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Critical ischaemia

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https://www.readbyqxmd.com/read/29318581/prostanoids-for-critical-limb-ischaemia
#1
REVIEW
Valeria Vietto, Juan Va Franco, Victoria Saenz, Denise Cytryn, Jose Chas, Agustín Ciapponi
BACKGROUND: Peripheral arterial occlusive disease (PAOD) is a common cause of morbidity and mortality due to cardiovascular disease in the general population. Although numerous treatments have been adopted for patients at different disease stages, no option other than amputation is available for patients presenting with critical limb ischaemia (CLI) unsuitable for rescue or reconstructive intervention. In this regard, prostanoids have been proposed as a therapeutic alternative, with the aim of increasing blood supply to the limb with occluded arteries through their vasodilatory, antithrombotic, and anti-inflammatory effects...
January 10, 2018: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/29314703/a-retrospective-cost-analysis-of-angioplasty-compared-to-bypass-surgery-for-lower-limb-arterial-disease-in-an-australian-tertiary-health-service
#2
Natalie Ly Ngu, James Lisik, Dinesh Varma, Gerard S Goh
INTRODUCTION: Percutaneous transluminal angioplasty (PTA) and surgical bypass (BYP) are treatment options for symptomatic peripheral arterial disease (PAD). PTA and BYP have different clinical outcomes and cost implications. This paper aims to compare hospital-related costs of PTA and BYP for PAD of the lower limbs in an Australian health service. METHODS: A retrospective cost analysis using clinical and financial data from an urban, tertiary hospital was performed...
January 5, 2018: Journal of Medical Imaging and Radiation Oncology
https://www.readbyqxmd.com/read/29306852/trichosporon-asahii-septic-thrombophlebitis-following-lower-extremity-amputation-in-an-immunocompetent-host
#3
Pradeep Kumar Mada, Folusakin Ayoade, Ailing Li, John Todd
A 59-year-old man with a history of peripheral vascular disease status post femoral popliteal bypass presented with critical limb ischaemia of the left leg. An arterial Doppler ultrasound showed an occluded graft requiring an above knee amputation. Five days after surgery, the patient developed fever, leucocytosis, significant stump swelling and pain, and serosanguinous discharge from his wound. Wound swab cultures from the stump grew Trichosporon asahii A venous Doppler ultrasound revealed extensive thrombosis of the left lower extremity...
January 6, 2018: BMJ Case Reports
https://www.readbyqxmd.com/read/29305093/pilot-assessment-of-the-angiosome-concept-by-intra-operative-fluorescence-angiography-after-tibial-bypass-surgery
#4
Ulrich Rother, Werner Lang, Raymund E Horch, Ingo Ludolph, Alexander Meyer, Olaf Gefeller, Susanne Regus
OBJECTIVES: The "angiosome" concept as a model for decision making in revascularisation of patients with critical limb ischaemia (CLI) has been subject to lively discussion in recent years. The aim of this prospective pilot study was to use intra-operative fluorescence angiography to provide further data on the angiosome concept on the level of microcirculation after tibial bypass surgery. DESIGN, MATERIALS, AND METHODS: This was a prospective analysis of 40 patients presenting with CLI Rutherford stage IV to VI before and after tibial bypass surgery...
January 2, 2018: European Journal of Vascular and Endovascular Surgery
https://www.readbyqxmd.com/read/29297363/critical-illness-and-flat-batteries
#5
REVIEW
Mervyn Singer
An exaggerated, dysregulated host response to insults such as infection (i.e. sepsis), trauma and ischaemia-reperfusion injury can result in multiple organ dysfunction and death. While the focus of research in this area has largely centred on inflammation and immunity, a crucial missing link is the precise identification of mechanisms at the organ level that cause this physiological-biochemical failure. Any hypothesis must reconcile this functional organ failure with minimal signs of cell death, availability of oxygen, and (often) minimal early local inflammatory cell infiltrate...
