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Sample records for acute limb ischaemia

  1. Extravascular incidental findings in run-off CT angiography in patients with acute limb ischaemia: incidence and clinical relevance

    Aim: To evaluate the incidence and clinical relevance of extravascular incidental findings (EVIFs) in CT angiography of the abdominal aorta and lower extremities (run-off CTA) in patients presenting with acute limb ischaemia (ALI). Materials and methods: In this institutional review board-approved, retrospective study, 141 run-off CTA examinations conducted between 2005 and 2013 of patients (67 women, mean age 80 years; 74 men, mean age 69 years) presenting with clinical symptoms of ALI were re-evaluated by two radiologists (2 and 7 years of experience in interpreting run-off CTA). Imaging was conducted using 16- and 64-section CT systems. Image acquisition ranged from the costodiaphragmatic recess to the forefoot. The medical history form of each patient served as the standard of reference for assessment of incidence of EVIFs. CT morphology was assessed to assign EVIFs to one of three categories of clinical relevance: (I) immediate, (II) potential, and (III) no clinical relevance. Results: Thirty-eight patients had category I findings, including four patients (2.8%) with previously unknown malignancy and 67 patients with category II EVIFs. In total 473 extravascular EVIFs were found in 141 patients: 52 category I, 163 category II and 258 category III. Conclusion: EVIFs with immediate clinical relevance are very common in run-off CTA in patients presenting with acute peripheral artery disease. Therefore, it is important to evaluate all body regions included in a CT examination carefully, even if the clinical focus is on vascular evaluation. The adequate classification of these EVIFs is required to avoid possible unnecessary diagnostic work-up with associated risks and costs. - Highlights: • Run-off CTA in patients with acute PAD often reveals EVIF. • The CT appearance allows a classification of EVIFs into categories. • Prior unknown cancer was present in 2.8% of the patients. • Classification of EVIF is important to prevent unnecessary diagnostic work-up.

  2. Acute ischaemias as a result of vasospasm following thrombosis prophylaxis with Dihydroergotamine/Heparin

    Vasospastic reactions with ischaemia following combined thrombosis prophylaxis with dihydroergotamine and heparin were reported in literature several times. This article reports 3 cases involving ischaemia following traumas to the limb, and 2 cases with ischaemia developing after surgical traumas. Acute renal insufficiency was observed in a patient with spasms of the renal arteries for the first time who sustained renal insufficiency requiring dialysis as a late sequela. Though rare, thromboembolism prophylaxis using dihydroergotamine/heparin may cause serious sequelae; hence, any combined thrombosis prophylaxis with require a critical indication. (orig.)

  3. Acute ischaemias as a result of vasospasm following thrombosis prophylaxis with Dihydroergotamine/Heparin

    Meybier, H.; Kraemer, K.L.; Maeder, N.; Allenberg, J.R.; Kretzschmar, U.

    1987-08-01

    Vasospastic reactions with ischaemia following combined thrombosis prophylaxis with dihydroergotamine and heparin were reported in literature several times. This article reports 3 cases involving ischaemia following traumas to the limb, and 2 cases with ischaemia developing after surgical traumas. Acute renal insufficiency was observed in a patient with spasms of the renal arteries for the first time who sustained renal insufficiency requiring dialysis as a late sequela. Though rare, thromboembolism prophylaxis using dihydroergotamine/heparin may cause serious sequelae; hence, any combined thrombosis prophylaxis with require a critical indication. (orig.)

  4. Regularity of hypoxia inducible factor 1 alpha expression in acute myocardial ischaemia in rats

    LI Zhi-gang; WANG Jiang-feng; CHENG Jian-ding; LIU Yan-wei; XING Hao-wei; WANG Yong; CHEN Yu-chuan

    2007-01-01

    @@ Acute myocardial ischaemia is a common acute disease and a common cause of sudden death. However, it is difficult to diagnose in patients who died within 6 hours after the onset of myocardial ischaemia.

  5. Lower limb ischaemia and reperfusion injury in healthy volunteers measured by oxidative and inflammatory biomarkers

    Halladin, N. L.; Busch, Sarah Victoria Ekeløf; Alamili, M.;

    2015-01-01

    OBJECTIVE: Ischaemia-reperfusion (IR) injury is partly caused by the release of reactive oxygen species and cytokines and may result in remote organ injury. Surgical patients are exposed to surgical stress and anaesthesia, both of which can influence the IR response. An IR model without these...... at any sampling time. CONCLUSION: Twenty minutes of lower limb ischaemia does not result in an ischaemia-reperfusion injury in healthy volunteers, measurable by oxidative and pro- and anti-inflammatory biomarkers in muscle biopsies and in the systemic circulation....

  6. Percutaneous transluminal angioplasty of iliac and femoral arteries in severe lower-limb ischaemia

    Jørgensen, B; Henriksen, L O; Karle, A;

    1988-01-01

    Percutaneous transluminal angioplasty was performed 92 times in 86 patients with severe lower-limb ischaemia (40% occlusion), giving rise to rest pain and/or gangrene. The patients were thereafter observed for periods up to 5 years. Criteria for success were appearance of normal groin pulse (iliac...

  7. Spinal cord stimulation to achieve wound healing in a primary lower limb critical ischaemia referral centre.

    De Caridi, Giovanni; Massara, Mafalda; David, Antonio; Giardina, Massimiliano; La Spada, Michele; Stilo, Francesco; Spinelli, Francesco; Grande, Raffaele; Butrico, Lucia; de Franciscis, Stefano; Serra, Raffaele

    2016-04-01

    Critical lower limb ischaemia is a diffuse pathology that could cause claudication, severe ischaemic pain and tissue loss. The common treatment includes modification of risk factors, pharmacological therapy and endovascular or surgical revascularisation of the lower limb to restore a pulsatile flow distally. Spinal cord stimulator is seen as a valid alternative in patients unsuitable for revascularisation after endovascular or surgical revascularisation failure and as adjuvant therapy in the presence of a functioning bypass in patients with extensive tissue loss and gangrene presenting a slow and difficult wound healing. We report our experience on spinal cord stimulation (SCS) indication and implantation in patients with critical lower limb ischaemia, at a high-volume centre for the treatment of peripheral arterial disease. PMID:24712687

  8. Sequential aortofemoropopliteal/distal bypass for treatment of critical lower-limb ischaemia.

    Zukauskas, G; Ulevicius, H; Triponis, V

    1995-12-01

    Multilevel arterial occlusive disease is often the main cause of critical ischaemia of the lower limb. The aim of this study was to determine the diagnostic criteria that could help select patients for sequential aortofemoropopliteal/distal reconstruction and to compare the results after simultaneous and two-stage surgery. Some 1953 aortofemoral reconstructions were performed during a 6-year period (1987-1992). In 245 cases (12.5%) sequential aortofemorodistal (popliteal or tibia) procedures were performed for critical limb ischaemia Fontaine classification grade III and IV. Two-segment reconstructions were performed in one stage in 161 cases (group A), and two separate operations were performed, the outflow procedure usually following within 12 months after inflow surgery, in 84 cases (group B). The preoperative mortality rates were 3.2% in group A (five deaths) and 5.9% in group B (five deaths). Limb salvage rates were 95.6% at 1 year and 90.4% at 5 years for group A and 88.8% at 1 year and 80.0% at 5 years for group B. Primary inflow bypass patency rates were 97.7% at 1 year and 91.3% at 5 years for group A and 93.4% at 1 year and 76.3% at 5 years for group B, while secondary inflow bypass patency rates were 98.8% at 1 and 5 years for group A, and 95.3% and 88.3% at 1 and five years respectively for group B. Primary outflow bypass patency rates were 91.4% at 1 year and 65.5% at 5 years for group A, and 84.9% at 1 year and 59.4% at 5 years for group B. Secondary outflow bypass patency rates were 92.2% at 1 year and 81.8% at 5 years for group A, and 86.1% at 1 year and 65.9% at 5 years for group B. The data demonstrate that single-stage multisegment reconstruction for multilevel arterial occlusive disease is a safe and effective method of treating critical limb ischaemia. PMID:8745192

  9. Thrombolysis significantly reduces transient myocardial ischaemia following first acute myocardial infarction

    Mickley, H; Pless, P; Nielsen, J R;

    1992-01-01

    In order to investigate whether thrombolysis affects residual myocardial ischaemia, we prospectively performed a predischarge maximal exercise test and early out-of-hospital ambulatory ST segment monitoring in 123 consecutive men surviving a first acute myocardial infarction (AMI). Seventy...... less than 0.02). Thrombolysis resulted in a non-significant reduction in exercise-induced ST segment depression: prevalence 43% vs 62% in controls. However, during ambulatory monitoring the duration of transient myocardial ischaemia was significantly reduced in thrombolysed patients: 322 min vs 1144...... myocardial ischaemia. This may explain the improvement in myocardial function during physical activities, which was also observed in this study....

  10. Tibial corticotomy and periosteal elevation induce angiogenesis in chronic critical limb ischaemia.

    El-Awady, Saleh; Ali, Ayman M; Kumber, Osama; El-Maksoud, Sied Abd; Fareed, Mohamed

    2008-12-01

    Corticotomy and periosteal elevation as a surgical procedure for management of chronic critical limb ischaemia is a relatively new technique. The current study aimed at assessing its safety, efficiency and cost/benefit ratio. The procedure was performed in 36patients. Preoperative documentation for age, sex, co-morbidities, ankle systolic pressure, and magnetic resonance contrast angiography was obtained. Early results included evaluation of skin perfusion. Late results involved assessment of wound healing, which was documented with photographs and was graded (healed, healing, resistant, recurrent), pain (intermittent claudication and pain at rest), Kelkar score, procedure morbidity, patient satisfaction and quality of life. Mean age was 68.03 +/- 5.5 years; 23 patients were males (63.9%) and 13 females (36.1%). Twenty (55.6%) patients had ankle systolic pressure < 50 mmHg and 29 (80.5%) had infra-inguinal vascular disease. Skin perfusion improved in 33/36 patients (91.7%). At final follow-up, 34 patients (94.1%) achieved complete wound healing. Relief from ischaemic rest pain and intermittent claudication was achieved in 86.1% and 55.6% respectively, with 20 (55.6%) patients having an excellent Kelkar score. Only one patient required a major amputation. Morbidity was noted in 17.7% of cases. Patient satisfaction scores at 12 months and at final follow-up were 7.1 +/- 1.3, and 8.7 +/- 1.7 respectively, on a scale from 0 to 10. Quality of life was markedly improved as compared to the preoperative status (overall score: p = 0.05, mental health scale: p <0.05 and pain/anxiety domain: p < 0.001). The procedure appears to represent an interesting tool, which should be evaluated in randomised studies. Our findings support the postulated angiogenic effect of the fracture haematoma. PMID:19205331

  11. Endovascular interventional therapy for acute limb ischemia

    Acute limb ischemia is an urgent and common clinical condition which occurs when the blood flow to a certain extremity is suddenly blocked b either embolic agent or thrombotic vascular lesion. Prompt restoration of perfusion through early intervention can significantly decrease the incidence of amputation and mortality. The main therapeutic methods include surgical operation and endovascular interventional technique. For recent years, considerable progress in treating acute limb ischemia with endovascular interventional technique has been achieved. This article aims to make a comprehensive review in respect of the endovascular intervention therapy for acute limb ischemia. (authors)

  12. Importance of thrombosis and thrombolysis in silent ischaemia: comparison of patients with acute myocardial infarction and unstable angina.

    Gurfinkel, E.; Altman, R.; Scazziota, A.; Rouvier, J.; Mautner, B

    1994-01-01

    OBJECTIVE--To investigate whether plaque rupture and thrombosis have a role in silent ischaemia as well as in unstable angina. DESIGN--Prospective analysis of the results of haemostatic diagnostic tests at the moment of developing silent ischaemia at rest. SETTING--Coronary care unit. PATIENTS--22 patients with acute myocardial infarction, 12 patients with symptomatic angina (unstable angina), and 10 normal volunteers (control group). INTERVENTIONS--Continuous cardiac monitoring detected 15 a...

  13. [Use of drug-free methods of treatment in comprehensive therapy of patients with stage II chronic lower limb ischaemia].

    Makarov, I V; Lukashova, A V

    2016-01-01

    Analysed herein are the results of treating a total of 139 patients presenting with stage II chronic lower limb ischaemia. The patients were subdivided into three groups, depending on the variant of treatment performed. Group One patients (n=57) received standard conservative therapy combined with ozone therapy, with the Group being further subdivided into two subgroups: patients of subgroup 1a (n=28) were subjected to intravenous administration of ozonated physiological solution (OPS), subgroup 1b patients (n=29) were given big autohemoozonetherapy (BAT). Group Two patients (n=62) underwent complex treatment including beside medical ozone gravitation therapy (GT). Group Two patients were also subdivided into two subgroups: subgroup 2a patients (n=31) received standard conservative therapy combined with OPS and GT, subgroup 2b patients (n=31) received standard conservative therapy in combination with BAT and GT. Group Three (Control Group) was composed of 20 patients receiving standard conservative therapy alone. The highest efficacy was observed in the subgroup of patients receiving OPS and GT, with the patients of this subgroup showing a statistically significant increase in the pain-free walking distance by 116.5% and in the ankle-brachial index by 49.2%, also demonstrating the most pronounced positive dynamics of lipid metabolism parameters: a decrease in total cholesterol by 21.3%, low density lipoproteins by 25.4%, very low density lipoproteins by 24.2% and triglycerides by 18.5%. Besides, a tendency was observed towards normalization of the haemostasis system indices: fibrinogen decreased by 21.8%, prothrombin index by 13%, fibrin monomer complexes retraction by 18.2%, and the clotting time increased by 20.7%. Hence, combined use of ozonated physiological solution and gravitation therapy in treatment of patients with stage II chronic lower limb ischaemia promotes a considerable increase in the pain-free walking distance and ankle-brachial index, as well as

  14. Lidoflazine in the early stages of acute myocardial ischaemia.

    Coker, S. J.; Fagbemi, O.; Parratt, J R

    1982-01-01

    1 Pretreatment of anaesthetized rats with intravenously administered lidoflazine (an antianginal agent) reduced the incidence and severity of ventricular arrhythmias which resulted from acute coronary artery ligation. Ventricular fibrillation was completely prevented by doses of 50 micrograms/kg and 2 mg/kg and no animal so treated died ( contrast 50% incidence of fibrillation in the controls and 30% mortality). 2 In anaesthetized greyhound dogs, lidoflazine (2 mg/kg) administration resulted ...

  15. One of the most urgent vascular circumstances: Acute limb ischemia

    Acar, Rezzan D; Sahin, Muslum; Kirma, Cevat

    2013-01-01

    Acute limb ischemia is a sudden decrease in limb perfusion that threatens limb viability and requires urgent evaluation and management. Most of the causes of acute limb ischemia are thrombosis of a limb artery or bypass graft, embolism from the heart or a disease artery, dissection, and trauma. Assessment determines whether the limb is viable or irreversibly damaged. Prompt diagnosis and revascularization by means of catheter-based thrombolysis or thrombectomy and by surgery reduce the risk o...

  16. Re-do operations after failed multisegmental reconstructive arterial surgery for critical limb ischaemia.

    Zukauskas, G; Ulevicius, H; Janusauskas, E

    1997-08-01

    The purpose of this study was to investigate the long-term graft patency rates after multisegmental arterial reconstruction for treatment of chronic critical limb ischemia, and to evaluate the role of re-do surgery in treatment of graft failure. A total of 449 aortofemoropopliteal/tibial grafts carried out over a 10-year period were retrospectively reviewed. All patients were operated upon with chronic critical limb ischemia grade III and IV according to the Fontaine classification; 221 operations were performed in one stage (group A), and 228 in two stages (group B). Distribution of graft failures in the postoperative period, re-do operations and their impact on limb salvage were investigated using life-table methods. During follow up, 62 cases of inflow graft thrombosis were observed (23 in group A and 39 in group B). To correct the inflow graft failure, 59 re-do procedures were performed (27 in group A, 32 in group B). Inflow graft failures were most common during 24 months after primary surgery. During the same period, 92 cases of isolated outflow graft thrombosis were observed (45 in group A and 47 in group B). Outflow graft thromboses were most common after 24-36 months. For treatment of recurrent symptoms caused by outflow graft thrombosis, 68 re-do operations were performed. The 5 year cumulative primary graft patency, secondary graft patency and limb salvage rates were 43.2%, 71.8% and 79.9% in group A, and 23.8%, 54% and 67.5% in group B respectively. In conclusion the long term primary graft patency rate after multisegmental aortofemoropopliteal/tibial reconstructive surgery is low and significantly lower, when compared with single segment reconstructions. Re-do operations have a positive impact on secondary long-term graft patency and limb salvage. PMID:9350799

  17. Endovascular Management of Acute Limb Ischemia.

    Hynes, Brian G

    2011-09-14

    Despite major advances in pharmacologic and endovascular therapies, acute limb ischemia (ALI) continues to result in significant morbidity and mortality. The incidence of ALI may be as high as 13-17 cases per 100,000 people per year, with mortality rates approaching 18% in some series. This review will address the contemporary endovascular management of ALI encompassing pharmacologic and percutaneous interventional treatment strategies.

  18. The path from art to evidence in treating critical limb ischaemia--reflections on 35 years' experience.

    Lepäntalo, M

    2012-01-01

    Despite numerous attempts, chronic critical limb ischaemia (CLI) has not been unequivocally defined as yet. Its epidemiology is poorly investigated and its prevalence probably higher than anticipated. It is accompanied by high mortality and morbidity irrespective of the way it is treated. Its management is very expensive. Additionally, the prevailing diabetes epidemic is increasing the need for revascularizations although there is a clear lack of evidence as to when to revascularize an ulcerated diabetic foot. The fast development of endovascular techniques blurs the vision as the window of opportunity for gathering proper evidence keeps narrowing. The notion of endovascular artistry prevails, but attempts to conduct proper studies with clear definitions, strict criteria and appropriate outcome measures in a standardised manner should continue--preferably using propensity scoring if randomised controlled trials are not possible. This review highlights some of the steps leading from art to evidence and illustrates the difficulties encountered along the path. In parallel with this overview, the progress of the treatment for CLI in Finland is described from the perspective of the work concluded at Helsinki University Central Hospital. PMID:22623439

  19. Prognostic significance of transient myocardial ischaemia after first acute myocardial infarction: five year follow up study

    Mickley, H; Nielsen, J R; Berning, J;

    1995-01-01

    OBJECTIVE: To assess the five year prognostic significance of transient myocardial ischaemia on ambulatory monitoring after a first acute myocardial infarction, and to compare the diagnostic and long term prognostic value of ambulatory ST segment monitoring, maximal exercise testing, and...... infarction. MAIN OUTCOME MEASURES: Relation of ambulatory ST segment depression, exercise test variables, and left ventricular ejection fraction to subsequent objective (cardiac death or myocardial infarction) or subjective (need for coronary revascularisation) events. RESULTS: 23 of the 123 patients had...... a first myocardial infarction who can perform exercise tests before discharge. Patients at high risk of future myocardial infarction or death from cardiac causes are not identified. Ambulatory monitoring and exertional angina distinguish a small subset of patients who will develop severe angina...

  20. Acute upper arm ischaemia: a rare presentation of non-Hodgkin's lymphoma.

    Daruwalla, Z J

    2010-12-01

    Digital ischaemia has been sparsely reported in current literature. Its association with lymphomatous conditions has been described in even more exceptional occurrences. We present the first case of upper arm ischaemia associated with non-Hodgkin\\'s lymphoma. A brief literature review of this rare phenomenon is also accompanied with it.

  1. Inhibition of cyclo-oxygenase-2 exacerbates ischaemia-induced acute myocardial dysfunction in the rabbit

    Rossoni, Giuseppe; Muscara, Marcelo N.; Cirino, Giuseppe; Wallace, John L

    2002-01-01

    The effects of treatment with a number of cyclo-oxygenase inhibitors, (celecoxib, meloxicam, DuP-697 and aspirin) on ischaemia-reperfusion-induced myocardial dysfunction were examined using an in vitro perfused rabbit heart model.Ischaemia resulted in myocardial dysfunction, as indicated by a significant increase in left ventricular end diastolic pressure and marked changes in coronary perfusion pressure and left ventricular developed pressure. In the post-ischaemic state, coronary perfusion ...

  2. Thrombolytic therapy in acute lower limb ischemia.

    Pilger, E

    1996-01-01

    Surgical revascularization as the initial therapy in acute lower limb ischemia (ALLI) is associated with a high cumulative mortality and amputation rate. Catheter-directed delivery of low-dose thrombolytic agents (intra-arterial thrombolysis, IAT) offers the possibility for a gentle revascularization with a minimum of stress for the patients. In two randomized studies, the primary rates of revascularization, amputation, and mortality did not differ significantly between IAT and surgical revascularization. However, in one study the 6-month event-free survival rate was 85% in the IAT group, and 63% in the surgical group. Also in the second study the 12-month results were significantly better in the IAT group (event-free survival 75%) than in the surgical group (event free survival 52%). The high-dose urokinase regimen recommended by some authors in IAT is associated with an unacceptable cerebral bleeding rate of up to 2%. Low-dose recombinant tissue-type plasminogen activator (rt-PA) (0.02 to 0.05 mg/h) is the most suitable agent in IAT because of rapid lysis and low bleeding complications. Patients with ALLI, classified as viable or threatened without neurologic deficit, benefit most from the IAT as the initial therapy in ALLI. When IAT is performed as the initial therapy in ALLI, surgical intervention becomes unnecessary in approximately one-third of the patients. In another third the subsequent correction of the cause of the ALLI can be performed electively, which reduces mortality and morbidity rates. PMID:8711491

  3. Lumbar sympathectomy under CT guidance: therapeutic option in critical limb ischaemia; la simpaticolisi TC guidata: alternativa terapeutica delle ischemie critiche

    Pieri, Stefano; Agresti, Paolo [Az. Osp. S. Camillo-Forlanini, Roma (Italy). U.O. di radiologia vascolare ed interventistica; Ialongo, Pasquale; Fedeli, Stefano [Radiologia diagnostica Busi, Roma (Italy); Di Cesare, Fabio; Ricci, Guiseppe [Az. Osp. S. Camillo-Forlanini, Roma (Italy). Chirurgia vascolare

    2005-04-01

    Purpose: Lumbar sympathectomy is a complementary therapeutic option for patients with severe peripheral vascular occlusive disease presenting rest pain or gangrene and not eligible for surgical revascularisation. Traditional surgical sympathectomy was widely used in the past. However, due to its invasive character, it has increasingly been replaced by percutaneous techniques and, in some recent cases, by laparoscopic procedures. Percutaneous lumbar sympathectomy is a safe, cost-effective and widely available treatment option. We report our experience on 19 patients subjected to percutaneous sympathectomy under CT guidance. Materials and methods: Between 1998 and 2000, 19 patients underwent percutaneous sympathectomy under CT guidance. All patients had severe vascular disease of the lower extremities (Fontaine stage IV), with rest pain and gangrene. They were not eligible for surgical revascularization. Phenol was injected at the level of L2 and L4 using two 22 G needles (15 cm long). Signs of interrupted sympathetic activity usually occur 2'-15' after the procedure with warmth and flushing and dryness of the lower extremities. Results: Percutaneous sympathectomy under CT guidance is a simple, safe and well-tolerated procedure with a low rate of complications. Of the 19 patients, 9 (47.3%) showed clinical improvement, whereas 5 experienced a worsening of ischaemia in the month immediately following the procedure. Discussion: Results suggest that percutaneous lumbar sympathectomy causes a sympathetic blockade in patients with advanced vascular disease of the limb. CT guidance ensures a high level of precision in drug dosing, thus lowering the risk of complications. Although the results are demoralizing. the impossibility of achieving surgical revascularisation in advanced peripheral arteriosclerosis enhances the role of Ct-guided percutaneous sympathectomy in relieving rest pain and healing ulcers in order to postpone the amputation. [Italian] Scopo: La

  4. Protective effects of dexrazoxane against acute ischaemia/reperfusion injury of rat hearts

    Neckář, Jan; Boudíková, Adéla; Mandíková, Petra; Štěrba, M.; Popelová, O.; Mikšík, Ivan; Dabrowská, L.; Mráz, J.; Geršl, V.; Kolář, František

    2012-01-01

    Roč. 90, č. 9 (2012), s. 1303-1310. ISSN 0008-4212 R&D Projects: GA AV ČR(CZ) IAAX01110901; GA ČR(CZ) GA305/09/0416 Institutional research plan: CEZ:AV0Z50110509 Keywords : heart * dexrazoxane * ischaemia * reperfusion * infarct size * arrhythmias * cardioprotection * reactive oxygen species Subject RIV: FR - Pharmacology ; Medidal Chemistry Impact factor: 1.556, year: 2012

  5. Inhibition of the group I mGluRs reduces acute brain damage and improves long-term histological outcomes after photothrombosis-induced ischaemia

    Hailong Li; Nannan Zhang; Grace Sun; Shinghua Ding

    2013-01-01

    Group I mGluRs (metabotropic glutamate receptors), including mGluR1 and mGluR5, are GPCRs (G-protein coupled receptors) and play important roles in physiology and pathology. Studies on their role in cerebral ischaemia have provided controversial results. In this study, we used a PT (photothrombosis)-induced ischaemia model to investigate whether antagonists to the group I mGluRs may offer acute and long-term protective effects in adult mice. Our results demonstrated that administration with m...

  6. Activated protein C attenuates acute ischaemia reperfusion injury in skeletal muscle.

    Dillon, J P

    2012-02-03

    Activated protein C (APC) is an endogenous anti-coagulant with anti-inflammatory properties. The purpose of the present study was to evaluate the effects of activated protein C in the setting of skeletal muscle ischaemia reperfusion injury (IRI). IRI was induced in rats by applying rubber bands above the levels of the greater trochanters bilaterally for a period of 2h followed by 12h reperfusion. Treatment groups received either equal volumes of normal saline or activated protein C prior to tourniquet release. Following 12h reperfusion, muscle function was assessed electrophysiologically by electrical field stimulation. The animals were then sacrificed and skeletal muscle harvested for evaluation. Activated protein C significantly attenuated skeletal muscle reperfusion injury as shown by reduced myeloperoxidase content, wet to dry ratio and electrical properties of skeletal muscle. Further in vitro work was carried out on neutrophils isolated from healthy volunteers to determine the direct effect of APC on neutrophil function. The effects of APC on TNF-alpha stimulated neutrophils were examined by measuring CD18 expression as well as reactive oxygen species generation. The in vitro work demonstrated a reduction in CD18 expression and reactive oxygen species generation. We conclude that activated protein C may have a protective role in the setting of skeletal muscle ischaemia reperfusion injury and that this is in part mediated by a direct inhibitory effect on neutrophil activation.

  7. Acute limb ischemia in cancer patients: should we surgically intervene?

    Tsang, Julian S

    2012-02-01

    BACKGROUND: Cancer patients have an increased risk of venous thromboembolic events. Certain chemotherapeutic agents have also been associated with the development of thrombosis. Reported cases of acute arterial ischemic episodes in cancer patients are rare. METHODS: Patients who underwent surgery for acute limb ischemia associated with malignancy in a university teaching hospital over a 10-year period were identified. Patient demographics, cancer type, chemotherapy use, site of thromboembolism, treatment and outcome were recorded. RESULTS: Four hundred nineteen patients underwent surgical intervention for acute arterial ischemia, 16 of these patients (3.8%) had associated cancer. Commonest cancer sites were the urogenital tract (n = 5) and the lungs (n = 5). Eight patients (50%) had been recently diagnosed with cancer, and four (25%) of these cancers were incidental findings after presentation with acute limb ischemia. Four patients (25%) developed acute ischemia during chemotherapy. The superficial femoral artery was the most frequent site of occlusion (50%), followed by the brachial (18%) and popliteal (12%) arteries. All patients underwent thromboembolectomy, but two (12%) patients subsequently required a bypass procedure. Six patients (37%) had limb loss, and in-patient mortality was 12%. Histology revealed that all occlusions were due to thromboembolism, with no tumor cells identified. At follow-up, 44% of patients were found to be alive after 1 year. CONCLUSION: Cancer and chemotherapy can predispose patients to acute arterial ischemia. Unlike other reports that view this finding as a preterminal event most appropriately treated by palliative measures, in this series, early diagnosis and surgical intervention enabled limb salvage and patient survival.

  8. Sustained Isoprostane E2 Elevation, Inflammation and Fibrosis after Acute Ischaemia-Reperfusion Injury Are Reduced by Pregnane X Receptor Activation.

    Aimen O Amer

    Full Text Available Liver grafts donated after cardiac death are increasingly used to expand the donor pool but are prone to ischaemic-type biliary lesions. The anti-inflammatory effects of the activated pregnane X receptor have previously been shown to be beneficial in a number of inflammatory liver conditions. However, its role in reducing peri-portal inflammation and fibrosis following ischaemia-reperfusion injury has not been investigated. Hepatic injury and its response to pregnane X receptor activation was examined after partial hepatic ischaemia-reperfusion injury induced by surgically clamping the left and middle lobar blood vessels in rats. Molecular and pathological changes in the liver were examined over the following 28 days. Ischaemia-reperfusion injury resulted in transient cholestasis associated with microvillar changes in biliary epithelial cell membranes and hepatocellular injury which resolved within days after reperfusion. However, in contrast to chemically-induced acute liver injuries, this was followed by sustained elevation in isoprostane E2, peri-portal inflammation and fibrosis that remained unresolved in the ischaemic reperfused lobe for at least 28 days after clamping. Administration of pregnenolone-16α-carbonitrile--a rodent-specific pregnane X receptor activator--resulted in significant reductions in cholestasis, hepatic injury, ischaemic lobe isoprostane E2 levels, peri-portal inflammation and fibrosis. Hepatic ischaemia-reperfusion injury therefore results in inflammatory and fibrotic changes that persist well beyond the initial ischaemic insult. Drug-mediated activation of the pregnane X receptor reduced these adverse changes in rats, suggesting that the pregnane X receptor is a viable drug target to reduce ischaemic-type biliary lesions in recipients of liver transplants donated after cardiac death.

  9. Diagnostic imaging of limbs in children with acute leukemia

    Objective: To evaluate X-ray and MRI features of limbs in childhood acute leukemia. Methods: Thirteen children with acute leukemia in our pediatric hematology ward were recruited. All patients were pathologically diagnosed by bone marrow aspiration and complained of bone or joint pain in the first visit. Conventional X-ray and MRI examinations of algesic sites were performed before clinical treatment and after complete remission. MR images were obtained with SE-T1WI, SE-T2WI and T2WI-fat suppressed sequences and symmetrical bilateralism was requested while scanning. X-ray and MRI manifestations were evaluated and compared. Results: All 13 patients had received X-ray examinations. Among them, 6 had normal X-ray findings, whereas the other 7 (14 sites) showed various abnormalities including radiolucent metaphyseal bands (5 sites), periosteal reaction (3 sites), osteapenia (2 sites), mixed lesions (lysis- sclerosis, 1 site), and permeative pattern (3 sites). The number of patients for MRI examinations was 8 (11 sites). Among them, 6 (9 sites) showed bone marrow infiltration and bone marrow necrosis accompanied by normal X-ray findings, another 2 (2 sites) showed bone marrow infiltration associated with radiographic abnormalities of periosteal reaction and radiolucent metaphyseal bands. Four cases were followed up within 1 week when reached complete remission by chemotherapy. MR images features included reduced sizes of bone marrow infiltration lesions associated with increased signal intensity on T1WI, and disappearance of double-line sign on bone marrow necrosis accompanied by signal homogenization. However, the radiograph before and after treatment in the same cases did not differ significantly. Conclusions: MRI was earlier and more comprehensive in showing limbs bone marrow abnormality than radiogram in acute leukemia children with chief complaint of osteoarticular pains. MRI might be one of indicators in following up therapeutic effect for AL children with

  10. Aortic plaque rupture in the setting of acute lower limb ischemia.

    O'Donnell, David H

    2012-02-01

    Acute aortic plaque rupture is an uncommon cause of acute lower limb ischemia. The authors report sequence computed tomographic imaging of a distal aortic plaque rupture in a young man with bilateral lower limb complications. Clinical awareness, prompt recognition and imaging, and appropriate treatment of this uncommon condition are necessary to improve patient outcomes.

  11. Catheter-directed thrombolysis for the treatment of acute lower limb ischemia: report of 30 cases

    Objective: To discuss the efficacy and safety of catheter-directed thrombolysis in treating acute lower limb ischemia. Methods: During the period from October 2009 to October 2012, 30 patients with acute lower limb ischemia were admitted to authors' hospital and received catheter-directed thrombolysis. The clinical data were retrospectively analyzed. Results: Direct effective response was obtained in 24 patients. Fogarty catheter embolectomy under DSA monitoring had to be carried out in 2 patients as they failed to respond catheter-directed thrombolysis. Two patients underwent amputation as a result of irreversible limb necrosis. One patient died from acute myocardial infarction. One patient died from multiple organs dysfunction caused by the absorption of toxins from the putrid limb. Conclusion: As a kind of minimally- invasive technique for acute lower limb ischemia, catheter-directed thrombolysis is safe and effective. (authors)

  12. A spatiotemporal theory for MRI T2 relaxation time and apparent diffusion coefficient in the brain during acute ischaemia: Application and validation in a rat acute stroke model.

