scholarly journals CHARACTERISTICS OF PURULONECROTIC LESIONS IN COVID-19 PATIENTS

2021 ◽  
pp. 19-26
Author(s):  
A.N. Belyaev ◽  
I.S. Pol'kina
Keyword(s):  
Social Life ◽  
Inflammatory Diseases ◽  
Lower Extremities ◽  
Limb Ischemia ◽  
Lower Limbs ◽  
Limb Amputation ◽  
Acute Limb Ischemia ◽  
Arterial Embolism ◽  
Group 2 ◽  
Group 1

The COVID-19 pandemic has changed not only our social life, but also the course of many diseases, including purulent-inflammatory diseases of the lower extremities. The aim of the paper is to assess the influence of COVID-19 on purulonecrotic lesions of the lower extremities. Materials and Methods. We analyzed the results of treatment of 65 patients with purulonecrotic lesions of the lower extremities. All the patients were divided into 2 groups: Group 1 – 32 Non-COVID-19 patients, Group 2 – 33 COVID-19 patients. We studied laboratory blood parameters, hemostatic systems, performed lungs computed tomography (CT), and color-coded duplex scanning (CDS) of veins. Results. COVID-19 is more likely to affect patients aged 60–69 (51.5 %) and females (66.7 %). In Group 2 the level of leukocytes was higher than in Group 1 (11.2×109 and 13.9 109, respectively, p<0.05). Patients in both groups showed a tendency to hypercoagulability during anticoagulant therapy. In Group 2 patients, the percentage of transfemoral amputations was higher than in Group 1 patients (58 % and 18.8 % respectively). Arterial embolism of the lower limbs in Group 2 was observed in 6 % of patients. There were no deaths in Group 1, but in Group 2 mortality rate was 33.3 %. Conclusion. COVID-19 increases the number of arterial and venous thrombosis, often complicated by acute limb ischemia. Ischemic purulonecrotic processes complicated by COVID-19 are more severe, often lead to major limb amputation and are an important aggravating factor leading to death. Key words: COVID-19, purulonecrotic complications, coagulation, amputation. Пандемия COVID-19 не только внесла коррективы в социальную жизнь, но и изменила течение многих заболеваний, в т.ч. и гнойно-воспалительных поражений нижних конечностей. Цель. Оценить влияние коронавирусной инфекции на течение гнойно-некротических поражений нижних конечностей. Материалы и методы. Проведен анализ результатов лечения 65 больных с гнойно-некротическими поражениями нижних конечностей. Пациенты были разделены на 2 группы: 1-я группа – 32 больных без COVID-19, 2-я группа – 33 больных с COVID-19. Исследовались лабораторные показатели крови, системы гемостаза, проводились компьютерная томография легких, цветное дуплексное сканирование вен, анализировались результаты лечения. Результаты. COVID-19 чаще поражаются пациенты в возрасте 60–69 лет (51,5 %) и лица женского пола (66,7 %). У больных 2-й группы уровень лейкоцитов был выше, чем в 1-й группе (11,2×109/л и 13,9 ×109/л соответственно, р<0,05). На фоне антикоагулянтной терапии у больных обеих групп отмечалась тенденция к гиперкоагуляции. У больных 2-й группы ампутации на уровне бедра достигли 58 %, что более чем в 2 раза больше, чем у больных 1-й группы (18,8 %). Тромбоэмболии артерий конечностей во 2-й группе составили 6 %. Летальности в первой группе не было, во 2-й группе – 33,3 %. Выводы. Коронавирусная инфекция способствует возрастанию количества артериальных и венозных тромбозов, нередко осложняющихся острой ишемией конечностей. Ишемические гнойно-некротические процессы на фоне COVID-19 имеют более тяжелое течение, часто приводят к высокой ампутации конечности и являются важным отягощающим фактором, приводящим к летальному исходу. Ключевые слова: COVID-19, гнойно-некротические осложнения, коагуляция, ампутация.

scholarly journals Embolism to the main limb arteries in patients with atrial fibrillation

