scholarly journals Peculiarities of Immidiate Postoperative Period in Abdominal Trauma With Splenic Injuries

2020 ◽  
Vol 9 (1) ◽  
pp. 14-20
Author(s):  
V. V. Maslyakov ◽  
Y. G. Shapkin ◽  
A. Y. Dadayev ◽  
S. A. Kulikov ◽  
M. A. Shikhmagomedov
Keyword(s):  
Mortality Rate ◽  
Abdominal Trauma ◽  
Postoperative Period ◽  
Complication Rate ◽  
Gunshot Wounds ◽  
Journey Time ◽  
Results Of Treatment ◽  
Time Gap ◽  
Open Injuries ◽  
D Dimer

INTRODUCTION. Splenic injuries in abdominal trauma is one of the most common injuries in abdominal surgery. The damage to this organ occurs in 22.3–30%. This is the second most common injury among damages to parenchymal organs.AIM OF STUDY. To study the immediate results of treatment and to determine the factors that influence the choice of tactics for open injuries of the spleen.MATERIALS AND METHODS. The study included 75 patients with abdominal wound and damaged spleen. In 54 (72%) patients, stab and slash wounds were revealed, in 21 (28%) patients there were gunshot wounds (bullet or fragment). All patients were divided into two groups: Group A included 44 (58.6%) of patients, where the time gap between the time of injury and the surgery did not exceed 1 hour, and Group B, which included 31 (41.3 %) of cases, where the time gap between the moment of injury and surgical intervention exceeded 1 hour.RESULTS. As a result of the study, it was found that organ-preserving operations for open injuries of the spleen were possible in 33.3% of cases. The choice of surgical tactics for injuries of this organ depended on the type of damage to the organ: in case of gunshot wounds of the spleen, the organ-preserving operation was not possible at all, but this operation was performed for stab/slash wounds in 33.3% of cases. The development of complications and deaths directly depended on the journey time: in the case of that time gap up to one hour, complications developed in 27.3% of cases, and the mortality rate was 15.9%. If the time of journey exceeded 1 hour, the number of complications increased to 77.4%, and mortality rate grew up to 51.6%. According to our data, the number of complications and deaths depended more on the time of admission than on the type of operation performed. In addition, it is necessary to note one more factor that affected the lethal outcome and this was the type of the wound. Therefore, as a result of the study, it was found that mortality in the group with gunshot wounds amounted to 17 out of 21 (80.95%), and for stab/slash wounds it was 6 out of 54 (11.1%). It was found that the journey time and the type of operation performed operation affected the level of D-dimer in patients with splenic injuries. So, the level of D-dimer was 566±0.3 ng/ml in the group of the wounded, delivered within an hour after trauma, and 643±0.2 ng/ml in the group where the journey time exceeded an hour.CONCLUSIONS. 1. Performing organ-preserving operations with open injuries of the spleen is possible in 46.3% of cases and only for stab and slash wounds. Organ-preserving operations cannot be performed for gunshot wounds.2. The number of complications and deaths is more dependent on the journey time to the hospital than on the type of operation performed. If a patient is admitted within an hour after trauma, the complication rate is 27.3%, and mortality rate is 15.9%. If the journey time exceeds one hour, the complication rate is 77.4% and the mortality rate is 51.6%.3. In patients splenic inguries, the journey time and the type of the operation performed affect the level of the D-dimer, which may affect the course of the immediate postoperative period.

The Results of Treatment of Gunshot Wounds to the Brain in Children

Neurosurgery ◽  
1990 ◽  
Vol 26 (1) ◽  
pp. 20-25 ◽  
Author(s):  
Michael E. Miner ◽  
Linda Ewing-Cobbs ◽  
Dennis R. Kopaniky ◽  
Juan Cabrera ◽  
Paul Kaufmann
Keyword(s):  
Mortality Rate ◽  
Gunshot Wounds ◽  
Neurological Status ◽  
Severe Disabilities ◽  
The Other ◽  
Results Of Treatment ◽  
Preventative Measures ◽  
The Brain ◽  
Commit Suicide ◽  
Age And Sex

