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Query: UMLS:C0022116 (ischemia)
 91,303 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Bradycardia was observed during acute cardiac tamponade and severe hemorrhage in pentobarbital-anesthetized morgrel dogs after bilateral cervical vagotomy, sympathectomy and intravenous atropine. An early and a late bradycardia developed during tamponade. A portion of the early bradycardia was produced by a paradoxical increase in vagal efferent nerve activity and a pacemaker shift; however, after vagotomy, sympathectomy and atropine, a significant (p less than 0.02) early and late bradycardia still developed during acute cardiac tamponade and severe hemorrhage. The activation sequence of high and low right atrial electrograms revealed that a pacemaker shift was responsible for the nonvagally mediated bradycardia observed with acute cardiac tamponade and severe hemorrhage. The early and late bradycardias occur with either tamponade or hemorrhage, suggesting that ischemia of the sinoatrial node was the apparent cause of the pacemaker shift and resultant bradycardia.
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PMID:Nonvagally mediated bradycardia during cardiac tamponade or severe hemorrhage. 727 47

Percutaneous cardiopulmonary support (PCPS) was used in 5 patients (4 males and 1 female); 70.2 +/- 10.8 years old) who underwent open heart surgery and failed to wean from the extracorporeal circuit because of profound heart failure unresponsive to maximal doses of catecholamines and intra-aortic balloon pump support. Duration of PCPS was 6975 +/- 5516 min, and the average flow was 1.51 +/- 0.26 l/min/m2. Heparin-coated circuit including the oxygenator was used to minimize the necessary dose of heparin, and activated clotting time (Celite ACT) was maintained between the range of 130 and 200 seconds. Despite this low-dose heparinization, mediastinal hematoma formation and subsequent cardiac tamponade occurred in 4 patients. Weaning from PCPS was successful in 3 patients for whom reexploration to remove hematoma was performed, and 2 of these 3 achieved long-term survival. During the use of PCPS, ipsilateral femoral artery, through which part of the pump flow was actively perfused. Owing to this maneuvering, limb ischemia did not occur in any case. From these findings, we could conclude that reexploration for mediastinal hematoma should be performed in weaning from PCPS for postoperative patients, even when low-dose heparinization was employed, and that active perfusion through the 18g catheter downstream to the ipsilateral lower limb is effective in preventing limb ischemia during relatively long time PCPS.
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PMID:[Relatively long time use of percutaneous cardiopulmonary support after unsuccessful weaning from intra-operative extracorporeal circulation--clinical considerations from an experience of 5 patients]. 759 40

Despite that intravenous thrombolysis can be regarded as the routine treatment of acute myocardial infarction, alternative or additive interventional procedures in some situations may be well indicated. Primary dilatation without preceding thrombolysis, introduced by G. Hartzler, has shown significantly better results in mortality, re-infarction rate, reduction of coronary stenoses, and improvement of ejection fraction compared to thrombolysis in several randomized studies. The procedure, however, is based on expensive logistics and very experienced operators. In patients with evident failure of lysis, large infarctions, depressed left ventricular function, and cardiogenic shock, rescue-PTCA is indicated. If it is performed early this intervention shows good acute and late results. The elective dilatation of residual stenoses after successfull thrombolysis is performed only in selected cases. Its main indication is proven ischemia within the first days and weeks after onset of infarction. Early cardiac surgery is performed in patients with cardiogenic shock, papillary or septum rupture, and with cardiac tamponade. Good results can also be expected in main stem stenoses and severe multivessel diseases. The optimal time of surgery, however, is still controversial. The Task Force of the International Society and Federation of Cardiology (IFSC) and the World Health Organization (WHO) has worked out recommendations for intracoronary maneuvers in various situations of the acute phase of myocardial infarction. With thoughtful consideration of indications these additional procedures in the hands of experienced teams play an important role in the acute treatment of this severe disease.
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PMID:[Intracoronary interventions in the early infarct period]. 786 83

