No abstract available.
Adult ; Arteriovenous Shunt, Surgical/*adverse effects ; Female ; Humans ; Ischemia/diagnosis/*etiology/surgery ; Ligation ; Peripheral Nervous System Diseases/diagnosis/*etiology/surgery ; *Renal Dialysis ; Reoperation ; Treatment Outcome ; Upper Extremity/*blood supply

PURPOSE: Cerebral ischemic lesions are frequently observed after carotid artery stenting (CAS), and anti-platelet agents are used to prevent stent thrombosis and peri-procedural complications. However, despite the premedication, cerebral ischemic lesions are observed, suggesting that they may rather be related to anti-platelet resistance. We, therefore, investigated the effects of anti-platelet resistance on the development of cerebral ischemic lesions after CAS. MATERIALS AND METHODS: We retrospectively reviewed patients who received CAS and selected patients for whom brain MRI was performed within 24 hours after CAS and for whom anti-platelet resistance was checked. Anti-platelet resistance was examined by the VerifyNow system. We analyzed the correlation between anti-platelet resistance and cerebral ischemic lesions detected on follow-up MRI. RESULTS: Among 76 patients, 45 (59.2%) developed new ischemic lesions after CAS. Twelve (15.8%) patients showed aspirin resistance and 50 (65.8%) patients showed clopidogrel resistance. Patients with a new ischemic lesion demonstrated a significantly greater frequency of clopidogrel resistance than those who had no new ischemic lesion (82.2% versus 41.9%, p=0.001). The frequency of aspirin resistance was not significantly different between the groups of patients with and without new ischemic lesions (20.0% versus 9.7%, p=0.340). In multivariate analysis, clopidogrel resistance was a significant risk factor for post-procedural cerebral ischemia. CONCLUSION: Anti-platelet resistance can be used to predict new ischemic lesions after CAS. Anti-platelet resistance should be evaluated in all patients prior to CAS to prevent ischemic complications related to CAS.
Aged ; Aspirin/*therapeutic use ; Brain Ischemia/diagnosis/*etiology ; Carotid Arteries/*surgery ; *Drug Resistance ; Female ; Humans ; Male ; Middle Aged ; Multivariate Analysis ; Platelet Aggregation Inhibitors/*therapeutic use ; Retrospective Studies ; Stents/*adverse effects

INTRODUCTIONThis paper reviews the epidemiology, aetiology and management of upper limb ischaemia in a series of 8 patients presenting to a tertiary referral centre over a 4-year period and the review of the pertinent literature.

MATERIALS AND METHODSDetails of patients admitted to Tan Tock Seng Hospital (TTSH) due to critical ischaemia of the upper limbs were obtained from admission summaries through the Computerised Patient Support System (CPSS) and operative notes through LOTUS.

RESULTSThere were 8 patients who presented with upper limb ischaemia excluding trauma and iatrogenic causes over the last 4 years. All patients underwent embolectomy. One patient had an amputation post-embolectomy. Our short-term results were encouraging with 7 patients who were well enough to be discharged. One patient had a massive brainstem stroke and was discharged home for comfort care at the request of the family.

CONCLUSIONCareful physical examination and history taking, prompt recognition of upper limb ischaemia and active approach to management in the form of embolectomy are crucial in obtaining a good outcome and reducing the risk of late disabling effects.

Aged ; Aged, 80 and over ; Anticoagulants ; therapeutic use ; Catheterization ; Coronary Angiography ; Embolectomy ; instrumentation ; Female ; Humans ; Ischemia ; diagnosis ; epidemiology ; etiology ; surgery ; Male ; Middle Aged ; Retrospective Studies ; Singapore ; epidemiology ; Treatment Outcome ; Upper Extremity ; blood supply

Duodenal injury is a serious abdominal organ injury. Duodenal fistula is one of the most serious complications in gastrointestinal surgery, which is concerned for its critical status, difficulty in treatment and high mortality. Thoracic and abdominal compound closed injury and a small part of open injury are common causes of duodenal injury. Iatrogenic or traumatic injury, malnutrition, cancer, tuberculosis, Crohn's disease etc. are common causes of duodenal fistula, however, there has been still lacking of ideal diagnosis and treatment by now. The primary treatment strategy of duodenal fistula is to determine the cause of disease and its key point is prevention, including perioperative parenteral and enteral nutrition support, improvement of hypoproteinemia actively, avoidance of stump ischemia by excessive separate duodenum intraoperatively, performance of appropriate duodenum stump suture to ensure the stump blood supply, and avoidance of postoperative input loop obstruction, postoperative stump bleeding or hematoma etc. Once duodenal fistula occurs, a simple and reasonable operation can be selected and performed after fluid prohibition, parenteral and enteral nutrition, acid suppression, enzyme inhibition, anti-infective treatment and maintaining water salt electrolyte and acid-base balance. Double tube method, duodenal decompression and peritoneal drainage can reduce duodenal fistula-related complications, and then reduce the mortality, which can save the lives of patients.
Abdominal Injuries ; complications ; Anti-Infective Agents ; therapeutic use ; Decompression, Surgical ; Digestive System Surgical Procedures ; adverse effects ; methods ; Drainage ; Duodenal Diseases ; diagnosis ; etiology ; prevention & control ; therapy ; Duodenum ; blood supply ; injuries ; surgery ; Enteral Nutrition ; Humans ; Hypoproteinemia ; therapy ; Intestinal Fistula ; diagnosis ; etiology ; prevention & control ; therapy ; Ischemia ; prevention & control ; Nutritional Support ; Parenteral Nutrition ; Postoperative Complications ; prevention & control ; therapy ; Suture Techniques ; Thoracic Injuries ; complications