Abstract Thirty-three children ranging in age from 8 months to 15 years were treated for gunshot wounds to the brain. Half of the children were less than 10 years old. Fifty-eight percent died. Mortality was influenced by the trajectory of the bullet, intent to commit suicide, and the neurological status immediately after injury. The age and sex of the child and the caliber of the bullet did not influence survival. Three-fourths of the deaths occurred within 24 hours of injury, suggesting these patients had a mortal wound from the onset. Eleven of the children were attempting suicide, 9 of whom died; 13 were playing with a gun, 5 of whom died; 2 were shot as innocent bystanders to crimes in progress; 1 was shot while involved in a criminal act; 1 was shot in a hunting accident; and in 2 who died within minutes of arrival, the circumstances of the shooting were not documented. Of the survivors, none was left vegetative after 6 months, 3 had severe disabilities, 9 were moderately disabled, and 2 had a good outcome. The mortality rate is strikingly similar to that of adults with similar injuries; however, the morbidity appears to be less. On the other hand, with simple preventative measures, virtually each injury would have been avoided. (Neurosurgery 26:20-25, 1990)

scholarly journals Treatment of patients with occlusive-stenotic diseases of the arteries by endovascular method

2021 ◽  
Vol 25 (3) ◽  
pp. 419-423
Author(s):  
V. V. Shaprynskyi
Keyword(s):  
Mortality Rate ◽  
Lower Extremity ◽  
Postoperative Period ◽  
Early Postoperative Period ◽  
Limb Amputation ◽  
Results Of Treatment ◽  
Lower Extremity Ischemia ◽  
The Right ◽  
Angioplasty And Stenting ◽  
Extremity Ischemia

Annotation. The case of successful treatment of a patient with critical lower extremity ischemia illuminates the possibilities of different approaches of the endovascular surgical method. The results of treatment of patients with occlusive-stenotic diseases of the lower extremities arteries as a result of obliterating atherosclerosis were analyzed. 243 patients underwent endovascular surgery. 14 (5.76%) patients were previously operated on. The multi-storey lesions were found in 35 (14.4%) cases. Most patients were ranged in age from 46 to 86 years. There were 175 men (72.0%) and 68 women (28.0%). The right lower extremity was affected more often – 148 (60.9%) patients than the left ones – 95 (39.1%). The thrombosis was diagnosed in 21 (10.6%) individuals as the most common complications in the early postoperative period. Limb amputation was performed in 12 patients. Mortality rate in the early postoperative period was 2.56% (4 patients died). It is established that the methods of choice in the reconstruction of stenotic-occlusive lesions of the arteries are: balloon angioplasty (and stenting), rotor-mechanical thromboaspiration, regional thrombolytic therapy. These methods are performed mainly under local anesthesia, they are minimally invasive and can be used in patients with severe comorbidities.

scholarly journals Atviri plonosios žarnos sužalojimai

2003 ◽  
Vol 1 (2) ◽  
pp. 0-0
Author(s):  
Edmundas Gaidamonis ◽  
Juozas Stanaitis ◽  
Sigitas Tamulis ◽  
Robertas Saltanavičius ◽  
Rytis Tutkus ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Small Bowel ◽  
Mortality Rate ◽  
Abdominal Trauma ◽  
Complication Rate ◽  
Postoperative Morbidity ◽  
Bowel Injury ◽  
Small Bowel Injury ◽  
Penetrating Abdominal Trauma ◽  
Complications And Mortality

