches for acute SMA occlusion. In a prospective study of patients with suspected intestinal ischemia, no biomarker was sufficiently accurate to detect this condition. In a second retrospective study, pancreatic amylase and troponin-I were elevated in a substantial proportion of patients with verified SMA occlusion. In an experimental animal model of acute SMA occlusion, microarray studies of ischemic small bowel wall were used to characterize the mRNA response to ischemia. Thrombospondin, Monocyte Chemoattractant Protein 1 and Gap Junction Alpha 1 were consistently up-regulated in all pigs with intestinal ischemia. Genes encoding previously proposed biomarkers for intestinal ischemia were either up-regulated, such as lactate dehydrogenase and creatine kinase, or down-regulated, such as intestinal fatty acid binding protein and glutathione S-transferase. In a study of the role of computed tomography in the diagnosis of SMA occlusion, it was shown that computed tomography with intravenous contrast was associated with improved survival. A retrospective analysis of all acute SMA revascularizations in Sweden 1999-2006 revealed that D-dimer was elevated in all 35 measured cases. Endovascular surgery was associated with better outcome than open surgery, both in short and in long term. The presence of postoperative short bowel syndrome was a strong independent risk-factor for decreased long-term survival. Conclusions: Data affirm that D-dimer may serve as an exclusion test for acute SMA occlusion, whereas elevated troponin-I and pancreatic amylase are potential diagnostic pitfalls. Contrast-enhanced computed tomography of the visceral arteries seems to be the best diagnostic method. Endovascular surgery is an option to open surgery in selected cases, and was associated with favourable outc

Acute occlusion of the superior mesenteric artery (SMA) is a condition associated with high mortality and morbidity. The aim of this thesis is to evaluate diagnostic and therapeutic approaches for acute SMA occlusion. In a prospective study of patients with suspected intestinal ischemia, no biomarker was sufficiently accurate to detect this condition. In a second retrospective study, pancreatic amylase and troponin-I were elevated in a substantial proportion of patients with verified SMA occlusion. In an experimental animal model of acute SMA occlusion, microarray studies of ischemic small bowel wall were used to characterize the mRNA response to ischemia. Thrombospondin, Monocyte Chemoattractant Protein 1 and Gap Junction Alpha 1 were consistently up-regulated in all pigs with intestinal ischemia. Genes encoding previously proposed biomarkers for intestinal ischemia were either up-regulated, such as lactate dehydrogenase and creatine kinase, or down-regulated, such as intestinal fatty acid binding protein and glutathione S-transferase. In a study of the role of computed tomography in the diagnosis of SMA occlusion, it was shown that computed tomography with intravenous contrast was associated with improved survival. A retrospective analysis of all acute SMA revascularizations in Sweden 1999-2006 revealed that D-dimer was elevated in all 35 measured cases. Endovascular surgery was associated with better outcome than open surgery, both in short and in long term. The presence of postoperative short bowel syndrome was a strong independent risk-factor for decreased long-term survival. Conclusions: Data affirm that D-dimer may serve as an exclusion test for acute SMA occlusion, whereas elevated troponin-I and pancreatic amylase are potential diagnostic pitfalls. Contrast-enhanced computed tomography of the visceral arteries seems to be the best diagnostic method. Endovascular surgery is an option to open surgery in selected cases, and was associated with favourable outc

Acute thrombo-embolic occlusion of the superior mesenteric artery (SMA) with intestinal infarction is a lethal disease, difficult to diagnose in time, with unknown incidence and cause-specific mortality. The aim of this thesis was to characterize the disease and to develop diagnostic methods. Two laboratory studies were conducted on patients with suspected acute SMA occlusion. A pilot-study showed that the fibrinolytic marker D-dimer was elevated in six patients with the disease. In the subsequent study including 101 patients, D-dimer was the only elevated coagulation marker in nine patients with the disease. In a prospective study 24 patients (median age 84 years) were identified, of whom four were diagnosed at autopsy, despite an autopsy-rate of 10%. One-fourth were initially nursed in non-surgical wards. Length of the intestinal infarction was a predictor for death. An analysis of patients from the three studies showed that D-Dimer was elevated in all 16 tested patients with the disease. Sixty patients with acute SMA occlusion underwent intestinal revascularisation and were registered in the Swedish Vascular Registry (SWEDVASC). One-year survival-rate was 40%. Previous vascular surgery was a negative risk-factor. A population-based study was conducted in Malmö, based on an autopsy-rate of 87%. Among 270 patients with the disease, 2/3 were diagnosed only at autopsy and 1/2 were managed in non-surgical wards. The incidence was 8.6 per 100000 person years. The age-standardized incidence increased exponentially without gender differences. The diagnosis was the cause of death in 1.2% among octogenarians and beyond. Thrombotic occlusions were located proximally within the SMA and associated with extensive intestinal infarctions. Synchronous embolism, often multiple, occurred in 2/3 of the patients with embolic occlusions. Conclusions: A normal D-dimer at presentation most likely excludes the diagnosis. Acute SMA occlusion was more frequent than previously estimated fro