    Knight, Michael J; McGarry, Bryony L; Rogers, Harriet J; Jokivarsi, Kimmo T; Gröhn, Olli Hj; Kauppinen, Risto A

    2016-07-01

    The objective of this study is to present a mathematical model which can describe the spatiotemporal progression of cerebral ischaemia and predict magnetic resonance observables including the apparent diffusion coefficient (ADC) of water and transverse relaxation time T2 This is motivated by the sensitivity of the ADC to the location of cerebral ischaemia and T2 to its time-course, and that it has thus far proven challenging to relate observations of changes in these MR parameters to stroke timing, which is of considerable importance in making treatment choices in clinics. Our mathematical model, called the cytotoxic oedema/dissociation (CED) model, is based on the transit of water from the extra- to the intra-cellular environment (cytotoxic oedema) and concomitant degradation of supramacromolecular and macromolecular structures (such as microtubules and the cytoskeleton). It explains experimental observations of ADC and T2, as well as identifying the rate of spread of effects of ischaemia through a tissue as a dominant system parameter. The model brings the direct extraction of the timing of ischaemic stroke from quantitative MRI closer to reality, as well as providing insight on ischaemia pathology by imaging in general. We anticipate that this may improve patient access to thrombolytic treatment as a future application. PMID:26661188

  13. Acute lower limb compartment syndrome after Cesarean section: a case report

    Sütterlin Marc

    2011-04-01

    Full Text Available Abstract Introduction Acute compartment syndrome of the lower limb is a rare but severe intra- and post-partum complication. Prompt diagnosis is essential to avoid permanent functional restriction or even the loss of the affected limb. Clinical signs and symptoms might be nonspecific, especially in the early stages; therefore, knowledge of predisposing risk factors can be helpful. Case presentation We present the case of a 32-year-old Caucasian woman with acute post-partum compartment syndrome. Conclusion Acute compartment syndrome is an important differential diagnosis for the sudden onset of intra- or post-partum lower-limb pain. Predisposing factors for the manifestation of acute compartment syndrome in an obstetric environment are augmented intra-partum blood loss, prolonged hypotensive episodes and the use of oxytocin to support or induce labor because of its vasoconstrictive properties. Treatment is prompt surgical decompression by performing fasciotomy in any affected muscular compartments.

  14. The interventional intra-arterial thrombolysis of acute ischemia of lower limb in elderly patients

    Objective: To investigate the efficacy and safety of intra-arterial thrombolysis by using interventional procedure for the treatment of acute ischemia of lower limb in elderly patients. Methods: During the period of Sep. 2007-March 2009 intra-arterial thrombolysis through interventional manipulation was performed in 18 elderly patients (aged 60 -87 years) with acute ischemia of lower limb. The clinical data, diagnoses, therapeutic schemes,perioperative complications and their managements, etc. were retrospectively analyzed. The efficacy and safety of intra-arterial thrombolysis for the treatment of acute ischemia of lower limb in elderly patients were evaluated. Results: The interval between the onset of symptom to confirmation of the diagnosis ranged from 4 hours to 12 days. Most patients were accompanied with several kinds of multi-system chronic diseases. Intra-arterial thrombolysis lasting for 1 -3 days was carried out, which was followed by endovascular angioplasty and stent implantation for the residual vascular lesions. The main complications that occurred in 15 patients included bleeding, postoperative fever, limb reperfusion injury, pulmonary embolism, etc. After the treatment,three patients had to receive toe amputation surgery (1 -3 toes), and successful limb salvage was obtained in 14 patients. One patient died of multiple organ failure due to reperfusion injury after revascularization. Conclusion: Intra-arterial thrombolysis with the aid of interventional manipulation is a safe and effective treatment for acute ischemia of lower limb in elderly patients, and in such clinical setting this technique should be considered as the treatment of first choice. (authors)

  15. Critical limb ischaemia in a diabetic population from an Asian Centre: angiographic pattern of disease and 3-year limb salvage rate with percutaneous angioplasty as first line of treatment

    Tan, M; Pua, U; Wong, DES; Punamiya, SJ; Chua, GC; Teo, N

    2010-01-01

    Purpose: Lower extremity amputation prevention (LEAP) is an ongoing program in our institution aimed at salvaging limbs in patients with critical limb ischemia (CLI). Patients in the LEAP program with reconstructible anatomy on initial Doppler imaging received either bypass surgery or percutaneous transluminal balloon angioplasty (PTA). We present the 3 year limb salvage rate and angiographic disease patterns in 42 consecutive diabetic patients with CLI who received PTA in 2005. Methods and M...

  16. Pneumococcal sepsis presenting as acute compartment syndrome of the lower limbs: a case report

    Doddi Sudeendra; Singhal Tarun; Sinha Prakash

    2009-01-01

    Abstract Introduction Acute compartment syndrome is a surgical emergency requiring immediate fasciotomy. Spontaneous onset of acute compartment syndrome of the lower limbs is rare. We present a very rare case of pneumococcal sepsis leading to spontaneous acute compartment syndrome. Case presentation A 40-year-old Caucasian man presented as an emergency with spontaneous onset of pain in both legs and signs of compartment syndrome. This was confirmed on fasciotomy. Blood culture grew Streptococ...

  17. Management of renal dysfunction following term perinatal hypoxia-ischaemia.

    Sweetman, Deirdre U

    2013-03-01

    Acute kidney injury frequently develops following the term perinatal hypoxia-ischaemia. Quantifying the degree of acute kidney injury is difficult, however, as the methods currently in use are suboptimal. Acute kidney injury management is largely supportive with little evidence basis for many interventions. This review discusses management strategies and novel biomarkers that may improve diagnosis and management of renal injury following perinatal hypoxia-ischaemia.

  18. Pneumococcal sepsis presenting as acute compartment syndrome of the lower limbs: a case report

    Doddi Sudeendra

    2009-02-01

    Full Text Available Abstract Introduction Acute compartment syndrome is a surgical emergency requiring immediate fasciotomy. Spontaneous onset of acute compartment syndrome of the lower limbs is rare. We present a very rare case of pneumococcal sepsis leading to spontaneous acute compartment syndrome. Case presentation A 40-year-old Caucasian man presented as an emergency with spontaneous onset of pain in both legs and signs of compartment syndrome. This was confirmed on fasciotomy. Blood culture grew Streptococcus pneumoniae. Conclusion Sepsis should be strongly suspected in bilateral acute compartment syndrome of spontaneous onset.

  19. [Acute and chronic limb ischemia in endurance athletes - a serious diagnosis of exercise-induced lower limb pain].

    Regus, Susanne; Lang, Werner

    2016-07-01

    Lower extremity pain due to acute or chronic ischemia in high performance endurance athletes is an often forgotten differential diagnosis. A variety of symptoms constitues a multi-disciplinary challenge. Intermittent claudication or acute ischemia are clinical symptoms indicative of this vascular disease. The most important basic methods of investigation are anamnesis and clinical examination. Furthermore, the determination of the ankle-brachial index (ABI) and duplexsonography should be considered. In addition, modern cross-sectional imaging techniques such as computed tomography angiography (CTA) or magnetic resonance angiography (MRA) are recommended. In case of suspect findings, the digital substraction angiography (DSA) represents a high resolution image technique for illustration of the vessel lumen. If necessary, interventional therapy (balloon angioplasty or clot lysing) can be performed simultaneously. Surgical revision remains the gold-standard of therapy and the fastest way in which athletes regain maximum performance abilities. Correct diagnosis of lower limb ischemia affecting endurance athletes should be performed without delays. Determining the ankle-brachial index following maximal exertion represents the most important diagnostic tool. Surgical treatment techniques as decompression and revascularisation provide the best long-term results. PMID:27464284

  20. Efficacy of Intravenous Paracetamol Versus Intravenous Morphine in Acute Limb Trauma

    Jalili, Mohammad; Mozaffarpour Noori, Ali; Sedaghat, Mojtaba; Safaie, Arash

    2016-01-01

    Background: Efficient pain management is one of the most important components of care in the field of emergency medicine. Objectives: This study was conducted to compare intravenous paracetamol and intravenous morphine sulfate for acute pain reduction in patients with limb trauma. Patients and Methods: In a randomized double-blinded clinical trial, all patients (aged 18 years and older) with acute limb trauma and a pain score of greater than 3/10 in the emergency department were recruited; they received either 1 g intravenous paracetamol or 0.1 mg/kg intravenous morphine sulfate over 15 minutes. The primary outcome was the pain score measured on a numerical rating scale at 0, 15 and 30 minutes after commencing drug administration. The requirement for rescue analgesia and the frequency of adverse reactions were also recorded. Results: Sixty patients randomly received either IV paracetamol (n = 30) or IV morphine (n = 30). The mean reduction in numerical rating scale pain intensity scores at 30 minutes was 3.86 (± 1.61) for paracetamol, and 2.16 (± 1.39) for morphine. However, pain relief was significantly higher in the paracetamol group compared to the morphine group (P < 0.001). Four patients in the paracetamol group and 15 patients in the morphine group needed rescue analgesia and the difference was significant (P = 0.05). Conclusions: Intravenous paracetamol appears to provide better analgesia than intravenous morphine in acute limb trauma. Further larger studies are required. PMID:27218042

  1. Abdominal aortic occlusion and vascular compromise secondary to acute gastric dilatation in a patient with bulimia

    Elsharif, M; Doulias, T; Aljundi, W; Balchandra, S

    2014-01-01

    Acute gastric dilation is a rare but recognised complication in patients with bulimia and anorexia following binge episodes owing to decreased bowel motility. We present a rare case of acute gastric dilation secondary to bulimia in an otherwise healthy 18-year-old female patient that resulted in compression and complete occlusion of the abdominal aorta, leading to acute mesenteric and bilateral lower limb ischaemia. This resolved immediately following a laparotomy and gastric decompression.

  2. Endovascular diagnostics and treatment of stenosis, acute thrombosis and chronic occlusion of arteries and upper limbs

    Full text: Diseases of the upper limb arteries are significantly rarer than those of the lower limbs but they are not causes and due to the lack of diagnostic algorithms are often missed. the symptoms are not typical except for those in acute thrombosis. The complaints in acute thrombosis is strong, sudden pain in the limb or part of it, bruising or paleness of the ischemic area and a lack of pulsation. Diagnosis is fairly easy – clinical events, difference in blood pressure or a lack of blood pressure in the affected limb, a total lack of blood pressure or a difference in the pressure in the left and right arm. Then complaints in stenosis and chronic occlusions is significantly less pronounced and is expressed as weakness in the affected limb, heaviness, bluish or paleness. If the proximal segments are affected Still’s syndrome is often observed. The complaints is not decisive for diagnosis. A difference in blood pressure of more than 20 mm Hg and an echodoppler examination of the arteries are the main criteria for directing the patients for angiography. Contrast CT and MRT are not used often. treatment is vascular surgery and endovascular. In acute thrombosis priority takes vascular surgery through extraction of the thrombi with Fogerty catheters, and in chronical stenosis and occlusions – dilation and stenting. Clinical cases: Case 1 – Revascularization of artery brachialis, radialis and ulnaris after acute occlusion L.Y., 77 years old. Complains of sharp pain and bruising of right forearm since two hours before hospitalization. A lack of blood flow was identified using palpation and echodoppler. After a diagnostic angiography , thrombaspiration was undertaken, through a leading catheter, recovering blood flow in both arteries and stenting of the proximal segment of artery radialis. Case 2: Revascularization of Trunkus brachiocefalicus K.P., 65 years old. Suffering from bradypsychia for several months. Bradypsychia becomes worse after manual labor

  3. Dynamics of Urinary Calprotectin after Renal Ischaemia

    Ebbing, Jan; Seibert, Felix S.; Pagonas, Nikolaos; Bauer, Frederic; Miller, Kurt; Kempkensteffen, Carsten; Günzel, Karsten; Bachmann, Alexander; Seifert, Hans H.; Rentsch, Cyrill A.; Ardelt, Peter; Wetterauer, Christian; Amico, Patrizia; Babel, Nina; Westhoff, Timm H.

    2016-01-01

    Background: Urinary calprotectin has been identified as a promising biomarker for acute kidney injury. To date, however, the time-dependent changes of this parameter during acute kidney injury remain elusive. The aim of the present work was to define the time-course of urinary calprotectin secretion after ischaemia/reperfusion-induced kidney injury in comparison to neutrophil gelatinase—associated lipocalin, thereby monitoring the extent of tubular damage in nephron sparing surgery for kidney tumours. Methods: The study population consisted of 42 patients. Thirty-two patients underwent either open or endoscopic nephron sparing surgery for kidney tumours. During the surgery, the renal arterial pedicle was clamped with a median ischaemic time of 13 minutes (interquartile range, 4.5–20.3 minutes) in 26 patients. Ten retro-peritoneoscopic living donor nephrectomy patients and 6 nephron sparing surgery patients in whom the renal artery was not clamped served as controls. Urinary calprotectin and neutrophil gelatinase—associated lipocalin concentrations were repeatedly measured by enzyme-linked immunosorbent assay and assessed according to renal function parameters. Results: Urinary concentrations of calprotectin and neutrophil gelatinase—associated lipocalin increased significantly after ischaemia/reperfusion injury, whereas concentrations remained unchanged after nephron sparing surgery without ischaemia/reperfusion injury and after kidney donation. Calprotectin and neutrophil gelatinase—associated lipocalin levels were significantly increased 2 and 8 hours, respectively, post-ischaemia. Both proteins reached maximal concentrations after 48 hours, followed by a subsequent persistent decrease. Maximal neutrophil gelatinase—associated lipocalin and calprotectin concentrations were 9-fold and 69-fold higher than their respective baseline values. The glomerular filtration rate was only transiently impaired at the first post-operative day after ischaemia

  4. Percutaneous hydromechanical thrombectomy in acute and subacute lower-limb ischemia

    Purpose: A prospective study should evaluate the primary and 2-year results of treating acute and subacute lower-limb ischemia with hydromechanical thrombectomy (HTE). Materials and methods: Consecutively 64 patients, 12 with viable and 52 with threatening limb ischemia and onset of symptoms within 8±9 days, were treated and controlled for 24 months. An 8 F hydromechanical thrombectomy device (HTK), was used. It sucks and shreds the thrombi. The shredded particles are transported to the outside. Results: In 8 patients a total, in the others a partial restoration of the vessel lumen up to 70-50% was achieved in a mean time of 34 minutes. Residual thrombi, underlying atherosclerotic vessel disease and occluded arteries with a small diameter made adjunctive interventions (balloon angioplasty, percutaneous aspiration thrombectomy, lysis) necessary. Clinical symptoms and the ankle-brachial index improved significantly (p<0.01). Primary patency was 72%, 70%, 67%, and 65%; the limb salvage rates were 81%, 78%, 75%, and 73% for one, 3, 12, and 24 months respectively. Device-induced complications did not occur. Conclusions: The HTK allowed a rapid reduction of fresh thrombotic material without complications. In 78% of the cases adjunctive therapies are required for wall-adherent thrombi and when tibial vessels with smaller lumina are included. Longterm results are comparable to literature data for fibrinoloytic or operative regimens. The advantage, however of the HTK seems to be the reduction of intervention time and intra-arterial dosage of fibrinolytic drugs. (orig.)

  5. Analysis of temporal dynamics in imagery during acute limb ischemia and reperfusion

    Irvine, John M.; Regan, John; Spain, Tammy A.; Caruso, Joseph D.; Rodriquez, Maricela; Luthra, Rajiv; Forsberg, Jonathon; Crane, Nicole J.; Elster, Eric

    2014-03-01

    Ischemia and reperfusion injuries present major challenges for both military and civilian medicine. Improved methods for assessing the effects and predicting outcome could guide treatment decisions. Specific issues related to ischemia and reperfusion injury can include complications arising from tourniquet use, such as microvascular leakage in the limb, loss of muscle strength and systemic failures leading to hypotension and cardiac failure. Better methods for assessing the viability of limbs/tissues during ischemia and reducing complications arising from reperfusion are critical to improving clinical outcomes for at-risk patients. The purpose of this research is to develop and assess possible prediction models of outcome for acute limb ischemia using a pre-clinical model. Our model relies only on non-invasive imaging data acquired from an animal study. Outcome is measured by pathology and functional scores. We explore color, texture, and temporal features derived from both color and thermal motion imagery acquired during ischemia and reperfusion. The imagery features form the explanatory variables in a model for predicting outcome. Comparing model performance to outcome prediction based on direct observation of blood chemistry, blood gas, urinalysis, and physiological measurements provides a reference standard. Initial results show excellent performance for the imagery-base model, compared to predictions based direct measurements. This paper will present the models and supporting analysis, followed by recommendations for future investigations.

  6. [Open thrombectomy in treatment of acute thromboses of lower-limb deep veins].

    Shaĭdakov, E V; Porembskaia, O Ia; Tsarev, O I; Khmel'niker, S M

    2014-01-01

    Thrombosis of lower-limb deep veins is one of the most common vascular diseases in the world. For a long time the generally accepted treatment policy was conservative therapy with anticoagulants. The article is a review of the literature containing the results of studies carried out over the past two decades and confirming efficacy of surgical treatment for acute venous thrombosis. Presented are the data showing that thrombectomy performed within the first 10-14 days from the onset of the disease, improving quality of life of patients and preventing invalidization thereof. The gained world experience makes it possible to work out the most effective approaches to treatment of acute venous thromboses. PMID:25646547

  7. Aggressive treatment of acute limb ischemia due to thrombosed popliteal aneurysms

    Objective: The absence of infra-popliteal runoff in patients with acute limb ischemia and thrombosed popliteal aneurysms carries a high risk of amputation. A combined treatment method involving thrombolysis and surgery is reported. Material and methods: Information regarding six patients was reviewed. Ankle brachial indices and degree of ischemia were recorded. All patients underwent digital subtraction angiography. In five patients thrombus dissolution was achieved using a combination of mechanical and pharmacologic therapy. One patient was judged incapable of withstanding any delay in reperfusion and was treated with isolated limb perfusion using a thrombolytic agent. All patients underwent surgical revascularization. Follow-up (1-3 years) consisted of duplex examinations at 6 months and yearly thereafter. Results: Five patients had no measurable ankle-brachial index (ABI), while one patient had an ABI of 0.4. Initial angiography noted all patients to have no runoff in continuity to the pedal arch. Following thrombolytic therapy, an adequate bypass vessel was noted in all cases, with reconstitution of the plantar arch in five patients. Distal revascularizations included one peroneal, and five below knee popliteal arterial bypasses. Fasciotomies were performed in four of the six patients. There were no amputations. One patient developed a persistent foot drop. Two patients developed bypass grafts occlusions; one of which required therapy. Conclusion: The pre-operative use of thrombolytic therapy is a safe and effective method to achieve limb salvage in this patient population. Patients must be capable of withstanding an additional period of ischemia allowing for reconstitution of distal runoff. Isolated limb perfusion is of use when a delay to reperfusion cannot be tolerated. (Copyright (c) 1998 Elsevier Science B.V., Amsterdam. All rights reserved.)

  8. Long-term primary patency prognostic factors after endovascular therapy for acute lower limb ischemia

    Objective: To assess prognostic factors regarding long-term primary patency for patients who underwent intra-arterial thrombolysis and/or adjuvant endovascular techniques due to acute lower limb ischemia. Methods: Consecutive patients with ALI of the lower extremities treated via interventional methods between January 2005 and June 2010 were identified and reviewed (exclude patient suffered from aortic dissection involved artery of lower extremity or trauma). Analyze the potential variables with univariable analysis and only factors associated with long-term primary patency with a P value less than 0.1 in univariable analysis were introduced into the Cox regression mode. Total long-term primary patency and grouped primary patency were assessed using Kaplan-Meier estimation. Results: The analyzed dataset included 107 limbs treated in 101 patients presenting with ALI (class Ⅰ 15, class Ⅱ A 36, class Ⅱ B to Ⅲ 56, according to Rutherford classification). Eight nine limbs were enrolled in follow-up.The mean followup was 34 months (range: 1 to 53 months). Primary patency at 12, 24 and 36 months was 87%, 68% and 55%, respectively. Multivariable analyses identified patients presenting with diabetes mellitus (P=0.00), PAOD (P<0.02) and thrombolysis time (P<0.02) were associated with primary patency. Compare the patency rate of patients with different thrombolysis time, the results showed that the patency rate of the patients thrombolysis time less than 4 d was higher than those more than 4 c. Conclusions: Interventional therapy remains an effective treatment option for patients presenting with lower extremity ALI. Diabetes mellitus and PAOD negatively affect the rates of limb primary patency. Thrombolysis should be limited to <4 days. (authors)

  9. Comparison of obstructing blood flow interventional embolectomy and simple interventional embolectomy for acute lower limb arterial embolism

    Objective: To evaluate the effects (mortality, amputation rate, the length and expense of hospital stay, etc)of the obstructing blood flow interventional embolectomy and simple interventional embolectomy for acute lower limb arterial embolism. Methods: 79 cases of acute lower limb arterial embolism including 23 cases of two sites puncturing and obstructing blood flow interventional embolectomy and 56 cases treated by simple interventional embolectomy were retrospectively analyzed and compared. Results: Embolisms were removed in all 79 cases and arteries were reopened successfully. The mortality and the amputation rates of the simple and the obstructing blood flow embolectomies were 5.36%, 19.6%, and 4.35%, 8.70% respectively. Conclusion: Two sites puncturing and obstructing blood flow interventional embolectomy for acute lower limb arterial embolism is simple, safe and effective, comparing with the simple interventional embolectomy, with lower amputation rate, quicker recovery and lower expense, however with no statistical significance in mortalities. (authors)

  10. The effect of acute simvastatin administration on the severity of arrhythmias resulting from ischaemia and reperfusion in the canine: Is there a role for nitric oxide?

    Kisvári, Gábor; Kovács, Mária; Gardi, János; Seprényi, György; Kaszaki, József; Végh, Ágnes

    2014-06-01

    The present study has examined the effects and the possible mechanisms of a single dose of simvastatin on the severity of arrhythmias resulting from a 25min occlusion and reperfusion of the left anterior descending coronary artery in anaesthetized (chloralose and urethane) dogs. The control animals (n=16) were given the solvent of simvastatin by slow (over 5min) intracoronary (ic.) injection just prior to the occlusion. Twenty-six dogs were treated with simvastatin (0.1mg/kg) by the same route, both in the absence (n=15) and in the presence (n=11) of l-NAME. This latter was administered (5mg/kg, ic.) either alone (n=12) or 10min before the simvastatin treatment. The severity of ischaemia (epicardial ST-segment, inhomogeneity) and ventricular arrhythmias (ventricular premature beats [VPBs], ventricular tachycardia [VT] and fibrillation [VF]), plasma nitrite/nitrate levels, myocardial superoxide production and eNOS activity were assessed. Compared with controls simvastatin significantly reduced the number of VPBs (289±34vs. 94±25) and the episodes of VT (5.6±1.3vs. 0.3±0.2), the incidence of VT (88% vs. 20%) and VF (56% vs. 0%) during occlusion and increased survival (0% vs. 33%) on reperfusion. There were also less marked ischaemic changes in the simvastatin-treated dogs than in the controls. Simvastatin preserved eNOS activity and nitric oxide (NO) bioavailability during occlusion and attenuated superoxide production following reperfusion. All these effects of simvastatin (except for the protection against VF) were reversed by l-NAME. We conclude that simvastatin given just prior to ischaemia/reperfusion reduces the severity of arrhythmias. This effect involves both NO-dependent and NO-independent mechanisms. PMID:24685640

  11. Flow-mediated dilation in the inactive limb following acute hypoxic exercise.

    Katayama, Keisho; Yamashita, Shin; Iwamoto, Erika; Ishida, Koji

    2016-01-01

    The purpose of this study was to elucidate the effect of acute aerobic exercise performed under hypoxic conditions on flow-mediated dilation (FMD) in the inactive limb. Seven males participated in the study. The subjects performed two submaximal leg cycling on a semirecumbent ergometer at the same relative intensity (60% peak oxygen uptake) in normoxia [inspired oxygen fraction (FIO2) = 0·21] and hypoxia (FIO2 = 0·12-0·13) for 30 min. The brachial artery diameter and blood velocity during exercise were measured via ultrasound, and the antegrade and retrograde shear rates were calculated. Before and 5, 30 and 60 min after exercise, brachial artery FMD was measured in normoxia. FMD was estimated as the percentage increase in peak diameter from the baseline diameter at prior occlusion (%FMD) and as the controlling changes in baseline diameter (the corrected-%FMD). No difference in antegrade shear rate during exercise was detected between the normoxic and hypoxic conditions, whereas the retrograde shear rate was larger during hypoxic exercise. The %FMD decreased significantly at 5 min after exercise in both normoxia and hypoxia, and it returned to pre-exercise levels within 60 min of recovery. Significant decreases in FMD at 5 min after exercise had disappeared when the baseline diameter was controlled using an analysis of covariance (the corrected-%FMD). No significant differences were observed between the normoxic and hypoxic trials in the %FMD and corrected-%FMD following exercise. These results suggest that hypoxia has no impact on endothelial function in the inactive limb following acute aerobic exercise. PMID:25257848

  12. Total and subtotal amputation of lower limbs treated by acute shortening, revascularization and early limb lengthening with ilizarov ring fixation - a retrospective study.

    Kovoor, C C; George, V V; Jayakumar, R; Guild, A J; Bhaskar, D; Cyriac, A

    2015-10-01

    We present the results of 15 patients who sustained total or subtotal traumatic amputation of the lower limbs who were treated by acute limb shortening and stabilisation with external fixator, revascularization and early lengthening with Ilizarov ring fixator. The mean age of the patients was 28 years [5-38]. There were three females and 12 males. The mean Mangled Extremity Severity Score was 8.5 [range 6-11]. The mean amount of shortening done was 6.9cm [range 3-12.5] to enable revascularization and soft tissue repair. Three cases had to be amputated early because of failure of vascular repair. In the remaining 12 patients who were followed up the mean interval between revascularization and application of Ilizarov ring fixator was 4.7 weeks [range 3-10]. The mean follow up was 6.5 years [3-16 years]. Union occurred in all patients. Ten of the 12 patients returned to work and residual shortening was present in two cases. We conclude that whenever possible lower limb salvage should be undertaken. PMID:26256784

  13. Acute shortening and angulation for limb salvage in a paediatric patient with a high-energy blast injury.

    Pikkel, Yoav Yechezkel; Wilson, Jessica Jeanne; Kassis, Shokrey; Lerner, Alexander

    2014-01-01

    We present the case of an 8-year-old girl casualty of the Syrian conflict who arrived with open fractures of the right tibia and fibula with extensive bone and soft tissue loss as well as an open fracture of the left calcaneus as the result of a high-energy blast injury. She was successfully treated with repeated debridement procedures, external fixation with acute temporary shortening and angulation of the right leg and skin grafting to both lower limbs. PMID:24654251

  14. Robot-assisted upper-limb therapy in acute rehabilitation setting following stroke: Department of Veterans Affairs multisite clinical trial

    Charles G. Burgar, MD; Peter S. Lum, PhD; A. M. Erika Scremin, MD; Susan L. Garber, MA, OTR; H. F. Machiel Van der Loos, PhD; Deborah Kenney, MS, OTR; Peggy Shor, OTR

    2011-01-01

    This randomized, controlled, multisite Departmentof Veterans Affairs clinical trial assessed robot-assisted (RA)upper-limb therapy with the Mirror Image Movement Enabler(MIME) in the acute stroke rehabilitation setting. Hemipareticsubjects (n = 54) received RA therapy using MIME for either upto 15 hours (low-dose) or 30 hours (high-dose) or received up to15 hours of additional conventional therapy in addition to usualcare (control). The primary outcome measure was the Fugl-Meyer Assessment (F...

  15. Chronic inhibition of endoplasmic reticulum stress and inflammation prevents ischaemia-induced vascular pathology in type II diabetic mice

    Amin, Ali; Choi, Soo-Kyoung; Galan, Maria; Kassan, Modar; Partyka, Megan; Kadowitz, Philip; Henrion, Daniel; Trebak, Mohamed; Belmadani, Souad; Matrougui, Khalid

    2012-01-01

    Endoplasmic reticulum (ER) stress and inflammation are important mechanisms that underlie many of the serious consequences of type II diabetes. However, the role of ER stress and inflammation in impaired ischaemia-induced neovascularization in type II diabetes is unknown. We studied ischaemia-induced neovascularization in the hind-limb of 4-week-old db−/db− mice and their controls treated with or without the ER stress inhibitor (tauroursodeoxycholic acid, TUDCA, 150 mg/kg per day) and interle...

  16. Effects of motor imagery combined with functional electrical stimulation on upper limb motor function of patients with acute ischemic stroke

    Shou-feng LIU

    2015-03-01

    Full Text Available Objective To explore the effects of motor imagery (MI combined with the third generation functional electrical stimulation (FES on upper limb motor function in acute ischemic stroke patients with hemiplegia.  Methods Forty acute ischemic stroke patients, within 48 h of onset, were randomly divided into FES group (N = 20 and combination group (FES combined with motor imagery, N = 20. All patients received basic routine rehabilitation training, for example, good limb positioning, accepting braces, balance training and training in the activities of daily living (ADL. FES group received the third generation FES therapy and the combination group also received motor imagery for 2 weeks. All of the patients were assessed with Fugl-Meyer Assessment (FMA, Action Research Arm Test (ARAT and active range of motion (AROM of wrist dorsiflexion before and after 2 weeks of treatment.  Results After 2 weeks of treatment, the 2 groups had significantly higher FMA score, ARAT score and AROM of wrist dorsiflexion than that in pre-treatment (P = 0.000, for all. Besides, the FMA score (t = - 2.528, P = 0.016, ARAT score (t = - 2.562, P = 0.014 and AROM of wrist dorsiflexion (t = - 2.469, P = 0.018 in the combination group were significantly higher than that in the FES group. There were interactions of treatment methods with observation time points (P < 0.05, for all.  Conclusions Motor imagery combined with the third generation FES can effectively promote the recovery of upper limb motor function and motion range of wrist dorsiflexion in patients with acute ischemic stroke. DOI: 10.3969/j.issn.1672-6731.2015.03.008

  17. Myocardial ischaemia during tracheal intubation and extubation.

    Edwards, N D; Alford, A M; Dobson, P M; Peacock, J E; Reilly, C S

    1994-10-01

    The incidence of myocardial ischaemia during tracheal intubation and extubation was compared using ambulatory ECG monitoring in 60 patients undergoing a variety of different surgical operations. Seven patients had myocardial ischaemia after tracheal intubation and seven patients during tracheal extubation. The patients who developed myocardial ischaemia during tracheal extubation had significantly greater rate-pressure products immediately before tracheal extubation (P < 0.05) and 1 min after tracheal extubation (P < 0.01) compared with those patients who did not develop myocardial ischaemia during extubation. PMID:7999498

  18. Tailor-made rehabilitation approach using multiple types of hybrid assistive limb robots for acute stroke patients: A pilot study.

    Fukuda, Hiroyuki; Morishita, Takashi; Ogata, Toshiyasu; Saita, Kazuya; Hyakutake, Koichi; Watanabe, Junko; Shiota, Etsuji; Inoue, Tooru

    2016-01-01

    This article investigated the feasibility of a tailor-made neurorehabilitation approach using multiple types of hybrid assistive limb (HAL) robots for acute stroke patients. We investigated the clinical outcomes of patients who underwent rehabilitation using the HAL robots. The Brunnstrom stage, Barthel index (BI), and functional independence measure (FIM) were evaluated at baseline and when patients were transferred to a rehabilitation facility. Scores were compared between the multiple-robot rehabilitation and single-robot rehabilitation groups. Nine hemiplegic acute stroke patients (five men and four women; mean age 59.4 ± 12.5 years; four hemorrhagic stroke and five ischemic stroke) underwent rehabilitation using multiple types of HAL robots for 19.4 ± 12.5 days, and 14 patients (six men and eight women; mean age 63.2 ± 13.9 years; nine hemorrhagic stroke and five ischemic stroke) underwent rehabilitation using a single type of HAL robot for 14.9 ± 8.9 days. The multiple-robot rehabilitation group showed significantly better outcomes in the Brunnstrom stage of the upper extremity, BI, and FIM scores. To the best of the authors' knowledge, this is the first pilot study demonstrating the feasibility of rehabilitation using multiple exoskeleton robots. The tailor-made rehabilitation approach may be useful for the treatment of acute stroke. PMID:26478988

  19. Success of free flap anastomoses performed within the zone of trauma in acute lower limb reconstruction.

    Bendon, Charlotte L; Giele, Henk P

    2016-07-01

    Traditionally, in free flap cover of lower limb injuries, every attempt is made to perform anastomoses proximal to the zone of injury. We report on the success of anastomoses within the zone of trauma, at the level of the fracture, avoiding further dissection and exposure. The records of free flap reconstructions for fractures of the lower extremity at a tertiary trauma centre between 2004 and 2010 were retrospectively reviewed. A total of 48 lower limb fractures required free flap reconstruction, performed at 28 days post injury (0-275 days). Anastomoses were proximal (21), distal (5) or within the zone of trauma (22). There was no significant difference (p > 0.05) in return to theatre, revision of anastomosis or flap survival between groups. Of the 22 performed within the zone of injury, five returned to theatre but only two for revision of anastomosis and 20 (91%) of these flaps survived. Of the 48 free flaps, arterial anastomoses were end to end in 34 (71%) and end to side in 14 (30%). There was no significant difference (p > 0.05) in return to theatre, revision of anastomosis or flap survival between the end-to-end and end-to-side groups. There was a tendency for arterial anastomoses to be performed end to end outside the zone of trauma (23/26) compared to within the zone of trauma (11/22). Our data suggest that free flap anastomoses can be performed safely in the zone of trauma in lower limb injuries. PMID:27108076

  20. Diabetic Muscle Infarction: A Rare Cause of Acute Limb Pain in Dialysis Patients

    G. De Vlieger

    2013-01-01

    Full Text Available Diabetic muscle infarction is a rare microangiopathic complication occurring in patients with advanced diabetes mellitus. Diabetic patients with chronic kidney disease stage Vd are prone to develop this complication. The presenting symptom is a localized painful swelling of the affected limb. Symptoms usually resolve spontaneously during the following weeks, but frequent relapse can occur and in some cases swelling may lead to compartment syndrome. Biochemical blood analyses show an elevated C-reactive protein, but creatine kinase is often normal. Diagnosis can be made on clinical presentation and imaging, with magnetic resonance imaging as the gold standard. Histology is often not contributive. Treatment consists of rest, analgesics, rigorous glycemic control and low-dose aspirin. Severe cases of compartment syndrome require fasciotomy. In the current paper, we present two diabetic patients with cystic fibrosis, who are treated with automated peritoneal dialysis and suffered from episodic lower limb infarction. We subsequently review 48 episodes of diabetic muscle infarction previously reported in the literature in patients with end-stage renal disease.

  1. Robot-assisted upper-limb therapy in acute rehabilitation setting following stroke: Department of Veterans Affairs multisite clinical trial.

