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

In this study, we report the effect of selective perfusion to the visceral arteries during aortic cross-clamping at surgery for thoracoabdominal aortic aneurysms with an adjunct of femoro-femoral (F-F) extracorporeal bypass. The total series comprising 28 patients were divided into 3 groups according to the perfusion mode to the celiac and the renal arteries, i.e., group I; the arteries were continuously perfused by the extracorporeal bypass, group II; aortic cross-clamp excluded the branches from the bypass flow but selective perfusion was employed, and group III; the liver or the kidneys were subjected to ischemia. As a result, group III developed hepatic failure at the incidence of 50% which was characterized by hepatocellular damage followed by cholestatic dysfunction. As for postoperative renal function, this group revealed persistently high level of serum creatinine, and 60% of this series resulted in renal failure. On the contrary, group II showed a comparable effect to group I on the preservation of hepato-renal function, and there were no differences in the incidence of hepatic or renal failure between the two groups. Multiple organ failure was a predominant cause of hospital death, and it developed only in the cases with aortic cross-clamp time more than 90 minutes. However, avoiding ischemia achieved in group I or II significantly reduced the incidence of MOF and its related deaths. It is concluded that selective perfusion system incorporated with an aid of F-F partial bypass was a useful measure to protect vulnerable organs from ischemia and to reduce postoperative mortality and morbidities.
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PMID:[Adjunctive methods during surgery for thoracoabdominal aneurysms--effect of selective visceral arteries perfusion incorporated with partial femoro-femoral bypass]. 140 80

Early epidemiologic studies concluded that infection with systemic sepsis was the common pathway for the development of ARDS and eventual MOF. As a consequence, research investigation from 1977 to 1987 focused on later clinical events (e.g., immunosuppression, persistent hypercatabolism, and bacterial translocation). Now, it is believed that an initial massive traumatic insult can create severe SIRS independent of infection (one-hit model). Alternatively, a less severe traumatic insult can create an inflammatory environment (i.e., primes the host) such that a later, otherwise innocuous, secondary inflammatory insult precipitates severe SIRS (two-hit model). As a result of these newer inflammatory models, research interest during the last 5 years has shifted to investigating earlier clinical events (e.g., unrecognized flow-dependent oxygen consumption, ischemia/reperfusion, and priming/activation of the inflammatory response).
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PMID:Evolving concepts in the pathogenesis of postinjury multiple organ failure. 789 97

Revascularization of the spinal arteries with thoracic aortic aneurysm were performed on nineteen patients using partial extracorporeal bypass. They were 16 men and 3 women. Age range were from 33 to 70 years (mean 49.9 +/- 10.3 years). There were eleven patients of dissecting aneurysm (DeBakey type IIIb in eight patients, type I in two patients and type IIIa in one patient), and eight patients of non-dissecting thoracoabdominal aneurysm (including two patients with ruptured aneurysm). The number of revascularized spinal arteries were 60 pairs (average 3.2 pairs per each patient). The revascularized spinal arteries were localized between levels T4 and L5.36 pairs of the 60 existed between levels T8 and L2 from where the artery of Adamkiewicz arises. Seven patients (eleven spinal arteries) underwent selective angiography of the revascularized spinal arteries postoperatively, and the anterior spinal artery and the artery of Adamkiewicz was identified in three patients. Two patients died within one month, one from MOF and the another from intestinal perforation respectively (operative mortality 11.1%). One patient, with ruptured thoracoabdominal aortic aneurysm showed paraparesis postoperatively, but no paraplegia was found in any patients. We recommend that not only the artery of Adamkiewicz but also the spinal arteries at the midthoracic area from T4 to T8 should be revascularized, to prevent postoperative paraplegia. Replacing of extended thoracic aneurysm, our method (using partial extracorporeal circulation and segmental aortic clamping) was thought to prevent spinal cord ischemia.
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PMID:[Angiographic evaluation of reconstructed spinal arteries in thoracic aortic aneurysm surgery]. 822 9

The therapeutic concept of limb salvage or immediate amputation is controversial in patients with multiple trauma. Sixty-three multiple trauma patients (injury severity score ISS > 18 patients) with blunt arterial injuries were investigated. Twenty-seven had injuries of the upper limb and 36 patients of the lower limb. In 33 cases a limb salvage procedure was performed (group I), while in 30 cases the limb was amputated (group II). Neither group showed a significant difference in age (I: 33 +/- 3, II: 30 +/- 3 years), ISS (I: 30 +/- 2, II: 29 +/- 2 patients), time of ischemia (I: 238 +/- 30, II: 203 +/- 20 min) ICU stay (I: 18 +/- 4, II: 19 +/- 4 days). Lethality and morbidity were slightly increased in group I (death: I: n = 8; II: n = 4; MOF: I: n = 5; II: n = 3; Sepsis: I: n = 11, II: n = 4). No differences were found in the incidence of local infections (I: n = 12, II: n = 10). Secondary amputations were performed in 7 patients after 12 +/- 2 days (range 3-40; median: 5 days). We conclude that limb salvage did not increase the risk for severe complications. Lethality and morbidity were related to the severity of the injury. To prevent complications, secondary amputations had to be performed early.
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PMID:[Results of peripheral arterial vascular injury in polytraumatized patients]. 897 76

