scholarly journals POTENTIAL AND PERSPECTIVES OF INDIRECT REVASCULARIZATION IN TREATMENT OF LOWER LIMBS CRITICAL ISCHEMIA

2021 ◽  
Vol 29 (4) ◽  
pp. 490-503
Author(s):  
S.N. Yaroshkin ◽  
◽  
S.A. Sushkou ◽  
L.A. Fralou ◽  
◽  
...  
Keyword(s):  
Blood Flow ◽  
Soft Tissues ◽  
Lower Limbs ◽  
Cochrane Library ◽  
Muscular Tissue ◽  
Critical Ischemia ◽  
Actual Problem ◽  
Scientific Database ◽  
Slow Development ◽  
Indirect Revascularization

This review was undertaken by a literature search of the International scientific database PubMed and Cochrane library. The review highlights the issues and perspectives of indirect revascularization in the patients with lower limbs critical ischemia. The study revealedthat lower limbs critical ischemia remains the actual problem ofangiosurgery, despite of the widespread introduction of angioplasty and open vascular reconstruction. However, angioplasty and bypass surgery revascularization cannot be performed in some category of patients, so that the further improvement of indirect revascularization techniques has been of great interesttoresearchers. The severity of the ischemic process is determined not only by the mechanical blood flow restriction but also by the angiogenic potential of the surrounding soft tissues, foremost muscular one. Therefore, in the case of technical irreparability of the main blood flow it remains possible to preserve the limb by creating new vascular networks in the muscular tissue. Revascularizing osteotrepanation of the lower limb bones is considered to be theoptimal variant to achieve this result. The discontent of clinical outcomes occurred due to the slow development of the angiogenic effect, which in critical ischemia is fraught with loss of a limb until the maximal angiogenesis is reached. In recent years, cell therapyhas become a very promising and advanced scientific research topic. So that its methods have been actively introduced into practice; they are easily combined with revascularizing osteotrepanation and are able significantly accelerate angiogenesis induced by surgical bone injury. In this regard, there is reason to believe that curative effect increases when revascularising osteotrepanation is combined with cell therapy, including the use of bone marrow aspirates.

Doppler Comparative Measurements in the Reconstruction of Limbs with Flaps and Grafts

2017 ◽  
Vol 71 (1) ◽  
pp. 56-63
Author(s):  
Boro Dzonov ◽  
Lazo Noveski ◽  
Suzana Nikolovska ◽  
Elizabeta Zhogovska
Keyword(s):  
Blood Flow ◽  
Reconstructive Surgery ◽  
Soft Tissues ◽  
Continuous Wave ◽  
Power Doppler ◽  
Lower Limbs ◽  
Reconstructive Procedures ◽  
Significant Difference ◽  
Doppler Color

Abstract Doppler technique was first described by the Australian physicist and mathematician Christian Doppler. Doppler effect is defined as a reflection of high frequency sound waves of different frequency when they come in contact with the movable structure in the blood vessel. Waves that go to transducers are coded red, while waves that move away from the transducer are coded blue. Doppler main types can be classified as following: continuous wave (CW) Doppler, spectral Doppler, color Doppler and Power Doppler color. The study was realizedat the University Clinic for Plastic and Reconstructive Surgery. It is a randomized prospective study. During the study two groups of 30 patientseach were formed. Each patient was required a permission for reconstructive surgery procedure and an informed consent for participation in the study. For all patients a specially designed questionnaire (non-standardized) was filled out. 1. First (I) group of patients treated with flaps. In this group a type of reconstructive technique with skin or complex flapshas been applied. 2. Second group (II) of patients treated with grafts (split thickness grafts). In this group applied reconstruction comprised application of skin grafts with partial thickness. The study included patients with defects of the skin and soft tissues, whohad an indication for reconstructive surgery procedure. Exclusion criteria of patients for participation in the study were: children under 14 years of age, adults over 75 years, people with systemic diseases that can affect the results of reconstructive intervenetions and patients who have without periosteum bone-like surface defect as contraindication for skin grafting. The results of the reconstructive procedures according to the objectives set were investigated clinically into three time periods: preoperative, postoperative day 7 and day 30 postoperatively. The following investigations were carried out: determination of the circulation levels by means of Doppler; determination of the levels of limbs circulation is distal to the site of reconstruction in the pre-and postoperative period (day 7 and day 30); For the evaluation of blood flow the following parameters were used: • PSV-Peak systolic velocity • PI - Pulsatility index RI - Resistance indexPI and RI were calculated using the formula: • PI = PSV - EDV / Vmean • RI = PSV - EDV / PSV EDV indicates the flow velocity in late diastole and V mean, the average speed of blood flow through the artery. By assessment of arterial status before and after surgery through the analysis ofvascular waves at different locations of the vascular tree of the upper and lower extremities, we registered significant difference between the two examined groups, which speaks in favor of the use of flaps in reconstruction of the lower limbs.

