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Query: UMLS:C0432222 (SEM)
 47,337 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Laser Doppler (LD) measures blood flow in approximately one cubic millimeter of tissue. The LD instrument is well suited to the determination of the initiation of flow in the microcirculation after a period of arrest due to externally applied counterpressure. Radioisotope clearance and photoplethysmography have been used to measure skin perfusion pressure (SPP) in an effort to predict healing of ischemic ulcerations and amputation wounds. By placing the LD probe beneath a blood pressure cuff, SPP was measured at the forearm, thigh, calf, foot, dorsal and plantar great toe. The SPP was measured in 32 normal limbs and 26 limbs with rest pain, ulceration or gangrene. Skin of normal extremities and forearm and thigh skin of patients with ischemic lower extremities had a mean SPP of 47 mmHg (+/- 5 SEM). The SPP in ischemic extremities was significantly lower at the calf 22 +/- 4 (p less than .001), the foot 10 +/- 2 (p less than .0001), and the toe 16 +/- 4 (p less than .0001). SPP was greater at the plantar toe (73 +/- 5) than in all other locations. Skin of the plantar toe was unique among the sites measured because it is rich in arteriovenous anastomoses, which have a thermoregulatory function. The higher pressure probably reflects the fact that the larger arterioles have a higher intraluminal pressure than the capillaries and, therefore, a more proximal level of the microcirculation is measured by the LD instrument in thermoregulatory areas of the skin.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Noninvasive determination of skin perfusion pressure using a laser Doppler. 358 24

A totally implanted, intermittently inflatable, silicone rubber cuff, reservoir, and control mechanism were evaluated for use as an artificial sphincter in 18 female beagle dogs that had undergone ileostomy. The dogs were divided into daily 8-hour occlusion, test, and always open, control, groups. Animals were evaluated daily for continence and peristomal irritation. Quantitative aerobic and anaerobic cultures, measurements of ileal accommodation, net fluxes of H2O, Na, K, and taurocholate, fecal fat loss, and urinary excretion of oral 58Co X B12 plus mucosal suction biopsies were done at 4, 12, 24, and 36 weeks. Eight hours of daily occlusion caused dependable continence without causing damage to the underlying or upstream mucosa and significantly reduced the incidence of peristomal erosion (6.8 +/- 0.8 days/dog-days X 100 versus 50.7 +/- 7 days/dog-days X 100 [+/- SEM] [p less than 0.001]). Occlusion also promoted anaerobic bacterial growth (9.00 +/- 0.41 logs versus 6.70 +/- 0.58 logs [p less than 0.001]). Test animals showed significant capacitance accommodation of the terminal ileum without incurring defects in ileal absorptive or secretory function. Gangrenous herniation of small bowel through an aperture formed by an intestinal loop adhering to the capsule surrounding the cuff, device failure, and fibrotic obstruction occurred sporadically as late as 29 weeks after implantation. The artifical sphincter was effective and was physiologically well tolerated, but its specific liabilities require further address.
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PMID:Assessment of an implantable ileostomy sphincter. 401 9

The effects on severe arterial ischaemia of infusions of Prostaglandin E1 (PGE1) a vasodilator and inhibitor of platelet aggregation, were studied in 49 patients (aged 17-80). Criteria for patient selection included rest pain and/or digital ulceration and gangrene secondary to predominantly small vessel disease. PGE1 was infused at a low (6 ng/kg/min), intermediate (10 ng/kg/min) or high (14 ng/kg/min) dose rate via a central venous cannula on 52 occasions without serious side effects. Doppler studies, pulse volume recordings and infra red radiometry were used to quantify the clinical effects. Improvements in digital perfusion were demonstrated by increased pulse volume amplitude (7.1 +/- 1.1 to 21.6 +/- 2.7 mm mean +/- SEM) which remained significantly raised at 6 weeks (14.2 +/- 2.9 mm; P = less than 0.001 paired t test). Infra red digital temperatures were also significantly raised 6 weeks post infusion (27.2 +/- 0.6 degrees C to 29.5 +/- 0.6 degrees C; P less than 0.001). The majority of patients reported improvement in pain, and two thirds of 12 superficial ulcers healed in 6 weeks. These results show that PGE1, improves digital perfusion for several weeks in patients with severe arterial ischaemia.
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PMID:Prostaglandin E1 infusion for small vessel arterial ischaemia. 668 32

We reviewed diabetic gangrene in 104 American blacks and found that the clinical features were similar to those reported for the general diabetic population. We observed, however, that there was a significant association of hypertension with above-knee and bilateral amputations in our patients (P less than .001 and .01, respectively), and that the mean blood pressure of the bilateral amputees (124.5 +/- 3.8 mm Hg) (SEM) was significantly higher (P less than .005) than that of the unilateral amputees (114.4 +/- 1.7 mm Hg). There results suggest a strong association of hypertension with far-advanced occlusive vascular disease of the lower limbs. Moderately severe anemia (hematocrit 20% to 30%) was associated significantly with primary above-knee amputation and mortality (P less than .02 and .05, respectively). Mortality resulted mostly from mixed causes (cardiopulmonary failure, uremia, sepsis, diabetic coma). The dead patients had significantly increased prevalence of cardiac disease (P less than .02), higher frequency of above-knee amputation (P less than .01), and a duration of diabetes (17.4 +/- 2.8 years) significantly longer (P less than .025) than that of the surviving patients (12.0 +/- 1.0 years).
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PMID:Diabetic gangrene in black patients. 706 2

