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  1 / 922 MEDLINE  
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[PMID]:28853604
[Au] Autor:Green PA; Battersby C; Heath RM; McCrossan L
[Ad] Endereço:Royal Liverpool and Broadgreen University Hospitals NHS Trust , UK.
[Ti] Título:A fatal case of amphetamine induced ischaemic colitis.
[So] Source:Ann R Coll Surg Engl;99(7):e200-e201, 2017 Sep.
[Is] ISSN:1478-7083
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:Amphetamine induced ischaemic colitis is an exceedingly rare presentation of amphetamine toxicity. The cases reported in the literature have described mild or transient disease. We present a fatal case of ischaemic colitis induced by amphetamine use in a 44-year-old woman who presented in extremis after a cardiac arrest en route to the emergency department. A short history of headache, abdominal pain, vomiting and agitation preceded her admission. Imaging revealed changes consistent with ischaemic colitis. Emergency laparotomy revealed widespread colonic necrosis necessitating a subtotal colectomy. Despite aggressive resuscitation and inotropic support from arrival, the patient deteriorated intraoperatively and died in the immediate postoperative period. Histology showed arterial type ischaemia/reperfusion injury of the area supplied by the superior mesenteric artery. The patient's serum amphetamine level was 0.52mg/l (peak therapeutic levels <0.2mg/l). The postmortem examination concluded that amphetamines were the likely cause of the vasospasm, leading to profound colonic ischaemia.
[Mh] Termos MeSH primário: Anfetamina/efeitos adversos
Colite Isquêmica/induzido quimicamente
[Mh] Termos MeSH secundário: Adulto
Colectomia
Colite Isquêmica/complicações
Colite Isquêmica/cirurgia
Evolução Fatal
Feminino
Seres Humanos
Traumatismo por Reperfusão/etiologia
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Nm] Nome de substância:
CK833KGX7E (Amphetamine)
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170913
[Lr] Data última revisão:
170913
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170831
[St] Status:MEDLINE
[do] DOI:10.1308/rcsann.2016.0350


  2 / 922 MEDLINE  
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[PMID]:28677408
[Au] Autor:Kotsis T; Christoforou P; Asaloumidis N; Papaconstantinou I
[Ad] Endereço:1 Vascular Unit, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.
[Ti] Título:Delayed Sigmoid Ischemic Rupture Following Open Repair Abdominal Aortic Aneurysm.
[So] Source:Vasc Endovascular Surg;51(6):413-416, 2017 Aug.
[Is] ISSN:1938-9116
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Colon ischemia following aortic reconstruction is a severe complication with an incidence of 1% to 2% of the operated patients; this infrequent complication will be lethal for nearly half of these patients. Commonly, colon ischemia may be an intraoperative observation or an early postoperative finding. However, in the case presented here, sigmoid rupture and small and large intestine communication was revealed 3 months following repair of the abdominal aorta. A 71-year-old man, following open repair of an abdominal aortic aneurysm, went home on the fifth postoperative day. Four months later, he was admitted to the emergency department of our hospital, because of fever, diarrhea, and abdominal pain for about 5 days. After conservative treatment and improvement in symptoms, the patient was released only to return to hospital with the same symptoms after a month. On this second admission, the symptoms were initially mild and the patient seemed to improve, but suddenly he deteriorated and an exploratory laparotomy was conducted, which revealed a left colon ischemia and a communication between the sigmoid and the small intestine. A left hemicolectomy was performed, along with a temporary colostomy (Hartmann diversion). The patient, 2 years after the initial aortic repair and 10 months following the complete restoration of the large intestine continuity, is well with no further manifestations.
