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Chaudhary H, Mohan M, Jain A, Kumar V, Takia L, Sudhakar M, Angurana SK, Jindal AK. Acral Gangrene: Ugly Cousin of "COVID Toes" in Multisystem Inflammatory Syndrome in Children Associated with SARS-CoV-2? Pediatr Infect Dis J 2021; 40:e312-e313. [PMID: 33941741 DOI: 10.1097/inf.0000000000003181] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
A spectrum of dermatologic manifestations has been reported in multisystem inflammatory syndrome in children associated with SARS-CoV-2 infection. We report 2 patients with multisystem inflammatory syndrome in children and severe cardiovascular dysfunction who developed acral gangrene. Both responded well to therapy and recovered in the follow-up.
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Affiliation(s)
- Himanshi Chaudhary
- From the Allergy Immunology Unit, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Mithun Mohan
- Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Abhinay Jain
- Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Vijay Kumar
- Pediatric Intensive Care Unit, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Lalit Takia
- Pediatric Intensive Care Unit, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Murugan Sudhakar
- From the Allergy Immunology Unit, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Suresh Kumar Angurana
- Pediatric Intensive Care Unit, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ankur Kumar Jindal
- From the Allergy Immunology Unit, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Iqbal U. Gangrenous Gastritis: Unusual Cause Of Upper Gi Bleeding. J Ayub Med Coll Abbottabad 2019; 31:634-635. [PMID: 31933327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Chronic Mesenteric ischemia is an episodic hypoperfusion of small intestine due to atherosclerotic narrowing of mesenteric vessels. Typically, patients report postprandial epigastric pain. The association of abdominal pain with eating results in fear of eating and weight loss. Some patients present atypically with nausea, vomiting and/or GI bleeding likely from gut ischemia. We present here a case of 67-yearold male with history of COPD, Coronary artery disease and atrial fibrillation presented with hematemesis and black stools for one day. Patient reports no abdominal pain or weight loss. He was dizzy and nauseous. He was vitally stable and physical exam including abdominal exam was unremarkable except for the rectal exam which revealed black stools. Investigations revealed Haemoglobin of 16.1 and hematocrit of 45, WBCs of 34000 with 83% neutrophils and bicarbonate of 20. Patient underwent EGD for localizing the site of bleeding and showed stomach lumen completely filled with thrombus which prevented the accurate assessment if gastric mucosa. Repeat EGD was recommended and it revealed gangrenous appearing gastritis throughout with multiple clean ulcers which raised the suspicion of vascular compromise. CT angiography abdomen revealed complete proximal occlusion of Superior Mesenteric artery and near complete occlusion of celiac artery. He underwent successful SMA bypass from left iliac to mid SMA with PTFE graft. Symptoms of mesenteric ischemia can be non-specific and can mimic other aetiologies. Clinicians should consider this diagnosis in elderly patient with risk factors of atherosclerosis as early diagnosis reduces complication associated with serious life-threatening disease.
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A letter to Major-General Philip Mitchiner. Ann R Coll Surg Engl 2017; 99:428. [PMID: 28660830 DOI: 10.1308/rcsann.2017.0120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Cruz-Santiago J, Briceño-Sáenz G, García-Álvarez J, Beristain-Hernández JL. Gallstone ileus presenting as obstructive gangrenous appendicitis. Rev Esp Enferm Dig 2017; 109:150-151. [PMID: 28211283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
We present the very unusual case of a 38-year-old woman with acute appendicitis and intestinal obstruction. During surgery, a 2.5 cm gallstone impacted at the base of the cecal appendix was found as the cause of a gangrenous appendicitis and obstruction; a choledochal-duodenal fistula was found during the same surgery with no gallstones remaining in the gallbladder or elsewhere. The case was managed by appendectomy with retrieval of the gallstones and no other procedure was performed for the gallbladder or the fistula, since no other gallstone was found on examination. Previously, she was found to have a round, radio-opaque image on the right iliac fossa on imaging, initially identified as an appendicolith, but after pathological examination it turned out to contain cholesterol and calcium bilirubinate. Gallstone ileus as the cause of an obstructive gangrenous appendicitis is a very unusual disease presentation that should be kept in mind when finding an unusual appendicolith presentation in or out the appendix.