    Burgar, Charles G; Lum, Peter S; Scremin, A M Erika; Garber, Susan L; Van der Loos, H F Machiel; Kenney, Deborah; Shor, Peggy

    2011-01-01

    This randomized, controlled, multisite Department of Veterans Affairs clinical trial assessed robot-assisted (RA) upper-limb therapy with the Mirror Image Movement Enabler (MIME) in the acute stroke rehabilitation setting. Hemiparetic subjects (n = 54) received RA therapy using MIME for either up to 15 hours (low-dose) or 30 hours (high-dose) or received up to 15 hours of additional conventional therapy in addition to usual care (control). The primary outcome measure was the Fugl-Meyer Assessment (FMA). The secondary outcome measures were the Functional Independence Measure (FIM), Wolf Motor Function Test, Motor Power, and Ashworth scores at intake, discharge, and 6-month follow-up. Mean duration of study treatment was 8.6, 15.8, and 9.4 hours for the low-dose, high-dose, and control groups, respectively. Gains in the primary outcome measure were not significantly different between groups at follow-up. Significant correlations were found at discharge between FMA gains and the dose and intensity of RA. Intensity also correlated with FMA gain at 6 months. The high-dose group had greater FIM gains than controls at discharge and greater tone but no difference in FIM changes compared with low-dose subjects at 6 months. As used during acute rehabilitation, motor-control changes at follow-up were no less with MIME than with additional conventional therapy. Intensity of training with MIME was positively correlated with motor-control gains. PMID:21674393

  2. Robot-assisted upper-limb therapy in acute rehabilitation setting following stroke: Department of Veterans Affairs multisite clinical trial

    Charles G. Burgar, MD

    2011-05-01

    Full Text Available This randomized, controlled, multisite Departmentof Veterans Affairs clinical trial assessed robot-assisted (RAupper-limb therapy with the Mirror Image Movement Enabler(MIME in the acute stroke rehabilitation setting. Hemipareticsubjects (n = 54 received RA therapy using MIME for either upto 15 hours (low-dose or 30 hours (high-dose or received up to15 hours of additional conventional therapy in addition to usualcare (control. The primary outcome measure was the Fugl-Meyer Assessment (FMA. The secondary outcome measureswere the Functional Independence Measure (FIM, Wolf MotorFunction Test, Motor Power, and Ashworth scores at intake, discharge,and 6-month follow-up. Mean duration of study treatmentwas 8.6, 15.8, and 9.4 hours for the low-dose, high-dose,and control groups, respectively. Gains in the primary outcomemeasure were not significantly different between groups at follow-up. Significant correlations were found at discharge betweenFMA gains and the dose and intensity of RA. Intensity also correlatedwith FMA gain at 6 months. The high-dose group hadgreater FIM gains than controls at discharge and greater tone butno difference in FIM changes compared with low-dose subjectsat 6 months. As used during acute rehabilitation, motor-controlchanges at follow-up were no less with MIME than with additionalconventional therapy. Intensity of training with MIME waspositively correlated with motor-control gains.

  3. Patient delay is the main cause of treatment delay in acute limb ischemia: an investigation of pre- and in-hospital time delay

    Londero, Louise Skovgaard; Nørgaard, Birgitte; Houlind, Kim Christian

    2014-01-01

    the emergency department. It is important to identify existing problems in order to reduce time delay. The aim of this study was to collect data for patients with acute limb ischemia and to evaluate the time delay between the different events from onset of symptoms to specialist evaluation and further...... arterial thrombolysis was 5621 (1686-8376) minutes. At 30 days follow up, six patients had had the ischemic limb amputated above the ankle and four patients had died. CONCLUSIONS: We found that the largest time delay was between onset of symptoms and first contact to a medical doctor. A greater public...

  4. Insights from Computational Modeling in Inflammation and Acute Rejection in Limb Transplantation

    Wolfram, Dolores; Starzl, Ravi; Hackl, Hubert; Barclay, Derek; Hautz, Theresa; Zelger, Bettina; Brandacher, Gerald; Lee, W. P. Andrew; Eberhart, Nadine; Vodovotz, Yoram; Pratschke, Johann; Pierer, Gerhard; Schneeberger, Stefan

    2014-01-01

    Acute skin rejection in vascularized composite allotransplantation (VCA) is the major obstacle for wider adoption in clinical practice. This study utilized computational modeling to identify biomarkers for diagnosis and targets for treatment of skin rejection. Protein levels of 14 inflammatory mediators in skin and muscle biopsies from syngeneic grafts [n = 10], allogeneic transplants without immunosuppression [n = 10] and allografts treated with tacrolimus [n = 10] were assessed by multiplex...

  5. Late cerebral ischaemia after subarachnoid haemorrhage

    Edvinsson, L; Povlsen, G K

    2011-01-01

    Late cerebral ischaemia after subarachnoid haemorrhage (SAH) carries high morbidity and mortality because of reduced cerebral blood flow (CBF) and subsequent cerebral ischaemia. This is associated with upregulation of contractile receptors in cerebral artery smooth muscles via the activation of...... intracellular signalling. In addition, delayed cerebral ischaemia after SAH is associated with inflammation and disruption of the blood-brain barrier (BBB). This article reviews recent evidence concerning the roles of vasoconstrictor receptor upregulation, inflammation and BBB breakdown in delayed cerebral...... ischaemia after SAH. In addition, recent studies investigating the role of various intracellular signalling pathways in these processes and the possibilities of targeting signalling components in SAH treatment are discussed. Studies using a rat SAH model have demonstrated that cerebral arteries increase...

  6. Surgical manipulation compromises leukocyte mobilisation responses and inflammation after experimental cerebral ischaemia in mice

    Adam eDenes

    2014-01-01

    Full Text Available Acute brain injury results in peripheral inflammatory changes, although the impact of these processes on neuronal death and neuroinflammation is currently unclear. To facilitate the translation of experimental studies to clinical benefit, it is vital to characterize the mechanisms by which acute brain injury induces peripheral inflammatory changes, and how these are affected by surgical manipulation in experimental models. Here we show that in mice, even mild surgical manipulation of extracranial tissues induced marked granulocyte mobilisation (300% and systemic induction of cytokines. However, intracranial changes induced by craniotomy, or subsequent induction of focal cerebral ischaemia were required to induce egress of CXCR2-positive granulocytes from the bone marrow. CXCR2 blockade resulted in reduced mobilisation of granulocytes from the bone marrow, caused an unexpected increase in circulating granulocytes, but failed to effect brain injury induced by cerebral ischaemia. We also demonstrate that isoflurane anaesthesia interferes with circulating leukocyte responses, which could contribute to the reported vascular and neuroprotective effects of isoflurane. In addition, no immunosuppression develops in the bone marrow after experimental stroke. Thus, experimental models of cerebral ischaemia are compromised by surgery and anaesthesia in proportion to the severity of surgical stress and overall tissue injury. Understanding the inherent confounding effects of surgical manipulation and development of new models of cerebral ischaemia with minimal surgical intervention could facilitate better understanding of interactions between inflammation and brain injury.

  7. Percutaneous hydromechanical thrombectomy in acute and subacute lower-limb ischemia; Perkutane hydromechanische Thrombektomie bei akuter und subakuter arterieller Beinischaemie

    Hoepfner, W.; Bohndorf, K. [Klinik fuer Diagnostische Radiologie und Neuroradiologie, Augsburg (Germany); Vicol, C. [Herzchirurgische Klinik, Augsburg (Germany); Loeprecht, H. [Zentralklinikum Augsburg (Germany). Klinik fuer Gefaess- und Thoraxchirurgie

    2001-03-01

    Purpose: A prospective study should evaluate the primary and 2-year results of treating acute and subacute lower-limb ischemia with hydromechanical thrombectomy (HTE). Materials and methods: Consecutively 64 patients, 12 with viable and 52 with threatening limb ischemia and onset of symptoms within 8{+-}9 days, were treated and controlled for 24 months. An 8 F hydromechanical thrombectomy device (HTK), was used. It sucks and shreds the thrombi. The shredded particles are transported to the outside. Results: In 8 patients a total, in the others a partial restoration of the vessel lumen up to 70-50% was achieved in a mean time of 34 minutes. Residual thrombi, underlying atherosclerotic vessel disease and occluded arteries with a small diameter made adjunctive interventions (balloon angioplasty, percutaneous aspiration thrombectomy, lysis) necessary. Clinical symptoms and the ankle-brachial index improved significantly (p<0.01). Primary patency was 72%, 70%, 67%, and 65%; the limb salvage rates were 81%, 78%, 75%, and 73% for one, 3, 12, and 24 months respectively. Device-induced complications did not occur. Conclusions: The HTK allowed a rapid reduction of fresh thrombotic material without complications. In 78% of the cases adjunctive therapies are required for wall-adherent thrombi and when tibial vessels with smaller lumina are included. Longterm results are comparable to literature data for fibrinoloytic or operative regimens. The advantage, however of the HTK seems to be the reduction of intervention time and intra-arterial dosage of fibrinolytic drugs. (orig.) [German] Ziel: In einer prospektiven Studie wird der primaere und der Zweijahreserfolg eines Katheters zur hydromechanischen Thrombektomie (HTE) bei der Therapie der akuten und subakuten Beinischaemie untersucht. Material und Methode: Konsekutiv wurden 64 Patienten, 12 mit stark beeintraechtigender und 52 mit bedrohlicher Ischaemie seit 8{+-}9 Tagen, mit HTE therapiert und 24 Monate nachkontrolliert. Ein 8

  8. Prognostic significance of distal blood pressure measurements in patients with severe ischaemia

    Paaske, William; Tønnesen, K H

    1980-01-01

    The clinical course was followed and the ankle and toe blood pressures were measured with the strain gauge technique on 5 occasions during 2 years in 43 patients with pain at rest and/or ischaemic ulceration due to severe ischaemia of the legs on the basis of occlusive arterial disease. Although...... arteriosclerosis of the legs in non-diabetic patients is generally considered a benign disease from the standpoint of limb survival, the critical level of TPI (systolic toe blood pressure/systolic arm blood pressure) was found to be 0.07 as a TPI below this value was associated with an overall 82% risk of...... amputation. With TPI above 0.07, the chance of successful conservative therapy was about 40%. Diabetics with severe ischaemia must be regarded as a high risk group in respect of amputation (64%) and lethality (64%). A variance analysis was made on the pressure data: In patients with low pressure peripheral...

  9. Cardiac biomarkers in neonatal hypoxic ischaemia.

    Sweetman, D

    2012-04-01

    Following a perinatal hypoxic-ischaemic insult, term infants commonly develop cardiovascular dysfunction. Troponin-T, troponin-I and brain natriuretic peptide are sensitive indicators of myocardial compromise. The long-term effects of cardiovascular dysfunction on neurodevelopmental outcome following perinatal hypoxic ischaemia remain controversial. Follow-up studies are warranted to ensure optimal cardiac function in adulthood. CONCLUSION: Cardiac biomarkers may improve the diagnosis of myocardial injury, help guide management, estimate mortality risk and may also aid in longterm neurodevelopmental outcome prediction following neonatal hypoxic-ischaemia.

  10. Popliteo-pedal bypass surgery for critical limb ischemia.

    Good, D W

    2011-12-01

    Critical limb ischaemia due to distal arterial disease represents a significant challenge. Randomised controlled evidence suggests that open surgery may be superior to endovascular intervention but there is limited data on the specific clinical cohort with exclusively infra-popliteal disease.

  11. Isoprostanes--markers of ischaemia reperfusion injury.

    Sakamoto, H

    2012-02-03

    Ischaemia reperfusion injury is a common and important phenomenon that occurs predictably in patients undergoing such procedures as cardiopulmonary bypass, thrombolysis, surgery under tourniquet, organ transplantation or embolectomy. Oxidative stress and the resulting lipid peroxidation play a major role in reperfusion injury. Membrane and cellular dysfunction result and, subsequently, organ injury or failure may ensue. Traditional methods of quantifying ischaemia reperfusion injury, including measurement of malondialdehyde, lack specificity and sensitivity. It was reported in 1990 that isoprostanes, a series of prostaglandin-like compounds, are produced by the free radical-catalyzed peroxidation of arachidonic acid. Measurement of the isoprostane concentration in urine or plasma provides the most reliable, non-invasive method currently available to assess oxidative stress in vivo. Serial measurement of isoprostanes in biological fluids has enhanced our understanding of the mechanisms underlying ischaemia reperfusion injury itself and its role in certain diseases. Furthermore, measurement of the isoprostane concentration provides a means to assess the effects of prophylactic and therapeutic interventions. In the future, the development of rapid, simple assays for isoprostanes offers the potential to assess prognosis during and after ischaemia reperfusion events.

  12. Nuclear factor κB inactivation in the rat liver ameliorates short term total warm ischaemia/reperfusion injury

    Suetsugu, H; Iimuro, Y; Uehara, T.; Nishio, T; Harada, N; Yoshida, M; Hatano, E; Son, G; Fujimoto, J.; Yamaoka, Y.

    2005-01-01

    Background: In hepatic ischaemia/reperfusion injury, activated liver macrophages (Kupffer cells) are dominantly regulated by a transcription factor, nuclear factor κB (NFκB), with respect to expression of inflammatory cytokines, acute phase response proteins, and cell adhesion molecules.

  13. Myocardial ischaemia following cocaine and adrenaline exposure in a child during an ophthalmological procedure.

    McGovern, E

    2015-03-01

    We report a 23-month old girl who presented with bilateral epiphora who underwent bilateral lacrimal probing and syringing, during which a cocaine adrenaline solution was used. Two hours after the procedure she developed acute pulmonary oedema secondary to myocardial ischaemia. The patient was treated with intravenous glyceryltrinitrate and milrinone infusions; cardiac enzymes and left ventricular function normalised over the subsequent 72 hours. Topical administration of cocaine and adrenaline solution may have dangerous systemic cardiac effects and should always be used judiciously.

  14. Renal Ischaemia Reperfusion Injury: A Mouse Model of Injury and Regeneration

    Hesketh, Emily E.; Czopek, Alicja; Clay, Michael; Borthwick, Gary; Ferenbach, David; Kluth, David; Hughes, Jeremy

    2014-01-01

    Renal ischaemia reperfusion injury (IRI) is a common cause of acute kidney injury (AKI) in patients and occlusion of renal blood flow is unavoidable during renal transplantation. Experimental models that accurately and reproducibly recapitulate renal IRI are crucial in dissecting the pathophysiology of AKI and the development of novel therapeutic agents. Presented here is a mouse model of renal IRI that results in reproducible AKI. This is achieved by a midline laparotomy approach for the sur...

  15. Effect of Acute Alterations in Foot Strike Patterns during Running on Sagittal Plane Lower Limb Kinematics and Kinetics

    Kevin A. Valenzuela, Scott K. Lynn, Lisa R. Mikelson, Guillermo J. Noffal, Daniel A. Judelson

    2015-03-01

    Full Text Available subjects were identified through slow motion video playback (n = 21, age = 22.8±2.2 years, mass = 73.1±14.5 kg, height 1.75 ± 0.10 m. On day two, subjects performed five overground run trials in both their natural and unnatural strike patterns while motion and force data were collected. Data were collected over two days so that foot strike videos could be analyzed for group placement purposes. Several 2 (Foot Strike Pattern –forefoot strike [FFS], rearfoot strike [RFS] x 2 (Group – PFFG, PRFG mixed model ANOVAs (p < 0.05 were run on speed, active peak vertical ground reaction force (VGRF, peak early stance and mid stance sagittal ankle moments, sagittal plane hip and knee moments, ankle dorsiflexion ROM, and sagittal plane hip and knee ROM. There were no significant interactions or between group differences for any of the measured variables. Within subject effects demonstrated that the RFS condition had significantly lower (VGRF (RFS = 2.58 ± .21 BW, FFS = 2.71 ± 0.23 BW, dorsiflexion moment (RFS = -2.6 1± 0.61 Nm·kg-1, FFS = -3.09 ± 0.32 Nm·kg-1, and dorsiflexion range of motion (RFS = 17.63 ± 3.76°, FFS = 22.10 ± 5.08°. There was also a significantly higher peak plantarflexion moment (RFS = 0.23 ± 0.11 Nm·kg-1, FFS = 0.01 ± 0.01 Nm·kg-1, peak knee moment (RFS = 2.61 ± 0.54 Nm·kg-1, FFS = 2.39 ± 0.61 Nm·kg-1, knee ROM (RFS = 31.72 ± 2.79°, FFS = 29.58 ± 2.97°, and hip ROM (RFS = 42.72 ± 4.03°, FFS = 41.38 ± 3.32° as compared with the FFS condition. This research suggests that acute changes in foot strike patterns during shod running can create alterations in certain lower limb kinematic and kinetic measures that are not dependent on the preferred foot strike pattern of the individual. This research also challenges the contention that the impact transient spike in the vertical ground reaction force curve is only present during a rear foot strike type of running gait.

  16. Long term results of polytetrafluoroethylene in above knee femoropopliteal bypass for critical ischaemia.

    Kavanagh, E G

    2012-02-03

    Ninety-six consecutive above-knee femoropopliteal bypasses, using polytetrafluoroethylene (PTFE) preferentially, were performed for limb-threatening ischaemia. Cumulative primary graft patency was 68 per cent, 49 per cent and 36 per cent and limb salvage 93 per cent, 85 per cent and 75 per cent at 1, 3 and 5 yr respectively. As a result of poor long term survival (51 per cent at 5 yr), and the healing of remedial lesions before graft occlusion, 68 patients (72 per cent) required no further intervention. Eighteen secondary bypasses were undertaken, 12 using ipsilateral saphenous vein. In this group of elderly patients with poor life expectancy, where a limited operation is desirable, the use of PTFE provided excellent limb salvage with low morbidity. Although we can no longer justify our continued use of PTFE in every case of critical ischaemia because of its inferior patency to autogenous vein, we continue to use it preferentially in patients whose lifespan is likely to be short and in cases where a remedial lesion is present.

  17. Treatment of acute limb ischemia:a report of 126 cases%急性肢体动脉缺血126例治疗体会

    桑宏飞; 李晓强; 段鹏飞; 于小滨; 姜坤

    2011-01-01

    目的:探讨急性肢体动脉缺血(acute limb ischemia,ALI)的治疗方法.方法:采用药物、手术、介入方法治疗ALT 126例,其中动脉栓塞84例,血栓形成42例.按Rutherford分期,Ⅰ期13例,Ⅱ期107例,Ⅲ期6例.Ⅰ期采用药物抗凝溶栓,Ⅱ期采用手术取栓联合术中造影及介入治疗,Ⅲ期截肢.结果:Ⅰ期患者症状均完全缓解,无病死及截肢.Ⅱ、Ⅲ期术后30天病死6例,术后肢体存活109例,截肢(趾)11例.120例均痊愈出院.随访1~72个月,11例截肢(趾)肢体残体血供良好;存活109例肢体运动、感觉功能正常.结论:早期诊断,及时有效治疗和术后对再灌注损伤并发症的纠正,是提高疗效、降低截肢率和病死率的关键.%Objective:To discuss the management of acute limb ischemia. Methods:One hundred and twenty-six cases with acute limb ischemia that including 84 case of arterial embolism and 42 case of arterial thrombosis were analyzed. According to Rutherford criteria, there were 13 cases in category Ⅰ , 107 cases in category Ⅱ and 6 cases in category Ⅲ, respectively. Cases in category Ⅰ were adopted medical treatment,while in category Ⅱ , cases were mainly adopted surgical and/or interventional treatments, and cases in Ⅲ were amputated. Results :There were 6 deaths in category Ⅱ and Ⅲ within 30 days after treatments. Eleven cases were amputated. One hundred and twenty cases were recovered. The follow-up period was from 1 to 72 months. Conclusions: Expeditious diagnosis and immediate effective treatment, combined by alleviating reperfusion injury are key points in improving therapeutic effect of acute limb ischenia and reduce morbidity and mortality.

  18. A Rare Occurrence of Simultaneous Venous and Arterial Thromboembolic Events – Lower Limb Deep Venous Thrombosis and Pulmonary Thromboembolism as Initial Presentation in Acute Promyelocytic Leukemia

    Kutiyal, Aditya S.; Dharmshaktu, Pramila; Kataria, Babita; Garg, Abhilasha

    2016-01-01

    The development of acute myeloid leukemia has been attributed to various factors, including hereditary, radiation, drugs, and certain occupational exposures. The association between malignancy and venous thromboembolism events is well established. Here, we present a case of a 70-year-old Indian man who had presented with arterial and venous thrombosis, and the patient was later diagnosed with acute promyelocytic leukemia (APL). In our case, the patient presented with right lower limb deep venous thrombosis and pulmonary thromboembolism four months prior to the diagnosis of APL. Although thromboembolic event subsequent to the diagnosis of malignancy, and especially during the chemotherapy has been widely reported, this prior presentation with simultaneous occurrence of both venous and arterial thromboembolism has rarely been reported. We take this opportunity to state the significance of a complete medical evaluation in cases of recurrent or unusual thrombotic events. PMID:26949347

  19. Therapeutic modulation of liver ischaemia reperfusion injury

    Sheth, H.

    2011-01-01

    Liver Ischaemia Reperfusion Injury (IRI) leads to production of reactive oxygen species and cytokines, which affects hepatocellular function following liver resection and transplantation. This thesis examines 2 hypotheses: 1) The role of intravenous glycine in amelioration of liver IRI in a in vivo animal model of partial lobar liver IRI. 2) Does prophylactically administered N-acetylcysteine prevent liver IRI in patients undergoing elective liver resection. Materials ...

  20. The acute effect of match play on hamstring strength and lower limb flexibility in elite youth football players

    Wollin, M; Thorborg, K; Pizzari, T

    2016-01-01

    The aim of this study was to investigate the effect of competitive football match play on hamstring strength and lower limb flexibility. Fifteen male international youth football players were included. Hamstring strength and associated pain ratings, ankle dorsiflexion, hip extension, knee extensi...

  1. Artificial Limbs

    ... you are missing an arm or leg, an artificial limb can sometimes replace it. The device, which ... activities such as walking, eating, or dressing. Some artificial limbs let you function nearly as well as ...

  2. Limb Prosthetics

    ... in the Residual Limb A prosthesis is an artificial device that replaces a missing body part. A limb may be amputated or missing because of a blood vessel disorder (such as atherosclerosis or damage due to ...

  3. The acute effects of different training loads of whole body vibration on flexibility and explosive strength of lower limbs in divers

    Paradisis, G; Kirialanis, P; Mellos, V; Argitaki, P; Smirniotou, A

    2015-01-01

    The purpose of this study was to examine the acute effects of different vibration loads (frequency and amplitude) of whole-body vibration (WBV) on flexibility and explosive strength of lower limbs in springboard divers. Eighteen male and female divers, aged 19 ± 2 years, volunteered to perform 3 different WBV protocols in the present study. To assess the vibration effect, flexibility and explosive strength of lower limbs were measured before (Pre), immediately after (Post 1) and 15 min after the end of vibration exposure (Post 15). Three protocols with different frequencies and amplitudes were used in the present study: a) low vibration frequency and amplitude (30 Hz/2 mm); b) high vibration frequency and amplitude (50 Hz/4 mm); c) a control protocol (no vibration). WBV protocols were performed on a Power Plate platform, whereas the no vibration divers performed the same protocol but with the vibration platform turned off. A two-way ANOVA 3 x 3 (protocol × time) with repeated measures on both factors was used. The level of significance was set at p < 0.05. Univariate analyses with simple contrasts across time were selected as post hoc tests. Intraclass coefficients (ICC) were used to assess the reliability across time. The results indicated that flexibility and explosive strength of lower limbs were significantly higher in both WBV protocols compared to the no vibration group (NVG). The greatest improvement in flexibility and explosive strength, which occurred immediately after vibration treatment, was maintained 15 min later in both WBV protocols, whereas NVG revealed a significant decrease 15 min later, in all examined strength parameters. In conclusion, a bout of WBV significantly increased flexibility and explosive strength in competitive divers compared with the NVG. Therefore, it is recommended to incorporate WBV as a method to increase flexibility and vertical jump height in sports where these parameters play an important role in the success outcome of

  4. Involvement of spinal α2 -adrenoceptors in prolonged modulation of hind limb withdrawal reflexes following acute noxious stimulation in the anaesthetized rabbit.

    Harris, John

    2016-03-01

    The role of spinal α2 -adrenoceptors in mediating long-lasting modulation of hind limb withdrawal reflexes following acute noxious chemical stimulation of distant heterotopic and local homotopic locations has been investigated in pentobarbitone-anaesthetized rabbits. Reflexes evoked in the ankle extensor muscle medial gastrocnemius (MG) by electrical stimulation of the ipsilateral heel, and reflexes elicited in the ankle flexor tibialis anterior and the knee flexor semitendinosus by stimulation at the base of the ipsilateral toes, could be inhibited for over 1 h after mustard oil (20%) was applied to either the snout or into the contralateral MG. The heel-MG response was also inhibited after applying mustard oil across the plantar metatarsophalangeal joints of the ipsilateral foot, whereas this homotopic stimulus facilitated both flexor responses. Mustard oil also caused a significant pressor effect when applied to any of the three test sites. The selective α2 -adrenoceptor antagonist, RX 821002 (100-300 μg, intrathecally), had no effect on reflexes per se, but did cause a decrease in mean arterial blood pressure. In the presence of the α2 -blocker, inhibitory and facilitatory effects of mustard oil on reflexes were completely abolished. These data imply that long-lasting inhibition of spinal reflexes following acute noxious stimulation of distant locations involves activation of supraspinal noradrenergic pathways, the effects of which are dependent on an intact α2 -adrenoceptor system at the spinal level. These pathways and receptors also appear to be involved in facilitation (sensitization) as well as inhibition of reflexes following a noxious stimulus applied to the same limb. PMID:26804327

  5. DETECTION OF NITRIC OXIDE REDUCTION DURING ISCHAEMIA-REPERFUSION BY EPR SPECTROSCOPY

    KADKHODAEE M

    2001-01-01

    Full Text Available Introduction: Acute renal failure is a common consequence of sepisis due to concurrent renal ischaemia. The role of nitric oxide (NO in endotoxaemia and in ischaemic injury in the kidney is not well defined. Material and Methods: In this study we have used an animal model of sepsis induced by injection of bacterial lipopolysaccharide (LPS in the rat and measured renal nitric oxide by X-band electron paramagnetic resonance (EPR spectroscopy using the spin trap Fe2+-N-methyl-D-glucamine dithiocarbamate [Fe(MGD2] given by intravenous injection 6 minutes before sacrifice. Results: The characteristic EPR spectrum of [Fe(NO(MGD2] was observed in kidneys of rats treated with LPS for 5h. Rat kidneys subjected to 20 min ischaemia and 5 min reperfusion had lower concentrations of [Fe(NO(MGD2] (1.0 ± 0.6 (M compared to the contralateral nonischaemic kidneys (1.5 ± 0.9 (M, P<0.05. Conclusion: This study shows reduced levels of NO after renal ischaemia in vivo.

  6. Raynaud's phenomenon and digital ischaemia - pharmacologic approach and alternative treatment options.

    Linnemann, Birgit; Erbe, Matthias

    2016-05-01

    The primary goal of therapy is to reduce the frequency and intensity of Raynaud's attacks and to minimize the related morbidity rather than to cure the underlying condition. Treatment strategies depend on whether Raynaud's phenomenon (RP) is primary or secondary. All patients should be instructed about general measures to maintain body warmth and to avoid triggers of RP attacks. Pharmacologic intervention can be useful for patients with severe and frequent RP episodes that impair the patient's quality of life. Calcium channel blockers are currently the most prescribed and studied medications for this purpose. There has been limited evidence for the efficacy of alpha-1-adrenergic receptor antagonists, angiotensin receptor blockers, topical nitrates or fluoxetine to treat RP. The intravenously administered prostacyclin analogue iloprost can reduce the frequency and severity of RP attacks and is considered a second-line therapy in patients with markedly impaired quality of life, critical digital ischaemia and skin ulcers who are at risk for substantial tissue loss and amputation. Phosphodiesterase inhibitors (e.g., sildenafil) can also improve RP symptoms and ulcer healing whereas endothelin-1 receptor antagonists (e.g., bosentan) are mainly considered treatment options in secondary prevention for patients with digital skin ulcers related to systemic sclerosis. However, their use in clinical practice has been limited by their high cost. Antiplatelet therapy with low-dose aspirin is recommended for all patients who suffer from secondary RP due to ischaemia caused by structural vessel damage. Anticoagulant therapy can be considered during the acute phase of digital ischaemia in patients with suspected vascular occlusive disease attributed to the occurrence of new thromboses. In patients with critical digital ischaemia, consideration should be given to hospitalisation, optimisation of medical treatment in accordance with the underlying disease and evaluation for a

  7. Metabolic changes in the lungs after ischaemia

    The effects of variable periods of ischaemia on the isolated lungs of rats and rabbits, stored for up to 6 hours at 4 degrees Celsius, 21 degrees Celsius and 37 degrees Celsius under standardized conditions, were investigated in vitro in terms of oxygen consumption, the rate of 1-14C-leucine incorporation into soluble proteins, and 1-14C-palmitate incorporation into total phospholipids and lipid fractions. The endogenous oxygen uptake of rat lung slices in an air phase, from tissues stored at 4 degrees Celsius and 21 degrees Celsius under ischaemic conditions for 6 hours and at 37 degrees Celsius for 4 hours, was significantly different from the control values. The oxygen uptake of lungs from animals anaesthetized with pentobarbitone prior to exsanguination and stored for only 2 hours at 37 degrees Celsius differed significantly from control values. Judged by the rate of incorporation of radiolabelled leucine into soluble proteins and that of palmitate into total lipids and phospholipids of lungs after storage for increasing periods at 4 degrees Celsius and 37 degrees Celsius, significant differences were already found after one and a half hours. From this observation it would appear that these parameters are very sensitive indicators for assessing irreversible lung damage due to ischaemia

  8. Both autologous bone marrow mononuclear cell and peripheral blood progenitor cell therapies similarly improve ischaemia in patients with diabetic foot in comparison with control treatment

    Dubský, M.; Jirkovská, A.; Bém, R.; Fejfarová, V.; Pagacová, L.; Sixta, B.; Varga, M.; Langkramer, S.; Syková, Eva; Jude, E. B.

    2013-01-01

    Roč. 29, č. 5 (2013), s. 369-376. ISSN 1520-7552 R&D Projects: GA ČR GAP304/11/0653 Grant ostatní: GA MŠk(CZ) GAUK 362311 Institutional support: RVO:68378041 Keywords : stem cell therapy * diabetic foot * critical limb ischaemia Subject RIV: FP - Other Medical Disciplines Impact factor: 2.968, year: 2012

  9. 9th Hatter Biannual Meeting: position document on ischaemia/reperfusion injury, conditioning and the ten commandments of cardioprotection

    Bell, R. M.; Bøtker, H. E.; Carr, R. D.; Davidson, S. M.; Downey, J. M.; Dutka, D P; Heusch, G; Ibanez, B.; MacAllister, R; Stoppe, C; Ovize, M.; Redington, A.; Walker, J. M.; Yellon, D M

    2016-01-01

    In the 30 years since the original description of ischaemic preconditioning, understanding of the pathophysiology of ischaemia/reperfusion injury and concepts of cardioprotection have been revolutionised. In the same period of time, management of patients with coronary artery disease has also been transformed: coronary artery and valve surgery are now deemed routine with generally excellent outcomes, and the management of acute coronary syndromes has seen decade on decade reductions in cardio...

  10. Cardioprotective efficacy depends critically on pharmacological dose, duration of ischaemia, health status of animals and choice of anaesthetic regimen: a case study with folic acid

    Zuurbier, Coert J.; Heinen, Andre; Koeman, Anneke; Stuifbergen, Roy; Hakvoort, Theodorus BM; Weber, Nina C; Hollmann, Markus W.

    2014-01-01

    Background Acute, high-dose folic acid (FA) administration has recently been shown to possess unprecedented effective cardioprotection against ischaemia/reperfusion (I/R) injury. Here we explore the translation potential of FA as treatment modality for cardiac I/R. Methods Dependency of FA protection on dose, ischaemia duration, and eNOS was examined in an isolated mouse heart I/R model, whereas dependency on animal health status and anaesthesia was examined in an in vivo rat model of regiona...

  11. 3 BOLD MRI with low intrascan variability and high reproducibilityy of limb oxygenation measurements

    Hedstrom, E.; Patel, A.S.; Voigt, T.; Modarai, B.; Schaeffter, T.; Smith, A.; Nagel, E.

    2012-01-01

    Current imaging methods cannot reliably quantify muscle oxygenationin patients with limb ischaemia. We propose a high-resolution BOLD sequence whereby edge artefacts and vessels may be excluded from measurements. CONCLUSIONS: The sequence and analysis proposed shows lowintrascan variability and high

  12. Bone healing following irradiation during tourniquet ischaemia

    The bone harvest chamber (BHC) methodology, a titanium implant for quantitative evaluations of bone healing, was used in order to investigate the radioprotective function of anoxia, in healing bone tissue. After incorporation of one BHC in each proximal tibial metaphysis of a rabbit it was possible to collect newly formed bone specimens in 3-week-periods without animal sacrifice. The amount of bone was determined by microradiography and densitometry. Ten animals divided into 2 groups were used. One group receiving a single dose of 25 Gy during tourniquet ischaemia was compared with another receiving the same dose during normal blood perfusion. A significantly improved bone healing response was seen in the ischaemic group, with a tendency to further improvement with increasing time after irradiation. (orig.)

  13. A model for cerebral ischaemia from gaseous emboli

    Hague, J P; Chung, E M L

    2012-01-01

    The effects of bubbles on the cerebral bloodflow are difficult to quantify. We present a model to calculate how cerebral ischaemia is caused by deformable gaseous emboli. The model takes into account realistic adhesion forces, fluid dynamical considerations, a realistic parameterisaton for the rate of bubble dissolution and the effects of buoyancy. We find that neglecting deformability of bubbles leads to a vast overestimation of ischaemia. The inclusion of buoyancy effects reduces the proportion of the vasculature that becomes compromised, but increases blockage times, thus lowering the risk of transient ischaemia but increasing the potential for focal injury. We also investigate the number and size of bubbles in a sudden shower of emboli that leads to persistent ischaemia capable of neuronal injury. Finally we investigate mitigation techniques such as insufflation of the operative area with CO$_2$ and alterations in arterial pressure.