December 28, 2017: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/29273390/outcomes-of-patients-with-critical-limb-ischaemia-in-the-euclid-trial
#6
Lars Norgren, Manesh R Patel, William R Hiatt, Daniel M Wojdyla, F Gerry R Fowkes, Iris Baumgartner, Kenneth W Mahaffey, Jeffrey S Berger, W Schuyler Jones, Brian G Katona, Peter Held, Juuso I Blomster, Frank W Rockhold, Martin Björck
OBJECTIVES: Critical limb ischaemia (CLI) implies an increased risk of cardiovascular morbidity and mortality, and the optimal antithrombotic treatment is not established. DESIGN, MATERIALS, METHODS: The EUCLID trial investigated the effect of monotherapy with ticagrelor versus clopidogrel in 13,885 patients with peripheral artery disease (PAD); the primary endpoint was cardiovascular death, myocardial infarction, or ischaemic stroke. Patients planned for revascularisation or amputation within 3 months, were excluded...
December 19, 2017: European Journal of Vascular and Endovascular Surgery
https://www.readbyqxmd.com/read/29273182/-peripheral-arterial-disease-treatment
#7
Iléana Desormais, Victor Aboyans, Francis Pesteil, Philipe Lacroix
Medical management of peripheral arterial disease (PAD) patients is aimed at limb symptom relief and reducing systemic major adverse events risk. For the first purpose: exercise therapy is recommended in case of claudication; multidisciplinary evaluation for surgical options is mandatory in case of critical limb ischaemia. Reducing cardiac and stroke risk can be achieved through: statin prescription in most of the cases; antiplatelet agents in symptomatic PAD patients; cardio-vascular risk factors control.
December 19, 2017: La Presse Médicale
https://www.readbyqxmd.com/read/29240065/-secondary-reconstructions-after-endovascular-treatment-of-a-woman-with-critical-lower-limb-ischaemia
#8
A V Gavrilenko, A A Kravchenko, D V Shatalova
Primary endovascular interventions carried out according to the indications determined by the TASC II guidelines have proved successful in treatment of patients presenting with critical lower limb ischaemia. However, performing secondary and complicated reconstructions requires an individual approach with the assessment of all possible risks involved. Presented herein is a clinical case report regarding repeat reconstruction in a woman with critical lower limb ischaemia after a previously performed endovascular intervention...
2017: Angiologii︠a︡ i Sosudistai︠a︡ Khirurgii︠a︡, Angiology and Vascular Surgery
https://www.readbyqxmd.com/read/29237256/microrna-206-protects-against-myocardial-ischaemia-reperfusion-injury-in-rats-by-targeting-gadd45%C3%AE
#9
Changlin Zhai, Qang Qian, Guanmin Tang, Bingjiang Han, Huilin Hu, Dong Yin, Haihua Pan, Song Zhang
MicroRNAs are widely involved in the pathogenesis of cardiovascular diseases through regulating gene expression via translational inhibition or degradation of their target mRNAs. Recent studies have indicated a critical role of microRNA-206 in myocardial ischaemia-reperfusion (I/R) injury. However, the function of miR-206 in myocardial I/R injury is currently unclear. The present study was aimed to identify the specific role of miR-206 in myocardial I/R injury and explore the underlying molecular mechanism...
December 14, 2017: Molecules and Cells
https://www.readbyqxmd.com/read/29225030/a-rare-cause-of-critical-limb-ischaemia-an-aneurysmal-persistent-sciatic-artery
#10
Gabriele Pagliariccio, Luciano Carbonari
No abstract text is available yet for this article.
December 7, 2017: European Journal of Vascular and Endovascular Surgery
https://www.readbyqxmd.com/read/29201156/evidence-based-management-of-raynaud-s-phenomenon
#11
REVIEW
Ariane L Herrick
Raynaud's phenomenon (RP) is relevant to the rheumatologist because it may signify an underlying connective tissue disease and also because it can be very challenging to treat, especially when it has progressed to digital ulceration or critical ischaemia. This review article discusses diagnosis (does this patient have an underlying connective tissue disease?), including the role for nailfold capillaroscopy, and treatment. Management of 'uncomplicated' RP is first described and then treatment of RP complicated by progression to digital ulceration or critical ischaemia, highlighting recent advances (including phosphodiesterase type 5 inhibition, and endothelin 1 receptor antagonism) and the evidence base underpinning these...
