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

Some patients with chronic arterial obstruction of the limbs may still suffer the consequences of advanced tissue ischemia, including ulceration and rest pain, and face threatened limb loss in spite of available surgical, pharmacologic, and other treatments. Additional therapeutic modalities were thus sought to accomplish limb salvage. A literature review indicated that most reports on R-wave-triggered circumferential limb compression (cardiosynchronous limb compression [CSC]) demonstrate its ability to augment limb arterial blood flow and improve ischemic limbs. To determine the device's efficacy and safety, and possibly confirm earlier positive reports, a systematic study was undertaken, using older, as well as newer, more electronically reliable CSC devices. The present study was designed to determine the following: 1. objectively, by noninvasive vascular tests, changes in limb blood flow, if any, by CSC; 2. clinical effects of CSC, if any, on the ischemic limb; 3. duration of CSC-induced limb improvements, if any; 4. side effects or safety of CSC. The study demonstrated that CSC treatments: 1. caused increased limb blood flow as determined by increased ankle/arm indices and hallux photoplethysmograph waveform amplitudes during treatments; 2. led, in most cases, to improvement in or resolution of the presenting ischemic problem (eg, ulcer, cellulitis, rest pain); 3. induced limb improvements that persist for up to seven years 4. caused no adverse side effects.
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PMID:Cardiosynchronous limb compression: effects on noninvasive vascular tests and clinical course of the ischemic limb. 159 39

The barium enema is a safe and accurate diagnostic study of the colon but, in rare cases, complications may result. Many of these can be prevented by proper equipment and careful attention to technique. When a complication does occur, prompt recognition and management is vital in decreasing morbidity and mortality. Perforation of the bowel is the most frequent serious complication, occurring in approximately 0.02% to 0.04% of patients. Rarely the colon may burst due to excessive transmural pressure alone. However, a colon weakened by iatrogenic trauma or disease is more likely to perforate during an enema than is a normal healthy bowel. Injury to the rectal mucosa or anal canal due to the enema tip or retention balloon is probably the most common traumatic cause of barium enema perforation. Inflation of a retention balloon within a stricture, neoplasm, inflamed rectum, or colostomy stoma is particularly hazardous. Recent deep biopsy or polypectomy with electrocautery makes the bowel more vulnerable to rupture. The tensile strength of the bowel wall is impaired in elderly patients, patients receiving long-term steroid therapy, and in disease states including neoplasm, diverticulitis, inflammatory bowel disease, and ischemia. Intraperitoneal perforation leads to a severe, acute peritonitis with intravascular volume depletion. The ensuing shock may be rapidly fatal. Prompt fluid replacement and laparotomy are essential. If the patient survives the initial shock and sepsis, later complications caused by dense intraperitoneal adhesions may develop. Extraperitoneal perforation is usually less catastrophic but may result in pain, sepsis, cellulitis, abscess, rectal stricture, or fistula. Intramural extravasation often forms a persistent submucosal barium granuloma which may ulcerate or be mistaken for a neoplasm. The most dramatic complication of barium enema is venous intravasation of barium. Fortunately, this is quite rare as it may be immediately lethal. Most cases have been attributed to trauma from the enema tip or retention balloon, mucosal inflammation, or misplacement of the tip in the vagina. Bacteremia has been found in as many as 23% of patients following barium enema and, in rare cases, may cause symptomatic septicemia. Other less common complications include barium impaction, water intoxication, allergic reactions, and cardiac arrhythmias. Preparatory laxatives and cleansing enemas have been implicated in some instances of dehydration, rectal trauma, water intoxication, and perforation. Careful review of the indications for examination, previous radiographs, and clinical history will identify many of the patients at greater risk for complications so that appropriate precautions may be observed.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Recognition and prevention of barium enema complications. 188 35

Early detection of an inflammatory process involving bone and joints is very important in children with extremity pain. We reviewed the efficacy and pitfalls of three-phase bone scans in 100 consecutive children with acute extremity pain. Sixty-one of the subjects showed abnormalities on bone scans. The sensitivity and specificity of three-phase bone scans for acute osteomyelitis were 84% and 97%, respectively. Sensitivity and specificity for both acute septic joint and cellulitis were 93% and 100%, respectively. Pitfalls in interpretation of three-phase bone scans include simulation of infection by fracture and obscuration of osteomyelitis by septic arthritis, prior antibiotic treatment, and the occasional "cold" defect due to ischemia.
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PMID:Scintigraphic evaluation of extremity pain in children: its efficacy and pitfalls. 387 40

