Acute gastric dilatation is very uncommon and is of various etiologies, two of these being anorexia nervosa and bulimia. Several cases documenting complications of gastric dilatation were published; however, such severe complications, involving gastric infarction and compression of the aorta with ischemic injury of the bowels and lower extremities, are rare.
Conventional surgical therapy for advanced renal venous tumor thrombi results in high morbidity, so there is a need for less invasive techniques. This report presents the first case of a successful inferior vena cava (IVC) tumor thrombus removal without complications with balloon catheter (BC) via internal jugular vein (IJV), called the venous tumor thrombus pushing with balloon catheter (VTTP BC). Under the control of transesophageal echocardiogram and fluoroscope, a balloon catheter was sleeved on the guide wire, which was already inserted into the right internal jugular vein (IJV) and was driven distally above the IVC tumor thrombus. The balloon was inflated to occlude the IVC for prevention of pulmonary embolization. After the occlusion, the guide wire was driven to the cavotomy and was opened at the ostium of the right renal vein. It was pulled at both ends and stretched to serve as a rail. The balloon was gently pushed toward the cavotomy and the thrombectomy was completed. This is a less invasive method for treatment of venous tumor thrombus level 3 that can reduce surgical time, blood loss, and complication rates compared to the existing surgical methods. Also, it can be performed without thoracotomy, cardiopulmonary bypass, hypothermic circulatory arrest, and liver mobilization.
Postconditioning proves to be capable in conferring protection against different organ injuries caused by longer circulatory occlusions during elective major vascular surgeries.
Az akut végtagi artériás okklúzió a kialakuló súlyos szövődmények, valamint nagy mortalitása miatt rendkívüli klinikai jelentőséggel bír. A diagnózis felállítása egyszerű, azonban a stádiumbesorolás hosszabb idejű elzáródások kapcsán nem egyszerű objektív kritériumok hiányában. Ennek nagy gyakorlati jelentősége, a reverzíbilis és az irreverzíbilis károsodás terápiája közötti különbségben van: reverzíbilis károsodás esetén a keringés helyreállítása, irreverzíbilis károsodás esetén a végtag amputációja terápiás értékű. Az elzáródás következtében létrejövő hosszú idejű ischaemia a végtag fő tömegét képező vázizomrostok és a jelen lévő endothelsejtek károsodását idézi elő. Revascularisatio esetén, paradox módon további sérülések keletkeznek lokálisan, illetve a felszabaduló mediátorok szisztémás keringésbe jutásával távoli szervekben is. A károsodás fokának gyors és pontos megítélésére jelenleg nem áll rendelkezésre megfelelő eljárás. A közlemény célja a fenti kórállapot irodalmi összefoglalása, bemutatása, illetve egyes új, speciális diagnosztikus teszt ismertetése, mint például a jelenleg még kísérleti stádiumban lévő, különböző enzimhisztokémiai reakciók használata. Ezek gyors eredményt biztosíthatnak preoperatívan is, így megfelelő standardizálás után alkalmasak lehetnek rutin klinikai alkalmazásra. Orv. Hetil., 2010Hetil., , 151, 2057Hetil., -2066. Kulcsszavak: akut okklúzió, enzimhisztokémia, kritikus ischaemia, ischaemia-reperfúzió Acute lower limb critical ischemia -a review articleAcute limb arterial occlusion has great clinical signifi cance due to its high mortality and complication rates. Its diagnosis is easy; however staging after long-term occlusions can be very diffi cult with lack of exact criteria. It is crucial, since reversible stage should undergo revascularization, while with irreversible stage only amputation is curative. Due to occlusion, long-term ischemia occurs, resulting in injury of the muscle fi bers and endothelial cells. In case of revascularization the reperfusion causes more damage, than ischemia alone locally and initiates a remote organ injury. The aim of the review is to summarize the knowledge and fact and focus on some exact methods or parameters which can determine the degree of injury. One of these methods is a new approach which is the use of enzyme-histochemistric reactions, and could give rapid, precise results even preoperatively regarding tissue viability. Routine clinical application of it is predictable after proper standardization. Orv. Hetil., 2010, 151, 2057-2066 Keywords: acute occlusion, enzyme-histochemistry, critical ischemia, ischemia-reperfusion (Beérkezett: 2010. szeptember 3.; elfogadva: 2010. október 23.) Rövidítések ARDS = akut respiratorikus distressz szindróma; AMI = akut myocardialis infarctus; AMP = adenozin-monofoszfát; APTI = aktivált parciális tromboplasztin idő; ATP = adenozin-trifoszfát; AVI = akut végtagi ischaemia; CK = kreatinkináz; CLI = kritikus végtagi ischaemia; cNOS = konstitutív nitrogén-monoxid-szintáz; CTA = CT-angiográfi a; DSA = dig...
Introduction External aortic compression due to acute gastric dilation is a rare etiology of the lower limb ischemia. This phenomenon leads the author to design experimental study for reperfusion syndrome. The lower limb ischemia-reperfusion (IR) injury consists of local and systemic components called the reperfusion syndrome. It can progrediate into a multi-organ failure which defines postoperative survival. A postconditioning is a surgical technique, which has a potential to reduce IR injury, therefore to prohibit the development of reperfusion syndrome. Aim XXXto examine on an experimental model, whether postonditioning is a practicable technique in infarenal aortic surgeries. Materials and Methods Male Wistar rats underwent 180 minutes of infrarenal aortic occlusion with 4, 24 and 72 hours of reperfusion. Postconditioning (10 sec. reocclusion / 10 sec. perfusion in 6 cycles) was applied in one group of each reperfusion time. Blood, urine, and histological (muscle, lung, kidney and liver) samples were collected at the postischemic 4th, 24th, and 72th hour. Results The early inflammatory response (TNFa, free radicals) and late local inflammation were reduced by posctonditioning significantly. Postconditioning was able to reduce the remote organ injury of lungs and kidneys, the morphological and laboratorial results showed significant difference between the postconditioning and the control group in these two organs. The method's positive effect on remote organ injury remained long-term. Conclusion Postconditioning seems to be an applicable process to reduce both local inflammatory and systemic complications of IR injury following vascular surgeries.
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