Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0022116 (ischemia)
 91,303 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A forty-two years old male underwent an aortic arch replacement for an emergency treatment of dissecting aortic aneurysm (DeBakey type I). Separate cardiopulmonary bypass was used with main arterial inflow cannula inserted to right femoral artery. After the operation, ischemia of the right lower extremity led to acute renal failure due to myonephropathic-metabolic syndrome. Peritoneal dialysis, hemodialysis, and continuous arterio-venous hemofiltration were performed. Renal failure improved gradually. At the diuretic phase serum calcium concentration began to rise. Inspite of large amount of fluid and furosemide injection it became higher and finally reached to 20 mg/dl level. Calcitonin injection (320 mu/day) was very effective. In 2 months after surgery serum creatinine and calcium concentrations went down to normal range. Abnormalities in calcium metabolism are frequent in rhabdomyolysis-induced acute renal failure. However, it is rare to encounter such a remarkable hypercalcemia as seen in this patient. When treating MNMS we should pay attention to the changes of serum calcium concentration.
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PMID:[Dissecting aortic aneurysm associated with myonephropathic-metabolic syndrome and hypercalcemia]. 202 21

Fifty-seven patients underwent repair of atherosclerotic thoracoabdominal aortic aneurysms between 1978 and 1990. Five patients had urgent surgery for rupture. The 30-day operative mortality rate for the entire group was 18% (10 patients). Before July 1987, 19 patients (group 1) were operated on by use of a technique previously described. In these earlier patients the peritoneum was routinely entered, the diaphragm was divided radially, and no heparin was given. Among patients in group 1 there was a 30-day operative mortality rate of 42% (8 patients), and morbidity included myocardial infarction 4 (21%), respiratory failure 9 (47%), renal failure 12 (63%), bleeding requiring reoperation 4 (21%), and intestinal ischemia 3 (16%). Since July 1987 a standardized approach to all elective thoracoabdominal aortic aneurysms has been used in 38 patients (group 2). This method uses a left thoracoabdominal incision, circumferential division of the hemidiaphragm, retronephric totally extraperitoneal aortic exposure, single lung anesthesia, full heparinization, the graft inclusion technique, and liberal use of visceral endarterectomy. Patients in group 2 sustained a 30-day operative mortality rate of 5% (2 patients) and morbidity included myocardial infarction 2 (5%), respiratory failure 10 (26%), renal failure 11 (29%), bleeding requiring reoperation 1 (3%), paraplegia 6 (16%), and paraparesis 4 (11%). Modern surgery for repair of thoracoabdominal aortic aneurysm results in acceptably low operative mortality rates. Spinal cord ischemia remains an unresolved source of morbidity.
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PMID:Evolving experience with thoracoabdominal aortic aneurysm repair at a single institution. 203 2

Paraplegia after thoracic aortic aneurysm repair has an incidence of 2.2% to 24%. Oxygen-derived free radicals after reperfusion of an ischemic spinal cord may be partly responsible for neuronal destruction. We studied the effects of polyethylene glycol-conjugated superoxide dismutase (PEG-SOD), a free radical scavenger, as a way of increasing spinal cord tolerance to ischemia. Thirty rabbits underwent 40 minutes of aortic occlusion (a known model of paraplegia). Ten of these animals received 25,000 U/kg of PEG-SOD 24 hours before aortic occlusion and two additional doses of 10,000 U/kg, one before and one subsequent to spinal ischemia. Ten animals received superoxide dismutase in the same dosages as those receiving PEG-SOD. Ten control animals received placebo. All animals were studied for 96 hours, at which time a final neurological examination was performed and the results were recorded. Of the 10 animals treated with PEG-SOD, 2 were completely paralyzed whereas 8 had less (7) or no (1) neurological impairment. Eight of the 10 control animals and 9 of the 10 animals receiving superoxide dismutase were completely paralyzed. None of the control animals or animals receiving superoxide dismutase had a normal neurological examination (p less than or equal to 0.05). Treatment with PEG-SOD before and during occlusion increased the rabbit spinal cord tolerance to a 40-minute ischemic insult. Scavenging free radicals may lessen experimental spinal cord injury.
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PMID:Reducing postischemic paraplegia using conjugated superoxide dismutase. 203 20

MR images of the thoracic spinal cord were made in 24 patients who developed signs and symptoms of spinal cord ischemia or infarction following surgery for a thoracoabdominal aortic aneurysm. Findings consisted primarily of four different patterns of signal abnormalities in the distribution of the anterior spinal artery. These abnormalities were identified as types A-D, depending on the degree of involvement of the gray matter and surrounding white matter. We found good correlation between the distribution of the signal abnormalities in the cord, the severity of the neurologic deficits, and the clinical outcome. MR is the imaging method of choice for diagnosing spinal cord ischemia or infarction. A thorough knowledge of the spinal cord arterial territories is crucial for characterizing ischemic MR signal abnormalities and for differentiating them from other causes of myelopathy.
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PMID:Spinal cord ischemia after resection of thoracoabdominal aortic aneurysms: MR findings in 24 patients. 212 Oct 5