scholarly journals A Score of Run-Off (Outflow) Resistance in Lesions Femoropopliteal Arteries Using MSCT Angiography

2017 ◽  
pp. 90-102
Author(s):  
A. L. Maslov ◽  
A. E. Zotikov
Keyword(s):  
Blood Flow ◽  
Arteriovenous Fistula ◽  
Venous Blood ◽  
Lower Extremities ◽  
Arterial Disease ◽  
Lower Limbs ◽  
Venous Blood Flow ◽  
Critical Ischemia ◽  
Type D ◽  
Msct Angiography

Despite the ongoing treatment, in 10–20% of patients with obliterating diseases of the arteries of the lower limbs, the progression of the disease leads to amputation, with mortality rates being up to 50%.The aim: to determine the effectiveness of MSCT angiography in patients with type-D femoral-popliteal arteries according to TASC II with critical ischemia of the lower extremities and poor condition of outflow tracts for performing arterialization of venous blood flow and / or superimposition of arteriovenous fistula.Material and methods. 145 MSCT angiographic studies were performed for patients with arterial diseases of the lower extremities performed in “RAMSAY Diagnostics Rus”Moscow. For the analysis, 53 (37% of the total) of the patient with lesions of the femoropopliteal segment of Type D according to TASC II were selected. The analysis of the state of the arterial outflow pathways was carried out according to the modified Rutherford classification, where each artery of the shin was maximally assigned 3 points depending on the degree of stenosis, the blood flow resistance was estimated as 0 points – the absence of stenosis or stenosis less than 20%, 1 point stenosis 20–49% 2 points stenosis 50–99%, 3 points – occlusion.Results. The degree of resistance of arteries of outflow tracts of 39 limbs (16 right and 23 left) was calculated in 53 patients: 10 points in 23.7% of cases; 9 points in 5.1%; 8 points – 2.5%; 7 points 18%, 6 points in 5%; 5 points 2.5%; 4 points 15.4%; 3 points 7.7%; 2 points 0; 1 point 20.5%. In patients with poor arterial outflow, with a score greater than 7, there is a high risk of early thrombosis of the prosthesis, so such patients undergo an operation with the formation of an unloading arteriovenous fistula.Conclusion. MSCT angiography of the arteries of the lower extremities is an effective method for determining the severity of arterial damage with an accurate definition of the level, extent, prevalence with the possibility of using different classifications, including TASC II and theRutherford classification. It can be used as a screening, expert method in patients with arterial diseases of the lower extremities, may be an alternative to direct angiography, used to assess patients in the postoperative period.Key words: peripheral arterial disease, outflow score, ball classification of outflow tracts, runoff score, computed tomography, angiography. 

scholarly journals Pathogenesis of ischemia/reperfusion syndrome

2018 ◽  
Vol 99 (4) ◽  
pp. 640-644 ◽  
Author(s):  
D E Kutepov ◽  
M S Zhigalova ◽  
I N Pasechnik
Keyword(s):  
Blood Flow ◽  
Lower Limb ◽  
Ischemia Reperfusion ◽  
Vascular Complications ◽  
Limb Ischemia ◽  
Biologically Active ◽  
Lower Limbs ◽  
Ion Pump ◽  
Critical Ischemia ◽  
Lower Limb Ischemia