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Hingorani A, Ascher E, Marks N, Mutyala M, Shiferson A, Flyer M, Jacob T. Comparison of Computed Tomography Angiography to Contrast Arteriography for Patients Undergoing Evaluation for Lower Extremity Revascularization. Vasc Endovascular Surg 2016; 41:115-9. [PMID: 17463200 DOI: 10.1177/1538574406297265] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In an effort to explore alternatives to contrast arteriography, we compared computed tomography angiography to contrast arteriography for defining anatomic features of patients undergoing lower extremity revascularization. From November 2003 to March 2004, 36 inpatients with chronic lower extremity ischemia underwent contrast arteriography and computed tomography angiography before undergoing lower extremity revascularization procedures. A Siemens 16 slice multiplanar computed tomography device with bolus tracking was used for these exams. The reports of these tests and images were compared prospectively, and the differences in the aorto-iliac segment, femoral-popliteal, and infrapopliteal segments were noted. The vessels were classified as mild disease (<50%), moderate disease (50%-70%), severe (71%-99%), and occluded. The studies and treatment plans based on these data were compared. The mean age was 76 ± 12 years (SD). Indications for the procedures included gangrene (45%), ischemic ulcer (32%), rest pain (19%), and severe claudication (3%); 69% were diabetics. Accuracy of computed tomography angiography in the aorto-iliac, femoral-popliteal, and infrapopliteal segments was 100%, 81%, and 59%, respectively. Thirteen of 18 (72%) of these disagreements resulted in a different procedure than that suggested by computed tomography angiography. A review of the data obtained in this series indicated that computed tomography angiography appears to be unable to obtain adequate information in this highly selected population at our institution.
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Affiliation(s)
- Anil Hingorani
- Division of Vascular Surgery, Department of Surgery, Mainmonides Medcine Center, Brooklyn, New York 11219, USA
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Habenicht KI, Wright CJ, Hunter CT, Adraktas DD, Hathuc VM, Kaiser ML, Hildreth AN, Miller PR. Do Radiographic Findings of Gangrenous Cholecystitis in the Preoperative Setting Influence Patient Outcome? Am Surg 2016; 82:E28-E30. [PMID: 26802850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- Katherine I Habenicht
- Department of General Surgery, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
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Rosenblum JK, Dym RJ, Sas N, Rozenblit AM. Gallbladder torsion resulting in gangrenous cholecystitis within a parastomal hernia: findings on unenhanced CT. J Radiol Case Rep 2013; 7:21-5. [PMID: 24421934 DOI: 10.3941/jrcr.v7i12.1518] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Gallbladder torsion is a rare cause of acute gangrenous cholecystitis; its occurrence within an abdominal hernia has not been previously reported. We present such a case occurring within a parastomal hernia and imaged with unenhanced CT.
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Affiliation(s)
| | - R Joshua Dym
- Department of Radiology, Montefiore Medical Center, Bronx, NY, USA
| | - Norman Sas
- Department of Surgery, Montefiore Medical Center, Bronx, NY, USA
| | - Alla M Rozenblit
- Department of Radiology, Montefiore Medical Center, Bronx, NY, USA
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Affiliation(s)
- A Schattner
- Department of Medicine, Kaplan Medical Centre, Jerusalem, Israel
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Oya J, Hanai K, Miura J, Maruyama S, Ishii A, Syono K, Shinjo T, Iwamoto Y. Diabetic gangrene in multiple fingers and toes after a dog bite in an elderly patient with type 2 diabetes. Intern Med 2011; 50:1303-7. [PMID: 21673466 DOI: 10.2169/internalmedicine.50.4930] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A 78-year-old diabetic woman experienced multiple sites of gangrene not only in fingers that were directly bitten by a dog but also in fingers and toes that had not beenbitten. Her glycemic control was fair and microvascular complications were mild. There were no clinical findings related to angitis, collagenosis or severe infection. The fingers and toes with gangrene were amputated. The pathological diagnosis was diabetic gangrene. This report presents a case of multiple sites of gangrene of the fingers and toes after a dog bite in an elderly patient with type 2 diabetes.
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Affiliation(s)
- Junko Oya
- Diabetes Center, Tokyo Women's Medical University, Japan.
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Paul SP, Paulie N, Hawes D. Appendicitis presenting as gastroenteritis: the importance of making a correct diagnosis. Nurs Times 2010; 106:20. [PMID: 20836477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
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Unnikrishnan AG, Gowri P, Arun K, Varma AK, Kumar H. Tropical chronic pancreatitis and peripheral vascular disease. A case report. JOP 2007; 8:198-200. [PMID: 17356243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
CONTEXT It is well-known that subjects with diabetes resulting from tropical chronic pancreatitis are prone to diabetic microvascular complications (neuropathy, nephropathy and retinopathy). However, macrovascular complications (coronary artery disease, stroke and peripheral vessel disease) are rare, as these subjects are younger, leaner and have lower cholesterol levels. CASE REPORT We report the case of a 51-year-old male who had tropical chronic pancreatitis, diabetes and severe peripheral vessel disease with gangrene. He was lean, had borderline lipid levels and was normotensive. His ECG was normal. CONCLUSIONS Peripheral vascular disease can occur in these diabetic subjects, even without additional risk factors for atherosclerotic vascular disease. All subjects with tropical chronic pancreatitis and diabetes should have a complete foot examination once a year, in addition to screening for other vascular complications.
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Abstract
Hepatobiliary scintigraphy evaluates the biliary clearance of Tc-99m-labeled iminodiacetic acid agents (Tc-99m IDA) and has a high sensitivity and specificity for the diagnosis of acute cholecystitis. False-negative studies are extremely rare. We describe an apparently normal nonmorphine-augmented hepatobiliary study in gangrenous acalculous cholecystitis. Based on clinical findings, computed tomography, and ultrasound demonstration of a dilated gallbladder, a cholecystectomy was performed. Pathologic examination of the gallbladder revealed acute gangrenous cholecystitis with culture positive for Klebsiella pneumoniae.
