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

We have reviewed the records of 25 patients who underwent a transmetatarsal amputation at San Francisco General Hospital. The average patient age was 63 years old. Twelve of the patients were diabetic, while transmetatarsal amputations were performed in eleven with simple arteriosclerosis. Two patients underwent amputations for either trauma or nonhealing ulcer. Thirteen of the patients healed their amputation, and twelve of these became ambulatory. Eleven required higher amputation, because of nonhealing due to infection in seven and progressive ischemia in four. One patient died on the first postoperative day of pneumonia. The failure group was younger, contained more diabetics, and had a higher incidence of infection. The operative procedure of transmetatarsal amputation is described. We believe that patients with distal gangrene without spreading infection should be considered for transmetatarsal amputation, reserving initial below-knee amputation for those with greater involvement of the foot.
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PMID:Transmetatarsal amputation. 92 34

In 48 canine kidneys submitted to an ischemia of 2 min duration normal cortical ATP values with a nearly unchanged content of total adenine nucleotides (SAN) were resumed by a five minute gravity perfusion. During the following 24 hours of low flow perfusion at 6 degrees C the extent of preservation of ATP and SAN correlated with the arterial oxygen pressure of the perfusate.
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PMID:[Effect of pO2 in perfusate on metabolism of preserved dog kidneys]. 120 23

Symptomatic visceral atherosclerosis is a major surgical challenge because of its life-threatening course and the complexity of its definitive operative treatment. Evolution in the operative approach to the visceral aorta and progress in the intraoperative management of patients undergoing complex vascular reconstructions prompted a review of the authors' cumulative experience in the surgical management of chronic visceral ischemia. Among all patients undergoing visceral revascularization at the University of California, San Francisco during the past three decades, 74 patients were identified whose primary reconstruction used transaortic endarterectomy (TA TEA) (n = 48) or antegrade bypass (AB) (n = 26), the authors' preferred revascularization techniques. The two treatment groups were comparable in gender distribution, age, presenting symptoms, and physical findings, although the amount of preoperative weight loss was greater in the AB group (35.8 +/- 19.5 versus 22.4 +/- 12.0, p = 0.003). The groups were also comparable in the prevalence of atherosclerosis risk factors, symptomatic vascular disease at other sites, and previous vascular operations. However associated renal artery atherosclerosis was slightly greater in the TA TEA group (58.3% versus 23.1%, p = 0.07) when compared to the AB group. Antegrade bypass was usually performed transabdominally (88.5%), while TA TEA was approached thoracoretroperitoneally (75.0%). Celiac revascularization was almost universal in both treatment groups, but the TA TEA group underwent significantly more frequent superior mesenteric artery (SMA) revascularization (93.8% versus 46.2%, p = 0.0001) and slightly more frequent inferior mesenteric repair (18.8% versus 3.8%, p = 0.07) than the AB group. In addition the frequency of combined renal and visceral repair (25.0% versus 0.0%, p = 0.01) as well as combined aortic, renal, and visceral repair (22.9% versus 3.8%, p = 0.03) was significantly greater in the TA TEA group. The obligatory interval of renal and visceral ischemia did not differ between the two approaches. The perioperative mortality rate was 12.2% and was the same for TA TEA (14.6%) and AB (7.7%). Overall the incidence of complications was the same with either operative approach, although patients in the TA TEA group tended to have multiple complications (17.1% versus 0.0, p = 0.03) and all significant pulmonary complications occurred in this group. Two patients were lost to follow-up. The cumulative percentage of patients who remained asymptomatic following AB or TA TEA was (respectively) 95.8% and 97.3% at 1 year and 86.5% and 86.1% at 5 years. Both of these operative approaches provide durable symptom relief with acceptable operative morbidity and mortality rates.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Chronic visceral ischemia. Three decades of progress. 192 9

In ischemic canine kidneys protected by Bretschneider's HTK solution the glycolytic lactate production is limited by a low renal substrate content. However, for anaerobic energy supply ischemic organs depend on glycolysis. To evaluate the role of glycolysis in renal protection, the relationship between lactate production and anaerobic energy supply was examined in protected kidneys of dogs, sheep, and swine. Additionally, in canine kidneys an attempt was made to improve anaerobic energy provision by adding glucose to the protective solution. The results were as follows: (1) According to increasing lactate production from swine to dog to sheep, intraischemic ATP decay was delayed least in swine and most in sheep. (2) Glucose addition (10 mM) to the HTK solution roughly doubled the time for ATP to fall to 1 mumol/g dry wt (tATP) in dogs. (3) The greater the lactate production in all three species, the lower the decrease in SAN (ATP + ADP + AMP) from 5 to 120 min of ischemia. (4) A glucose additive in the protective solution led to a significant (p less than .005) increase of SAN in dogs at 120 min of ischemia. A sufficient substrate supply seems to be an essential component of a reliable renal protection.
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PMID:Glucose content and efficiency of glycolysis in protected ischemic kidneys of different species. 212 43

