The Superior Mesenteric Syndrome is a rare and controversial disease. The compression of the duodenum by the mesentericartery and aorta causes an intermitent obstruction. Preoperative diagnosis is very difficult.We present one case of this syndrome in a pacient with severe weight loss and signs of high intestinal obstruction. The diagnosis was based on clinical and radiologic findings. A duodenojejunostomy was performed after medi- cal treatment failure.This patient died on the 20 th posoperative day due to cardiac complications. This syndro-
Superior mesentericartery syndrome is a rare and life- threatening clinical condition caused by the compression of the third portion of the duodenum between the aorta and the superior mesenteric artery’s proximal part. This compression may lead to chronic intermittent, acute total or partial obstruction. Sudden weight-loss and the related decrease in the fat tissue are considered to be the etio- logical reason of acute stenosis. Weight-loss accompa- nied by nausea, vomiting, anorexia, epigastric pain, and bloating are the leading complaints. Barium radiographs, computerized tomography, conventional angiography, tomographic and magnetic resonance angiography are used in the diagnosis. There are medical and surgical ap- proaches to treatment. We hereby present the case of a patient with superior mesentericartery syndrome with delayed diagnosis.
In conclusion, these studied neonates showed a signifi- cant evolution of the blood flow of superior mesentericartery on the 7th day of life, represented by the Peak Sys- tolic Velocity and the End Diastolic Velocity improve, and a better vasodilatation response after feeding.
2005). This report drove us to further investigate the cardiovascular effects induced by HSE, since other ACE inhibiting plants, such as Ouratea semiserrata and Cecropia glaziovii, also exhibited strong vasodilator activity (Braga et al., 2000; Lacaille-Dubois et al., 2001; Cortes et al., 2002). In the present work, we describe an endothelium-dependent vasodilator effect of HSE in superior mesentericartery rings of rats, through a mechanism dependent on release of nitric oxide (NO) and endothelium-derived hyperpolarizing factor (EDHF). Besides, based on the HPLC ﬁngerprint obtained for HSE, the compound that might contribute for the observed activity is also discussed.
a graphic representation of a glass bath chamber containing a piece of the mesentericartery cut as a ring-like segment, which should be immersed in Krebs-Henseleit physiological solution. The bath chamber typically possesses an external compartment, which should be connected to a thermal circulator pump (1). Rings were suspended on stainless steel triangular pieces, with one edge of each triangular device passed through the vessel’s lumen for tension measurements using cotton thread (2) for connection of one triangular piece to the force transducer (3). The second triangular piece was connected on a fixed point inside the chamber. The bath chamber also allows oxygen bubbling (4) on its internal compartment, which may be drained through a point (5) in procedures for solution changes. In mounting the tissue with the small hand-made triangular pieces (6), the operator must be aware of the parallel arrangement of steel devices (✓) and avoid the crossing of metal loops in the vessel’s lumen (X).
It has been shown that the increased levels of LBP and membrane CD14 enhanced the responses of both blood monocytes and tissue macrophages to endotoxin Figure 6. Effect of mesenteric lymph reperfusion (MLR) on the indices related to endotoxin (ET) translocation and inflammatory response in splenic homogenate of rats with superior mesentericartery occlusion (SMAO) shock. Data are reported as means±SD, n=6. A, ET level. B, Lipopolysaccharide receptor (CD14) level. C, Lipopolysaccharide-binding protein (LBP) level. D, Tumor necrosis factor-a (TNF-a) level. *P,0.05 vs sham group; #
Several studies have indicated that vascular oxidative stress plays a major role in aging-related endothelial dysfunction [14,25,33]. Indeed, an increased level of superoxide anions [14,25,33], and also hydrogen peroxide as shown in the present study, is observed in the aged arterial wall. Moreover, several sources of reactive oxygen species have been involved and, in particular, NADPH oxidase in the rat aorta and mesentericartery [33,34], xanthine oxidase in the rat aorta , cyclooxygenase-2 in pig pial arteries , and uncoupled endothelial NO synthase in the mouse mesentericartery . The present findings suggest that, besides NADPH oxidase, cyclooxygenases, and uncoupled endothelial NO synthase, cytochrome P450 monoxygenases and the mitochondrial respiration chain contribute also to the increased oxidative stress in the mesentericartery of middle-aged rats. Superoxide anions are known to reduce the bioavailability of NO both by reacting with NO to form peroxynitrite and by oxidizing tetrahydrobiopterin, an essential co-factor of NO synthase [38,39]. Moreover, the beneficial effect of the RWPs treatment on aging-related endothelial dysfunction appears to involve their ability to prevent the excessive oxidative stress in the aged arterial wall. The antioxidant effect may due to their ability to directly interact with superoxide anions and other reactive oxygen species such as hydroxy and peroxy radicals . It may also be due to their ability to prevent the aging-related upregulation of the NADPH oxidase subunits nox1 and p22phox, and to improve the mitochondrial formation of ROS as shown in the present study. Previous studies have also shown that RWPs prevent the expression of NADPH oxidase in the aorta subsequently to the infusion of a hypertensive dose of angiotensin II to rats . Moreover, tea polyphenols prevented the expression of NADPH oxidase and up-regulated that of catalase in vascular cells [41,42].