[Mh] Termos MeSH primário: Aneurisma da Aorta Abdominal/cirurgia
Implante de Prótese Vascular/efeitos adversos
Colite Isquêmica/etiologia
Colo Sigmoide
[Mh] Termos MeSH secundário: Idoso
Aneurisma da Aorta Abdominal/diagnóstico por imagem
Colectomia
Colite Isquêmica/diagnóstico por imagem
Colite Isquêmica/terapia
Colo Sigmoide/diagnóstico por imagem
Colo Sigmoide/cirurgia
Colostomia
Seres Humanos
Masculino
Recidiva
Ruptura Espontânea
Fatores de Tempo
Resultado do Tratamento
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170918
[Lr] Data última revisão:
170918
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170706
[St] Status:MEDLINE
[do] DOI:10.1177/1538574417718445


  3 / 922 MEDLINE  
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[PMID]:28276832
[Au] Autor:Yngvadottir Y; Karlsdottir BR; Hreinsson JP; Ragnarsson G; Mitev RUM; Jonasson JG; Möller PH; Björnsson ES
[Ad] Endereço:a Department of Internal Medicine, Division of Gastroenterology and Hepatology , The National University Hospital of Iceland , Reykjavik , Iceland.
[Ti] Título:The incidence and outcome of ischemic colitis in a population-based setting.
[So] Source:Scand J Gastroenterol;52(6-7):704-710, 2017 Jun - Jul.
[Is] ISSN:1502-7708
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: Population-based studies on patients with ischemic colitis (IC) are limited. We aimed to determine the incidence, risk factors and outcome of patients with IC. METHODS: A retrospective nationwide study was conducted on adult patients with histologically confirmed IC in 2009-2013 in Iceland. IC patients were matched for age and gender with patients hospitalized with lower gastrointestinal bleeding. Data were collected on clinical presentation, comorbidities, smoking habits, management and outcome. RESULTS: Eighty-nine patients, 61 (69%) females and mean age of 65 years (±17), fulfilled the predetermined criteria. Females were older than males, 68 years (±14) vs. 59 years (±20) (p = .0170). The mean cumulative incidence was 7.3 cases per 100,000 inhabitants. A total of 57 (64%) patients presented with abdominal pain, hematochezia and diarrhea. IC was localized in the left colon in 78 (88%) patients. Overall, 62 (70%) patients had cardiovascular disease vs. 53 (60%) of control group (NS) and 55 (62%) had a history of smoking vs. 53 (60%) in control group (NS). Ten (11%) patients required surgery and/or died within 30-days from hospital admission. At the end of follow-up, 7 (9%) patients had experienced recurrence of IC with an estimated 3-year recurrence rate of 15%. CONCLUSIONS: IC is a common clinical phenomenon that affects a wide range of age groups, but is most prominent among elderly women. It typically presents with a clinical triad of abdominal pain, hematochezia and diarrhea. Most cases are mild and self-limiting with a good prognosis.
[Mh] Termos MeSH primário: Colite Isquêmica/epidemiologia
Colite Isquêmica/fisiopatologia
Colo/patologia
Hemorragia Gastrointestinal/etiologia
[Mh] Termos MeSH secundário: Adulto
Distribuição por Idade
Idoso
Idoso de 80 Anos ou mais
Estudos de Casos e Controles
Comorbidade
Feminino
Hospitalização
Seres Humanos
Islândia/epidemiologia
Incidência
Modelos Logísticos
Masculino
Meia-Idade
Recidiva
Estudos Retrospectivos
Fatores de Risco
Índice de Gravidade de Doença
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171005
[Lr] Data última revisão:
171005
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170310
[St] Status:MEDLINE
[do] DOI:10.1080/00365521.2017.1291718


  4 / 922 MEDLINE  
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[PMID]:28264212
[Au] Autor:Bremer S; Kowald T; Chavan A
[Ti] Título:Die Bedeutung der Vena mesenterica inferior und des Thumbtack-Signs bei der Diagnostik der ischämischen Kolitis ­ Ein Fallbericht..
[So] Source:Rofo;189(3):248-250, 2017 Mar.
