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Critical ischaemia

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https://www.readbyqxmd.com/read/28923277/animal-models-of-ischaemic-stroke-and-characterisation-of-the-ischaemic-penumbra
#1
REVIEW
Christopher McCabe, Mariana M Arroja, Emma Reid, I Mhairi Macrae
Over the past forty years, animal models of focal cerebral ischaemia have allowed us to identify the critical cerebral blood flow thresholds responsible for irreversible cell death, electrical failure, inhibition of protein synthesis, energy depletion and thereby the lifespan of the potentially salvageable penumbra. They have allowed us to understand the intricate biochemical and molecular mechanisms within the 'ischaemic cascade' that initiate cell death in the first minutes, hours and days following stroke...
September 16, 2017: Neuropharmacology
https://www.readbyqxmd.com/read/28902825/-treatment-of-patients-with-critical-lower-limb-ischaemia-endovascular-methods-or-reconstructive-operations
#2
A V Gavrilenko, A A Kravchenko, A É Kotov, D V Shatalova
Presented herein is a review of the literature related to endovascular methods of treatment of patients with critical lower limb ischaemia. This is followed by comparative assessment of the outcomes of endovascular and open surgical interventions. Also covered are problems concerning appropriate therapeutic decision making, taking into consideration peculiarities of lower limb ischaemia and the state at the expense of insufficiency of inflow/outflow.
2017: Angiologii︠a︡ i Sosudistai︠a︡ Khirurgii︠a︡, Angiology and Vascular Surgery
https://www.readbyqxmd.com/read/28901690/hypothenar-hammer-syndrome-in-an-office-worker
#3
Fan Zhang, Yuranga Weerakkody, Patrik Tosenovsky
Hypothenar hammer syndrome (HHS) is an uncommon cause of unilateral Raynaud's phenomenon, splinter haemorrhages and hypothenar weakness. The typical patient is a male blue-collar worker who uses their hypothenar eminence to hammer objects as part of their work. The distal ulnar artery beyond Guyon's canal is superficial and vulnerable to blunt trauma. CTA and MRA are common initial investigations and can suggest the diagnosis. DSA is the gold standard imaging modality and offers therapeutic opportunities. Management is controversial, but unless there is critical digital ischaemia, conservative treatment is first line...
September 13, 2017: Journal of Medical Imaging and Radiation Oncology
https://www.readbyqxmd.com/read/28876693/continuation-of-feeds-in-the-unstable-burns-patient
#4
A L Rooi, A Muganza, E A Ndobe, M Nel
BACKGROUND: Early enteral nutrition (EEN) and the continuation of enteral nutrition (EN) are critical factors in burn patients, who typically have higher nutritional needs due to their post-injury hypercatabolic state and their additional need for nutrients to aid in the healing of wounds and skin grafts. In the critically ill patient, EN is the preferred mode of administration; however, controversy exists regarding the concomitant use of EN and intravenous vasopressor agents in the haemodynamically unstable patient...
June 2017: South African Journal of Surgery. Suid-Afrikaanse Tydskrif Vir Chirurgie
https://www.readbyqxmd.com/read/28876565/pattern-and-distribution-of-peripheral-arterial-disease-in-diabetic-patients-with-critical-limb-ischemia-rutherford-clinical-category-4-6
#5
M J Motsumi, N G Naidoo
BACKGROUND: This study investigated the pattern and distribution of peripheral arterial disease in diabetic patients with critical limb ischaemia (CLI) and to stratify the findings according to the patients' risk factor profile, gender and age group. METHOD: We conducted a one-year prospective descriptive study (January 2014 to December 2014) at Groote Schuur Hospital, University of Cape Town. The research protocol and the informed consent were approved by the Institutional Review Board, and all subjects included in this study gave an informed consent...