MR images of the thoracic spinal cord were made in 24 patients who developed signs and symptoms of spinal cord ischemia or infarction following surgery for a thoracoabdominal aortic aneurysm. Findings consisted primarily of four different patterns of signal abnormalities in the distribution of the anterior spinal artery. These abnormalities were identified as types A-D, depending on the degree of involvement of the gray matter and surrounding white matter. We found good correlation between the distribution of the signal abnormalities in the cord, the severity of the neurologic deficits, and the clinical outcome. MR is the imaging method of choice for diagnosing spinal cord ischemia or infarction. A thorough knowledge of the spinal cord arterial territories is crucial for characterizing ischemic MR signal abnormalities and for differentiating them from other causes of myelopathy.
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PMID:Spinal cord ischemia after resection of thoracoabdominal aortic aneurysms: MR findings in 24 patients. 212 84

A 67-year-old man underwent graft replacement for the descending thoracic aortic aneurysm with the aid of temporary external bypass. Intraoperative evoked spinal potentials (ESPs) were monitored to detect the spinal cord ischemia. Incomplete paraplegia with sensory dissociation was developed in this patient after surgery, despite well maintained ESPs throughout the aortic cross-clamping. ESPs have been widely used as a mean of detecting early impairment of spinal neural conduction during aortic surgery. However, ESPs are principally mediated through posterior and lateral column pathways and they are not always a reliable monitor to predict paraplegia in aortic surgery.
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PMID:[A case report of descending thoracic aortic aneurysm associated with anterior spinal artery syndrome despite no marked ESP changes]. 221 47

A 63-year-old man of thoracoabdominal aortic aneurysm was transferred to our department. Thoracic and abdominal enhanced CT scan revealed a Crawford's type I A thoracoabdominal aortic aneurysm ruptured into the right extrapleural and retroperitoneal spaces. Without any more additional examination, graft replacement and reconstruction of a lower intercostal artery were performed with an aid of femoro-femoral bypass. Although the postoperative course was complicated by hypertension, hypoventilation and liver dysfunction, the patient recovered from the operation and 10 months later he is leading an almost normal life. Since emergency operation of thoracoabdominal aneurysm is the most courageous challenge because of the difficulties of exposure and visceral organ protection against ischemic, there have been only nine cases with successful surgery in Japan. Now we actively reconstruct lower intercostal and lumbar arteries to prevent spinal cord ischemia without ESCP monitoring in emergency cases.
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PMID:[A case of thoracoabdominal aortic aneurysm ruptured into the right extrapleural cavity]. 225 Apr 43

A 60-year-old man suffered from paraplegia after the operation for thoracic aortic aneurysm and died 10 months after the operation. Detailed examination on the distribution of spinal cord lesions and of the locations of anterior radicular arteries revealed that the spinal cord ischemia occurred at the mid-thoracic segments between T-6 and T-10; the artery of Adamkiewicz entered at T-12; another radicular artery entered at T-4. We concluded that the spinal cord ischemia was caused by the interruption of the radicular artery at T-4 and that the segments nourished by the blood flow of the artery of Adamkiewicz were intact. We suggest that in some patients important radicular arteries other than the artery of Adamkiewicz are essential to preserve blood flow to the upper or middle thoracic spinal segments.
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PMID:[A case report of paraplegia following an operation for thoracic aortic aneurysm--with special reference to pathological findings of the spinal cord]. 234 13

Various blood flow disturbances in intraabdominal digestive organs were studied clinically and experimentally from a viewpoint of vascular surgery. Acute gastric mucosal lesion may occur due to ischemia and reperfusion injury of the gastric mucosa. Bleeding from stomach ulcer may be rarely caused by consumption coagulopathy along with aortic aneurysm. Heparin therapy was successful to interrupt it. Gastrectomy is not indicated for such condition but aneurysm should be repaired. Portal vein reconstruction for the radical resection of hepatic, biliary and pancreatic cancers should be carefully made, because early or late stenosis occurs frequently, and they may connect to early or late morbidities or mortalities. On the other hand, resection and replacement of the suprarenal vena cava invaded by the retroperitoneal malignant tumor may be safely carried out. For the acute mesenteric arterial occlusion, early diagnosis and arterial reconstruction are essential to save catastrophe. Positive Doppler sound on the vasa recta seems to be the most reliable parameter for assessing bowel viability. Approach from the proximal large arteries is recommended for uncontrollable intraperitoneal bleeding.
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PMID:[Blood flow disturbance in digestive organs--a viewpoint of vascular surgery]. 258 8

Four cases of basilar artery occlusion with a follow-up from 7 to 12 years are reported. The first patient, a 60 year old woman, had a proximal occlusion which was revealed by an acute brain stem ischemia. The second case was a 63 year old man with an aortic aneurysm who had a single episode of vertebro-basilar insufficiency. Cerebral angiography demonstrated a lower basilar artery occlusion. The third patient, a 60 year-old woman, had been operated from right carotid artery and left vertebral artery stenosis; 8 years later, without clinical manifestations, a left carotid artery stenosis and an occlusion of the lower part of the basilar artery were discovered. The evolution was eventless after a left carotid endarterectomy. The last case was a 60 year old man who had a lower basilar artery occlusion associated with a left internal carotid occlusion. There was a full recovery after a hemiplegic stroke. From our personal cases and the review of the literature, long term survival after basilar artery occlusion may occur in occlusions restricted to the lower or middle part of the basilar artery and with a good collateral supply from carotid and cerebellar arteries.
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PMID:[Long term survival after basilar artery occlusion. 4 cases]. 259 68


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