Edmundas Gaidamonis, Juozas Stanaitis, Sigitas Tamulis, Robertas Saltanavičius, Rytis Tutkus, Kazimieras Brazauskas, Aurelijus Grigaliūnas, Moisejus Racinas, Jonas Stasinas, Tomas Saladis, Raimundas LunevičiusVilniaus universiteto Bendrosios ir kraujagysliųchirurgijos klinikos Bendrosios chirurgijos centras,Vilniaus greitosios pagalbos universitetinė ligoninė,Šiltnamių g. 29, LT-2043, VilniusEl paštas: [email protected] Įvadas / tikslas Teigiama, kad pooperacinių komplikacijų dažnis ir mirštamumas sužalojus plonąją žarną priklauso nuo traumos apimties ir gretutinių pilvo ertmės organų sužalojimų. Darbo tikslas – įvertinti ligonių, kuriems buvo atvirų plonosios žarnos sužalojimų, gydymo rezultatus, nustatyti veiksnius, lemiančius pooperacines komplikacijas ir mirštamumą. Metodai Darbo pobūdis – retrospektyvus. Nagrinėtos 1982–1991 metais VMUL ir 1991–1998 metais VGPUL nuo atviros plonųjų žarnų traumos operuotų 126 ligonių ligos istorijos. Duomenys rinkti pagal specialų traumą patyrusių ligonių duomenų registravimo protokolą. Vertinta: ligonių amžius, lytis, traumos mechanizmas, operacijos rizikos laipsnis, hemodinamikos būklė, instrumentiniai tyrimai, organo sužalojimo laipsnis, pilvo ertmės organų ir kombinuoti kitų sistemų sužalojimai, operacijos dydis, pooperacinės komplikacijos, baigtis. Rezultatai Pooperacinių komplikacijų radosi 32 ligoniams (25,4 %), iš jų 6 ligoniai mirė (mirštamumas 4,8 %). Ligonių, kuriems buvo I–III ir IV–V laipsnio plonosios žarnos sužalojimai, komplikacijų dažnio skirtumas (23,4 % ir 60 %) buvo statistiškai patikimas (p < 0,01). Pooperacinių komplikacijų buvo 11,9 % ligonių, pagal ASA klasifikaciją priklausančių I–III grupei, ir 52,9 % ligonių, priklausančių IV–V grupei (p < 0,01); mirštamumas I–III grupės ligonių buvo 1,8 %, IV–V grupės – 23,5 % (p < 0,005). Mirštamumas nestabilios hemodinamikos atveju buvo daugiau kaip 5 kartus didesnis (15 % ir 2,8 %) (p = 0,05). Įvertinus penetruojančios pilvo traumos indekso (PATI) ir pooperacinių komplikacijų bei mirštamumo priklausomybę paaiškėjo, kad komplikacijų dažnis buvo 3,6 karto didesnis ligonių, kurių PATI didesnis kaip 25 (p < 0,001), o mirštamumas – net 12,8 karto (p < 0,005). Išvados Atviri plonosios žarnos sužalojimai diagnozuoti 11,7 % ligonių, operuotų nuo atvirų pilvo ertmės organų trauminių sužalojimų. Plonosios žarnos sužalojimai sudaro 18 % atvirų pilvo sužalojimų. Lengvesnių sužalojimų (I–III laipsnio) komplikacijų dažnis 3 kartus mažesnis nei sunkesnių (IV–V laipsnio). Pooperacinių komplikacijų dažnį ir mirštamumą taip pat lemia gretutinių organų sužalojimai ir nestabili hemodinamika. Penetruojančios pilvo traumos indeksas (PATI) – statistiškai patikimas pooperacinių komplikacijų ir mirštamumo vertinimo rodiklis. Didesnis už 25 PATI rodo didelę pooperacinių komplikacijų ir mirštamumo riziką. Prasminiai žodžiai: atviros pilvo traumos, plonosios žarnos sužalojimai, pooperacinės komplikacijos, mirštamumas, pilvo traumos indeksas. Penetrating small bowel injury Edmundas Gaidamonis, Juozas Stanaitis, Sigitas Tamulis, Robertas Saltanavičius, Rytis Tutkus, Kazimieras Brazauskas, Aurelijus Grigaliūnas, Moisejus Racinas, Jonas Stasinas, Tomas Saladis, Raimundas Lunevičius Background / objective To evaluate the results of treatment of patients with penetrating small bowel injuries and to determine the main factors affecting postoperative morbidity and mortality. Methods Medical records for 126 patients admitted with penetrating small bowel injuries between 1982 and 1998 were reviewed. The patients' age, ASA grade, presence of shock, method of diagnosis, injury grade according to OIS, penetrating abdominal trauma index, operative management, morbidity and mortality were taken into consideration. Results Isolated injuries were found in 47 cases (37.3%). Twenty patients (15.9%) had associated injuries of the organs of the other systems. Postoperative complications developed in 32 patients (25.4%), 6 patients died (mortality rate 4.8%). Postoperative complications were more frequent in patients with grade IV–V versus grade I–III of injury (60% versus 23.4%, p < 0.01). The complications were less in cases of a proximal part of small bowel injury (21.4%), versus a 36.5% complication rate in patients with injuries of the middle and distal parts of the small bowel (p = 0.05). The rate of postoperative complications was 3.6 times higher in patients with PATI over 25 than in patients with PATI from 2 to 25 (p < 0.001); the mortality rate was almost 12.8 times higher (p < 0.005). According to ASA, the rate of postoperative complications and mortality was 11.9% versus 52.9% (p < 0.01) and 1.8% versus 23.5% (p < 0.005) respectively in patients with ASA grade I–III and grades IV–V. Haemodynamical stability had no statistically reliable influence on the postoperative complication rate (40% in stable and 22.6% in unstable haemodynamic patients), but it had a statistically significant influence on mortality rate (15% with unstable and 2.8% with stable haemodynamics, p = 0.05). Conclusions Penetrating small bowel injuries were detected in 11.7% of patients operated on for abdominal trauma and in 18% of patients due to penetrating abdominal injuries. Isolated injuries were found in 37.3% of cases. Most of the patients were haemodynamically stable (84.2%), with grades I–III of injury (88.1%). The operation option was associated to the grade of the injury: primary repair was performed in 86% and resection in 13.5% of cases. The higher risk of complications and mortality rate was associated with a poor general condition (ASA grade IV–V), unstable haemodynamical status, grade of injury more than III, PATI more than 25, and injuries of the distal part of the small bowel. Tube enterodecompression had no influence on the suture insuffitiency rate. Keywords: penetrating abdominal trauma, small bowel injury, postoperative morbidity, mortality, abdominal trauma index.

