Статті в журналах: "Ischemia Etiology"

1

Natarajan, Balaji, Prashant Patel, and Ashis Mukherjee. "Acute Lower Limb Ischemia—Etiology, Pathology, and Management." International Journal of Angiology 29, no. 03 (June 27, 2020): 168–74. http://dx.doi.org/10.1055/s-0040-1713769.

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AbstractAcute limb ischemia (ALI) is a vascular emergency associated with a high risk for limb loss and death. Most cases result from in situ thrombosis in patients with preexisting peripheral arterial disease or those who have undergone vascular procedures including stenting and bypass grafts. The other common source is cardioembolic. The incidence has decreased in recent times due to better anticoagulation strategies. Patients with suspected ALI should be evaluated promptly by a vascular specialist and consideration should be given for transfer to a higher level of care if such expertise is not available locally. Initial assessment should focus on staging severity of ischemic injury and potential for limb salvage. Neurological deficits can occur early and are an important poor prognostic sign. Duplex ultrasound and computed tomography angiography help plan intervention in patients with a still-viable limb and prompt catheter-based angiography is mandated in patients with an immediately threatened limb. Further investigations need to be pursued to differentiate embolic from thrombotic cause for acute occlusion as this can change management. Options include intravascular interventions, surgical bypass, or a hybrid approach. In this article, the authors discuss the common etiologies, clinical evaluation, and management of patients presenting with acute limb ischemia.

2

Calugaru, Dan. "Etiology, pathogenesis, and diagnosis of neovascular glaucoma." International Journal of Ophthalmology 15, no. 6 (June 18, 2022): 1005–10. http://dx.doi.org/10.18240/ijo.2022.06.20.

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Neovascular glaucoma is defined as iris and/or anterior chamber angle neovascularization associated with increased intraocular pressure. It is a secondary glaucoma that is most frequently caused by severe retinal ischemia. The most common diseases responsible for the development of neovascular glaucoma are diabetic retinopathy, ischemic central retinal vein occlusion, and ocular ischemic syndrome. Uncommon causes include ocular radiation, ocular tumors, uveitis and other miscellaneous conditions. Vascular endothelial growth factor is an important and likely predominant agent involved in the pathogenesis of intraocular neovascularization and neovascular glaucoma. The evolution of clinical and histopathological changes from predisposing conditions to the occurrence of rubeosis iridis and neovascular glaucoma is divided into four stages: prerubeosis, preglaucoma, open angle glaucoma, and angle-closure glaucoma.

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Charron, Paul, and Jeff Smith. "Mesenteric Venulitis in a 71-Year-Old Man after Acute Appendicitis." American Surgeon 71, no. 7 (July 2005): 574–77. http://dx.doi.org/10.1177/000313480507100707.

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Mesenteric inflammatory veno-occlusive disease (MIVOD) is a clinicopathological entity recently described for a case series of patients with intestinal ischemia of unknown etiology. MIVOD is characterized as a venulitis with lymphocytic, necrotizing, or mixed granulomatous morphology. The disease seems to be self-limiting with resolution of symptoms after surgical resection. We describe a 71-year-old man who developed focal intestinal ischemia in the postoperative period after laparoscopic appendectomy. At re-exploration, a 20-cm segment of grossly ischemic jejunum was identified and resected. The excised specimen demonstrated early ischemic mucosal injury and necrotizing mesenteric venulitis with thrombosis, consistent with verso-occlusive disease. The etiology of this rare vasculitis is currently unknown. We present our case report, which is followed by a review of the literature of MIVOD.

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Gherman, Robert B., Marc H. Incerpi, Deborah A. Wing, and T. Murphy Goodwin. "Ballantyne syndrome: Is placental ischemia the etiology?" Journal of Maternal-Fetal and Neonatal Medicine 7, no. 5 (January 1998): 227–29. http://dx.doi.org/10.3109/14767059809020448.

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Dobrilovic, Nick, Bryan J. Ellis, and Creighton B. Wright. "Vasculitis as an etiology for mesenteric ischemia." American Journal of Gastroenterology 95, no. 9 (September 2000): 2570. http://dx.doi.org/10.1111/j.1572-0241.2000.02907.x.

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Pineles, S. L., M. Y. Chang, E. L. Oltra, M. S. Pihlblad, J. P. Davila-Gonzalez, T. C. Sauer, and F. G. Velez. "Anterior segment ischemia: etiology, assessment, and management." Eye 32, no. 2 (November 17, 2017): 173–78. http://dx.doi.org/10.1038/eye.2017.248.

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Earnshaw, Jonothan J. "Demography and etiology of acute leg ischemia." Seminars in Vascular Surgery 14, no. 2 (June 2001): 86–92. http://dx.doi.org/10.1053/svas.2001.23158.

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Dyck, P. J., H. Yasuda, J. Karnes, A. Lais, P. OʼBrien, and E. J. Service. "ISCHEMIA IN THE ETIOLOGY OF DIABETIC POLYNEUROPATHY." Journal of Neuropathology and Experimental Neurology 44, no. 3 (May 1985): 346. http://dx.doi.org/10.1097/00005072-198505000-00127.

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9

Gherman, Robert B., Marc H. Incerpi, Deborah A. Wing, and T. Murphy Goodwin. "Ballantyne syndrome: Is placental ischemia the etiology?" Journal of Maternal-Fetal Medicine 7, no. 5 (September 1998): 227–29. http://dx.doi.org/10.1002/(sici)1520-6661(199809/10)7:5<227::aid-mfm3>3.0.co;2-i.

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10

Rink, Cameron, and Savita Khanna. "MicroRNA in ischemic stroke etiology and pathology." Physiological Genomics 43, no. 10 (May 2011): 521–28. http://dx.doi.org/10.1152/physiolgenomics.00158.2010.

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Small, noncoding, microRNAs (miRNAs) have emerged as key mediators of posttranscriptional gene silencing in both pathogenic and pathological aspects of ischemic stroke biology. In stroke etiology, miRNA have distinct expression patterns that modulate pathogenic processes including atherosclerosis (miR-21, miR-126), hyperlipidemia (miR-33, miR-125a-5p), hypertension (miR-155), and plaque rupture (miR-222, miR-210). Following focal cerebral ischemia, significant changes in the miRNA transcriptome, independent of an effect on expression of miRNA machinery, implicate miRNA in the pathological cascade of events that include blood brain barrier disruption (miR-15a) and caspase mediated cell death signaling (miR-497). Early activation of miR-200 family members improves neural cell survival via prolyl hydroxylase mRNA silencing and subsequent HIF-1α stabilization. Pro- (miR-125b) and anti-inflammatory (miR-26a, -34a, -145, and let-7b) miRNA may also be manipulated to positively influence stroke outcomes. Recent examples of successfully implemented miRNA-therapeutics direct the future of gene therapy and offer new therapeutic strategies by regulating large sets of genes in related pathways of the ischemic stroke cascade.

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Küçükşahin, Orhan, Aşkın Ateş, Alexis K. Okoh, Emre Kulahcioglu, Murat Turgay, and Gülay Kınıklı. "Treatment Resistant Severe Digital Ischemia Associated with Antiphospholipid Syndrome in a Male Patient with Systemic Sclerosis." Case Reports in Rheumatology 2014 (2014): 1–3. http://dx.doi.org/10.1155/2014/291382.

