scholarly journals Outcome of Early Surgical Intervention in Acute Lower Limb Ischemia due to Thromboembolism

2014 ◽  
Vol 7 (1) ◽  
pp. 38-43
Author(s):  
QA Azad ◽  
NAK Ahsan ◽  
AM Asif Rahim ◽  
SAN Alam ◽  
M Rahman
Keyword(s):  
Lower Limb ◽  
Surgical Intervention ◽  
Limb Ischemia ◽  
Artery Occlusion ◽  
Arterial Embolism ◽  
Vascular Flow ◽  
Femoral Artery Occlusion ◽  
Group A ◽  
Group B ◽  
Early Surgical Intervention

Background: Acute lower extremity ischemia is a common vascular disease and considered limb- and life- threatening. The present study evaluated and compared the outcome of early and late surgical intervention in acute lower limb ischemia due to thromboembolism. Methodology: This non randomized comparative parallel study was conducted at the Department of Cardiovascular Surgery, NICVD, Dhaka, Bangladesh from January 2007 to December 2008 for duration of two year. Total 80 patients were enrolled in this study. The patients were divided into equal two groups, Group A, for early surgical intervention (with in 24 hours) and Group B, late surgical intervention (more than 24 hours). Results: Mean (±SD) age of both Group A and Group B was 51.93 (±11.73) and 47.00 (± 11.01) years. Male and female ratio of the total study population was 1.76:1 Pain and absence of pulse distal to occlusion was common for all. Cold extremity, sensory deficit, motor deficit, diminish vascular flow was the commonest findings of both group. In Group A, 57.5% had superficial femoral artery occlusion, 22.5% had iliac artery and 20.0% popliteal artery occlusion. In Group B, 42.5% had superficial femoral artery occlusion, 32.5% had popliteal artery occlusion and 25.0% had iliac artery occlusion. Fasciotomy was performed in 15.0% patients of Group A and in 22.0% patients of Group B. After Fogarty embolectomy in group A and group B had warm extremity (80.0% vs. 65.0%), pulsation distal to occlusion (90.0% vs. 75.0%), intact sensory function (82.5% vs. 67.5%), intact motor function (80.0% vs. 65.0%), and normal vascular flow by Doppler US (80.0% vs. 65.0%). During postoperative period history of bleeding, infection, reperfusion injury, muscle necrosis and limb amputation were 12.5% vs. 10.0%, 5.0% and 7.5%, 17.5% vs. 35.0%, 15.0% vs. 12.5% and 37.5% vs. 32.5% respectively. Conclusion: Duration of embolism may be the significant factor determining the outcomes of the management of acute arterial embolism in the lower extremities. The 24- hour duration of arterial embolism is a crucial factor influencing the surgical the management and early diagnosis and shifting of patients to specified centre as early as possible to save limb as well as life. DOI: http://dx.doi.org/10.3329/cardio.v7i1.20799 Cardiovasc. j. 2014; 7(1): 38-43

scholarly journals Comparison of Digital Subtraction Angiography Combined Arterial Thrombectomy Versus Simple Arterial Thrombectomy in the Treatment of Acute Lower Limb Ischemia

2021 ◽  
Author(s):  
Hongwei Ge ◽  
Bin Song ◽  
Xin Wang ◽  
Yunfeng Zhu ◽  
Yiming Huang ◽  
...  
Keyword(s):  
Blood Flow ◽  
Success Rate ◽  
Digital Subtraction Angiography ◽  
Lower Limb ◽  
Limb Ischemia ◽  
Digital Subtraction ◽  
Lower Limb Ischemia ◽  
Primary Surgery ◽  
Group A ◽  
Group B

