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

Between May 1966 and June 1991, 129 patients underwent surgical repair of thoracoabdominal aneurysms, with an overall 30-day mortality rate of 35%. In 75 operations (58%) performed electively, 11 deaths (15%) occurred, and in 54 cases (42%) of either symptomatic or ruptured aneurysms 34 deaths (63%; p less than 0.001) occurred. No one survived among six patients with preoperative hypotension (less than 90 mm Hg) or cardiac arrest. In 16 patients (12%) the etiology of aneurysms was a result of chronic aortic dissection, and the mortality rate in this subgroup was 44%. In the remaining 113 patients (88%) where the etiology was atherosclerosis, 38 deaths occurred (34%; p = 0.433). Spinal cord ischemia occurred in 25 cases (21%) among 116 patients who survived operation. Partial ischemia occurred in six cases (25%), and complete paraplegia occurred in the remainder. Complete and partial paraplegia occurred in 16 of 42 cases (38%) when all of the thoracic aorta was replaced (Crawford groups I, II) and in 9 of 74 cases (12%) when only the abdominal or lower thoracic aorta was replaced (Crawford groups III, IV; p = 0.016). Other complications included myocardial infarction (14 cases, 11%), respiratory failure (46 cases, 36%), and renal failure (33 cases, 27%). The major prospect for improved early survival of patients with thoracoabdominal aneurysms seems to be early detection and elective repair before the occurrence of symptoms.
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PMID:Thoracoabdominal aneurysm repair: a representative experience. 157 33

To make the ischemic effect on spinal cord clear, different vessels of the cord of 38 dogs, in 5 groups, were electrically cauterized individually or in combination. The animals in each group were sacrificed in due time periods, and the pathology of corresponding segment of each cord was observed grossly and under electron as well as light microscopes. The findings were described in this paper. As a consequence, the dogs in each group manifested paraplegia varying in degrees. However, dogs with the anterior cord artery and unilateral radicular artery, or both the anterior and posterior cord arteries cauterized developed irreversible, complete paraplegia. Cauterization of the anterior cord artery, or the posterior cord artery and unilateral radicular artery, or the radicular artery on both sides, gave rise to reversible, incomplete paraplegia. Anatomy of vessels of the spinal cord of other 9 dogs were dissected and studied. Their presence and distribution were cited and referred to the discussion about the effect of ischemia induced by electrifying them individually or in combination.
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PMID:[Experimental observations on spinal cord injury produced by electrifying the vessels of the cord in dogs]. 277 30

Referring to the experimental study on acute spinal cord injury, it is known that gray matter falls into an ischemia after injury, but opinions have not been unanimous whether or not the white matter falls into ischemia or hyperemia. The blood flow through the white matter varies according to the severity of the injury and degree of resultant paraplegia. Using rabbits, the authors carried out a series of experimental acute spinal cord impaction injury giving impactions at different strength stepwise, i.e., 400, 300, 200 and 100 gcf (g X cm X force) respectively at the 9th thoracic level of the spinal cord. Thus, upon observation of the paralysed levels and measurement of variable spinal cord blood flows according to the hydrogen clearance method, it was concluded as follows: In the 400 and 300 gcf impaction groups a complete paraplegia was observed with a decrease of spinal cord blood flow both in the gray and white matters. In the 200 gcf group mainly incomplete paraplegia was occurred, and while gray matter showed ischemia, white matter showed indefinite response consisting of both ischemia and hyperemia. In the 100 gcf impaction group the gray matter fell into ischemia, but white matter showed a biphasic increase of blood flow. From the above results it was noted that upon impaction causing complete paraplegia spinal white matter shows ischemia and upon impaction giving transient paraplegia blood flow increases. Ischemia thus does not appear to be a common behavior of spinal cord blood flow spinal cord injury.
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PMID:[Variations in spinal cord blood flow in stepwise spinal cord impaction injury]. 650 87