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We report the case of a male patient with limited cutaneous systemic sclerosis (SSc) that was complicated with severe digital ischemia, resistant to medical treatment. Due to the lack of treatment response, further laboratory and imaging studies were conducted. Findings were compatible with antiphospholipid syndrome and oral warfarin was added to the treatment regimen. After successful anticoagulation no further recurrences of digital ischemia were seen. An underlying etiology in SSc patients with treatment resistant digital ischemic necrosis should be suspected for accompanying antiphospholipid syndrome (APS).

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Pommergaard, Hans-Christian, Michael Patrick Achiam, Jakob Burcharth, and Jacob Rosenberg. "Impaired Blood Supply in the Colonic Anastomosis in Mice Compromises Healing." International Surgery 100, no. 1 (January 1, 2015): 70–76. http://dx.doi.org/10.9738/intsurg-d-13-00191.1.

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Abstract Colon anastomotic leakage has a multifactorial etiology and ischemia is considered one of the most important single factors. However, no existing animal models have established a direct link between ischemia and anastomotic leakage. The aim of this study was to establish a model of colon anastomotic leakage as a result of tissue ischemia. In colon anastomoses of 53 C57BL/6 mice, varying degrees of ischemia were induced. Supplying vessels were divided with bipolar coagulation in order to reduce anastomotic breaking strength and create clinical anastomotic leakage. Breaking strength of all the ischemic anastomoses were significantly lower compared with controls. Increasing ischemia resulted in higher rates of large bowel obstruction without creating anastomotic leakage. Healing was compromised as a result of impaired blood supply. However, clinical leakage was absent. Pure ischemia in otherwise healthy experimental animals may be too simple of an approach to create clinical leakage.

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Bouomrani, Salem, Salem Bouomrani, Oussema Souissi, Mouna Guermazi, Mouna Guermazi, Souad Yahyaoui, and Safa Trabelsi. "An Unexpected Etiology of Myocardial Ischemia in Young." Journal Of Hypertension And Cardiology 2, no. 4 (April 8, 2019): 13–19. http://dx.doi.org/10.14302/issn.2329-9487.jhc-19-2719.

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Introduction The cardiac localization of hydatid cyst (HC) is rare and little known. It is exceptionally primary and isolated. Myocardial ischemia remains an exceptional and unusual manifestation of this localization. We report the original observation of cardiac HC revealed by acute myocardial ischemia in a young subject. Observation A 35-year-old patient with no notable pathological history was admitted to our department via the emergency room for acute anterior chest pain. The somatic examination was without abnormalities as well as the baseline biological tests. The electrocardiogram demonstrated epicardial ischemia in the infero-lateral territory without other abnormalities. The cardiac troponin I was slightly elevated (32ng/l, N<19ng/l). Subsequent controls after 30min, 60min and 180min did not show significant variations. Subsequent investigations (CT, coro-CT, coronary angiography) led to the diagnosis of intramyocardial HC of the left ventricle, with no abnormalities of the coronary arteries. After surgical excision, the evolution was favorable with normalization of the electrocardiogram and the troponin Ic. Conclusion Cardiac localization of this parasitosis is exceptional and characterized by an important clinical polymorphism making its diagnosis a real challenge. It seems useful to discuss the diagnosis of cardiac HC in front of any unexplained electrocardiogram abnormality occurring in endemic zone.

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Wiśniewski, Adam, Karolina Filipska, Joanna Sikora, and Grzegorz Kozera. "Aspirin Resistance Affects Medium-Term Recurrent Vascular Events after Cerebrovascular Incidents: A Three-Year Follow-up Study." Brain Sciences 10, no. 3 (March 19, 2020): 179. http://dx.doi.org/10.3390/brainsci10030179.

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Background: The aim of this prospective, a three-year follow-up study, was to establish the role of high on-treatment platelet reactivity (HTPR) in predicting the recurrence of vascular events in patients after cerebrovascular incidents, particularly in the aspect of stroke etiology. Methods: The study included 101 subjects with non-embolic cerebral ischemia (69 patients with ischemic stroke and 32 patients with transient ischemic attack) treated with 150 mg of acetylsalicylic acid (aspirin) a day. The platelet reactivity was tested in the first 24 h after the onset of cerebral ischemia by impedance aggregometry. Recurrent vascular events, including recurrent ischemic stroke, transient ischemic attack, myocardial infarction, systemic embolism, or sudden death of vascular reason, were assessed 36 months after the onset of cerebral ischemia. Results: Recurrent vascular events occurred between 3 and 9 months after onset in 8.5% of all subjects; in the HTPR subgroup, recurrent vascular events occurred in 17.9%; in the normal on-treatment platelet reactivity (NTPR) subgroup, they occurred in 4.6%. We did not notice early or long-term recurrent events. Aspirin resistant subjects had a significantly higher risk of recurrent vascular events than did aspirin sensitive subjects (Odds ratio (OR) = 4.57, 95% Confidence interval (CI) 1.00–20.64; p = 0.0486). Cox proportional hazard models showed that large-vessel disease (Hazard ratio (HR) 12.04, 95% CI 2.43–59.72; p = 0.0023) and high on-treatment platelet reactivity (HR 4.28, 95% CI 1.02–17.93; p = 0.0465) were independent predictors of recurrent vascular events. Conclusion: Aspirin resistance in the acute phase of cerebral ischemia was associated with a higher risk of recurrent medium-term vascular events, coexisting with large-vessel etiology of stroke. Platelet function-guided personalized antiplatelet treatment should be considered for patients with recurrent strokes, especially when due to large-vessel disease.

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Tjandra, H. "Neonatal Necrotizing Enterocolitis." Paediatrica Indonesiana 18, no. 9-10 (June 13, 2017): 287. http://dx.doi.org/10.14238/pi18.9-10.1978.287-98.

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Neonatal Necrotizing Enterocolitis (NEC) is a highly lethal disease of the newborn infant, which has aroused great interest in the past decades. It is characterized by ischemic necrosis of the intestinal wall, frequently leading to perforation and death. Unlike most neonatal emergencies, it is acquired and can be successfully treated without operation in most cases.The etiology is still obscure and is considered to be multifactorial. Intesti11al ischemia, infections, cow's milk, and hyperosmolar feeding are among the important factors associated with the pathogenesis of NEC in the newborn Many other factors are also related to the occurrence of this disease but some of them are still controversial.The general opinion is that requiring a background of mucosal ischemia and damage; the presence of both intestinal bacteria and enteric feedings appear to be of significant etiologic factors. The important pathologic lesion is the mucosal damage and necrosis involving mostly the ileum and colon exdept the duodenum. Perforations usually occur in the ileocecal region where the intestinal wall is extremely thin.

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Johnston, William E. "Preconditioning the Brain and Heart: Implications for Cardiac Surgery." Seminars in Cardiothoracic and Vascular Anesthesia 4, no. 2 (July 2000): 70–79. http://dx.doi.org/10.1053/vc.2000.6483.