Abstract Background: This study aimed to compare the clinical efficacy of digital subtraction angiography (DSA) combined arterial thrombectomy versus simple arterial thrombectomy in the treatment of acute lower limb ischemia (ALI). Methods: This retrospective cohort study collected the clinical data from 125 patients (129 affected lower limbs) with ALI who underwent emergency surgery from March 2010 to November 2019. Patients were consecutively divided into Group A and Group B. Patients in Group A underwent simple arterial thrombectomy via the Fogarty catheterization. Patients in Group B underwent arterial thrombectomy, and the DSA was performed during the surgery. The differences in the success rate of primary surgery, the second intervention rate, and the amputation/mortality rate within 30-d after surgery were compared. Results: In Group A, 4 of 70 limbs (5.7%) were amputated, 54 of 70 limbs (77.1%) had improved blood flow, 14 of 70 limbs (20.0%) received a second intervention, and 3 of 68 patients (4.4%) died within 30 d. In Group B, 1 of 59 limbs (1.7%) was amputated, 56 of 59 limbs (94.9%) had improved blood flow, 3 of 59 limbs (5.1%) received a second intervention, and 2 of 57 patients (3.5%) died within 30-d. The success rate of primary surgery, the second intervention rate, and the amputation rate of Group B were significantly lower than Group A (P<0.05). Conclusion: Arterial thrombectomy combined with DSA may effectively improve the clinical efficacy of patients with ALI.

scholarly journals Lumbar disc herniation: Early surgery versus prolonged conservative treatment.

2020 ◽  
Vol 27 (09) ◽  
pp. 1784-1789
Author(s):  
Urooj Fatimah Siddiqui ◽  
Muhammad Faiq Ali ◽  
Muhammad Asim Khan Rehmani ◽  
Atiq Ahmed Khan ◽  
Sheeraz ◽  
...  
Keyword(s):  
Conservative Treatment ◽  
Lumbar Disc Herniation ◽  
Disc Herniation ◽  
Surgical Intervention ◽  
Lumbar Disc ◽  
Outcome Variable ◽  
P Value ◽  
Group A ◽  
Group B ◽  
Early Surgical Intervention

We seek to compare pain sensation after surgical and conservative treatment in patients having sciatica with lumbar disc herniation in a routine clinical setting. Objectives: To compare the outcome of early surgical intervention versus prolonged conservative treatment in patients with sciatica due to herniated lumbar intervertebral discs. Study Design: Randomized Control Trial. Setting: Department of Neurosurgery, Dow University of Health Sciences, Civil Hospital Karachi. Period: Aug 1, 2017 till May 31, 2018. Material & Methods: Data was prospectively collected from patients after taking a consent. A total of 70 patients, with 35 patients in each Group A (early surgical intervention) and Group B (prolonged conservative treatment) were included. Demographic data was presented as simple descriptive statistics giving mean and standard deviation and qualitative variables were presented as frequency and percentages. P-value of ≤ 0.05 was taken significant. Effect modifiers were controlled through stratification to see the effect of these on the outcome variable. Post stratification independent t-test was applied taking p-value of ≤0.05 as significant. Results: Mean age in group A and B was 45.18±7.64 and 42.78±5.87 years respectively. 30 (85.7%) were male and 05 (14.3%) were female in group A. 28 (80%) were male and 07 (20%) were female in group B. Mean pre and post VAS score in group A was (7.18±0.71 and 2.18±0.55) and group B was (7.78±0.34 and 3.26±0.21). Mean pre and post SF36 BP score in group A was (24.18±3.81 and 65.54±6.14) and group B was (34.29±4.91 and 68.21±5.87). Conclusion: Many patients continue to refer conservative treatment of sciatica, despite of pain but given the results of this study, early surgical intervention appears to be superior to medical management for the treatment of Sciatica with respect to patient outcome.

scholarly journals Comparison of digital subtraction angiography combined arterial thrombectomy versus simple arterial thrombectomy in the treatment of acute lower limb ischemia

BMC Surgery ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Hongwei Ge ◽  
Bin Song ◽  
Xin Wang ◽  
Yunfeng Zhu ◽  
Yiming Huang ◽  
...  
Keyword(s):  
Blood Flow ◽  
Success Rate ◽  
Digital Subtraction Angiography ◽  
Lower Limb ◽  
Limb Ischemia ◽  
Digital Subtraction ◽  
Lower Limb Ischemia ◽  
Primary Surgery ◽  
Group A ◽  
Group B

