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

In osteomyelitis, bone-scan findings precede the appearance of bone changes on radiographs. In cases where focal ischemia occurs, the earliest scan finding may be a "cold" area that later becomes "hot" as active periostitis develops.
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PMID:Unusual bone-scan findings in acute osteomyelitis: case report. 17 40

Demyclinating lesions of the spinal cord, including multiple sclerosis as well as other less common diseases, probably represent the etiology of a substantial proportion of all idiopathic myelopathies. Magnetic resonance imaging (MRI) has made major advances in the diagnosis and characterization of demyclinating disease. Infections of the spine may have severe consequences and, if detected early, are usually treatable processes. Osteomyelitis and epidural abscesses have characteristic imaging findings. Poor outcomes are more often due to delays in clinical presentation or the debilitated condition of the patients than to limitations in the accuracy of MRI diagnosis. Cavitary lesions of the spinal cord were among the first applications in which MRI proved its superiority to previously available techniques. Accurate diagnosis of these lesions involves detecting characteristics findings and relating these observations to the clinical history. Spinal cord infarction is relatively rare due to the extensively collateralized blood supply to the spinal canal. However, aortic aneurysms and the surgery for these lesions places the blood supply of the distal spinal cord and conus at risk. The syndrome of postoperative spinal cord infarction has characteristic clinical findings. However, MRI may contribute to distinguishing transient ischemia from true infarction and to predicting the severity of the final deficit.
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PMID:Inflammation, infection, cavitary disorders, and ischemia. 157 87

Thirty-eight hip disarticulations performed in 34 patients were retrospectively reviewed. The indications were ischemia secondary to atherosclerosis in 17 cases, femoral osteomyelitis in 10, and trauma in 11. Patient ages ranged from 20 to 95 years. The mortality was 60% in patients with ischemia with preoperative infection, 20% in patients with ischemia without preoperative infection, 22% in patients with femoral osteomyelitis, 100% in patients with trauma with preoperative infection, and 33% in patients with trauma without preoperative infection. The overall mortality was 44%. Postoperative wound infections were frequent (63%) and had poor correlation with the presence of a preoperative wound infection. No patient was able to use a prosthesis after hip disarticulation, but most were independent in wheelchairs.
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PMID:Hip disarticulation. An 11-year experience. 234 79

Two cases of thumb replantation and one of finger revascularization complicated by Aeromonas hydrophila infection are reported. Two digits were lost because of infection in soft tissue and osteomyelitis. One thumb had extensive necrosis. In all cases the infection was difficult to eradicate, probably because of ischemia. All three patients sustained their injuries while cutting meat or fish. These infection sources have not been previously reported. Note is made of Aeromonas hydrophila in medicinal leeches that are used in microvascular surgery and the potential for iatrogenic infection.
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PMID:Aeromonas hydrophila infection complicating digital replantation and revascularization. 199 83

Inhalation of pressurized 100% oxygen is a helpful adjunctive treatment for certain patients, because the increased oxygen carried by the blood to the tissue enhances new growth of microcirculation and, thus, healing. Patients with tissue breakdown after radiation therapy, refractory osteomyelitis, gas gangrene, soft-tissue infection with necrosis from mixed aerobic and anaerobic organisms, crush injuries resulting in acute ischemia, and compromised skin grafts or non-healing wounds are likely to benefit from hyperbaric oxygen therapy.
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PMID:Hyperbaric oxygen therapy. Promoting healing in difficult cases. 351 70

