Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0022116 (ischemia)
 91,303 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

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

The HELLP syndrome (hemolysis, elevated liver enzymes, low platelet count) is a severe complication of pre-eclampsia with high risk for mother and fetus. During the last 40 months 27 parturients met the diagnostic criteria for HELLP syndrome in the University Hospital of Kiel (Tables 1-3). In 24 cases cesarean section was performed. Fetal mortality was 17.2%. In 13 women an uneventful clinical course resulted, all other patients developed complications: renal insufficiency (11 cases), disseminated intravascular coagulation (DIC) (4), intracerebral hemorrhage (1), cerebrovascular ischemia (1), eclamptic convulsions (3), reoperation due to intra- or extra-abdominal hemorrhage (4), severe blood loss ex vagina following spontaneous delivery (1), and liver rupture (1). Despite these severe complications no maternal death was observed. DIC, intrauterine death, and a rapid increase in liver enzymes are considered to be serious prognostic factors that could help to identify high-risk patients. The following recommendations for therapy of parturients suffering from HELLP syndrome are given: epidural anesthesia is not an appropriate method in HELLP syndrome because of the risk of epidural hemorrhage due to thrombopenia. At the present time general anesthesia seems to be the method of choice. Inhalation anesthetics such as halothane, enflurane, or isoflurane should probably be omitted in view of the preexisting hepatopathy. The high risk and the unpredictable postpartum course strongly indicate intensive care for parturients with HELLP syndrome. Antihypertensive, antieclamptic therapy and prophylactic measures to avoid renal insufficiency or hemorrhage (e.g. early substitution of erythrocytes, thrombocytes, and coagulation factors) deserve special attention. Co-operation between obstetrician and anesthesiologist is essential to obtain optimal therapy for these high-risk patients.
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PMID:[Anesthesia and intensive therapy of pregnant women with the HELLP syndrome]. 231 3

1. Electrophysiological techniques were used to characterize responses of afferent fibers in pelvic nerve of adult, virgin female rats to mechanical or chemical stimulation of internal reproductive organs and to mechanical stimulation of other pelvic organs. 2. In an in vivo barbiturate-anesthetized preparation, pelvic nerve afferent fibers responded to a wide variety of mechanical stimulation applied to restricted regions of the vaginal canal, caudal uterus (body and cervix), bladder, ureter, colon, or anus. 3. Single-fiber mechanoreceptive fields were invariably confined to a single organ. Notably, responses could be evoked not only by gentle stimulation of the unit's receptive field directly on the organ itself, but also by stimulating the field indirectly with intense stimulation through the appropriate part of a contiguous organ. This innervation feature is consistent with the separability of pelvic organ functions under innocuous conditions but their confusion under noxious ones. 4. Receptive fields on the reproductive organs extended from the caudal edge of the vagina to the uterine body (including the cervix) but were most often located in the fornix (vaginocervical junction). Most units had no or low levels of spontaneous activity. Their responses to mechanical stimuli were usually slowly or moderately adapting and time-locked to the stimulus. 5. Fibers with vaginal receptive fields (including the fornix) responded best either to vaginal distension with a balloon or, more often, to a probe moving along the internal vaginal surface in a direction toward the cervix. They were observed most frequently during the proestrus stage of the rat's estrous cycle. These fibers, therefore, seem particularly suited for relaying information about stimuli that occur during mating. 6. Fibers with receptive fields on the uterine cervix and body responded best to static pressure and were observed less frequently than those with vaginal fields, regardless of estrous stage. They were, however, sensitized by hypoxia. In addition, irritation of the uterus increased the probability of observing them. These fibers, therefore, may exert their primary function during reproductive conditions different from those of virgin rats, such as parturition. 7. Response activity of most of the mechanoreceptive afferent fibers supplying reproductive organs increased as the stimulus intensity increased into the noxious range; i.e., into a range in which the stimulus momentarily produced ischemia at the stimulus site. In addition, in an in vitro preparation, pelvic nerve fibers responded in a dose-dependent manner to injections through the uterine artery of bradykinin (BRAD) as well as to other algesic chemicals, 5-hydroxytryptamine (5-HT) and KCl.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Functional properties of afferent fibers supplying reproductive and other pelvic organs in pelvic nerve of female rat. 231 44