Abstract Background This study aimed to compare the clinical efficacy of digital subtraction angiography (DSA) combined arterial thrombectomy versus simple arterial thrombectomy in the treatment of acute lower limb ischemia (ALI). Methods This retrospective cohort study collected the clinical data from 124 patients (128 affected lower limbs) with ALI who underwent emergency surgery from March 2010 to November 2019. Patients were consecutively divided into Group A and Group B. Patients in Group A underwent simple arterial thrombectomy via the Fogarty catheterization. Patients in Group B underwent arterial thrombectomy, and the DSA was performed during the surgery. The differences in the success rate of primary surgery, the second intervention rate, and the amputation/mortality rate within 30-days after surgery were compared. Results In Group A, 4 of 70 limbs (5.7%) were amputated, 54 of 70 limbs (77.1%) had improved blood flow, 14 of 70 limbs (20.0%) received a second intervention, and 3 of 68 patients (4.4%) died within 30 days. In Group B, 1 of 58 limbs (1.7%) was amputated, 56 of 58 limbs (96.6%) had improved blood flow, 3 of 58 limbs (5.2%) received a second intervention, and 2 of 56 patients (3.5%) died within 30-days. The success rate of primary surgery, the second intervention rate, and the amputation rate of Group B were significantly lower than Group A (P < 0.05). Conclusion Arterial thrombectomy combined with DSA may effectively improve the clinical efficacy of patients with ALI.

Correlation of transcranial Doppler sonography findings with timing of aneurysm surgery

1990 ◽  
Vol 73 (1) ◽  
pp. 72-76 ◽  
Author(s):  
Bertil Romner ◽  
Bengt Ljunggren ◽  
Lennart Brandt ◽  
Hans Saveland
Keyword(s):  
Transcranial Doppler ◽  
Doppler Sonography ◽  
Surgical Intervention ◽  
Transcranial Doppler Sonography ◽  
Content Type ◽  
Significant Difference ◽  
Group A ◽  
Group B ◽  
Early Surgical Intervention ◽  
Flow Velocities

✓ Thirty-six patients with a proven first subarachnoid hemorrhage (SAH) from a ruptured supratentorial aneurysm were subjected to repeated transcranial Doppler sonography assessments. Eighteen individuals (Group A) were operated on within 48 hours, while the other 18 (Group B) had surgery between 49 and 96 hours after SAH. The patients represented two clinically comparable groups. In the first 72 hours post-SAH, no increased flow velocities suggestive of arterial narrowing or vasospasm were recorded. There was no significant difference in preoperative flow velocities between the groups. Postoperative flow velocities were significantly lower in patients operated on within 48 hours (p < 0.001). Two patients, who had surgery on Day 4 post-SAH and who showed the highest recorded postoperative flow velocities, died from cerebral vasospasm and infarction. The results favor a referral system which enables early surgical intervention not only to prevent rebleeds but also aimed at reducing delayed ischemic dysfunction.

Safety aspect of intraoperative, local urokinase lysis in patients with acute lower limb ischemia

2021 ◽  
pp. 1-10
Author(s):  
Schierling Wilma ◽  
Bachleitner Kathrin ◽  
Kasprzak Piotr ◽  
Betz Thomas ◽  
Stehr Alexander ◽  
...  
Keyword(s):  
Major Bleeding ◽  
Lower Limb ◽  
Limb Ischemia ◽  
Major Amputation ◽  
Artery Occlusion ◽  
Outflow Tract ◽  
Intracranial Bleeding ◽  
Minor Bleeding ◽  
Free Survival ◽  
Lower Limb Ischemia