Transcranial magnetic stimulation (TMS) is a non-invasive diagnostic method particularly suited to investigation of the long motor tracts. The clinical value of this method in many cortical and subcortical diseases has been well established, but comparable studies for most spinal cord diseases have still to be made. Forty patients in whom spinal cord disease was established by clinical examination, cerebrospinal fluid examination, and magnetic resonance imaging (MRI) were studied by means of somatosensory evoked potentials (SEP, median and tibial nerve stimulation) and magnetic motor evoked potentials (MEP, first dorsal interosseus and tibialis anterior muscle recordings after transcranial and spinal stimulation). The underlying pathology was neoplastic (n = 16), inflammatory (n = 15) or ischemic (n = 9). Clinical signs and symptoms ranged from slight sensory disturbances to complete paraplegia and had developed within minutes (ischemia) or over many years (benign neoplastic disease). The overall frequency of pathological SEP was slightly higher than that of MEP (78% vs 68%) which was statistically not significant (p > 0.05). This was also true for the subgroups, except for pure motor disorders, which gave the same yield for both methods. Decreased amplitudes or absence of MEP were more frequent in neoplastic than in inflammatory lesions (75% vs 33%, p < 0.05). In the latter, however, MEP more often occurred with increased latencies (40% vs 31%, p > 0.05, n.s.). Pathological SEP were found in 75% of patients presenting with pure motor abnormalities, while pathological MEP were found in 30% of patients with pure sensory disturbances.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Magnetic motor evoked potentials (MEP) in diseases of the spinal cord. 788 35

The authors report a case of acute bacterial (Staphylococcus aureus) endocarditis in a 70-year-old woman, revealed by a febrile cerebral ischemic accident. Ultrasonography confirmed the presence of a large posterior mitral valve vegetation interfering with left ventricular filling. The sudden onset of complete paraplegia and acute ischemia of the lower limbs suggested thrombosis of the abdominal aorta, which was confirmed by aortography. These features indicated that a vegetation fragment had migrated, obstructing the aortic bifurcation and causing secondary thrombosis. This led in turn to involvement of the medullary arteries and the onset of paraplegia. Unfortunately, acute renal insufficiency and major left heart failure rapidly developed, and the patient died. Autopsy confirmed the diagnosis of aortic thrombosis with involvement of the renal arteries. Multiple visceral infarcts were noted as well as the large mitral vegetation. This case illustrates the potential severity of systemic embolism complicating endocarditis due to Staphylococcus aureus. The accident was remarkable because of the aortic acute occlusion and the association with paraplegia, an unusual neurologic complication.
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PMID:[Aortic thrombosis during acute endocarditis caused by Staphylococcus aureus]. 812 Apr 67

Experiments were undertaken to determine the relationship between evoked spinal cord potential (ESP) and the partial pressure of oxygen in tissue in the epidural space (E-pO2) during aortic clamping. Eighteen adult mongrel dogs were studied as follows. In group I (n = 6), the descending thoracic aorta was clamped partially at the proximal site for 15 min to maintain the distal arterial pressure at 60, 40, and 20 mmHg consecutively at 15 min intervals. In group II (n = 6), the descending thoracic aorta was clamped proximally for 30 min. In group III (n = 6), the descending thoracic aorta was cross-clamped at proximal and distal sites for 30 min. Postoperative complete paraplegia was observed in 4 of 6 dogs in group III, but none in group II. The change in ESP with aorta cross-clamping was very mild in groups I and II. Transient increases and decreases in the ESP amplitude were observed in group III. The decrease of E-pO2 correlated well with the distal arterial pressure, and a rapid return to baseline of the E-pO2 was observed after declamping. The E-pO2 changed in response to spinal ischemia more rapidly than did ESP in all groups. The critical level of E-pO2 was 50 mmHg or a 40% decrease from baseline. Because the ESP reflects spinal function and the E-pO2 reflects spinal blood pressure, we propose that combined recording of ESP and E-pO2 would improve spinal monitoring during thoracic aortic surgery.
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PMID:Spinal epidural oxygen partial pressure and evoked spinal cord potential in relation to the severity of spinal ischemia during cross-clamping of the thoracic aorta. 812 10

The neuroprotective effect of epidural cooling before and during spinal cord ischemia on the neurological, neurophysiological, and histopathological outcome was evaluated after 40 min of proximal and distal thoracic aorta crossclamping in dogs. In the normothermic group (n = 12), no attempt was made to change the spinal cord temperature. Four of eight animals showed complete paraplegia and four had partial recovery. The N3 component of spinal somatosensory-evoked potentials recovered to only 11.7 +/- 1.4% after 2 hr of recirculation and to 45% of control value after 2 days of survival. In the transverse sections taken from L1-L7 segments, apparent interneuronal damage in the intermediate zone was found after 2 hr of reperfusion followed by a heavy loss of interneurons after 2 days of survival and functionally defined as fully developed paraplegia. In the hypothermic group (n = 12), the spinal cord temperature was lowered 3 min before aortic crossclamping with a bolus of epidurally administered 0.9 N saline solution (8 ml/kg at 5 degrees C) to 28.5 +/- 1.3 degrees C and was maintained throughout the crossclamping time with the additional infusion of the same solution (20 ml/kg/40 min) using a peristaltic pump. Seven of eight animals had no neurological deficit and one animal showed partial recovery, which was significantly better than the motor score for the normothermic group (P < 0.05). The SSEP revealed 55% of postsynaptic (N3) wave recovery after 2 hr of recirculation and 92% recovery after 2 days survival, which was significantly higher than those for the normothermic animals (P < 0.05). Histological analysis showed almost full protection of interneurons and A-motoneurons verified after 2 hr and 2 days, respectively. We conclude that spinal cord epidural cooling has a highly protective effect against ischemic spinal cord damage under experimental conditions of high thoracic aorta crossclamping in dogs.
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PMID:Panmyelic epidural cooling protects against ischemic spinal cord damage. 841 78