[Is] ISSN:1438-9010
[Cp] País de publicação:Germany
[La] Idioma:ger
[Mh] Termos MeSH primário: Colite Isquêmica/diagnóstico por imagem
Angiografia por Tomografia Computadorizada/métodos
Veias Mesentéricas/diagnóstico por imagem
Intensificação de Imagem Radiográfica/métodos
[Mh] Termos MeSH secundário: Idoso
Diagnóstico Diferencial
Seres Humanos
Masculino
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Em] Mês de entrada:1708
[Cu] Atualização por classe:170830
[Lr] Data última revisão:
170830
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170307
[St] Status:MEDLINE
[do] DOI:10.1055/s-0042-118958


  5 / 922 MEDLINE  
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[PMID]:28222619
[Au] Autor:Yamanouchi S; Ogawa S; Kusunoki R; Miyaoka Y; Fujishiro H; Kohge N; Kinoshita Y
[Ad] Endereço:1 Department of Gastroenterology, Shimane Prefectural Central Hospital, Izumo, Shimane, Japan.
[Ti] Título:Seasonal variation in occurrence of ischemic colitis: a retrospective study.
[So] Source:J Int Med Res;45(1):340-351, 2017 Feb.
[Is] ISSN:1473-2300
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:Objectives We aimed to identify the clinical characteristics of ischemic colitis (IC) and to investigate the occurrence of seasonal variation. Methods From January 2008 to December 2014, 368 had IC as the reason for their admission. A total of 364 patients were enrolled in this study. We investigated patient characteristics and seasonal variations in incidence. Results The mean age (±standard deviation) of patients with IC at diagnosis was 66.8 (±16.9) years. Most patients had abdominal pain (341 cases), hematochezia (337 cases), and diarrhea (199 cases) as their chief complaints. The clinical courses of the disease were classified as transient (294 cases), stricture (17 cases), gangrenous (2 cases), and indeterminate types (51 cases). Although IC tended to occur less frequently in winter, the seasonal difference was not significant. Conclusion There is currently no evidence for seasonal variation in hospital admissions for IC.
[Mh] Termos MeSH primário: Colite Isquêmica/diagnóstico
Colite Isquêmica/epidemiologia
Hospitalização/estatística & dados numéricos
[Mh] Termos MeSH secundário: Dor Abdominal/fisiopatologia
Idoso
Idoso de 80 Anos ou mais
Ritmo Circadiano/fisiologia
Colite Isquêmica/fisiopatologia
Diarreia/fisiopatologia
Feminino
Hemorragia Gastrointestinal/fisiopatologia
Seres Humanos
Incidência
Japão/epidemiologia
Masculino
Meia-Idade
Estudos Retrospectivos
Estações do Ano
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1705
[Cu] Atualização por classe:171004
[Lr] Data última revisão:
171004
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170223
[St] Status:MEDLINE
[do] DOI:10.1177/0300060516684276


  6 / 922 MEDLINE  
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[PMID]:28216366
[Au] Autor:Farivar BS; Kalsi R; Drucker CB; Goldstein CB; Sarkar R; Toursavadkohi S
[Ad] Endereço:Division of Vascular Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, Md. Electronic address: bfarivar@live.com.
[Ti] Título:Implications of concomitant hypogastric artery embolization with endovascular repair of infrarenal abdominal aortic aneurysms.
[So] Source:J Vasc Surg;66(1):95-101, 2017 Jul.