BACKGROUND: Acute lower limb ischemia (ALI) is associated with a high risk of limb loss and death. OBJECTIVE: The present study evaluates the safety of intraoperative, local urokinase lysis in patients with ALI and crural artery occlusion. METHODS: A total of 107 patients (115 legs) were treated surgically for ALI with additional intraoperative urokinase lysis to improve the outflow tract. Minor and major bleeding as well as efficacy of treatment and amputation-free survival were investigated. RESULTS: Complete restoration of at least one run-off vessel was achieved in 64%. Collateralization was improved in 34%. Lysis failed in 2%. Major amputation rate was 27%overall (12%within 30 days) and depended on Rutherford class of ALI (overall/30 day: IIa 11%/6%; IIb 20%/17%; III 37%/15%). Amputation-free survival turned out to be 82%after 30 days, 58%after one, and 41%after five years. Minor bleeding occurred in 21%(24/115) and major bleeding in 3.5%(4/115). One of these patients died of haemorrhage. No patient experienced intracranial bleeding. CONCLUSION: Intraoperative urokinase lysis improves limb perfusion and causes low major and intracranial bleeding. It can be safely applied to patients with severe ischaemia when surgical restoration of the outflow tract fails.

Advantages and limitations of the use of tractography and fMRI in the treatment of anaplastic glioma

2021 ◽  
pp. 32-42
Author(s):  
Igor Aleksandrovich Medyanik ◽  
Simon Quarteng Badu
Keyword(s):  
Neurological Disorders ◽  
Preoperative Diagnosis ◽  
Surgical Intervention ◽  
Complete Resection ◽  
Anaplastic Glioma ◽  
Neurological Deficits ◽  
Neural Pathways ◽  
Histological Subtype ◽  
Group A ◽  
Group B

The possibility of using only tractography as a preoperative diagnosis of anaplastic glioma is limited due to its inability to show the exact functional location of the tumor; therefore, the combination of tractography and fMRI seems to be a more promising complex diagnostic method. In neurooncology, complete resection without or with minimal neurological deficit is the goal of surgical intervention. The aim of the study was to investigate the advantages and limitations of the use of tractography and fMRI in the treatment of anaplastic glioma compared to standard CT or MRI. The study involved 48 patients who were divided into two groups based on the use of fMRI and tractography: group A (24 patients) and without it — group B (24 patients). The groups were compared in terms of age, sex, histological subtype of anaplastic glioma, degree of resection, postoperative complications, and dynamics of neurological disorders. The combination of fMRI and tractography is the best preoperative diagnosis, it is safe and allows localizing neural pathways, preserve them during surgery, and reduce postoperative neurological deficits.

scholarly journals A Comparison of Oral Gabapentin and Oral Pregabalin as Preemptive Analgesia for Orthopedic Surgery Under Spinal Anaesthesia

2021 ◽  
Vol 9 (1) ◽  
pp. 74-78
Author(s):  
Neena Jain ◽  
Rahul Bankapur ◽  
Preeti Lamba ◽  
saurav Singh
Keyword(s):  
Side Effects ◽  
Postoperative Pain ◽  
Spinal Anesthesia ◽  
Spinal Anaesthesia ◽  
Orthopedic Surgery ◽  
Lower Limb ◽  
Analgesic Efficacy ◽  
Double Blind Study ◽  
Group A ◽  
Group B

Background and Aims: Gabapentin and pregabalin, by decreasing noxious stimulus induced excitatory neurotransmitter release at central nervous system, may attenuate central sensitization and eventually decrease development of postoperative pain. We evaluated preemptive analgesic efficacy of single dose of oral gabapentin 600 mg and pregabalin 75mg for postoperative pain in patients undergoing lower limb orthopedic surgery under spinal anesthesia. Material and methods: A prospective, randomized, double blind study was conducted on 70 patients aged between 18 to 60 years with ASA grade 1 and 2 posted for lower limb surgeries under spinal anaesthesia. Patients were allocated into Group A and Group B receiving oral gabapentin(600mg) and oral pregabalin (75mg) respectively 1.5 hours before surgery. Primary objective was assessing duration and quality of analgesia by Visual Analogue Scale (VAS) score at 2,4,6,8,10,12,16,20 and 24 hours.Secondary objective was to assess total dose of rescue analgesic in first 24 hours, perioperative hemodynamic change and various side effects. Statistical Analysis used: Categorical data was compared using Chi- square test. Quantitative parametric data was analysed using unpaired student t-test. P value < 0.05 was considered statistically significant. Results: Mean duration of analgesia in Group A (10.53 ± 2.686 hours) was longer than Group B (7.943±3.199hr) (P = 0.0006).Mean number of analgesic dosesrequired in first 24 hourswere less in Group A (1.429 ± 0.5021) ascompared to Group B (1.771±0.6897) (P = 0.0202).All patients remained hemodynamically stable with no significant side effects noted in either group. Conclusion: We conclude that preemptive analgesic efficacy of oral gabapentin 600mg is better in comparison to oral pregabalin 75 mg for patients posted for lower limb orthopedic surgeries under spinal anesthesia.