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Affiliation(s)
- Christopher Ananian
- Nuclear Medicine, Department of Radiology, Hospital of Saint Raphael, Yale University School of Medicine, New Haven, CT 06511, USA.
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Hamada T, Tanaka M, Hashimoto Y, Yamauchi M, Shigeoka N, Nakai K, Suenaga K. Contrast-enhanced sonographic findings of gangrenous meckel diverticulitis. J Ultrasound Med 2006; 25:1227-31. [PMID: 16929027 DOI: 10.7863/jum.2006.25.9.1227] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Affiliation(s)
- Toshihide Hamada
- Department of Gastroenterology, Miyoshi Central Hospital, 531 Higashisakeya, Miyoshi, Hiroshima 728-8502, Japan.
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Mandolfino T, Canciglia A, D'Alfonso M, Carmignani A. Infrainguinal revascularization based on duplex ultrasound arterial mapping. INT ANGIOL 2006; 25:256-60. [PMID: 16878073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
AIM Recent reports have advocated duplex ultrasound arterial mapping (DUAM) as the sole preoperative imaging modality for planning infrainguinal revascularization. This study reports the outcome of arterial revascularization procedures for chronic limb ischemia based on DUAM. METHODS From January 2002 to December 2004, 253 patients (175 men, 78 women) underwent infrainguinal revascularization based on DUAM. The indications for surgery were severe claudication (11%), rest pain (15%), gangrene (40%), non-healing ulcer (34%). Preoperative evaluation consisted of DUAM alone in 208 cases (82%) or a combination of DUAM and contrast arteriography (CA) in 30 (12%) and intraoperative angiography or direct exploration in 15 (6%). DUAM allowed imaging from the distal aorta to the pedal arteries and the selection of inflow and outflow bypass anastomosis sites. CA was deemed necessary due to technical difficulties or medico-legal reasons. RESULTS DUAM procedure time averaged 90+30 min. Proximal anastomosis was located in common femoral arteries in 202 cases, popliteal in 51. Distal anastomosis was to the tibial arteries in 144 cases and pedal arteries in 109. Primary patency was 89% and 67% at 12 and 36 months. Secondary patency was 93% and 82% at 12 and 36 months. CONCLUSIONS This experience shows that DUAM may be a safe alternative to CA for patients with chronic limb ischemia. Adequate training and experience is necessary to utilize this technique as the sole preoperative imaging modality for planning infrainguinal revascularization.
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Affiliation(s)
- T Mandolfino
- Unit and Specializing School of Vascular Surgery,University of Messina, Messina, Italy.
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Rubino V, Kirkwood ID, Bellon M, Chatterton BE. Gangrene after inadvertent intraarterial injection of amphetamine: appearance on a three-phase Tc-99m MDP bone scan. Clin Nucl Med 2006; 31:335-7. [PMID: 16714893 DOI: 10.1097/01.rlu.0000218774.81715.59] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Vito Rubino
- Department of Nuclear Medicine and Bone Densitometry, The Royal Adelaide Hospital, Adelaide, Australia.
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Vasugi Z, Danda D. Systemic lupus erythematosis with antiphospholipid antibody syndrome: a mimic of Buerger's disease. J Postgrad Med 2006; 52:132-3. [PMID: 16679678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/09/2023] Open
Abstract
This case report is about a past smoker who presented with history of recurrent ulcers and digital gangrene with claudication pain of the left foot for the past fifteen years. Clinical examination and angiogram showed disease involving the peripheral vessels of lower limb. This patient had been labeled as Buerger's disease 15 years ago based on clinical and demographic profile of the illness. We felt that the progression of the disease despite the patient having stopped smoking 15 years ago along with the presence of elevated inflammatory markers in the blood with proteinuria was not in keeping with the nature of the disease. Further evaluation revealed that the patient had systemic lupus erythematosus with antiphospholipid antibody syndrome. This case highlights the need for a careful search for diseases, which can mimic Buerger's disease in young smokers who present with peripheral vascular disease and who have an atypical clinical presentation or progression.
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Affiliation(s)
- Z Vasugi
- Department of Medicine II, Christian Medical College and Hospital, Vellore-632004, Tamil Nadu, India.