2022 ◽  
Vol 20 (4) ◽  
pp. 14-20
Author(s):  
M. V. Mel’nikov ◽  
A. V. Sotnikov ◽  
D. S. Kozhevnikov ◽  
M. V. Solov’yeva ◽  
S. A . Boldueva
Keyword(s):  
Atrial Fibrillation ◽  
Limb Ischemia ◽  
Limb Amputation ◽  
Acute Ischemia ◽  
Acute Limb Ischemia ◽  
Surgical Department ◽  
The Past ◽  
Group 3 ◽  
Group 1

Introduction. Acute limb ischemia due to embolism in patients with atrial fibrillation remains poorly studied. Objective – to study the clinical significance and role of atrial fibrillation (AF) in the development of embolism to the bifurcation of the aorta and the main arteries of the limbs. Materials and methods. Treatment results of 1816 patients with acute ischemia of the extremities due to embolism treated at a specialized vascular surgical department for the past 30 years were analyzed. 1611 (88.7 %) of them had AF. The distribution into studied groups was according to the period time factor. Group 1 (n = 744) consisted of patients admitted in the period from 1991 to 2000; in group 2 (n = 568) – admitted in the period from 2001 to 2010, in group 3 (n = 299) – from 2011 to 2020. Methods included clinical examination, electrocardiography, Doppler-ultrasound, echocardiography. Results. The role of rheumatic heart disease as a cause of AF has decreased over the past decades by almost 10 times (from 19.5 % in group 1 to 2.0 % in group 3). Currently, the main background diseases for the development of AF are arterial hypertension and various forms of coronary artery disease. Embolism in patients with AF may develop in the arteries of all vascular areas of the systemic circulation, but in the practice of a vascular surgeon more often in the main arteries of minor caliber – the brachial (24.5 %) and popliteal (13.0 %). Multiple embolisms to various vascular areas were found in 2.8 % of patients. Urgent surgical revascularization of the limb by open embolectomy was performed in 1481 (91.9 %) patients that allowed 1348 (83.7 %) to be discharged with limb-sparing. Conclusion. In patients with acute limb ischemia of embologenic ethiology, comorbid AF has 88.7 % of them. Urgent embolectomy allows 83.7 % of patients to be discharged without limb amputation. Hospital mortality in the period 1991–2000 was 15.6 %, the last decade has been reduced to 7.4 %.

Analysis of therapy effectiveness of deep vein thrombosis of lower limbs with warfarin and rivaroxaban in the long-term period

2020 ◽  
Author(s):  
А.А. Полянцев ◽  
Д.В. Фролов ◽  
Д.В. Линченко ◽  
Ю.В. Щелокова ◽  
Т.А. Литвинова ◽  
...  
Keyword(s):  
Deep Vein Thrombosis ◽  
Oral Anticoagulants ◽  
Lower Limbs ◽  
Prophylactic Regimen ◽  
Therapy Regimen ◽  
Vein Thrombosis ◽  
Group 2 ◽  
Deep Vein ◽  
Group 1