[Is] ISSN:1097-6809
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: Hypogastric artery embolization (HAE) is associated with significant risk of ischemic complications. We assessed the impact of HAE on 30-day outcomes of endovascular aneurysm repair (EVAR) of infrarenal abdominal aortic aneurysms. METHODS: We queried the American College of Surgeons National Surgical Quality Improvement Program database from 2011 to 2014 to identify and to compare clinical features, operative details, and 30-day outcomes of EVAR with those of concomitant HAE with EVAR (HAE + EVAR). Multivariate analysis was performed to determine preoperative and intraoperative factors associated with development of significant complications observed in patients with HAE + EVAR. RESULTS: In a cohort of 5881 patients, 387 (6.6%) underwent HAE + EVAR. Compared with EVAR, a higher incidence of ischemic colitis (2.6% vs 0.9%; P = .002), renal failure requiring dialysis (2.8% vs 1%; P = .001), pneumonia (2.6% vs 1.3%; P = .039), and perioperative blood transfusion (17% vs 13%; P = .024) was noted after HAE + EVAR. Thirty-day thromboembolic events, strokes, myocardial infarction, lower extremity ischemia, reoperation, and readmission rates were not significantly different (P > .05). Mortality at 30 days in HAE + EVAR patients was 4.1% compared with 2.5% with EVAR (P = .044). HAE was independently associated with increased risk of colonic ischemia (adjusted odds ratio, 2.98; 95% confidence interval, 1.44-6.14; P = .003) and renal failure requiring dialysis (adjusted odds ratio, 2.22; 95% confidence interval, 1.09-4.53; P = .029). However, HAE was not an independent predictor of mortality. Average length of hospital stay was 4 ± 8.5 days after HAE + EVAR vs 3.3 ± 5.9 days after EVAR (P = .001). CONCLUSIONS: Concomitant HAE with EVAR is associated with longer and more complicated hospital stays. Ischemic colitis is a rare complication of EVAR. HAE increases the risk of ischemic colitis and renal failure requiring dialysis. This study highlights the importance of hypogastric artery preservation during EVAR.
[Mh] Termos MeSH primário: Aneurisma da Aorta Abdominal/terapia
Implante de Prótese Vascular/efeitos adversos
Colite Isquêmica/etiologia
Embolização Terapêutica/efeitos adversos
Procedimentos Endovasculares/efeitos adversos
Pelve/irrigação sanguínea
Insuficiência Renal/etiologia
[Mh] Termos MeSH secundário: Idoso
Idoso de 80 Anos ou mais
Aneurisma da Aorta Abdominal/diagnóstico por imagem
Aneurisma da Aorta Abdominal/fisiopatologia
Aneurisma da Aorta Abdominal/cirurgia
Artérias/fisiopatologia
Distribuição de Qui-Quadrado
Colite Isquêmica/diagnóstico
Colite Isquêmica/terapia
Bases de Dados Factuais
Embolização Terapêutica/métodos
Feminino
Seres Humanos
Tempo de Internação
Modelos Logísticos
Masculino
Meia-Idade
Análise Multivariada
Razão de Chances
Fluxo Sanguíneo Regional
Sistema de Registros
Diálise Renal
Insuficiência Renal/diagnóstico
Insuficiência Renal/terapia
Estudos Retrospectivos
Fatores de Risco
Fatores de Tempo
Resultado do Tratamento
Estados Unidos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1707
[Cu] Atualização por classe:170713
[Lr] Data última revisão:
170713
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170221
[St] Status:MEDLINE


  7 / 922 MEDLINE  
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[PMID]:28089622
[Au] Autor:Cossé C; Sabbagh C; Fumery M; Zogheib E; Mauvais F; Browet F; Rebibo L; Regimbeau JM
[Ad] Endereço:Department of Digestive and Oncological Surgery, Amiens University Hospital, Jules Verne University of Picardie, Amiens, France; INSERM U1088, Jules Verne University of Picardie, Amiens, France; Clinical Research Centre, Amiens University Hospital, Jules Verne University of Picardie, Amiens, France.
[Ti] Título:Serum procalcitonin correlates with colonoscopy findings and can guide therapeutic decisions in postoperative ischemic colitis.
[So] Source:Dig Liver Dis;49(3):286-290, 2017 Mar.
