In patients with inflammatory bowel diseases (IBD) the prevalence of thrombosis is 6.2%, the average incidence of thromboembolism (TE) is 3.6 times higher compared to normal population. The TE is a common extraintesti...In patients with inflammatory bowel diseases (IBD) the prevalence of thrombosis is 6.2%, the average incidence of thromboembolism (TE) is 3.6 times higher compared to normal population. The TE is a common extraintestinal complication of IBD, squarely associated with the IBD activity. The application of antico-agulant and thrombolytic therapy in severe IBD is an unresolved issue. Herein we report the first case in literature of an active IBD patient with an upper limb acute arterial occlusion and successful catheter-directed thrombolysis (CDT). A 46-year-old male patient is reported who had Crohn's disease for 10 years. His right hand suddenly became cold and painful. Angiography proved acute occlusion of the brachial and radial artery. Vascular surgery intervention was not applicable. Endoscopy showed extended, severe inflammation of the colon. Despite the severe endoscopic findings, frequent bloody stools and moderate anaemia, CDT with recombinant tissue plasminogen activator was performed. The control angiography proved improvement, the radial artery pulse appeared. No bleeding complication was observed. This case supports that CDT-after careful estimation of the bleeding risk-can be effective and safe in patients with severe or life-threatening TE and active IBD.展开更多
基金Supported by the "Mecenatura" grant of Debrecen University 3/1999 to K. P., and grants from the Hungarian Ministry of Health (ETT 41/2000 to I. A., and ETT 026/2003 to F. E.) from the Hungarian Science Research Fund (OTKA 043296 to F. E.).
文摘瞄准：在煽动性的肠疾病(IBD ) 学习内皮和可诱导的氮的氧化物 synthases (eNOS 和 i NOS ) 和他们的角色的表示。方法：我们检验了重量的单位的效果一在人的脐的静脉 endothelial (HUVEC ) 的功能和生存能力上与活跃 Crohn 的疾病(CD ) 和 ulcerative (UC ) 从病人获得了。HUVEC 面对与活跃 CD 或 UC 从病人包含健康控制，或浆液的分享的浆液的媒介为 0-48 h 是有教养的。eNOS 和 i NOS 的表示被免疫荧光设想，并且由西方的污点的测密度术确定了。增长活动被 Ki-67 免疫的计算机化的图象分析估计反应房间，并且也面对 NOS 禁止者测试了， 10 (-4) mol/L L 名字。Apoptosis 和坏死被 annexin-V-biotin 方法并且由分别地染色的 propidium 碘化物检验。结果：在 HUVEC 立即在到 UC 的暴露以后，浆液 eNOS 显著地被导致，在 12 h 到达一座山峰。相反，在 eNOS 的减少与 CD 重量的单位在孵化以后被观察一 eNOS 铺平的 and 在与控制(18%+/-16% 对 23%+/-15% P【0.01 ) 相比的 20 h 是最小的。UC 或 CD 浆液与控制相比在 i NOS 引起了重要增加(UC：300%+/-21% ；CD：275%+/-27% 对 108%+/-14% ， P【0.01 ) 。Apoptosis/necrosis 特征没在任何一个实验显著地不同。增加的增长活动与 L 名字面对 CD 浆液或术后疗法被检测。文化与 CD 浆液在 24 h 处理以后显示出像试管的形成。结论：IBD 重量的单位一在 eNOS/iNOS 的比率的唤起的变化，而没影响 HUVEC 的生存能力。这些同时包含了 eNOS 的下面规定和 i NOS 的起来规定，导致增加的增长活动并且可能 endothelial 的减少的反煽动性的保护。
文摘In patients with inflammatory bowel diseases (IBD) the prevalence of thrombosis is 6.2%, the average incidence of thromboembolism (TE) is 3.6 times higher compared to normal population. The TE is a common extraintestinal complication of IBD, squarely associated with the IBD activity. The application of antico-agulant and thrombolytic therapy in severe IBD is an unresolved issue. Herein we report the first case in literature of an active IBD patient with an upper limb acute arterial occlusion and successful catheter-directed thrombolysis (CDT). A 46-year-old male patient is reported who had Crohn's disease for 10 years. His right hand suddenly became cold and painful. Angiography proved acute occlusion of the brachial and radial artery. Vascular surgery intervention was not applicable. Endoscopy showed extended, severe inflammation of the colon. Despite the severe endoscopic findings, frequent bloody stools and moderate anaemia, CDT with recombinant tissue plasminogen activator was performed. The control angiography proved improvement, the radial artery pulse appeared. No bleeding complication was observed. This case supports that CDT-after careful estimation of the bleeding risk-can be effective and safe in patients with severe or life-threatening TE and active IBD.