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Miyamoto M, Yasutake M, Takano H, Takagi H, Takagi G, Mizuno H, Kumita S, Takano T. Therapeutic angiogenesis by autologous bone marrow cell implantation for refractory chronic peripheral arterial disease using assessment of neovascularization by 99mTc-tetrofosmin (TF) perfusion scintigraphy. Cell Transplant 2005; 13:429-37. [PMID: 15468685 DOI: 10.3727/000000004783983837] [Citation(s) in RCA: 87] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
We investigated efficacy and safety of implantation of autologous bone marrow mononuclear cells plus platelets, including endothelial progenitor cells (EPCs), for recovering refractory chronic peripheral arterial disease (PAD) using visual and quantitative analyses by 99mTc-tetrofosmin (TF) perfusion scintigraphy, and also investigated various quantitative assessments objectively. We performed 12 consecutive cases and 19 limbs and hands with severe chronic PAD that were almost Fontaine class IV (11/12 cases, about 92%) in this trial. This treatment was very effective in relieving severe pain of PAD, especially for Buerger's disease. We used a visual analog scale (VAS) for measurement of pain level. The maximum pain level before implantation was 66.5+/-5.0 mm, and it decreased to 12.1+/-2.2 mm after implantation (p < 0.001). Rest pain in legs and fingers was resolved in 11 cases (11/12 cases, 92%). All patients could measure pain-free walking time on a treadmill, which improved remarkably (140+/-53 s before implantation vs. 451+/-74 s after implantation, p = 0.034). Resting ankle brachial pressure index (ABI) in legs implanted with bone marrow mononuclear cells was also improved (0.65+/-0.08 before implantation vs. 0.73+/-0.07 after implantation, p = 0.055). According to 99mTc-TF perfusion scintigraphy, the proximal area (region from knee to ankle) was 1.32+/-0.10 before implantation versus 1.56+/-0.11 after implantation (p = 0.007). 99Tc-TF perfusion scintigraphy in the distal area (region from ankle to end of toes, or from wrist to end of fingers) was 0.79+/-0.06 before implantation versus 0.83+/-0.06 after implantation (p = 0.29). Ischemic legs and hands that were injected showed increased perfusion blood flow. 99mTc-TF perfusion scintigraphy was effective to estimate visual and quantitative analysis of collateral vessels in neovascularization. We were successful with this new treatment for the most severe, chronic PAD that was not curable by any of the current treatments. Thus, this therapeutic angiogenesis could be a new strategy for saving severe ischemic limbs and hands.
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Affiliation(s)
- Masaaki Miyamoto
- First Department of Internal Medicine, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan.
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Mandolfino T, Canciglia A, Lamberto S, Carmignani A, D'Alfonso M, Bottari A. [Comparison between magnetic resonance angiography and duplex ultrasound for preoperative planning of lower limb revascularisation]. Chir Ital 2005; 57:615-20. [PMID: 16241092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
The purpose of this study was to compare magnetic resonance angiography with duplex ultrasound for defining anatomical features relevant to performing lower limb revascularisation. From June 2003 to June 2004, 30 consecutive patients with chronic lower limb ischaemia underwent magnetic resonance angiography and duplex ultrasound investigations before undergoing lower limb revascularisation procedures. The mean age was 72 years (range: 45-93). Indications for the procedure included resting pain (6 cases), ischaemic ulcer (8 cases), and gangrene (16 cases). We compared magnetic resonance angiography and duplex ultrasonography findings and the differences in the aorto-iliac, femoro-popliteal and infrapoliteal segments were noted. Magnetic resonance angiography and duplex ultrasound findings agreed in 13/15 cases (86%) in the aorto-iliac segment, in 14/17 (82%) in the femoro-popliteal segment, and in 8/11 (74%) in the infrapopliteal segment. In all, duplex ultrasound agreed with intraoperative findings in 97% of cases while magnetic resonance angiography agreed in 81%. These data show that magnetic resonance angiography is less accurate than duplex ultrasound in the infrapopliteal segment. Adeguate training is necessary before duplex ultrasound can be used as the only preoperative imaging procedure.
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Abstract
Necrosis of the ligamentum teres hepatis is a very rare and misdiagnosed pathology. Four cases have been reported in the literature. Clinical symptoms with acute abdominal pain suggest peritonitis. The diagnostic may be obtained by CT scan of the abdomen revealing a hypo/dense circular lesion, anterior to the liver, to the junction of the segments III and IV, associated with inflammation. The mechanism of isolated necrosis of the round liver ligament remains unclear. In the absence of a preoperative diagnosis, a video-laparoscopic exploration is proposed.
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Apras S, Elsurer R, Calguneri M, Haznedaroglu IC, Ozbalkan Z, Karakaya G, Coplu L. Massive deep venous thrombosis and venous gangrene in a 29-year-old case: metastatic epidermoid carcinoma with an unknown primary. ACTA ACUST UNITED AC 2004; 9:297-300. [PMID: 15621738 DOI: 10.1080/10245330410001714239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Cancer-associated venous thromboembolism is a severe form of paraneoplastic syndrome. It rarely leads to venous gangrene. We report a case who presented with multiple deep venous thrombosis and venous gangrene of the lower extremity. During the follow-up period, the patient developed bilateral cervical and right supraclavicular lymphadenopathies. The fine needle aspiration of the lymph nodes revealed metastatic epidermoid carcinoma of an unknown primary. Thrombotic manifestations may complicate the clinicopathological course of malignancies.