Ischemia/reperfusion syndrome is a collective concept that combines various pathological conditions developing against the background of the restoration of the main blood flow in the organ or limb segment, which has long been subjected to ischemia or traumatic amputation. Intensive care physicians often see ischemia/reperfusion syndrome after restoration of blood supply in patients with critical ischemia of the lower limb. The rate of critical ischemia of the lower limbs ranges from 400 to 1000 cases per 1 million of the population. The number of lower limb amputations due to critical lower limb ischemia in economically developed countries is 13.7-32.3 cases per 100,000 of the population. The main etiological factors of critical lower limb ischemia are atherosclerosis of peripheral vessels and vascular complications of diabetes. The pathogenesis of ischemia/reperfusion syndrome is based on a complex of pathophysiological changes resulting from the restoration of blood flow in previously ischemic lower limb. Restoration of blood circulation leads to massive flow into the systemic bloodstream of anaerobic metabolism products, free myoglobin, biologically active substances and inflammatory mediators. The main sources of reperfusion damage are activated forms of oxygen, in particular, superoxide radical О2-, nitric oxide, lipid peroxidation products. In the conditions of primary ischemia, and then tissue reperfusion, excessive production of activated oxygen forms leads to damage of biological structures (lipids, proteins, deoxyribonucleic acid), which causes disruption of normal cell functioning or its death due to necrosis or apoptosis, ion pump dysfunction, adhesion of leukocytes and increased vascular permeability.

scholarly journals Mapping evidence on the effects of gender-affirming hormone therapy on the hard and soft tissues of the craniofacial complex in transgender people: a protocol for a scoping review

2021 ◽  
Vol 10 (1) ◽  
Author(s):  
M. F. Van den Bosch ◽  
C. M. Wiepjes ◽  
M. Den Heijer ◽  
L. J. Schoonmade ◽  
R. E. G. Jonkman ◽  
...  
Keyword(s):  
Systematic Review ◽  
Scoping Review ◽  
Soft Tissues ◽  
Grey Literature ◽  
Cochrane Library ◽  
Sex Characteristics ◽  
Transgender People ◽  
Link Type ◽  
Scoping Reviews ◽  
Craniofacial Complex

Abstract Background Gender-affirming hormone (GAH) therapy aims to support the transition of transgender people to their gender identity. GAHs can induce changes in their secondary sex characteristics such as the development of breasts in transgender females and increased muscle mass in transgender males. The face and its surrounding tissues also have an important role in gender confirmation. The aim of this scoping review is to systematically map the available evidence in order to provide an overview of the effects of GAH therapy on the hard and soft tissues of the craniofacial complex in transgender people. Methods/design The Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA) extension for Scoping Reviews was consulted for reporting this protocol. The methods were based on the Arksey and O’Malley’s framework and the Reviewer’s Manual of the Joanna Briggs Institute for conducting scoping reviews. Ten transgender people were involved in the development of the primary research question through short interviews. The eligibility criteria were defined for transgender people undergoing GAH therapy and for quantitative and qualitative outcomes on the hard and soft tissues of the craniofacial complex. Eligible sources of evidence include observational, experimental, qualitative, and mixed method studies. No exclusion criteria will be applied for the language of publication and the setting. To identify eligible sources of evidence, we will conduct searches from inception onwards in PubMed, Embase.com, the Cochrane Library, Web of Science Core Collection, Scopus, CINAHL, LIVIVO, and various grey literature sources such as Google Scholar. Two reviewers will independently select eligible studies in these information sources and will subsequently conduct data extraction. The same operators will chart, categorize, and summarize the extracted data. A narrative summary of findings will be conducted. Frequency counts of quantitative and qualitative data on items such as concepts, populations, interventions, and other characteristics of the eligible sources will be given. Where possible, these items will be mapped descriptively. Discussion We chose the scoping review over the systematic review approach, because the research questions are broad-spectrum and the literature is expected to be widely scattered. No systematic review has previously assessed this topic. Identifying knowledge gaps in this area and summarizing and disseminating research findings are important for a wide spectrum of stakeholders, in particular, for transgender people who want to undergo additional interventions such as plastic or orthognathic surgery or orthodontics. Systematic review registration This protocol was registered in the Open Science Framework: https://osf.io/e3qj6

scholarly journals SAT0560 THE PROGNOSTIC VALUE OF ULTRASONOGRAPHIC FINDINGS IN INDIVIDUALS WITH ASYMPTOMATIC HYPERURICEMIA

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1238.2-1238
Author(s):  
W. Li ◽  
W. Fan ◽  
J. Zhu ◽  
Z. Chen ◽  
F. Liu
Keyword(s):  
Blood Flow ◽  
Prognostic Value ◽  
Soft Tissues ◽  
Bone Erosion ◽  
Gouty Arthritis ◽  
Diagnostic Value ◽  
First Metatarsal ◽  
American College Of Rheumatology ◽  
European League Against Rheumatism ◽  
Peking University