Afferent fibers in the rat hypogastric and pelvic nerves supply the uterus and vagina, respectively, the former being responsive mainly to intense uterine stimuli, the latter to gentle and intense vaginal stimuli (Berkley et al. 1993c). If such responses result in sensory experiences, those produced by uterine and vaginal stimulation should differ, uterine stimuli being experienced mainly as pain and vaginal stimuli experienced in various ways, including pain. To test this hypothesis, 48 young virgin rats were first trained to make an operant response to escape a noxious tail-pinch stimulus. Latex balloons inserted into the rat's uterine horn or vagina were then distended to various volumes and the metestrous rat's detection behaviors and operant escape response probabilities measured. Approximately 26% of the 23 rats tested failed to respond to uterine stimulation, even when it produced ischemia. For the rest, detection and escape responses occurred only to ischemic stimuli and never to all of them, even at the highest volumes. In contrast, all 25 rats tested responded readily to vaginal distension, often to all of them at high volumes. Detection behaviors occurred at distension magnitudes lower than those that evoked escape responses. These results support the hypothesis that sensory consequences of uterine and vaginal stimulation differ. Because effective uterine stimuli were larger than any that would occur in a normal physiological state in non-pregnant/parturient rats, normally occurring uterine states in such rats are probably insensible. In addition, while the behavioral responses did indeed reflect differences in hypogastric and pelvic nerve response properties, the results also indicated that activity produced in those fibers, even by abnormal stimuli, does not inevitably result in behavior.
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PMID:Behavioral responses to uterine or vaginal distension in the rat. 764 35

Various techniques of vaginal repair used in the reconstruction of cloacal deformities are discussed. In 4 years we performed primary reconstruction of cloacal anomalies in 4 children, 3 of whom had hydrocolpos and 1 vaginal agenesis. Vaginal reconstruction was done using a variety of techniques tailored to the primary anomaly. Distal vaginal occlusion related to ischemia occurred in 2 patients and in both the vagina was successfully reconstructed at a second stage procedure. Overall cosmetic and functional results were good. All patients are dry but require clean intermittent catheterization and 3 currently require a bowel regimen at followup of 18 months to 4 years.
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PMID:Technical considerations in the repair of cloacal vaginal deformities. 786 40

After treatment of cervical carcinoma, recurrent disease may be observed in multiple sites at imaging. Both typical and atypical manifestations of recurrent disease occur. Typical manifestations of recurrent cervical carcinoma involve the pelvis and lymph nodes. Pelvic recurrences may be observed as masses involving the cervix and uterus, vagina or vaginal cuff, parametria, bladder, ureters, rectum, or ovaries and may result in fistula formation or hydronephrosis. Nodal recurrence may be identified as enlarged pelvic and retroperitoneal nodes. Atypical manifestations of recurrent cervical carcinoma are being recognized with greater frequency due to the use of intensive pelvic radiation therapy, the evolution of improved imaging techniques, and the more frequent use of imaging as a means of surveillance. These atypical manifestations may involve the solid organs of the abdomen (focal masses) as well as the peritoneum, mesentery, and omentum (implants); gastrointestinal tract (obstruction, fistula formation, ischemia); chest (metastases to the lung parenchyma, pleura, and pericardium); bones (destructive lesions); and other sites. Familiarity with the imaging features of recurrent cervical carcinoma in these anatomic locations will facilitate prompt, accurate diagnosis and treatment.
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PMID:Recurrent cervical carcinoma: typical and atypical manifestations. 1051 48

Pelvic cancer causes several types of pain, i.e., visceral, neuropathic, and somatic pain. Somatic pain is due to stimulation of nociceptors in the integument and supporting structures, namely, striated muscles, joints, periosteum, bones, and nerve trunks by direct extension through fascial planes and their lymphatic supply. In 60% of patients with malignant disease of soft tissues, nerve trunk, and sacral invasion from carcinoma of the cervix, uterus, vagina, colon, rectum, and other tissues in women, and from penile, prostate, and colorectal carcinoma and sarcoma in men, they have neuropathic pain. The infiltration of the perineal nerves results in lumbosacral plexopathies and complete destruction of the nerve, including perineural lymphatic invasions producing symptomatic sensory loss, causalgia, and deafferentation. Visceral pain is the result of spasms of smooth muscles of hallow viscus; distortion of capsule of solid organs; inflammation; chemical irritation; traction or twisting of mesentery; and ischemia, or necrosis, and encroachment of pelvis and presacral tumors. Pain of these types is managed by different modalities depending on the age of the patient, the expected life expectancy, availability of invasive and non-invasive pain control modalities, and the resources of the patient, community, and health care agencies. Patients with pelvic cancer can live with less pain due to better pain-control modalities that are available today with the help of dedicated and caring algologists.
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PMID:Pelvic cancer pain. 1113 74