Введение. Влияние стандартной и альтернативных схем антикоагулянтной терапии на степень и скорость реканализации глубоких вен привлекает внимание современных исследователей. Цель исследования: сравнение эффективности терапии тромбоза глубоких вен (ТГВ) нижних конечностей варфарином и ривароксабаном в отдаленном периоде. Материалы и методы. В исследование включено 94 пациента с ТГВ нижних конечностей, которые были разделены на 2 группы в зависимости от назначенной схемы лечения. Средний возраст 50 пациентов группы 1 составил 44,0 12,6 лет, 44 больных группы 2 39,5 11,7 лет. Пациентам группы 1 был назначен варфарин, группы 2 ривароксабан в течение 6 мес после выписки. Конечная точка наблюдения 4 года. Результаты. Прием антикоагулянта ранее установленного срока прекратили 18 (36) пациентов из группы 1 и 2 (4,5) пациента из группы 2. Режим эластической компрессии в обеих группах пациенты соблюдали нерегулярно. Рецидив венозных тромбоэмболических осложнений в группе 1 отмечен в 11 (22) случаях, в группе 2 у 7 (15,9) пациентов. Отрицательная динамика ультразвукового обследования складывалась у пациентов обеих групп: у 16 пациентов группы 1 и у 9,1 группы 2 появились признаки поражения ранее неизмененных вен или окклюзия ранее проходимой вены после перенесенного тромбоза без клиники острого венозного тромбоза в анамнезе. Трофические расстройства отмечены у одного пациента группы 2 и у 1/3 пациентов группы 1 к четвертому году наблюдения. Значимые отличия между группами были получены по таким параметрам, как приверженность к лечению и степень тяжести венозной недостаточности, оцениваемая клинически, в пользу ривароксабана. Заключение. Неудовлетворительные результаты лечения при использовании стандартной схемы терапии ТГВ требуют назначения препаратов из группы новых оральных антикоагулянтов с возможным внедрением схемы профилактического приема. Introduction. Effect of standard and alternative anticoagulant therapy regimens on the degree and rapidity of deep vein recanalization attracts the attention of modern researchers. Aim: to compare the treatment effectiveness of deep vein thrombosis (DVT) of lower limbs with warfarin and rivaroxaban in the long-term period. Materials and methods. The study included 94 patients with DVT of lower limbs they were divided into 2 groups depending on the prescribed treatment regimen. The average age of 50 patients of group 1 was 44.0 12.6 years, 44 patients of group 2 39.5 11.7 years. Warfarin was prescribed to patients of group 1, rivaroxaban to patients of group 2 treatment was prescribed for 6 months after discharge. The endpoint of observation was 4 years. Results. 18 (36) patients from group 1 and 2 (4.5) patients from group 2 stopped taking the anticoagulant earlier than target date. Elastic compression treatment patients in both groups kept irregularly. Recurrence of venous thromboembolic complications in group 1 was noted in 11 (22) cases, in group 2 in 7 (15.9) patients. The negative ultrasound dynamics was observed in patients of both groups: 16 of patients in group 1 and 9.1 in group 2 had lesion signs of previously unchanged veins or occlusion of a previously passable vein after thrombosis without clinic of acute venous thrombosis. Trophic disorders were identified in 1 patient in group 2 and in 1/3 of patients in group 1 by the 4th year of observation. Significant differences between the groups were obtained in favor of rivaroxaban according to such parameters as adherence to treatment and the severity of venous insufficiency. Conclusion. Unsatisfactory results of DVT treatment with standard therapy regimen require the administration of new oral anticoagulants with the possible introduction of prophylactic regimen.

Endoscopic approaches to benign sphenoid sinus lesions: development of an algorithm based on 13 years of experience

2014 ◽  
Vol 128 (9) ◽  
pp. 791-796 ◽  
Author(s):  
A S Elhamshary ◽  
H E Romeh ◽  
M F Abdel-Aziz ◽  
S M Ragab
Keyword(s):  
Revision Surgery ◽  
Sphenoid Sinus ◽  
Inflammatory Diseases ◽  
Endoscopic Approach ◽  
Surgical Approaches ◽  
Transnasal Approach ◽  
First Choice ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

AbstractObjective:To develop an algorithm for selecting the optimal endoscopic approach for benign sphenoid lesions.Methods:Charts of 392 patients were reviewed and categorised according to disease nature and extent as follows: group 1 comprised isolated sphenoid sinus lesion cases, group 2 consisted of pansinus lesion cases and group 3 comprised lateral sphenoid recess lesion cases. Surgical approaches, difficulties and complications were noted.Results:A transnasal approach was employed in 40.8 per cent of cases (23.2 per cent were group 1 patients, 16.1 per cent were group 2 patients and 1.5 per cent were group 3 patients), a transethmoidal approach was utilised in 54.3 per cent of cases (group 2 patients) and a transpterygopalatine fossa approach was selected in 4.9 per cent of cases (group 3 patients). Surgical difficulties were encountered in 11.9, 10.8 and 0 per cent of patients in whom transnasal, transethmoidal or transpterygopalatine approaches were utilised, respectively.Conclusion:Radio-pathological categorisation provided a means of developing an algorithm for selecting the most appropriate endoscopic approach. Transnasal sphenoidotomy should be the first choice of approach whenever applicable. Lateral sphenoid recess non-inflammatory diseases should be managed through a transpterygopalatine fossa approach. Revision surgery does not play a key role in the algorithm.

