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

Six patients underwent emergency surgery for descending aortic injury following blunt trauma to the chest; three survived. Associated injury was a critical factor in two of the three patients who died. In the third patient, prolonged ischemia of the lower half of the body due to total aortic distraction with a distal aortic flap produced irreversible changes that were manifest during reperfusion of the body. Angiography is recommended if the patient's condition is stable and other injuries demanding immediate surgical attention are not present. If, however, there are other serious injuries and adequate distal perfusion, then these other injuries should be corrected before aortic repair is undertaken.
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PMID:Rupture of the thoracic aorta following blung trauma. 115 66

A case of right lower-leg replantation after 42-hr ischemia is presented. Revascularization of the other foot with circulatory decompensation after 36-hr ischemia was carried out simultaneously. The replanted lower leg survived. Following its shortening in replantation by 12 cm, right lower-leg lengthening by 8 cm was carried out 1.5 years after replantation with the aid of a distraction apparatus. The locomotor function in both lower extremities recovered.
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PMID:Successful replantation of the lower leg after 42-hour ischemia: case report. 145 70

The method of treatment after Ilizarov was used in 28 patients with occlusion of lower extremity arteries, mainly of distal localization, with the III and IV degrees of ischemia. Osteotomy of mainly the tibial bone and distraction of the free osseous split was performed during 31-36 days. Two patients had fractures of the bone during operative interventions, after operation four patients had purulent complications or necrosis of the skin around the wire. The immediate positive result was noted in 20 patients. Their fate was followed-up in remote periods from 2 to 19 months, good results were observed in 18 patients. The use of the Ilizarov method was most justified in patients with the III and IV degrees of ischemia when other methods of treatment failed to give any effect and surgical reconstruction of the vessels is impossible. When treating patients with the IV degree, it is necessary to take into consideration the late appearance of revascularization and possibility of temporary deterioration. The use of the Ilizarov method foresees provision of the joint work of an angiosurgeon and a traumatologist-orthopedist.
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PMID:[The effectiveness of G. A. Ilizarov's method in treating patients with III- and IV-stage chronic ischemia of the lower extremities]. 196 53

Twenty hogs were administered the following procedures before, during, and after overdistraction of the spinal column at T5-T6: somatosensory (SEP) and neurogenic-motor evoked potentials (NMEPs), hydrogen clearance procedures, Stagnara wake-up tests, and aortic-injection of silastic plastic. To ensure that overdistraction was possible, a nonosseous, circumferential osteotomy was made at T5-T6 and distraction applied in one-ratchet increments using Harrington instrumentation. Overdistraction was maintained for 3, 5, 6, 10, 15, 20, 25, or 30 minutes. Results indicated that the duration of overdistraction, as represented by lost NMEPs, was always correlated with the animal's clinical status on wake-up test. If overdistraction was maintained more than 6 minutes, 100% of the animals demonstrated positive wake-up results; if maintained between 5 and 6 minutes, 75% demonstrated positive wake-up results; and if maintained less than 5 minutes, only 25% demonstrated positive wake-up results. Time-to-loss of the NMEPs and SEPs, after onset of overdistraction, fell within two groups: slow and fast. In the slow group, it required slightly more than 20 minutes (mean = 20.6) for the potentials to be lost, while in the fast-loss group data were lost in slightly less than 4 minutes (mean = 3.6). Blood flow studies and inspection of the spinal cord revealed that the mechanism of action for the slow group appeared to be ischemia of the spinal cord that extended several centimeters above and below the site of maximum distraction. In the fast-loss group, it appeared that gross structural damage, with some very localized ischemia, were the mechanisms of actions influencing the integrity of the spinal cord.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Relationship between duration of spinal cord ischemia and postoperative neurologic deficits in animals. 221 5

Ilizarov applied revolutionary methods for salvaging limbs with severe congenital, posttraumatic, or other acquired deformities. His methods, which use a universal system of ring external fixators with tensioned transosseous wires, were developed over the past 35 years at his institute in Kurgan, USSR. These noninvasive techniques have proved successful in over 300,000 patients (adults and children) treated for bone shortening and intercalary deficiency, angulatory and rotational malalignment, active infection, ischemia, joint contractures, and nonunions. Bone transportation involves moving a free segment of living bone to fill intercalary bone defects with vital bone. The trailing end of the transport bone segment maintains continuity with the host bone surface by distraction osteogenesis. The leading end of the transport bone segment fuses to the target bone surface by transformational osteogenesis. The small diameter of the transosseous wires contributes to better patient tolerance over the prolonged treatment times required for gradual distraction at 1 mm per day.
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PMID:Local bone transportation for treatment of intercalary defects by the Ilizarov technique. Biomechanical and clinical considerations. 265 35

