A case of acute superior mesenteric arterial occlusion with successful emergency simultaneous side-to-end anastomosis.

A 72-year-old woman was transferred to our critical care center because of transient loss of consciousness and aphasia. She had a history of abdominal pain, nausea, and atrial fibrillation, and reported on admission mild abdominal rebound tenderness, inflammatory response, acidosis and renal dysfunction. We suspected acute superior mesenteric arterial occlusion (SMAO) after cerebral infarction. We performed simultaneous reconstruction with side-to-end anastomosis using circular and linear staplers, rather than jejunostomy, which avoided the loss of massive intestinal contents and frequent diarrhea. A detailed history is important to make a diagnosis of acute SMAO and simultaneous reconstruction with side-to-end anastomosis is an important treatment option.

Treatment of hepatic encephalopathy by on-line hemodiafiltration: a case series study.

BACKGROUND: It is thought that a good survival rate of patients with acute liver failure can be achieved by establishing an artificial liver support system that reliably compensates liver function until the liver regenerates or a patient undergoes transplantation. We introduced a new artificial liver support system, on-line hemodiafiltration, in patients with acute liver failure. METHODS: This case series study was conducted from May 2001 to October 2008 at the medical intensive care unit of a tertiary care academic medical center. Seventeen consecutive patients who admitted to our hospital presenting with acute liver failure were treated with artificial liver support including daily on-line hemodiafiltration and plasma exchange. RESULTS: After 4.9 +/- 0.7 (mean +/- SD) on-line hemodiafiltration sessions, 16 of 17 (94.1%) patients completely recovered from hepatic encephalopathy and maintained consciousness for 16.4 +/- 3.4 (7-55) days until discontinuation of artificial liver support (a total of 14.4 +/- 2.6 [6-47] on-line hemodiafiltration sessions). Significant correlation was observed between the degree of encephalopathy and number of sessions of on-line HDF required for recovery of consciousness. Of the 16 patients who recovered consciousness, 7 fully recovered and returned to society with no cognitive sequelae, 3 died of complications of acute liver failure except brain edema, and the remaining 6 were candidates for liver transplantation; 2 of them received living-related liver transplantation but 4 died without transplantation after discontinuation of therapy. CONCLUSIONS: On-line hemodiafiltration was effective in patients with acute liver failure, and consciousness was maintained for the duration of artificial liver support, even in those in whom it was considered that hepatic function was completely abolished.

Synthetic studies on selective type 4 phosphodiesterase (PDE 4) inhibitors. 1. Structure-activity relationships and pharmacological evaluation of 1,8-naphthyridin-2(1H)-one derivatives.

In order to develop novel and orally active phosphodiesterase (PDE) 4 inhibitors, random screening was performed using our chemical library to find YM-10335 possessing the 1,8-naphthyridin-2(1H)-one skeleton which is a completely different structure from rolipram. In this report, the syntheses and structure-activity relationships of the YM-10335 derivatives were described. Some compounds showed selective inhibitory activities for PDE 4 derived from human peripheral blood cells and no effect on the other PDE types (1, 2, 3, 5). The inhibition of the tumor necrosis factor-alpha (TNF-alpha) release in vitro and the carrageenan-induced pleurisy in rats were also described.