Prospective review of a single center's general pediatric neurosurgical intraoperative and postoperative complication rates

2014 ◽  
Vol 13 (1) ◽  
pp. 107-113 ◽  
Author(s):  
Erik J. van Lindert ◽  
Hans Delye ◽  
Jody Leonardo
Keyword(s):  
Mortality Rate ◽  
Adverse Events ◽  
Postoperative Complication ◽  
Complication Rate ◽  
Surgical Procedure ◽  
Neurosurgical Procedures ◽  
Complication Rates ◽  
Tumor Surgery ◽  
Infection Rates ◽  
Targeted Interventions

Object The authors conducted a study to compare the complication rate (CR) of pediatric neurosurgical procedures in a general neurosurgery department to the CRs that are reported in the literature and to establish a baseline of CR for further targeted improvement of quality neurosurgical care. Methods The authors analyzed the prospectively collected data from a complication registration of 1000 consecutive pediatric neurosurgical procedures in 581 patients from the beginning of the registration in January 2004 through August 2008. A pediatric neurosurgeon was involved in 50.5% of the procedures. All adverse events (AEs) from induction of anesthesia until 30 days postoperatively were recorded. Results Overall, 229 complications were counted in 202 procedures. The overall CR was 20.2%, with a 2.7% intraoperative CR and a 17.5% postoperative CR. Tumor surgery was associated with the highest CR (32.7%), followed by CSF disorders (21.8%). The mortality rate was 0.3%. An unplanned return to the operating room in relation to an AE happened in 10.5% of all procedures and in 52% of procedures associated with AEs, the majority of which were related to CSF disorders. Conclusions The CR in pediatric neurosurgical procedures was significant, and more than half of the patients with an AE required a repeat surgical procedure. Analysis of CRs should be a prerequisite for the prevention of complications and for the development of targeted interventions to reduce the CR (for example, infection rates).

scholarly journals Liver and Pancreatic Resection in the Elderly

HPB Surgery ◽  
1997 ◽  
Vol 10 (4) ◽  
pp. 259-261 ◽  
Author(s):  
O. J. Garden
Keyword(s):  
Survival Rate ◽  
Liver Resection ◽  
Mortality Rate ◽  
Elderly Patients ◽  
Complication Rate ◽  
Pancreatic Resection ◽  
The Elderly ◽  
Term Survival ◽  
Pancreatic Resections

