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

In 26 patients with carcinoma of the esophagus or gastroesophageal junction, intestinal interposition was performed in post-resection reconstruction, using left colon in 21 cases, right colon in one and a long jejunal segment in four cases. The tumor involved the gastric cardia in 16 patients with colonic interposition and five underwent palliative resection. Infectious pulmonary and abdominal complications were common. Three patients required reoperation, for empyema, ischemic colonic segment and subphrenic abscess, respectively. Ischemia of the interposed segment occurred in two patients, necessitating removal of the segment in one. There was no anastomotic dehiscence and no tumor in the margins of the resected tissue. The 30-day postoperative mortality was 1/22 and the mean postoperative hospital stay 24 days, with 11 patients discharged directly to their homes. The functional results 6 months postoperatively were favorable in most survivors, and only three complained of dysphagia.
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PMID:Colonic interposition for reconstruction after resection of cancer in the esophagus and gastroesophageal junction. 167 28

This elderly male with a long history of alcohol abuse presented with an acute pleural trauma and hemopneumothorax, which may have served as the precipitating medical illness for cecal volvulus. He subsequently developed bacterial peritonitis as a complication of his bowel obstruction. It is probable that his pleural cavity was seeded hematogenously via a bacteremia from his peritonitis, thus accounting for the empyema with species typical of bowel flora. Cecal bascule is a type of cecal volvulus that causes intestinal obstruction. Diagnosis is difficult, but a delay in recognition may result in intestinal ischemia, perforation, sepsis, and even death. Cecal ischemia or gangrene cannot always be determined based on physical examination or laboratory findings. Plain films of the abdomen may be helpful, and barium enema has been advocated by some authors. However, laparotomy is often necessary for definitive diagnosis and therapy. While cecal volvulus has not been reported to occur frequently in the elderly, the relatively common occurrence of anatomic predisposition in addition to the widespread use of respirators and the increasing age and number of medical illnesses of our population make it possible that cecal volvulus will be seen with increasing frequency in the future.
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PMID:Cecal bascule: an overlooked diagnosis in the elderly. 172 51

The article discusses the results of treatment of acute ischemia of the pleura in 60 children with the use of intracavitary laser therapy. The empyema cavity was irradiated through a quartz flexible monocrystal light guide. The authors studied the effect of helium-neon laser beam on the empyema microflora, the condition of immunity, and the specific features of the clinical course of acute empyema of the pleura. Treatment by helium-neon laser radiation promotes rapid closure of bronchopleural fistulas, reduces the period of treatment, causes an immunocorrection effect, and does not exert a bactericidal effect on the flora.
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PMID:[Helium-neon laser irradiation in combined treatment of children with suppurative diseases of the lungs and pleura]. 205 2

Bacterial hepatic abscesses are a rare but serious disease. They develop either secondary to injuries or ischemia of the liver, infections in the drainage area of the portal vein, systemic sepsis or biliary infections. An abscess secondary to injuries or ischemia of the liver or infections in the drainage area of the portal vein, is usually caused by a mixed flora consisting of gramnegative aerobes and anaerobic bacteria. Hepatic abscesses secondary to systemic sepsis contain Staphylococci or Streptococci, while in abscesses on the basis of biliary infections gramnegative organisms are found. Clinically, one can find signs of systemic sepsis, pain in the right upper quadrant and a tender enlarged liver. Jaundice is absent unless a biliary obstruction is present simultaneously. The diagnosis is confirmed by ultrasonography or computerized tomography. An uncertain diagnosis can be confirmed by aspiration under ultrasonographic or computertomographic guidance. The therapy consists of administration of antibiotics and surgical or percutaneous drainage. Surgical drainage via laparotomy is always mandatory if one suspects a primary infectious focus within the abdomen. The mortality of multiple liver abscesses is 20 per cent, that of single abscesses 10 per cent. Amebic abscesses have been observed in nonendemic regions sporadically after travel or spontaneously. Clinical and radiological manifestations are the same as for bacterial abscesses. They are differentiated from bacterial abscesses by positive serology for amebiasis or aspiration which yields the typical anchovy paste. Most important complications are hepato-bronchial fistulae, empyema and amebic pericarditis. The therapy consists of a nitroimidazole and a luminal amebicide. Except for diagnostic reasons aspiration is only indicated for large abscesses of the left lobe of the liver. Mortality of an uncomplicated amebic liver abscess should be under one per cent.
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PMID:[Pathology, diagnosis and therapy of liver abscess]. 330 50

The author reports the case of a patient presenting with a recurrent right hydrocele after tapping, associated with an infectious syndrome resulting in a swollen and painful right compartment of the scrotum, which failed to respond to antibiotic treatment. A right scrotal incision revealed a vaginal empyema and a swollen and enflamed testicle and epididymis. After a right ochiectomy, an anatomopathological examination showed a severe ischemia of the testicle and epididymis associated with arteriosclerotic stenosis of the testicular artery.
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PMID:[Spontaneous orchi-epididymitis due to necrosis of ischemic vascular origin]. 652 90