Acute thrombo-embolic occlusion of the superior mesenteric artery (SMA) with intestinal infarction is a lethal disease, difficult to diagnose in time, with unknown incidence and cause-specific mortality. The aim of this thesis was to characterize the disease and to develop diagnostic methods. Two laboratory studies were conducted on patients with suspected acute SMA occlusion. A pilot-study showed that the fibrinolytic marker D-dimer was elevated in six patients with the disease. In the subsequent study including 101 patients, D-dimer was the only elevated coagulation marker in nine patients with the disease. In a prospective study 24 patients (median age 84 years) were identified, of whom four were diagnosed at autopsy, despite an autopsy-rate of 10%. One-fourth were initially nursed in non-surgical wards. Length of the intestinal infarction was a predictor for death. An analysis of patients from the three studies showed that D-Dimer was elevated in all 16 tested patients with the disease. Sixty patients with acute SMA occlusion underwent intestinal revascularisation and were registered in the Swedish Vascular Registry (SWEDVASC). One-year survival-rate was 40%. Previous vascular surgery was a negative risk-factor. A population-based study was conducted in Malmö, based on an autopsy-rate of 87%. Among 270 patients with the disease, 2/3 were diagnosed only at autopsy and 1/2 were managed in non-surgical wards. The incidence was 8.6 per 100000 person years. The age-standardized incidence increased exponentially without gender differences. The diagnosis was the cause of death in 1.2% among octogenarians and beyond. Thrombotic occlusions were located proximally within the SMA and associated with extensive intestinal infarctions. Synchronous embolism, often multiple, occurred in 2/3 of the patients with embolic occlusions. Conclusions: A normal D-dimer at presentation most likely excludes the diagnosis. Acute SMA occlusion was more frequent than previously estimated fro

Acute thrombo-embolic occlusion of the superior mesenteric artery (SMA) with intestinal infarction is a lethal disease, difficult to diagnose in time, with unknown incidence and cause-specific mortality. The aim of this thesis was to characterize the disease and to develop diagnostic methods. Two laboratory studies were conducted on patients with suspected acute SMA occlusion. A pilot-study showed that the fibrinolytic marker D-dimer was elevated in six patients with the disease. In the subsequent study including 101 patients, D-dimer was the only elevated coagulation marker in nine patients with the disease. In a prospective study 24 patients (median age 84 years) were identified, of whom four were diagnosed at autopsy, despite an autopsy-rate of 10%. One-fourth were initially nursed in non-surgical wards. Length of the intestinal infarction was a predictor for death. An analysis of patients from the three studies showed that D-Dimer was elevated in all 16 tested patients with the disease. Sixty patients with acute SMA occlusion underwent intestinal revascularisation and were registered in the Swedish Vascular Registry (SWEDVASC). One-year survival-rate was 40%. Previous vascular surgery was a negative risk-factor. A population-based study was conducted in Malmö, based on an autopsy-rate of 87%. Among 270 patients with the disease, 2/3 were diagnosed only at autopsy and 1/2 were managed in non-surgical wards. The incidence was 8.6 per 100000 person years. The age-standardized incidence increased exponentially without gender differences. The diagnosis was the cause of death in 1.2% among octogenarians and beyond. Thrombotic occlusions were located proximally within the SMA and associated with extensive intestinal infarctions. Synchronous embolism, often multiple, occurred in 2/3 of the patients with embolic occlusions. Conclusions: A normal D-dimer at presentation most likely excludes the diagnosis. Acute SMA occlusion was more frequent than previously estimated fro

Acute thrombo-embolic occlusion of the superior mesenteric artery (SMA) with intestinal infarction is a lethal disease, difficult to diagnose in time, with unknown incidence and cause-specific mortality. The aim of this thesis was to characterize the disease and to develop diagnostic methods. Two laboratory studies were conducted on patients with suspected acute SMA occlusion. A pilot-study showed that the fibrinolytic marker D-dimer was elevated in six patients with the disease. In the subsequent study including 101 patients, D-dimer was the only elevated coagulation marker in nine patients with the disease. In a prospective study 24 patients (median age 84 years) were identified, of whom four were diagnosed at autopsy, despite an autopsy-rate of 10%. One-fourth were initially nursed in non-surgical wards. Length of the intestinal infarction was a predictor for death. An analysis of patients from the three studies showed that D-Dimer was elevated in all 16 tested patients with the disease. Sixty patients with acute SMA occlusion underwent intestinal revascularisation and were registered in the Swedish Vascular Registry (SWEDVASC). One-year survival-rate was 40%. Previous vascular surgery was a negative risk-factor. A population-based study was conducted in Malmö, based on an autopsy-rate of 87%. Among 270 patients with the disease, 2/3 were diagnosed only at autopsy and 1/2 were managed in non-surgical wards. The incidence was 8.6 per 100000 person years. The age-standardized incidence increased exponentially without gender differences. The diagnosis was the cause of death in 1.2% among octogenarians and beyond. Thrombotic occlusions were located proximally within the SMA and associated with extensive intestinal infarctions. Synchronous embolism, often multiple, occurred in 2/3 of the patients with embolic occlusions. Conclusions: A normal D-dimer at presentation most likely excludes the diagnosis. Acute SMA occlusion was more frequent than previously estimated fro