A vesicovaginal fistula is an abnormal passage between the bladder and the vagina. It is a hole in the lower posterior wall of the bladder and sometimes the urethra through which urine continuously drips toward the vagina, without possibility of control. Since women suffering from vesicovaginal fistulas are commonly infertile, the problem affects their entire social, family and gyneco-obstetrical lives. Fistulas are a complication of difficult deliveries and occur frequently in some rural and isolated regions of Africa insufficiently served by maternity hospitals. Fistulas develop in the course of deliveries prolonged by any cause when the baby's head presses against the bladder wall, causing necrosis of the wall by ischemia. The fistula appears several days after delivery of an usually stillborn infant. Fistulas are most commonly seen in young women, over half of whom are primiparas. Risk factors include small stature with narrow pelvis and excision. But the lack of obstetric care and midwives in rural zones and the difficulty of transfer to a hospital are the major factors. The fistula may measure several mm to several cm in length. The bladder has a reduced capacity because of sclerosis. The fistula may affect the urethra, uterus, vagina, and in very severe cases the rectum. Continuous local and urinary infection is almost always present. Early diagnosis is important because treatment is simpler, but it is more difficult than later diagnosis and symptoms may be masked by postpartum incontinence caused by trauma to the perineum which usually regresses spontaneously. An evaluation of the size and exact location of the fistula and the condition of the bladder and other affected organs is necessary before corrective surgery can be planned. 1 or 2 weeks of preoperative preparation may be needed to treat anemia, parasites, urinary infections, and cutaneous lesions. Treatment may require from several weeks to several months. Numerous surgical procedures are possible. The choice depends on the lesions and the habits of the surgeon. Curative surgery may not be possible in the most severe cases. Palliative surgery requires careful longterm follow-up that is seldom possible in Africa. When the final outcome is good, the patient must be carefully advised that hospital care is imperative during any subsequent pregnancies to avoid another fistula. Prevention in the form of screening of difficult deliveries and transfer to the nearest hospital at any moment is the best form of treatment for this condition.
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PMID:[Vesico-vaginal fistulas]. 1228 72

We describe a new technique combining in situ vaginal wall and polypropylene mesh slings that may decrease potential erosive complications caused by synthetic materials. A folded mucosal patch harboring the polypropylene mesh was placed between mid-urethra and bladder neck. Using this technique, 12 consecutive women (age range 44-66 years) were operated. Preoperative evaluation included a detailed history, pelvic examination, stress test, cystourethroscopy, basic urodynamic evaluation (cystometry, Valsalva leak point pressure measurement), and urine culture. Based on these evaluations, three, seven, and two patients had type I, II, and III stress urinary incontinence, respectively. A paraurethral cyst excision was carried out in one patient and anterior colporrhaphy in four patients during the same operation. No ischemia or sloughing at the operation site occurred in any case. Pelvic examination was repeated in all patients after 3 and 6 months of follow-up and symptoms were determined after 12 months of follow-up in eight patients by telephone interview. Average follow-up was 10 months (range: 6-14 months). None of the patients were incontinent, or complained of sexual dysfunction or erosive complications after 1 year. Since there are two distinct barriers between the sling and both urethra and vagina, our technique covers all advantages of a sling procedure with synthetic materials and avoids the risk of urethral and vaginal erosion. The other advantage of this technique is the concomitant utilization of the vaginal wall as sling material.
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PMID:A new technique combining both polypropylene and vaginal wall sling procedures: can it minimize the risk of urethral and vaginal erosion occurring with synthetic materials? 1599 96

Obstetric fistula is a devastating complication of obstructed labor that affects more than two million women in developing countries, with at least 75,000 new cases every year. Prolonged pressure of the infant's skull against the tissues of the birth canal leads to ischemia and tissue death. The woman is left with a hole between her vagina and bladder (vesicovaginal) or vagina and rectum (rectovaginal) or both, and has uncontrollable leakage of urine or feces or both. It is widely reported in scientific publications and the media that women with obstetric fistula suffer devastating social consequences, but these claims are rarely supported with evidence. Therefore, the true prevalence and nature of the social implications of obstetric fistula are unknown. An integrative review was undertaken to determine the current state of the science on social implications of obstetric fistula in sub-Saharan Africa.
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PMID:Social implications of obstetric fistula: an integrative review. 1924 52


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