December 2017: Therapeutic Advances in Musculoskeletal Disease
https://www.readbyqxmd.com/read/29128300/enteral-versus-parenteral-early-nutrition-in-ventilated-adults-with-shock-a-randomised-controlled-multicentre-open-label-parallel-group-study-nutrirea-2
#12
Jean Reignier, Julie Boisramé-Helms, Laurent Brisard, Jean-Baptiste Lascarrou, Ali Ait Hssain, Nadia Anguel, Laurent Argaud, Karim Asehnoune, Pierre Asfar, Frédéric Bellec, Vlad Botoc, Anne Bretagnol, Hoang-Nam Bui, Emmanuel Canet, Daniel Da Silva, Michael Darmon, Vincent Das, Jérôme Devaquet, Michel Djibre, Frédérique Ganster, Maité Garrouste-Orgeas, Stéphane Gaudry, Olivier Gontier, Claude Guérin, Bertrand Guidet, Christophe Guitton, Jean-Etienne Herbrecht, Jean-Claude Lacherade, Philippe Letocart, Frédéric Martino, Virginie Maxime, Emmanuelle Mercier, Jean-Paul Mira, Saad Nseir, Gael Piton, Jean-Pierre Quenot, Jack Richecoeur, Jean-Philippe Rigaud, René Robert, Nathalie Rolin, Carole Schwebel, Michel Sirodot, François Tinturier, Didier Thévenin, Bruno Giraudeau, Amélie Le Gouge
BACKGROUND: Whether the route of early feeding affects outcomes of patients with severe critical illnesses is controversial. We hypothesised that outcomes were better with early first-line enteral nutrition than with early first-line parenteral nutrition. METHODS: In this randomised, controlled, multicentre, open-label, parallel-group study (NUTRIREA-2 trial) done at 44 French intensive-care units (ICUs), adults (18 years or older) receiving invasive mechanical ventilation and vasopressor support for shock were randomly assigned (1:1) to either parenteral nutrition or enteral nutrition, both targeting normocaloric goals (20-25 kcal/kg per day), within 24 h after intubation...
November 8, 2017: Lancet
https://www.readbyqxmd.com/read/29122678/exosomes-and-cardioprotection-a-critical-analysis
#13
REVIEW
Sean M Davidson, Derek M Yellon
Exosomes are nano-sized vesicles released by numerous cell types that appear to have diverse beneficial effects on the injured heart. Studies using exosomes from stem cells or from the blood have indicated that they are able to protect the heart both in models of acute ischaemia and reperfusion, and during chronic ischaemia. In addition to decreasing initial infarct size, they are able to stimulate angiogenesis, reduce fibrosis and remodelling, alter immune cell function and improve long-term cardiac contractile function...
November 6, 2017: Molecular Aspects of Medicine
https://www.readbyqxmd.com/read/29116654/cardiovascular-and-all-cause-mortality-in-patients-with-intermittent-claudication-and-critical-limb-ischaemia
#14
S T W van Haelst, C Koopman, H M den Ruijter, F L Moll, F L Visseren, I Vaartjes, G J de Borst
BACKGROUND: The aim of this study was to evaluate absolute mortality risks and to determine whether changes in mortality risk occurred in patients with intermittent claudication (IC) or critical limb ischaemia (CLI) in the Netherlands between 1998 and 2010. METHODS: Data for patients treated between 1998 and 2010 were obtained from Dutch nationwide registers: the Hospital Discharge Register, Population Register and Cause of Death Register. The registers were used to obtain information regarding IC and CLI hospitalizations, co-morbidities, demographic factors, and date and cause of death...
November 8, 2017: British Journal of Surgery
https://www.readbyqxmd.com/read/29109739/a-case-of-polyarteritis-nodosa-presenting-as-rapidly-progressing-intermittent-claudication-of-right-leg
#15
Chathuranga Lakmal Fonseka, Sampath Rukshani Galappaththi, Dayakshi Abeyaratne, Nirmali Tissera, Lalith Wijayaratne
Background: Polyarteritis nodosa (PAN) is a medium vessel vasculitis which causes significant morbidity and mortality. Usually, it presents with constitutional symptoms with angiographic evidence of aneurysms or segmental stenosis of arteries of mesenteric or renal vasculature. It is exceedingly uncommon for PAN to present with symptomatic progressive intermittent claudication. Case Presentation: We describe a 60-year-old male who presented with rapidly progressive intermittent claudication of his right leg...