September 2017: South African Journal of Surgery. Suid-Afrikaanse Tydskrif Vir Chirurgie
https://www.readbyqxmd.com/read/28857508/systemic-tlr2-antibody-application-in-renal-ischaemia-and-reperfusion-injury-decreases-akt-phosphorylation-and-increases-apoptosis-in-the-mouse-kidney
#6
Anja Urbschat, Patrick Baer, Kai Zacharowski, Vera Sprunck, Bertram Scheller, Florian Raimann, Thorsten Jürgen Maier, Axel Hegele, Rainer Hofmann, Jan Mersmann
Acute kidney injury remains an important cause of renal dysfunction. In this context, toll-like receptors have been demonstrated to play a critical role in the induction of innate and inflammatory responses. Among these, toll-like receptor 2 (TLR2) is constitutively expressed in tubular epithelial cells of the kidney and is also known to mediate ischaemia reperfusion (IR) injury. Adult male C57BL/6JRj mice were randomized into 7 groups (n=8): A non-operative control group (CTRL) and 6 interventional groups in which mice were subjected to a 30-min...
August 30, 2017: Basic & Clinical Pharmacology & Toxicology
https://www.readbyqxmd.com/read/28838085/long-term-survival-and-fate-of-the-leg-in-de-novo-intermittent-claudication
#7
Hisao Kumakura, Hiroyoshi Kanai, Yoshiaki Hojo, Toshiya Iwasaki, Shuichi Ichikawa
Aims: The long-term life expectancy and fate of the leg, including progression rate to critical limb ischaemia (CLI), were analysed in de novo patients with intermittent claudication (IC). Methods and results: A prospective cohort study was performed in 1107 patients with de novo IC. The endpoints were overall survival (OS), freedom from major adverse cardiovascular events (MACE), freedom from major adverse cardiovascular and limb events (MACLE), and fate of the leg...
July 1, 2017: European Heart Journal. Quality of Care & Clinical Outcomes
https://www.readbyqxmd.com/read/28835456/systematic-review-of-pharmacological-therapies-for-the-management-of-ischaemic-pain-in-patients-with-non-reconstructable-critical-limb-ischaemia
#8
REVIEW
Áine Ní Laoire, Fliss E M Murtagh
BACKGROUND: Critical limb ischaemia (CLI) is a severe manifestation of peripheral arterial disease, characterised by chronic ischaemic rest pain, ulcers or gangrene. Management of ischaemic pain is challenging in patients with no options for revascularisation and optimal pharmacological therapies have not been established. OBJECTIVES: To identify and evaluate the effectiveness of pharmacological therapies to treat ischaemic pain secondary to non-reconstructable CLI...
August 23, 2017: BMJ Supportive & Palliative Care
https://www.readbyqxmd.com/read/28832559/critical-limb-ischaemia-artery-repair
#9
David Holmes
No abstract text is available yet for this article.
August 23, 2017: Nature
https://www.readbyqxmd.com/read/28830892/life-threatening-intraoperative-anaphylaxis-as-a-result-of-chlorhexidine-present-in-instillagel
#10
Joshua Totty, James Forsyth, Anthony Mekako, Ian Chetter
A 70-year-old man with left lower limb critical ischaemia was admitted to our vascular unit for a femoral-popliteal bypass. He had experienced a skin reaction to chlorhexidine 6 months previously during an angioplasty procedure. After intubation, once in the operating theatre, the patient had a urinary catheter inserted using Instillagel. Around 30 min later the patient had a full-blown anaphylactic reaction that required aggressive medical management and the abandoning of surgery. Postoperative allergy testing confirmed that the suspected primary trigger for the anaphylaxis was indeed chlorhexidine, which was present in Instillagel...
August 21, 2017: BMJ Case Reports
https://www.readbyqxmd.com/read/28797662/amputation-rates-mortality-and-pre-operative-comorbidities-in-patients-revascularised-for-intermittent-claudication-or-critical-limb-ischaemia-a-population-based-study
#11
E Baubeta Fridh, M Andersson, M Thuresson, B Sigvant, B Kragsterman, S Johansson, P Hasvold, M Falkenberg, J Nordanstig
OBJECTIVES: The aims of this population based study were to describe mid- to long-term amputation risk, cumulative incidence of death or amputation, and differences in pre-operative comorbidities in patients revascularised for lower limb peripheral artery disease (PAD). METHODS: This was an observational cohort study. Data from the Swedish National Quality Registry for Vascular Surgery (Swedvasc) were combined with mandatory national health care registries and patient medical records...