Acute thrombo-embolic occlusion of the superior mesenteric artery (SMA) with intestinal infarction is a lethal disease, difficult to diagnose in time, with unknown incidence and cause-specific mortality. The aim of this thesis was to characterize the disease and to develop diagnostic methods. Two laboratory studies were conducted on patients with suspected acute SMA occlusion. A pilot-study showed that the fibrinolytic marker D-dimer was elevated in six patients with the disease. In the subsequent study including 101 patients, D-dimer was the only elevated coagulation marker in nine patients with the disease. In a prospective study 24 patients (median age 84 years) were identified, of whom four were diagnosed at autopsy, despite an autopsy-rate of 10%. One-fourth were initially nursed in non-surgical wards. Length of the intestinal infarction was a predictor for death. An analysis of patients from the three studies showed that D-Dimer was elevated in all 16 tested patients with the disease. Sixty patients with acute SMA occlusion underwent intestinal revascularisation and were registered in the Swedish Vascular Registry (SWEDVASC). One-year survival-rate was 40%. Previous vascular surgery was a negative risk-factor. A population-based study was conducted in Malmö, based on an autopsy-rate of 87%. Among 270 patients with the disease, 2/3 were diagnosed only at autopsy and 1/2 were managed in non-surgical wards. The incidence was 8.6 per 100000 person years. The age-standardized incidence increased exponentially without gender differences. The diagnosis was the cause of death in 1.2% among octogenarians and beyond. Thrombotic occlusions were located proximally within the SMA and associated with extensive intestinal infarctions. Synchronous embolism, often multiple, occurred in 2/3 of the patients with embolic occlusions. Conclusions: A normal D-dimer at presentation most likely excludes the diagnosis. Acute SMA occlusion was more frequent than previously estimated fro

This study was performed to determine whether the infusion of prostaglandin E1 (PGE1) via the superior mesenteric artery (SMA) lessens hypoxic hepatic injury in beagle dogs subjected to major hepatectomy and dearterialization. Changes in systemic and hepatic hemodynamics by infusion of PGE1 were measured in intact and dearterialized dogs. The effects of infusion at 0.02 μg/kg/min were also studied in dogs that underwent resection of 55% of the liver and complete dearterialization. PGE1 infusion significantly increased portal vein flow and hepatic oxygen delivery....

The version of record of this article, first published in La Radiologia Medica, is available online at Publisher’s website: https://doi.org/10.1007/s11547-024-01858-z., Objectives: To evaluate the ability of 50-keV virtual monoenergetic images (VMI) to depict abdominal arteries in abdominal CT angiography (CTA) compared with 70-keV VMI with photon-counting detector CT (PCD-CT). Methods: Fifty consecutive patients who underwent multiphase abdominal scans between March and April 2023 were included. Signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) were quantitatively assessed for the abdominal aorta (AA), celiac artery (CeA), superior mesenteric artery (SMA), renal artery (RA), and right hepatic artery (RHA) at both 50- and 70-keV VMI. In addition, 3D images from CTA were analyzed to measure arterial lengths and evaluate the visualization of distal branches. Results: Significantly higher SNR and CNR were observed at 50-keV compared to 70-keV VMI for all arteries: AA (36.54 and 48.28 vs. 25.70 and 28.46), CeA (22.39 and 48.38 vs. 19.09 and 29.15), SMA (23.34 and 49.34 vs. 19.67 and 29.71), RA (22.88 and 48.84 vs. 20.15 and 29.41), and RHA (14.38 and 44.41 vs. 13.45 and 27.18), all p < 0.05. Arterial lengths were also significantly longer at 50-keV: RHA (192.6 vs. 180.3 mm), SMA (230.9 vs. 216.5 mm), and RA (95.9 vs. 92.0 mm), all p < 0.001. Conclusion: In abdominal CTA with PCD-CT, 50-keV VMI demonstrated superior quantitative image quality compared to 70-keV VMI. In addition, 50-keV VMI 3D CTA allowed better visualization of abdominal artery branches, highlighting its potential clinical advantage for improved imaging and detailed assessment of abdominal arteries.