  14. Ivabradine reduces myocardial stunning in patients with exercise-inducible ischaemia.

    Maranta, F; Tondi, L; Agricola, E; Margonato, A; Rimoldi, O; Camici, Paolo G

    2015-11-01

    Ivabradine is an effective treatment for angina in patients with stable coronary artery disease (CAD) and for heart failure. Experiments in a canine model have shown that ivabradine reduces both acute left ventricular (LV) dysfunction and post-ischaemic stunning. Aim of this study was to investigate the effect of ivabradine on LV dysfunction and stunning in patients with CAD and exercise-inducible ischaemia. Fifteen patients with ejection fraction >40 % and heart rate >70 bpm were enrolled. After pharmacologic washout, echocardiography was performed at rest, at peak treadmill exercise and during recovery until return to baseline. After 2 weeks of ivabradine (7.5 mg bid) stress echocardiography was repeated at the same workload achieved during washout. Peak global and segmental (ischaemic vs. remote normal segments) LV longitudinal strain (LS) was assessed by 2D speckle tracking analysis. At washout, LS was significantly impaired in ischaemic compared to remote segments at peak stress and for several minutes during recovery. After ivabradine a smaller, albeit still significant, impairment of LS in ischaemic segments was observed at peak whilst no difference with remote segments was present during recovery. Furthermore, the average global LS value improved significantly after treatment. In conclusion, ivabradine reduces both acute LV dysfunction and stunning in patients with CAD and exercise-inducible ischaemia. We hypothesise that this mechanism might contribute to reduce chronic LV dysfunction in patients with CAD. In this setting the drug might limit the development of hibernating myocardium which is believed to result from repeated episodes of ischaemia and stunning. PMID:26419678

  15. Trimetazidine and liver preservation against ischaemia-reperfusion injury

    Mosbah, Ismail Ben; Abdennebi, Hassen B.; Zaouali, Mohamed A.; Padrissa-Altés, Susagna; Peralta, Carmen; Roselló-Catafau, Joan

    2007-01-01

    Trimetazidine is an anti-ischaemic drug used for angina pectoris treatment. Recently, it has been shown that trimetazidine protects against hepatic ischaemia reperfusion injury. Several hypotheses have been proposed to explain the exact hepatoprotective mechanisms but they still remain unclear. This review assesses the possible mechanisms responsible for the increase of the liver's tolerance against ischaemia-reperfusion injury with special emphasis on: (1) the prevention of oxidative stress ...

  16. Lower-limb MRI in the staging and re-staging of osteonecrosis in paediatric patients affected by acute lymphoblastic leukaemia after therapy

    Ippolito, D.; Masetto, A.; Franzesi, C.T.; Bonaffini, P.A.; Sironi, S. [University of Milano-Bicocca Milan, School of Medicine, Monza (Italy); Department of Diagnostic Radiology, H. San Gerardo, Monza (Italy); Sala, A.; Biondi, A. [University of Milano-Bicocca Milan, School of Medicine, Monza (Italy); H. San Gerardo, Department of Paediatric Haematology, Monza (Italy)

    2016-04-15

    To assess the diagnostic value of MRI examination in detecting and monitoring osteonecrotic lesions (ON) in childhood acute lymphoblastic leukaemia (ALL) after chemotherapy (CHT) and/or bone marrow transplantation (BMT). Seventy-three patients (37 males, mean age 12.4 years old) with ALL after treatment underwent a lower-limb MR examination between November 2006 and March 2012. In 47 there was clinical suspicion of ON, 26 were asymptomatic. Studies were performed with a 1 T and a 1.5 T scanner, acquiring short tau inversion recovery (STIR) and T1-weighted sequences in coronal plane from the hips to the ankles. The average acquisition time was 18 min. Considering baseline and follow-up examinations, the overall number of MRI studies was 195. Fifty-four of 73 patients showed ON at MRI study, with an overall number of 323 ON (89 involving articular surface, 24 with joint deformity, JD). Twenty-five of 47 symptomatic patients showed subchondral ON lesions, 11 developed JD. Three of 26 asymptomatic patients showed subchondral bone ON at baseline examination but no JD at follow-up. Twenty-two of 28 BMT, 32/45 CHT patients developed ON. Our MRI protocol proved to be feasible in evaluating ON in paediatric patients. Studies should be addressed only to symptomatic patients. (orig.)

  17. Lower-limb MRI in the staging and re-staging of osteonecrosis in paediatric patients affected by acute lymphoblastic leukaemia after therapy

    To assess the diagnostic value of MRI examination in detecting and monitoring osteonecrotic lesions (ON) in childhood acute lymphoblastic leukaemia (ALL) after chemotherapy (CHT) and/or bone marrow transplantation (BMT). Seventy-three patients (37 males, mean age 12.4 years old) with ALL after treatment underwent a lower-limb MR examination between November 2006 and March 2012. In 47 there was clinical suspicion of ON, 26 were asymptomatic. Studies were performed with a 1 T and a 1.5 T scanner, acquiring short tau inversion recovery (STIR) and T1-weighted sequences in coronal plane from the hips to the ankles. The average acquisition time was 18 min. Considering baseline and follow-up examinations, the overall number of MRI studies was 195. Fifty-four of 73 patients showed ON at MRI study, with an overall number of 323 ON (89 involving articular surface, 24 with joint deformity, JD). Twenty-five of 47 symptomatic patients showed subchondral ON lesions, 11 developed JD. Three of 26 asymptomatic patients showed subchondral bone ON at baseline examination but no JD at follow-up. Twenty-two of 28 BMT, 32/45 CHT patients developed ON. Our MRI protocol proved to be feasible in evaluating ON in paediatric patients. Studies should be addressed only to symptomatic patients. (orig.)

  18. Inflammation-mediating cytokine response to acute handcycling exercise with/without functional electrical stimulation-evoked lower-limb cycling

    Thomas A. W. Paulson, MSc

    2014-07-01

    Full Text Available This feasibility study compared the plasma inflammation-mediating cytokine response to an acute bout of handcycling (HC with and without the addition of functional electrical stimulation (FES-evoked lower-limb cycling. On two separate occasions, five recreationally active, community-based participants with motor complete paraplegia (thoracic 5–7 performed 30 min HC and hybrid exercise (HYB at a fixed power output. Venous blood samples were collected at rest, immediately postexercise, 1 h postexercise (post+1 and 2 h postexercise (post+2. Plasma interleukin (IL-6, IL-10, IL-1 receptor antagonist (IL-1ra, adrenaline, and cortisol concentrations were determined via enzyme-linked immunoassay. Plasma IL-6 concentrations were significantly (p 0.05 increase in IL-6 was observed at post+1 in HC, with concentrations significantly higher in HYB at post+2 (p < 0.02. Plasma IL-1ra was unaffected in both trials. Although not reaching statistical significance (p = 0.15, a ~1-fold increase in IL-10 concentration was seen in HYB at post+2. In contrast, increases in adrenaline (p < 0.04 and cortisol (p = 0.08 were observed immediately postexercise in HC and HYB. Initial findings suggest paralyzed skeletal muscle releases IL-6 in response to FES-evoked contractions. HYB may provide a greater anti-inflammatory potential in individuals with a thoracic spinal cord injury compared with HC alone.

  19. [Recanalization of lower-limb deep veins as an index of efficacy of treatment for acute venous thrombosis].

    Kuznetsov, M R; Sapelkin, S V; Boldin, B V; Leont'ev, S G; Neskhodimov, L A

    2016-01-01

    The authors analysed the results of examination and treatment of a total of 102 patients presenting with iliofemoral venous thrombosis. During treatment, ultrasonographic duplex scanning was used to determine the localization of the proximal margin of thrombotic masses, the time of appearing of the first signs of recanalization, its degree at various levels of the deep venous system, as well as alteration in velocity of the venous blood flow in the deep veins of the lower limbs. The dynamics of clinical symptoms was assessed by the visual analogue scale. Clinical and instrumental examination was performed on day 10, and then 1, 3, 6 and 12 months after the beginning of treatment. The patients were subdivided into three groups. Group One comprised 38 patients receiving therapy with low-molecular-weight heparin (enoxaprin) followed by switching to indirect anticoagulants (warfarin) combined with venotonics (original highly-purified diosmin 600 mg once daily). Group Two was composed of 33 patients receiving rivaroxaban at a dose of 15 mg twice daily for 3 weeks, followed by 20 mg once daily. Group Tree patients (n=31) were also given rivaroxaban according to the above-described standard regimen but in combination with venotonics (original highly-purified diosmin 600 mg once daily). The obtained findings showed that prescribing rivaroxaban to patients from the first day of the disease made it possible to considerably improve and accelerate the processes of restoration of patency of deep veins of lower extremities as compared with the patients taking vitamin K antagonists (warfarin). In patients receiving rivaroxaban, there were no cases of residual thrombotic occlusions of the major veins, and recanalization in three fourths of patients was assessed as good and in the remaining third as moderate. In the warfarin group, occlusion in the iliac veins was noted to persist persisted in 13% of patients, with good recanalization observed only in half of the patients. Addition

  20. The intestinal tract as the major source of interleukin 6 production during abdominal aortic clamping and hind limb ischaemia-reperfusion injury O trato intestinal como a principal fonte na producao de interleucina 6 durante clampeamento da aorta abdominal e lesão de isquemia/rererfusão de membros inferiores

    Márcio Benedito Palma Pimenta

    2007-01-01

    Full Text Available PURPOSE: The aim of this study was to investigate whether the hind limbs or intestinal tract is the most important initiator of the inflammatory response secondary aortic clamping and hind limb ischemia/reperfusion injury. METHODS: Blood samples of Wistar rats obtained from posterior cava vein, portal vein, and heart cavity during either laparotomy (control group, n=8 or laparotomy + 2 h of aortic clamping and bilateral hind limb ischemia (ischemia group, n=8, or 2 h after ischemia and 2 h of reperfusion (ischemia-reperfusion group, n=8 were assayed for interleukin 6 (IL-6 and C-reactive protein (CRP. RESULTS: Serum IL-6 at the heart (223.6±197.9 [10-832] pg/mL was higher (pOBJETIVO: Investigar qual o principal mediador da resposta inflamatória na lesao de isquemia/reperfusão após clampeamento da aorta abdominal e isquemia dos membros inferiores: o intestine ou as extremidades inferiores. MÉTODOS: amostra de sangue de ratos Wistar coletados da cava posterior, porta e cavidade cardíaca during tanto laparotomia (grupo controle n=8 ou laparotomia + 2 horas de clampeamento aórtico e isquemia bilateral de membros posteriores (grupo isquemia n=8, ou 2 h de isquemia seguido por 2 horas de reperfusão (grupo isquemia/reperfusão n=8, onde foram dosados interleucina 6 e proteína C-reativa. RESULTADOS: Il-6 no coração (223.6±197.9 [10-832] pg/mL foi maior (p<0.001 tanto na veia porta (133.08±108.52 [4-372] pg/mL quanto na veia cava posterior (127.58±109.15 [8-388] pg/mL. PCR não foi significativamente diferente entre os grupos. CONCLUSÃO: o trato intestinal foi responsável pela resposta inflamatória secundária a lesão de isquemia/reperfusão.

  1. 9th Hatter Biannual Meeting: position document on ischaemia/reperfusion injury, conditioning and the ten commandments of cardioprotection.

    Bell, R M; Bøtker, H E; Carr, R D; Davidson, S M; Downey, J M; Dutka, D P; Heusch, G; Ibanez, B; Macallister, R; Stoppe, C; Ovize, M; Redington, A; Walker, J M; Yellon, D M

    2016-07-01

    In the 30 years since the original description of ischaemic preconditioning, understanding of the pathophysiology of ischaemia/reperfusion injury and concepts of cardioprotection have been revolutionised. In the same period of time, management of patients with coronary artery disease has also been transformed: coronary artery and valve surgery are now deemed routine with generally excellent outcomes, and the management of acute coronary syndromes has seen decade on decade reductions in cardiovascular mortality. Nonetheless, despite these improvements, cardiovascular disease and ischaemic heart disease in particular, remain the leading cause of death and a significant cause of long-term morbidity (with a concomitant increase in the incidence of heart failure) worldwide. The need for effective cardioprotective strategies has never been so pressing. However, despite unequivocal evidence of the existence of ischaemia/reperfusion in animal models providing a robust rationale for study in man, recent phase 3 clinical trials studying a variety of cardioprotective strategies in cardiac surgery and acute ST-elevation myocardial infarction have provided mixed results. The investigators meeting at the Hatter Cardiovascular Institute workshop describe the challenge of translating strong pre-clinical data into effective clinical intervention strategies in patients in whom effective medical therapy is already altering the pathophysiology of ischaemia/reperfusion injury-and lay out a clearly defined framework for future basic and clinical research to improve the chances of successful translation of strong pre-clinical interventions in man. PMID:27164905

  2. Secondary prevention with calcium antagonists after acute myocardial infarction

    Hansen, J F

    1992-01-01

    Experimental studies have demonstrated that the 3 calcium antagonists nifedipine, diltiazem, and verapamil have a comparable effect in the prevention of myocardial damage during ischaemia. Secondary prevention trials after acute myocardial infarction, which aimed at improving survival and...

  3. Effect of sodium nitrite on ischaemia and reperfusion-induced arrhythmias in anaesthetized dogs: is protein S-nitrosylation involved?

    Mária Kovács

    Full Text Available To provide evidence for the protective role of inorganic nitrite against acute ischaemia and reperfusion-induced ventricular arrhythmias in a large animal model.Dogs, anaesthetized with chloralose and urethane, were administered intravenously with sodium nitrite (0.2 µmol kg(-1 min(-1 in two protocols. In protocol 1 nitrite was infused 10 min prior to and during a 25 min occlusion of the left anterior descending (LAD coronary artery (NaNO2-PO; n = 14, whereas in protocol 2 the infusion was started 10 min prior to reperfusion of the occluded vessel (NaNO2-PR; n = 12. Control dogs (n = 15 were infused with saline and subjected to the same period of ischaemia and reperfusion. Severities of ischaemia and ventricular arrhythmias, as well as changes in plasma nitrate/nitrite (NOx levels in the coronary sinus blood, were assessed throughout the experiment. Myocardial superoxide and nitrotyrosine (NT levels were determined during reperfusion. Changes in protein S-nitrosylation (SNO and S-glutathionylation were also examined.Compared with controls, sodium nitrite administered either pre-occlusion or pre-reperfusion markedly suppressed the number and severity of ventricular arrhythmias during occlusion and increased survival (0% vs. 50 and 92% upon reperfusion. There were also significant decreases in superoxide and NT levels in the nitrite treated dogs. Compared with controls, increased SNO was found only in NaNO2-PR dogs, whereas S-glutathionylation occurred primarily in NaNO2-PO dogs.Intravenous infusion of nitrite profoundly reduced the severity of ventricular arrhythmias resulting from acute ischaemia and reperfusion in anaesthetized dogs. This effect, among several others, may result from an NO-mediated reduction in oxidative stress, perhaps through protein SNO and/or S-glutathionylation.

  4. The Use of the “Preclosure” Technique for Antegrade Aspiration Thrombectomy with Large Catheters in Acute Limb Ischemia

    This study was designed to assess retrospectively short- and mid-term outcomes of the use of a suture-mediated closure device to close the antegrade access in patients undergoing percutaneous aspiration thrombectomy with large catheters for acute leg ischemia. Between November 2005 and February 2010, a suture-mediated active closure system (ProGlide® 6F, Abbott) was placed before arterial sheath (mean 9 F, range 6–12 F) introduction in 101 patients (74 men, 73 %, mean age 70.1 ± 12.6 years standard deviation). Data regarding mortality, complications, and factors contributing to vascular complications at the access site was collected for 6 month after the intervention to detect device-related problems. As a coincidence, 77 patients had follow-up visits for a duplex ultrasound. There were a total of 19 vascular complications (19 %) at the puncture site, all of which were of hemorrhagic nature and none of which consisted of vessel occlusion. Two major outcome complications (2 %) occurred. A retroperitoneal hematoma and a serious inguinal bleeding required additive treatment and did not result in permanent sequelae. Nine cases involved death of which eight were not attributable to the closure and one remained unclear. Successful closure was achieved in 95 patients (94 %); additional manual compression was sufficient in the majority of the remaining patients. Numerous factors contributing to vascular complications were encountered. With acceptable short- and mid-term outcomes, the “preclose” technique can be a reliable option for the closure of a large antegrade femoral access even for patients at a high risk of vascular complications, such as those undergoing aspiration thrombectomy.

  5. Fractal dimension as an index of left ventricular ischaemia: a pilot study

    Myocardial perfusion is performed by the left and the right coronary arteries, which deliver blood to the left and right ventricles, respectively. The impairment of arterial flow supply to the cardiac muscle by disease denotes a phenomenon known as ischaemia. Previous studies have demonstrated the ability of fractal dimension (FD) value of a physiological parameter in differentiating healthy/pathological behaviours. The aim of this study consisted in quantifying the loss of ventricular thickness fractal complexity in order to determine if FD is an intrinsic marker of acute coronary ischaemia. Five mongrel dogs weighing 18.8–26.5 kg (24.4 ± 3.3, mean ± SD) were submitted to this studio. A left ventricular pressure transducer and a fluid-filled catheter for later calibration of the pressure transducer were introduced through a stab wound near the apex. Two pairs of ultrasonic microcrystals (5 MHz) for continuous wall thickness measurements were implanted at the anterior and posterior walls of the left ventricle following a previously described technique. During coronary occlusion, the ischemic wall started to thin at the very onset of relaxation (showing abnormal motility), while the normoperfused wall displayed postejective thickening. Concomitantly, posterior ventricular wall thickness and anterior wall ventricular thickness showed a significant decrease in its FD value (P <0.05). In conclusion, loss of time series fractal complexity (waveform fine structure diminution or ‘unwrinkling’) constitutes a marker of the presence of an ischemic process. As a result, a single scalar value is sufficient to characterize the entire behaviour of the time series. This value manifested a similar trend compared to the most well-known clinical indices of myocardial ischaemia. (paper)

  6. The Myocardial Ischaemia National Audit Project (MINAP)

    Herrett, Emily; Smeeth, Liam; Walker, Lynne; Weston, Clive; MINAP Academic Group; Fox, Keith

    2010-01-01

    AIMS OF MINAP: To audit the quality of care of patients with acute coronary syndrome and provide a resource for academic research. QUALITY OF CARE INTERVENTIONS: Feedback to hospitals, ambulance services and cardiac networks regarding benchmarking of performance against national standards and targets. SETTING: All 230 acute hospitals in England and Wales. Years: 2000-present. POPULATION: Consecutive patients, unconsented. Current number of records: 735 000. STARTPOINTS: Any acute coronary syn...

  7. Acute mesenteric ischemia and duodenal ulcer perforation: a unique double pathology

    Haruna Lois; Aber Ahmed; Rashid Farhan; Barreca Marco

    2012-01-01

    Abstract Background Acute mesenteric ischaemia and duodenal perforation are surgical emergencies with serious consequences. Patients presenting with acute mesenteric ischaemia alone face a high mortality rate as high as 60% whereas those presenting with peptic ulcer perforation the mortality rates range from 6-14%. There are very few reported cases of patients presenting with this dual pathology. Case presentation We report a unique case of a 53 year old Italian lady who presented with acute ...

  8. 儿童急性白血病四肢骨关节的影像研究%Diagnostic imaging of limbs in children with acute leukemia

    宋英儒; 李晨晖; 李国; 叶伟; 黄仲奎; 龙莉玲; 罗建明

    2011-01-01

    目的 探讨急性白血病儿童患者四肢骨关节的X线和MRI特点.方法 搜集以骨关节疼痛为主诉,经临床及骨髓穿刺确诊为急性白血病的13例患儿,对其疼痛部位均行X线平片检查,8例同时行MR检查,其中4例经过化疗达完全缓解后1周内行原疼痛部位的X线和MRI复查.对2种不同影像表现进行分析.结果 13例中,6例X线表现正常,7例共14处可见骨质异常:十骺端透亮带5处,骨膜反应3处,混杂密度骨质破坏1处,浸润性骨质改变3处,骨质疏松2处.MR检查8例共11处,6例共9处MRI表现为骨髓浸润、坏死,X线表现正常;2例共2处MRI表现为骨髓浸润,X线可见骨膜反应及干骺端透亮带.4例化疔达完全缓解后1周内复查,MRI显示骨髓浸润、坏死病灶范围缩小并T1WI骨髓信号不均匀增高,坏死灶呈较均匀长T1、长T2信号,边界清晰,双边征消失,相同病例治疗前后X线复查未见明显改变.结论 以骨关节痛为主诉的急性白血病患儿,MRI较X线能更早期、全面地检测到骨关节的病变,MRI可作为临床疗效监测的指标之一.%Objective To evaluate X-ray and MRI features of limbs in childhood acute leukemia.Methods Thirteen children with acute leukemia in our pediatric hematology ward were recruited.Allpatients were pathologically diagnosed by bone marrow aspiration and complained of bone or joint pain in the first visit.ConventionaI X-ray and MRI examinations of algesic sites were performed before clinical treatment and after complete remission.MR images were obtained with SE-T1WI,SE-T2WI and T2WI-fat suppressed sequences and symmetria bilateralis was requested while scanning.X-ray and MRI manifestations were evaluated and compared.Resuits All 13 patients had received X-ray examinations.Among them,6 had normal X-ray findings,whereas the other 7(14 sites)showed various abnormalities including radiolucent metaphyseal bands(5 sites),periosteal reaction(3 sites),osteapenia(2 sites

  9. Prevalence and prediction of silent ischaemia in diabetes mellitus: a population-based study

    May, O; Arildsen, H; Damsgaard, E M;

    1997-01-01

    OBJECTIVES: The aim of the study was to estimate the prevalence of silent ischaemia in diabetic subjects in the population, to compare the prevalence of silent ischaemia in diabetics and non-diabetics and to attempt to predict the presence of silent ischaemia in diabetic subjects. METHODS: A random...... sample of 120 users of insulin and 120 users of oral hypoglycaemic agents aged 40-75 years living in the Danish municipality of Horsens were asked to participate in the study. Corresponding to the youngest half of the sample two non-diabetic controls were randomly selected from the Central Population...... registered simultaneously with ECG evidence of ischaemia. Individuals with ischaemia, but without angina pectoris, were defined as persons with silent ischaemia. RESULTS: Seventy-four percent of the invited group were included. The observed prevalence of silent ischaemia in diabetics was 13.5% (95% CI = 8...

  10. Treatment of severe foot ischaemia by defibrination with ancrod

    Tønnesen, K H; Sager, P; Gormsen, J

    1978-01-01

    Forty-two patients, mean age 68 years, with severe leg ischaemia were randomly treated with placebo or by controlled defibrination with ancrod for 3 weeks. Plasma fibrinogen concentration was kept at about 20% of normal in the ancrod treated group. The two groups proved to be well matched regardi...

  11. AAV-mediated in vivo functional selection of tissue-protective factors against ischaemia.

    Ruozi, Giulia; Bortolotti, Francesca; Falcione, Antonella; Dal Ferro, Matteo; Ukovich, Laura; Macedo, Antero; Zentilin, Lorena; Filigheddu, Nicoletta; Gortan Cappellari, Gianluca; Baldini, Giovanna; Zweyer, Marina; Barazzoni, Rocco; Graziani, Andrea; Zacchigna, Serena; Giacca, Mauro

    2015-01-01

    Functional screening of expression libraries in vivo would offer the possibility of identifying novel biotherapeutics without a priori knowledge of their biochemical function. Here we describe a procedure for the functional selection of tissue-protective factors based on the in vivo delivery of arrayed cDNA libraries from the mouse secretome using adeno-associated virus (AAV) vectors. Application of this technique, which we call FunSel, in the context of acute ischaemia, revealed that the peptide ghrelin protects skeletal muscle and heart from ischaemic damage. When delivered to the heart using an AAV9 vector, ghrelin markedly reduces infarct size and preserves cardiac function over time. This protective activity associates with the capacity of ghrelin to sustain autophagy and remove dysfunctional mitochondria after myocardial infarction. Our findings describe an innovative tool to identify biological therapeutics and reveal a novel role of ghrelin as an inducer of myoprotective autophagy. PMID:26066847

  12. Acute direct inguinal hernia resulting from blunt abdominal trauma: Case Report

    Hipkins Gabrielle

    2010-06-01

    Full Text Available Abstract We report a case of traumatic inguinal hernia following blunt abdominal trauma after a road traffic accident and describe the circumstances and technique of repair. The patient suffered multiple upper limb fractures and developed acute swelling of the right groin and scrotum. CT scan confirmed the acute formation of a traumatic inguinal hernia. Surgical repair was deferred until resolution of the acute swelling and subcutaneous haematoma. The indication for surgery was the potential for visceral strangulation or ischaemia with the patient describing discomfort on coughing. At surgery there was complete obliteration of the inguinal canal with bowel and omentum lying immediately beneath the attenuated external oblique aponeurosis. A modified prolene mesh hernia repair was performed after reconstructing the inguinal ligament and canal in layers. To our knowledge, this is the first documented case of the formation of an acute direct inguinal hernia caused as a result of blunt abdominal trauma with complete disruption of the inguinal canal. Surgical repair outlines the principles of restoration of normal anatomy in a patient who is physiologically recovered from the acute trauma and whose anatomy is distorted as a result of his injuries.

  13. 肌内效贴对急性期脑卒中患者上肢功能恢复的影响%The Influence of Kinesiotape Therapy on the Recovery of Upper Limb Function of Acute Stroke Patients

    陈志标; 陈焕洲; 冼祖新; 蔡远忠; 梁方旭; 王本国

    2015-01-01

    Objective:To investigate the influence of kinesiotape therapy on the recovery of upper limb function of acute stroke patients. Methods:50 cases of acute stroke patients were randomly divided into control group (n=25) and treatment group (n=25), both of which received conventional re-habilitation treatment (exercise in bed, acupuncture and physical agents therapy, trunk control training, upper limb function training, balance training, ambulation exercise, ADL training), while treatment group combined with kinesiotape therapy, once every other day, maintain>24h for every single time, totally for 2 weeks;before treatment and after 2 weeks, used FMA, MBI scores to evaluate the improvement of upper limb function and activi-ties of daily living of two groups. Results:After treatment, the improvement of FMA score and MBI score of treatment group were both significantly better than those of control group (P24h,共2周;在治疗前、治疗2周后采用简式Fugl-Meyer上肢功能评分(FMA)、改良巴氏指数量表(MBI)评分评价两组患者上肢运动功能及日常生活活动能力的改善情况.结果:治疗后,治疗组FMA评分、MBI评分改善程度均显著优于对照组(P<0.05).结论:肌内效贴可有效提高急性期脑卒中患者的治疗效果,促进患者上肢运动功能恢复,改善日常生活活动能力.

  14. Mesenteric ischaemia after endovascular coiling of ruptured cerebral aneurysms.

    Kamel, M H

    2012-02-03

    Three patients were referred to a national neurosurgical centre following CT evidence of subarachnoid haemorrhage. The three patients, who were referred from different institutions within a seven week period, were Fisher grade 3 and WFNS Grade I at all times. Angiography showed a PCOM aneurysm in one case, a ruptured Basilar tip aneurysm and an unruptured ACOM aneurysm in another case, and an ACOM aneurysm in the third case. It was decided that the aneurysms were suitable for endovascular coiling. These patients had unremarkable intraoperative catheterizations and coiling but subsequently deteriorated post-operatively due to mesenteric ischaemia. Two patients required colectomy for mesenteric ischaemia, and the third arrested secondary to sepsis from bowel perforation. We discuss the various causes that may explain this association, and we alert the neurosurgical community for this complication which has not been reported before.

  15. Diagnostic evaluation of cerebro-vascular transient ischaemia

    Seventy-one cases, including 16 controls, were studied by combined radionuclide, computerized tomography and electroencephalographic techniques. The sensitivity of radionuclide scanning was 67% in carotid transient ischaemia and rose to 83% when combined with the other two techniques. Thirty-five per cent of the cases with vertebro-basilar insufficiency were detected by radionuclide scanning only. Computerized tomography detected 10% of the cases of older infarction in the atherosclerotic group, while none were detected by radionuclide scanning. (author)

  16. Quantification of macular ischaemia in sickle cell retinopathy.

    C. M. Lee; Charles, H C; Smith, R. T.; Peachey, N S.; Cunha-Vaz, J G; Goldberg, M F

    1987-01-01

    Macular ischaemia has a central role in the pathophysiology and prognosis of retinal macular disease. We attempted to quantitate two of its major components as follows: vascular nonperfusion, by measuring the foveal avascular zone (FAZ), using fluorescein angiography; and functional damage, using automated perimetry of the central 30 degrees. Sickle cell disease was chosen for study because it was considered a prototype for a purely ischaemic retinopathy without an exudative component. We fou...

  17. Prevalence of asymptomatic myocardial ischaemia in diabetic subjects.

    Koistinen, M J

    1990-01-01

    OBJECTIVE--To compare the prevalence of silent myocardial ischaemia associated with coronary artery disease in diabetic subjects with that in controls of similar age and sex. DESIGN--A controlled study in which subjects with positive findings on exercise electrocardiography, 24 hour electrocardiographic recording, or dynamic thallium scintigraphy (diabetics only) underwent coronary angiography. SETTING--Academic medical centre; referral based cardiology clinic. SUBJECTS--136 Diabetic subjects...

  18. Intermittent claudication due to ischaemia of the lumbosacral plexus

    Wohlgemuth, W.; Rottach, K.; Stoehr, M.

    1999-01-01

    The distinct clinical syndrome of exercise induced ischaemia of the lumbosacral plexus is not a widely known cause for intermittent claudication. Eight patients with the mentioned syndrome were investigated clinically, neurophysiologically, and with imaging techniques. The clinical examination showed a typical exercise induced sequence of symptoms: pain, paraesthesia, and sensory and motor deficits. The underlying vascular conditions were high grade stenoses or occlusions of the a...

  19. Ischaemia-induced (symptomatic) migraine attacks may be more frequent than migraine-induced ischaemic insults

    Olesen, Jes; Friberg, L; Olsen, T S; Andersen, A R; Lassen, N A; Hansen, P E; Karle, A

    Fifteen consecutive patients with a diagnostic problem of ischaemia-induced migraine with aura (symptomatic migraine) or migraine-associated ischaemia (migrainous infarction) were studied in order to elucidate the mechanisms. Three had a 1 month flurry of daily attacks of migraine auras with or w...... ischaemia-induced migraine attacks may be more frequent than migraine-induced ischaemic insults. Therefore, migraine is not as strong a risk factor for stroke as indicated by the mere coincidence of the two disorders....