Videolaparoscopy has been widely used in the treatment of pathologies as cholelithiasis, appendicitis and adrenal tumor. Nowadays, has also been used to treat type II endoleaks after endovascular repair of abdominal aortic aneurysms. The goal of this work is to report one case of inferior mesentericartery endoleak treated by videolaparoscopy.
Hepatic artery variations are described using Michels’ (1955) and Hiatt’s (1994) classiication. Our results showed the existence of a ninth type of vari- ation according to Michels’ classiication (Table 1), which was that the common hepatic artery arises from the superior mesentericartery and this was found in 10% of patients. his corresponds to the ith type of variation according to Hiatt’s classiica- tion. Iezzi et al. (2008) revealed the presence of these variations in 3.6% patients. In cadaveric studies of Michels (1955) this variation was found in 4.5% of cadavers. he greater percentage of this variation in our study may be explained by the smaller number of respondents.
turbulence in the region of the anastomosis, because of differences in the complacency of the artery wall and the wall of the vascular substitute and the shear stress resulting from the changing blood flow in the area of vascular anastomosis. The greater complacency and malleability of vascular bioprostheses preserved in L-Hydro is evidence that their use for construction of AVFs involves reduced neointimal hyperplasia-generating stimulation, when compared with ePTFE vascular prostheses.
Background: Many dialysis patients do not have the necessary conditions for construction of a native arteriovenous fistula (AVF). Expanded Polytetrafluoroethylene (ePTFE) vascular prostheses are the most widely-used option, but it is known that they are inferior to native vein AVFs. Objectives: To identify a graft with superior performance to ePTFE, comparing their results with those of AVFs made from bovine mesenteric arteries treated with L-Hydro technology (Labcor Laboratories ). Methods: A prospective and controlled study of 10 patients with AVFs constructed with ePTFE and 10 patients with L-Hydro bioprostheses, matched for comorbidities. The variables studied were: primary patency, assisted primary patency, and secondary patency, surgical manipulability, and prevalence of infections. The performance of prostheses was assessed by duplex-scan and repeated consultations with health professionals at hemodialysis clinics. The chi-square test was used for statistical analysis. Results: After 1 year of postoperative follow-up, secondary and primary patency rates were higher for L-Hydro than ePTFE AVFs. Fewer interventions were needed to maintain AVF patency in the L-Hydro AVF group. The most common complication was graft thrombosis, which was more frequent in the ePTFE group. While the figures indicate more favorable outcomes in the L-Hydro AVFs, this could not be confirmed with the statistical treatment employed. Conclusions: The L-Hydro graft appears to be a valuable alternative option for AVFs, since it seems to require fewer interventions to maintain patency when compared to ePTFE grafts.