Preventing amputation continues to be a significant challenge when popliteal vascular injuries occur. A retrospective review of cases from the San Diego County (California) Trauma System identified 108 patients with 76 blunt and 32 penetrating arterial injuries. The limb preservation rate was 88%; there were 13 amputations. The fracture-dislocated knee injury and close-range shotgun blasts were particularly limb threatening. In general, the trauma system achieved rapid evaluation of injuries and early operative intervention. All 13 patients who underwent amputations presented with signs of severe ischemia. Concomitant injuries to the popliteal vein, tibial nerves, and soft tissue were significantly more frequent in patients who underwent amputations. The importance of complete fasciotomy for compartment hypertension, early reconstructive management of soft-tissue injuries, and expeditious arterial repair, frequently without preoperative roentgenographic suite arteriography, is emphasized. An aggressive, multidisciplinary approach is required to achieve a functional extremity when popliteal vascular trauma occurs.
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PMID:Popliteal vascular trauma. A community experience. 222 73

Acute myocardial infarction can be stratified into electrocardiographic subsets based on the presence or absence of new Q waves. This stratification has important clinical and prognostic utility. Coronary angiography during acute non-Q-wave compared with Q-wave infarction shows much higher infarct-related artery patency rates (about 75 vs. 10%) and increased coronary collateralization. Culprit legion morphology in non-Q-wave infarction commonly is complex. The frequent demonstration of recurrent clinical ischemia, or residual thallium-201 uptake abnormalities, and metabolic activity on persistent emission tomography suggest the presence of viable myocardium in the distribution of the non-Q-wave infarction usually represents 20-25% of acute myocardial infarctions. The University of California San Diego Collaborative Postinfarction Database and other large studies have found non-Q-wave infarctions to be more common in patients with a history of previous infarction and congestive heart failure, although their mortality during acute hospitalization is lower. However, in long-term followup to one year and beyond, non-Q-wave infarct mortality rates equal those of Q-wave infarction. Patients at low early and late risk of mortality include those with a first infarction who are under age 70, whereas patients with evidence of residual ischemia postinfarction are at increased risk of events. It is interesting to speculate that the settings of unstable angina pectoris, non-Q-wave infarction, and perhaps the picture after thrombolysis for acute myocardial infarction, have pathophysiologic similarities which may carry implications for future research and therapy.
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PMID:Non-Q-wave myocardial infarction: incidence, pathophysiology, and clinical course compared with Q-wave infarction. 269 Nov 40

Several techniques have been used to revascularize the visceral circulation. Although initially successful, these repairs often have a significant rate of late occlusion. To determine the durability of transaortic endarterectomy (TEA) and antegrade aortovisceral grafting, we reviewed the last 67 consecutive patients operated on at the University of California, San Francisco for chronic visceral ischemia. The patients were principally middle-aged (mean, 59 years) women (76%) with atherosclerotic disease involving at least two major visceral arteries. Forty-seven patients underwent TEA; 22 patients had associated renal endarterectomy, and 15 patients had simultaneous aortic reconstructions. Twenty patients had an aortovisceral antegrade bypass placed as their only reconstruction. Two of these had concomitant aortic reconstructions. There were five perioperative deaths. Of the 62 patients available for follow-up, 60 patients who had a total of 111 major visceral branch repairs have been followed up for 6 months to 14 years (mean, 4.4 years). Four patients (7%) have had recurrent visceral ischemia. Two patients had recurrent symptoms and have been asymptomatic for nearly 5 and 6 years, respectively, after successful reoperations. Two patients had intestinal infarction and died as a result. Thirty-four patients have had follow-up aortography that showed 58 widely patent reconstructions, two asymptomatic single-vessel stenoses, and one asymptomatic occlusion. TEA and antegrade visceral bypass provided long-term relief of symptoms and prevented visceral gangrene in 56 of 60 patients (93%). The prolonged patency of these reconstructions is attributed to the following: They originate from undiseased or endarterectomized aorta, they provide optimal, nonturbulent flow, and they avoid the inherent technical pitfalls of retrograde grafting.
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PMID:Durability of endarterectomy and antegrade grafts in the treatment of chronic visceral ischemia. 370 42

The influence of retrograde oxygen persufflation (ROP) on renal adenine nucleotide, glucose and lactate contents was examined in canine kidneys during up to 5 days of hypothermic preservation. Organs with or without predamage in 30-min normothermic ischemia were preserved and the results compared to kidneys after hypothermic ischemic storage (HIS): ROP preservation resulted in a significantly higher maintenance of cellular energy-rich substances than in HIS with even normal adenine nucleotide contents and energy charge potentials for the first 24 h. As in HIS preservation of normal kidneys, where the total adenine nucleotide content (SAN) paralleled the loss of viability for the first 1-2 days, in ROP were SAN and even the lactate content also correlated to renal viability for 2-3 days. But in contrast to this correlation, which would favor adenine nucleotide determinations for viability testing, in predamaged kidneys no correlation of SAN or lactate with renal viability was found during HIS or ROP. Thus the determination of cellular energy-rich adenine nucleotides and lactate accumulation confirms the superiority of ROP over HIS preservation. But the SAN or lactate tests lose their prognostic value for posttransplant renal viability if normothermic ischemia precedes the preservation period.
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PMID:Adenine nucleotide levels of canine kidneys during hypothermic aerobic or anaerobic storage in Collins solution. 729 81