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Despite many recent advances in emboli detection, aortic imaging, myocardial preservation, and perfusion equipment, ischemic injury to the heart and brain remains a serious complications after cardiac surgery. Hypoperfusion (particularly in the heart) and microem boli (particularly in the brain) during cardiopulmonary bypass constitute the etiology of ischemia. Although hypothermia has traditionally been the mainstay for systemic protection from transient ischemia, there has been a general trend to accept warmer heart and core temperatures during bypass, which increases the poten tial for ischemic injury to various organs. This article discusses recent advances in the understanding of myocardial and brain preconditioning and their poten tial role to provide additional protection during cardiac surgery.

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Lendzion, Rebecca J., Gert Frahm-Jensen, and James Keck. "Acute Mesenteric Ischemia." Clinics in Colon and Rectal Surgery 35, no. 03 (May 2022): 227–36. http://dx.doi.org/10.1055/s-0042-1743283.

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AbstractThe surgical treatment of occlusive acute mesenteric ischemia (AMI) without revascularization is associated with an 80% overall mortality. Early diagnosis is crucial, and revascularization may reduce overall mortality in AMI by up to 50%. A diagnosis of AMI requires a high index of clinical suspicion and the collaborative effort of emergency department physicians, general and vascular surgeons, and radiologists. This article provides an overview of the etiology, physiology, evaluation, and management of acute mesenteric ischemia.

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Almeida, Leila Azevedo de, João Carlos Hueb, Marcos Augusto de Moraes Silva, Rodrigo Bazan, Bruna Estrozi, and Cesar N. Raffin. "Cerebral ischemia as initial neurological manifestation of atrial myxoma: case report." Arquivos de Neuro-Psiquiatria 64, no. 3a (September 2006): 660–63. http://dx.doi.org/10.1590/s0004-282x2006000400027.

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Cerebral infarctions of cardiac etiology are observed in around 20% of patients with ischemic stroke. Cerebral ischemia is the first clinical manifestation in 1/3 of cases of atrial myxomas. Although almost half of patients with atrial myxoma show changes at neurological exam, non-hemorrhagic cerebral infarction is seen in computed tomography in practically all cases. We present the case of a 40 year-old woman whose first clinical manifestation of atrial myxoma was an ischemic stroke. We point out to the possibility of silent cerebral infarction in atrial myxoma patients.

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Dee, Simpson L., Khalid Butt, and Gita Ramaswamy. "Intestinal Ischemia." Archives of Pathology & Laboratory Medicine 126, no. 10 (October 1, 2002): 1201–4. http://dx.doi.org/10.5858/2002-126-1201-ii.

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Abstract Context.—As rejection in renal transplantation has become better controlled, gastrointestinal complications have become increasingly important. Ischemic colitis and colonic perforation are the most common of these lesions, contributing to morbidity and mortality in the early postoperative period. Objective.—We undertook this study to identify factors contributing to the risk of intestinal ischemia in patients undergoing renal transplantation and to define circumstances that may affect that risk. Methods.—We studied 356 patients undergoing renal transplantation during a 40-month period. We reviewed medical records, surgical pathology reports, autopsy reports, and pathology slides. Results.—Eleven (3.1%) of the patients developed ischemia of the small or large bowel or both within 20 days after transplantation, and 6 (54.5%) died as a result. Ten of these patients had received cadaveric kidneys and were older than 40 years. There was no sex predilection. The most common segment involved was the terminal ileum and ascending colon. We discuss possible reasons underlying these observations in this article. Conclusion.—The mechanism behind posttransplantation intestinal ischemia is multifactorial, but regardless of etiology, it is important to emphasize the risk of intestinal ischemia in patients who develop abdominal symptoms during the early posttransplantation period, particularly in patients older than 40 years who have received cadaveric kidneys.

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Helwani, Mohammad A., Amit Amin, Paul Lavigne, Srikar Rao, Shari Oesterreich, Eslam Samaha, Jamie C. Brown, and Peter Nagele. "Etiology of Acute Coronary Syndrome after Noncardiac Surgery." Anesthesiology 128, no. 6 (June 1, 2018): 1084–91. http://dx.doi.org/10.1097/aln.0000000000002107.

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Abstract Background The objective of this investigation was to determine the etiology of perioperative acute coronary syndrome with a particular emphasis on thrombosis versus demand ischemia. Methods In this retrospective cohort study, adult patients were identified who underwent coronary angiography for acute coronary syndrome within 30 days of noncardiac surgery at a major tertiary hospital between January 2008 and July 2015. Angiograms were independently reviewed by two interventional cardiologists who were blinded to clinical data and outcomes. Acute coronary syndrome was classified as ST–elevation myocardial infarction, non–ST–elevation myocardial infarction, or unstable angina; myocardial infarctions were adjudicated as type 1 (plaque rupture), type 2 (demand ischemia), or type 4b (stent thrombosis). Results Among 215,077 patients screened, 146 patients were identified who developed acute coronary syndrome: 117 were classified as non–ST–elevation myocardial infarction (80.1%); 21 (14.4%) were classified as ST–elevation myocardial infarction, and 8 (5.5%) were classified as unstable angina. After coronary angiography, most events were adjudicated as demand ischemia (type 2 myocardial infarction, n = 106, 72.6%) compared to acute coronary thrombosis (type 1 myocardial infarction, n = 37, 25.3%) and stent thrombosis (type 4B, n = 3, 2.1%). Absent or only mild, nonobstructive coronary artery disease was found in 39 patients (26.7%). In 14 patients (9.6%), acute coronary syndrome was likely due to stress-induced cardiomyopathy. Aggregate 30-day and 1-yr mortality rates were 7 and 14%, respectively. Conclusions The dominant mechanism of perioperative acute coronary syndrome in our cohort was demand ischemia. A subset of patients had no evidence of obstructive coronary artery disease, but findings were consistent with stress-induced cardiomyopathy.

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Iacobellis, Francesca, Donatella Narese, Daniela Berritto, Antonio Brillantino, Marco Di Serafino, Susanna Guerrini, Roberta Grassi, Mariano Scaglione, Maria Antonietta Mazzei, and Luigia Romano. "Large Bowel Ischemia/Infarction: How to Recognize It and Make Differential Diagnosis? A Review." Diagnostics 11, no. 6 (May 30, 2021): 998. http://dx.doi.org/10.3390/diagnostics11060998.

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Ischemic colitis represents the most frequent form of intestinal ischemia occurring when there is an acute impairment or chronic reduction in the colonic blood supply, resulting in mucosal ulceration, inflammation, hemorrhage and ischemic necrosis of variable severity. The clinical presentation is variable and nonspecific, so it is often misdiagnosed. The most common etiology is hypoperfusion, almost always associated with generalized atherosclerotic disease. The severity ranges from localized and transient ischemia to transmural necrosis of the bowel wall, becoming a surgical emergency, with significant associated morbidity and mortality. The diagnosis is based on clinical, laboratory suspicion and radiological, endoscopic and histopathological findings. Among the radiological tests, enhanced-CT is the diagnostic investigation of choice. It allows us to make the diagnosis in an appropriate clinical setting, and to define the entity of the ischemia. MR may be adopted in the follow-up in patients with iodine allergy or renal dysfunctions, or younger patients who should avoid radiological exposure. In the majority of cases, supportive therapy is the only required treatment. In this article we review the pathophysiology and the imaging findings of ischemic colitis.

