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

Laser Doppler flowmetry was used for intraoperative assessment of intestinal blood flow in five patients with small-bowel ischemia. In two patients with mechanically caused ischemia, bowel resection could be limited or avoided after flowmeter recordings. In two patients with mesenteric vascular occlusion, the flowmeter recording confirmed the macroscopic impression of irreversible gangrene. In a third subject with mesenteric vascular occlusion the extent of severe ischemia was clinically underestimated compared with the results obtained with the laser Doppler flowmeter. We conclude that, with further experience and development, laser Doppler flowmetry has great potential as a useful method for objective intraoperative assessment of blood flow in patients with small-bowel ischemia of various origins.
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PMID:Assessment of small-bowel ischemia by laser Doppler flowmetry. Some case reports. 294 61

In a chronic dog model, colocolostomies with intact blood supplies were constructed with the circular stapler. By means of "tight" stapling, an ischemic suture line was induced (suture line blood flow reduced to less than 10% of baseline mucosal blood flow). Under these conditions, only one of 20 anastomoses resulted in stenosis at 1 month. Correctly stapled colocolostomies were then performed in bowels rendered ischemic by removal of all mesenteric arcades for 4 to 6 cm. Mucosal blood flow in such ischemic bowels was reduced to 30% and 16% of control, respectively, and suture line blood flow was as low as that of the tightly stapled anastomoses. Significant stenosis (more than 68% reduction of the lumen) was observed in the group with 6 cm of mesenteric clearance. In no dogs did peritonitis or colonic gangrene develop. Gross and histologic revascularization was evident when dogs were killed at 6 weeks. These findings suggest that it is ischemia of the bowel, rather than ischemia at the suture line itself, that leads to anastomotic stricture. In view of the known susceptibility of the human intestine to ischemia, the model may have overstated the degree of ischemia necessary to produce strictures in clinical practice. Since the induced acute ischemia did not persist in the chronic state, we conclude that it is the adequacy of collateral development that determines the outcome in this model.
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PMID:The role of tissue ischemia in the pathogenesis of anastomotic stricture. 318 97

Phlegmasia cerulea dolens (PCD) is a rare venous disorder that continues to be a major therapeutic challenge. We reviewed 16 cases of PCD treated during the past 15 years; 11 of the patients were male, and the average age of all the patients was 59 years. Malignant disease was the most common underlying condition (seven patients). Venous gangrene (VG) was present in seven extremities. Three treatment methods were used alone or in combination--intravenous heparin, venous thrombectomy, and thrombolytic therapy. Heparin was used initially in 13 patients; it yielded a successful result in seven (53%) patients, none of whom had VG. Venous thrombectomy was done in six patients; in three it was the primary procedure, in two it followed failure of heparin, and in one it followed failure of both heparin and thrombolytic therapy. Venous thrombectomy was successful in three (50%) patients, one of whom had early VG. Thrombolytic therapy was used on one occasion in conjunction with both heparin and venous thrombectomy, without benefit. Five patients died, all with VG, three after heparin only, one after heparin and venous thrombectomy, and one after all three treatment methods. Review of the 38 cases reported in the recent literature shows comparable results. These data suggest that nongangrenous forms of PCD respond well to systemic anticoagulation. Combination therapy using venous thrombectomy and heparin is indicated for severe ischemia, early VG, or failure of PCD to improve after six to 12 hours of heparin therapy. Phlegmasia cerulea dolens with VG is the lethal form of the entity and responds poorly to established therapy. Future therapeutic trials need to consider aggressive use of thrombolysis with or without thrombectomy.
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PMID:Phlegmasia cerulea dolens: therapeutic considerations. 327 26

Venous thrombosis in an extremity, when extensive, can cause reversible tissue ischemia or frank gangrene even without arterial or capillary occlusion. Patients gradually or abruptly develop severe pain, extensive edema, and cyanosis of the extremity, nearly always in the legs. Gangrene can occur unless the venous obstruction is relieved. Such ischemic venous thrombosis can complicate surgery, trauma, childbirth, or prolonged immobility, but malignant neoplasms, either obvious or occult, are a major predisposing factor. The optimal therapy is anticoagulation and thrombectomy. Patients with venous gangrene may require amputation if extensive, deep-tissue destruction occurs. The mortality rate for ischemic venous thrombosis is about 40%, the cause of death usually being the underlying disease or pulmonary emboli.
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PMID:Ischemic forms of acute venous thrombosis. 330 May 67