Acute limb ischemia due to arterial embolism of tumor

1990 ◽  
Vol 13 (6) ◽  
pp. 372-374 ◽  
Author(s):  
Parvati Ramchandani ◽  
Michael C. Morris ◽  
Robert M. Zeit
Keyword(s):  
Limb Ischemia ◽  
Acute Limb Ischemia ◽  
Arterial Embolism

scholarly journals Analysis of associated diseases in patients with acute critical lower limb ischemia

2013 ◽  
Vol 66 (1-2) ◽  
pp. 41-45 ◽  
Author(s):  
Vladimir Manojlovic ◽  
Vladan Popovic ◽  
Dragan Nikolic ◽  
Djordje Milosevic ◽  
Janko Pasternak ◽  
...  
Keyword(s):  
Mortality Rate ◽  
Lower Limb ◽  
Balloon Catheter ◽  
Limb Ischemia ◽  
Lower Limbs ◽  
Metabolic Decompensation ◽  
Arterial Embolism ◽  
Lower Limb Ischemia ◽  
Associated Diseases ◽  
Arterial Blood

Introduction. Acute critical lower limb ischemia refers to the state of severely impaired vitality of lower limbs due to acute occlusion of arterial blood vessel by a thrombus or emboli. Surgical revascularization in the first 6-12 hours after the onset of symptoms gives the best results. However, a high mortality rate and probability of limb loss make this problem more debatable, and can be related with associated diseases. Material and Methods. This research included 95 patients who had been operated within the first 12 hours after the onset of symptoms of critical limb ischemia. We collected the following data: age and sex of patients, etiology of limb ischemia, type of operation, associated diseases and outcome of treatment. Results and Discussion. Most of the patients were 70 to 80 years old, both sexes being equally represented. There was significantly more arterial embolism (70%) than thrombosis on the prior arterial lesion. Most of the embolizations were treated with Fogarty balloon catheter embolectomy (98%); however, a great number of arterial thrombosis demanded more complex ?inflow? and ?outflow? ensuring procedures such as thromboendarterectomy and bypass (33%). The performed surgical procedures showed no statistical differences when final outcome was analyzed. Amputation had to be performed in about 3% of the patients and all of them were diabetics. Mortality rate in this research was 10.5% and 7/10 with this outcome had severe form of chronic myocardiopathy and metabolic decompensation. Conclusion. Acute critical lower limb ischemia should be treated surgically as soon as possible. Negative outcomes are associated with comorbidity and general condition of the patient.

Mobilization of Stem Cells from the Bone Marrow Is Required for Neovascularization of Ischemic Limbs in Mice.

Blood ◽  
2005 ◽  
Vol 106 (11) ◽  
pp. 4233-4233
Author(s):  
Jeong-A Kim ◽  
Chang -Hoon Lee ◽  
Jin-A. Yoon ◽  
Woo-Sung Min ◽  
Chun-Choo Kim
Keyword(s):  
Stem Cells ◽  
Bone Marrow ◽  
Hind Limb ◽  
Limb Ischemia ◽  
Hind Limb Ischemia ◽  
Ischemic Limb ◽  
Group 3 ◽  
Group 2 ◽  
Surgically Induced ◽  
Group 1