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Saileela, R., C. Shanthi, Krishna Manohar, Raghavan Subramanyan, and KM Cherian. "Myocardial ischemia following arterial switch operation: An uncommon etiology." Annals of Pediatric Cardiology 5, no. 2 (2012): 194. http://dx.doi.org/10.4103/0974-2069.99626.

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Castro, Victor J., Cesar Larrauri, and Alfonso Bryce. "Transient ischemia as a possible etiology for ventricular dysfunction." Journal of the American College of Cardiology 39, no. 1 (January 2002): 181. http://dx.doi.org/10.1016/s0735-1097(01)01690-4.

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Trompeter, Markus, Thurid Brazda, Christopher T. Remy, Thomas Vestring, and Peter Reimer. "Non-occlusive mesenteric ischemia: etiology, diagnosis, and interventional therapy." European Radiology 12, no. 5 (December 21, 2001): 1179–87. http://dx.doi.org/10.1007/s00330-001-1220-2.

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Grau, Armin J., Martin Eicke, Christoph Burmeister, Roland Hardt, Eberhard Schmitt, and Sieghard Dienlin. "Risk of Ischemic Stroke and Transient Ischemic Attack Is Increased up to 90 Days after Non-Carotid and Non-Cardiac Surgery." Cerebrovascular Diseases 43, no. 5-6 (2017): 242–49. http://dx.doi.org/10.1159/000460827.

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Background: The risk of stroke after cardiac and carotid surgery is well established. In contrast, stroke risk in association with non-cardiac and non-carotid surgery and its time course are insufficiently known. We investigated the prevalence of recent and planned surgery among patients with stroke and transient ischemic attack (TIA), time dependency of stroke risk, stroke etiology, and interruption of antithrombotic medication in association with surgery. Methods: Data on type and date of surgery and similar interventions within the last year or planned for the next 2 weeks were anonymously collected together with demographic data, vascular risk factors, stroke severity, handicap before stroke and stroke etiology within a state-wide, mandatory, hospital-based acute stroke care quality monitoring project (Rhineland-Palatinate, Germany) for 1 year (2010). Results: Non-carotid and non-cardiothoracic surgery was reported as performed within 1 year before the index event or as planned for the next 2 weeks thereafter in 532 out of 12,120 patients with ischemic stroke/TIA (4.4%). Compared to 91-365 days before stroke/TIA as reference period, risk of cerebral ischemia (per day analysis) was increased for surgery within 61-90 days before ischemia (rate ratio 2.0, 95% CI 1.5-2.8) and continuously increased along shorter intervals between stroke and surgery (31-60 days: rate ratio 3.6, 95% CI 2.9-4.5; 15-30 days: rate ratio 8.2, 95% CI 6.7-10.1; 8-14 days: rate ratio 13.2, 95% CI 10.3-16.8; 4-7 days: rate ratio 16.5, 95% CI 12.2-22.1) peaking at an interval of 1-3 days before ischemia (rate ratio 34.0, 95% CI 26.9-42.8). On the day of surgery, rate ratio was 14.8 (95% CI 7.8-27.9) and for planned surgery it was 2.7 (95% CI 1.8-4.0). Results were similar for first-ever and for recurrent ischemic stroke. Perioperative stroke/TIA was positively associated with atrial fibrillation and cardioembolic stroke etiology, higher mortality, more severe neurological deficits at discharge, and longer hospital stay; and it was inversely associated with microangiopathic etiology and discharge at home. In 34.5% of patients with recent/planned surgery, prior antithrombotic or anticoagulant medication had been interrupted. Conclusions: Recent or planned surgery imposes a considerable short-term stroke risk particularly by cardioembolism with cessation of medication as an important contributor. Stroke after surgery is associated with poor outcome and high mortality. Better strategies to reduce the burden of perioperative stroke are urgently required.

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O'Leary, Michael P., Angela L. Neville, Jessica A. Keeley, Dennis Y. Kim, Christian De Virgilio, and David S. Plurad. "Predictors of Ischemic Bowel in Patients with Small Bowel Obstruction." American Surgeon 82, no. 10 (October 2016): 992–94. http://dx.doi.org/10.1177/000313481608201030.

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Preoperative diagnosis of ischemic bowel in patients with small bowel obstruction (SBO) is a clinical challenge. The aim of this study was to identify preoperative variables associated with ischemic bowel found at operative exploration. We performed a 5-year retrospective review of patients admitted to a university affiliated, county funded hospital who underwent exploratory laparoscopy or laparotomy for SBO. Patients were excluded if they had a known preoperative malignancy or hernia on physical examination. Multivariate logistic regression was used to determine factors independently associated with bowel ischemia or ischemic perforation. One hundred and sixteen patients underwent exploratory surgery for SBO. Mean age was 52 ± 14 years and most were male [64 (55.2%)]. Adhesions [92 (79.3%)] were the most common etiology of obstruction. Leukocytosis ( P = 0.304) and acidosis ( P = 0.151) were not significantly associated with ischemia or ischemic perforation. In addition, history of prior SBO ( P = 0.618), tachycardia ( P = 0.111), fever ( P = 0.859), and time from admission to operation ( P = 0.383) were not predictive of ischemic bowel. However, hyponatremia (≤134 mmol/L) and CT scan findings of wall thickening or a suspected closed loop were independently associated with bowel ischemia. Awareness of these predictors should heighten the concern for ischemic bowel in patients presenting with SBO.

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Finkelstone, Lee, Ellen Wolf, and Marjorie W. Stein. "Etiology of Small Bowel Thickening on Computed Tomography." Canadian Journal of Gastroenterology 26, no. 12 (2012): 897–901. http://dx.doi.org/10.1155/2012/282603.

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BACKGROUND: Abdominal pain is often evaluated using imaging, most often with computed tomography (CT). While CT is sensitive and specific for certain diagnoses, small bowel thickening is a nonspecific finding on CT with a broad differential diagnosis including infection, inflammation, ischemia and neoplasm.METHOD: A review of medical records of patients who underwent CT scans of the abdomen and pelvis over a one-year period and exhibited small bowel thickening were retrospectively evaluated to determine the final diagnosis.RESULTS: The etiologies of small bowel thickening on CT were as follows: infection (113 of 446 [25.34%]); reactive inflammation (69 of 446 [15.47%]); primary inflammation (62 of 446 [13.90%]); small bowel obstruction (38 of 446 [8.52%]); iatrogenic (33 of 446 [7.40%]); neoplastic (32 of 446 [7.17%]); ascites (30 of 446 [6.73%]); unknown (28 of 446 [6.28%]); ischemic (24 of 446 [5.38%]); and miscellaneous (17 of 446 [3.81%]).CONCLUSION: Infectious and inflammatory (primary or reactive) conditions were the most common cause of small bowel thickening in the present series; these data can be used to formulate a more specific differential diagnosis.