October 2017: European Journal of Vascular and Endovascular Surgery
https://www.readbyqxmd.com/read/28795888/effective-wound-bed-preparation-using-maggot-debridement-therapy-for-patients-with-critical-limb-ischaemia
#12
A Nishijima, M Gosho, R Yoshida, S Yanagibayashi, M Takikawa, J Nishijima, M Sekido, N Yamamoto
OBJECTIVE: Patients with critical limb ischaemia (CLI) lack sufficient blood flow in to the limb, which leads to difficulties in the normal wound healing process. Therefore, maggot debridement therapy (MDT) has not generally been recommended for CLI patients. We evaluated the effectiveness of wound bed preparation by MDT in CLI patients who had undergone mid-foot amputation. METHODS: Patients who underwent mid-foot amputation after angioplasty between April 2014 and October 2016 were retrospectively investigated by classifying them into an MDT group or a conventional treatment group...
August 2, 2017: Journal of Wound Care
https://www.readbyqxmd.com/read/28790028/staged-retroperitoneal-mesenteric-revascularisation-and-aortobifemoral-bypass-after-endovascular-rescue-for-acute-mesenteric-ischaemia
#13
Shepard Peir Johnson, Melani Lighter, Harry Linne Anderson, Abdulhameed Aziz
Visceral artery revascularisation through a retroperitoneal approach provides an infrequent yet viable, alternative means of managing mesenteric ischaemia in patients with previous abdominal operations. We present a unique case implementing this surgical approach in a 55-year-old man in which we performed a retroperitoneal aortobifemoral bypass with concomitant retrograde jump graft from the aortic prosthesis to the superior mesenteric artery (SMA) for bilateral lower extremity rest pain and chronic mesenteric ischaemia...
August 8, 2017: BMJ Case Reports
https://www.readbyqxmd.com/read/28760771/diabetic-nephropathy-is-this-an-immune-disorder
#14
REVIEW
Greg H Tesch
Chronic diabetes is associated with metabolic and haemodynamic stresses which can facilitate modifications to DNA, proteins and lipids, induce cellular dysfunction and damage, and stimulate inflammatory and fibrotic responses which lead to various types of renal injury. Approximately 30-40% of patients with diabetes develop nephropathy and this renal injury normally progresses in about a third of patients. Due to the growing incidence of diabetes, diabetic nephropathy is now the main cause of end-stage renal disease (ESRD) worldwide...
August 15, 2017: Clinical Science (1979-)
https://www.readbyqxmd.com/read/28754429/assessment-of-minimum-important-difference-and-substantial-clinical-benefit-with-the-vascular-quality-of-life-questionnaire-6-when-evaluating-revascularisation-procedures-in-peripheral-arterial-disease
#15
J Nordanstig, M Pettersson, M Morgan, M Falkenberg, C Kumlien
OBJECTIVES: Patient reported outcomes are increasingly used to assess outcomes after peripheral arterial disease (PAD) interventions. VascuQoL-6 (VQ-6) is a PAD specific health-related quality of life (HRQoL) instrument for routine clinical practice and clinical research. This study assessed the minimum important difference for the VQ-6 and determined thresholds for the minimum important difference and substantial clinical benefit following PAD revascularisation. MATERIALS AND METHODS: This was a population-based observational cohort study...