2017: Case Reports in Medicine
https://www.readbyqxmd.com/read/29105269/the-impact-of-coronary-artery-disease-and-left-ventricular-ejection-fraction-on-the-prognosis-of-patients-with-peripheral-artery-disease
#16
Takuya Tsujimura, Osamu Iida, Takayuki Ishihara, Masashi Fujita, Masaharu Masuda, Shin Okamoto, Kiyonori Nanto, Takashi Kanda, Akihiro Sunaga, Mitsuyoshi Takahara, Masaaki Uematsu
The impact of the severity of coronary artery disease (CAD) and left ventricular ejection fraction (LVEF) on the prognosis of patients with peripheral artery disease (PAD) has not been systematically studied. We retrospectively analysed 622 patients with PAD (intermittent claudication (IC): n = 446; critical limb ischaemia (CLI): n = 176). The association of SYNTAX score and LVEF with mortality was analysed using the Cox proportional hazard model. In patients with IC, a high SYNTAX score was significantly associated with mortality, whereas reduced LVEF was significantly associated with mortality in patients with CLI...
November 2017: Internal Medicine Journal
https://www.readbyqxmd.com/read/29065790/surgical-and-endovascular-venous-arterialization-for-treatment-of-critical-limb-ischaemia
#17
Michael Lichtenberg, Michiel A Schreve, Roberto Ferraresi, Daniel A F van den Heuvel, Çagdas Ünlü, Vincent Cabane, Steven Kum
Patients with critical limb ischaemia have a poor life expectancy. Aggressive revascularization is accepted in order to preserve their independence in the final phase of their lives. Bypass surgery and more recently endovascular interventions with angioplasty and stenting have become the treatment of choice to prevent amputation and to resolve pain. However, as many as 20 % of patients with critical limb ischaemia are unsuitable candidates for a vascular intervention because of extensive occlusions of outflow in the crural and pedal vessels...
October 25, 2017: VASA. Zeitschrift Für Gefässkrankheiten
https://www.readbyqxmd.com/read/29064271/effects-of-extracorporeal-cardiopulmonary-resuscitation-on-neurological-and-cardiac-outcome-after-ischaemic-refractory-cardiac-arrest
#18
Francesca Cesana, Leonello Avalli, Laura Garatti, Anna Coppo, Stefano Righetti, Ivan Calchera, Elisabetta Scanziani, Paolo Cozzolino, Cristina Malafronte, Andrea Mauro, Federica Soffici, Endrit Sulmina, Veronica Bozzon, Elena Maggioni, Giuseppe Foti, Felice Achilli
BACKGROUND: Extracorporeal cardiopulmonary resuscitation is increasingly recognised as a rescue therapy for refractory cardiac arrest, nevertheless data are scanty about its effects on neurologic and cardiac outcome. The aim of this study is to compare clinical outcome in patients with cardiac arrest of ischaemic origin (i.e. critical coronary plaque during angiography) and return of spontaneous circulation during conventional cardiopulmonary resuscitation vs refractory cardiac arrest patients needing extracorporeal cardiopulmonary resuscitation...
October 1, 2017: European Heart Journal. Acute Cardiovascular Care
https://www.readbyqxmd.com/read/29060154/long-term-monitoring-of-a-pressure-ulcer-risk-patient-using-thermal-images
#19
Stephanie L Bennett, Rafik Goubran, Frank Knoefel
Patients in an immobile state are susceptible to pressure ulcers, which are localized injuries to the skin and/or underlying tissues due to prolonged pressure. This paper builds upon a body of work examining in-hospital older adult patients at-risk of developing pedal pressure ulcers by examining thermal images of one patient, who was reporting pain in her right foot, over 112 days of a hospital stay. Thermal images of the patient's left and right heels and malleoli were subjected to image processing to remove noise and enhance contrast, region selection and feature extraction to observe changes in temperature over time...
July 2017: Conference Proceedings: Annual International Conference of the IEEE Engineering in Medicine and Biology Society
https://www.readbyqxmd.com/read/29057728/-a-multidisciplinary-approach-in-diabetic-foot-disease-is-mandatory
#20
J G van Baal, W B Aan de Stegge, N C Schaper
The history of two patients (66- and 53-year-old males) with diabetes and peripheral neuropathy illustrates the variety of clinical presentations and pitfalls in treatment of diabetic foot ulcers. Peripheral arterial disease and mechanical stress as a consequence of peripheral neuropathy are important risk factors for developing an ulcer and eventually loss of a limb. Revascularisation of the limb should be considered in the presence of critical limb ischaemia or in the presence of mild to severe ischaemia in combination with a deep infection...
2017: Nederlands Tijdschrift Voor Geneeskunde
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