Background: Liver resection, or pancreaticoduodenectomy, has traditionally been thought to have a high morbidity and. mortality rate among the elderly. Recent improvements in surgical and anesthetic techniques, an increasing number of elderly patients, and an increasing need to justify use of limited health care resources prompted an assessment of recent surgical outcomes.Methods: Five hundred seventy-seven liver resections (July 1985–July 1994) performed for metastatic colorectal cancer and 488 pancreatic resections (October 1983–July 1994) performed for pancreatic malignancies were identified in departmental data bases. Outcomes of patients younger than age 70 years were compared with those of patients age 70 years or older.Results: Liver resection for 128 patients age 70 years or older resulted in a 4% perioperative. mortality rate and a 42% complication rate. Median hospital stay was 13 days, and 8% of the patients required admission to the intensive care unit (ICU). Median survival was 40 months, and the 5-year survival rate was 35%. No difference were found between results for the elderly and those for younger patients who had undergone liver resection, except for a minimally shorter hospital stay fortheyoungerpatients (median, 12 days vs. 13 days p=0.003). Pancreatic resection for 138 elderly patients resulted in a mortality rate of 6% and a complication rate of 45%. Median stay was 20 days, and 19% of the patients required ICU admission, results identical to those for the younger cohort. Long-term survival was poorer for the elderly patients, with a 5-year survival rate of 21% compared with 29% for the younger cohort (p=0.03).Conclusions: Major liver or pancreatic resections can be performed for the elderly with acceptable morbidity and mortality rates and possible long-term survival. Chronologic age alone is not a contraindication to liver or pancreatic resection for malignancy.

Abstract 13317: Acute Pulmonary Embolism in Covid-19 Patients: Presenting Characteristics, Outcomes and Risk Stratification Strategies

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Hai Xu ◽  
Angel Martin ◽  
Avneet SINGH ◽  
Mangala Narasimhan ◽  
Joe Lau ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Intensive Care ◽  
Mortality Rate ◽  
Length Of Stay ◽  
Risk Stratification ◽  
Clinical Outcomes ◽  
Acute Pulmonary Embolism ◽  
Severe Bleeding ◽  
Study Cohort ◽  
D Dimer

Introduction: Pulmonary Embolism in coronavirus disease 2019 (COVID-19) patients have been increasingly reported in observational studies. However, limited knowledge describing their diagnostic features and clinical outcomes exist to date. Our study aims to systemically analyze their clinical characteristics and to investigate strategies for risk stratification. Methods: We retrospectively studied 101 patients with concurrent diagnoses of acute pulmonary embolism and COVID-19 infection, admitted at two tertiary hospitals within the Northwell Health System in New York City area. Clinical features including laboratory and imaging findings, therapeutic interventions, intensive care unit (ICU) admission, mortality and length of stay were recorded. D-dimer values were respectively documented at COVID-19 and PE diagnoses for comparison. Pulmonary Severity Index (PESI) scores were used for risk stratification of clinical outcomes. Results: The most common comorbidities were hypertension (50%), obesity (27%) and hyperlipidemia (32%) among our study cohort. Baseline D-dimer abnormalities (4647.0 ± 8281.8) were noted on admission with a 3-fold increase at the time of PE diagnosis (13288.4 ± 14917.9; p<0.05). 5 (5%) patients required systemic thrombolysis and 12 (12%) patients experienced moderate to severe bleeding. 31 (31%) patients developed acute kidney injury (AKI) and 1 (1%) patient required renal replacement therapy. Throughout hospitalization, 23 (23%) patients were admitted to intensive care units, of which 20 (20%) patients received invasive mechanical ventilation. The overall mortality rate was 20%. Majority of patients (65%) had Intermediate to high risk PESI scores (>85), which portended a worse prognosis with higher mortality rate and length of stay. Conclusions: This study provides characteristics and early outcomes for hospitalized patients with COVID-19 and acute pulmonary embolism. D-dimer levels and PESI scores may be utilized to risk stratify and guide management in this patient population. Our results should serve to alert the medical community to heighted vigilance of this VTE complication associated with COVID-19 infection, despite the preliminary and retrospective nature inherent to this study.