Altogether 26 cases of anaerobic infection (AI) of various etiology were analysed. Local tissue ischemia and operations on gastrointestinal organs in patients with secondary immunodeficit conditions are the factors facilitating the development of AI. The distinction is made between clostridial AI with a rapidly progressing gaseous gangrene and the non-clostridial AI with a slower course of a serous-purulent phlegmoma. Anaerobic myositis is observed in all forms of AI. Depending on the localisation of AI, anaerobic cellulitis and fasciitis are mentioned which occur mainly in non-clostridial AI. The treatment of AI and the mechanisms of death are discussed.
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PMID:[Comparative clinico-morphological characteristics of peace-time anaerobic infections]. 632 25

The normal bacterial flora of the skin represents an important host defense mechanism against invasion by potentially pathogenic organisms. This flora is primarily composed of aerobic diphtheroids (Corynebacterium species), anaerobic diphtheroids (Propriono-bacterium acnes), and coagulase-negative staphylococci. Gram-negative bacilli may be present in limited numbers in intertriginous areas. Localized cutaneous infections occur in ostensibly normal hosts, often after trivial trauma, examples being streptococcal or staphylococcal impetigo, staphylococcal furunculosis, or more unusual infections due to agents such as Mycobacterium marinum. When the skin is injured more extensively by trauma, burns, ischemia with ulceration, or iatrogenic manipulations, or when host immunologic defenses are suppressed, more severe infections are likely to supervene, and the threat of systemic dissemination of infecting microorganisms increases. Cutaneous infection in immunosuppressed hosts may involve the same pyogenic bacteria that affect normal subjects or it may involve a variety of opportunistic invaders, including herpes viruses, gram-negative bacilli, mycobacteria, and deep or superficial mycoses. The skin may also be affected by infections whose primary site lies elsewhere in the body. Cutaneous manifestations may be secondary to hematogenous seeding of the causative agent or to the effects of toxins or immune complexes. Certain microbial agents may initiate a wide variety of cutaneous lesions, depending on route of infection and the status of the host. Thus, cutaneous lesions attributable to Pseudomonas aeruginosa range from "green nail syndrome" and self-limited folliculitis to ecthyma gangrenosum. Similarly, group A streptococci may produce pyoderma, cellulitis, lymphangitis, erysipelas, or scarlet fever. We recently described a syndrome of recurrent cellulitis in the saphenous vein donor extremities of patients who have undergone coronary artery bypass grafts. Most patients have associated tinea pedis. The pathophysiologic aspects of this syndrome are probably multifactorial, involving compromise of lymphatic or venous drainage, bacterial infection, elaboration of bacterial toxins, and hypersensitivity to bacterial or fungal products, or both. Coagulase-negative staphylococci are exhibiting a more prominent pathogenic potential than heretofore. When they infect immunosuppressed hosts or patients with indwelling intravascular catheters or cardiac prostheses, coagulase-negative staphylococci may cause life-threatening disease.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Cutaneous infections: microbiologic and epidemiologic considerations. 637 67

Fifty patients were treated for 52 mycotic aneurysms secondary to intravenous drug abuse. An initial misdiagnosis of cellulitis or abscess in 17% of the patients was corrected after arteriography or bleeding following operative drainage. There was no ischemia following ligation and excision of aneurysms of the radial, brachial, external iliac, deep femoral, and superficial femoral arteries. Excision of the common femoral artery in four patients and femoral bifurcation in 25 led to marked morbidity in 28 patients without simultaneous revascularization. Ischemia occurred in 53% of these patients; it was mild in 21% with claudication only. Severe, limb-threatening ischemia occurred in 32% and led to amputation in 21%. Six patients underwent artificial bypass, including one for absent back-bleeding at the time of ligation, four for immediate severe ischemia, and one for late ischemia. Two infected grafts were removed; another became thrombotic. Cultures were positive for 73% of aneurysms and blood of 46% of the patients.
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PMID:Mycotic aneurysm. New concepts in therapy. 668 76

Porcine necrotic ear syndrome is a disease of swine characterized by large erosive lesions at the margin of the pinna(e). The gross and microscopic characteristics of the lesions were studied in 38 pigs selected from eight affected swine herds. The progression of the lesions was examined in a herd of 174 weaned pigs in a total confinement nursery. The lesions began as a superficial vesicular dermatitis associated with superficial auricular trauma and progressed to become exudative and encrusted. Localized lesions slowly healed or sporadically progressed to deep necrotic ulcers. The early lesions resembled the epidermal changes produced by Staphylococcus hyicus. Deep ulceration and necrosis was attributed to the invasion of streptococci into the dermis resulting in cellulitis, vasculitis, thrombosis, ischemia, and necrosis.
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PMID:Lesions of porcine necrotic ear syndrome. 673 Jan 99