Abstract We examined whether the injection of bone marrow mononuclear cells (BM-MNCs) or mesenchymal stem cells (MSCs) might augment angiogenesis and collateral vessel formation in a mouse model of hind limb ischemia. C57BL/6 BM-MNCs were isolated by centrifugation through a Histopaque density gradient and MSCs were obtained from C57BL/6 bone marrow and cultured in low-glucose DMEM media. Unilateral hind limb ischemia was surgically induced in C57BL/6 mice (control; n=4), and autologous BM-MNCs (Group 1; n=4, 1.8±0.2 x107/animal) or MSCs (Group 2; n=4, 1.0±0.14 x106/animal) or BM-MNCs and MSCs (Group 3; n=4, 2.3±0.1 x107 and 1.1±0.21 x106/animal) were transplanted into the ischemic tissue. Six weeks after transplantation, the group 1, group 2 and group 3 had a higher capillary/muscle ratio (0.82±0.12 vs 0.85±0.08 vs 0.97 ±0.03) than control (0.46±0.12, p&lt;0.05) (Fig. 1). This result suggested that direct local transplantation of autologous BM-MNCs or MSCs seems to be a useful strategy for therapeutic neovascularization in ischemic tissues. Next, we evaluated whether bone marrow derived stem cells were participated in the process of local injected stem cells forming new vessels. In general, mobilizing stem cells from bone marrow to local site, MMP-9 has been known as an important molecule. So we used the MMP-9 deficient KO mice and wild type, 129SvEv mice were used in the experiments. Autologous BM-MNCs and MSCs were transplanted into the ischemic limb in MMP-9 (−/−) (n=4) after unilateral hind limb ischemia was surgically induced and then the same experiments was done in MMP-9 (+/+) mice (n=4). The number of the injected BM-MNCs and MSCs was 2.2±0.05 x107 and 0.87±0.17 x106/animal in MMP-9 (−/−). And the number of the injected BM-MNCs and MSCs was 2.1±0.17 x107 and 0.98±0.09 x106/animal in MMP-9 (+/+). No difference was seen in the BM-MNCs and MSCs were injected or not (0.52±0.07 vs 0.49±0.03,) in MMP-9 (−/−). But, in the case that BM-MNCs and MSCs were injected, the higher capillary/muscle ratio was seen in MMP-9 (+/+) compared to control (0.86 ±0.09 vs 0.49±0.03, P&lt;0.05) (Fig 2). This data indicated that the mobilization of bone marrow derived stem cells would have an important role in the neovasculrization although the stem cells were injected directly into the muscle of ischemic limb. Figure Figure Figure Figure

scholarly journals Superior Mesenteric Arterial Embolism Associated with an Acute Limb Ischemia: A Case Report and Literature Review

2014 ◽  
Vol 04 (04) ◽  
pp. 181-186 ◽  
Author(s):  
Abdesslam Bouassria ◽  
Elbachir Benjelloun ◽  
Imane Kamaoui ◽  
Hicham Elbouhaddouti ◽  
Ouadii Mouaqit ◽  
...  
Keyword(s):  
Case Report ◽  
Literature Review ◽  
Limb Ischemia ◽  
Acute Limb Ischemia ◽  
Arterial Embolism

scholarly journals Therapeutic Angiogenesis for Severely Ischemic Limbs — from Bench to Bedside in Acute Vascular Care

2017 ◽  
Vol 3 (4) ◽  
pp. 160-171
Author(s):  
Theodora Benedek ◽  
István Kovács ◽  
Imre Benedek
Keyword(s):  
Surgical Treatment ◽  
Limb Salvage ◽  
Arterial Occlusion ◽  
Limb Ischemia ◽  
Therapeutic Angiogenesis ◽  
Lower Limbs ◽  
Current Status ◽  
High Morbidity ◽  
Acute Limb Ischemia ◽  
Promising Alternative

Abstract Severe limb ischemia represents a critical condition, being associated with high morbidity and mortality rates. Patients with critical limb ischemia (CLI) require urgent initiation of interventional or surgical treatment, as restoration of the blood flow is the only way to ensure limb salvage in these critical cases. At the same time, in acute limb ischemia, a dramatic form of sudden arterial occlusion of the lower limbs, the integrity of the limb is also seriously threatened in the absence of urgent revascularization. From patients with CLI, 40% are “no option CLI”, meaning patients in whom, due to anatomical considerations or to the severity of the lesions, there is no possibility to perform interventional or surgical treatment or they have failed. Therapeutic angiogenesis has been proposed to serve as an effective and promising alternative therapy for patients with severe limb ischemia who do not have any other option for revascularization. This review aims to present the current status in therapeutic angiogenesis and the role of different approaches (gene or cell therapy, intra-arterial vs. intramuscular injections, different sources of cells) in increasing the rates of limb salvage in patients with severe ischemia of the lower limbs.