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Affiliation(s)
- Sule Apras
- Unit of Rheumatology, Hacettepe University Medical Faculty Hospital, Ankara, Turkey
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Hirota M, Inoue K, Kimura Y, Mizumoto T, Kuwata K, Ohmuraya M, Ishiko T, Beppu T, Ogawa M. Non-occlusive mesenteric ischemia and its associated intestinal gangrene in acute pancreatitis. Pancreatology 2004; 3:316-22. [PMID: 12890994 DOI: 10.1159/000071770] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2002] [Accepted: 04/25/2003] [Indexed: 12/11/2022]
Abstract
BACKGROUND/AIMS Non-occlusive mesenteric ischemia (NOMI) has been defined as diffuse intestinal ischemia that often results in intestinal gangrene in the presence of a patent arterial trunk. The prevalence and nature of NOMI in acute pancreatitis was investigated. METHODS A total of 120 consecutive patients with acute pancreatitis managed in the Department of Surgery II, Kumamoto University Medical School, from April 1992 through December 2002, were investigated retrospectively. Among them, 60 patients had the severe form. RESULTS The overall mortality of acute pancreatitis patients was 8.3% (10/120). The prevalence and mortality of acute pancreatitis associated with NOMI were 6.7% (8/120) and 63% (5/8), respectively, while those of patients with NOMI-associated intestinal gangrene were 4.2% (5/120) and 100% (5/5), respectively. The mortality of patients with severe acute pancreatitis who did not develop NOMI was 10% (5/52). All patients with NOMI-associated intestinal gangrene quickly progressed and subsequently died of multiple organ failure. Plasma creatine phosphokinase (CPK) and lactate levels were elevated significantly in patients with NOMI. CONCLUSION Acute pancreatitis associated with NOMI was extremely severe. If the plasma CPK and lactate levels are extremely high, NOMI should be suspected.
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Affiliation(s)
- Masahiko Hirota
- Department of Surgery II, Kumamoto University Medical School, Kumamoto City, Kumamoto, Japan
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Abstract
Gangrenous cholecystitis is a serious complication of acute cholecystitis and is associated with increased morbidity and mortality rates. We report a case in which the diagnosis was suggested by ultrasound, but cholecystectomy delayed due to atypical clinical presentation and a false negative radionuclide biliary scan.
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Affiliation(s)
- Robert L Grant
- Division of Medical Imaging, Flinders Medical Centre, Bedford Park, Adelaide, South Australia, Australia
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Rivera-Nieves J, Bamias G, Alfert J, Bickston SJ, Moskaluk CA, Cominelli F. Intestinal ischemia and peripheral gangrene in a patient with chronic renal failure. Gastroenterology 2002; 122:495-9. [PMID: 11832463 DOI: 10.1053/gast.2002.31387] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Gastrointestinal complications are common in patients with renal failure and result in significant morbidity and mortality. Systemic calciphylaxis is an uncommon complication of renal failure, characterized by disseminated intravascular calcification and associated with progressive vascular compromise. We describe the case of a 63-year-old woman who presented with abdominal pain, elevated transaminases, and skin manifestations consistent with a vasculitic process. Hand films and skin biopsies showed extensive vascular calcification, and a computerized tomography scan confirmed colonic perforation and disseminated visceral vascular calcification. Histologic analysis of the resected skin and colonic tissues revealed extensive ischemic damage and mural calcification of medium to large vessels. Gastrointestinal involvement has been reported in only 3 prior cases of calciphylaxis; consequently, gastroenterologists are often unaware of this disease entity and may fail to recognize it, even in patients with the classical presentation. Prompt diagnosis is crucial, as parathyroidectomy may result in clinical improvement in up to two thirds of patients who present with elevated parathyroid hormone levels.
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Affiliation(s)
- Jesús Rivera-Nieves
- Digestive Health Center of Excellence, University of Virginia, Charlottesville, Virginia, USA.
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Abstract
OBJECTIVE To review the outcomes of five cases of pulmonary resection for lung gangrene. DESIGN A retrospective chart review. SETTING A tertiary referral centre. POPULATION STUDIED Five patients who underwent pulmonary resection for lung gangrene between April and December 1999. MAIN RESULTS Pathological confirmation of lung gangrene was obtained in all cases. Three patients were ventilator dependent. All five patients had ongoing sepsis despite antibiotic therapy. Additional indications for resection included bronchopleural fistula (two patients), empyema (three patients) and hemoptysis (one patient). In two cases, there was evidence of bilateral, diffuse necrotizing pneumonia, while in three cases the process was localized to one side. Computed tomography revealed cavitation in four cases and the absence of blood supply to the affected lung in one case. Surgical resection included wedge resection (one patient), lobectomy (two patients), bilobectomy (one patient) and pneumonectomy (one patient). In all cases, the bronchial stump was reinforced with an intercostal flap. Postoperative empyema occurred in two cases, one treated by thoracoscopic decortication, the other by percutaneous drainage. There were no instances of stump leak and no deaths. One patient remains ventilator dependent. CONCLUSIONS Resection for lung gangrene is possible even in the setting of diffuse parenchymal changes and ventilator dependency. A computed tomography scan of the chest is important to make the diagnosis of lung gangrene and to plan operative management. Reinforcement of the bronchial stump is critical.