July 25, 2017: European Journal of Vascular and Endovascular Surgery
https://www.readbyqxmd.com/read/28753096/conservative-treatment-of-patients-with-thromboangiitis-obliterans-or-cannabis-associated-arteritis-presenting-with-critical-lower-limb-ischaemia
#16
George Galyfos, Stavros Kerasidis, Georgios Kastrisios, Sotirios Giannakakis, Ioannis Sachmpazidis, Christiana Anastasiadou, Georgios Geropapas, Anastasios Papapetrou, Gerasimos Papacharalampous, Chrisostomos Maltezos
BACKGROUND: Proper management of patients with thromboangiitis obliterans (TAO) or cannabis-associated arteritis (CAA), presenting with critical lower limb ischaemia (CLI) remains controversial, and data are limited. PATIENTS AND METHODS: Patients with TAO or CAA presenting with CLI between 2011 and 2016 were retrospectively evaluated. Patients requiring primary intervention were excluded. Conservative treatment included: (a) weight-adjusted bemiparin plus six hours/day intravenous iloprost for 28 days, (b) aspirin (100 mg/day) plus cilostazol (100 mg twice/day) after discharge, and (c) strict recommendations/monitoring for smoking cessation...
July 28, 2017: VASA. Zeitschrift Für Gefässkrankheiten
https://www.readbyqxmd.com/read/28711979/acute-kidney-injury-and-critical-limb-ischaemia-associated-with-the-use-of-the-so-called-legal-high-3-fluorophenmetrazine
#17
Michael Fawzy, Wei San Wong-Morrow, Anthony Beaumont, Chris K T Farmer
Until the law in the United Kingdom (UK) changed in May 2016 so called "legal highs" or "new psychoactive substances" were freely available in high street shops across the UK. Following prohibition these drugs are still easily purchased illegally via the internet. We report a case of a patient who self-administered 3-fluorophenmetrazine intravenously with catastrophic consequences. Adverse effects were almost immediate with symptoms of malaise and tachycardia. Two days post administration he was transferred to the intensive therapy unit with acute kidney injury and irreversible four limb ischaemia...
July 15, 2017: CEN Case Reports
https://www.readbyqxmd.com/read/28670345/the-comparative-efficacy-of-angiosome-directed-and-indirect-revascularisation-strategies-to-aid-healing-of-chronic-foot-wounds-in-patients-with-co-morbid-diabetes-mellitus-and-critical-limb-ischaemia-a-literature-review
#18
Benedictine Y C Khor, Pamela Price
BACKGROUND: Ischaemic ulcerations have been reported to persist and/or deteriorate despite technically successful revascularisations; a higher incidence of which affects patients with diabetes and critical limb ischaemia. In the context of wound healing, it is unclear if applications of the angiosome concept in 'direct revascularisation' (DR) would be able to aid the healing of chronic foot ulcerations better than the current 'best vessel' or 'indirect revascularisation' (IR) strategy in patients with co-morbid diabetes and critical limb ischaemia...
2017: Journal of Foot and Ankle Research
https://www.readbyqxmd.com/read/28665187/is-contrast-enhanced-ultrasonography-a-useful-tool-for-the-evaluation-of-muscular-microcirculation-in-patients-with-critical-limb-ischaemia
#19
Christophe Seinturier, Sophie Blaise, Olivier Pichot, Sebastien Guigard, Céline Genty, Jean Luc Magne, Jean Luc Bosson, Gilles Pernod, Patrick Henry Carpentier
No abstract text is available yet for this article.
June 30, 2017: VASA. Zeitschrift Für Gefässkrankheiten
https://www.readbyqxmd.com/read/28651504/critical-care-management-of-aneurysmal-subarachnoid-haemorrhage-in-australia-and-new-zealand-what-are-we-doing-and-where-to-from-here
#20
RANDOMIZED CONTROLLED TRIAL
Andrew A Udy, Sacha Schweikert, James Anstey, Matthew Anstey, Jeremy Cohen, Oliver Flower, Edward Saxby, Andrew van der Poll, Anthony Delaney
Patients with an aneurysmal subarachnoid haemorrhage (SAH) frequently require admission to the intensive care unit. There, a variety of therapeutic strategies are initiated, in addition to definitive procedures aimed at securing the aneurysm. Despite a substantial investment in caring for these patients, outcomes for this group remain poor. Although the severity of the initial bleed is crucial in this context, many patients undergo further deterioration in the ICU. Delayed cerebral ischaemia is a significant cause of longterm morbidity and mortality after SAH...
June 2017: Critical Care and Resuscitation: Journal of the Australasian Academy of Critical Care Medicine
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