scholarly journals Functional autonomy and sarcopenia markers in women over 55 years of age

2021 ◽  
Vol 69 (4) ◽  
Author(s):  
Jhon Fredy Ramírez-Villada ◽  
Carlos Mario Arango-Paternina ◽  
Annie Tibaduiza-Romero ◽  
Leonardo Rodríguez-Perdomo ◽  
Nery Cecilia Molina Restrepo ◽  
...  
Keyword(s):  
Fat Mass ◽  
Multiple Linear Regression Model ◽  
Gait Pattern ◽  
Lower Limbs ◽  
Physically Active ◽  
Functional Autonomy ◽  
Colombian Women ◽  
Group 2 ◽  
Appendicular Mass ◽  
Group 1

Introduction: Some parameters used to diagnose sarcopenia, and functional autonomy disorders can lead to interpretation and classification errors. Objective: to analyze sarcopenia markers and their relationship with the strength and gait of physically active older women aged between 55 and 76 years. Materials & Methods: Analytical observational study conducted in 178 physically active Colombian women who were distributed in two age groups (Group 1: 55-66 years, n=98, and Group 2: 67-76 years, n=80). A multiple linear regression model was used to establish possible correlations between strength and gait indicators (dependent variables) and body composition (independent variables). Results: In group 1 (G1) the fat mass and the appendicular mass (appendicular lean/height2(kg/m2)) explained the variance of the power in the lower limbs (SJ: p= 0.001, R2 =0.56; CMJ: p =0.001, R2 =0.51; CMJAS: R2 =0.60, P= 0.001). Similar results were observed in group 2 (G2) (SJ: R2=0.32, DW=2.14; CMJ: R2 = 0.51, DW=2.38; CMJAS: R2=0.41, DW=2.56). Furthermore, fat mass explained differently the variance in G1 and G2 regarding the gait pattern (G1: p=-0.006; R2=20%; G2: p =-0.001; R2=29%).  Conclusion: The records of fat and appendicular mass allow studying negative changes in lower limb strength, and their effect on the gait pattern, as well as identifying the type of sarcopenia and functional autonomy disorders in Colombian physically active Colombian women aged 55 to 76 years.

scholarly journals Bleeding complications at the access sites during catheter directed thrombolysis for acute limb ischaemia: Mini review

2021 ◽  
Vol 5 (1) ◽  
pp. 001-003
Author(s):  
Noory Elias ◽  
Böhme Tanja ◽  
Beschorner Ulrich ◽  
Zeller Thomas
Keyword(s):  
Treatment Options ◽  
Limb Ischemia ◽  
Lower Limbs ◽  
Bleeding Complications ◽  
Limb Ischaemia ◽  
Acute Limb Ischemia ◽  
Access Site ◽  
Catheter Directed Thrombolysis ◽  
Acute Limb Ischaemia ◽  
Surgical Bypass

Acute and subacute ischemia of the lower limbs represents a major emergency with a high in-hospital mortality, complication, and leg amputation rates. Treatment options for acute limb ischemia include systemic anticoagulation, followed by various catheter based options including infusion of fibrinolytic agents (pharmacological thrombolysis), pharmacomechanical thrombolysis, catheter-mediated thrombus aspiration, mechanical thrombectomy, and any combination of the above or open surgical intervention (thromboembolectomy or surgical bypass). Minor and major bleeding complication during catheter directed thrombolysis (CDT) especially at access site are frequent. Bleeding complications require often an interruption or termination of CDT affecting clinical outcome of the patients. Recently we examined a new access site bleeding protection device during CDT.

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