[Is] ISSN:1878-3562
[Cp] País de publicação:Netherlands
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Postoperative ischaemic colitis (POIC) is a life-threatening vascular gastrointestinal condition. Serum procalcitonin (PCT) levels be of value in the detection of necrosis. AIMS: To evaluate the correlation between serum PCT levels and the colonoscopic assessment of the severity of POIC. METHODS: Between January 2007 and November 2014, 150 patients with POIC and PCT data were included in the study. The main outcome measure was the correlation between serum PCT and the colonoscopy-based assessment of the severity of POIC (according to Favier's classification: stage 1/2 without multi-organ failure vs. stage 2/3 with multi-organ failure). RESULTS: Eighty-five percent of the stage 1 cases (n=22) had a serum PCT level ≤2µg/L; 63% (n=19) of the stage 2 cases with multi-organ failure had a PCT level between 4 and 8µg/L, and 70% (n=52) of the stage 3 cases had a PCT level ≥8µg/L. The PCT level was strongly correlated with the Favier stage (Spearman's rho: 0.701; p<0.0001). PCT levels were similar in stage 2 cases with multi-organ failure and in stage 3 cases (16.06µg/L vs. 7.79µg/L, respectively; p=0.35). CONCLUSION AND RELEVANCE: Serum PCT is correlated with stage 2/3 POIC requiring surgery. If PCT ≥5µg/L, surgery should be considered.
[Mh] Termos MeSH primário: Calcitonina/sangue
Colite Isquêmica/sangue
Colite Isquêmica/terapia
Colonoscopia
[Mh] Termos MeSH secundário: Adulto
Idoso
Idoso de 80 Anos ou mais
Biomarcadores/sangue
Colite Isquêmica/complicações
Feminino
França
Seres Humanos
Masculino
Meia-Idade
Insuficiência de Múltiplos Órgãos/sangue
Insuficiência de Múltiplos Órgãos/complicações
Período Pós-Operatório
Valor Preditivo dos Testes
Curva ROC
Estudos Retrospectivos
Índice de Gravidade de Doença
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Biomarkers); 9007-12-9 (Calcitonin)
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170912
[Lr] Data última revisão:
170912
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170117
[St] Status:MEDLINE


  8 / 922 MEDLINE  
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[PMID]:27838817
[Au] Autor:Kwak HD; Kang H; Ju JK
[Ad] Endereço:Division of Colorectal Surgery, Department of Surgery, Chonnam National University Hospital, 42 Jaebong-ro, Gwangju, 61469, South Korea.
[Ti] Título:Fulminant gangrenous ischemic colitis: is it the solely severe type of ischemic colitis?
[So] Source:Int J Colorectal Dis;32(1):147-150, 2017 Jan.
[Is] ISSN:1432-1262
[Cp] País de publicação:Germany
[La] Idioma:eng
[Ab] Resumo:PURPOSE: The purposes of the study are to evaluate the characteristics of gangrenous colitis and to identify clinicobiological factors. METHODS: We performed a retrospective study of 75 patients in whom the diagnosis was made endoscopically and confirmed pathologically, between March 2004 and March 2010 at a tertiary teaching hospital. We classified ischemic colitis into the reversible and irreversible types (gangrenous colitis). The influence of factors, such as medical history, symptoms, physical examination, laboratory abnormalities, endoscopic findings, abnormalities on computed tomography, perioperative issues, complications, and several scoring systems, on gangrenous ischemic changes and mortality was evaluated by univariate and multivariate analyses. RESULTS: Ischemic colitis was classified as gangrenous ischemic type in 19 patients. The sigmoid colon was the most common site of involvement. However, the disease distribution was significantly different between the two groups. Pancolitis was most commonly observed for fulminant gangrenous colitis. A difference between the two groups was detected for several factors: age, mortality, physiologic score, APACHE II, mean arterial pressure at the time of admission, heart rate, albumin level, and sodium bicarbonate concentration. Multivariate analysis indicated four factors predictive of gangrenous colitis: absence of hematochezia, abdominal tenderness, absence of diarrhea, and albumin level. Another multivariate analysis excluding gangrenous change factors for mortality indicated four factors: arterial pH, serum sodium bicarbonate (metabolic acidosis), albumin (<3.0), and arterial oxygenation. CONCLUSION: Absence of diarrhea and hematochezia, presence of abdominal tenderness, and hypoalbuminemia could be the predictors for development of gangrenous changes of ischemic colitis.