Multiple organ failure is with an incidence of 10-25% and a mortality of 50-70% the most severe complication after severe trauma. Intestinal ischemia and a corresponding impaired gut barrier function is thought to have a high impact on the development of multiple organ failure after severe trauma. Under normal conditions the intestinal wall is a sufficient barrier against bacteria and their products. Gut ischemia is followed by mucosal lesions, the intestinal permeability is increased. Translocating bacteria and bacterial products (endotoxin, peptidoglykan) can lead to a local and/or systemic immun-inflammatory response, which is made responsible for the development of multiple organ failure. Tonometry as a possibility of monitoring intestinal ischemia as well as a tool to estimate the prognosis of multiple trauma patients is still discussed controversially. Dopexamin, which directly influences intestinal ischemia (goal directed therapy) might be a successful treatment option, however until now no clinical study about beneficial effects of dopexamine in severely injured patients is available. Selective gut decontamination showed no clinical benefits in multiple trauma patients. Early enteral nutrition especially with immunomodulating ingredients ("immunonutrition") decreases posttraumatic complications as well as the incidence of MOF. However a reduction of mortality could not be described in severely injured patients so far.
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PMID:[The intestine as the central organ in the development of multiple organ failure after severe trauma--pathophysiology and therapeutic approaches]. 958 78

Aortic cross-clamping is the cornerstone of abdominal aortic aneurysm surgery. The transient ischemia of the inferior hemisoma, and mainly of the large bowel, is then a current condition, usually well tolerated. At the time of vascular clamps removal, the ischemia-reperfusion syndrome may take place, and evolution toward multiple organ failure is an actual risk. The large bowel has a crucial role in the sequence of events causing ischemia-reperfusion syndrome, even when intestinal ischemia is not evident during aneurysmectomy. In this paper, current concepts of ischemia-reperfusion syndrome are reviewed, and the role of the colon after abdominal aortic cross-clamping for aneurysmectomy is focused. Principles of prevention of MOF from ischemia-reperfusion syndrome are pointed out.
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PMID:[Ischemia-reperfusion of the colon following clamping of the abdominal aorta]. 1041 15

Between January 1990 and December 1999, 20 patients underwent the valve surgery concomitant with coronary artery bypass grafting. There were 16 males and 4 females, their mean age was 66.5 years. Of the 20 patients, aortic stenosis was noted in 7, aortic regurgitation in 3, mitral stenosis in one, and mitral regurgitation in 9 patients. The cause of mitral regurgitation was considered to be an ischemic change in six patients, including ruptured papillary muscle due to myocardial infarction in two patients. On the contrary, LMT lesion was recognized in 5, LAD lesion in 17, LCX in 16, and RCA in 12 patients. Seven patients had preoperative myocardial infarction, three patients were required preoperative IABP support. AVR was performed in 10, MVR in 5, and MAP in 5 patients. The number of bypass was 1.9 +/- 0.85. Four patients died of LOS and MOF. The remaining 16 patients have been doing well. The significant difference between the survived and the not survived patients was recognized in the factor of emergency, preoperative IABP, papillary muscle rupture due to myocardial infarction, history of PTCA, LAD lesion, and the time of CPB. The factors regarding coronary artery had the influence on the outcome of a patients of valve surgery concomitant with CABG. Therefore, an appropriate myocardial protection and perioperative management for ischemia were mandatory.
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PMID:[Perioperative risk factors in valve surgery concomitant with coronary artery bypass grafting]. 1093 83

The abdominal compartment syndrome (ACS) is defined a situation of high degrade abdominal hypertension (IAH) with clinicals signs of multiorganic dysfunction. It's observed like in the intensive care, in particular surgycals and postraumatics, there is ever a bigger frequence of complications presented by criticals patients. The various trials remark a changeable incidence, but the common factor is characterized by a particular severity of scores. All the possibles mechanicals, haemorragicals, infiammatories, and postraumatics causes act, but don't enable the stability among abdominal content, abdominal compliance and parietal tension. The initial triad of effects is constitued by the elevation of diaphragm and the visceral and vascular compression; after this triad provoke a pathophysiologic system that, through various levels, bring to a respiratory, renal and cardiocirculatory dysfunction and to a parietal, hepatic and intestinal ischemia with consequent bacterical translation: sepsis and MOF. The Burch's classification (1996) report four levels of gravity by the slight (< 15 mmHg) to the heavyest (> 35 mmHg): the firsts two levels are of intensivistic competence and for the detention are used conservatives metodics and pharmacological approach; instead in the lasts two levels it's necessary to foresee a surgycal treatment of laparotomy, washing and drainage with following temporary paret's closure. The mortality is now very elevated (29-62%) especially when it's already established a multiorganical dysfunction; therefore it's necessary forward its appearance through the monitorization of abdominal pression (IAP) with the measurement of vescical pression in alls criticals patients at the aim to treat immediately the firsts signs of IAH.
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PMID:[Pathophysiological and clinical trials of the abdominal compartment syndrome]. 1734 91