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Betül Gunduz, Zahide, and Aysun Ozsahin. "Acute ischemic stroke in young adult: Atrial fibrillation, hyperthyroidism, and COVID-19 collaboration." SAGE Open Medical Case Reports 9 (January 2021): 2050313X2110486. http://dx.doi.org/10.1177/2050313x211048632.

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Atrial fibrillation is a frequently detected cardiac arrhythmia in the etiology of ischemic stroke. The incidence of atrial fibrillation and the risk of it causing ischemic stroke increase significantly with age; it is rare in young people. It is known that the risk of developing atrial fibrillation is high when there is a background of hyperthyroidism. COVID-19 is thought to cause thromboembolic events, cardiac pathologies, and endocrine disorders. A 54-year-old presented with right-sided hemiplegia and motor aphasia of 1.5 h duration. On evaluation, he tested positive for SARS-CoV-2 imaging was suggestive of acute pons ischemia and found to have hyperthyroidism and atrial fibrillation. It is clear that atrial fibrillation, which is highly unlikely to cause ischemic stroke in young adults, may develop due to hyperthyroidism. COVID-19 has been suggested as a cause of atrial fibrillation and hyperthyroidism. It is also thought to be involved in the etiology of stroke by causing hypercoagulation or triggering vasoconstriction through the renin–angiotensin system.

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Schweizer, Sophie, Andreas Meisel, and Stefanie Märschenz. "Epigenetic Mechanisms in Cerebral Ischemia." Journal of Cerebral Blood Flow & Metabolism 33, no. 9 (June 12, 2013): 1335–46. http://dx.doi.org/10.1038/jcbfm.2013.93.

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Treatment efficacy for ischemic stroke represents a major challenge. Despite fundamental advances in the understanding of stroke etiology, therapeutic options to improve functional recovery remain limited. However, growing knowledge in the field of epigenetics has dramatically changed our understanding of gene regulation in the last few decades. According to the knowledge gained from animal models, the manipulation of epigenetic players emerges as a highly promising possibility to target diverse neurologic pathologies, including ischemia. By altering transcriptional regulation, epigenetic modifiers can exert influence on all known pathways involved in the complex course of ischemic disease development. Beneficial transcriptional effects range from attenuation of cell death, suppression of inflammatory processes, and enhanced blood flow, to the stimulation of repair mechanisms and increased plasticity. Most striking are the results obtained from pharmacological inhibition of histone deacetylation in animal models of stroke. Multiple studies suggest high remedial qualities even upon late administration of histone deacetylase inhibitors (HDACi). In this review, the role of epigenetic mechanisms, including histone modifications as well as DNA methylation, is discussed in the context of known ischemic pathways of damage, protection, and regeneration.

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Shreshtha, Suruchi, Ashu K. Sekhose, and Sujitha S. "Acute mesenteric ischemia with tuberculous mesenteric lymphadenitis in a young female." International Surgery Journal 4, no. 5 (April 22, 2017): 1809. http://dx.doi.org/10.18203/2349-2902.isj20171646.

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We present the case of an 18 year old female with tuberculous mesenteric lymphadenopathy who came to hospital with peritonitis and acute mesenteric ischemia. An emergency exploratory laparotomy with resection of gangrenous small bowel and right colon with end-to-end anastomosis was performed. Subsequent evaluation for etiology of bowel gangrene was essentially normal. By exclusion, the most likely cause of acute mesenteric ischemia in this patient was of unknown etiology which is indeed rare. However, tuberculosis as a cause of mesenteric vasculitis and bowel gangrene needs to be explored.

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Kurtz, Brian, Abdalhai Alshoubi, Katrina Nguyen, and Eric Gehres. "Methamphetamine-Induced Bowel Ischemia in a 50-Year-Old Male." Case Reports in Critical Care 2022 (April 5, 2022): 1–4. http://dx.doi.org/10.1155/2022/9690034.

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Methamphetamine intoxication is a known risk factor for nonocclusive mesenteric ischemia (NOMI). We describe a case of a 50-year-old male with a history of polysubstance abuse who presented to the Emergency Department with severe abdominal pain and coffee-ground emesis. Computed tomographic (CT) imaging demonstrated portal venous gas and diffuse colonic wall thickening concerning for ischemic colitis. The patient underwent exploratory laparotomy with resection of the ascending colon as well as a necrotic section of the jejunum. Further embolic workup was negative with a subjective history of amphetamine use prior to presentation. NOMI has a high fatality rate, and we recommend providers include drug-induced bowel infarction on their differential when presented with findings of ischemic bowel of unclear etiology.

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Witte, Otto W., Hans-J. Bidmon, Klaus Schiene, Christoph Redecker, and Georg Hagemann. "Functional Differentiation of Multiple Perilesional Zones after Focal Cerebral Ischemia." Journal of Cerebral Blood Flow & Metabolism 20, no. 8 (August 2000): 1149–65. http://dx.doi.org/10.1097/00004647-200008000-00001.

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Transient and permanent focal cerebral ischemia results in a series of typical pathophysiologic events. These consequences evolve in time and space and are not limited to the lesion itself, but they can be observed in perilesional (penumbra) and widespread ipsi- and sometimes contralateral remote areas (diaschisis). The extent of these areas is variable depending on factors such as the type of ischemia, the model, and the functional modality investigated. This review describes some typical alterations attributable to focal cerebral ischemia using the following classification scheme to separate different lesioned and perilesional areas: (1) The lesion core is the brain area with irreversible ischemic damage. (2) The penumbra is a brain region that suffers from ischemia, but in which the ischemic damage is potentially, or at least partially, reversible. (3) Remote brain areas are brain areas that are not directly affected by ischemia. With respect to the etiology, several broad categories of remote changes may be differentiated: (3a) remote changes caused by brain edema; (3b) remote changes caused by waves of spreading depression; (3c) remote changes in projection areas; and (3d) remote changes because of reactive plasticity and systemic effects. The various perilesional areas are not necessarily homogeneous; but a broad differentiation of separate topographic perilesional areas according to their functional state and sequelae allows segregation into several signaling cascades, and may help to understand the functional consequences and adaptive processes after focal brain ischemia.

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Ernandes Neto, Miguel, Lucas de Moraes Soler, Halita Vieira Gallindo Vasconcelos, Daniela Cristina dos Santos, Rosa Marlene Viero, and Luis Gustavo Modelli de Andrade. "Histopathological features of thrombotic microangiopathies in renal biopsies." Journal of Nephropathology 8, no. 3 (July 12, 2019): 27. http://dx.doi.org/10.15171/jnp.2019.27.