Peripheral arterial obstructive disease with symptoms of ischemia in the limbs is a common cause of disability, morbidity, and even mortality in the elderly. The most important cause is atherosclerosis, which is ultimately a systemic problem, but the cardinal symptom in the limbs is intermittent claudication. Unfortunately, the elderly patient often displays severe ischemia with pain at rest, and ulceration or gangrene of the extremity, even where there was a paucity of prior claudication, perhaps due to associated illness which reduces mobility. The essential aspects of clinical diagnosis and assessment of severity of ischemia involve relatively simple bedside techniques, and noninvasive laboratory methodology is mainly of value in selection of patients for angiography and potential revascularization. While conventional therapy involves bypass surgery, an expanding array of drugs and the advent of interventional angiographic measures including angioplasty offer alternatives which were not available even a few years ago.
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PMID:Peripheral vascular disease: medical evaluation and treatment. 331 89

A prospective study was performed between May 1982 and March 1987 to assess the value of intraoperative prereconstruction angiography (IPA) in limb salvage. Eligibility was limited to patients with rest pain, ischemic ulcers, or gangrene limited to the toes: only candidates for infrapopliteal bypass were included. Seventy-eight such patients were examined with preoperative angiography. Delayed films, selective catheterization, reactive hyperemia, or vasodilators were used routinely. In only 11 of 78 patients (14%) was the runoff adequately visualized, demonstrating the tibial vessels and the pedal arch. The remaining 67 patients (86%) (with nonreconstructable disease by currently accepted outflow criteria) had surgical exposure of a tibial or pedal artery for IPA. In 56 of these patients (84%) good runoff was demonstrated and bypass was performed. The reconstruction rate was 86% (67 of 78 patients), significantly higher than the 33% rate reported by others. The operative mortality rate was 2.8% (2 of 78 patients). We concluded that in severe ischemia preoperative angiography is often inadequate in demonstrating runoff, even with adjunctive measures to dilate the outflow vessels. IPA through the tibial and pedal vessels eliminates all of the proximal vascular resistance, thereby providing a "completion angiogram" before reconstruction. This in turn extends reconstructability to many patients who would otherwise undergo primary amputation.
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PMID:Extended reconstruction rate for limb salvage with intraoperative prereconstruction angiography. 272 72

The authors analysed 267 consecutive primary aortofemoral grafts to identify the reasons for reoperation within the first 2 years postoperatively. Forty-one (8%) of the 521 limbs required a second operation. Precursors to reoperation were: occlusion of a superficial femoral artery (12%), gangrene (27%) and severe acute ischemia (35%). The rationale for reoperation was classified as technical 11, questionable selection (candidates for percutaneous transluminal angioplasty or inappropriate operation) 9, disease progress 11, residual symptoms 9, contralateral symptoms 1. The commonest technical problem was blind endarterectomy which preceded seven reoperations, five for thrombosis of the graft or a superficial femoral artery which was patent initially. Although 218 limbs had an occluded or severely stenosed superficial femoral artery, only 26 (12%) required reoperation within the first 2 years. The authors believe that the incidence of reoperation after aortofemoral bypass can be reduced by identifying the limbs at risk, by appropriate selection for percutaneous transluminal angioplasty, avoiding blind outflow endarterectomy and considering concomitant femoropopliteal bypass when gangrene is present.
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PMID:Reoperation within 2 years of aortofemoral bypass. 339 Jul 68

Necrotizing dermatitis in patients being treated with cancer chemotherapeutic agents can be of several types. Microbial causes can include a variety of bacteria and fungi, the most common being Pseudomonas aeruginosa. Gangrene from occlusive causes is not uncommon among cancer patients with coexisting atheromatous, thromboembolic, or obliterative vascular disease. Toxic gangrene is most commonly caused by extravasation of intravenously administered cytotoxic antineoplastic drugs but has also been associated with the use of coumarin congeners and the bite of the brown recluse spider. Pyoderma gangrenosum is an idiopathic condition that has been reported in association with myeloproliferative disorders. Finally, necrosis can be caused by the neoplasm itself, when its growth is so great that blood vessels are compressed and ischemia of the surrounding tissue results.
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PMID:Necrotizing dermatitis in patients receiving cancer chemotherapy. 346 38

An arteriovenous fistula, created for hemodialysis access, may on occasion produce ischemia or even gangrene of the extremity distal to the fistula. This article describes a simple plethysmographic test which will accurately differentiate a steal syndrome from other causes of ischemia, pain, or necrosis and will allow the surgeon to remedy the problem in a specific way.
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PMID:Plethysmography and the diagnosis of the steal syndrome following placement of arteriovenous fistulas and shunts for hemodialysis access. 355 72

We report two children with finger tip ischaemia resulting from woollen mittens. Ischaemia has progressed to gangrene and required amputation of the affected finger.
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PMID:Unusual finger tip injury in children. 356 12


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