Although spinal ischemia is a very well recognized complication after operation on the thoraco-abdominal and abdominal aorta, it is very rare following coronary artery bypass surgery. A case of a 56-year-old man, who had juxtarenal aortic occlusion and became paraplegic after internal mammary artery grafting for ischemic heart disease is reported. The complete paraplegia was thought to be due to interruption of critical collateral blood supply to the spinal cord.
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PMID:Ischemic spinal cord injury after aortocoronary bypass operation. A case report. 1238 79

The pathophysiology of ischemia/reperfusion injury involves extravascular migration of leukocytes from the bloodstream to the site of injury. Leukocyte adhesion and intercellular adhesion molecule-1 (ICAM-1) play an important role in the recruitment of leukocytes to the site of injury. In this study, we evaluated the role of the ICAM-1 in spinal cord ischemia and the therapeutic effects of epidural ICAM-1 monoclonal antibody (Mab). The descending aorta was occluded below the renal artery with an aneurysm clip in rabbits anesthetized with halothane. The following variables were evaluated, in addition to ICAM-1 expression in the lumbar spinal cord, in animals receiving saline or ICAM-1 Mab via the epidural route: (1) leukocyte recruitment in the lumen of capillary vessels of the lumbar spinal cord (L6-7) at 8 h after 30 min of aortic occlusion and (2) neurological evaluation at 20 h after aortic occlusion of 10, 15, 17.5, 20, or 25 min. Paraplegia was graded with the following scale: Grade 0, no deficit; Grade 1, partial deficit; and Grade 2, complete paraplegia. Spinal cord ischemia increased the expression of ICAM-1 in the endothelium of spinal cord capillaries and led to capillary leukocyte recruitment and extravascular migration into the lumbar spinal cord parenchyma, which was ablated with epidural ICAM-1 Mab. Epidural ICAM-1 Mab reduced neurological deficits and offered neuroprotection. These findings demonstrate the involvement of the ICAM-1 pathway in spinal cord ischemia and the neuroprotective effects of epidural ICAM-1 Mab. Strategies to ameliorate spinal cord ischemia may entail the administration of leukocyte antiadhesion molecules into the neuraxial space.
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PMID:The therapeutic effects of epidural intercellular adhesion molecule-1 monoclonal antibody in a rabbit model: involvement of the intercellular adhesion molecule-1 pathway in spinal cord ischemia. 1293 16

Spinal manipulation is a form of back and other musculoskeletal pain treatment that often involves a high-velocity thrust, a technique in which the joints are adjusted rapidly. The main objective of chiropractors is to correct spinal malalignment and relieve the nerves, allowing them to function optimally (Ernst In: Expert Rev Neurother 7:1451-1452, 2007; Oppenheim et al. In: Spine J 5:660-666, 2005). The evidence for the effectiveness of this treatment based on randomized clinical trials still remains uncertain (Cassidy et al. In: Spine 33(4 suppl): S176-S183, 2008; Dupeyron et al. In: Ann Readapt Med Phys 46:33-40, 2003; Ernst et al. In: Expert Rev Neurother 7:1451-1452, 2007; Hurwitz et al. In: J Manipulative Physiol Ther 27:16-25, 2007; Thiel et al. In: Spine 32: 2375-2378, 2007). Several case reports and series have been focusing on the risks of chiropraxis, especially on the cervical spine, although the risk/benefit ratio for certain selected patients could be acceptable (Powell et al.In: Neurosurgery 33:73-78, 1993). We describe the case of a 45-year-old woman who suffered complete paraplegia shortly after a chiropractic maneuver in the thoracic spine. Dorsal CT showed a calcified disc herniation at the T8-T9 level and MRI revealed a diffuse spinal cord ischemia from T6 to the conus medullaris without spinal cord compression at the level of herniation. Despite a normal arteriography, authors suggest a vascular injury as the cause of the deficit.
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PMID:Acute paraplegia after chiropraxis. 2055 41


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