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Background: Thrombotic microangiopathy (TMA) is a morphologic lesion characterized by thrombi occluding microvasculature related to endothelial injury. Objectives: This study aimed to assess the association between histopathological findings and etiology of TMA. Patients and Methods: This cross-sectional study comprised a sample of 34 patients who underwent renal biopsy and received an initial TMA diagnoses resulting in 29 definitive TMA cases. We evaluated the TMA features and clinical histopathological correlation. Results: The most frequent etiologies were atypical hemolytic uremic syndrome (aHUS) (n= 10; 34.5%), hemolytic uremic syndrome caused by Shiga toxin-producing Escherichia coli (STECHUS) (n=6; 24.1%) and secondary causes of TMA (n= 12; 41.4%). We found the following histological features; patients with aHUS had thrombi in 60% of biopsies, membranoproliferative glomerulonephritis (MPGN)-like pattern in 20% and ischemia in 20%; patients with STEC-HUS had thrombi (14.3%), MPGN-like pattern (14.3%), endothelial swelling (14.3%) and ischemia (57.1%); patients with secondary etiologies had thrombi (58.3%), endothelial swelling (16.7%), ischemia (16.7%) and MPGN-like pattern (8.3%). Conclusions: The distribution of classic TMA findings was not related to etiology in spite of microthrombi having been found mostly in aHUS and secondary etiologies, whereas ischemia was found mainly in STEC-HUS. We did not find a histopathological pattern to each etiology of TMA.

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O’Keefe, Elizabeth, Katherine E. Schwetye, John Nazarian, Richard Perrin, Robert E. Schmidt, and Robert Bucelli. "A 66-Year-Old Woman with a Progressive, Longitudinally Extensive, Tract Specific, Myelopathy." Case Reports in Neurological Medicine 2016 (2016): 1–9. http://dx.doi.org/10.1155/2016/4125294.

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A 66-year-old woman presented with progressive lancinating pain and sensory deficits attributable to a myelopathy of unclear etiology. Spinal cord magnetic resonance imaging showed a longitudinally extensive T2-hyperintense lesion of the dorsal columns. Comprehensive serum, urine, and cerebrospinal fluid analyses failed to identify an etiology. Empiric intravenous methylprednisolone and intravenous immunoglobulin were of no benefit and serial screens for an occult malignancy were negative. She developed dysesthesias and allodynia affecting her entire body and lost the use of her arms and legs due to severe sensory ataxia that was steadily progressive from onset. She opted against additional aggressive medical management of her condition and passed away on hospice eleven months after symptom onset. Autopsy revealed findings most consistent with polyphasic spinal cord ischemia affecting the dorsal and lateral white matter tracts and, to a lesser extent, adjacent gray matter. The underlying etiology for the progressive vasculopathy remains unknown. Spinal cord ischemia affecting the posterior spinal cord is rare and to our knowledge this case represents the only instance of a progressive spinal cord tractopathy attributable to chronic spinal cord ischemia.

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Fayzieva, Munis Dilshod qizi, and Durdona Djurabaevna Usmanova. "FEATURES OF COGNITIVE IMPAIRMENT DEPENDING ON THE STAGE OF CHRONIC CEREBRAL ISCHEMIA." UZBEK MEDICAL JOURNAL 2, no. 1 (January 30, 2021): 56–61. http://dx.doi.org/10.26739/2181-0664-2021-1-10.

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The article presents the results of the analysis of literature sources on chronic cerebral ischemia, etiology and pathogenetic mechanisms of the development of cognitive impairment. In the pathogenesis of chronic cerebral ischemia, systemic and local factors are important, leading to disorders of cerebral hemodynamics, the most adverse effect is exerted by their combination. The most common cause of local disorders of cerebral blood flow is atherosclerotic stenosis and occlusion of intracerebral and extracranial vesselsthat perform transport and distribution functions.Keywords: chronic cerebral ischemia, cognitive disorders, neurological disorders

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Majumder, Sabbiha Nadia, Abdul Kader Sheikh, Mehjabeen Jahangir, and Romana Chowdhury. "Moyamoya Disease Presenting as Ischemic Stroke Following Heamorrhagic Strokein a 46-year-old Man: A Case Report." Bangladesh Medical Journal 48, no. 1 (October 23, 2019): 54–58. http://dx.doi.org/10.3329/bmj.v48i1.50193.

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Moyamoya is a rare cerebrovascular disease of unknown etiology. It can affect both children and adults. Ischemic symptoms are common in younger age while adults presents with intracranial hemorrhage. Cerebral ischemia after hemorrhage within a narrow time frame or simultaneous presentation with both hemorrhage and ischemia in the same clinical setting is a rare encounter. Diagnosis is confirmed by doing cerebral angiogram. Here, we report a case of 46-year-old man who presented with hemiparesis and imaging of brain showed ishaemic stroke initially and subsequently he also developed haemorrhagic stroke. Later, magnetic resonance imaging and digital substraction angiogram of brain confirmed Moyamoya disease. He was managed conservatively with significant improvement of his hemiparesis. Bangladesh Med J. 2019 Jan; 48 (1): 54-58

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Rangel Guerra, R., and J. Montemayor-Montoya. "PO02-MO-10 Essential thrombocytosis as etiology of cerebral ischemia." Journal of the Neurological Sciences 285 (October 2009): S165. http://dx.doi.org/10.1016/s0022-510x(09)70631-8.

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Roy, Sashwati, Sabyasachi Biswas, Savita Khanna, Gayle Gordillo, Valerie Bergdall, Jeanne Green, Clay B. Marsh, Lisa J. Gould, and Chandan K. Sen. "Characterization of a preclinical model of chronic ischemic wound." Physiological Genomics 37, no. 3 (May 2009): 211–24. http://dx.doi.org/10.1152/physiolgenomics.90362.2008.

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Chronic ischemic wounds presenting at wound clinics are heterogeneous with respect to etiology, age of the wound, and other factors complicating wound healing. In addition, there are ethical challenges associated with collecting repeated biopsies from a patient to develop an understanding of the temporal dynamics of the mechanisms underlying chronic wounds. The need for a preclinical model of ischemic wound is therefore compelling. The porcine model is widely accepted as an excellent preclinical model for human wounds. A full-thickness bipedicle flap approach was adopted to cause skin ischemia. Closure of excisional wounds placed on ischemic tissue was severely impaired resulting in chronic wounds. Histologically, ischemic wounds suffered from impaired re-epithelialization, delayed macrophage recruitment and poorer endothelial cell abundance and organization. Compared with the pair-matched nonischemic wound, unique aspects of the ischemic wound biology were examined on days 3, 7, 14, and 28 by systematic screening of the wound tissue transcriptome using high-density porcine GeneChips. Ischemia markedly potentiated the expression of arginase-1, a cytosolic enzyme that metabolizes the precursor of nitric oxide l-arginine. Ischemia also induced the SOD2 in the wound tissue perhaps as survival response of the challenged tissue. Human chronic wounds also demonstrated elevated expression of SOD2 and arginase-1. This study provides a thorough database that may serve as a valuable reference tool to develop novel hypotheses aiming to elucidate the biology of ischemic chronic wounds in a preclinical setting.

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Cao, Cathy, Ashley Martinelli, Brian Spoelhof, Rafael H. Llinas, and Elisabeth B. Marsh. "In Potential Stroke Patients on Warfarin, the International Normalized Ratio Predicts Ischemia." Cerebrovascular Diseases Extra 7, no. 2 (August 11, 2017): 111–19. http://dx.doi.org/10.1159/000478793.