From January 1989 to September 1993, 59 consecutive patients (35 males and 24 females, mean age 59.6 years old) underwent surgical repair of aortic dissection on the cardiovascular surgical unit at Takeda Hospital. The type of aortic dissection were classified according to Stanford University criteria. Twenty-two patients had acute type A (Ac-A), 10 had chronic type A (Ch-A), 4 had acute type B (Ac-B), and 23 had chronic type B (Ch-B) dissection. Seventeen dissections (29%) in the entire group of 59 cases had ruptured (including cardiac tamponade, pleural effusion and hemoptysis etc.). Ischemia of lower extremity occurred in 7 patients and ischemia of visceral organs in 3 patients. Type A dissection were approached via a median sternotomy and cardiopulmonary bypass with systemic hypothermia. Type B dissections were approached through a left postrolateral thoracotomy. Left heart bypass (left atrial-femoral in 8 cases) and partial cardiopulmonary bypass (femoral-femoral in 12 cases) generally were utilized. Resection of intimal tear and replacement of aorta with vascular grafts (including aortic arch in 19 cases) were performed in most patients and primary closure of the intimal tear was performed in 9 cases using GRF. The over-all operative mortality rate was 36% (8/22) for Ac-A, 20% (2/10) for Ch-A, 25% (1/4) for Ac-B, 22% (5/23) for Ch-B. Main causes of operative death was perioperative brain damage. It is necessary to improve the operative mortality for Ac-A dissections (especially in replacement of aortic arch and arch vessels). Further researches are needed regarding optimal methods of the cerebral protection during reconstruction of aortic arch.
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PMID:[Results of surgical treatment of aortic dissections]. 788 69

The interdigestive migrating motor complex (MMC) has been demonstrated to be a reliable indicator of intestinal motility and function. The effects of low perfusion on the MMC have never been studied. Fourteen newborn Yorkshire piglets (5 to 18 days old, weighing 2.9 +/- 0.4 kg) underwent celiotomy under general anesthesia with placement of four jejunal electrodes (50 cm apart) as well as a superior mesenteric artery (SMA) Doppler flow probe and a pericardial catheter. Group 1 (n = 5) had operation alone. Group 2 (n = 9) had nonocclusive mesenteric ischemia induced by reversible cardiac tamponade for 5 hours between postoperative days 6 to 12. All subjects had MMC phase III electrical activity, cycling time, and propagation velocity recorded daily. In group 2 MMCs were recorded prior to and during ischemia, and during reperfusion. Group 2 animals had 75% +/- 4% decrease in SMA flow during the tamponade period. During the ischemic period, the MMC cycling time (CT) increased from 67 +/- 10 (mean +/- SEM) to 98 +/- 12 minutes (P < .05) and MMC propagation velocity (PV) decreased to 4.2 +/- 2.2 from a baseline value of 10.5 +/- 1.5 cm/min (P < .05). During reperfusion CT and PV values were not significantly different from baseline. The validity of this model is confirmed by the comparable baseline recordings in groups 1 and 2, and by the return of MMC to baseline values within 4 to 7 hours of reperfusion, as seen in group 2.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:The effects of ischemia and reperfusion on intestinal motility. 846 47

The dissection is termed Type A according to the Stanford classification, if the ascending aorta is involved. It is termed type B, if the ascending aorta is not involved. Most patients with Type A aortic dissection die from intrapericardial rupture with cardiac tamponade, free pleural rupture, massive aortic regurgitation, or coronary or cerebral malperfusion (ischemic heart disease or stroke). Most patients with Type B dissection die from free pleural rupture or renal or visceral vascular complications. The resultant compromise of various aortic branches (inomunate, carotid, subclavian, spinal, renal, superior mesentric, or iliac arteries) results in a wide variety of symptoms and signs (shock, dyspnea, stroke, paraplegia, anuria, abdominal pain or extremity ischemia).
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PMID:[Pathophysiology and complications of aortic dissection]. 896 89