Transcutaneous oxygen partial pressure measurement (TcPO2) using a polarographic probe heating the skin at 44 degrees C provides informations about the capacity of blood to supply skin with oxygen. As oxygen is necessary for tissue survival, TcPO2 could constitute an adequate parameter for the determination of an amputation level. Among 67 amputations performed between 1983 and, 1984, we included in this study 34 patients (35 amputations), in whom TcPO2 was preoperatively measured (24 males, 10 females, mean age 67 years, range 19-86 years). Twenty two were diabetics. Twenty patients suffered from severe ischemia (stage Fontaine 4); 13 patients suffered from chronic diabetic lesions or/and osteomyelitis and two patients suffered from frostbite. The follow-up period lasted until operative wound was healed or a more proximal amputation was undertaken (mean 2.5 months, range 15 days to 10 months). Five operative wounds did not heal, so that a more proximal amputation was undertaken. TcPO2 was below 20 mm Hg in 3 of these 5 patients. TcPO2 was above 20 mm Hg in 24 among 30 patients in whom operative wound healed. When TcPO2 is above 20 mm Hg, the probability of operative wound healing is 92%. When TcPO2 is below 20 mm Hg, the risk of a more proximal amputation is 33%. Distal systolic blood pressure has no predictive value. It is concluded than when TcPO2 is above 20 mm Hg, the probability of healing of operative wound is clinically acceptable. When TcPO2 is below 20 mm Hg, 1 of 3 patients will be reamputated at a more proximal level, but healing does occur in 66% of patients.
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PMID:[Determination of the amputation level by transcutaneous PO2 measurement and distal arterial systolic pressure]. 377 53

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

This case report utilizes a recently popularized method of radiologic examination for peripheral vascular disease. In a diabetic foot with osteomyelitis, ischemia, and gangrene we have assessed patent arterial supply in the distal arterial tree. This examination has allowed the authors to accurately predict wound healing potential preoperatively at a specific anatomic level.
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PMID:Intravenous digital subtraction angiography and its use in amputation level consideration in the ischemic forefoot. 397 45

Two cases are reported of osteomyelitis in the proximal end of the femur and humerus, respectively, with subsequent reduction of the blood supply to the corresponding head. A hypothesis is presented to explain the genesis of the ischemia, and the implications on treatment of osteomyelitis of the hip and shoulder regions.
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PMID:Ischemia of the childhood femoral and humeral head epiphyses following osteomyelitis. A hypothesis on its cause. 648 56

Recent enthusiasm for the cervical esophagogastric anastomosis has arisen because of its perceived low morbidity. Although catastrophic complications of a cervical esophagogastric anastomosis are unusual, they can and do occur, and prevention is possible if the potential for them is recognized. Among 856 patients undergoing a cervical esophagogastric anastomosis after transhiatal esophagectomy, catastrophic cervical infectious complications occurred in 11 patients (1.3%): vertebral body osteomyelitis (1), epidural abscess with neurologic impairment (2), pulmonary microabscesses from internal jugular vein abscess (1), tracheoesophagogastric anastomotic fistula (1), and major dehiscence necessitating anastomotic takedown (6). These complications became manifest from 5 to 85 days after the esophageal resection and reconstruction (mean 19 days). Leakage from a gastric suspension stitch placed in the anterior spinal ligament over the vertebral bodies resulted in a posterior gastric leak and either osteomyelitis or an epidural abscess in three patients, none of whom had evidence of extravasation on the routine barium swallow 10 days after operation. Cervical exploration for a presumed anastomotic leak led to the unexpected discovery of an abscess formed by the stomach and the adjacent wall of the internal jugular vein, which was ligated and resected. One patient without symptoms who was discharged from the hospital with a contained anastomotic leak on the postoperative barium swallow was readmitted 7 days later with a cervical tracheoesophagogastric anastomotic fistula of which he ultimately died. In 6 patients (7% of those who had anastomotic leaks) there was sufficient gastric ischemia or necrosis, or both, to necessitate takedown of the anastomosis and intrathoracic stomach, cervical esophagostomy, and insertion of a feeding tube. As a result of this experience, it is recommended that cervical gastric suspension sutures either be omitted entirely or placed in the fascia over the longus colli muscles anterior to the spine, but not directly into the prevertebral fascia overlying the vertebral bodies or cervical disks. All but minute cervical anastomotic leaks, even if apparently contained, are best drained rather than treated expectantly. Patients who remain febrile and ill after bedside drainage of a cervical esophagogastric anastomosis leak should undergo cervical reexploration in the operating room; major gastric ischemia or necrosis, or both, may warrant takedown of the anastomosis and intrathoracic stomach.
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PMID:Catastrophic complications of the cervical esophagogastric anastomosis. 747 1


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