Empyema after pneumonectomy is often associated with a bronchopleural fistula (BDF) and has a significant mortality. Management options include systemic antibiotics and observation, adequate pleural drainage, appropriate parenteral antibiotics, removal of necrotic tissue, and obliteration of residual pleural space. We prefer to treat the empyema with the procedure originally described by Clagett and Geraci in 1963. They demonstrated that postpneumonectomy empyema could be successfully treated by open pleural drainage, frequent wet-to-dry dressing changes, and when the thorax was clean, secondary chest wall closure with obliteration of the pleural cavity with an antibiotic solution. Failure was most often caused by a persistent or recurrent fistula. Because of this, when a BPF is present, the original Clagett technique was modified to include transposition of a well-vascularized muscle to cover the stump at the time of open drainage to prevent further ischemia and necrosis. Our preference is intrathoracic transposition of extrathoracic skeletal muscle. The goals of therapy for postpneumonectomy empyema remain a healthy patient with a a healed chest wall and no evidence of drainage or infection. Excellent results can be obtained in more than 80% of patients by using the Clagett procedure and intrathoracic muscle transposition when a BPF is present.
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PMID:Management of postpneumonectomy empyema and bronchopleural fistula. 1130 20

Complications after esophagectomy related to ischemia of the graft are dreaded. Prompt assessment of the situation is essential. The series presented describes our experience regarding the evaluation of gastric tube complications. A score is presented classifying flexible endoscopy and CT-scan findings. A retrospective analysis from the charts of 47 consecutive patients who underwent esophagectomy for cancer was conducted. Patients who underwent upper endoscopy during admittance were entered in this study. Findings on flexible endoscopy and CT scan were systematic scored. According to the findings, different attitudes were taken. Between January 2006 and December 2007, 47 patients underwent esophagectomy for cancer. Eleven (23%) out of 47 patients were suspected to have complications related to the viability of the anastomosis. Median period to deterioration was 5 days. In 3 (27%) patients, stent placement was the only intervention necessary. In 2 (18%) patients, stent placement was combined with drainage of abscesses in the upper mediastinum. Five (46%) patients required a new right thoracotomy, with drainage of mediastinal abscesses and empyema. In 2 patients a limited resection and a new cervical anastomosis with a stent was created. Mean intensive care admission and hospital admittance was 30.2 days and 67.9 days, respectively. Two patients (18%) died during hospital admittance. All cervical anastomosis required postoperative dilatation. No complications related to the use of flexible endoscopy were seen. An aggressive policy is adopted in patients deteriorating following esophagectomy. CT-scanning of the thorax and a flexible endoscopy of the gastric conduit should always be performed. Direct therapy should be adopted without delay.
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PMID:Systematic approach of postoperative gastric conduit complications after esophageal resection. 1939 47

Imaging plays an essential role in the evaluation of patients after cranial surgery. It is important to be familiar with the normal anatomy of the cranium; the indications for different surgical techniques such as burr holes, craniotomy, craniectomy, and cranioplasty; their normal postoperative appearances; and complications such as tension pneumocephalus, infection, abscess, empyema, hemorrhage, hematoma, herniation, hygroma, and trephine syndrome. Postoperative infection and hemorrhage are common to all neurosurgical procedures, where-as other complications are peculiar to certain procedures (eg, drill "plunging" during burr hole creation and sinking skin flap after craniec-tomy). Recognizing life-threatening complications such as tension pneumocephalus and paradoxical herniation, which require urgent intervention, is important for a better clinical outcome. Computed tomography is fast, cost effective, and easily accessible for first-line imaging. Magnetic resonance imaging has higher sensitivity for detecting postoperative infection and ischemia, but diffusion-weighted imaging may be less reliable for detecting postoperative infections.
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PMID:Imaging of the post-operative cranium. 2022 29

We present a rare case of subdural empyema with cerebral arteritis and brain ischemia in the middle cerebral artery distribution secondary to odontogenic maxillary sinusitis. A 32-year-old man was admitted to our hospital because of high fever and generalized convulsions. Computed tomography(CT)and magnetic resonance imaging(MRI)showed subdural empyema at the left convexity, with a small amount of air. An interruption of the right maxillary sinus floor corresponding to the alveolar process was evident on coronal CT. He was diagnosed as having subdural empyema caused by odontogenic maxillary sinusitis. MR angiography showed stenosis of the left middle cerebral artery(MCA). Despite antibiotic administration, he became drowsy and developed aphasia with right hemiparesis. Repeat MRI showed enlargement of the encapsulated subdural empyema with increased midline shift to the right. We performed prompt surgical evacuation with craniotomy, endoscopic drainage of the sinusitis, and tooth extraction. A hyperintense lesion was observed on subsequent diffusion-weighted imaging in the left MCA distribution. After repeat drainage of the re-enlarged subdural empyema, he was discharged without apparent neurological deficits. This case indicates that subdural empyema from odontogenic sinusitis requires a suitable imaging study of the brain, head, and neck region, and a multidisciplinary approach involving a neurosurgeon, otolaryngologist, and oral surgeon. Prompt initiation of appropriate antibiotic therapy with surgical intervention is recommended for treatment of subdural empyema from odontogenic sinusitis.
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PMID:[A Case of Subdural Empyema with Cerebral Arteritis and Brain Ischemia in the Middle Cerebral Artery Distribution, Secondary to Odontogenic Maxillary Sinusitis]. 3081 77