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Fulminant Colitis
Published in Stephen M. Cohn, Alan Lisbon, Stephen Heard, 50 Landmark Papers, 2021
Michael F. Musso, Adrian W. Ong
Causes of ischemic colitis are generally divided into occlusive disease (e.g., surgery, thromboemboli, vasculitides) and non-occlusive disease (e.g., various shock etiologies, drugs). Segmental involvement of the colon is typical, with the left colon being most commonly affected. Pancolonic involvement is unusual, occurring in 13% in one study [11]. While 50–60% have non-gangrenous IC that resolves with resuscitation and empiric antibiotics, the remainder will develop irreversible colonic damage manifested by gangrene, stricture, or, rarely, a fulminant course characterized by a toxic, rapidly progressing course with colectomy being necessary [12].
Management of Acute Intestinal Ischaemia
Published in Peter Sagar, Andrew G. Hill, Charles H. Knowles, Stefan Post, Willem A. Bemelman, Patricia L. Roberts, Susan Galandiuk, John R.T. Monson, Michael R.B. Keighley, Norman S. Williams, Keighley & Williams’ Surgery of the Anus, Rectum and Colon, 2019
Michael J. Stamos, John V. Gahagan
Conventional angiography is unique compared to the other studies in that it provides the ability for both diagnosis and therapy. It has long been and continues to be the gold standard for diagnosis of mesenteric ischaemia. Both anterior-posterior and lateral views should be obtained with aortography. The anterior views visualise disease within the distal mesenteric vessels. The lateral views allow for detection of proximal disease at the origins of the coeliac artery, SMA and IMA. In the setting of non-occlusive disease, angiography allows for the intra-arterial infusion of a vasodilator, such as papaverine, which can be both diagnostic and therapeutic.
Coronary vasospasm as an etiology of recurrent ventricular fibrillation in the absence of coronary artery disease: a case report
Published in Journal of Community Hospital Internal Medicine Perspectives, 2021
Binita Bhandari, Tejaswi Kanderi, Keerthi Yarlagadda, Mehreen Qureshi, Saketram Komanduri
Seven months after discharge, the patient came to the emergency department complaining of sudden substernal chest discomfort, which he rated at 10 out of 10 in intensity. His vital signs on presentation were temperature of 98.6 F, BP 166/93 mmHg, pulse rate of 69/min, respiratory rate of 48/min, and an oxygen saturation of 93% on room air. His chest discomfort improved with sublingual nitroglycerine and morphine. An ECG revealed ST elevations in lead I and aVL with reciprocal ST–T wave changes in inferior leads (Figure 3). He underwent emergency cardiac catheterization with concerns for ACS, which revealed no focal coronary spasms, and non–occlusive disease with a left ventricular ejection fraction (EF) of 50–55% and mild hypokinesia in the anterolateral wall. His labs showed an elevated troponin level of 2.58 ng/ml (normal <0.03). A complete blood count, basic metabolic panel, serum electrolytes, and lipid panel were all within normal limits. A repeat ECG showed resolution of prior ECG changes (Figure 4). The patient was discharged on aspirin 81 mg once a day, atorvastatin 40 mg once a day, increased amlodipine to 10 mg, sotalol 120 mg twice a day, and nitroglycerin 0.4 mg as needed for chest pain. Of note is his Imdur had been stopped a few days prior to his presentation as he had not had any recurrent` chest pain and had started using sildenafil citrate as needed for erectile dysfunction.
Latest developments in chronic total occlusion percutaneous coronary intervention
Published in Expert Review of Cardiovascular Therapy, 2020
Ilias Nikolakopoulos, Evangelia Vemmou, Judit Karacsonyi, Iosif Xenogiannis, Gerald S. Werner, Anthony H. Gershlick, Stephane Rinfret, Masahisa Yamane, Alexandre Avran, Mohaned Egred, Santiago Garcia, M. Nicholas Burke, Emmanouil S. Brilakis
In patients who present with ST-segment elevation myocardial infarction (STEMI), especially when complicated with cardiogenic shock, the presence of a concurrent CTO in a non-infarct-related artery was associated with higher short- and long-term mortality as compared with single vessel disease (hazard ratio: 4.4; 95% confidence interval [CI]: 3.3 to 5.9; p < 0.001) or multivessel (non-occlusive) disease (hazard ratio: 2.85; 95% CI: 2.2 to 3.8; p < 0.001) [28,29].