| 1. |
- Acosta, Stefan, et al.
(författare)
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Causes and consequences of mesenteric embolization after endovascular aorto-iliac intervention - a nested case control study
- 2017
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Ingår i: Anaesthesiology Intensive Therapy. - 1642-5758. ; 49:2, s. 122-129
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Tidskriftsartikel (refereegranskat)abstract
- Background: Causes and consequences of mesenteric embolization after endovascular aorto-iliac procedures have not been studied adequately. Methods: Consecutive patients with mesenteric embolization after endovascular aorto-iliac intervention between 2011 and 2015 (case-group, n = 9) were investigated and compared with age, gender and procedure-matched random controls (n = 36). Results: Compared to the control group, a higher proportion of patients with mesenteric embolization were current smokers (89% vs. 53%; P = 0.048) and had renal insufficiency at admission (44% vs. 11%; P = 0.019). In patients treated for aorto-iliac occlusive disease, aortic irregularity (shagginess) was more severe (P = 0.015), visceral thrombus volume was larger (P = 0.004) and operation-Time was longer (P = 0.009) among the case-group. However, no differences were found between cases with mesenteric embolization caused by endovascular aortic aneurysm repair versus controls. Myoglobin, arterial blood lactate, aspartate aminotransferase, alanine aminotransferase and pancreatic amylase levels were elevated in 100%, 67%, 89%, 89%, 89% and 56% of patients with mesenteric embolization, respectively. Overall in-hospital mortality among cases was 33% (3/9). The in-hospital mortality was 17% (1/6) in patients treated with open abdomen therapy, of whom five were managed with stomas. Conclusion: Smoking cessation, careful patient selection and procedure planning with identification of severe shaggy aortas might prevent mesenteric embolization during aorto-iliac procedures. In suspected cases of mesenteric embolization, elevated myoglobin and arterial blood lactate may be indicative of this complication. Aspartate and alanine aminotranferases, as well as pancreatic amylase, are also relevant tests to assess the extent of organ ischaemia. Damage control with open abdomen therapy and the creation of stomas seem justifiable in order to improve survival in this complex situation.
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| 2. |
- Acosta, Stefan, et al.
(författare)
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Open abdomen in acute mesenteric ischemia
- 2019
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Ingår i: Anaesthesiology Intensive Therapy. - : Termedia Sp. z.o.o.. - 1642-5758. ; 51:2, s. 159-162
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Tidskriftsartikel (refereegranskat)abstract
- In acute mesenteric ischemia, early diagnosis should optimally be followed by either open or endovascular intestinal revascularization. All too often, diagnosis is delayed and diagnosis and treatment are performed at the same time during explorative laparotomy. The majority of patients will be diagnosed when transmural intestinal infarction has developed and at this time point damage control strategies involving intestinal revascularization, bowel resection, open abdomen and second look may be necessary to salvage the patient. This review outlines the principles of the damage control surgery approach in acute mesenteric ischemia and the rationale for temporary open abdomen. In patients in need of long-term open abdomen therapy, negative pressure wound therapy with continuous fascial traction is a preferred technique achieving a high delayed fascial closure rate.
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| 3. |
- Klåvus, Anton, et al.
(författare)
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“Notame”: Workflow for non-targeted LC-MS metabolic profiling
- 2020
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Ingår i: Metabolites. - : MDPI AG. - 2218-1989 .- 2218-1989. ; 10:4
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Tidskriftsartikel (refereegranskat)abstract
- Metabolomics analysis generates vast arrays of data, necessitating comprehensive workflows involving expertise in analytics, biochemistry and bioinformatics in order to provide coherent and high-quality data that enable discovery of robust and biologically significant metabolic findings. In this protocol article, we introduce notame, an analytical workflow for non-targeted metabolic profiling approaches, utilizing liquid chromatography-mass spectrometry analysis. We provide an overview of lab protocols and statistical methods that we commonly practice for the analysis of nutritional metabolomics data. The paper is divided into three main sections: the first and second sections introducing the background and the study designs available for metabolomics research and the third section describing in detail the steps of the main methods and protocols used to produce, preprocess and statistically analyze metabolomics data and, finally, to identify and interpret the compounds that have emerged as interesting.
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| 4. |
- Kärkkäinen, Jussi M., et al.
(författare)
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Acute mesenteric ischemia (part I) - Incidence, etiologies, and how to improve early diagnosis
- 2017
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Ingår i: Best Practice and Research in Clinical Gastroenterology. - : Elsevier BV. - 1521-6918. ; 31:1, s. 15-25
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Tidskriftsartikel (refereegranskat)abstract
- Acute mesenteric ischemia (AMI) is generally thought to be a rare disease, but in fact, it is more common cause of acute abdomen than appendicitis or ruptured abdominal aortic aneurysm in patients over 75 years of age. In occlusive AMI, surgical treatment without revascularization is associated with as high as 80% overall mortality. It has been shown that early diagnosis with contrast-enhanced computed tomography and revascularization can reduce the overall mortality in AMI by up to 50%. However, only a minority of patients with AMI are being treated actively with revascularization in the United States, and the situation is very likely similar in Europe as well. What can we do to improve diagnostic performance, so that more patients get proper treatment? The diagnosis is a collaborative effort of emergency department surgeons, gastrointestinal and vascular surgeons, and radiologists. The etiological categorization of AMI should be practical and guide the therapy. Furthermore, the limitations of the diagnostic examinations need to be understood with special emphasis on computed tomography findings on patients with slowly progressing "acute-on-chronic" mesenteric ischemia.