  20. Managing the asymptomatic diabetic patient with silent myocardial ischaemia.

    Doubell, A F

    2002-01-01

    Coronary artery disease is common in diabetic patients and remains the major cause of death in these patients. However myocardial ischaemia resulting from coronary lesions does not always give rise to symptoms. The managing physician must therefore consider the benefit of screening for silent myocardial ischaemia in diabetic patients. Screening all diabetic patients is not recommended. The challenge to the physician is to select the patient subgroups likely to benefit from screening. Patients with more than one cardiac risk factor (dyslipidaemia, hypertension, smoking, family history, micro-albuminuria) in addition to diabetes, as well as patients with established macrovascular disease, e.g. peripheral vascular disease, will benefit most from screening. A standard treadmill stress ECG is the recommended screening test. A number of additional tests have been proposed to select high-risk patients for screening. Of these, testing for microalbuminuria and elevated CRP levels are most likely to influence decision-making. Once silent ischaemia has been detected in a diabetic patient, the mainstay of treatment remains the aggressive control of risk factors, improvement of glycaemic control and aspirin therapy. The use of beta-blockers and ACE-inhibitors often need consideration. The attending physician must then consider referring the patient to a cardiologist for angiography and possible intervention. This decision is based on the presence of poor prognostic signs during the stress ECG and the number of risk factors present. Microalbuminuria and elevated CRP levels are helpful in assisting with the risk stratification process. PMID:12389062

  1. Sodium nitrate alleviates functional muscle ischaemia in patients with Becker muscular dystrophy.

    Nelson, Michael D; Rosenberry, Ryan; Barresi, Rita; Tsimerinov, Evgeny I; Rader, Florian; Tang, Xiu; Mason, O'Neil; Schwartz, Avery; Stabler, Thomas; Shidban, Sarah; Mobaligh, Neigena; Hogan, Shomari; Elashoff, Robert; Allen, Jason D; Victor, Ronald G

    2015-12-01

    Becker muscular dystrophy (BMD) is a progressive X-linked muscle wasting disease for which there is no treatment. BMD is caused by in-frame mutations in the gene encoding dystrophin, a structural cytoskeletal protein that also targets other proteins to the sarcolemma. Among these is neuronal nitric oxide synthase mu (nNOSμ), which requires specific spectrin-like repeats (SR16/17) in dystrophin's rod domain and the adaptor protein α-syntrophin for sarcolemmal targeting. When healthy skeletal muscle is exercised, sarcolemmal nNOSμ-derived nitric oxide (NO) attenuates α-adrenergic vasoconstriction, thus optimizing perfusion. In the mdx mouse model of dystrophinopathy, this protective mechanism (functional sympatholysis) is defective, resulting in functional muscle ischaemia. Treatment with a NO-donating non-steroidal anti-inflammatory drug (NSAID) alleviates this ischaemia and improves the murine dystrophic phenotype. In the present study, we report that, in 13 men with BMD, sympatholysis is defective mainly in patients whose mutations disrupt sarcolemmal targeting of nNOSμ, with the vasoconstrictor response measured as a decrease in muscle oxygenation (near infrared spectroscopy) to reflex sympathetic activation. Then, in a single-arm, open-label trial in 11 BMD patients and a double-blind, placebo-controlled cross-over trial in six patients, we show that acute treatment with oral sodium nitrate, an inorganic NO donor without a NSIAD moiety, restores sympatholysis and improves post-exercise hyperaemia (Doppler ultrasound). By contrast, sodium nitrate improves neither sympatholysis, nor hyperaemia in healthy controls. Thus, a simple NO donor recapitulates the vasoregulatory actions of sarcolemmal nNOS in BMD patients, and constitutes a putative novel therapy for this disease. PMID:26437761

  2. Twenty cases of acute cerebral infarction complicated with deep venous thrombosis in lower limb%急性脑梗死并发下肢深静脉血栓形成20例

    麦卫华; 王俊峰; 刘汉伟; 韩蓉蓉

    2011-01-01

    目的 探讨急性脑梗死患者并发下肢深静脉血栓形成(LDVT)的发病原因、临床特点及诊治方法.方法 对我科收治的20例急性脑梗死并发LDVT患者的病例资料进行回顾性分析.结果 20例脑梗死并发LDVT患者中,65岁以上占55%,血清纤维蛋白原增高者占65%,红细胞压积升高者占45%.瘫痪侧肢体LDVT发生率为75%,健侧肢体为10%.左侧LDVT占60%,右侧LDVT占25%.脑梗死后1周内LDVT发生率最高(55%).LDVT发病3 d内的4例患者行尿激酶溶栓治疗,LDVT发病3-14 d的14例患者行低分子肝素抗凝治疗,两组治愈显效率比较差异无统计学意义(75%V8 57%,P>0.05).结论 高龄、血液粘滞度增高、长期卧床及解剖因素等均是急性脑梗死患者发生LDVT的重要原因.溶栓与抗凝治疗疗效类似,均为治疗LDVT的有效手段.急性脑梗死患者早期防治LDVT具有重要意义.%Objective To investigate the etiological factors, clinical characteristics, diagnosis and treatment of deep venous thrombosis in lower limb ( LDVT) in patients with acute cerebral infarction (CI).Methods Clinical datas of twenty cases of acute CI complicated with LDVT who were hospitalized in our department were analyzed retrospectively. Results Among these 20 cases, the percentage of patients over 65 years old was fifty - five. The percentages of patients with increased serum fibrinogen and hematocrit were sixty - five and forty - five respectively. The incidence rates of LDVT happened in palsy and normal limbs were 75% and 10% , respectively. The percentage of DVT in left lower limb was sixty, while that in right lower limb was twenty - five. The incidence rate of LDVT within one week after acute CI was the highest (55% ). Four cases with LDVT happened within three days received thrombolysis therapy by urokinase. Fourteen cases with LDVT happened in three to fourteen days received anticoagulant therapy by low molecular heparin. Healing rates between the two groups were

  3. Medium intensity oral anticoagulants versus aspirin after cerebral ischaemia of arterial origin (ESPRIT) : a randomised controlled trial

    Halkes, P H A; van Gijn, J; Kappelle, L J; Koudstaal, P J; Algra, A

    2007-01-01

    BACKGROUND: Oral anticoagulants are better than aspirin for secondary prevention after myocardial infarction and after cerebral ischaemia in combination with non-rheumatic atrial fibrillation. The European/Australasian Stroke Prevention in Reversible Ischaemia Trial (ESPRIT) aimed to determine wheth

  4. Lipocalin-2 released in response to cerebral ischaemia mediates reperfusion injury in mice.

    Wang, Guona; Weng, Yi-Chinn; Han, Xiqian; Whaley, James D; McCrae, Keith R; Chou, Wen-Hai

    2015-07-01

    Thrombolysis remains the only effective therapy to reverse acute ischaemic stroke. However, delayed treatment may cause serious complications including hemorrhagic transformation and reperfusion injury. The level of lipocalin-2 (LCN2) is elevated in the plasma of ischaemic stroke patients, but its role in stroke is unknown. Here, we show that LCN2 was acutely induced in mice after ischaemic stroke and is an important mediator of reperfusion injury. Increased levels of LCN2 were observed in mouse serum as early as 1 hr after transient middle cerebral artery occlusion (tMCAO), reaching peak levels at 23 hrs. LCN2 was also detected in neutrophils infiltrating into the ipsilateral hemisphere, as well as a subset of astrocytes after tMCAO, but not in neurons and microglia. Stroke injury, neurological deficits and infiltration of immune cells were markedly diminished in LCN2 null mice after tMCAO, but not after permanent MCAO (pMCAO). In vitro, recombinant LCN2 protein induced apoptosis in primary cultured neurons in a dose-dependent manner. Our results demonstrate that LCN2 is a neurotoxic factor secreted rapidly in response to cerebral ischaemia, suggesting its potential usage as an early stroke biomarker and a novel therapeutic target to reduce stroke-reperfusion injury. PMID:25702801

  5. Measurement of ischaemia-reperfusion in patients with intermittent claudication using NMR-based metabonomics.

    Coolen, S.A.; Daykin, C.A.; Duynhoven, JP van; Dorsten, FA van; Wulfert, F.; Mathot, J.; Scheltinga, M.R.; Stroosma, O.; Vader, H.; Wijnen, M.H.W.A.

    2008-01-01

    Intermittent claudication has proved to be a good in vivo model for ischaemia-reperfusion. For assessment of ischaemia-reperfusion damage, the known biochemical markers all have disadvantages with respect to sensitivity and interference with other physiological events. In this work, we studied the m

  6. Acute iliac artery thrombosis and pyloric ulcer perforation - unique double emergency pathologies detected with MDCT

    Full text: Acute iliac artery thrombosis and pyloric ulcer perforation are both emergencies that require different surgical approach. Both conditions have serious consequences and high mortality rate. There are fewer reports on simultaneous cases of such surgical emergencies. We present a case of 67 years old man with abdominal pain with acute onset and paleness and pain in the left lower extremity. the patient was referred for a CT for assessment of acute limb ischaemia and also suspected mesenteric thrombosis. MDCT of abdomen and peripheral CT angiography of lower extremities was performed. The aim is to show the benefit of MDCT examination in depicting varieties of pathologies encountered in emergency patients. MDCT showed total occlusion of left iliac artery. No signs of mesenteric thrombosis were evident and the mesenteric arteries were patent. However there was free air in the peritoneal cavity suggestive of perforation. the patient was operated - arterial thrombectomy was performed together with pyloric ulcus excision. MDCT is an excellent non-invasive method that can give prompt answers to surgical emergencies

  7. Non-occlusive mesenteric ischaemia of a free jejunal flap.

    Onoda, Satoshi; Kimata, Yoshihiro; Yamada, Kiyoshi; Koshimune, Seijiro; Onoda, Tomoo; Shirakawa, Yasuhiro

    2013-05-01

    Free jejunal transfer using microsurgery after oesophageal or pharyngeal cancer resection is a useful operative approach. However, the disadvantage of free tissue transfer is the risk of necrosis of the transferred tissue due to impaired blood supply. In addition, jejunal flaps are more prone to blood-flow disorders such as ischaemia and congestion compared with other types of flaps. The causes of local blood supply disorders after microsurgery are divided broadly into two classes: one is thrombosis of an artery and/or vein in the anastomotic region and the other consists of local physical factors such as compressive pressure derived from haematoma formation and the effect of infection of the vascular pedicle. In this report, two rare cases of blood-flow disorder of the transferred free jejunum are described. In both cases, no signs of significant infection or occlusion of the vascular pedicles were present and late necrosis progressed gradually. The patients showed remarkable weight loss and a poor nutritional state due to inadequate preoperative nutritional intake. The necrosis was considered to be a result of non-occlusive mesenteric ischaemia of a free jejunal flap, and the factors contributing to free jejunal necrosis were reviewed. PMID:23395151

  8. 四肢战创伤并发急性肾衰竭危险因素的logistic回归分析%Logistic regression analysis of the risk factors of acute renal failure complicating limb war injuries

    程昌志; 赵东海; 李全岳; 曲海燕; 陈伯成; 林舟丹

    2011-01-01

    Objective To explore the risk factors of complication of acute renal failure (ARF) in war injuries of limbs. Methods The clinical data of 352 patients with limb injuries admitted to 303 Hospital of PLA from 1968 to 2002 were retrospectively analyzed. The patients were divided into ARF group (n=9) and non-ARF group ( n=343) according to the occurrence of ARF, and the case-control study was carried out. Ten factors which might lead to death were analyzed by logistic regression to screen the risk factors for ARF,including causes of trauma, shock after injury, time of admission to hospital after injury, injured sites, combined trauma, number of surgical procedures, presence of foreign matters, features of fractures, amputation, and tourniquet time. Results Fifteen of the 352 patients died (4.3%) , among them 7 patients (46.7%) died of ARF, 3 (20.0%) of pulmonary embolism, 3 (20.0 %) of gas gangrene,and 2 (13.3%) of multiple organ failure. Univariate analysis revealed that the shock, time before admitted to hospital, amputation and tourniquet time were the risk factors for ARF in the wounded with limb injuries, while the logistic regression analysis showed only amputation was the risk factor for ARF ( P<0.05). Conclusion ARF is the primary cause-of-death in the wounded with limb injury.Prompt and accurate treatment and optimal time for amputation may be beneficial to decreasing the incidence and mortality of ARF in the wounded with severe limb injury and ischemic necrosis.%目的 探讨四肢战创伤并发急性肾衰竭(ARF)的危险因素.方法 回顾性分析1968-2002年收治的352例四肢战创伤患者,根据是否发生ARF将患者分为ARF组(9例)和非ARF组(343例)并进行病例对照研究,选择可能影响患者死亡的10个因素(致伤物、伤后是否休克、伤后入院时间、受伤部位、有无合并伤、手术次数、有否异物存留、骨折性质、是否截肢、止血带时间)进行logistic回归分析,筛

  9. Results of distal revascularization in elderly patients for critical ischemia of the lower limbs.

    Illuminati, G; Calio, F G; Bertagni, A; Piermattei, A; Vietri, F; Martinelli, V

    1999-04-01

    Thirty eight patients over 75 years of age were operated upon of 40 distal arterial revascularizations for critical ischaemia of the lower limbs. Arterial reconstruction was proposed to ambulatory, self sufficient patients, with a patent artery of the leg or the foot in continuity with pedal arch, at arteriography. The revascularized artery was the peroneal in 14 cases, the anterior tibial in 11, the posterior tibial in 9, the dorsalis pedis in 5, and the external plantar artery in 1 case. Postoperative mortality was 2.6%. No postoperative arterial occlusion occurred and no postoperative amputation needed to be performed. The mean follow-up of 37 patients surviving operation was 21 months (ext. 2-52 months). At 36 months interval, patients' survival was 43%, primary patency rate was 57%, and limb salvage rate was 76%, at life-table analysis. Distal revascularization enables a good number of elderly patients in critical ischaemia of the lower limb, to enjoy an active, independent life, with a viable limb. PMID:10352735

  10. Phantom limb pain

    ... shooting pain Achy pain Burning pain Cramping pain Phantom limb pain will lessen over time for most people. ... Elsevier; 2012:chap 44. Bang MS, Jung SH. Phantom limb pain. In: Frontera, WR, Silver JK, eds. Essentials ...

  11. Application value of ultrasound in transcatheter thrombolysis of acute lower limb deep phlebothrombosis%超声在急性下肢深静脉血栓形成局部置管溶栓中的应用价值

    魏俊涛

    2012-01-01

    Objective To explore the application value of ultrasound in transcatheter thrombolysis of acute lower limb deep phlebothrombosis. Methods Thirty-eight patients with acute lower limb deep phlebothrombosis were enrolled in this study, Before the operation, an inferior vena cava filter was inserted through the femoral vein or the internal jugular vein on the healthy side. Under ultrasound localization and guidance, the popliteal vein was punctured and the thrombolysis catheter was inserted, then urokinase was continuously poured by using the micro pump, 24~48 h later, ultrasonography was preformed again. Results Puncture needle was successfully inserted in the popliteal vein, and the thrombolysis catheter was placed into the suitable position. Ultrasound guidance successed in 38 patients. During the treatment, the position of the catheter was changed with ultrasound guidance according to the thrombolysis condition in 4 patients. 2~7 d later, 33 patients were cured basically, 4 patients were improvrd, 1 patient was invalid. No massive hemorrhage or pulmonary embolism happened. Conclusion Ultrasound has important clinical value in preoperative diagnosis, intraoperative guidance, postoperative medication and curative effect evaluation of transcatheter thrombolysis in patients with acute lower limb deep phlebothrombosis.%目的 探讨超声在急性下肢深静脉血栓形成(DVT)患者局部置管溶栓中的应用价值.方法 38例急性下肢DVT患者,术前经健侧股静脉或颈内静脉置入下腔静脉滤器.在超声定位和引导下,穿刺患侧腘静脉,置入溶栓导管.微泵持续注入尿激酶,24~48 h后超声监测.结果 超声定位下穿刺针均顺利进入腘静脉;超声引导下溶栓导管均被置入血栓合适位置,38例超声引导全部成功.治疗过程中,根据血栓消融情况,4例在超声引导下调整了溶栓导管位置.经过2~7 d溶栓治疗后行超声检查,33例基本治愈,4例好转,1例无效.无一例发生

  12. TRENDS IN REVASCULARIZATION FOR CRITICAL LIMB ISCHEMIA OF LOWER LIMBS

    Ravikumar

    2014-07-01

    Full Text Available OBJECTIVE: To study the trends in revascularization procedures done for critical limb ischemia (CLI of lower limbs. MATERIALS AND METHODS: Total of 166 revascularization procedures done for CLI by a single vascular surgeon between June 2010 and May 2014 at Kempegowda Institute of Medical Sciences Bangalore. Both endovascular and open bypass procedures for lower limb ischemia were included. This retrospective study was conducted to evaluate the outcomes of the procedures and to see the trends in the management of CLI of lower limb. Only elective cases were included in the study. Emergency revascularization procedures for acute limb ischemia and those below 45 years suspected to be thromboangiitis obliterans were excluded STUDY PERIOD: Review of 4 year experience from June 2010 to May 2014. Follow up period was 24 months. Patients were predominantly male (94%, of the 5th and 7th decade of life (Median age 60 years.All patients presented with chronic lower limb ischemia with critical limb ischemia. Commonest presentation was disabling claudication, rest pain with ulcerations and digital gangrene. Co morbid conditions included diabetes mellitus, smoking history, hypertension, hyperlipidemia, cardiac disease. Total procedures done: Open- 104, Endovascular- 62. Open procedures: Aorto-femoral (21 femoro-femoral (33 femoropopliteal (50. Primary endovascular revascularization procedures angioplasty alone (53 % angioplasty + stenting (47 %. Complication rate was significantly higher and the mean hospital stay was significantly longer with open surgery (15%, 10 days compared with endovascular surgery (0.08%, 4days (P < 0.05. Furthermore the number of endovascular revascularization procedures done significantly increased from6% in the first period (June 2010-May 2011 to 61% in the last period (June2013-May2014. CONCLUSIONS: Endovascular procedures for CLI have largely replaced open surgical procedures. Angioplasty is a feasible, safe, and effective

  13. RNase1 prevents the damaging interplay between extracellular RNA and tumour necrosis factor-α in cardiac ischaemia/reperfusion injury.

    Cabrera-Fuentes, H A; Ruiz-Meana, M.; Simsekyilmaz, S.; Kostin, S; Inserte, J.; Saffarzadeh, M.; Galuska, S. P.; Vijayan, V.; Barba, I; Barreto, G.; Fischer, S.; Lochnit, G; Ilinskaya, O. N.; Baumgart-Vogt, E; Böning, A.

    2014-01-01

    Despite optimal therapy, the morbidity and mortality of patients presenting with an acute myocardial infarction (MI) remain significant, and the initial mechanistic trigger of myocardial "ischaemia/reperfusion (I/R) injury" remains greatly unexplained. Here we show that factors released from the damaged cardiac tissue itself, in particular extracellular RNA (eRNA) and tumour-necrosis-factor α (TNF-α), may dictate I/R injury. In an experimental in vivo mouse model of myocardial I/R as well as ...

  14. In situ saphenous vein bypass for limb salvage.

    Sarcina, A; Carlesi, R; Bellosta, R; Agrifoglio, G

    1993-02-01

    A total of 130 infrapopliteal in situ saphenous vein bypasses were performed in 128 patients between January 1980 and June 1991. The indication for surgery was critical ischaemia with impending limb loss in 121 patients; seven suffered from severe claudication. The distal anastomosis was to the popliteal artery below the knee in 60 cases (46.2%) and in 70 (53.8%) to the tibioperoneal arteries. The results, in terms of secondary patency and limb salvage rates, of the first 68 procedures (1980-1985) and subsequent 62 (1986-June 1991) were compared. In the first period, a secondary patency rate of 42.6% and a limb salvage rate of 67.0% were obtained, compared with 71.3 and 80.8% respectively in the second. These differences are significant for patency (P < 0.005) and limb salvage (P < 0.01). These results show that the in situ technique can give acceptable results but a learning period with a high percentage of early failures is to be expected. PMID:8075993

  15. Transcranial Doppler for detection of cerebral ischaemia during carotid endarterectomy

    Jørgensen, L G; Schroeder, T V

    1992-01-01

    We evaluated transcranial Doppler sonography (TCD) for the detection of cerebral ischaemia during carotid endarterectomy in 30 male and 14 female patients with ipsilateral focal cerebro-vascular symptoms. Surgery was performed during halothane-nitrous oxide anaesthesia with moderate hypocapnia....... Eight patients had a temporary shunt owing to contralateral occlusion or a stump pressure below 40 mmHg, and/or EEG flattening. Transcranial Doppler sonography was followed intra-operatively together with electro-encephalography (EEG), internal carotid artery (ICA) pressures and cerebral blood flow (CBF...... Vmean clamp: Vmean pre-clamp ratio of less than 0.6 showed an accuracy with respect to CBF below 20 ml 100 g-1 min-1 of 89%. AVmeanclamp:Vmean pre-clamp ratio below 0.4 detected all all patients with EEG flattening (n = 3) (accuracy 97%). The corresponding level of accuracy obtained with stump pressure...

  16. Regional myocardial ajmaline concentration and antiarrhythmic activity for ischaemia- and reperfusion-induced arrhythmias in rats.

    Okumura, K; Hashimoto, Y.; Yasuhara, M; R. Hori

    1988-01-01

    1. Antiarrhythmic actions of ajmaline against ischaemia (left coronary artery occlusion for 15 min) and subsequent reperfusion-induced arrhythmias were investigated in anaesthetized rats. 2. Ajmaline (2 mg kg-1, i.v.) was effective in suppressing ischaemia-induced arrhythmias whether given pre- or post-occlusion. 3. Ajmaline diminished the reperfusion-induced arrhythmias completely when given pre-occlusion but had little effect when given post-occlusion. 4. Reperfusion-induced increases in pl...

  17. The effect of voluntarily ingested buprenorphine on rats subjected to surgically induced global cerebral ischaemia

    Kalliokoski, Otto Henrik; Abelson, Klas; Koch, Janne; Boschian, Anna; Thormose, Sarah F; Fauerby, Natasha; Rasmussen, Rune Skovgaard; Johansen, Flemming Fryd; Hau, Jann

    2010-01-01

    The effect of perioperatively administered buprenorphine analgesia on rats subjected to surgically induced global ischaemia was assessed. Rats supplied with buprenorphine, mixed in nut paste for voluntary ingestion, displayed significant reductions in postoperative excretions of faecal corticoste......The effect of perioperatively administered buprenorphine analgesia on rats subjected to surgically induced global ischaemia was assessed. Rats supplied with buprenorphine, mixed in nut paste for voluntary ingestion, displayed significant reductions in postoperative excretions of faecal...

  18. LDTk: Limb Darkening Toolkit

    Parviainen, Hannu

    2015-01-01

    We present a Python package LDTk that automates the calculation of custom stellar limb darkening (LD) profiles and model-specific limb darkening coefficients (LDC) using the library of PHOENIX-generated specific intensity spectra by Husser et al. (2013). The aim of the package is to facilitate analyses requiring custom generated limb darkening profiles, such as the studies of exoplanet transits--especially transmission spectroscopy, where the transit modelling is carried out for custom narrow passbands--eclipsing binaries (EBs), interferometry, and microlensing events. First, LDTk can be used to compute custom limb darkening profiles with uncertainties propagated from the uncertainties in the stellar parameter estimates. Second, LDTk can be used to estimate the limb-darkening-model specific coefficients with uncertainties for the most common limb-darkening models. Third, LDTk can be directly integrated into the log posterior computation of any pre-existing modelling code with minimal modifications. The last a...

  19. Cocaine-associated lower limb ischemia.

    Collins, Chris G

    2011-07-25

    Cocaine-associated thrombosis has been reported in the literature with reports of vascular injuries to cardiac, pulmonary, intestinal, placental, and musculoskeletal vessels; however, injury of the pedal vessels is rare. We report on a 31-year-old man who presented 2 months following a cocaine binge with limb-threatening ischemia without an otherwise identifiable embolic source. Angiography confirmed extensive occlusive disease of the tibioperoneal vessels. The patient improved following therapy with heparin and a prostacyclin analogue. Cocaine-induced thrombosis should be considered in patients presenting with acute arterial insufficiency in the lower limb without any other identifiable cause.

  20. Cost effectiveness of diagnostic strategies for patients with acute, undifferentiated chest pain

    Goodacre, S; Calvert, N.

    2003-01-01

    Objectives: Patients presenting to hospital with acute, undifferentiated chest pain have a low, but important, risk of significant myocardial ischaemia. Potential diagnostic strategies for patients with acute, undifferentiated chest pain vary from low cost, poor effectiveness (discharging all home) to high cost, high effectiveness (admission and intensive investigation). This paper aimed to estimate the relative cost effectiveness of these strategies.

  1. 急性下肢缺血130例的临床特点分析和治疗体会%Clinical feature and treatment for 130 cases of acute lower limb ischemia

    阿卜杜?卡维; 李杰; 赖远辉; 艾文佳; 王深明; 李晓曦

    2013-01-01

    Objective To investigate the clinical features and treatment of acute lower limb ischemia. Methods A retrospective analysis was carried out of patients who were admitted and treated for ALLI from January 2003 to December 2009. Results 82 cases of acute arterial embolism and 48 cases of acute thrombosis were studied. Clinical features:The overall incidence and co-incidence of CHD and AF was higher in the embolization group, and the patients in this group were treated earlier. In the acute thrombosis group:winter incidence was higher;men and smoking history were majority, older in average, and later for treatment. A systemic thrombolysis and anticoagulation therapy was taken in 12 cases and 9 patients undertook catheter thrombolysis. Fogarty catheter embolectomy procedures were performed in 81 cases, and 15 patients received immediate graft by-pass after the removal of thrombosis. An amputation was the first choice in 13 patients, and 8 patients underwent amputation of the second phase. A total of 27 patients underwent open decompression of compartment. Overall amputation rate was 16.15%; hospital mortality rate was 6.9%. Smoking, diabetes and onset time were independent risk factors for limb preservation. Conclusions ALLI should be treated as early as possible. Fogarty catheter embolectomy is effective for the acute arterial embolism. Preoperative assessment is important for acute arterial thrombosis and thrombolysis and/or graft by-pass should be used if necessary.%目的:探讨急性下肢缺血(ALLI)的临床特点及治疗方法。方法回顾性分析2003年1月至2009年12月收治的ALLI患者的临床资料,根据病因将其分为急性动脉栓塞组(AE组)和急性血栓形成组(AT组),比较两组起病特点和治疗方法的异同,分析影响保肢的因素。结果共收治130例ALLI,其中AE组82例,发病率略高,合并冠心病、风湿性心脏病、房颤者多,起病情况急,症状重,就诊时间多

  2. Acute type II cryoglobulinaemic vasculitis mimicking atherosclerotic peripheral vascular disease.

    Saeed, A

    2012-01-31

    Atherosclerotic peripheral vascular disease is a common presenting cause for digital ischaemia in life long smokers. Acute severe Type II Cryoglobulinaemic vasculitis is a rare yet important cause, which may present with similar clinical features and which if undiagnosed may be rapidly fatal. Following the instigation of therapy with intravenous methylprednisolone and cyclophosphamide this patient made an excellent recovery.

  3. Limb Salvage After Bone Cancer

    ... Blog Donate Now Select Page Limb Salvage After Bone Cancer Home > Understanding Children’s Cancer > Late Effects of Treatment > Limb Salvage After Bone Cancer Limb salvage is a surgical procedure that replaces ...

  4. Long-chain acylcarnitines determine ischaemia/reperfusion-induced damage in heart mitochondria.

    Liepinsh, Edgars; Makrecka-Kuka, Marina; Volska, Kristine; Kuka, Janis; Makarova, Elina; Antone, Unigunde; Sevostjanovs, Eduards; Vilskersts, Reinis; Strods, Arnis; Tars, Kaspars; Dambrova, Maija

    2016-05-01

    The accumulation of long-chain fatty acids (FAs) and their CoA and carnitine esters is observed in the ischaemic myocardium after acute ischaemia/reperfusion. The aim of the present study was to identify harmful FA intermediates and their detrimental mechanisms of action in mitochondria and the ischaemic myocardium. In the present study, we found that the long-chain acyl-CoA and acylcarnitine content is increased in mitochondria isolated from an ischaemic area of the myocardium. In analysing the FA derivative content, we discovered that long-chain acylcarnitines, but not acyl-CoAs, accumulate at concentrations that are harmful to mitochondria. Acylcarnitine accumulation in the mitochondrial intermembrane space is a result of increased carnitine palmitoyltransferase 1 (CPT1) and decreased carnitine palmitoyltransferase 2 (CPT2) activity in ischaemic myocardium and it leads to inhibition of oxidative phosphorylation, which in turn induces mitochondrial membrane hyperpolarization and stimulates the production of reactive oxygen species (ROS) in cardiac mitochondria. Thanks to protection mediated by acyl-CoA-binding protein (ACBP), the heart is much better guarded against the damaging effects of acyl-CoAs than against acylcarnitines. Supplementation of perfusion buffer with palmitoylcarnitine (PC) before occlusion resulted in a 2-fold increase in the acylcarnitine content of the heart and increased the infarct size (IS) by 33%. A pharmacologically induced decrease in the mitochondrial acylcarnitine content reduced the IS by 44%. Long-chain acylcarnitines are harmful FA intermediates, accumulating in ischaemic heart mitochondria and inducing inhibition of oxidative phosphorylation. Therefore, decreasing the acylcarnitine content via cardioprotective drugs may represent a novel treatment strategy. PMID:26936967

  5. Outcome of patients with atrial fibrillation after intravenous thrombolysis for cerebral ischaemia.

    Padjen, Visnja; Bodenant, Marie; Jovanovic, Dejana R; Ponchelle-Dequatre, Nelly; Novakovic, Novak; Cordonnier, Charlotte; Beslac-Bumbasirevic, Ljiljana; Leys, Didier

    2013-12-01

    The question of whether i.v. rt-PA is beneficial in patients with ischaemic stroke and atrial fibrillation (AF) remains unresolved. Our objective was to evaluate the outcome of patients with AF who received i.v. rt-PA for stroke in the registries of Lille (France) and Belgrade (Serbia). End-points were poor outcome [modified Rankin Scale (mRS) 3-6], and symptomatic haemorrhagic transformation (sHT) according to ECASS3. Of 734 consecutive patients, 155 (21.2 %) had AF. The unadjusted comparison found patients with AF to be 12 years older, more likely to be women, to have hypertension, and baseline INR > 1.2, and less likely to be smokers. They had higher baseline NIHSS scores, diastolic blood pressure, and serum glucose concentrations, and lower platelet counts. They did not differ for sHT (5.8 vs. 5.5 %; p = 0.893), but they more frequently had poor outcomes (52.3 vs. 35.2 %; p independent predictor of sHT was baseline NIHSS (adjOR 1.05 per 1 point increase; 95 % CI 1.01-1.10). Independent variables associated with poor outcome were age (adjOR 1.04 for 1 year increase; 95 % CI 1.03-1.06), baseline NIHSS (adjOR 1.17 per 1 point increase; 95 % CI 1.13-1.21), and sHT (adjOR 47.6; 95 % CI 10.2-250) but not AF. In patients treated with i.v. rt-PA for cerebral ischaemia, those with AF have worse outcomes because they are older and have more severe strokes at admission. This result suggests that we should focus on prevention and research of more aggressive strategies at the acute stage. PMID:24068372

  6. Protective effects of Rosmarinic acid against renal ischaemia/reperfusion injury in rats

    Objective: To investigate the potential protective effects of Rosmarinic acid (RA) on rats exposed to ischaemia/reperfusion renal injury. Methods: The prospective study was conducted at Abant Izzet Baysal University, Turkey, and comprised 21 male Spraque Dawley rats weighing 250-270g each. They were divided into three equal groups. Unilaterally nephrectomised rats were subjected to 60 minutes of left renal ischaemia followed by 60 minutes of reperfusion. Group 1 had shamoperated animals; group 2 had ischaemia/reperfusion untreated animals; and group 3 had ischaemia/reperfusion animals treated with rosmarinic acid. Serum creatinine, blood urea nitrogen, tissue malondialdehyde, glutathione peroxidase, superoxide dismutase and myeloperoxidase (MPO) activities, and light microscopic findings were evaluated. SPSS 17 was used for statistical analysis. Results: Treatment of rats with rosmarinic acid produced a reduction in the serum levels of creatinine and blood urea nitrogen compared to the other groups. However, no statistically significant difference was found. The levels of malondialdehyde and myeloperoxidase were decreased in the renal tissue of group 3, while glutathione peroxidose and superoxide dismutase levels remained unchanged. The injury score decreased in the treatment group rats compared to the untreated group. Rosmarinic acid significantly decreased focal glomerular necrosis, dilatation of Bowman's capsule, degeneration of tubular epithelium, necrosis in tubular epithelium, and tubular dilatation. Conclusions: Rosmarinic acid prevented ischaemia/reperfusion injury in the kidneys by decreasing oxidative stress. (author)

  7. Out on a Limb: Investigating the Anatomy of Tree Limbs

    Shaw, Edward L.

    2008-01-01

    The author presents several upper elementary science activities involving tree limbs that were collected after severe weather conditions. The activities involved 3rd-grade students arranging tree limb pieces in the correct order from the trunk to the tip of the limb, measuring the pieces, determining the age of a tree limb by its rings,…

  8. Abdominal symptoms during physical exercise and the role of gastrointestinal ischaemia : a study in 12 symptomatic athletes

    ter Steege, Rinze W. F.; Geelkerken, Robert H.; Huisman, Ad B.; Kolkman, Jeroen J.

    2012-01-01

    Background Gastrointestinal (GI) symptoms during exercise may be caused by GI ischaemia. The authors report their experience with the diagnostic protocol and management of athletes with symptomatic exercise-induced GI ischaemia. The value of prolonged exercise tonometry in the diagnostic protocol of

  9. [Phantom limb pains].

    Giraux, Pascal

    2015-03-01

    With the radical experience of an amputation, the adaptation of body image is often incomplete. Some people experience phantom body perceptions, often painful and difficult to treat, after the amputation of a limb. PMID:26145132

  10. Ischaemia/reperfusion injury in experimentally induced abomasal volvulus in sheep.

    Sharifi, K; Mostaghni, K; Maleki, M; Badiei, K

    2007-07-01

    The purpose of the study was to evaluate ischaemia/reperfusion injury in simulated abomasal volvulus in sheep. Sixteen ewes were randomly allocated to three groups. The control group (n=4) served as sham-operated controls. The animals of the ischaemia group and reperfusion group (n=6, each) underwent a simulated 'abomasal volvulus'. The abomasum was exteriorized under general inhalation anesthesia and forced into a 180( composite function) anticlockwise rotation around its longitudinal axis, followed by another 270( composite function) anticlockwise rotation around its transectional axis. All ewes were monitored for 4 h. In the reperfusion group, volvulus was released after 3 h (i.e., 1 h of reperfusion). In the ischaemia group, the volvulus remained for 4 h (no reperfusion). Vital signs were monitored and some haematological and biochemical parameters were measured, without any significant differences. Full-section biopsy specimens were taken at the 3rd and 4th hours from the greater curvature of the abomasum. Histopathological lesions were scored according to the severity of mucosal oedema, submucosal oedema, haemorrhage submucosal and submuscularis layers, and polymorphonuclear infiltration on a scale of 0 to 4 (nil, mild, moderate, severe, and extreme). Another biopsy specimen was taken at the 4th hour for transmission electron microscopic examination. The scored lesions in light-microscopic examination were significantly different at the 3rd and 4th hours between the control and the experimental groups (p0.1). Within-group comparisons (3rd hour with 4th hour) revealed no significant differences. In transmission electron microscopic examination there were no remarkable changes in the control group, but in the ischaemia and reperfusion groups there were remarkable cellular (epithelial and goblet cells), mitochondrial and microvillous changes that strongly implied the occurrence of ischaemia (pmodel of simulated abomasal volvulus in sheep and that ischaemia

  11. Diagnosis of myocardial ischaemia using exercise ST mapping and afterload 201Tl scintigraphy

    Two non-invasive methods are compared used in the diagnosis of myocardial ischaemia, i.e. precordial exercise mapping of the ST segment and after load 201Tl scintigraphy of the myocardium.High sensitivity of mapping (89.3%) and of 201Tl scan (92.9%) was found compared to the findings on the coronary arteries. The specificity of both methods was lower (57.1%). Both methods give similar results in diagnosis of myocardial ischaemia; for localization the affection site thallium scintigraphy of the myocardium is preferably used. (author). 2 figs., 2 tabs., 23 refs

  12. Hypoxaemia and myocardial ischaemia during and after endoscopic cholangiopancreatography: call for further studies

    Rosenberg, J; Jørgensen, L N; Rasmussen, Verner;

    1992-01-01

    Sixteen non-selected patients undergoing endoscopic cholangiopancreatography (ERCP) after diazepam premedication were monitored for oxygen saturation (SpO2) with a pulse oximeter and for myocardial ischaemia with a Holter tape recorder from 2 h before ERCP to 6 h after the procedure. One patient ...

  13. Outcome of splanchnic blood flow determination in patients with suspected chronic intestinal ischaemia. A retrospective survey

    Møller, Søren; Madsen, Jan Lysgård

    2002-01-01

    surgery. However, no studies have evaluated the impact of splanchnic blood flow determination on therapy in such patients. OBJECTIVE: The aim of the present study was therefore to analyse the outcome of splanchnic blood flow determination in patients with suspected chronic intestinal ischaemia. METHODS...