COMPARATIVE STUDY BETWEEN EPIDURAL BUPIVACAINE WITH BUPRENORPHINE AND EPIDURAL BUPIVACAINE FOR POST-OPERATIVE ANALGESIA IN ABDOMINAL AND LOWER LIMB SURGERY

2021 ◽  
pp. 29-31
Author(s):  
Anant Prakash ◽  
Rahul Kumar ◽  
Chandeshwar Choudhary ◽  
Debarshi Jana
Keyword(s):  
Comparative Study ◽  
Lower Limb ◽  
Heart Beat ◽  
Epidural Administration ◽  
Visual Analogue Pain ◽  
Post Operative Period ◽  
Epidural Bupivacaine ◽  
Lower Limb Surgery ◽  
Group A ◽  
Group B

Background: Epidural administration of various analgesics gained increasing popularity following the discovery of opioid receptors in the spinal cord capable of producing potent analgesia. This effect seems to be greatest when epidural anaesthesia in continued in the post-operative period as epidural analgesia. It is now clear that epidural administration of opioids. Ours was a comparative study between epidural bupivacaine with buprenorphine and epidural bupivacaine for post-operative analgesia in abdominal and lower limb surgery. Methods: 60 patients undergoing lower abdominal and lower limb surgeries of either sex with ASA grade 1 and 2 aged between 20 and 60 years for divided into two groups. After completion of the surgery and when the effect of local anaesthetic wears of and the patients complains of pain the intended study drugs were given when visual analogue pain score touched 5 cm mark. Group – A: Patients received 8ml of 0.25% bupivacaine + 0.15mg of buprenorphine. Group – B: patients received 0.25% of bupivacaine alone. In the post-operative period the following parameters were studied, 1. Onset of analgesia, 2. Duration of analgesia, 3. Vital parameters such as heart beat, blood pressure, respiratory rate, sedation score and visual analogue score were recorded, 4. Side effects like nausea, vomiting, hypotension, respiratory depression, and pruritus allergic reaction were looked for. Results: It is observed that onset of analgesia in Group A (0.25% bupivacaine + 0.15mg buprenorphine) was 7.35 min. When compared to Group B which 15.5 min, which is statically signicant (P<0.05). Duration of analgesia in Group A is 17.23 hrs compared to Group B, which is 5.2 hrs, this is statically signicant (P<0.05). Visual analogue scale was reduced in Group A compared to Group B Conclusions: Addition of buprenorphine to bupivacaine by epidural injection for post-operative analgesia improves the onset, The duration and the quality of analgesia

The Value of Abdominal and Pelvic CT Scan in Trauma Patients With Low Injury Severity Score and High Glasgow Coma Scale

2021 ◽  
pp. 000313482110474
Author(s):  
Tarik Wasfie ◽  
Daniel Rivera ◽  
Mursal Naisan ◽  
Shelby Zaremba ◽  
Mikayla Depuydt ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Glasgow Coma Scale ◽  
Physical Examination ◽  
Injury Severity ◽  
Surgical Intervention ◽  
Trauma Patients ◽  
Ct Findings ◽  
Group A ◽  
Fast Exam ◽  
Group B