INTESTINAL INJURIES IN COMBINED ABDOMINAL TRAUMA

2021 ◽  
Vol Special issue (1) ◽  
pp. 37-43
Author(s):  
Numonjon Haydarov ◽  
◽  
Ishnazar Mustafakulov ◽  
Xudoyberdi Karabaev ◽  
Xushvakt Umedov ◽  
...  
Keyword(s):  
Natural Disasters ◽  
Abdominal Trauma ◽  
Human Body ◽  
Gunshot Wounds ◽  
Multiple Injuries ◽  
Steady Increase ◽  
Industrial Accidents ◽  
Military Conflicts ◽  
The World

In recent years, there has been a steady increase in injuries all over the world. Man-made and natural disasters, local military conflicts, transport and industrial accidents in 50-60% of cases of all injuries lead to combined and multiple injuries to organs and systems of the human body, and, as a result, to high sanitary losses in the first hours and days [1,2,5,11,16,22,26,].This article discusses intestinal injuries in combined abdominal trauma.Keywords:trauma, gunshot wounds of the colon, closed abdominal trauma

scholarly journals Acute postoperative perforated ulcers of the small bowel as a topical problem of modern surgery

2019 ◽  
Vol 178 (2) ◽  
pp. 33-37
Author(s):  
V. P. Zemlyanoy ◽  
A. B. Singaevskiy ◽  
D. V. Gladyshev ◽  
N. M. Vryblevskiy ◽  
E. M. Nesvit ◽  
...  
Keyword(s):  
Small Intestine ◽  
Small Bowel ◽  
Mortality Rate ◽  
Postoperative Period ◽  
Topical Problem ◽  
Emergency Operations ◽  
Pelvic Organs ◽  
The Past ◽  
Oncological Diseases ◽  
High Level

The objective is to study acute perforated ulcers of the small bowel, which arise as a complication after operations on the abdominal and pelvic organs.Material and methods. A retrospective analysis of patient’s cases whose postoperative period was complicated by the development of acute perforated ulcers of small bowel.Results. Over the past 20 years, the frequency of this complication increased by 8 times. In the structure of primary nosology, various types of oncological diseases prevail (69.4 %), moreover most patients underwent emergency operations. Most often, this complication occurred on the 4–10th day of the postoperative period, and the ulcers were multiple. Among these patients, there was an extremely high mortality rate of 74.2 %.Conclusion. Considering the significant increase in the number of this complication in recent years and the high level of mortality among patients, a detailed study of acute perforated ulcers of the small intestine of the postoperative period is necessary.

scholarly journals Changes in Indicators of Microcirculation in the Early Postoperative Period in the Treatment of Diaphyseal Fractures of the Shin Bones Using a Plate with Limited Contact

2019 ◽  
Vol 4 (3) ◽  
pp. 58-62
Author(s):  
A. I. Plakhov ◽  
L. I. Kolesnikova ◽  
L. I. Korytov ◽  
V. G. Vinogradov ◽  
M. A. Darenskaya
Keyword(s):  
Postoperative Period ◽  
Lower Limb ◽  
Blood Circulation ◽  
Early Period ◽  
Metal Plate ◽  
Early Postoperative Period ◽  
Control Group ◽  
Doppler Flowmetry ◽  
Results Of Treatment ◽  
Diaphyseal Fractures

Background. Unsatisfactory results of treatment, such as delayed consolidation and non-fusion of fractures, the formation of false joints and limb bone defects, have no tendency to decrease. We can assume that one of the leading factors of complications in traumatology is a violation of microcirculation in the affected segment of the limb.Aims. To identify patterns of changes in the parameters of the microcirculatory bed of the damaged segment of the lower limb when fixing bone fragments with a plate with limited contact in the early period after surgery.Materials and methods. In 25 patients, we studied four parameters of microcirculation of the lower limb segment with application of laser Doppler flowmetry. The control group consisted of 25 healthy volunteers, comparable in age and sex with the study group.Results. We found that in the early postoperative period (from the first to the 10th day after the surgery) in patients with diaphyseal fractures of the tibia operated with metal plate with limited contact there was an increase in microcirculation by 75.69 %, an increase in the proportion of the nutritive component of microcirculation compared to the shunt fraction by 24.64 %, as well as an increase in more than one ratio of the amplitude of the heart and respiratory range. All of that indicates a local circulatory disorder in the nutritive arterial hyperemia. We note that the increase in the amplitude of the respiratory component by 17.22 % and the equality of the amplitude of the cardiac range compared with the control group indicate violations of local blood circulation by the type of venous stagnation.Conclusion. On the basis of the results obtained, we note that patients with diaphyseal fractures of the shin bones treated with metal osteosynthesis with a plate with limited contact in the early postoperative period develop a violation of local blood circulation in the stagnant-hyperemic type.

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