  14. Brainstem ischaemia presenting as naloxone-reversible coma followed by downward gaze paralysis.

    Goldman, S.; Cordonnier, M J; Sztencel, J

    1984-01-01

    A 65-year-old man showed naloxone-reversible unconsciousness followed by downward gaze paralysis. CT scan suggested an ischaemic lesion in the mesodiencephalic region. This observation represents the first case of naloxone-reversible coma related to brainstem ischaemia.

  15. Interrelation of ST-segment depression during bicycle ergometry and extent of myocardial ischaemia by myocardial perfusion SPECT

    The aim of this study was to compare ST-segment depression (STD) during bicycle ergometry and extent of myocardial ischaemia assessed by myocardial perfusion SPECT (MPS) in a large patient cohort. Consecutive patients (n = 955) referred for MPS with bicycle ergometry and interpretable stress ECG were evaluated with respect to ECG and MPS findings of ischaemia. The maximal STD was recorded and exercise ECG was considered ischaemic if STD was horizontal or downsloping (≥1 mm). MPS was interpreted using a 20-segment model with a scale of 0 to 4. A summed stress (SSS), summed rest (SRS) and summed difference score (SDS = SSS-SRS, e.g. extent of ischaemia) were derived. Ischaemia was defined as an SDS ≥ 2. An exercise-induced STD was present in 215 patients (22%) and myocardial ischaemia on MPS was present in 366 patients (38%). The extent of ST-segment depression and the number of ECG leads with significant STD were each strongly and significantly associated with increasing severity of ischaemia and the number of coronary territories involved (p < 0.01 for all correlations). These data demonstrate a strong correlation between the extent of STD, number of ischaemic leads and severity of myocardial ischaemia as assessed by MPS during bicycle ergometry. (orig.)

  16. Atrophy of the corpus callosum correlates with white matter lesions in patients with cerebral ischaemia

    Many studies of white matter high signal (WMHS) on T2-weighted MRI have disclosed that it is related to cerebral ischaemia and to brain atrophy. Atrophy of the corpus callosum (CC) has also been studied in relation to ischaemia. Our objective was to test the hypothesis that CC atrophy could be due to ischaemia. We therefore assessed CC, WMHS and brain atrophy in patients with risk factors without strokes (the risk factor group) and in those with infarcts (the infarct group), to investigate the relationships between these factors. We studied 30 patients in the infarct group, 14 in the risk factor group, and 29 normal subjects. Using axial T1-weighted MRI, cortical atrophy and ventricular enlargement (brain atrophy) were visually rated. Using axial T2-weighted MRI, WMHS was assessed in three categories: periventricular symmetrical, periventricular asymmetrical and subcortical. Using the mid-sagittal T1-weighted image, the CC was measured in its anterior, posterior, midanterior and midposterior portions. In the normal group, no correlations were noted between parameters. In the infarct group, there were significant correlations between CC and brain atrophy, and between CC atrophy and WMHS. After removing the effects of age, gender and brain atrophy, significant correlations were noted between some CC measures and subcortical WMHS. In the risk factor group, there were significant correlations between CC and brain atrophy and between CC atrophy and WMHS. After allowance for age, gender and brain atrophy, significant correlations between some CC measures and periventricular WMHS remained. The hypothesis that CC atrophy could be due to cerebral ischaemia was supported by other analyses. Namely, for correlations between the extent of infarcts and partial CC atrophy in patients with anterior middle cerebral artery (MCA) and with posterior MCA infarcts, there were significant correlations between the extent of infarct and midanterior CC atrophy in the former, and posterior

  17. Atrophy of the corpus callosum correlates with white matter lesions in patients with cerebral ischaemia

    Meguro, K.; Yamadori, A. [Section of Neuropsychology, Division of Disability Science, Tohoku University Graduate School of Medicine, 2-1, Seiryo-machi, Aoba-ku, 980-8575 Sendai (Japan); Constans, J.M.; Courtheoux, P.; Theron, J. [MR Unit, University of Caen School of Medicine, Caen (France); Viader, F. [Department of Neuroradiology, University of Caen School of Medicine, Caen (France)

    2000-06-01

    Many studies of white matter high signal (WMHS) on T2-weighted MRI have disclosed that it is related to cerebral ischaemia and to brain atrophy. Atrophy of the corpus callosum (CC) has also been studied in relation to ischaemia. Our objective was to test the hypothesis that CC atrophy could be due to ischaemia. We therefore assessed CC, WMHS and brain atrophy in patients with risk factors without strokes (the risk factor group) and in those with infarcts (the infarct group), to investigate the relationships between these factors. We studied 30 patients in the infarct group, 14 in the risk factor group, and 29 normal subjects. Using axial T1-weighted MRI, cortical atrophy and ventricular enlargement (brain atrophy) were visually rated. Using axial T2-weighted MRI, WMHS was assessed in three categories: periventricular symmetrical, periventricular asymmetrical and subcortical. Using the mid-sagittal T1-weighted image, the CC was measured in its anterior, posterior, midanterior and midposterior portions. In the normal group, no correlations were noted between parameters. In the infarct group, there were significant correlations between CC and brain atrophy, and between CC atrophy and WMHS. After removing the effects of age, gender and brain atrophy, significant correlations were noted between some CC measures and subcortical WMHS. In the risk factor group, there were significant correlations between CC and brain atrophy and between CC atrophy and WMHS. After allowance for age, gender and brain atrophy, significant correlations between some CC measures and periventricular WMHS remained. The hypothesis that CC atrophy could be due to cerebral ischaemia was supported by other analyses. Namely, for correlations between the extent of infarcts and partial CC atrophy in patients with anterior middle cerebral artery (MCA) and with posterior MCA infarcts, there were significant correlations between the extent of infarct and midanterior CC atrophy in the former, and posterior

  18. Coronary plaque quantification and fractional flow reserve by coronary computed tomography angiography identify ischaemia-causing lesions

    Gaur, Sara; Øvrehus, Kristian Altern; Dey, Damini; Leipsic, Jonathon; Bøtker, Hans Erik; Jensen, Jesper Møller; Narula, Jagat; Ahmadi, Amir; Achenbach, Stephan; Ko, Brian S; Christiansen, Evald Høj; Kaltoft, Anne Kjer; Berman, Daniel S; Bezerra, Hiram; Lassen, Jens Flensted; Nørgaard, Bjarne Linde

    2016-01-01

    AIMS: Coronary plaque characteristics are associated with ischaemia. Differences in plaque volumes and composition may explain the discordance between coronary stenosis severity and ischaemia. We evaluated the association between coronary stenosis severity, plaque characteristics, coronary computed...... tomography angiography (CTA)-derived fractional flow reserve (FFRCT), and lesion-specific ischaemia identified by FFR in a substudy of the NXT trial (Analysis of Coronary Blood Flow Using CT Angiography: Next Steps). METHODS AND RESULTS: Coronary CTA stenosis, plaque volumes, FFRCT, and FFR were assessed in...

  19. Can neural blocks prevent phantom limb pain?

    Borghi, Battista; D'Addabbo, Marco; Borghi, Raffaele

    2014-07-01

    Phantom limb syndrome (PLS) is a syndrome including stump pain, phantom limb pain and not-painful phantom sensations, which involves a large part of amputee patients and often has devastating effects on their quality of life. The efficacy of standard therapies is very poor. Nerve blocks have been investigated for the treatment and prevention of PLS. Epidural and peripheral blocks limited to the first three postamputation days can only reduce acute pain but cannot prevent the later development of PLS. Recent studies have shown that ambulatory prolonged peripheral nerve block (up to 30 days postamputation) may represent a new possible option to treat phantom pain and prevent the development of PLS and chronic pain. PMID:25300383

  20. The effect of electrical neurostimulation on collateral perfusion during acute coronary occlusion

    van den Heuvel Ad FM; de Smet Bart JGL; Tan Eng-Shiong; Jessurun Gillian A; DeJongste Mike JL; Anthonio Rutger L; de Vries Jessica; Staal Michiel J; Zijlstra Felix

    2007-01-01

    Abstract Background Electrical neurostimulation can be used to treat patients with refractory angina, it reduces angina and ischemia. Previous data have suggested that electrical neurostimulation may alleviate myocardial ischaemia through increased collateral perfusion. We investigated the effect of electrical neurostimulation on functional collateral perfusion, assessed by distal coronary pressure measurement during acute coronary occlusion. We sought to study the effect of electrical neuros...

  1. Digital distal lower limb angiography: comparison of selective iliac injection with vasodilators and bolus chasing technique

    From October 1992 to May 1993 we carried out a prospective study on 30 patients, mean age 70 years, suffering from lower limb ischaemia (mild, n = 12; moderate, n = 9; severe, n = 9). Four masked investigators compared the outcome of two techniques for the preoperative evaluation of distal vessels of the lower limbs. The reference technique was digital subtraction angiography (DSA) with selective iliac injection, fixed centring on one ankle, and use of vasodilators. The new method was DSA with the so-called bolus chasing technique: after an injection above the aortic bifurcation, an acquisition during a continuous longitudinal translation movement allows all the arteries of the lower limbs to be visualised down to the most distal point. Both techniques are well tolerated and we found no significant difference in the number of distal arteries seen with the two methods. To assess the permeability of the distal lower limb network, the bolus tracking technique is as informative as an iliac selective injection, without its constraints. Consequently, we will routinely use it as the technique of choice. (orig.)

  2. Radionuclide assessment of lower limb perfusion using 99mTc-MIBI in early stages of atherosclerosis

    The aim of the work was a scintigraphic evaluation of regional blood supply of thigh and calf muscles using 99mTc-MIBI as a radiopharmaceutical, in early stages of atherosclerosis revealed during ultrasonographic examination of lower limbs, in patients without typical clinical symptoms of chronic ischaemia of lower limbs and with preserved normal Doppler spectrum of blood flow. Moreover, basic relations between early signs of lower limb atherosclerosis and abnormal myocardial perfusion, as well as asymptomatic hypoperfusion of lower limbs, were analysed. Stress and rest radionuclide study of lower limb muscles and myocardium using 99mTc-MIBI was performed in 47 men, who were divided into two groups based on ultrasonography results. The first group (group I) comprised 22 patients with early atherosclerotic changes in peripheral vessels and the second (group II) comprised 25 people with normal arteries. For the purposes of quantification of study results normal values of regional blood supply and indices of asymmetry at levels of thighs and calves, as proposed by Segall et al., were applied. Myocardial scintigrams were evaluated according to widely accepted rules (visual and semi quantitative ? normative analysis). Mean values of stress and rest perfusion indices of thighs as well as calves in gr. I were statistically significantly lower (p < 0.001) than in gr. II. Incidence of asymmetry in the stress perfusion of calves and thighs was statistically significantly higher (p = 0.04) in patients with atherosclerotic changes as compared with the control group. Abnormal myocardial perfusion was found in 77% of patients from group I and in 28% from group II (p = 0.001). Reversible, stress induced ischaemia was found in 59% and 16%, resp. (p = 0.01). 1. Radionuclide study revealed a reduced stress as well as rest perfusion of lower limb muscles in clinically asymptomatic patients with atherosclerotic changes of lower limb vessels of low degree and a preserved normal Doppler

  3. Dexmedetomidine protects from post-myocardial ischaemia reperfusion lung damage in diabetic rats

    Kip, Gülay; Çelik, Ali; Bilge, Mustafa; Alkan, Metin; Kiraz, Hasan Ali; Özer, Abdullah; Şıvgın, Volkan; Erdem, Özlem; Arslan, Mustafa; Kavutçu, Mustafa

    2015-01-01

    Objective Diabetic complications and lipid peroxidation are known to have a close association. Lipid peroxidation commonly occurs at sites exposed to ischaemia, but distant organs and tissues also get damaged during ischaemia/reperfusion (I/R). Some of these targets are vital organs, such as the lung, liver, and kidney; the lung is the most frequently affected. The aim of our study was to investigate the effects of dexmedetomidine on I/R damage in lung tissue and on the oxidant/anti-oxidant system in diabetic rats. Material and methods Diabetes was induced with streptozotocin (55 mg/kg) in 18 Wistar Albino rats, which were then randomly divided into three groups (diabetes control (DC), diabetes plus ischaemia-reperfusion (DIR), and diabetes plus dexmedetomidine-ischaemia/reperfusion (DIRD)) after the effects of diabetes were clearly evident. The rats underwent a left thoracotomy and then ischaemia was produced in the myocardium muscle by a left anterior descending artery ligation for 30 min in the DIR and DIRD groups. I/R was performed for 120 min. The DIRD group received a single intraperitoneal dose of dexmedetomidine (100 µg/kg); the DIR group received no dexmedetomidine. Group DC was evaluated as the diabetic control group and also included six rats (C group) in which diabetes was not induced. These mice underwent only left thoracotomy and were closed without undergoing myocardial ischaemia. Histopathological changes, activities of catalase (CAT) and glutathione-S-transferase anti-oxidant enzymes, and malondialdehyde (MDA) levels were evaluated in the lung tissues of all rats. Results Neutrophil infiltration/aggregation was higher in the DIR group than in the C, DC, and DIRD groups (p=0.001, p=0.013, and p=0.042, respectively). The lung injury score was significantly higher in the DIR group than in the C and DC groups (p<0.0001 and p=0.024, respectively). The levels of MDA were significantly higher in the DIR group than in the C and DIRD groups. CAT activity

  4. Dexmedetomidine protects from post-myocardial ischaemia reperfusion lung damage in diabetic rats

    Gülay Kip

    2015-09-01

    Full Text Available Objective: Diabetic complications and lipid peroxidation are known to have a close association. Lipid peroxidation commonly occurs at sites exposed to ischaemia, but distant organs and tissues also get damaged during ischaemia/reperfusion (I/R. Some of these targets are vital organs, such as the lung, liver, and kidney; the lung is the most frequently affected. The aim of our study was to investigate the effects of dexmedetomidine on I/R damage in lung tissue and on the oxidant/anti-oxidant system in diabetic rats. Material and methods: Diabetes was induced with streptozotocin (55 mg/kg in 18 Wistar Albino rats, which were then randomly divided into three groups (diabetes control (DC, diabetes plus ischaemia-reperfusion (DIR, and diabetes plus dexmedetomidine-ischaemia/reperfusion (DIRD after the effects of diabetes were clearly evident. The rats underwent a left thoracotomy and then ischaemia was produced in the myocardium muscle by a left anterior descending artery ligation for 30 min in the DIR and DIRD groups. I/R was performed for 120 min. The DIRD group received a single intraperitoneal dose of dexmedetomidine (100 µg/kg; the DIR group received no dexmedetomidine. Group DC was evaluated as the diabetic control group and also included six rats (C group in which diabetes was not induced. These mice underwent only left thoracotomy and were closed without undergoing myocardial ischaemia. Histopathological changes, activities of catalase (CAT and glutathione-S-transferase anti-oxidant enzymes, and malondialdehyde (MDA levels were evaluated in the lung tissues of all rats. Results: Neutrophil infiltration/aggregation was higher in the DIR group than in the C, DC, and DIRD groups (p=0.001, p=0.013, and p=0.042, respectively. The lung injury score was significantly higher in the DIR group than in the C and DC groups (p<0.0001 and p=0.024, respectively. The levels of MDA were significantly higher in the DIR group than in the C and DIRD groups. CAT

  5. Increased phospholipase A2 and decreased lysophospholipase activity in the small intestinal mucosa after ischaemia and revascularisation.

    Otamiri, T; Franzén, L; Lindmark, D; Tagesson, C.

    1987-01-01

    The influence of ischaemia and revascularisation on lipid peroxidation and phospholipid metabolism in the rat small intestinal mucosa was investigated. Two hours of total ischaemia followed by five minutes of revascularisation caused not only accumulation of malondialdehyde in the mucosa, but also increased activity of phospholipase A2, decreased activity of lysophospholipase, and increased ratio between lysophosphatidylcholine and phosphatidylcholine. Pretreatment with the phospholipase A2 i...

  6. Advances in the understanding of delayed cerebral ischaemia after aneurysmal subarachnoid haemorrhage [version 1; referees: 4 approved

    Liam Flynn

    2015-11-01

    Full Text Available Delayed cerebral ischaemia has been described as the single most important cause of morbidity and mortality in patients who survive the initial aneurysmal subarachnoid haemorrhage. Our understanding of the pathophysiology of delayed cerebral ischaemia is meagre at best and the calcium channel blocker nimodipine remains the only intervention to consistently improve functional outcome after aneurysmal subarachnoid haemorrhage. There is substantial evidence to support cerebral vessel narrowing as a causative factor in delayed cerebral ischaemia, but contemporary research demonstrating improvements in vessel narrowing has failed to show improved functional outcomes. This has encouraged researchers to investigate other potential causes of delayed cerebral ischaemia, such as early brain injury, microthrombosis, and cortical spreading depolarisation. Adherence to a common definition of delayed cerebral ischaemia is needed in order to allow easier assessment of studies using multiple different terms. Furthermore, improved recognition of delayed cerebral ischaemia would not only allow for faster treatment but also better assessment of interventions. Finally, understanding nimodipine’s mechanism of action may allow us to develop similar agents with improved efficacy.

  7. Deleterious Effects of High Dose Connexin 43 Mimetic Peptide Infusion After Cerebral Ischaemia in Near-Term Fetal Sheep

    Alistair J. Gunn

    2012-05-01

    Full Text Available Hypoxic-ischaemic brain injury at birth is associated with 1–3/1000 cases of moderate to severe encephalopathy. Previously, we have shown that connexin 43 hemichannel blockade, with a specific mimetic peptide, reduced the occurrence of seizures, improved recovery of EEG power and sleep state cycling, and improved cell survival following global cerebral ischaemia. In the present study, we examined the dose response for intracerebroventricular mimetic peptide infusion (50 µmol/kg/h for 1 h, followed by 50 µmol/kg/24 h (low dose or 50 µmol/kg/h for 25 h (high dose or vehicle only (control group, starting 90 min after the end of ischaemia, following global cerebral ischaemia, induced by 30 min bilateral carotid artery occlusion, in near-term fetal sheep (128 ± 1 days gestation. Both peptide infusion groups were associated with a transient significant increase in EEG power between 2–12 h after ischaemia. The ischaemia-low dose group showed a significant recovery of EEG power from day five compared to the ischaemia-vehicle and -high dose groups. In contrast, the high dose infusion was associated with greater secondary increase in impedance (brain cell swelling, as well as a trend towards a greater increase in lactate concentration and mortality. These data suggest that higher doses of connexin mimetic peptide are not beneficial and may be associated with adverse outcomes, most likely attributable to uncoupling of connexin 43 gap junctions leading to dysfunction of the astrocytic syncytium.

  8. Multifractal and nonlinear assessment of autonomous nervous system response during transient myocardial ischaemia

    We assess autonomic nervous system response during prolonged percutaneous transluminal coronary angioplasty (PTCA) using heart rate variability analysis with multifractal indices. These indices are used to evaluate the effects of the PTCA procedures at different arteries and locations. A total of 55 patients from the Staff3 database, with no prior history of myocardial infarction, were included in the study. The indices increased significantly during the transient ischaemia and reperfusion periods, indicating an increase in nonlinear multifractal characteristics and a change in temporal correlations in heartbeat fluctuations. This indicates that significant multifractal and nonlinear complex reactions in the autonomic control of the heart rate occurred during coronary artery occlusions and suggests that the multifractal indices may be a promising nonlinear technique for evaluating autonomic nervous system response in the presence of transient myocardial ischaemia

  9. Outcome of splanchnic blood flow determination in patients with suspected chronic intestinal ischaemia. A retrospective survey

    Møller, Søren; Madsen, Jan Lysgård

    2002-01-01

    flow: A, normal response (splanchnic blood flow > or = 200 ml/min); B, possible abnormal response (splanchnic blood flow 51-199 ml/min); and C, definitive abnormal response (splanchnic blood flow < or = 50 ml/min). Where surgery took place, the type of operation was noted. RESULTS: Forty patients had a...... normal meal-induced response, 23 patients had a possible abnormal response and 10 patients had a definitive abnormal response, which gave evidence of chronic intestinal ischaemia. In the total patient population, the increase in splanchnic blood flow was significantly correlated to an increase in hepatic...... oxygen uptake (r = 0.38, P < 0.002) and to body weight (r = 0.36, P < 0.01). A total of seven patients (10%) underwent successful revascularization. CONCLUSIONS: Ten of the patients with suspected chronic intestinal ischaemia had abnormal meal-induced splanchnic blood flow and 30% of these patients...

  10. Cardiac arrhythmia and myocardial ischaemia related to cocaine and alcohol consumption.

    Boag, F; Havard, C W

    1985-01-01

    Following the drinking of 150 g of alcohol and a large amount of intra-nasal cocaine a previously healthy 31 year old man developed severe retrosternal pain and circulatory failure. An electrocardiogram showed supra-ventricular tachycardia with widespread ischaemic changes. Following electrical cardioversion electrocardiographic evidence of myocardial ischaemia persisted for 1 h. Two days later basal and exercise electrocardiograms were normal. The combination of alcohol and cocaine may be li...

  11. Evolution and resolution of oedema following severe temporary cerebral ischaemia in the gerbil.

    Avery, S.; Crockard, H A; Russell, R. R.

    1984-01-01

    Regional cerebral blood flow (rCBF) and oedema following profound temporary ischaemia were studied in the gerbil. Ninety-four per cent of animals died within 24 hours of reperfusion; 50% by 4 hours. Regional differences in oedema (specific gravity method), Evans blue (EB) staining and rCBF (hydrogen clearance technique) occurred. Oedema developed during arterial occlusion, being inversely proportional to residual flow and was markedly exacerbated during reperfusion. Reperfusion hyperaemia was...

  12. Optimising cardioprotection during myocardial ischaemia: targeting potential intracellular pathways with glucagon-like peptide-1

    Clarke, Sophie J; McCormick, Liam M; Dutka, David P

    2014-01-01

    Coronary heart disease and type-2 diabetes are both major global health burdens associated with an increased risk of myocardial infarction (MI). Following MI, ischaemia-reperfusion injury (IRI) remains a significant contributor to myocardial injury at the cellular level. Research has focussed on identifying a strategy or intervention to minimise IRI to optimise reperfusion therapy, with the aim of delivering a superior clinical outcome. The incretin hormone glucagon-like peptide-1, already an...

  13. Evaluating the translational potential of progesterone treatment following transient cerebral ischaemia in male mice

    Wong, Raymond; Gibson, Claire L.; Kendall, David A; Bath, Philip MW

    2014-01-01

    Background Progesterone is neuroprotective in numerous preclinical CNS injury models including cerebral ischaemia. The aim of this study was two-fold; firstly, we aimed to determine whether progesterone delivery via osmotic mini-pump would confer neuroprotective effects and whether such neuroprotection could be produced in co-morbid animals. Results Animals underwent transient middle cerebral artery occlusion. At the onset of reperfusion, mice were injected intraperitoneally with progesterone...

  14. Profound retinal ischaemia after ranibizumab administration in an eye with ocular ischaemic syndrome

    Kofoed, Peter Kristian; Munch, Inger Christine; Larsen, Michael

    2009-01-01

    Abstract. Purpose: To report the result of ranibizumab administration in an eye with ocular ischaemic syndrome. Methods: Fluorescein angiography, ocular pneumoplethysmography and retinal vessel calibre measurement. Results: An 85-year-old man with ocular ischaemic syndrome demonstrated vision loss......, retinal vessel calibre constriction and profound retinal ischaemia after intravitreal ranibizumab. Conclusion: We advise against the use of intravitreal vascular endothelial growth factor inhibitors in eyes with ocular ischaemic syndrome....

  15. Therapeutic effects of policosanol and atorvastatin against global brain ischaemia-reperfusion injury in gerbils

    V Molina

    2013-01-01

    Full Text Available Stroke is the third cause of death and the first of permanent adult disability. Pretreatment with policosanol and atorvastatin has been effective in experimental models of cerebral ischaemia in rodents. The objective was to compare the therapeutic effects of policosanol and atorvastatin in a model of global cerebral ischaemia in gerbils. Gerbils were distributed into seven groups, a negative control and six with ischaemia-reperfusion-induced global cerebral ischemia (one vehicle positive control, two policosanol (100 and 200 mg/kg, two atorvastatin (10 and 20 mg/kg and one aspirin (60 mg/kg group. Treatments were given 4 h after ischaemia induction. Effects on ischemia-reperfusion-induced symptoms, hyperlocomotion, damage of pyramidal hipoccampal neurons and increased plasma oxidative markers were investigated. Positive, not negative controls, exhibited clinical symptoms, hyperlocomotion, neuronal damage and increased plasma oxidative markers. Policosanol (100 and 200 mg/kg reduced significantly ischemia-reperfusion-induced symptoms, the frequency of symptomatic animals, histological scores of neuronal damage and plasma oxidative markers as compared with the positive control group. Atorvastatin (10 and 20 mg/kg decreased significantly the symptoms and histological scores, but unchanged the frequency of symptomatic gerbils and oxidative variables. Only the highest dose of policosanol (200 mg/kg and atorvastatin (20 mg/kg reduced significantly ischemia reperfusion-induced hyperlocomotion, policosanol being the most effective. Aspirin 60 mg/kg lowered significantly symptom score, the rate of symptomatic gerbils and hyperlocomotion versus the positive controls, but failed to modify oxidative parameters. In conclusion, postreperfusion treatment with policosanol and atorvastatin was effective for ameliorating symptoms, hyperlocomotion and neurological damage of hippocampal CA1 neurons in gerbils with ischemia-reperfusion-induced global cerebral

  16. Nitric oxide, superoxide, and peroxynitrite in myocardial ischaemia-reperfusion injury and preconditioning

    Ferdinandy, Péter; Schulz, Richard

    2003-01-01

    There appears to be a controversy in the study of myocardial ischaemia-reperfusion injury and preconditioning whether nitric oxide (NO) plays a protective or detrimental role. A number of findings and the interpretation of the results to date do not support such a controversy. An understanding of the latest developments in NO, superoxide (O2−·) and peroxynitrite (ONOO−) biology, as well as the various ischaemic animal models utilized is necessary to resolve the apparent controversy. NO is an ...

  17. Critical leg ischaemia with tissue loss : a challenge for the vascular surgeon

    Söderström, Maria

    2011-01-01

    There is a widespread reporting habit of combining the outcomes for patients with rest pain (Fontaine III) and tissue loss (Fontaine IV) under the single category of critical leg ischaemia (CLI). This study focused on patients with ischaemic tissue loss treated with infrainguinal bypass surgery (IBS). All patients included in the study were treated at Helsinki University Central Hospital in 2000-2007. First, ulcer healing time after IBS and factors influencing healing time were prospecti...

  18. Effects of ischaemia-reperfusion and cyclosporin-A on cardiac muscle ultrastructure

    JURADO, F.; Bellón, J.M.; J. A. Pareja; Golittsin, A.; Millán, L.; Pascual, G.; Buján, J.

    1998-01-01

    The present study investigates the effects on the cardiac muscle cell of two of the determining factors for the success of organ transplant; ischaemia-perfusion and immunosuppressive treatment with cyclosporin-A (CsA). To this end an abdominal, heterotopic heart transplant model in singenic Sprague-Dawley rats was employed. Three study groups were established: Group I (control, n=15) animals undergoing heart transplant without treatment; Group I1 (n=15) ani...

  19. Facilitated defensive coping, silent ischaemia and ECG left-ventricular hypertrophy: the SABPA study

    Malan, Leoné; Huisman, Hugo W.; Van Rooyen, Johannes M.; Schutte, Rudolph; Schutte, Aletta E; Fourie, Carla M. T.; Malan, Nico T; De Geus, Eco J.C.N.

    2012-01-01

    Background: Defensive active coping responses (being-in-control, acceptance of the stressor as reality) have been associated with vascular hyper-responsiveness in urban Africans. However, the association between active coping responses, blood pressure (BP), and ECG-derived left-ventricular hypertrophy (LVH) responses is unknown. Objectives and methods: Associations between BP, silent ischaemia and ECG Cornell product LVH were assessed in 161 African and Caucasian men with active coping res...

  20. Changes in the basal ganglia and thalamus following reperfusion after complete cerebral ischaemia

    We report specific changes bilaterally in the basal ganglia and thalamus following reperfusion after complete cerebral ischaemia. A 69-year-old man, resuscitated after cardiac arrest, showed symmetrical low-density lesions in the head of the caudate nucleus and lentiform nucleus on CT. MRI revealed methaemoglobin derived from minor haemorrhage in the basal ganglia and thalamus, not evident on CT. We suggest that this haemorrhage results from diapedesis of red blood cells through the damaged capillary endothelium following reperfusion. (orig.)

  1. Inducible myocardial ischaemia diagnosed using computed tomography dipyridamole stress myocardial perfusion technique

    Improved multi-detector computed tomography (MDCT) temporal and spatial resolution allows for the assessment of coronary artery disease, left ventricular systolic function and resting myocardial perfusion defects with high sensitivity and specificity. Here we present a case using a novel combination technique of cardiac computed tomography scanning with dipyridamole stress for the detection of functionally significant coronary disease, and demonstrate that dipyridamole-induced myocardial ischaemia is both detectable and quantifiable by cardiac MDCT.

  2. A finite volume method solution for the bidomain equations and their application to modelling cardiac ischaemia.

    Johnston, Peter R

    2010-01-01

    This paper presents an implementation of the finite volume method with the aim of studying subendocardial ischaemia during the ST segment. In this implementation, based on hexahedral finite volumes, each quadrilateral sub-face is split into two triangles to improve the accuracy of the numerical integration in complex geometries and when fibre rotation is included. The numerical method is validated against previously published solutions obtained from slab and cylindrical models of the left ventricle with subendocardial ischaemia and no fibre rotation. Epicardial potential distributions are then obtained for a half-ellipsoid model of the left ventricle. In this case it is shown that for isotropic cardiac tissue the degree of subendocardial ischaemia does not affect the epicardial potential distribution, which is consistent with previous findings from analytical studies in simpler geometries. The paper also considers the behaviour of various preconditioners for solving numerically the resulting system of algebraic equations resulting from the implementation of the finite volume method. It is observed that each geometry considered has its own optimal preconditioner. PMID:19639486

  3. A protocol for quantitative PET in cerebral ischaemia

    Full text: The Austin Hospital Centre for PET is involved in research protocols utilising 15O-labelled gases and 15O-labelled water to study regional cerebral blood flow, and oxygen metabolism. The Stroke Unit in particular refers patients for both PET and SPECT imaging as part of clinical research protocols into the time evolution of cerebral tissue viability following ischaemic insult, and the effect of intervention with anticoagulant therapy on patient outcome. These studies, involving the co-ordination of isotope production and quality control, administration of radioactive gases and water, arterial blood sampling and complex image processing, whilst maintaining patient care of often acutely ill patients, present a challenging task for the nuclear medicine technologist. We describe our protocol which consists of an 15O-carbon dioxide perfusion study, transmission scan, 15O-oxygen metabolism study, and 15O water perfusion study with automated arterial blood sampling performed during all three acquisitions. Selected patients also undergo 99mTc-HMPAO SPECT immediately following the PET study. The automated arterial blood sampler, 15O-water generator and 15O-gas delivery system (GDS) are unique to PET and their operation and application to patient studies will be described. To date, 85 patient studies have been performed using this protocol and we find it relatively easy to apply in the clinical setting and reasonably well tolerated by patients. In the future it is hoped to dispense with the need for arterial blood sampling thus making these studies a suitable proposition for the clinical evaluation of even very acute stroke patients

  4. Acute Anteroseptal Myocardial Infarction after a Negative Exercise Stress Test

    Abdullah M. Al-Alawi; Jyotsna Janardan; Peck, Kah Y.; Alan Soward

    2016-01-01

    A myocardial infarction is a rare complication which can occur after an exercise stress test. We report a 48-year-old male who was referred to the Mildura Cardiology Practice, Victoria, Australia, in August 2014 with left-sided chest pain. He underwent an exercise stress test which was negative for myocardial ischaemia. However, the patient presented to the Emergency Department of the Mildura Base Hospital 30 minutes after the test with severe retrosternal chest pain. An acute anteroseptal ST...

  5. [Therapy of phantom limb pain].

    Schwarzer, Andreas; Zenz, Michael; Maier, Christoph

    2009-03-01

    About 80 % of all extremity amputations suffer from phantom limb pain following the operation. In this context, it is important to differentiate between painful phantom limb sensations, non-painful phantom limb sensations and residual limb pain. The pathophysiology of phantom limb pain is not fully understood. Current research findings ascribe a major pathophysiological role to cortical changes as well as a disturbed body perception. Peripheral and spinal mechanisms appear less relevant in the development of phantom limb pain. An essential part of the therapy is the pharmacological treatment with antidepressants, anticonvulsives and opioids. Another significant aspect of therapy is senso-motory training, important to mention here would be mirror therapy, lateralisation and motor imaging. In case of an elective amputation, an epidural or axiliar plexus catheter should be considered prior to the amputation. The perioperative treatment with ketamine is debated. PMID:19266417

  6. Limb lengthening in achondroplasia

    Sanjay K Chilbule

    2016-01-01

    Full Text Available Background: Stature lengthening in skeletal dysplasia is a contentious issue. Specific guidelines regarding the age and sequence of surgery, methods and extent of lengthening at each stage are not uniform around the world. Despite the need for multiple surgeries, with their attendant complications, parents demanding stature lengthening are not rare, due to the social bias and psychological effects experienced by these patients. This study describes the outcome and complications of extensive stature lengthening performed at our center. Materials and Methods: Eight achondroplasic and one hypochondroplasic patient underwent bilateral transverse lengthening for tibiae, humeri and femora. Tibia lengthening was carried out using a ring fixator and bifocal corticotomy, while a monolateral pediatric limb reconstruction system with unifocal corticotomy was used for the femur and humerus. Lengthening of each bone segment, height gain, healing index and complications were assessed. Subgroup analysis was carried out to assess the effect of age and bone segment on the healing index. Results: Nine patients aged five to 25 years (mean age 10.2 years underwent limb lengthening procedures for 18 tibiae, 10 femora and 8 humeri. Four patients underwent bilateral lengthening of all three segments. The mean length gain for the tibia, femur and humerus was 15.4 cm (100.7%, 9.9 cm (52.8% and 9.6 cm (77.9%, respectively. Healing index was 25.7, 25.6 and 20.6 days/cm, respectively, for the tibia, femur and humerus. An average of 33.3% height gain was attained. Lengthening of both tibia and femur added to projected height achieved as the 3 rd percentile of standard height in three out of four patients. In all, 33 complications were encountered (0.9 complications per segment. Healing index was not affected by age or bone segment. Conclusion: Extensive limb lengthening (more than 50% over initial length carries significant risk and should be undertaken only after due

  7. Revising the link between proton-pump inhibitors and risk of acute myocardial infarction-a case-crossover analysis.

    Turkiewicz, Aleksandra; Perez Vicente, Raquel; Ohlsson, Henrik; Tydén, Patrik; Merlo, Juan

    2015-01-01

    The purpose of this study is to investigate if the prescription of proton-pump inhibitors (PPIs) was associated with a sudden risk of acute myocardial infarction (AMI) while controlling for time-invariant confounding by using a case-crossover design. An association might indicate that physicians take prodromal symptoms of myocardial ischaemia for dyspepsia.