Oxygent, a second-generation perfluorocarbon (Perflubron) emulsion (Alliance Pharmaceutical Corporation, San Diego, CA) with superior oxygen delivery characteristics and greater stability than previous perfluorocarbon emulsions, was evaluated as a cerebroprotective agent in a dog model of partial brain stem ischemia. Six dogs were exposed to 20 minutes of isolated brain stem ischemia after receiving an intravenous bolus of Oxygent at a dose of 1.5 ml/kg. Brain stem auditory evoked potentials (BAEP) and regional cerebral blood flow were measured before and during the ischemia and for 5 hours after reperfusion. Changes in BAEP in this group were compared with those in four control dogs that experienced an identical ischemic period but that did not receive Oxygent. During the ischemic period, both control and Oxygent-treated animals experienced a dramatic decline in BAEP to under 10% of the baseline value. After reperfusion, the BAEP increased in both groups to between 50 and 70% of the baseline. In the Oxygent-treated group, the BAEP continued to recover to a final sustained level of over 80% of baseline. In contrast, the control animals suffered a drop in BAEP to 23% of baseline after the brief postischemic peak. The continued improvement in the BAEP in the Oxygent-treated group compared with the control groups suggests that Oxygent may be of some value as a protective agent to the brain stem during ischemia. This effect may be the result of improved oxygen delivery to the brain stem or may be related to other effects of Oxygent, such as reduction of reperfusion injury. Results suggest that Oxygent may be useful as a cerebroprotectant during cerebrovascular surgeries that require temporarily reducing blood flow to the brain stem.
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PMID:Intravenous perflubron emulsion administration improves the recovery of auditory evoked potentials after temporary brain stem ischemia in dogs. 773 16

Acadesine (5-amino-4-imidazole carboxamide riboside) is a purine nucleoside analog that has been shown in animals to reduce myocardial ischemic injury by selectively increasing the availability of adenosine in ischemic tissues. Because patients undergoing coronary artery bypass graft (CABG) surgery are especially vulnerable to developing myocardial ischemia, we investigated whether perioperative use of this adenosine-regulating drug with potential anti-ischemic properties could modify the incidence and severity of perioperative myocardial ischemia. The goals of this study were to evaluate safety and the effects of acadesine on myocardial ischemia, left ventricular function, and, secondarily, on adverse clinical outcomes (myocardial infarction, heart failure, life-threatening dysrhythmias, and death) in patients undergoing CABG surgery. One hundred sixteen patients were randomized to receive one of three continuous intravenous dosing regimens (placebo [control] or one of two doses of acadesine [high- and low-dose infusion]) in double-blind fashion intraoperatively and in the early postoperative period (total infusion time was 7 h). Multidose cold crystalloid cardioplegia (each containing either acadesine or placebo) was used for myocardial protection. All were monitored for potentially drug-related adverse events and the presence of myocardial ischemia was assessed by continuous Holter electrocardiography (ECG) and transesophageal echocardiography (TEE). All patients received standardized anesthetic, surgical, and hemodynamic management during the intraoperative period. All research data (ECG, TEE, outcome data) were evaluated at the coordinating center (San Francisco) in blinded fashion to ensure that uniform data analysis criteria were employed. The administration of acadesine was safe: mild increases in plasma uric acid (a metabolite of acadesine) occurred only in patients receiving high doses (mean increase 1.6 +/- 0.2 mg/dL) and were without clinical sequelae. Before drug administration in the preoperative period (baseline), the incidence and severity of ECG ischemia did not differ among the three groups (placebo = 18%; low-dose = 14%; high-dose = 14%). During prebypass, the incidence of ECG ischemia was similar in all three groups (0%, 3%, 3%, respectively). The incidence of TEE ischemia was numerically lower in the two acadesine groups (high-dose = 6%, low-dose = 15%) than in the control group (19%), but this was not statistically significant (P = 0.22). During postbypass, the incidence of ECG ischemia was 11% in the high-dose group, 22% in the low-dose group, and 18% in the control group (P = 0.42), and TEE ischemia was similar in incidence in all groups (placebo = 29%; low dose = 27%; high-dose = 24%) (P = 0.86).(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:An initial multicenter, randomized controlled trial on the safety and efficacy of acadesine in patients undergoing coronary artery bypass graft surgery. SPI Research Group. 797 87


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