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27
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Brancatelli G, Rossello M. Images in hepatology. Gas in the portal vein. J Hepatol 1999; 30:1151. [PMID: 10406196 DOI: 10.1016/s0168-8278(99)80272-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Affiliation(s)
- G Brancatelli
- Institute of Radiology, Università di Palermo, Italy
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Aoun N, Smayra T, Haddad-Zebouni S, Slaba S, Ghossain M, Atallah N. [Acute cholecystitis using computed tomography: usefulness of the trabeculation of the peri-cholecystic adipose tissue]. J Radiol 1999; 80:575-8. [PMID: 10417890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Abstract
PURPOSE To evaluate the significance of pericholecystic fat stranding on CT, and to compare it to other CT findings in patients with acute cholecystitis. MATERIALS AND METHODS The CT examinations of 14 patients with proven acute cholecystitis were retrospectively reviewed and evaluated for the presence of findings consistent with this diagnosis. RESULTS The most common CT finding was stranding of the pericholecystic fat (13 patients), followed by gallbladder distension (11 patients). Pericholecystic or perihepatic fluid was present in 6 patients in association with severe acute cholecystitis (6 patients) and biliary peritonitis (2 patients). CONCLUSION Stranding of the pericholecystic fat was the most common CT findings in patients with acute cholecystitis, followed by gallbladder distension.
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Affiliation(s)
- N Aoun
- Service de Radiodiagnostic, Hôtel-Dieu de France, Beyrouth, Liban
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Castier Y, Lesèche G, Palombi T, Petit MD, Cerceau O. Early experience with cryopreserved arterial allografts in below-knee revascularization for limb salvage. Am J Surg 1999; 177:197-202. [PMID: 10219854 DOI: 10.1016/s0002-9610(99)00010-0] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
BACKGROUND Below-knee revascularization for limb salvage in the absence of a suitable autogenous saphenous vein is a frequent challenge associated with a high amputation rate. The aim of this prospective study was to evaluate the usefulness of cryopreserved arterial allografts in such cases. METHODS Arterial allografts were harvested from multiple organ donors and cryopreserved at -80 degrees C. From March 1993 to December 1997, 35 cryopreserved arterial allografts were used as below-knee bypasses for repeated limb salvage in 32 patients. There were 15 men and 17 women with a mean age of 75 years (+/-10.7). Seven patients had rest pain and 25 patients (78%) had gangrene or nonhealing ulceration. Runoff was through a single tibial vessel in 25 cases (71%) and two vessels in 10 cases. Previous ipsilateral bypasses had been done in 26 of 35 limbs (74%). Patients were followed up prospectively for an average period of 18 months (range 2 to 56). RESULTS Aneurysmal dilatation occurred in two patent grafts, requiring segmental replacement at 13 and 18 months, respectively. The overall primary patency rate was 75% at 6 months, 57% at 12 months, and 39% at 18 months. The overall secondary patency rate was 75% at 6 months, 75% at 12 months, and 59% at 18 months. Overall limb salvage rate was 80% at 12 months, 73% at 18 months. CONCLUSIONS These early data indicate that below-knee bypass with arterial allografts results in acceptable patency and limb salvage. Arterial allografts may be a useful alternative to other arterial substitutes in a difficult group of patients with critical ischemia and no suitable saphenous vein.
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Affiliation(s)
- Y Castier
- Service de Chirurgie Vasculaire et Thoracique, Hôpital Beaujon, Clichy, France
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30
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Szuba A, Cooke JP, Rockson SG. Images in vascular medicine. Phlegmasia coerulea dolens--venous gangrene. Vasc Med 1998; 3:29-31. [PMID: 9666529 DOI: 10.1177/1358836x9800300106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- A Szuba
- Division of Cardiovascular Medicine, Falk Cardiovascular Research Center, Stanford University School of Medicine, CA 94305, USA
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31
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Gómez D, Izquierdo V, Macias E, Siurana R, Pujol A, Virgala C. Three phase bone imaging in a patient with fulminant meningococcemia. Clin Nucl Med 1998; 23:256-7. [PMID: 9554208 DOI: 10.1097/00003072-199804000-00022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- D Gómez
- Nuclear Medicine Service, University Hospital of Joan XXIII, Tarragona, Spain
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32
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Bloom C, Hamilton P, Cassoff J, Pinsky M, Rosenbloom M, Sabloff B, Arenson AM, Hickey N, Lisbona A. Scrotal ultrasonography: a pictorial essay. Can Assoc Radiol J 1998; 49:12-20. [PMID: 9494459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Affiliation(s)
- C Bloom
- Department of Radiology, Sunnybrook Health Science Centre, North York, Ont
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33
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Affiliation(s)
- P T Makler
- University of Medicine and Dentistry of New Jersey, Stratford, USA
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34
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Affiliation(s)
- I Gayed
- Department of Nuclear Medicine, St. Luke's Episcopal Hospital, Houston, TX 77030, USA
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35
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Hayashi AK, Soudry G, Dibos PE. Rim sign. Radionuclide imaging in a patient with acute gangrenous cholecystitis and cholelithiasis after nonspecific abdominal ultrasonography. Clin Nucl Med 1997; 22:388-9. [PMID: 9193810 DOI: 10.1097/00003072-199706000-00009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- A K Hayashi
- Department of Nuclear Medicine, Franklin Square Hospital, Baltimore, MD 21237, USA
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36
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Michel F, Fauchery A, Belhadj M, Couailler JF, Martin-Champetier R. [The contribution of imagery in the early diagnosis of Fournier's gangrene]. Prog Urol 1997; 7:471-5. [PMID: 9273078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Scrotal ultrasonography, completed by MRI, allowed the early diagnosis of a case of Fournier's gangrene, before the appearance of subcutaneous crepitation allowing rapid treatment adapted to the extent of necrosis. Ultrasonography is recommended in the assessment of inflammatory disease of the scrotum and/or perineum. MRI is able to refine the ultrasonographic data, and define the extent of gangrene as well as its starting point.