We report three cases of streptococci cellulitis of the hand. The characteristic clinical presentation suggested streptococcus infection; locoregional edema, rash, echymosis, phlyctena and signs of finger ischemia. Operative findings also suggested streptococcus infection: swelling of brownish subcutaneous tissue and local thrombus formation. There was no true pus formation. Streptococcus was identified in all 3 cases. Emergency surgical treatment is needed. The portal is opened, followed by extensive fasciotomy and debridement of all necrosed tissue. Partial suture is indicated. Antibiotics can be used as an adjunct but are not sufficient alone.
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PMID:[Streptococcus cellulitis. Apropos of 3 clinical cases]. 897 45

The relative value of and selective indications for specific applications of noninvasive testing and imaging in hemodialysis access patients are reviewed. Preoperatively, clinical arterial assessment, including an Allen's test, should be done routinely. This should be augmented by interrogating the ulnar and radial arteries with a Doppler probe, using collateral compression testing, in complex cases, particularly in patients with a history of previous failed fistulas or radial artery cannulations for blood pressure or blood gas monitoring. Vein mapping, using a duplex scan, is valuable in any patient in whom the superficial veins are not easily visible and distend nicely with tourniquet application. Patients who have previously had chronic cannulation of the subclavian or jugular veins, for hemodialysis or other reasons, should have proximal venous outflow obstruction ruled out by a duplex study. Postoperatively, baseline and serial noninvasive monitoring of the arteriovenous fistula (AVF) or shunt cannot be justified as a routine, but study is indicated if a thrill over the venous outflow cannot be detected postoperatively, veins do not become progressively distended after creation of a fistula, or good flows cannot be achieved during hemodialysis. However, in current practice, a dysfunctional, failing, or failed fistula or shunt is usually identified by the observations of the dialysis technician, and the patient is directly referred to the angiography suite, not the vascular diagnostic laboratory. The true identity and extent of such local complications as hematoma, seroma, abscess, cellulitis with phlegmon, or pseudoaneurysm may be difficult to define without the help of ultrasound imaging, which also can direct diagnostic aspiration. Finally, noninvasive testing, consisting of monitoring digital pressures and plethysmography, and their response to compression of the fistula, its venous outflow, the feeding artery proximally and distally, and the companion artery, is a key initial step in evaluating patients with disabling hand symptoms, distinguishing distal steal from focal ischemia, or, by elimination, pointing to venous congestion or secondary carpal tunnel syndrome.
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PMID:The value of noninvasive testing before and after hemodialysis access in the prevention and management of complications. 930 32

The objective of this study was to examine and characterize limb-threatening lower extremity wound or soft tissue complications after coronary artery bypass (CABG) and determine risk factors for their cause. While minor wound problems of the leg after CABG are not uncommon, serious limb-threatening complications, though less frequent, do occur and are often de-emphasized in the surgical literature. A review of 1090 consecutive CABG procedures performed from January 1, 1995 through December 31, 1995 was instituted, which screened for limb-threatening lower extremity wound or soft tissue complications defined as wounds that: required additional surgery for treatment; prolonged the length of stay; or which required lengthy home health nursing for treatment. Minor lymph leaks, leg swelling, infections or wound problems treated as an outpatient were excluded. Of 1090 patients, 54 (5.0%) experienced a limb-threatening lower extremity complication. Complications were categorized as vein harvest incision non-healing (n = 36, 66.7%), decubitus ulceration (n = 11, 20.4%), forefoot ischemia/embolization (n = 10, 18.5%), groin hematoma/abscess (n = 6, 11.1%), severe cellulitis (n = 3, 5.6%), or a combination (n = 12, 22.2%). Statistically significant risk factors by univariate and bivariate analysis for a complication included older age (68 years vs 62 years, p = 0.007), female sex (57% vs 28%, p < 0.001), diabetes (57% vs 33%, p = 0.005) and longer pump time (129 min vs 114 min, p = 0.009). These complications necessitated five major lower extremity amputations and nine revascularization procedures. Chronic lower extremity ischemia from peripheral vascular disease (PVD) was a major contributing factor for the development of wounds in at least 23 (42.6%) of these patients, though suspected in only 10 (43.5%) preoperatively. A non-healing vein harvest incision below the knee of a patient retrospectively found to have inadequate distal circulation for healing occurred in 17 (31.5%) of the total 54 cases. It was concluded that non-healing vein incisions, decubitus ulcers and forefoot ischemic lesions frequently occurring in older diabetic females with undetected pre-existing PVD, comprise the majority of limb-threatening leg complications after CABG. Nearly one-third of the complications may have been avoided had the vein harvest incision not been made at the ankle of a patient with unappreciated PVD.
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PMID:An analysis of limb-threatening lower extremity wound complications after 1090 consecutive coronary artery bypass procedures. 1040 54


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