[Mh] Termos MeSH primário: Colite Isquêmica/complicações
Gangrena/complicações
[Mh] Termos MeSH secundário: Idoso
Feminino
Seres Humanos
Masculino
Análise Multivariada
Fatores de Risco
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1704
[Cu] Atualização por classe:170926
[Lr] Data última revisão:
170926
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:161114
[St] Status:MEDLINE
[do] DOI:10.1007/s00384-016-2700-9


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[PMID]:27819873
[Au] Autor:Chavez JA; Chen W; Frankel WL; Arnold CA
[Ad] Endereço:Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, OH.
[Ti] Título:Hydrophilic Polymer-associated Ischemic Enterocolitis.
[So] Source:Am J Surg Pathol;41(2):271-276, 2017 Feb.
[Is] ISSN:1532-0979
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Hydrophilic polymer coating of medical devices serves to lubricate the device and prevent device-related complications. The coating can be mechanically disrupted and result in downstream injury via presumed thromboembolism. This process has been reported in the brain, heart, lung, and skin, and has been replicated through animal studies and in vitro histologic processing of the polymer coating. We report the first description of hydrophilic polymer-associated ischemic enterocolitis in a series of 7 specimens (small bowel=2, colon=4, aortic thrombus=1) from 3 patients. We report a 4% incidence among all patients with an ischemic bowel resection between April 29, 2014 and August 8, 2016. All patients developed bowel ischemia within 1 day of aortic repair, and all bowel resection specimens showed polymers, mainly in the submucosal vessels in areas of extensive ischemia. The polymers appeared as basophilic, intravascular, serpiginous structures. In a patient who developed acute paralysis after the aortic repair, identical polymers were identified in the aortic thrombus and the ischemic bowel segment. We demonstrate that the polymers display an altered morphology over time and with various graft types, and that the degrading polymers are associated with a foreign body giant cell reaction. Special stains can aid in diagnosis, with the polymers turquoise on a colloidal iron stain, pink on von Kossa and mucicarmine stains, and pale blue on trichrome. Clinical follow-up was available up to 115 weeks: 1 patient died, and 2 are alive and well. In summary, we report a new diagnostic entity to be considered in the differential diagnosis of iatrogenic ischemic injuries in the gastrointestinal tract. Awareness of this entity is important to elucidate the cause of ischemia and to prevent misdiagnosis of the polymers and their associated giant cell reaction as a parasitic infection, granulomatous vasculitis, sarcoidosis, and idiopathic inflammatory bowel disease.
[Mh] Termos MeSH primário: Colite Isquêmica/induzido quimicamente
Colite Isquêmica/patologia
Procedimentos Endovasculares/efeitos adversos
Polímeros/efeitos adversos
[Mh] Termos MeSH secundário: Idoso
Procedimentos Endovasculares/instrumentação
Feminino
Seres Humanos
Masculino
Meia-Idade
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Polymers)
[Em] Mês de entrada:1707
[Cu] Atualização por classe:170719
[Lr] Data última revisão:
170719
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:161108
[St] Status:MEDLINE
[do] DOI:10.1097/PAS.0000000000000765


  10 / 922 MEDLINE  
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[PMID]:27637870
[Au] Autor:Cuny P; Houot M; Ginisty S; Horowicz S; Plassart F; Mentec H; Eftekhari P
[Ad] Endereço:Centre régional de pharmacovigilance, hôpital Fernand-Widal, AP-HP, 200, rue du Faubourg-Saint-Denis, 75475 Paris cedex 10, France; Service de pharmacie, centre hospitalier Victor-Dupouy, 69, rue du Lieutenant-Colonel-Prudhon, 95107 Argenteuil, France. Electronic address: pasccuny@gmail.com.
[Ti] Título:[Quetiapine and anticholinergic drugs induced ischaemic colitis: A case study].