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Affiliation(s)
- F Michel
- Service de Chirurgie Urologique-Andrologie, Hôpital du Bocage, Dijon, France
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37
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Butković V, Capak D, Stanin D, Sehić M. Arteriography after ligation of the brachial and femoral artery in the dog. VET MED-CZECH 1996; 41:319-22. [PMID: 8933713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Ligation of the brachial and femoral artery in 30 dogs did not cause permanent lameness, no signs of gangrene or edema being visible whatsoever. The complete collateral circulation could not be detected arteriographically within the first two hours after the ligation of these blood vessels. However, at the same time after the the surgery the pulse could be felt by palpation of limbs.
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Affiliation(s)
- V Butković
- Institute of Roentgenology, Ultrasonic Diagnostics and Physical Therapy, Veterinary Faculty, University of Zagreb, Croatia
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Abstract
A neonate with extremity gangrene resulting from intrauterine embolization of infarcted placental substances is discussed. This rare clinical entity is thought to be most commonly a manifestation of embolic phenomenon during maturation of the neonatal circulatory system. Management of neonatal gangrene is conservative, delaying amputation as long as possible since the line of demarcation tends to migrate distally. Evidence of multiple emboli should be carefully sought prior to definitive treatment.
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Affiliation(s)
- M M Carr
- Hospital for Sick Children, Toronto, Canada
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39
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Karacagil S, Löfberg AM, Granbo A, Lörelius LE, Bergqvist D. Value of duplex scanning in evaluation of crural and foot arteries in limbs with severe lower limb ischaemia--a prospective comparison with angiography. Eur J Vasc Endovasc Surg 1996; 12:300-3. [PMID: 8896472 DOI: 10.1016/s1078-5884(96)80248-6] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To compare Duplex scanning with angiography for evaluation of crural and pedal arteries in limbs with lower limb ischaemia. DESIGN The findings obtained during Duplex scanning and angiography were prospectively compared in a blinded manner. SETTING Departments of Surgery, Diagnostic Radiology and Clinical Physiology, University Hospital. MATERIALS Duplex scanning and selective angiography of femoropopliteal, crural and foot arteries were performed in 40 limbs (38 patients, 480 segments) with intermittent claudication (n = 6), rest pain (n = 13) and ulcer/gangrene (n = 19). Each arterial segment were graded into four categories: normal, < or = 50% diameter reduction, > 50% diameter reduction and occlusion. Pedal arteries were evaluated as patency or occlusion of dorsal pedal artery and plantar arch. CHIEF OUTCOME MEASURES Accuracy (AC), sensitivity (SE), specificity (SP), positive predictive (PPV), negative predictive (NPV) and kappa values. MAIN RESULTS The Duplex scanning of the tibioperoneal trunk, crural and pedal arteries had an accuracy of 80% (kappa = 0.6). The SE, SP, PPV and NPV values were 83%, 77%, 79% and 81%, respectively. The SP was relatively low for the peroneal artery (58%) compared to the others. CONCLUSIONS The results demonstrate the feasibility and reliability of Duplex scanning in detecting crural and pedal artery lesions in lower limbs with severe ischaemia.