Introduction Computed tomography scans became the mainstay of emergency department (ED) evaluation of trauma patients including those with a high Glasgow Coma Scale (GCS) and a low Injury Severity Score (ISS). We elected to find the value of abdominal and pelvic CT in patients with negative physical examination and Focused Assessment of Sonography for Trauma (FAST) on arrival to the ED. Methods This study is a retrospective analysis of 901 consecutive patients from 2017 to 2019 who presented to the ED with level 2 and 3 activation criteria. Each patient received a physical examination, CT abdomen and pelvis, and FAST exam. Data were collected on external factor including GCS, ISS, age, sex, comorbidities, anticoagulation use, and surgical intervention. The patients were divided into 2 groups, Group A and B. Group A consisted of patients with a negative physical exam, FAST, and CT result. Group B included patients with a negative physical exam and FAST exam with positive CT findings. Statistical analysis was done using a Student’s t-test and chi-square test for significance value of P < .05. Institutional Review Board approval was obtained for this study. Results A total of 901 patients were analyzed which included 489 (54.3%) male and 412 (45.7%) female with a mean age of 56.2 (SD = 22.62) years. Out of the 901 patients, 461 patients received a physical, FAST, and CT exam. Group A consisted of 442 (95.9%) patients and Group B had 19 (4.1%) patients. Both groups were similar in GCS and ISS scoring with no significance difference in age, sex, comorbidities, and anticoagulation use. There was a significant difference in the ICU and hospital mean length of stay when CT scan was positive [2 (SD = 4.23) days vs. .6 (SD = 1.33) days with P < .0001 and 4.57 (SD ± 4.17) days vs. 2.5 (SD = 2.00) days with P < .0001, respectively]. The CT findings of the 19 patients in group B consisted of 6 incidentalomas, 5 vertebral compression fractures, 4 pelvic bone fractures, 1 minor liver contusion, 1 non-specific bowel thickening, 1 non-displaced rib fracture, and 1 case of small amount of free fluid in the pelvis. None of the CT findings required surgical intervention. Conclusion Computed tomography of the abdomen and pelvis in trauma patients with high GCS and low ISS with initial negative physical and FAST examination did not provide additional critical information.

scholarly journals Comparing the Analgesic Efficacy of Intrathecal Bupivacaine Alone with Intrathecal Bupivacaine Midazolam or Magnesium Sulphate Combination in Patients Undergoing Elective Infraumbilical Surgery

2016 ◽  
Vol 2016 ◽  
pp. 1-6 ◽  
Author(s):  
Josef Attia ◽  
Amany Abo Elhussien ◽  
Mostafa Zaki
Keyword(s):  
Side Effects ◽  
Magnesium Sulphate ◽  
Lower Limb ◽  
Analgesic Efficacy ◽  
Motor Blockade ◽  
Sensory Blockade ◽  
Lower Limb Surgery ◽  
Group A ◽  
Group B ◽  
Limited Duration

Background. Spinal anaesthesia, which is one of the techniques for infraumbilical surgeries, is most commonly criticized for limited duration of postoperative analgesia. Aim of the Work. The aim of this study was to decrease bupivacaine dose used in spinal anesthesia in patients undergoing orthopedic lower limb surgery and reduce its possible side effects. Patient and Methods. Sixty adult patients of both sexes, divided into three. Group C received 2.5 mL bupivacaine and 0.5 mL saline 0.9%. Group A received 2.5 mL bupivacaine and 0.5 mL midazolam. Group B received 2.5 mL bupivacaine and 0.5 mL magnesium sulphate. Results. As regards onset of both motor and sensory blockade, there are a significant decrease in group A and a significant increase in group B as compared to group C, with a significant decrease in duration of motor blockade and significant increase in duration of sensory blockade in both group A and group B, respectively, as compared to group C, with a significant decrease in the duration of sensory blockade in group B as compared to group C. Conclusions. These results suggested that intrathecal midazolam as an adjuvant for bupivacaine increases the duration of both sensory and motor blockade more than that of magnesium sulphate.

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