Chronic mesenteric ischemia is a rare disease that is generally caused by progressive stenosis or occlusion of one or more mesenteric arteries. Several authors have discussed the minimum number of diseased vessels for symptoms to appear, based on ultrasound studies showing critical stenosis of at least one mesentericartery in up to 17.5% of asymptomatic people over 65 years old, although other authors recognize that in 9% of chronic cases symptomatic involvement is only in one artery (5% with SMA and 4% with CT involvement). 1,6
dissected. We observed all unpaired and paired branches of the abdominal aorta, starting at the celiac trunk and extending through the superior mesentericartery, renal arteries, gonadal arteries and inferior mesentericartery. Between two unpaired branches of the abdominal aorta and the superior and inferior mesenteric arteries, we observed an additional renal artery arising from the anterolateral side of the abdominal aorta, reaching the lower pole of the right kidney. We discussed, observed and compared our finding to the literature and came to the conclusion that we had located an accessory right renal artery. A few pictures of the right kidney with its blood supply were taken, capturing the main and accessory right renal arteries (Figures 1, 2). In our male cadaver, the origins of the main right renal artery and the inferior accessory right renal artery were 19.8 mm and 53 mm below the superior mesentericartery, respectively. The main right renal artery arose 19.8 mm below the superior mesentericartery, passed behind the inferior vena cava and reached the superior pole of the right kidney, where the main right renal vein left the right kidney (Figures 1, 2). The inferior accessory right renal artery arose 53 mm below the superior mesentericartery and ran anteriorly to the inferior vena cava directly into the inferior pole of the right kidney, in the area where the accessory right renal vein left the right kidney (Figures 1, 2). The right testicular artery arose from the lateral side of the abdominal aorta approximately 9.5 mm below the main right renal artery and ran down the front of inferior Beata PATASI 
In all the samples of opossuns (Didelphis albiventris) of this research was verified that the cranial mesentericartery arises from the abdominal aorta ventral face, caudally to the celiac trunk. Regardless its origin, the cranial artery directs ventralcaudally and sends as a branch the pancreatic-duodenal caudal artery, and a varied number of pancreatic branches (Fig.1). The middle colic artery, as observed in all the animals, irrigates the large intestine, that is, the left colon and cecum, anastomising with the left colic artery (Fig. 1).
Celiac mesenteric ganglion in Saguinus niger was surrounding the celiac artery in the left antimere. In domestic cat this ganglion is a projection around the cranial mesentericartery (Ribeiro et al. 2000a), while in buffalo, the celiac mesenteric ganglion demonstrated varied morphologic arrangements, being the most predominant a single ganglion divided in two portions (right and left) around celiac and cranial mesenteric arteries and the two portions joined at the level of caudal margin of the cranial mesentericartery, presenting a semilunar shape (Ribeiro et al. 2000a). In dog, the celiac mesenteric plexus is arranged in a net around the origin of the celiac and cranial mesenteric arteries (Rocha and Massone 2006).
The CrMA is a intraperitoneal vessel 17.21 cm long, that crosses the mesentery horizontally with respect to where it emerges from the ventral surface of the abdominal aorta (Tab. I). Other arteries that contribute to the nourishment of the por- tion of the small intestine irrigated by the CrMA, and a portion of the large intestine, including the caudal mesentericartery (CaMA), celiac trunk and pancreatic duodenal arteries, are also identified (Fig. 1). The CrMA emerges from the retroperitoneum and enters the abdominal cavity through the mesothelium, the space between the two peritoneal layers, which extends to sur- round the intestines as the parietal peritoneum.
Conservative clinical treatment consists of the reestablishment and maintenance of blood pressure levels, hemodynamic support, parenteral hydration and, sometimes, fasting for patients with postprandial abdominal pain. Additionally, the use of platelet anti-aggregating agents, parenteral heparin or oral anticoagulants should be evaluated because they knowingly decrease the risk of thrombosis secondary to dissection. Recent studies showed that conservative clinical treatments are better in cases of superior mesentericartery dissection without signs of acute intestinal ischemia 30 . However, there are no
In group A, the cranial mesentericartery was occluded by atraumatic vascular clamp for 30 minutes (ischemia phase). After placing the clamp, the small intestine was repositioned in the abdominal cavity and the wound was closed with continuous suture of the skin with nylon monofilament 4-0 (mononylon ® ). After the ischemia phase, the abdominal wall was opened again by removing the suture and the vascular clamp was removed, beginning the reperfusion phase, which lasted 60 minutes. In all three groups, reperfusion was initiated, the abdomen was closed once again by continuous suture of the skin with nylon monofilament 4-0 until the end of the experiment.
In the current study, we demonstrated the technical feasibility and potential clinical utility of Doppler sonogra- phy for patients with CD. The sonographic parameters analyzed showed that most measurements in the aorta and in the superior mesentericartery were significantly different in the CD patients relative to either healthy subjects or patients with IBS. For assessment of disease activity, only the aortic measurements of maximum flow volume and aortic peak systolic velocity were significantly correlated with CDAI, with lower values in active CD. In addition, after selecting these two parameters, we determined cut-off points to accurately classify patients with regard to disease activity. The results indicate that the stratification of aortic maximum flow volume and peak systolic velocity values allowed a simple and accurate distinction to be made between active and inactive CD patients.