The G. A. Ilizarov's method was used for the treatment of 46 patients with occlusion of the arteries of the lower extremities at stages III and IV of ischemia. The treatment has proved to be ineffective in 10 patients. The use of a method in active aggravation of the inflammatory-necrotic process, postoperative arterial spasm and thrombosis, excess in the permissible rate of the bone split distraction, wrong choice of the level of osteotomy were the main causes of unsatisfactory outcomes.
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PMID:[Causes of unsatisfactory results of the treatment of chronic ischemia of the lower limbs using G. A. Ilizarov's method]. 279 70

The purpose of this study was to report the effects of spinal cord compression, ischemia, and distraction on clinical status, and somatosensory (SEP) and neurogenic-motor evoked potentials (NMEPs) in animals. The authors also reported their clinical experience with NMEPs elicited from humans undergoing surgery for spinal deformities. Results from the animal studies indicate that NMEPs are more sensitive and specific to the effects from spinal cord compression, ischemia, and distraction than SEPs. In every situation, NMEPs always correlated with the animal's post-surgical clinical status, while SEPs demonstrated an unacceptable false positive and false negative rate. In the 111 clinical cases in which NMEPs were administered, reliable NMEPs were easily elicited in more than 90% of the cases. In the remaining cases, no reliable NMEPs could be recorded because of procedural errors, which have been resolved. The results from this study suggest that the use of NMEPs should be considered as an adjunct to SEPs when monitoring spinal cord function during surgery.
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PMID:Sensitivity and specificity of somatosensory and neurogenic-motor evoked potentials in animals and humans. 306 Oct 24

Spinal cord injury in children often occurs without evidence of fracture or dislocation. The mechanisms of neural damage in this syndrome of spinal cord injury without radiographic abnormality (SCIWORA) include flexion, hyperextension, longitudinal distraction, and ischemia. Inherent elasticity of the vertebral column in infants and young children, among other age-related anatomical peculiarities, render the pediatric spine exceedingly vulnerable to deforming forces. The neurological lesions encountered in this syndrome include a high incidence of complete and severe partial cord lesions. Children younger than 8 years old sustain more serious neurological damage and suffer a larger number of upper cervical cord lesions than children aged over 8 years. Of the children with SCIWORA, 52% have delayed onset of paralysis up to 4 days after injury, and most of these children recall transient paresthesia, numbness, or subjective paralysis. Management includes tomography and flexion-extension films to rule out incipient instability, and immobilization with a cervical collar. Delayed dynamic films are essential to exclude late instability, which, if present, should be managed with Halo fixation or surgical fusion. The long-term prognosis in cases of SCIWORA is grim. Most children with complete and severe lesions do not recover; only those with initially mild neural injuries make satisfactory neurological recovery.
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PMID:Spinal cord injury without radiographic abnormalities in children. 708 88

Experiments were performed to assess the effects of vertebral column distraction on evoked potential responses from multiple recording sites along the conducting pathway in the monkey, and on concurrent blood flows, measured with the radioactive microsphere technique, along the axis of the central nervous system. Linear distractive loads were applied until the amplitude of the evoked response was significantly reduced. In four monkeys, the loads (100 to 150 lb) were sustained, whereas in two monkeys the forces (80 to 110 lb) were relaxed. The earliest response changes were most marked in recordings dependent upon the integrity of the upper cervical dorsal columns or brain stem-lemniscal pathway. The responses returned to control levels with load relaxation, but maintenance of the tractive load produced generalized and progressive response attenuation. At selected periods of significant changes in the evoked potential response, blood flow remained stable except for the late onset of regional ischemia in the middle cervical through upper thoracic spinal cord levels in the animals undergoing sustained loads. These findings indicate that brain-stem or spinal cord dysfunction occurring with both acute and gradual elongation of the spinal canal are the result of excess tensile stress acting on fiber tracts, and the delayed onset of spinal cord ischemia is the probable result of a similar mechanical process acting upon intrinsic spinal cord blood vessels.
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PMID:Effects of vertebral column distraction in the monkey. 713 Oct 66

Distraction is considered to be a factor in many spinal cord injuries. With a specially designed distraction apparatus and the 14C-antipyrine autoradiographic technique, the effect of distraction on spinal cord blood flow (SCBF) in cats was studied. Distraction was performed at L2-3 at a rate of 0.25 cm/10 min, and the spinal evoked response (SER) was monitored by stimulating the sciatic nerve and recording at T-13. The SCBF was assessed in five control animals, four animals in whom the SER was markedly altered by distraction, and five animals after the SER had been abolished and an additional 0.5 cm distraction applied. Control cats had gray- and white-matter flows of 44.5 +/- 1.4 (SEM) and 10.5 +/- 0.4 ml/100 gm/min, respectively. Distraction to the point of marked SER alteration caused a 50% loss of SCBF at and caudal to the distraction site. An additional 0.5 cm distraction produced total abolition of SCBF at the distraction site and for a considerable distance rostral and caudal to it. Thus, it is shown that spinal distraction causes cord ischemia similar to that seen with other types of spinal cord injury. In addition, distraction severe enough to cause loss of the SER has already produced severe cord ischemia.
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PMID:The effect of spinal distraction on regional spinal cord blood flow in cats. 744 35


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