Thrombosis of the celiac artery trunk is a rare cause of acute abdominal pain. Thrombosis of the celiac artery carries a high mortality and morbidity when the diagnoses and treatment are delayed. It is frequently associated with other cardiovascular events. The most common etiology is atherosclerosis. 20–30% of cases may have symptoms of chronic mesenteric ischemia. Main goal of the treatment is to reestablish the diminished or stopped mesenteric blood flow and to avoid end-organ ischemia. Essential thrombocythemia is a chronic myeloproliferative disorder characterized by marked increase in thrombocyte number and clinical presentation may be with thrombotic episodes, hemorrhage, or both. To our knowledge this is the first report of celiac artery thrombosis and superior mesenteric artery stenoses in a patient with essential thrombocythemia. The patient was managed successfully with surgical treatment.
The pathogenesis of acute coronary syndrome (ACS) and transient myocardial ischemia (TMI) is not completely understood. Therefore, the authors studied the biological indicators of thrombogenesis and sympathetic activity. The study was conducted on 50 patients with acute coronary syndrome and 30 patients with stable angina pectoris. Treatment was standardized with low-molecular-weight heparin and 300 mg aspirin/day but with no IIb/IIIa inhibitors, an oral beta-blocker, diltiazem 60 mg tid, glyceryl trinitrate i.v. in patients with ACS but with mononitrates orally and low-molecular-weight heparin in patients with stable angina. Twenty-four-hour continuous ECG monitoring and ST segment analysis were performed on day 2 of admission and heart rate analysis was performed 10, 5, and 1 minute before and during the myocardial ischemia periods. Blood sampling for von Willebrand factor (vWf) determination was performed through a peripheral vein at 8 AM, noon, 6 PM and 10 PM and half an hour after the description of angina. The patients with ACS were grouped as transient myocardial ischemia positive (n = 20) and negative (n = 30). The patients with stable angina were designated as the control group (n = 30). The detected vWf levels at 4 different daytime periods in patients with ACS were significantly higher than those in patients with stable angina. At the 6 PM to 10 PM period, the vWf level increase was significantly higher in patients with TMI than in the patients without TMI. At the 8 AM to noon period, the detected vWf levels decreased significantly in both TMI groups. During the nocturnal ischemia periods, the increase in vWf levels immediately after angina was significantly more apparent than the detected changes during daytime ischemia. Analysis showed that heart rates before the ischemia during stable angina episodes were significantly higher than those in TMI (-) (silent) angina. The heart rate difference between 10 minutes before and during the ischemia in the angina group was significantly different from that during TMI (-) (silent) ischemia. The heart rates at the times related to ischemia in the nocturnal period were significantly lower than those in the daytime period. The heart rate differences between the ischemia-related times and during the ischemia were significantly higher in daytime ischemic attacks than in nocturnal ischemic attacks. The study confirms that the vWf level, which is an indicator of thrombogenesis, was significantly increased in patients with ACS. Nocturnal ischemia is associated with thrombogenesis. Daytime ischemia is associated with increased sympathetic activity, and symptomatic ischemia is usually associated with increased sympathetic activity.
Abdominal aortic aneurysm (AAA) is the most common type of aneurismal diseases. Generally, it is asymptomatic and when it is ruptured, it develops with high morbidity and mortality. Case report: A 62-years-old male patient consulted our emergency with a pain at his dorsum and lumbar part. Cardiologist with a suspicion of coronary artery disorder or dissection, coronary angiography was executed. Consecutive lesions of LAD artery (left anterior descending) 40% -50% and 90%, CX artery (circumflex) 40% and 80% -90%, and a lesion of RCA (right coronary artery) 20% -30% were detected. With a suspicion of rupture, abdominal aneurysm tomography (CT) was demanded. In the tomography, a 7-cm-diameter ruptured abdominal aortic aneurysm was diagnosed. Levosimendan support was started. Under the support of levosimendan a Y graft operation was performed. The operation was ended up with levosimendan support considering that coronary bypass would increase mortality and morbidity. Discussion: Approximately 50% of the ruptured aneurysms are died before they reach hospital while the 30% -70% operated ones are died within 30 days after operation. Early diagnosis and follow-up is extremely important to decrease morbidity and mortality. The patients consulting with rupture must be taken to the operation without delay. What should be done if coronary artery disorder is detected in the patient whose AAA is ruptured and if the bypass is necessary? In our opinion, a decision must be made according to the patient's clinical condition. As a result of our case, we thought repairing the abdominal aortic aneurysm necessitates the other comorbidites must be treated medically. We aimed to decrease the cardiac oxygen requirement by starting levosimendan and decline afterload. If the patient, whose coronary artery disorder is detected, is under risk and his overall condition is bad, we think that coronary bypass operation can be delayed.
Aortoenteric fistula is one of the rare complications of abdominal aortic aneurysm. The segment of intestine most frequently involved in aortoenteric fistula is the duodenum, whereas the colon is a very rare site of fistula formation.To the author's knowledge, only 13 cases have been reported in the literature to have a primary arteriocolic fistula caused by abdominal aortic aneurysm. Primary repair of the fistulization between aorta and transverse colon, resection of aneurysm, and left axillofemoral, femorofemoral bypass were performed on the patient, who represents the fourteenth case in the literature. No important complication developed and the patient was discharged from the hospital on the fifteenth postoperative day but died on the twenty-fourth postoperative day at another hospital from myocardial infarction.
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