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Affiliation(s)
- S Karacagil
- Department of Surgery, University Hospital, Uppsala, Sweden
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40
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Affiliation(s)
- Y H Loh
- Department of Nuclear Medicine, Concord Repatriation General Hospital, Sydney, Australia
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41
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Abstract
BACKGROUND Buerger's disease is a specific, idiopathic, recurrent, segmental, inflammatory, obliterative vascular disease involving medium-sized arteries and veins of the limbs. We performed omental transfer on a group of patients with Buerger's disease that had previously undergone lumbar sympathectomy and the results are described. METHODS Between January 1988 and December 1993, 100 cases of peripheral vascular disease (PVD) diagnosed as Buerger's Disease were subjected to femoral angiography. Fifty cases of angiographic intermediate/distal type blocks underwent omental transposition. RESULTS Of 50 patients subjected to omental transfer all had intermittent claudication, 40 had rest pain of whom 36 had non-healing ulcers, 8 had gangrene and 32 had bilateral lower limb involvement. Fifteen patients underwent bilateral omental transfer and posterior tibial artery biopsy was performed in 40. All patients showed improved skin temperature, rest pain decreased in 36 and claudication distance increased in 48. Ulcers healed in 32 of 36 patients and the line of demarcation receded in six of eight patients with gangrene. CONCLUSIONS Omental transfer improved skin and muscle microcirculation and forestalled the need for amputation by providing symptomatic relief and clinically arresting the progress of Buerger's disease. Omental transfer should be considered seriously as an alternative to other modalities of therapy to delay the ischaemic complications of Buerger's disease.
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Affiliation(s)
- I Singh
- Department of Surgery, Maulana Azad Medical College, New Delhi, India
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42
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Abstract
A patient with Buerger's disease is described in whom reconstruction of a gangrenous forefoot with a free flap has been successfully performed. In order to limit the amputation level, a more aggressive approach toward reconstruction in young patients seems appropriate. To our knowledge, this is the first described case of free flap reconstruction of a gangrenous defect in a Buerger patient.
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Affiliation(s)
- K Van Landuyt
- Department of Plastic and Reconstructive Surgery, University Hospital, Ghent, Belgium
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44
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Affiliation(s)
- V S Dogra
- Department of Radiology, St. Louis Regional Medical Center, Missouri
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45
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Abstract
An additional sonographic sign of gangrenous cholecystitis, namely the loss of the mucosal/gall-bladder wall echo in a setting of acute cholecystitis, is described. It was found prospectively in six patients and correlated well with the presence of mucosal/wall necrosis on histological gallbladder specimens. Other reported signs of gangrenous cholecystitis are reviewed.
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Affiliation(s)
- P M Mok
- Department of Radiology, North Shore Hospital, Auckland, New Zealand
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46
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Affiliation(s)
- M Maeda
- Department of Radiology and Surgery, Tsuchiura Kyodo Hospital, Ibaraki, Japan
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Cumming MJ, Levi CS, Ackerman TE. US case of the day. Fournier gangrene. Radiographics 1994; 14:1423-4. [PMID: 7855351 DOI: 10.1148/radiographics.14.6.7855351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Affiliation(s)
- M J Cumming
- Department of Radiology, Health Sciences Centre, Winnipeg, Manitoba, Canada
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48
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Abstract
Fournier's gangrene is an uncommon gas-forming infection of the scrotum which if not recognized early and treated appropriately may be fatal. In three patients recently seen at our institution, computed tomography (CT) was instrumental in establishing the correct diagnosis and determining the extent of the infectious process prior to surgery. The imaging findings at CT and its differential diagnosis are illustrated. A brief review of the current theories of pathogenesis of this interesting entity is presented.
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Affiliation(s)
- M A Amendola
- Department of Radiology, University of Miami/Jackson Memorial Medical Center, FL 33101
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49
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Gaeta M, Loria G, Cantoni S, Loria F, Frola C. [The computed tomographic aspects in a case of Fournier's gangrene]. Radiol Med 1994; 87:903-5. [PMID: 8041955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- M Gaeta
- Servizio di Diagnostica per Immagini, Ospedale Piemonte, USL 42, Messina
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50
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Abstract
Pulmonary gangrene is an uncommon but life-threatening complication of bacterial pneumonia. Only four cases of pulmonary gangrene due to Mycobacterium tuberculosis have been described to date; another case of pulmonary gangrene was attributed to unidentified mycobacteria. We report a fetal case of tuberculous pulmonary gangrene (TPG) and review the literature on this infection. To our knowledge this is the first case of TPG documented by thoracic computed tomographic scanning. Radiological features of pulmonary gangrene are distinctive, and identification of pulmonary parenchyma in the mass on computed tomography may be considered as pathognomonic. Analysis of the six cases revealed that most of the patients were aged, and one-half of them were alcohol abusers. Right-upper-lobe involvement predominated. When performed, sputum smears disclosed acid-fast bacilli. M. tuberculosis was cultured from sputum or pathologic material in five of the six cases. Four patients (66.7%) died. Four of six patients with TPG received antituberculous therapy, and two of them survived; no patient underwent surgical intervention. Although surgical management has been successfully employed in cases of bacterial pulmonary gangrene, TPG has always been treated with medical therapy alone. In spite of administration of antituberculous therapy, mortality is high.
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Affiliation(s)
- J López-Contreras
- Department of Internal Medicine, Hospital de la Santa Creu i Sant Pau, Universitat Autonoma de Barcelona, Spain
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