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Background: Stroke can occur in patients on warfarin despite anticoagulation. Patients with a low international normalized ratio (INR) should theoretically be at greater risk for ischemia than those who are therapeutic. Therefore, INR may be able to indicate whether new neurological deficits are more likely strokes or stroke mimics in patients on warfarin. This study evaluates the association and predictive value of INR in determining the likelihood of ischemia. Methods: Patients were identified using the acute stroke registry at a Primary Stroke Center from January 2013 through December 2014. All adult patients undergoing evaluation for acute stroke with prior documented use of warfarin and an INR level at presentation were included. Data were collected regarding patient demographics, medical comorbidities, stroke severity, reason for anticoagulation, and laboratory studies including INR. Student t tests and χ2 analysis were used to evaluate factors associated with increased likelihood of ischemia (stroke or transient ischemic attack) versus mimic. Significant results were entered into a multivariable regression analysis. Sensitivity and specificity analyses were conducted to determine the predictive value of INR for ischemic risk. Results: 116 patients were included; 46 were diagnosed with ischemia, 70 were diagnosed as mimics. 75% of patients were on warfarin for atrial fibrillation versus 25% for venous thrombosis. A statistically significant difference in mean INR for patients with ischemia (n = 46) versus mimics (n = 70) was observed (1.7 vs. 2.8; p < 0.001). In multivariable analysis, both sub-therapeutic INR (p < 0.001) and atrial fibrillation (p = 0.014) were predictors of ischemia. In patients with an INR ≥2, the predictive value of having a non-ischemic etiology was 79%. No patient with an INR of ≥3.6 was found to have ischemia. Conclusions: Sub-therapeutic INR and atrial fibrillation are strongly associated with ischemia in patients on warfarin presenting with acute neurologic symptoms. Ischemia is far less likely in patients with an INR of ≥2 and rare in those with an INR ≥3.6. This study shows that the INR value of a patient on warfarin can help stratify patients’ risk for acute ischemic stroke and guide further neurologic imaging and workup.

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Gurung, Anu, Ramesh Raj Bist, Sagar Rajkarnikar, and Ram Shrestha. "Causes of Isolated Oculomotor Nerve Palsy in Patients Presenting to Eye Outpatient Department at Shree Birendra Hospital." Medical Journal of Shree Birendra Hospital 11, no. 1 (March 13, 2013): 21–23. http://dx.doi.org/10.3126/mjsbh.v11i1.7762.

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Introduction: Although oculomotor nerve palsy is associated with signifycant morbidity. The etiology of oculomotor nerve palsy are ischemic, trauma, aneurysm, tumors, inflammatory, idiopathic etc. The present study was performed to determine the etiology of isolated oculomotor nerve palsy in our population. Methods: The hospital data of patients of isolated oculomotor nerve palsy cases reported to the eye department of Shree Birendra Hospital from March 2009 to March 2011 were collected and retrospectively analyzed for the etiology of the disease. The detail history (ocular and medical), examination and investigations were collected from patient’s case records. All patients had been evaluated for hypertension and diabetes mellitus. Neuroimaging, MRI had been performed in all cases. The etiology of isolated oculomotor nerve palsy was classified into ischemia, idiopathic, trauma, aneurysm and neoplastic. Results: During the study period there were 16 eyes of 16 patients who were suffering from isolated oculomotor nerve palsy. The commonest cause was found to be ischemic in 7 patients (43.75%) followed by idiopathic in 5 patients (31.25%). Pupil was involved in 3 patients (18.75%). MRI was carried out in all 16 patients, but revealed positive only in two cases (one intracranial aneurysm and other Non Hodgkin’s Lymphoma). Remaining 14 MRI were normal. Conclusions: Oculomotor nerve palsy is an uncommon disease and commonest cause was ischemic followed by idiopathic. The cause should be ruled out as the treatment depends on the cause. Medical Journal of Shree Birendra Hospital; Jan-June 2012/vol.11/Issue1/21-23 DOI: http://dx.doi.org/10.3126/mjsbh.v11i1.7762

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Shavkuta, G. V. "Chronic mesenteric ischemia." South Russian Journal of Therapeutic Practice 3, no. 3 (October 4, 2022): 108–15. http://dx.doi.org/10.21886/2712-8156-2022-3-3-108-115.

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Federation Despite the increased interest of the scientific community in diseases associated with atherosclerosis, the widespread use and availability in clinical practice of diagnostic research methods (Doppler ultrasound, CT, MRI), allowing to visualize the vessels of the abdominal cavity, chronic mesenteric ischemia remains an underestimated, undiagnosed and insufficiently studied disease, mainly due to the lack of knowledge and awareness among doctors, which leads to delays in diagnosis and delayed treatment of patients, which significantly increases the risk of death. Currently, new recommendations for clinical, physical, laboratory and instrumental diagnostics of chronic mesenteric ischemia have been developed and are being implemented. These documents should help primary care physicians in early detection of this disease, optimization of treatment and reduction of mortality from this pathology. The lecture highlights the issues of etiology, pathogenesis, classification, clinical course, laboratory and instrumental diagnostics, as well as the possibilities of conservative and surgical treatment of chronic mesenteric ischemia.

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Stewart, David, and Kenneth Waxman. "Marathon Pancreatitis: Is the Etiology Repetitive Trauma?" American Surgeon 70, no. 6 (June 2004): 561–63. http://dx.doi.org/10.1177/000313480407000622.

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Abdominal pain frequently occurs after long-distance running. The cause of the pain may be due to dehydration, diaphragmatic ischemia, muscular spasm, or myonecrosis. However, data regarding the frequency of these purported causes are currently lacking. Pancreatitis can also occur after long-distance running, but few cases have been reported, and the etiology is controversial. We report a case of pancreatitis in a thin, muscular marathon runner. We suggest the etiology in this case may be traumatic as the pancreas may have suffered repetitive injury against the posterior abdominal wall and spine.

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Andreeva, Kalina, Meixia Zhang, Wei Fan, Xiaohong Li, Yinlu Chen, Jovan D. Rebolledo-Mendez, and Nigel G. Cooper. "Time-Dependent Gene Profiling Indicates the Presence of Different Phases for Ischemia/Reperfusion Injury in Retina." Ophthalmology and Eye Diseases 6 (January 2014): OED.S17671. http://dx.doi.org/10.4137/oed.s17671.

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Ischemia/reperfusion (IR) injury has been associated with several retinal pathologies, and a few genes/gene products have been linked to IR injury. However, the big picture of temporal changes, regarding the affected gene networks, pathways, and processes remains to be determined. The purpose of the present study was to investigate initial, intermediate, and later stages to characterize the etiology of IR injury in terms of the pathways affected over time. Analyses indicated that at the initial stage, 0-hour reperfusion following the ischemic period, the ischemia-associated genes were related to changes in metabolism. In contrast, at the 24-hour time point, the signature events in reperfusion injury include enhanced inflammatory and immune responses as well as cell death indicating that this would be a critical period for the development of any interventional therapeutic strategies. Genes in the signal transduction pathways, particularly transmitter receptors, are downregulated at this time. Activation of the complement system pathway clearly plays an important role in the later stages of reperfusion injury. Together, these results demonstrate that the etiology of injury related to IR is characterized by the appearance of specific patterns of gene expression at any given time point during retinal IR injury. These results indicate that evaluation of treatment strategies with respect to time is very critical.

