Differentiating between segmental arterial mediolysis and other arterial vasculopathies to establish an early diagnosis - a systematic literature review and proposal of new diagnostic criteria.

Segmental arterial mediolysis (SAM) is a rare vascular disease, characterized by acute but transient vulnerability of the wall of medium-sized arteries. The most characteristic feature of SAM is its biphasic course: an injurious phase marked by acute weakness of the arterial wall leading to acute dissection and/or hemorrhage, followed by a reparative phase in which granulation tissue and fibrosis restore the injured arterial wall. Residual stenosis, aneurysms, and/or arterial wall irregularities may remain visible on future imaging studies. Differentiating between SAM and other arterial vasculopathies is difficult due to its similarities with many other vascular diseases, such as vasculitis, fibromuscular dysplasia, inherited connective tissue disorders, and isolated visceral artery dissection. In this systematic review, we provide an overview on SAM, with an emphasis on the differential diagnosis and diagnostic work-up. We propose new diagnostic criteria to help establish a prompt diagnosis of SAM, illustrated by case examples from our multidisciplinary vascular clinic.

Severe Abdominal Complaints after Technical Successful Endovascular Treatment of Chronic Splanchnic Ischemia.

Reperfusion syndrome (RS) after revascularization of an arterial occlusion of the lower leg is a well-known complication. RS after splanchnic revascularization, however, is an infrequent and less-known phenomenon. We present a patient with persisting abdominal complaints after revascularization of the celiac trunk and superior mesenteric artery suggesting reocclusion. Although computed tomography angiography showed patent splanchnic arteries, an impressive hyperperfusion state of liver and spleen was visualized. Complaints diminished steadily with conservative therapy, but RS can cause severe complications such as liver failure and multiple organ failure. Ignorance of RS might interfere with adequate treatment and can contribute to a high in-hospital mortality rate.

Ultrasonography to quantify hepatic fat content: validation by 1H magnetic resonance spectroscopy.

An abundance of fat stored within the liver, or steatosis, is the beginning of a broad hepatological spectrum, usually referred to as fatty liver disease (FLD). For studies on FLD, quantitative hepatic fat ultrasonography would be an appealing study modality. Objective of this study was to develop a technique for quantifying hepatic fat content by ultrasonography and validate this using proton magnetic resonance spectroscopy ((1)H MRS) as gold standard. Eighteen white volunteers (BMI range 21.0-42.9) were scanned by both ultrasonography and (1)H MRS. Altered ultrasound characteristics, present in the case of FLD, were assessed using a specially developed software program. Various attenuation and textural based indices of FLD were extracted from ultrasound images. Using linear regression analysis, the predictive power of several models (consisting of both attenuation and textural based measures) on log 10-transformed hepatic fat content by (1)H MRS were investigated. The best quantitative model was compared with a qualitative ultrasonography method, as used in clinical care. A model with four ultrasound characteristics could modestly predict the amount of liver fat (adjusted explained variance 43.2%, P = 0.021). Expanding the model to seven ultrasound characteristics increased adjusted explained variance to 60% (P = 0.015), with r = 0.789 (P < 0.001). Comparing this quantitative model with qualitative ultrasonography revealed a significant advantage of the quantitative model in predicting hepatic fat content (P < 0.001). This validation study shows that a combination of computer-assessed ultrasound measures from routine ultrasound images can be used to quantitatively assess hepatic fat content.

Short-term outcome of loop ileostomy closure under local anesthesia: results of a feasibility study.

BACKGROUND: Loop ileostomy is an established technique for temporary deviation of bowel contents to avoid clinical anastomotic leakage, fistulas, or use of an inflamed colon. Anesthetic risks and postoperative complications of the closure operation result in a significant proportion of ileostomies that are never closed, factors that should be borne in mind when fashioning temporary stomas. We investigated loop ileostomy closure under local anesthesia as a way to avoid these problems. METHODS: As a feasibility study, 15 successive patients underwent closure of a loop ileostomy under local anesthesia. The patients' experience of the procedure, postoperative pain, analgesia requirements, and oral intake were prospectively evaluated. RESULTS: Procedures could be comfortably completed under safe doses of local anesthesia. Use of standard nasogastric tubes was avoided and immediately postoperatively patients were able to resume a full oral diet. Discharge was on the second postoperative day (median). Complications were paralytic ileus for two days (1 patient), anastomotic leakage (1 patient), and superficial wound infection (1 patient). CONCLUSION: Reversal of loop ileostomy can be performed safely and comfortably under local anesthesia. Postoperative results compare favorably with those of routine procedures.