This retrospective study analyses the clinical presentation, surgical management and early outcome of 174 patients (mean age +/- SEM: 73 +/- 15 yrs) admitted for critical limb ischaemia. 145 (84%) had tissue loss at admission: toe gangrene or ischaemic ulcer in 77, and gangrene extending beyond the forefoot in 68. 87 primary limb amputations and 107 revascularisations were performed at iliofemoral (n = 20), suprapopliteal (n = 22) or infrapopliteal level. The postoperative mortality rate was 14% in the "Amputation" group and 9% in the "Revascularisation" group but the difference was not statistically significant. Infective complications were comparable in both groups, although 5 of 14 deaths after amputation were directly related to infection and all deaths after revascularisation resulted from cardiovascular complications. The early limb salvage rate after revascularisation was 82%. 19 secondary limb amputations were performed for bypass failure. Patients in whom primary amputations were required were older (p < 0.03) and had significantly higher rates of heart disease and nonambulatory status (respectively, 24 vs 17%, p < 0.05; and 37 vs 13%, p < 0.001) than patients in whom revascularisation was performed. Ischaemic rest pain and tissue loss confined to digit gangrene or ischaemic ulcer occurred more frequently than extensive gangrene in the "Revascularisation" group (p < 0.0001), while extensive gangrene extending beyond the forefoot occurred more frequently than ischaemic rest pain and tissue loss in the "Amputation" group (p < 0.0001). Late presentation of patients and enhanced tissue loss are probably the reasons for the higher primary amputation rate in our patients compared to that observed elsewhere. In patients amenable to revascularisation (56%), arterial reconstruction for critical limb ischaemia improves the chances of limb salvage.
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PMID:Surgical management of critical limb ischaemia in the French West Indies. 986 59

Wild-type or equipotent variants of recombinant staphylokinase (rSak) were given intra-arterially (as a 2 mg bolus injection followed by an infusion of 1 mg/h or 0.5 mg/h overnight, with concomitant heparin [1000 IU/h]) to 191 patients of less than 80 years (62 +/- 1 years, mean +/- SEM), with a peripheral arterial occlusion (PAO) of less than 120 days (mean 14 +/- 1 days, median 11 days, 5 to 95 percentiles 3 to 30 days). Ninety nine patients presented with acute or subacute ischemia, 57 with severe claudication, 33 with chronic rest pain and 2 with gangrene. Occlusion occurred in 122 native arteries and in 69 grafts. Revascularization was complete in 83 percent (158/191), partial in 13 percent (24/191) and absent in 4 percent (7/191) after administration of 12 +/- 0.5 mg rSak over 14 +/- 0.7 h. Complete revascularization of acute occlusions of popliteal or more distal arteries was less frequent (60 percent, 15/25) than of acute occlusions of more proximal native arteries (95 percent, 37/39, p <0.001) or grafts (89 percent, 50/56, p = 0.005). Additional endovascular procedures were performed in 47 percent and subsequent elective bypass surgery in 23 percent of patients. Major bleeding occurred in 12 percent (23/191), one month mortality was 3.1 percent (6/191) and one year mortality was 6.9 percent (12/174). However, four patients (2.1 percent) had an intracranial bleeding following therapy: a 85 year old woman with severe diabetic arteriopathy, who was included in violation of the protocol, a 79 and a 74-year-old woman and a 74-year-old man, all with severe hypertension and limb threatening ischemia; these four patients died within two months after treatment. Amputations were performed within the first year in 16 of 162 surviving patients (9.8 percent): in 7 percent (7/96) with an occluded native artery and 14 percent (9/66) with an occluded graft (p = 0.19). No significant difference in lysis rate, one month mortality or one year amputation-free survival was observed in occlusions of recent onset (< or =14 days, n = 126) as compared to occlusions of longer duration (>14 days, n = 65). Treatment was interrupted prematurely in 4 patients because of a suspected allergic reaction. Fibrinogen levels remained unaffected during treatment (3.3 +/- 0.1 g/l before vs. 3.3 +/- 0.1 g/l after infusion, n = 167). In conclusion, rSak appears to be a highly effective thrombolytic agent in patients with PAO, resulting in a low one month mortality (3.1 percent) and a high one year amputation free survival (84 percent), with an acceptable incidence of major bleedings, but with occasional fatal intracranial hemorrhages.
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PMID:Outcome and one year follow-up of intra-arterial staphylokinase in 191 patients with peripheral arterial occlusion. 1082 59