Background:Chronic and steady asymptomatic hyperuricemia (AHU) can eventually lead to the deposition of monosodium urate crystals in joints and soft tissues. The rate of progression from AHU to clinically evident gout varies and mainly depends on serum uric acid levels. However, little is known about the prognostic value of ultrasonographic findings in individuals with AHU in detail.Objectives:To explore the prognostic value of ultrasonographic findings in individuals with asymptomatic hyperuricemia.Methods:We analyzed the ultrasonographic findings (snowstorm sign, double-contour (DC) sign, tophi, bone erosion, and abnormal blood flow) of bilateral knees, ankles and the first metatarsal-phalangeal joints (1st MTP) of individuals with AHU at Peking University People’s hospital between June 2014 and May 2016. All individuals were followed up for two years.Results:Among 218 individuals with AHU, the prevalence of snowstorm sign, DC sign, tophi, bone erosion and abnormal blood flow was 41%, 23%, 4%, 9% and 13%, respectively. Gout attacked in 36 patients during 2-year follow-up with 4.5 years of HU duration. The first attack affected the 1st MTP in 60%, the ankle in 31%, and the knee in 11% of the patients with gout. Patients with gout attack has longer hyperuricemia duration compared with individuals with AHU without gout attack. DC sign, tophi, and bone erosion on ultrasound were more frequently presented in patients with gout attack compared with individuals with AHU without gout attack. However, the prevalence of snowstorm sign and and abnormal blood flow on ultrasound has no significant differences between patients with gout attack and individuals with AHU without gout attack.Conclusion:Longer hyperuricemia duration, DC sign, tophi, and bone erosion on ultrasound in individuals with AHU could be associated with gout attack.References:[1]Neogi T, Jansen TL, Dalbeth N, Fransen J, Schumacher HR, Berendsen D, et al. 2015 Gout classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative. Ann Rheum Dis. 2015;74(10):1789-98.[2]Estevez-Garcia IO, Gallegos-Nava S, Vera-Pérez E, Silveira LH, Ventura-Ríos L, Vancini G, et al. Levels of cytokines and MicroRNAs in individuals with asymptomatic hyperuricemia and ultrasonographic findings of gout: A Bench-to-Bedside Approach. Arthritis Care Res. 2018;70(12):1814-21.[3]Elsaman AM, Muhammad EM, Pessler F. Sonographic findings in gouty arthritis: diagnostic value and association with disease duration. Ultrasound Med Biol. 2016;42(6):1330-6.[4]Joosten LAB, Crişan TO, Bjornstad P, Johnson RJ. Asymptomatic hyperuricaemia: a silent activator of the innate immune system. Nat Rev Rheumatol. 2020;16(2):75-86.Acknowledgments:This work was supported by National Natural Science Foundation of China (No. 81571684 to Jiaan Zhu), Peking University People’s Hospital Research and Development Funds (RDC2014-02 to Wenting Fan).Disclosure of Interests:None declared

scholarly journals Accuracy and Reliability of Soft Tissue Landmarks Using Three-Dimensional Imaging in Comparison With Two-Dimensional Cephalometrics: A Systematic Review

2020 ◽  
Vol 54 (4) ◽  
pp. 289-296
Author(s):  
Adeeba Ali ◽  
Anil K. Chandna ◽  
Anshul Munjal
Keyword(s):  
Systematic Review ◽  
Soft Tissue ◽  
3D Imaging ◽  
Soft Tissues ◽  
Three Dimensional ◽  
Database Search ◽  
Cochrane Library ◽  
Two Dimensional ◽  
Imaging Tool ◽  
Electronic Database Search

Background: Concerns about the accuracy and reliability of soft tissue landmarks using two-dimensional (2D) and three-dimensional (3D) imaging. Objective: The aim of the systematic review is to estimate accuracy and reliability of soft tissue landmarks with 2D imaging and 3D imaging for orthodontic diagnosis planning and treatment planning purposes. Data Sources: Electronic database search was performed in MEDLINE via PubMed, Embase via embase.com, and the Cochrane library website. Selection Criteria: The data were extracted according to two protocols based on Centre for Evidence-Based Medicine (CEBM) critical appraisal tools. Next, levels of evidence were categorized into three groups: low, medium, and high. Data Synthesis: Fifty-five publications were found through database search strategies. A total of nine publications were included in this review. Conclusion According to the available literature, 3D imaging modalities were more accurate and reliable as compared to 2D modalities. Cone beam computed tomography (CBCT) was considered the most reliable imaging tool for soft tissues.