Adequate prehospital care of the severely traumatised patient is important to prevent or attenuate early as well as late life threatening complications, such as tissue hypoxia, ischemia/reperfusion injury and finally multiple organ failure. A mismatch of oxygen supply and oxygen demand is a hallmark in the pathophysiology of multiple trauma. Oxygen supply may be diminished by the following factors: shock-related decrease of cardiac output, anemia and hypoxia. On the other hand, oxygen demand may be increased by pain, panic, and agitation. Hence, it is a central point in prehospital care to reduce this supply-demand imbalance by identification and prompt reversal of the underlying causes. Most often, shock is caused by hypovolaemia and tissue injury ("traumatic-hemorrhagic shock"). However, shock may also be a result of central nervous system injury (neurogenic shock as a special form of distributive shock) or circulatory obstruction, e.g tension pneumothorax or cardiac tamponade (obstructive shock). Volume resuscitation by means of crystalloid or colloid solutions is an essential part in the therapy of the traumatic-haemorrhagic shock. In addition, catecholamines may be necessary in order to achieve an adequate arterial pressure. However, if bleeding cannot be controlled in the prehospital setting, only moderate volume support and permissive hypotension as well as rapid transportation into the next hospital may be preferable. This may be the case in penetrating thoracic or abdominal injuries as well as in traumatic amputations of the proximal limb. On the contrary, in patients with severe head injury, hypotension must be avoided by all means. Obstructive shock has to be treated urgently by insertion of a chest drain or drainage of the pericardium, respectively. Under all circumstances, it is an essential part of prehospital therapy to provide sufficient analgesia as soon as possible. Prehospital anesthesia, combined with artificial ventilation may be necessary for optimal patient management. Furthermore, ventilatory support is indicated when respiratory failure, loss of consciousness, or severe shock are present. Additional oxygen should be given whenever possible, even in the absence of an overt hypoxic state. Important additional measures are cervical spine immobilisation and reposition as well as splinting of long bone fractures or luxations, in order to avoid secondary injury of the spinal cord or ongoing tissue and vascular damage.
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PMID:[Emergency management of polytrauma patients]. 902 49

Pericardial cysts are usually detected by chance are are clinically silent in most cases. Nevertheless, symptoms and serious complications may occur. We describe a case of pericardial cyst diagnosed in an 8-year-old boy who was admitted with chest pain. Echocardiography revealed a mild to moderate pericardial effusion and a 7.5 x 5.5 cm intrapericardial echo-free lesion consistent with a pericardial cyst. Surgery was carried out 3 days afterward because of the patient's worsening condition, the progressive increase of pericardial effusion, and the onset of initial signs of cardiac tamponade. The cyst showed a long and easily movable vascular pedicle and inflammatory areas involving the pericardial surface. Like the pericardial effusion, the contents of the mass appeared as serosanguineous fluid on aspiration. Histologic examination confirmed the diagnosis of pericardial cyst and showed findings according to ischemia-related lesions of the cyst. The coexistence of pericardial cyst and cardiac tamponade is very unusual. The atypical anatomy and clinical course suggest a distinct and so far undescribed pathogenetic mechanism for this association: the torsion of a vascular pedicle and the subsequent development of ischemia-related lesions of the cyst.
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PMID:Complicated pericardial cyst: atypical anatomy and clinical course. 982 5

The importance of temperature in the development of necrosis after myocardial ischemia in the beating heart is becoming apparent. Recent studies have shown that the proportion of the ischemic risk zone that becomes necrotic is directly correlated with temperature. This fact suggests the potential therapeutic benefits of reducing myocardial temperature after coronary artery occlusion. We have shown in a number of experimental protocols in the rabbit model of myocardial infarction that topical regional hypothermia reduces infarct size even when instituted after coronary artery occlusion. The reduction in myocardial temperature required to obtain this benefit is modest ( 30 degrees C to 34 degrees C). Topical regional hypothermia allows targeted cooling of a zone of the heart. Myocardial cooling can also be achieved by perfusing the pericardial sac with a chilled fluid by using a closed-circuit catheter system that does not cause cardiac tamponade. This technique also protects myocardium during ischemia. Myocardial hypothermia might be a useful technique to limit ischemic damage during infarction or as adjunctive therapy during minimally invasive cardiac surgery.
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PMID:Myocardial hypothermia: a potential therapeutic technique for acute regional myocardial ischemia. 1021 May 4

Coronary perforation or rupture is an infrequent complication of angioplasty which may have a poor prognosis and influence patient survival. Cardiac tamponade or the presence of ischemia leading to acute myocardial infarction may require emergency cardiac surgery. Surgical treatment of perforation or rupture of the coronary arteries is based on prolonged inflation with angioplasty balloons or autoperfusion. There are few studies on the placement of covered stents to seal the perforation. We present the case of a patient who presented saphenous vein graft rupture following high pressure stent implantation requiring percutaneous placement of a covered stent.
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PMID:[Repair of saphenous vein perforation with covered stent during angioplastic]. 1114 64


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