[Ti] Título:Colite ischémique sous quétiapine associée à d'autres molécules anticholinergiques : à propos d'un cas..
[So] Source:Encephale;43(1):81-84, 2017 Feb.
[Is] ISSN:0013-7006
[Cp] País de publicação:France
[La] Idioma:fre
[Ab] Resumo:INTRODUCTION: The aim of this paper is to underline the need for systematic monitoring of patients treated with anticholinergic antipsychotic drugs. We present the clinical history of a 34-year-old adult, treated with quetiapine in combination with other drugs with anticholinergic effects. CASE REPORT: A 34-year-old male adult had been suffering from bipolar disorder since 2001. He was treated with risperidone, but he was not compliant due to adverse effects, including decreased libido and erectile dysfunction. On June 5th 2012, it was decided to administrate 600mg per day of quetiapine in combination with tropatepine consequent to an episode of agitation and aggressiveness. On June 14th 2012, while the patient was receiving diazepam and valproic acid, loxapine oral solution was introduced. On June 23th, the patient started mentioning digestive disorders, such as diffuse abdominal pain with constipation but continued to pass gaz. On June 25th, at 6:30 am, he declared abdominal pain, which worsened at 8:15 am despite administration of analgesics, followed by malaise and onset of vomiting. His laboratory tests showed leukocytosis 11.2G/L with neutrophils 7.7G/L. The abdomen's radiograph without preparation showed small bowel and colonic air-fluid levels. The result of the CT scan confirmed an occlusive syndrome affecting the whole small gut and colon. At 1 pm, the patient's condition worsened. He received an intramuscular injection of 100mg of loxapine and an opioid treatment, including tramadol and morphine. At 2:30 pm, the clinical condition further deteriorated with an onset of generalized abdominal contracture, the absence of abdominal breathing, sweating, tachycardia at 104 beats per minute, and hypothermia of 34.5°C. He was transferred to an intensive care unit. Laboratory tests showed metabolic acidosis, elevated liver enzymes and acute renal failure. He received volume expansion and was treated by renal replacement therapy and antibiotics. He was intubated and transferred to the operating room. At laparotomy, both colonic necrosis with perforation and necrosis of the small bowel were seen. The patient underwent total colectomy with small bowel resection, distal ileostomy and closure of the rectal stump. The onset of septic and hemorrhagic state required further surgery on June 26th. The evolution was characterized by multi-organ failure with acute anuric renal failure, multiple cardiac arrests, and systemic bacterial and fungal infection. On July 24th, this unfavorable outcome lead to death. In summary, the patient had an occlusive syndrome due to neuroleptics and complications, including mesenteric ischemia with necrotizing colitis. DISCUSSION/CONCLUSION: Quetiapine, like all antipsychotics, has anticholinergic effects, including cardiac, psychiatric and digestive disorders. The combination of anticholinergic drugs decreases intestinal peristalsis. Without any prompt management, this decrease can result in a colonic ischemia or necrosis. In patients treated with neuroleptics, the onset of constipation must alert medical staff. Systematic monitoring of bowel movements should be performed in any patient receiving anticholinergic drugs.
[Mh] Termos MeSH primário: Transtorno Bipolar/tratamento farmacológico
Antagonistas Colinérgicos/administração & dosagem
Antagonistas Colinérgicos/efeitos adversos
Colite Isquêmica/induzido quimicamente
Fumarato de Quetiapina/administração & dosagem
Fumarato de Quetiapina/efeitos adversos
[Mh] Termos MeSH secundário: Adulto
Colite Isquêmica/diagnóstico
Interações Medicamentosas
Quimioterapia Combinada/efeitos adversos
Seres Humanos
Masculino
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE; REVIEW
[Nm] Nome de substância:
0 (Cholinergic Antagonists); 2S3PL1B6UJ (Quetiapine Fumarate)
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170926
[Lr] Data última revisão:
170926
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:160918
[St] Status:MEDLINE



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