  8. Donor brain death leads to differential immune activation in solid organs but does not accelerate ischaemia-reperfusion injury.

    Ritschl, Paul Viktor; Ashraf, Muhammad Imtiaz; Oberhuber, Rupert; Mellitzer, Vanessa; Fabritius, Cornelia; Resch, Thomas; Ebner, Susanne; Sauter, Martina; Klingel, Karin; Pratschke, Johann; Kotsch, Katja

    2016-05-01

    A comparative analysis of inflammation between solid organs following donor brain death (BD) is still lacking and the detailed influence of BD accelerating ischaemia-reperfusion injury (IRI) post-transplantation remains to be addressed. Applying a murine model of BD, we demonstrated that 4 h after BD organs were characterized by distinct inflammatory expression patterns. For instance, lipocalin 2 (LCN2), a marker of acute kidney injury, was selectively induced in BD livers but not in kidneys. BD further resulted in significantly reduced frequencies of CD3(+) CD4(+) , CD3(+) CD8(+) T cells and NKp46(+) NK cells in the liver, whereas BD kidneys and hearts were characterized by significantly lower frequencies of conventional dendritic cells (cDCs). Syngeneic models of kidney (KTx) and heart transplantation (HTx) illustrated stronger gene expression in engrafted BD hearts only, but 20 h post-transplantation both organs displayed comparable intragraft lymphocyte frequencies, except for NK cells and graft function. Moreover, the complement factor C3d deposit detected in small vessels and capillaries in cardiac syngrafts did not significantly differ between BD and sham-transplanted groups. Finally, no further influence of donor BD on graft survival was detected in an allogeneic heart transplantation setting (C57BL/6 grafts into BALB/c recipients). We show for the first time that BD organs are characterized by a varying inflammatory profile; however, BD does not accelerate IRI in syngeneic KTx and HTx. Copyright © 2016 Pathological Society of Great Britain and Ireland. Published by John Wiley & Sons, Ltd. PMID:26890577

  9. Therapeutic hypothermia for acute stroke

    Olsen, Tom Skyhøj; Weber, Uno Jakob; Kammersgaard, Lars Peter

    2003-01-01

    Experimental evidence and clinical experience show that hypothermia protects the brain from damage during ischaemia. There is a growing hope that the prevention of fever in stroke will improve outcome and that hypothermia may be a therapeutic option for the treatment of stroke. Body temperature is...... directly related to stroke severity and outcome, and fever after stroke is associated with substantial increases in morbidity and mortality. Normalisation of temperature in acute stroke by antipyretics is generally recommended, although there is no direct evidence to support this treatment. Despite its...... obvious therapeutic potential, hypothermia as a form of neuroprotection for stroke has been investigated in only a few very small studies. Therapeutic hypothermia is feasible in acute stroke but owing to serious side-effects--such as hypotension, cardiac arrhythmia, and pneumonia--it is still thought of...

  10. Acute Disseminated Encephalomyelitis

    Kambiz Sotoudeh

    Full Text Available Acute disseminated encephalomyelitis (ADEM is an acute, inflammatory, monophasic, demyelinating and immune-mediated disorder of central nervous system; occurs mostly in children after systemic viral infections or vaccinations. Acute polysymptomatic neurologic signs such as encephalopathy, paralysis of limbs, cranial nerve involvement, ataxia and optic neuritis are common manifestations. Brain magnetic resonance imaging study is essential for diagnosis and enabling prompt diagnosis and treatment. Evidence of multifocal lesions of demyelination in subcortical white matter are seen. They are usually bilateral and asymmetrical. Treatment optins have included steroids, immunoglobulins, and plasmapheresis. ADEM is treatable and prognosis is good.

  11. Arterial mapping of lower limbs

    A bibliographic review is realized in the arterial mapping of lower limbs by ultrasonographic. The physical properties of the Doppler effect applied to diagnostic ultrasound are described. The anatomical characteristics of the general arterial system and specifically of the lower limbs arterial system are mentioned. Pathologies of the ischemic arterial disease of lower limbs are explained. The study characteristics of lower limbs arterial mapping are documented to determine its importance as appropriate method for the assessment of lower limb ischemia. An adequate arterial mapping of lower limbs is recognized in atherosclerotic ischemic disease as a reliable initial method alternative to arteriography. Arteriography is considered as reference pattern for therapeutic decision making in patients with critical ischemia of the lower limbs. Non-invasive methods to assess the arterial system of lower limbs has evidenced the advantages of the arterial mapping with Doppler, according to the consulted literature. The combination morphological and hemodynamic information has been possible and a map of the explored zone is made. The arterial mapping by ultrasonography has offered similar reliability to angiography

  12. Supernumerary phantom limb after stroke

    Bakheit, A; Roundhill, S

    2005-01-01

    The perception of a phantom limb is commonly reported after amputations. However, only a few cases have been described after a stroke. This article presents a patient who reported a supernumerary phantom limb (pseudopolymelia) after spontaneous intracerebral haemorrhage and discusses the possible underlying mechanisms for this rare phenomenon.

  13. Evaluation of Limb-Girdle Muscular Dystrophy

    2014-03-06

    Becker Muscular Dystrophy; Limb-Girdle Muscular Dystrophy, Type 2A (Calpain-3 Deficiency); Limb-Girdle Muscular Dystrophy, Type 2B (Miyoshi Myopathy, Dysferlin Deficiency); Limb-Girdle Muscular Dystrophy, Type 2I (FKRP-deficiency)

  14. Hypothermic preconditioning of donor organs prior to harvesting and ischaemia using ice-cold intravenous fluids.

    Kämäräinen, Antti; Virkkunen, Ilkka; Tenhunen, Jyrki

    2009-07-01

    To promote organ transplantation and viability, hypothermia has been applied as a protective agent for decades. Current management of organ preservation includes hypothermia as a component of static storage. In rare cases, hypothermic perfusion is initiated in the donor organs prior to harvesting but this requires invasive perfusion techniques. Therefore, hypothermic organ protection is currently achieved only after organ retrieval and onset of ischaemic injury cascades. The relevant mechanisms of cellular and organ damage involve ischaemia-reperfusion injury and apoptosis. In this hypothesis, we propose the possibility of inducing hypothermic protective effects prior to organ harvesting using infusion of ice-cold (+4 degrees C) intravenous fluid in the organ donor. This method of cooling to mild hypothermia (32-34 degrees C) has been found feasible in e.g. cardiac arrest victims and already during the ischaemic insult. We hypothesize that cooling with ice-cold fluid preceding organ harvesting would downregulate organ metabolism and oxygen consumption resulting in improved tolerance to ischaemia. Furthermore, according to existing evidence, mild hypothermia possesses anti-apoptotic effects and suppresses reperfusion associated inflammatory response. Finally, diabetes insipidus is often observed in the brain dead donor. Subsequent hypovolemia is conveniently treated with additional infusion of cold intravenous fluid. We offer this hypothesis as a simple method of improving donor organ viability via improved tolerance to ischaemia and reperfusion injury. This method of hypothermic preconditioning seems safe, inexpensive and easily applicable in virtually every institution treating organ donors. The feasibility and effects of this hypothesis could be further evaluated in comparison to current treatment protocols in laboratory settings including evaluation of organ preservation. PMID:19269108

  15. Prevention of myocardial enzyme release by ranolazine in a primate model of ischaemia with reperfusion.

    Allely, M. C.; Alps, B J

    1990-01-01

    In control anaesthetized baboons subjected to 30 min occlusion of the left anterior descending coronary artery, followed by 5.5 h reperfusion, total plasma levels for creatine kinase (CK) and lactate dehydrogenase (LDH) were markedly elevated in a time-related manner. In a second group of baboons pretreated 10 min prior to ischaemia with ranolazine [(+/-)-N-(2,6-dimethyl-phenyl)-4[2-hydroxy-3-(2-methoxyphenoxy)propyl]-1 - piperazine acetamide dihydrochloride; RS-43285-193] at 500 micrograms k...

  16. The effects of levosimendan on brain metabolism during initial recovery from global transient ischaemia/hypoxia

    Roehl Anna B

    2012-08-01

    Full Text Available Abstract Backround Neuroprotective strategies after cardiopulmonary resuscitation are currently the focus of experimental and clinical research. Levosimendan has been proposed as a promising drug candidate because of its cardioprotective properties, improved haemodynamic effects in vivo and reduced traumatic brain injury in vitro. The effects of levosimendan on brain metabolism during and after ischaemia/hypoxia are unknown. Methods Transient cerebral ischaemia/hypoxia was induced in 30 male Wistar rats by bilateral common carotid artery clamping for 15 min and concomitant ventilation with 6% O2 during general anaesthesia with urethane. After 10 min of global ischaemia/hypoxia, the rats were treated with an i.v. bolus of 24 μg kg-1 levosimendan followed by a continuous infusion of 0.2 μg kg-1 min-1. The changes in the energy-related metabolites lactate, the lactate/pyruvate ratio, glucose and glutamate were monitored by microdialysis. In addition, the effects on global haemodynamics, cerebral perfusion and autoregulation, oedema and expression of proinflammatory genes in the neocortex were assessed. Results Levosimendan reduced blood pressure during initial reperfusion (72 ± 14 vs. 109 ± 2 mmHg, p = 0.03 and delayed flow maximum by 5 minutes (p = 0.002. Whereas no effects on time course of lactate, glucose, pyruvate and glutamate concentrations in the dialysate could be observed, the lactate/pyruvate ratio during initial reperfusion (144 ± 31 vs. 77 ± 8, p = 0.017 and the glutamate release during 90 minutes of reperfusion (75 ± 19 vs. 24 ± 28 μmol·L-1 were higher in the levosimendan group. The increased expression of IL-6, IL-1ß TNFα and ICAM-1, extend of cerebral edema and cerebral autoregulation was not influenced by levosimendan. Conclusion Although levosimendan has neuroprotective actions in vitro and on the spinal cord in vivo and has been shown to cross the blood–brain barrier, the present

  17. Simulated ischaemia-reperfusion conditions increase xanthine dehydrogenase and oxidase activities in rat brain slices.

    Battelli, M G; Buonamici, L; Virgili, M; Abbondanza, A; Contestabile, A

    1998-01-01

    Xanthine dehydrogenase and oxidase activities increased by 87% in rat brain slices after 30 min in vitro ischaemia. A further 41% increase was induced by 30 min simulated reperfusion of ischaemic slices. No conversion from the dehydrogenase to the oxidase activity was observed. The increment of enzyme activity was not due to neosynthesis of the enzyme, since it was not affected by the addition of cycloheximide during the ischaemic incubation. The increased oxygen-dependent form of the enzyme could aggravate the ischaemic brain injury by free radicals production, in particular after reperfusion. PMID:9460697

  18. Phantom limbs and neural plasticity.

    Ramachandran, V S; Rogers-Ramachandran, D

    2000-03-01

    The study of phantom limbs has received tremendous impetus from recent studies linking changes in cortical topography with perceptual experience. Systematic psychophysical testing and functional imaging studies on patients with phantom limbs provide 2 unique opportunities. First, they allow us to demonstrate neural plasticity in the adult human brain. Second, by tracking perceptual changes (such as referred sensations) and changes in cortical topography in individual patients, we can begin to explore how the activity of sensory maps gives rise to conscious experience. Finally, phantom limbs also allow us to explore intersensory effects and the manner in which the brain constructs and updates a "body image" throughout life. PMID:10714655

  19. Prevalence and Characteristics of Phantom Limb Pain and Residual Limb Pain in the Long Term after Upper Limb Amputation

    Desmond, Deirdre M.; MacLachlan, Malcolm

    2010-01-01

    This study aims to describe the prevalence and characteristics of phantom limb pain and residual limb pain after upper limb amputation. One-hundred and forty-one participants (139 males; mean age 74.8 years; mean time since amputation 50.1 years) completed a self-report questionnaire assessing residual and phantom limb pain experience. Prevalence…

  20. Limb and hemispatial hypometria.

    Meador, K J; Moore, E E; Martin, R C; Loring, D W; Hess, D C; Heilman, K M

    2000-01-01

    In a previous study, we demonstrated that unilateral cerebral lesions produce hypometric limb movements of the contralateral arm and hemispatial (i.e., directional) hypometria for movements towards contralateral hemispace. In the present study, we investigated 10 patients with right cerebral lesions and 25 healthy controls using a task to uncouple deficits in sensory perceptual systems and motor-action output systems on directional hypometria. This task required participants, with their eyes closed, to reproduce lateral and medial horizontal displacements (15-27 cm) with each arm. Each participant was seated at a waist high table and had their hand placed at an origin point aligned with the axillary fold on the same side. Their hand was moved by the investigator from the origin point to a target point and brought back to the point of origin (input displacement). The participant was then asked to return their hand to either the same target point or to an equidistant target point in the opposite direction. Healthy dextral participants were significantly more hypometric with their right arm, but patients with right cerebral lesions exhibited an opposite pattern with overall left arm hypometria. In addition, patients were significantly more hypometric for movements when output displacements were toward left hemispace. No effect was found for direction of sensory input. The results suggest that the directional hypometria is predominantly produced by hemispatial output deficits. PMID:10761369

  1. Intracoronary and systemic melatonin to patients with acute myocardial infarction

    Halladin, Natalie L; Busch, Sarah Ekeløf; Jensen, Svend Eggert;

    2014-01-01

    INTRODUCTION: Ischaemia-reperfusion injury following acute myocardial infarctions (AMI) is an unavoidable consequence of the primary percutaneous coronary intervention (pPCI) procedure. A pivotal mechanism in ischaemia-reperfusion injury is the production of reactive oxygen species following...... following pPCI in patients with AMI. MATERIAL AND METHODS: The IMPACT trial is a multicentre, randomised, double-blinded, placebo-controlled study. We wish to include 2 × 20 patients with ST-elevation myocardial infarctions undergoing pPCI within six hours from symptom onset. The primary end-point is the...... Myocardial Salvage Index assessed by cardiovascular magnetic resonance imaging on day 4 (± 1) after pPCI. The secondary end-points are high-sensitivity troponin, creatinekinase myocardial band and clinical events. CONCLUSION: The aim of the IMPACT trial is to evaluate the effect of melatonin on reperfusion...

  2. Endograft Limb Occlusion in EVAR

    Taudorf, M; Jensen, L P; Vogt, K C;

    2014-01-01

    OBJECTIVE: To assess the incidence and outcome of graft limb occlusions after endovascular aortic repair (EVAR) of abdominal aortic aneurysm (AAA) in a high volume single centre. To quantify iliac artery tortuosity in patients with AAA and correlate this with limb occlusion. DESIGN: Data were......, subsequently, duplex ultrasound imaging was performed. Patients with limb occlusions were identified. For each index patient, two controls were obtained, one immediately preceding and one following the index patient in the consecutive cohort of EVAR patients. METHODS: Demographics and CTA data on limb graft...... occlusions were recorded and compared with a defined control group. Three different indices were used to describe the tortuosity of the iliac vessels based on preoperative CTA: pelvic artery index of tortuosity (PAI), common iliac artery index of tortuosity (CAI), and a visual description of vessel...

  3. Impaired fasting glucose in combination with silent myocardial ischaemia is associated with poor prognosis in healthy individuals

    Intzilakis, T; Mouridsen, Mette Rauhe; Almdal, T P;

    2012-01-01

    Aim  As both impaired fasting glucose and silent myocardial ischaemia are risk factors for cardiovascular disease and death, we hypothesized that these risk factors in combination would identify those subjects at the highest risk of adverse events. Methods  Healthy individuals without diabetes (n...

  4. High mean fasting glucose levels independently predict poor outcome and delayed cerebral ischaemia after aneurysmal subarachnoid haemorrhage

    Kruyt, N. D.; Roos, Y. W. B. M.; Mees, S. M. Dorhout; van den Bergh, W. M.; Algra, A.; Rinkel, G. J. E.; Biessels, G. J.

    2008-01-01

    Background: Hyperglycaemia has been related to poor outcome and delayed cerebral ischaemia (DCI) after aneurysmal subarachnoid haemorrhage (aSAH). Objective: This study aimed to assess whether in patients with aSAH, levels of mean fasting glucose within the first week predict poor outcome and DCI be

  5. Self-reported symptoms and risk factors for digital ischaemia among international world-class beach volleyball players.

    Van De Pol, Daan; Alaeikhanehshir, Sena; Maas, Mario; Kuijer, P Paul F M

    2016-06-01

    The prevalence of ischaemia-related symptoms is remarkably high among elite indoor volleyball players. Since the exposure to sport-specific demands may be higher in beach volleyball compared to indoor volleyball, the aim of this study was to assess the prevalence of ischaemia-related symptoms and associated risk factors among world-class beach volleyball players. Therefore, a questionnaire survey was performed among beach volleyball players active during the 2013 Grand Slam Beach Volleyball in the Netherlands. In total, 60 of the 128 beach volleyball players (47%) participated: 26 males and 34 females from 17 countries. The self-reported prevalence of cold or blue or pale digits in the dominant hand during or immediately after practice or competition was 38% (n = 23). Two risk factors were independently associated with symptoms of blue or pale digits: more than 14 years playing volleyball (odds ratio (OR) 4.42, 90% confidence interval (90% CI) 1.30-15.07) and sex (female) (OR 4.62, 90% CI 1.15-18.57). In conclusion, the prevalence of symptoms associated with digital ischaemia is high among international world-class beach volleyball players. Female sex and the length of the volleyball career were independently associated with an increased risk of ischaemia-related symptoms. The high prevalence of these seemingly innocuous symptoms and possible associated risk factors warrant regular monitoring since early detection can potentially prevent thromboembolic complications and irreversible tissue damage. PMID:26436960

  6. Preserved cardiac mitochondrial function and reduced ischaemia/reperfusion injury afforded by chronic continuous hypoxia: Role of opioid receptors

    Maslov, L. N.; Naryzhnaya, N. V.; Prokudina, E. S.; Kolář, František; Gorbunov, A. S.; Zhang, Y.; Wang, H.; Tsibulnikov, S.Yu.; Portnichenko, A. G.; Lasukova, T. V.; Lishmanov, Yu. B.

    2015-01-01

    Roč. 42, č. 5 (2015), s. 496-501. ISSN 1440-1681 R&D Projects: GA ČR(CZ) GAP303/12/1162 Institutional support: RVO:67985823 Keywords : cardioprotection * chronic hypoxia * ischaemia/reperfusion * mitochondrial function * opioid receptors Subject RIV: ED - Physiology Impact factor: 2.372, year: 2014

  7. Psychophysical correlates of phantom limb experience.

    Katz, J

    1992-01-01

    Phantom limb phenomena were correlated with psychophysiological measures of peripheral sympathetic nervous system activity measured at the amputation stump and contralateral limb. Amputees were assigned to one of three groups depending on whether they reported phantom limb pain, non-painful phantom limb sensations, or no phantom limb at all. Skin conductance and skin temperature were recorded continuously during two 30 minute sessions while subjects continuously monitored and rated the intens...

  8. Transcriptional responses in the adaptation to ischaemia-reperfusion injury: a study of the effect of ischaemic preconditioning in total knee arthroplasty patients

    Murphy, Terence

    2010-05-10

    Abstract Background Ischaemic preconditioning (IPC) has emerged as a method of reducing ischaemia-reperfusion injury. However, the complex mechanism through which IPC elicits this protection is not fully understood. The aim of this study was to investigate the genomic response induced by IPC in muscle biopsies taken from the operative leg of total knee arthroplasty patients in order to gain insight into the IPC mechanism. Methods Twenty patients, undergoing primary total knee arthroplasty, were randomly assigned to IPC (n = 10) and control (n = 10) groups. Patients in the IPC group received ischaemic preconditioning immediately prior to surgery. IPC was induced by three five-minute cycles of tourniquet insufflation interrupted by five-minute cycles of reperfusion. A muscle biopsy was taken from the operative knee of control and IPC-treated patients at the onset of surgery and, again, at one hour into surgery. The gene expression profile of muscle biopsies was determined using the Affymetrix Human U113 2.0 microarray system and validated using real-time polymerase chain reaction (RT-PCR). Measurements of C-reactive protein (CRP), erythrocyte sedimentation (ESR), white cell count (WCC), cytokines and haemoglobin were also made pre- and post-operatively. Results Microarray analysis revealed a significant increase in the expression of important oxidative stress defence genes, immediate early response genes and mitochondrial genes. Upregulation of pro-survival genes was also observed and correlated with a downregulation of pro-apoptotic gene expression. CRP, ESR, WCC, cytokine and haemoglobin levels were not significantly different between control and IPC patients. Conclusions The findings of this study suggest that IPC of the lower limb in total knee arthroplasty patients induces a protective genomic response, which results in increased expression of immediate early response genes, oxidative stress defence genes and pro-survival genes. These findings indicate that

  9. The effect of lidocaine on in vitro neutrophil and endothelial adhesion molecule expression induced by plasma obtained during tourniquet-induced ischaemia and reperfusion.

    Lan, W

    2012-02-03

    BACKGROUND: Changes in neutrophil and endothelial adhesion molecule expression occur during perioperative ischaemia and reperfusion (I\\/R) injury. We investigated the effects of lidocaine on neutrophil-independent changes in neutrophil and endothelial adhesion molecule expression associated with tourniquet-induced I\\/R. METHODS: Plasma was obtained from venous blood samples (tourniquet arm) taken before (baseline), during, 15 min, 2 and 24 h following tourniquet release in seven patients undergoing elective upper limb surgery with tourniquet application. Isolated neutrophils from healthy volunteers (n = 7) were pretreated in the presence or absence of lidocaine (0.005, 0.05 and 0.5 mg mL(-1) for 1 h, and then incubated with I\\/R plasma for 2 h. Human umbilical vein endothelial cells (HUVECs) were pretreated in the presence or absence of lidocaine (0.005, 0.05 and 0.5 mg mL(-1)) for 1 h, and then incubated with the plasma for 4 h. Adhesion molecule expression was estimated using flow cytometry. Data were analysed using ANOVA and post hoc Student-Newman-Keuls tests. RESULTS: I\\/R plasma (withdrawn 15 min following tourniquet release) increased isolated neutrophil CD11b (P = 0.03), CD18 (P = 0.01) and endothelial intercellular adhesion molecule-1 (ICAM-1) (P = 0.008) expression compared to baseline. CD11b, CD18 and ICAM-1 expression on lidocaine (0.005 mg mL(-1)) treated neutrophils was similar to control. CD11b (P < 0.001), CD18 (P = 0.03) and ICAM-1 (P = 0.002) expression on lidocaine (0.05 mg mL(-1)) treated neutrophils and HUVECs was less than that on controls. CONCLUSION: Increased in vitro neutrophil and endothelial cell adhesion molecule expression on exposure to plasma obtained during the early reperfusion phase is diminished by lidocaine at greater than clinically relevant plasma concentrations.

  10. Transcriptional responses in the adaptation to ischaemia-reperfusion injury: a study of the effect of ischaemic preconditioning in total knee arthroplasty patients

    Doran Peter P

    2010-05-01

    Full Text Available Abstract Background Ischaemic preconditioning (IPC has emerged as a method of reducing ischaemia-reperfusion injury. However, the complex mechanism through which IPC elicits this protection is not fully understood. The aim of this study was to investigate the genomic response induced by IPC in muscle biopsies taken from the operative leg of total knee arthroplasty patients in order to gain insight into the IPC mechanism. Methods Twenty patients, undergoing primary total knee arthroplasty, were randomly assigned to IPC (n = 10 and control (n = 10 groups. Patients in the IPC group received ischaemic preconditioning immediately prior to surgery. IPC was induced by three five-minute cycles of tourniquet insufflation interrupted by five-minute cycles of reperfusion. A muscle biopsy was taken from the operative knee of control and IPC-treated patients at the onset of surgery and, again, at one hour into surgery. The gene expression profile of muscle biopsies was determined using the Affymetrix Human U113 2.0 microarray system and validated using real-time polymerase chain reaction (RT-PCR. Measurements of C-reactive protein (CRP, erythrocyte sedimentation (ESR, white cell count (WCC, cytokines and haemoglobin were also made pre- and post-operatively. Results Microarray analysis revealed a significant increase in the expression of important oxidative stress defence genes, immediate early response genes and mitochondrial genes. Upregulation of pro-survival genes was also observed and correlated with a downregulation of pro-apoptotic gene expression. CRP, ESR, WCC, cytokine and haemoglobin levels were not significantly different between control and IPC patients. Conclusions The findings of this study suggest that IPC of the lower limb in total knee arthroplasty patients induces a protective genomic response, which results in increased expression of immediate early response genes, oxidative stress defence genes and pro-survival genes. These findings

  11. Justification for intravenous magnesium therapy in acute myocardial infarction

    Rasmussen, H S

    1988-01-01

    Recent studies have shown that patients with acute myocardial infarction (AMI) are magnesium-deficient and develop an additional transient decrease in serum magnesium concentrations (S-Mg c) during the acute phase of the infarct. Animal experiments, as well as studies on humans, have indicated...... that the acute decrease in S-Mg c as well as a more chronic magnesium (Mg) deficiency state are harmful to the myocardium in the setting of acute ischaemia. This knowledge has led during the last couple of years to the performance of four double-blind placebo controlled studies in which the effect of i.......v. magnesium therapy on mortality and incidence of arrhythmias in patients with AMI has been evaluated. Magnesium treatment more than halved the acute mortality and incidence of arrhythmias requiring treatment in three of the four intervention studies. The mechanisms behind the beneficial effect of magnesium...

  12. Application of vascular enhancement technology combined with panoramic ultrasound imaging in the interventional treatment of acute deep venous thrombosis of lower limbs%血管增强技术联合全景超声成像在下肢急性深静脉血栓介入治疗中的应用

    亓培君; 崔建华; 王兴田; 李立杰; 贺烨

    2011-01-01

    Objective To investigate the application value of ultrasonic vascular enhancement technology (VET) combined with panoramic ultrasound imaging (PUl) in the interventional treatment of acute deep venous thrombosis (ADVT)of lower limbs. Methods VET and PUl were used to detect 48 veins of lower limbs in 46 patients with ADVT of lower limbs during interventional procedures. The acquired images were compared with those obtained with 2D ultrasound, CDFI and DSA. Then the thrombolytic catheter was moved under dynamic monitoring of VET. Resalts VET could show catheter in the cavity and its top position, boundary contour of undissolved thrombus, small mural thrombus, vascular wall and ambient collateral circulation clearly with less artifacts and interferences. The image quality was better than that of 2D ultrasound and CDFI (P<0. 05). Compared with DSA, the coincident rate of VET with DSA was 87. 50% (42/48) for the diameter of the recanalized lumen of femoral vein in the same narrow portion tangent, of 2D ultrasound and CDFI with DSA was 37. 50% (18/48,x2=25. 60, P<0. 05). Panoramic images of VET were clear and informative. VET could show the movement of catheter in cavity clearly in dynamic conditions, and under its surveillance, the lateral hole of thrombolytic catheter was put to the vein that contained thrombus accurately. Conclusion VET combined with PUl has great clinical application value in the interventional treatment of ADVT of lower limbs.%目的 探讨超声血管增强技术(VET)联合全景超声成像(PUI)在下肢急性深静脉血栓(ADVT)介入治疗中的应用价值.方法 应用VET及PUI对46例接受下肢ADVT介入治疗患者的48侧下肢血管进行检查,将图像与二维超声及CDFI、DSA进行对比分析,并在VET动态监视下移动溶栓导管.结果 VET图像可清晰显示管腔内导管及其头端位置、未溶血栓边界轮廓、附壁小血栓、血管壁情况及周围侧支循环等,伪像和干扰减少,图像质量评

  13. Endovascular treatment of a chronically occluded limb of endograft with combination TNK pharmacological and EKOS thrombolytic catheter system

    Arterial occlusion is a common and sometimes devastating medical condition related to peripheral vascular and cardiovascular disease. These patients are at severe risk of limb loss and death. Those patients with embolic phenomena are at significantly higher mortality risk than those with thrombosis. Catheter directed therapies have been used routinely for restoration of perfusion to a limb removing the thrombosis or embolic material. Limb thrombosis following endovascular graft placement is a known complication occurring within the first year of the endograft. In many institutions, endovascular treatment of aortic limb occlusions has become the initial management for acute occlusions. We describe the endovascular treatment of a chronic occluded limb utilizing a combination of pharmacological and mechanical thrombolysis using the new ultrasound enhanced EKOS catheter system. Endovascular specialists should be aware that chronically occluded endograft limbs can be successfully treated in the endovascular suite with the EKOS system without requiring more invasive surgical therapies.

  14. Prevalence and characteristics of phantom limb pain and residual limb pain in the long term following upper limb amputation

    Desmond, Deirdre M.; MacLachlan, Malcolm

    2010-01-01

    This study aims to describe the prevalence and characteristics of phantom limb pain and residual limb pain following upper limb amputation. Methods: One-hundred and forty-one participants (139 males; mean age 74.8 years; mean time since amputation 50.1 years) completed a self-report questionnaire assessing residual and phantom limb pain experience. Results: Prevalence of phantom limb pain during the week preceding assessment was 42.6% (60/141). Prevalence of residual limb pain was 43.3% (61/1...

  15. Optimising cardioprotection during myocardial ischaemia: targeting potential intracellular pathways with glucagon-like peptide-1.

    Clarke, Sophie J; McCormick, Liam M; Dutka, David P

    2014-01-01

    Coronary heart disease and type-2 diabetes are both major global health burdens associated with an increased risk of myocardial infarction (MI). Following MI, ischaemia-reperfusion injury (IRI) remains a significant contributor to myocardial injury at the cellular level. Research has focussed on identifying a strategy or intervention to minimise IRI to optimise reperfusion therapy, with the aim of delivering a superior clinical outcome. The incretin hormone glucagon-like peptide-1, already an established basis for the treatment of type-2 diabetes, also has the potential to protect against IRI. We explain the physiology and cellular processes involved in IRI, and the intracellular pathways activated by GLP-1, which could intercept IRI and deliver cardioprotection. The review also examines the current preclinical and clinical evidence for GLP-1 in cardioprotection and future directions for research as we look for an effective adjunctive treatment to minimise IRI. PMID:24410815

  16. MEK1/2 inhibition attenuates vascular ETA and ETB receptor alterations after cerebral ischaemia

    Henriksson, Marie; Stenman, Emelie; Vikman, Petter;

    2007-01-01

    effect of inhibition of the MAP kinase/ERK kinase (MEK)1/2 on ET receptor alteration, brain damage, and neurology in experimental cerebral ischaemia. Transient middle cerebral artery occlusion (MCAO) was induced in male Wistar rats by the intraluminal filament technique. The animals received 100 mg...... MCAO, the contractile responses of the ETA and ETB receptors were augmented in the ipsilateral MCA. U0126 decreased this alteration in ET receptor response. Furthermore, treatment with U0126 significantly decreased the brain damage and improved neurological scores. Immunohistochemistry showed that....../kg intraperitoneally of the MEK1/2 inhibitor U0126 or vehicle in conjunction with the occlusion. After 24 h, the rats were decapitated and the brains removed. The middle cerebral arteries were dissected out and examined with myographs or immunohistochemistry. The ischaemic areas of the brains were compared. After the...

  17. Treatment outcomes of muscle debridement in acute upper limb compartment syndrome%肌肉清创治疗上肢急性期筋膜室间隔综合征的疗效

    王晓刚; 宫可同; 殷中罡; 阚世廉; 李瑞华; 尹路; 鲁毅军; 张宝贵

    2014-01-01

    目的 探索急性期筋膜室间隔综合征患者肌肉清创的手术方法并评估术后疗效.方法 回顾性分析自2005年6月至2013年3月不同原因引起的急性期筋膜室间隔综合征患者13例,全部在筋膜减张的同时行肌肉内坏死组织清创及神经肌肉松解.结果 12例患者直接闭合创面,1例在12 d后延迟闭合创面;11例在术后3周左右获得Ⅰ期愈合;术后3周内9例获得不同程度的运动及感觉功能改善;术后3个月以上5例患者获得随访,对运动和感觉功能恢复较满意.结论 肌肉清创作为筋膜减张术的补充,降低了肌肉内坏死部分所占的比例,使急性期患者创面直接闭合及Ⅰ期愈合的比例升高,并能通过早期功能锻炼,促进患肢近期和远期的功能康复.%Objective To introduce the procedures of muscle debridement in acute compartment syndromes and evaluate the surgical outcomes.Methods From June 2005 to March 2013,thirteen patients who sustained acute compartment syndrome underwent fasciotomy,extensive debridement of necrotic portion of the involved muscles as well as release of nerves and muscles in the meantime.Results Direct wound closure was possible in 12 patients.Delayed wound incision closure in 12 days was done in one patient.Primary wound healing was achieved in 11 patients around 3 weeks postoperatively.Nine patients obtained varied degrees of improvement in both motor and sensory functions.Five patients were follow-up for more than 3 months and they were rather satisfied with the muscle strength and sensory recovery.Conclusion In addition to fasciotomy,debridement of involved muscles can decrease the extent of muscle necrosis in acute compartment syndrome patients.It also increases the chance of direct wound closure and primary wound healing,facilitates early rehabilitation,and thus leads to much better short-term and long-term functional outcomes.

