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Anticoagulation control in active inflammatory bowel disease (IBD) is challenging because of hypercoagulation and bleeding complications. The strategy for treating chronic thromboembolic pulmonary hypertension (CTEPH) in IBD remains controversial because only a few studies have reported its successful treatment (Kim and Lang. Eur Respir...
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... pulmonary arteries (Fig. 2e, f ). Findings of the right heart catheter examination indicated severe pulmonary hypertension with the following parametric values: pulmonary artery pressure, 96/32 mmHg (mean, 53 mmHg); After undergoing thorough treatments for active IBD, PEA using intermittent circulatory arrest under deep hypothermia was performed (Fig. 3). PEA was performed through a median sternotomy using cardiopulmonary bypass with deep hypothermic intermittent circulatory arrest, similar to the techniques established by Jamieson et al. [5]. During PEA, the activated clotting time was strictly controlled between 350 and 500 s. Weaning from cardiopulmonary bypass was uneventful, and ...
Citations
... 132 Pulmonary hypertension is rare in IBD; however, IBD patients are at a higher risk for recurrent unprovoked venous thromboembolism and thus have the potential to develop chronic thromboembolic pulmonary hypertension. 133,134 A right heart catheterization would be required for definitive confirmation. ...
Inflammatory bowel disease can manifest in many extraintestinal organ systems. The most frequently involved extraintestinal locations include the mucocutaneous, hepatobiliary, and ocular organ systems. The respiratory tract is less commonly involved and is therefore frequently overlooked. Consequently, it is believed that involvement of the respiratory tract in patients with inflammatory bowel disease is underreported. The pathogenesis is thought to be multifactorial, involving the common embryologic origin shared by the respiratory and luminal digestive tract, molecular mimicry, and immunologic interactions leading to immune-complex deposition in affected tissue. The spectrum of manifestations of the respiratory tract related to inflammatory bowel disease is broad. It not only includes direct involvement of the respiratory tract (ie, airways, interstitium, and pleura) but also can result as a consequence of systemic involvement such as in thromboembolic events. In addition, it may also be related to other conditions that affect the respiratory tract such as sarcoidosis and alpha-1 antitrypsin deficiency. Though some conditions related to respiratory tract involvement might be subclinical, others may have life-threatening consequences. It is critical to approach patients with suspected inflammatory bowel disease–related respiratory tract involvement in concert with pulmonology, infectious diseases, and any other pertinent experts, as treatments may require a multidisciplinary overlap of measures. Therefore, it is of paramount importance for the clinician to be aware of the array of respiratory tract manifestations of patients with inflammatory bowel disease, in addition to the possible spectrum of therapeutic measures.
The article investigates the influence of visceral (surgical treatment of abdominal pathologies) and somatic pain syndrome (osteosynthesis) on dogs’ clinical parameters and haemostasis. It was found, that the best variant for abdominal operations in dogs is acepromazine-ketamine-propofol anaesthesia and for osteosynthesis – acepromazine-butorphanol-ketamine. The use of neuroleptics (acepromazine, xylazine) with general anaesthetics (ketamine, propofol, sodium thiopental) in abdominal operations ensured rapid entry into anaesthesia (< 2 min) and duration 19–23 min. The use of acepromazine-ketamine-propofol provided well-managed anaesthesia during 11.1 ± 0.5 min, rapid recovery (17.3 ± 2.4 min), without significant changes in heart rate (HR), respiratory rate (RR), blood pressure (BP), haemoglobin saturation (SpO2). Unbalanced anaesthesia and insufficient analgesia under xylazine-ketamine caused a sharp decrease in HR, BP, RR with their increase due to visceral pain, led to hypoxia (SpO2 < 92%). During the osteosynthesis, acepromazine-butorphanol-propofol-ketamine anaesthesia provided complete analgesia with twice the rapid recovery of dogs without significant changes in HR, RR, BP, SpO2 during surgery. Acepromazine-ketamine-thiopental anaesthesia accompanied by pronounced analgesia with a decrease in HR and BP. Xylazine-ketamine-thiopental anaesthesia, under apparent analgesia, led to hypotension (decreased HR, BP) and hypoxia (decreased RR, SpO2). The data obtained will optimize the selection of drugs' combinations for dogs' anaesthesia, taking into account the type of pain response.
The thoracic manifestations that may occur at any time in inflammatory bowel disease (IBD) patients encompass a wide variety of patterns: large and/or major airway inflammation and scarring, subacute and/or chronic bronchiolitis, e.g. ILDs such as organising or eosinophilic pneumonia, neutrophilic or granulomatous lung nodules, serositis, myocarditis and/or pneumomediastinum. Airway disease occurs more often post-colectomy, contrasting with ILD that may develop both in patients exposed to drugs, as well as in those off any medication. Provided alternative aetiologies and an infection are properly ruled out, corticosteroid therapy (inhaled and/or oral or parenteral) is the mainstay of management of IBD-related airway involvement. Oral corticosteroid therapy can be useful to treat significant IBD-or drug-related ILD.