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Henson, John W., Tara Benkers, and Connor McCormick. "Brainstem ischemic syndrome in juvenile NF2." Neurology Genetics 6, no. 4 (June 16, 2020): e446. http://dx.doi.org/10.1212/nxg.0000000000000446.

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ObjectiveA new case of brainstem ischemic necrosis in a young woman with de novo neurofibromatosis type 2 (NF2) is reported, and given notable similarities to 7 prior cases of brainstem stroke in the literature, features defining a possible syndrome were sought.MethodsCase review including detailed clinical assessment, neuroimaging analysis, genetic testing, and brain biopsy, followed by a multicase analysis.ResultsBrainstem ischemia in juvenile NF2 typically occurs in teenagers without previously known NF2 as an acute, monophasic presentation with restricted diffusion in the midbrain or pons following a recent hypoperfusion event, normal vascular imaging, obvious intracranial imaging features of NF2, typical inactivating NF2 alterations, biopsy showing necrosis without small vessel pathology, and subsequent aggressive NF2 lesion progression.ConclusionsBrainstem ischemia in juvenile NF2 is a rare syndrome of unclear etiology, possibly reflecting an unknown underlying vascular abnormality; a digenic effect is not excluded.

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Wallace, Alex, Yash Pershad, Aman Saini, Sadeer Alzubaidi, Sailendra Naidu, Grace Knuttinen, and Rahmi Oklu. "Computed tomography angiography evaluation of acute limb ischemia." Vasa 48, no. 1 (January 1, 2019): 57–64. http://dx.doi.org/10.1024/0301-1526/a000759.

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Abstract. Acute limb ischemia (ALI), a subclass of critical limb ischemia, is a medical emergency. The cause of ALI is usually thrombotic or embolic in nature, and the specific etiology often dictates the appropriate therapy. While the diagnosis is a clinical with common presenting symptoms, advances in ultrasound, computed tomography, and magnetic resonance technology have impacted the diagnosis and subsequent therapy. In ALI, the time to revascularization is critical and computed tomography angiography (CTA) provides a highly sensitive and specific technique for rapidly identifying occlusions and precisely defining vascular anatomy prior to interventions. In patients with significant renal disease, magnetic resonance angiography with or without contrast provides effective alternatives at the expense of imaging time. Treatment can include a variety of endovascular or surgical interventions, including thromboembolectomy, angioplasty, or bypass. Proper evaluation of the etiology of the ischemia, affected vasculature, and medical history is critical to select appropriate treatment and improve patient outcomes. Here, we examine the presentation, evaluation, and treatment of ALI and the role of CTA in diagnosis and therapy.

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GOVAERT, PAUL, PIET VANHAESEBROUCK, CLAUDINE DE PRAETER, URLIEN FRÄNKEL, and JULES LEROY. "Moebius Sequence and Prenatal Brainstem Ischemia." Pediatrics 84, no. 3 (September 1, 1989): 570–73. http://dx.doi.org/10.1542/peds.84.3.570.

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Congenital nonprogressive (bilateral) facial palsy and external ophthalmoplegia are essential clinical features for the diagnosis of Moebius syndrome. One century after its initial thorough description, the precise delineation and pathogenesis of the syndrome still remain obscure. Heuristic hypotheses concerning the latter have been put forward. Three major theories of etiology remain valid: primary brainstem nuclear hypoplasia, secondary brainstem nuclear degeneration, and brainstem atrophy secondary to muscular defect. None of these theories easily explains why, apart from cranial nerve dysfunction, the Moebius syndrome is frequently a part of oral-limb deficiency anomaly syndromes.

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Girvan, RJ, PA Stone, and JJ McGarry. "Acute dysvascular limb in a young adult. A case study." Journal of the American Podiatric Medical Association 84, no. 12 (December 1, 1994): 591–97. http://dx.doi.org/10.7547/87507315-84-12-591.

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Acute dysvascular limb in young adults is a rare entity. Diagnosis is often difficult because symptoms are not recognized as ischemic. The most common causes of this condition are premature atherosclerosis, thromboangiitis obliterans, microemboli, popliteal entrapment syndrome, collagen vascular disease, Takaysu's arteritis, and coagulopathy. A case study is presented to illustrate the disease process. A systematic approach to diagnosis, consisting of history and physical examination, palpation and auscultation of peripheral pulses at rest and following exercise, and noninvasive vascular examination at rest and following exercise, is recommended. Suggestion of an ischemic condition following noninvasive studies should be followed up with an arteriogram. The prognosis is dependent on the underlying etiology of the ischemia, early detection, and appropriate treatment.

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Khalifah, MosaadAbdaljawwad. "Risk Factors, Etiology and Treatment Modalities for Localized Alveolar Ischemia (The So-called Alveolar Osteitis): A Comprehensive Critical." Annals of Oral Health and Dental Research 2, no. 1 (January 17, 2018): R7–14. http://dx.doi.org/10.21276/aohdr.1917.

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Schiopu, Elena, Ann J. Impens, and Kristine Phillips. "Digital Ischemia in Scleroderma Spectrum of Diseases." International Journal of Rheumatology 2010 (2010): 1–8. http://dx.doi.org/10.1155/2010/923743.

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Systemic Sclerosis (Scleroderma, SSc) is a disease of unknown etiology characterized by widespread vasculopathy and extracellular matrix deposition leading to fibrosis and autoimmune processes. Digital ischemia (digital ulcers (DUs)) is the hallmark of SSc-related vasculopathy and is characterized by endothelial dysfunction leading to intimal proliferation and thrombosis. It happens frequently (30% of the patients each year) and it is associated with significant morbidity. This paper summarizes the current information regarding pathogenesis, definitions, management, and exploratory therapies in DUs associated with SSc.

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Makó, Katalin, Corina Ureche, and Emőke Horváth. "Large-vessel Giant Cell Arteritis: A Rare Cause of Acute Upper Limb Ischemia – Case Presentation and Review of the Literature." Journal Of Cardiovascular Emergencies 5, no. 4 (December 1, 2019): 148–53. http://dx.doi.org/10.2478/jce-2019-0017.

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Abstract Introduction: Acute upper extremity ischemia is an uncommon vascular emergency due to a relatively rich collateral network and low workload of the upper limb. Its consequences depend on the site and etiology of the arterial occlusion. Case presentation: Aiming to emphasize the emerging role of Doppler ultrasound in the diagnosis of acute upper limb ischemia, we report the case of a 70-year-old female, with severe left arm resting pain and digital cyanosis. Due to the patient’s age and the presence of cardiovascular risk factors, cardioembolic or thrombotic arterial occlusion would have been the most likely diagnosis in this case, but the color Doppler ultrasound revealed severe left axillary arterial stenosis with hypoechoic wall swelling, being highly suggestive for arteritis. Temporal artery biopsy was performed, which confirmed giant cell arteritis. An excellent clinical response was obtained after initiation of treatment. Conclusion: In acute upper limb ischemia, color duplex ultrasound provides quick information about the etiology and localization of arterial lesions, offering characteristic findings in case of large-vessel giant cell arteritis.

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