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| 5. |
- Kärkkäinen, Jussi M., et al.
(författare)
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Acute mesenteric ischemia (Part II) - Vascular and endovascular surgical approaches
- 2017
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Ingår i: Best Practice and Research in Clinical Gastroenterology. - : Elsevier BV. - 1521-6918. ; 31:1, s. 27-38
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Tidskriftsartikel (refereegranskat)abstract
- The modern treatment of acute mesenteric ischemia (AMI) requires seamless collaboration of gastrointestinal surgeons, vascular surgeons, and interventional radiologists. The treatment strategy is straightforward aiming at rapid restoration of blood flow to the intestine. Bowel resection is performed on demand. The first thing to consider is the patient's clinical condition at presentation, whether there are signs of peritonitis or not, and whether the patient is hemodynamically stable or not. Second, there are four etiologies of AMI that need to be distinguished as they differ in treatment: superior mesenteric artery embolism, mesenteric arterial occlusive disease, mesenteric venous thrombosis, and non-occlusive mesenteric ischemia. In this review, we describe the basic vascular and endovascular treatment modalities accompanied by a simple algorithm for the various situations in AMI. Furthermore, the indications for damage control and primary definitive surgery are discussed.
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| 6. |
- Meuronen, Topi, et al.
(författare)
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FADS1 rs174550 genotype and high linoleic acid diet modify plasma PUFA phospholipids in a dietary intervention study
- 2022
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Ingår i: European Journal of Nutrition. - : Springer Science and Business Media LLC. - 1436-6207 .- 1436-6215. ; 61:2, s. 1109-1120
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: Fatty acid desaturase 1 (FADS1) gene encodes for delta-5 desaturase enzyme which is needed in conversion of linoleic acid (LA) to arachidonic acid (AA). Recent studies have shown that response to dietary PUFAs differs between the genotypes in circulating fatty acids. However, interactions between the FADS1 genotype and dietary LA on overall metabolism have not been studied. Objectives: We aimed to examine the interactions of FADS1 rs174550 genotypes (TT and CC) and high-LA diet to identify plasma metabolites that respond differentially to dietary LA according to the FADS1 genotype. Methods: A total of 59 men (TT n = 26, CC n = 33) consumed a sunflower oil supplemented diet for 4 weeks. Daily dose of 30, 40, or 50 ml was calculated based on body mass index. It resulted in 17–28 g of LA on top of the usual daily intake. Fasting plasma samples at the beginning and at the end of the intervention were analyzed with LC–MS/MS non-targeted metabolomics method. Results: At the baseline, the carriers of FADS1 rs174550-TT genotype had higher abundance of long-chain PUFA phospholipids compared to the FADS1 rs174550-CC one. In response to the high-LA diet, LA phospholipids and long-chain acylcarnitines increased and lysophospholipids decreased in fasting plasma similarly in both genotypes. LysoPE (20:4), LysoPC (20:4), and PC (16:0_20:4) decreased and cortisol increased in the carriers of rs174550-CC genotype; however, these genotype–diet interactions were not significant after correction for multiple testing. Conclusion: Our findings show that both FADS1 rs174550 genotype and high-LA diet modify plasma phospholipid composition. Trial registration: The study was registered to ClinicalTrials: NCT02543216, September 7, 2015 (retrospectively registered).
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| 7. |
- Terlouw, Luke G., et al.
(författare)
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European guidelines on chronic mesenteric ischaemia : joint United European Gastroenterology, European Association for Gastroenterology, Endoscopy and Nutrition, European Society of Gastrointestinal and Abdominal Radiology, Netherlands Association of Hepatogastroenterologists, Hellenic Society of Gastroenterology, Cardiovascular and Interventional Radiological Society of Europe, and Dutch Mesenteric Ischemia Study group clinical guidelines on the diagnosis and treatment of patients with chronic mesenteric ischaemia
- 2020
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Ingår i: United European Gastroenterology Journal. - : Wiley. - 2050-6406 .- 2050-6414. ; 8:4, s. 371-395
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Forskningsöversikt (refereegranskat)abstract
- Chronic mesenteric ischaemia is a severe and incapacitating disease, causing complaints of post-prandial pain, fear of eating and weight loss. Even though chronic mesenteric ischaemia may progress to acute mesenteric ischaemia, chronic mesenteric ischaemia remains an underappreciated and undertreated disease entity. Probable explanations are the lack of knowledge and awareness among physicians and the lack of a gold standard diagnostic test. The underappreciation of this disease results in diagnostic delays, underdiagnosis and undertreating of patients with chronic mesenteric ischaemia, potentially resulting in fatal acute mesenteric ischaemia. This guideline provides a comprehensive overview and repository of the current evidence and multidisciplinary expert agreement on pertinent issues regarding diagnosis and treatment, and provides guidance in the multidisciplinary field of chronic mesenteric ischaemia.
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