  18. Pain Management in Four-Limb Amputation: A Case Report.

    Warner, Nafisseh S; Warner, Matthew A; Moeschler, Susan M; Hoelzer, Bryan C

    2015-09-01

    Acute pain following amputation can be challenging to treat due to multiple underlying mechanisms and variable clinical responses to treatment. Furthermore, poorly controlled preoperative pain is a risk factor for developing chronic pain. Evidence suggests that epidural analgesia and peripheral nerve blockade may decrease the severity of residual limb pain and the prevalence of phantom pain after lower extremity amputation. We present the perioperative analgesic management of a patient with gangrene of the bilateral upper and lower extremities as a result of septic shock and prolonged vasopressor administration who underwent four-limb amputation in a single procedure. A multimodal analgesic regimen was utilized, including titration of preoperative opioid and neuropathic pain agents, perioperative intravenous, epidural and peripheral nerve catheter infusions, and postoperative oral medication titration. More than 8 months postoperatively, the patient has satisfactory pain control with no evidence for phantom limb pain. To our knowledge, there have been no publications to date concerning analgesic regimens in four-limb amputation. PMID:26011696

  19. Radionuclide lymphoscintigraphy in limb edemas

    Indirect radionuclide lymphoscintigraphy is a safe, non-invasive and physiological method for the assessment of the limb lymphatic system. Colloids as antimony or rhenium sulphide labeled with 99m technetium have been widely used for morphological studies. Quantitative studies involving a continuous count rate monitoring of the injection sites followed by a computer analysis of dynamic image sequences have been a new promising step for an objective measurement of the peripheral lymphatic function. The injection site is always bilateral on the first web space of either the hand or the foot using a small volume (<0.2 mL) of the radiocolloid. This method has been validated on 30 young healthy volunteers and normal values established from a group of 125 upper and 141 lower limbs (normal subjects). The normal results showed a slight but continuous decrease in lymphatic function depending on the age of the subject. In pathological situations, we observed dysfunction of the lymphatic system in pure lymphoedemas or so-called lympho-venous edemas as demonstrated on the 1,182 upper and 2,463 lower limbs tested. The radionuclide lymphoscintigraphy may be helpful in cases of unilateral swollen limbs demonstrating a lymphatic dysfunction on a clinically normal contralateral limb at the first stage of a distal edema which appears within a few weeks or days, in a transient edema phase when normal status and oedema alternate. The lymphoscintigraphy gives objective and reproducible parameters necessary to assess the lymphatic variation under therapy (decongestive physiotherapy, surgery, drugs) and may be useful in the selection of new lympho-tonic treatments. This method is only reflecting the lymphatic function and is unable to appreciate the total lymphatic flow of the limb. Its results only reflect what happens at the injection site and it may be necessary to add a second test using a proximal injection in order to assess the occurrence of lymph nodes not visualized by the

  20. Peripheral and Central Venous Blood Glucose Concentrations in Dogs and Cats with Acute Arterial Thromboembolism

    S. Klainbart; Kelmer, E.; Vidmayer, B.; Bdolah‐Abram, T.; Segev, G.; Aroch, I.

    2014-01-01

    Background Acute limb paralysis because of arterial thromboembolism (ATE) occurs in cats and less commonly in dogs. ATE is diagnosed based on physical examination findings and, occasionally, advanced imaging. Hypothesis/Objectives Peripheral, affected limb venous glucose concentration is decreased in ATE, whereas its systemic concentration is within or above reference interval. Animals Client‐owned cats and dogs were divided into 3 respective groups: acute limb paralysis because of ATE (22 ca...

  1. Pediatric Traumatic Limb Amputation: The Principles of Management and Optimal Residual Limb Lengths.

    Khan, Muhammad Adil Abbas; Javed, Ammar Asrar; Rao, Dominic Jordan; Corner, J Antony; Rosenfield, Peter

    2016-01-01

    Pediatric traumatic limb amputations are rare and their acute and long term management can be challenging in this subgroup of patients. The lengthy and costly hospital stays, and resulting physical and psychological implications leads to significant morbidity. We present a summary of treatment principles and the evidence base supporting the management options for this entity. The initial management focuses on resuscitating and stabilization of the patients, administration of appropriate and adequate analgesics, and broad spectrum antibiotics. The patient should ideally be managed by an orthopedic or a plastic surgeon and when an amputation is warranted, the surgical team should aim to conserve as much of the viable physis as possible aimed at allowing bone development in a growing child. A subsequent wound inspection should be performed to assess for signs of ischemia or non-viability of tissue. Depending on the child's age, approximations of the ideal residual limb length can be calculated using our guidelines, allowing an ideal stump length at skeletal maturity for a well-fitting and appropriate prosthesis. Myodesis and myoplasties can be performed according to the nature of the amputation. Removable rigid dressings are safe and cost effective offering better protection of the stump. Complications such as necrosis and exostosis, on subsequent examination, warrant further revisions. Other complications such as neuromas can be prevented by proximal division of the nerves. Successful rehabilitation can be accomplished with a multidisciplinary approach, involving physiotherapist, play therapist and a child psychiatrist, in addition to the surgeon and primary care providers. PMID:27308235

  2. Secondary limb edemas following irradiation

    Tsyb, A.F.; Bardychev, M.S.; Guseva, L.I.

    1981-09-01

    The results of clinical examination and treatment of 96 patients with secondary limb edemas, developed at late periods after radiation therapy of malignant tumors are discussed. The genesis of edema is accounted both for direct radiation injury of lymphatics and blood vessels (veins) and fibrous changes of tissue in irradiated areas.

  3. Secondary limb edemas following irradiation

    The results of clinical examination and treatment of 96 patients with secondary limb edemas, developed at late periods after radiation therapy of malignant tumors are discussed. The genesis of edema is accounted both for direct radiation injury of lymphatics and blood vessels (veins) and fibrous changes of tissue in irradiated areas. (orig.)

  4. Limb-girdle muscular dystrophies

    ... it may involve other muscles. Causes Limb-girdle muscular dystrophies are a large group of genetic diseases in which there is muscle weakness and ... or a family member has been diagnosed with muscular dystrophy and you are planning a pregnancy. ... Genetic counseling may help some couples and families learn ...

  5. Chronic Lymphedema of the Lower Limb: A Rare Cause of Dislocation of Total Hip Arthroplasty.

    Vaishya, Raju; Agarwal, Amit Kumar; Gupta, Nishint; Vijay, Vipul

    2016-01-01

    Total hip arthroplasty (THA) in a patient with chronic lymphedema of both lower limbs is rarely reported in the literature. Chronic lymphedema is a challenging condition associated with various complications especially in a patient with THA. However, dislocation of the total hip prosthesis due to acute exacerbation of lower limb swelling in the postoperative period is an extremely rare complication. The cause that led to the dislocation of the prosthesis is intricate and difficult to assess, as this has not been discussed in the literature yet. We believe that the excessive weight of the limb due to chronic lymphedema had a deleterious effect on the biomechanics of total hip prosthesis, thereby increasing the tendency for dislocation. This case illustrates that chronic lymphedema of the lower limb should be dealt with aggressively using various modalities like intermittent pneumatic compression pumps and compression stockings after THA in such patients. PMID:27226940

  6. 运动想象疗法对急性脑梗死患者上肢瘫痪的效果及脑功能MRI的改变%Effects and changes of brain functional MRI of motor imagery therapy on acute cerebral infarction patients with upper limb paralysis

    冉茂胜; 叶建军; 马东兵; 张莉; 胡杰杰; 杨旭君; 乔小民; 姜晓萍

    2013-01-01

    Objective To investigate the effects and changes of brain functional MRI (fMRI) of motor imagery therapy on acute cerebral infarction ( ACI) patients with upper limb paralysis. Methods Seventy cases of ACI patients with hemiplegia were randomly divided into the control group (drug therapy + exercise) and motor imagery therapy group, each group had 35 cases. The treatment of motor imagery therapy group was on the basis of control group, add into motor imagery therapy, 2 times a day, for 30 d. Before and 30 d after treatment, the patients were scored by Fugl-Meyer scale (FMA) and functional independence measure scale (FIM) , the active range of motion ( AROM) of ipsilateral wrist was measured by a protractor, and the brain movement activation range was measured by blood oxygen level dependent fMRI. Results After treatment, the FMA, FIM scores of paralysis upper extremity, the AROM and range of brain activation were significantly higher or bigger than before treatment in the two groups (P<0. 05 -0.01). And these indicators of motor imagery therapy group were significantly higher or bigger than those in the control group (P<0. 05 —0.01). Conclusions Motor imagery therapy can promote the recovery of the upper limb motor function in acute cerebral infarction patients with hemiplegia, and expand the brain movement activation range on fMRI.%目的 研究运动想象疗法对急性脑梗死患者上肢瘫痪的效果及脑功能MRI(fMRI)的改变.方法 70例脑梗死偏瘫患者,随机分为对照组(药物治疗+运动)和运动想象治疗组,每组35例.运动想象治疗组在对照组的治疗基础上,进行运动想象疗法,每天2次,连续30 d.在治疗前和治疗后30 d,给患者进行Fugl-Meyer量表(FMA)、功能独立性评定量表(FIM)评分,用量角器测定患侧手腕主动活动范围(AROM);用血氧水平依赖性fMRI测定脑运动激活区范围.结果 两组患者治疗后瘫痪上肢的FMA、FIM评分、AROM及脑激活区的范围均明

  7. Protective effect of hydroalcoholic extract of Andrographis paniculata on ischaemia-reperfusion induced myocardial injury in rats

    Ojha, Shreesh Kumar; Bharti, Saurabh; Joshi, Sujata; Kumari, Santosh; Arya, Dharamvir Singh

    2012-01-01

    Background & objectives: Protecting myocardium from ischaemia-reperfusion (I-R) injury is important to reduce the complication of myocardial infarction (MI) and interventional revascularization procedures. In the present study, the cardioprotective potential of hydroalcoholic extract of Andrographis paniculata was evaluated against left anterior descending coronary artery (LADCA) ligation-induced I-R injury of myocardium in rats. Methods: MI was induced in rats by LADCA ligation for 45 min fo...

  8. Prolonged left ventricular dysfunction occurs in patients with coronary artery disease after both dobutamine and exercise induced myocardial ischaemia

    BARNES, E; Baker, C; Dutka, D.; Rimoldi, O; Rinaldi, C.; Nihoyannopoulos, P; Camici, P; Hall, R

    2000-01-01

    OBJECTIVE—To determine whether pharmacological stress leads to prolonged but reversible left ventricular dysfunction in patients with coronary artery disease, similar to that seen after exercise.
DESIGN—A randomised crossover study of recovery time of systolic and diastolic left ventricular function after exercise and dobutamine induced ischaemia.
SUBJECTS—10 patients with stable angina, angiographically proven coronary artery disease, and normal left ventricular function.
INTERVENTIONS—Tread...

  9. Metoprolol treatment for two years after coronary bypass grafting: effects on exercise capacity and signs of myocardial ischaemia.

    Sjöland, H.; Caidahl, K; Lurje, L.; Hjalmarson, A.; Herlitz, J

    1995-01-01

    OBJECTIVE--To evaluate whether prophylactic treatment with metoprolol for two years after coronary artery bypass grafting improves working capacity and reduces the occurrence of myocardial ischaemia in patients with coronary artery disease. METHODS--After coronary artery bypass grafting, patients were randomised to treatment with metoprolol or placebo for two years. Two years after randomisation, a computerised 12-lead electrocardiogram was obtained during a standardised bicycle exercise test...

  10. Subcutaneous low molecular weight heparin in place of heparin infusion during warfarin dose optimisation in cerebral ischaemia.

    Venketasubramanian, N; Chua, H C

    1998-09-01

    We explored the feasibility of using subcutaneous low-molecular-weight-heparin (LMWH) injections in place unfractionated heparin (UFH) while anticoagulating patients with cerebral ischemia. In this open-labeled, prospective study, patients admitted to our hospital with transient ischemic attacks or stroke requiring anticoagulation who were otherwise medically fit for discharge home were enrolled. The LMWH nadroparin (Fraxiparine) 4100 antiXa BID was administered. In those on UFH, this was stopped after the first dose of LMWH. Patients were sent home and LMWH was administered on an outpatient basis with simultaneous oral warfarin titration till INR reached 2.0. Fifteen patients (13 inpatients, two outpatients) were enrolled; 12 had stroke, one each had crescendo transient ischaemia attacks (TIAs) while on aspirin, TIAs and intracranial arterial stenosis, TIA and atrial fibrillation. Inpatients were discharged home within a median of 1 day (range 1-3 days). Median duration of LMWH therapy was 9 days (range 4-47 days); nine required LMWH for 10 days or less. Two patients reported bruising at the injection site. There was no death, cerebral ischaemia recurrence or major hemorrhage. Using LMWH in place of UFH in patients with cerebral ischaemia is a feasible and safe way of achieving optimal oral anticoagulation and can be done on an outpatient basis. PMID:9822840

  11. The value of the Duke Activity Status Index (DASI) in predicting ischaemia in myocardial perfusion scintigraphy - a prospective study

    Background: Functional capacity assessment may be a useful tool to stratify patients according to risk of coronary artery disease (CAD). The Duke Activity Status Index (DASI) is a functional assessment based on activities of daily living and cardiovascular fitness, assessed using a self-administered questionnaire. MATERIAL AND METHODS: We assessed the relationship between established clinical risk factors for CAD and the DASI with results of myocardial perfusion scintigraphy (MPS). The MPS results used in the analysis were the presence of reversible ischaemia and the resting left ventricular ejection fraction (LVEF). A DASI self-administered questionnaire was completed by 117 consecutive participants, and a patient history was taken to ascertain established risk factors. All participants underwent a stress test, and myocardial perfusion scintigraphy was performed. Statistical analysis consisted of logistic and linear regression using a statistical software package. RESULTS: The DASI was the only factor that correlated significantly with reversible ischaemia on MPS. None of the previously established risk factors had a significant association with reversible ischaemia within the model. Our study found a potential relationship between the DASI score and the left ventricular ejection fraction (LVEF) although this was not statistically significant. CONCLUSIONS: Our study findings suggest that the DASI may represent a powerful tool for risk stratification prior to investigation of CAD. A further study with a larger sample size will be required to investigate the predictive value of the DASI and the association with LVEF. (authors)

  12. Observation of limb movements reduces phantom limb pain in bilateral amputees

    Tung, Monica L; Murphy, Ian C; Griffin, Sarah C; Alphonso, Aimee L.; Hussey-Anderson, Lindsey; Hughes, Katie E; Weeks, Sharon R; Merritt, Victoria; Yetto, Joseph M; Pasquina, Paul F.; Tsao, Jack W.

    2014-01-01

    Background Mirror therapy has been demonstrated to reduce phantom limb pain (PLP) experienced by unilateral limb amputees. Research suggests that the visual feedback of observing a limb moving in the mirror is critical for therapeutic efficacy. Objective Since mirror therapy is not an option for bilateral lower limb amputees, the purpose of this study was to determine if direct observation of another person’s limbs could be used to relieve PLP. Methods We randomly assigned 20 bilateral lower ...

  13. Limb edemas in cancer patients

    Peters, P.E.; Groth, W.

    1983-06-20

    Diagnostic radiology in cancer patients suffering from limb edemas serves two main purposes: to detect or to rule out lymph node metastases, recurrent cancer, or secondary malignancies, and to differentiate venous edema from lymphedema. The authors suggest an algorithmic pathway where the non-invasive imaging modalities, real-time ultrasonography and computed tomography are recommended as the initial diagnostic step. Both techniques are equally well suited to detect enlarged lymph nodes with high accuracy. In addition, computed tomography allows to a certain degree to separate venous from lymphedema. Phlebography is rarely needed in these patients. Lymphography should only be considered in patients undergoing microsurgical reconstructive operations of the lymphatics (e.g. lymphovenous anastomoses) because this invasive study carries the risk of deteriorating the edematous limb.

  14. Limb edemas in cancer patients

    Diagnostic radiology in cancer patients suffering from limb edemas serves two main purposes: to detect or to rule out lymph node metastases, recurrent cancer, or secondary malignancies, and to differentiate venous edema from lymphedema. The authors suggest an algorithmic pathway where the non-invasive imaging modalities, real-time ultrasonography and computed tomography are recommended as the initial diagnostic step. Both techniques are equally well suited to detect enlarged lymph nodes with high accuracy. In addition, computed tomography allows to a certain degree to separate venous from lymphedema. Phlebography is rarely needed in these patients. Lymphography should only be considered in patients undergoing microsurgical reconstructive operations of the lymphatics (e.g. lymphovenous anastomoses) because this invasive study carries the risk of deteriorating the edematous limb. (orig.)

  15. Feasibility and safety of ultrasound-guided nerve block for management of limb injuries by emergency care physicians

    Sanjeev Bhoi; Tej P Sinha; Mahaveer Rodha; Amit Bhasin; Radhakrishna Ramchandani; Sagar Galwankar

    2012-01-01

    Background: Patients require procedural sedation and analgesia (PSA) for the treatment of acute traumatic injuries. PSA has complications. Ultrasound (US) guided peripheral nerve block is a safe alternative. Aim: Ultrasound guided nerve blocks for management of traumatic limb emergencies in Emergency Department (ED). Setting and Design: Prospective observational study conducted in ED. Materials and Methods: Patients above five years requiring analgesia for management of limb emergencies were ...

  16. Regenerative Engineering and Bionic Limbs

    James, Roshan; Laurencin, Cato T.

    2015-01-01

    Amputations of the upper extremity are severely debilitating, current treatments support very basic limb movement, and patients undergo extensive physiotherapy and psychological counselling. There is no prosthesis that allows the amputees near-normal function. With increasing number of amputees due to injuries sustained in accidents, natural calamities and international conflicts, there is a growing requirement for novel strategies and new discoveries. Advances have been mad...

  17. Gremlin1 induces anterior-posterior limb bifurcations in developing Xenopus limbs but does not enhance limb regeneration.

    Wang, Yi-Hsuan; Keenan, Samuel R; Lynn, Jeremy; McEwan, James C; Beck, Caroline W

    2015-11-01

    Gremlin1 (grem1) has been previously identified as being significantly up-regulated during regeneration of Xenopus laevis limbs. Grem1 is an antagonist of bone morphogenetic proteins (BMPs) with a known role in limb development in amniotes. It forms part of a self-regulating feedback loop linking epithelial (FGF) and mesenchymal (shh) signalling centres, thereby controlling outgrowth, anterior posterior and proximal distal patterning. Spatiotemporal regulation of the same genes in developing and regenerating Xenopus limb buds supports conservation of this mechanism. Using a heat shock inducible grem1 (G) transgene to created temperature regulated stable lines, we have shown that despite being upregulated in regeneration, grem1 overexpression does not enhance regeneration of tadpole hindlimbs. However, both the regenerating and contralateral, developing limb of G transgenics developed skeletal defects, suggesting that overexpressing grem1 negatively affects limb patterning. When grem1 expression was targeted earlier in limb bud development, we saw dramatic bifurcations of the limbs resulting in duplication of anterior posterior (AP) pattern, forming a phenotypic continuum ranging from duplications arising at the level of the femoral head to digit bifurcations, but never involving the pelvis. Intriguingly, the original limbs have AP pattern inversion due to de-restricted Shh signalling. We discuss a possible role for Grem1 regulation of limb BMPs in regulation of branching pattern in the limbs. PMID:26527308

  18. Outcomes of kidney paired donation transplants in relation to shipping and cold ischaemia time.

    Allen, Richard; Pleass, Henry; Clayton, Phil A; Woodroffe, Claudia; Ferrari, Paolo

    2016-04-01

    To assess the impact of shipping distance and cold ischaemia time (CIT) of shipped organs in a kidney paired donation (KPD) programme, we evaluated the outcomes of the initial 100 kidney transplants performed in the Australian KPD programme. In a 44-month period, 12 centres were involved in fifteen 2-way, twenty 3-way, one 4-way and one 6-way exchanges. Sixteen kidneys were transplanted at the same hospital (CIT 2.6 ± 0.6 h) and 84 required transport to the recipient hospital (CIT 6.8 ± 2.8 h). A spontaneous fall in serum creatinine by at least 10% within 24 h was observed in 85% of recipients, with no difference between nonshipped and shipped kidneys. There were two cases of transient delayed graft function requiring dialysis and patient and graft survival at 1 year were 99% and 97%, respectively. There was no difference in recipients of nonshipped compared with shipped kidneys with regard to serum creatinine at 1 month (mean difference (MD) 7.3 μmol/l, 95% CI -20.2 to 34.8, P = 0.59), 1-year graft survival (MD 3.9%, 95% CI -5.4 to 13.2, P = 0.41) or patient survival (MD -2.4%, 95% CI -10.0 to 5.2, P = 0.54). Despite prolonged CIT for interstate exchanges, the programme's decision to ship donor kidneys rather than the donor appears to be safe. PMID:26576040

  19. Use of a virtual integrated environment in prosthetic limb development and phantom limb pain.

    Alphonso, Aimee L; Monson, Brett T; Zeher, Michael J; Armiger, Robert S; Weeks, Sharon R; Burck, J M; Moran, C; Davoodie, R; Loeb, G; Pasquina, Paul F; Tsao, Jack W

    2012-01-01

    Patients face two major difficulties following limb loss: phantom limb pain (PLP) in the residual limb and limited functionality in the prosthetic limb. Many studies have focused on decreasing PLP with mirror therapy, yet few have examined the same visual ameliorating effect with a virtual or prosthetic limb. Our study addresses the following key questions: (1) does PLP decrease through observation of a 3D limb in a virtual integration environment (VIE) and (2) can consistent surface electromyography (sEMG) signals from the VIE drive an advanced modular prosthetic limb (MPL)? Recorded signals from the residual limb were correlated to the desired motion of the phantom limb, and changes in PLP were scored during each VIE session. Preliminary results show an overall reduction in PLP and a trend toward improvement in signal-to-motion accuracy over time. These signals allowed MPL users to perform a wide range of hand motions. PMID:22954877

  20. Influence of acute glycaemic level on measures of myocardial infarction in non-diabetic pigs

    Diemar, Sarah S; Sejling, Anne-Sophie; Iversen, Kasper K; Engstrøm, Thomas; Honge, Jesper L; Tønder, Niels; Vejlstrup, Niels; Idorn, Manja; Ekström, Kathrine; Pedersen-Bjergaard, Ulrik; Thorsteinsson, Birger; Dalsgaard, Morten

    2015-01-01

    OBJECTIVE: Patients with diabetes are at increased risk of experiencing myocardial infarction. The influence of the prevailing plasma glucose level on infarction and mortality after acute ischaemia is however unknown. The aim was to study the effect of the acute plasma glucose level on the...... myocardial infarction size in a closed-chest pig model. DESIGN: 38 non-diabetic pigs were randomised to hypoglycaemic (1.8-2.2 mmol/l; n = 15), normoglycaemic (5-7 mmol/l; n = 12) or hyperglycaemic glucose clamping (22-23 mmol/l; n = 11). After 30 min within glucose target myocardial infarction was induced...

  1. The role of cardiac magnetic resonance imaging following acute myocardial infarction

    Wong, Dennis T.L.; Richardson, James D.; Puri, Rishi; Nelson, Adam J.; Teo, Karen S.L.; Worthley, Matthew I. [Royal Adelaide Hospital, Cardiovascular Research Centre, Adelaide (Australia); University of Adelaide, Department of Medicine, Adelaide (Australia); Bertaso, Angela G. [Royal Adelaide Hospital, Cardiovascular Research Centre, Adelaide (Australia); Worthley, Stephen G. [Royal Adelaide Hospital, Cardiovascular Research Centre, Adelaide (Australia); University of Adelaide, Department of Medicine, Adelaide (Australia); Cardiovascular Investigational Unit, Adelaide, SA (Australia)

    2012-08-15

    Advances in the management of myocardial infarction have resulted in substantial reductions in morbidity and mortality. However, after acute treatment a number of diagnostic and prognostic questions often remain to be answered, whereby cardiac imaging plays an essential role. For example, some patients will sustain early mechanical complications after infarction, while others may develop significant ventricular dysfunction. Furthermore, many individuals harbour a significant burden of residual coronary disease for which clarification of functional ischaemic status and/or viability of the suspected myocardial territory is required. Cardiac magnetic resonance (CMR) imaging is well positioned to fulfil these requirements given its unparalleled capability in evaluating cardiac function, stress ischaemia testing and myocardial tissue characterisation. This review will focus on the utility of CMR in resolving diagnostic uncertainty, evaluating early complications following myocardial infarction, assessing inducible ischaemia, myocardial viability, ventricular remodelling and the emerging role of CMR-derived measures as endpoints in clinical trials. (orig.)

  2. Effects of systemic non-steroidal anti-inflammatory drugs on nociception during tail ischaemia and on reperfusion hyperalgesia in rats.

    Gelgor, L.; Butkow, N.; Mitchell, D.

    1992-01-01

    1. We have investigated the effects of five non-steroidal anti-inflammatory drugs (NSAIDs) on nociception during ischaemia and on reperfusion hyperalgesia in rats. 2. We induced tail ischaemia in conscious rats by applying a tourniquet at the base of the tail until the rats exhibited co-ordinated escape behaviour when we released the tourniquet. 3. We assessed hyperalgesia by measuring the tail flick latency following tail immersion in water at 49 degrees C, before applying and immediately after releasing the tourniquet, and then at 30 min intervals for 2 h. 4. Intraperitoneal injection of NSAIDs prior to applying the tourniquet had no effect on the co-ordinated escape behaviour during ischaemia, nor on tail flick latency in the absence of prior ischaemia. However all the drugs attenuated reperfusion hyperalgesia in a log dose-dependent manner. Doses required to abolish hyperalgesia, were indomethacin 5 mg kg-1, diclofenac sodium 42 mg kg-1, ibuprofen 54 mg kg-1, dipyrone 168 mg kg-1 and paracetamol 170 mg kg-1. 5. We conclude that the mechanisms underlying nociception during ischaemia are not the same as those underlying reperfusion hyperalgesia. Moreover our procedure provides a rapid and more humane method for measuring the antinociceptive potency of NSAIDs. PMID:1559131

  3. Bilateral hind limb hypoplasia in a foal

    Hypoplasia affecting both hind limbs was observed in a neonatal foal. Scintigraphy aided in establishing diagnosis and prognosis. Radiography revealed an abnormally shaped middle phalanx and lack of the distalphalanx and navicular bone in the right hind limb, with an abnormally shaped distal phalanx and navicular bone in the left hind limb. Scintigraphic findings were closely correlated with the radiographic findings. Radiographic and scintigraphic findings were confirmed at postmortem examination

  4. Risk indicators of reduction limb defects.

    Aro, T.; Heinonen, O P; Saxén, L

    1983-01-01

    The birth of a child with a reduction limb defect (RLD) was evaluated in relation to vaginal bleeding, threatened abortion, and other complications of pregnancy, placental weight, birth weight, family history, parental age, and the outcome of previous pregnancies. The material consisted of 453 cases of reduction limb defect and an equal number of non-malformed controls matched for time and place. The children were born in Finland during 1964-77. The cases with reduction limb defect without ad...

  5. Acute organophosphorus poisoning complicated by acute coronary syndrome.

    Pankaj, Madhu; Krishna, Kavita

    2014-07-01

    We report a case of 30 year old alcoholic male admitted with vomiting, drowsiness, limb weakness and fasciculations after alleged history of consumption of 30 ml of chlorpyriphos insecticide. He had low serum cholinesterase levels. With standard treatment for organophosphorus poisoning (OPP), he improved gradually until day 5, when he developed neck and limb weakness and respiratory distress. This intermediate syndrome was treated with oximes, atropine and artificial ventilation. During treatment, his ECG showed fresh changes of ST elevation. High CPK & CPK-MB levels, septal hypokinesia on 2D echo suggested acute coronary syndrome. Coronary angiography was postponed due to his bedridden and obtunded status. The patient finally recovered fully by day 15 and was discharged. Acute coronary syndrome is a rare occurrence in OP poisoning. The present case thus emphasises the need for careful electrocardiographic and enzymatic monitoring of all patients of organophosphorus poisoning to prevent potential cardiac complication which can prove fatal. PMID:25672037

  6. Apoptosis is not an invariable component of in vitro models of cortical cerebral ischaemia

    Paul Alexander JONES; Gillian Ruth MAY; Joyce Ann MCLUCKIE; Akinori IWASHITA; John SHARKEY

    2004-01-01

    Characterising the mechanisms of cell death following focal cerebral ischaemia has been hampered by a lack of an in vitro assay emulating both the apoptotic and necrotic features observed in vivo. The present study systematically characterised oxygen-glucose-deprivation (OGD) in primary rat cortical neurones to establish a reproducible model with components of both cell-death endpoints. OGD induced a time-dependent reduction in cell viability, with 80% cell death occurring 24 h after 3 h exposure to 0% O2 and 0.5 mM glucose. Indicative of a necrotic component to OGDinduced cell death, N-methyl-D-aspartate (NMDA) receptor inhibition with MK-801 attenuated neuronal loss by 60%.The lack of protection by the caspase inhibitors DEVD-CHO and z-VAD-fmk suggested that under these conditions neurones did not die by an apoptotic mechanism. Moderating the severity of the insult by decreasing OGD exposure to 60 min did not reduce the amount of necrosis, but did induce a small degree of apoptosis (a slight reduction in cell death was observed in the presence of 10 μtM DEVD-CHO). In separate experiments purported to enhance the apoptotic component, cells were gradually deprived of O2, exposed to 4% O2 (as opposed to 0%) during the OGD period, or maintained in serum-containing media throughout. While NMDA receptor antagonism significantly reduced cortical cell death under all conditions, a caspase-inhibitor sensitive component of cell death was not uncovered. These studies suggest that OGD of cultured cortical cells models the excitotoxic, but not the apoptotic component of cell death observed in vivo.

  7. Correction of biochemical and functional disorders in brain ischaemia with laser therapy

    Musienko, Julia I.; Nechipurenko, Natalia I.; Vasilevskaya, Ludmila A.

    2005-08-01

    Application of intravenous laser irradiation of blood (ILIB) is considered to be the most effective method of laser therapy and its application is expedient pathogenetically in the ischemic disturbances. The aim of this study is to investigate ILIB influence with red helium-neon laser (HNL) with 630 nm wavelength and different powers on blood oxygen transport (BOT), cerebral and dermal microhaemodynamics (MGD), hydro-ion balance in normal rabbits and after modeling of local ischemia of brain (LIB). Experimental cerebral ischemia is characterized by development of BOT disturbance, ionic disbalance and edema in the ischemic brain region. Microcirculation disturbances with worsening of the cerebral and dermal MHD were revealed. ILIB with HNL radiation of 2.5 and 4.5 mW powers provokes dehydratation of brain structure alone with the K+, Na+ concentration decreasing and hemoglobin-oxygen affinity increasing in intact group of animals. There was not revealed marked changes of cerebral MHD condition here. Using of ILIB in rabbits after LIB contributes for improving function of BOT, normalizing of water content in all cerebral structures compared to operated animals. Preventive ILIB provoked improvement of speckl-optical parameters and marked protective effect on microhaemodynamics processes in superficial brain structures. HNL radiation with 1.0 mW power results in worsening of oxygen transport, cerebral and skin MHD, hydro-ion homeostasis in animals with LIB modeling. Thus, laser haemotherapy contributes for improving of hydro-ion status, blood oxygen transport and cerebral microcirculation in brain ischemia, what allows considering that helium-neon radiation with the pointed regimen is substantiated pathogenetically in brain ischaemia.

  8. Extracellular Control of Limb Regeneration

    Calve, S.; Simon, H.-G.

    Adult newts possess the ability to completely regenerate organs and appendages. Immediately after limb loss, the extracellular matrix (ECM) undergoes dramatic changes that may provide mechanical and biochemical cues to guide the formation of the blastema, which is comprised of uncommitted stem-like cells that proliferate to replace the lost structure. Skeletal muscle is a known reservoir for blastema cells but the mechanism by which it contributes progenitor cells is still unclear. To create physiologically relevant culture conditions for the testing of primary newt muscle cells in vitro, the spatio-temporal distribution of ECM components and the mechanical properties of newt muscle were analyzed. Tenascin-C and hyaluronic acid (HA) were found to be dramatically upregulated in the amputated limb and were co-expressed around regenerating skeletal muscle. The transverse stiffness of muscle measured in situ was used as a guide to generate silicone-based substrates of physiological stiffness. Culturing newt muscle cells under different conditions revealed that the cells are sensitive to both matrix coating and substrate stiffness: Myoblasts on HA-coated soft substrates display a rounded morphology and become more elongated as the stiffness of the substrate increases. Coating of soft substrates with matrigel or fibronectin enhanced cell spreading and eventual cell fusion.

  9. Prostacyclin-producing human mesenchymal cells target H19 lncRNA to augment endogenous progenitor function in hindlimb ischaemia

    Deng, Yuxiao; Yang, Zhongwei; Terry, Toya; Pan, Su; Woodside, Darren G.; Wang, Jingxiong; Ruan, Kehe; Willerson, James T.; Dixon, Richard A. F.; Liu, Qi

    2016-01-01

    Promoting the paracrine effects of human mesenchymal stem cell (hMSC) therapy may contribute to improvements in patient outcomes. Here we develop an innovative strategy to enhance the paracrine effects of hMSCs. In a mouse hindlimb ischaemia model, we examine the effects of hMSCs in which a novel triple-catalytic enzyme is introduced to stably produce prostacyclin (PGI2-hMSCs). We show that PGI2-hMSCs facilitate perfusion recovery and enhance running capability as compared with control hMSCs ...

  10. Repertaxin, a novel inhibitor of rat CXCR2 function, inhibits inflammatory responses that follow intestinal ischaemia and reperfusion injury

    Souza, Danielle G; Bertini, Riccardo; Vieira, Angelica T.; Cunha, Fernando Q.; Poole, Steve; Allegretti, Marcello; Colotta, Francesco; Teixeira, Mauro M

    2004-01-01

    Neutrophils are thought to play a major role in the mediation of reperfusion injury. CXC chemokines are known inducers of neutrophil recruitment. Here, we assessed the effects of Repertaxin, a novel low molecular weight inhibitor of human CXCL8 receptor activation, on the local, remote and systemic injuries following intestinal ischaemia and reperfusion (I/R) in the rat.Pre-incubation of rat neutrophils with Repertaxin (10−11–10−6 M) inhibited the chemotaxis of neutrophils induced by human CX...