Increased blood flow to lower limbs after plasma exchange in two patients with familial hypercholesterolemia

1982 ◽  
Vol 41 (2-3) ◽  
pp. 421-425 ◽  
Author(s):  
A. Postiglione ◽  
P. Rubba ◽  
N. Scarpato ◽  
A. Iannuzzi ◽  
M. Mancini
Keyword(s):  
Blood Flow ◽  
Plasma Exchange ◽  
Familial Hypercholesterolemia ◽  
Lower Limbs ◽  
Increased Blood Flow

scholarly journals Custom-Made 3D-Printed Implants as Novel Approach to Reconstructive Surgery after Oncologic Resection in Pediatric Patients

2021 ◽  
Vol 10 (5) ◽  
pp. 1056
Author(s):  
Giovanni Beltrami ◽  
Gabriele Ristori ◽  
Anna Maria Nucci ◽  
Alberto Galeotti ◽  
Angela Tamburini ◽  
...  
Keyword(s):  
Pediatric Patients ◽  
Soft Tissues ◽  
Lower Limbs ◽  
Host Bone ◽  
Limb Salvage Surgery ◽  
Musculoskeletal Tumor ◽  
Musculoskeletal Tumor Society ◽  
Custom Made ◽  
3D Printed

Recently, custom-made 3D-printed prostheses have been introduced for limb salvage surgery in adult patients, but their use has not been described in pediatric patients. A series of 11 pediatric patients (mean age 10.8 years; range 2–13) with skeletal tumors treated with custom-made implants for the reconstruction of bony defects is described. Patients were followed up every 3 months. Functional results were evaluated by the Musculoskeletal Tumor Society Score (MSTS) for upper and lower limbs. The mean follow-up was 25.7 months (range 14–44). Three patients died after a mean of 19.3 months postoperatively—two because of disease progression and the other from a previous malignancy. Three patients experienced complications related to soft tissues. One patient required device removal, debridement, and antibiotic pearls for postoperative infection. Partial osseointegration between grafts and host bone was observed within a mean of 4 months. At the final follow-up, mean MSTS score was 75%. 3D prostheses may yield biological advantages due to possible integration with the host bone and also through the use of vascularized flaps. Further research is warranted.

Use of intravenous alprostadil in patients with severe critical ischemia of the lower limbs

Vascular ◽  
2018 ◽  
Vol 27 (3) ◽  
pp. 318-323
Author(s):  
Jorge Enrique Machado-Alba ◽  
Manuel E Machado-Duque
Keyword(s):  
Critical Limb Ischemia ◽  
Adverse Reactions ◽  
Limb Ischemia ◽  
Cross Sectional Study ◽  
Lower Limbs ◽  
Critical Ischemia ◽  
Cross Sectional ◽  
Potential Benefits ◽  
Advanced Stages ◽  
Clinical Records

Objectives To determine the indications for the use, potential benefits, and adverse reactions of alprostadil in a group of Colombian patients. Methods A retrospective cross-sectional study was conducted in patients diagnosed with critical limb ischemia who received alprostadil in five hospitals in Colombia between September 2011 and July 2017. We reviewed the clinical records of each patient to obtain the sociodemographic and pharmacological variables, clinical stages, complications, comorbidities, reported effectiveness and adverse reactions. Results Sixty-one patients treated with alprostadil were evaluated; 50.8% of patients were men, and the average age of 72.5 ± 10.7 years. A total of 86.9% of patients were hypertensive, and 65.6% were diabetic. A total of 77.0% presented ulceration, and this condition was considered as a diabetic foot in 57.4% of patients. A total of 81.9% of patients were classified as Fontaine stage 4; 60.7% received therapy as initially indicated, with an average of 19 days of alprostadil use. Regarding the therapy results, 58.0% of the patients with ulcers or trophic lesions showed improvement, 86.2% showed improvement of pain, and the limb was saved in 72.1% of patients. Conclusions Critical limb ischemia was presented by patients with advanced age and high cardiovascular risk who were treated during severe and advanced stages where therapeutic options are limited. Treatment with alprostadil achieved satisfactory results with improvement in ulcers, pain, and limb salvage rates in this series of patients.

Sign in / Sign up

Export Citation Format

Share Document