Current endovascular management of the ischaemic diabetic foot.

Ischaemic diabetic foot ulcers pose a significant problem which is associated with a high likelihood of amputation. With the advent of endovascular surgery, the management of lower limb arterial lesions in the diabetic population has become more appealing. Coronary 0.014 monorail guide wires, appropriate sized angioplasty balloons and stents, and subintimal recanalisation, are all useful adjuncts and techniques to achieve revascularization. This article reviews the modern endovascular management of the diabetic foot.

Cerebral perfusion patterns in patients with extracranial carotid atherosclerosis and the impact of carotid stenting. A review.

Patients with extracranial carotid atherosclerosis, either symptomatic or asymptomatic, demonstrate altered cerebral perfusion. Carotid revascularization procedures, such as carotid endarterectomy or stenting, aim mainly at stroke prevention from thromboembolic events, whereas their effects on cerebral perfusion, particularly those seen after carotid stenting, have not been extensively examined. Moreover, ischemia and reperfusion injury have been recognized as devastating complications of these procedures. The present work is a literature review of cerebral perfusion patterns in normal individuals and in patients with carotid artery stenosis prior to and after carotid stenting.

Metabolic alterations of skeletal muscle tissue after prolonged acute ischemia and reperfusion.

Acute tissue ischemia is usually followed by considerable disturbances of cellular metabolism that often lead to cell death. Reperfusion improves cellular function by withdrawing the toxic products of ischemia and providing energy sources, although sometimes it worsens it. The purpose of this experimental work is to study the metabolic disturbances in skeletal muscle tissue of canines after prolonged acute ischemia in relation to the values of certain substances (ATP, lactate, pyruvate, the ratio of lactate to pyruvate [L/P], and glucose) and whether the alterations in the values of these substances could be used as prognostic indices of the magnitude of tissue damage and the possibility of inverting it. We used 15 mongrel dogs. Complete acute ischemia was induced in the right lower limb lasting 12 h. Reperfusion also lasted for 12 h. The left lower limb was used as reference value. Before the beginning of ischemia, at (1/2), 1, 6, and 12 h after the induction of ischemia, and at (1/2), 1, 6, and 12 h after the restoration of circulation, blood samples, and tissue biopsies were obtained from the healthy and the experimental limb for the measurement of ATP, lactate, pyruvate, the ratio of L/P, and glucose. From the statistical analysis of the values of the controlled parameters the following were concluded: The changes in ATP, lactate, pyruvate, and the L/P ratio in the venous blood of the experimental limb and in the intracellular space of the suffering skeletal muscle could be used as indices to evaluate ischemic injury to the skeletal muscles, the course of its development, and the possibility of reversal after reperfusion.

[Vascular reconstruction in the aorto-iliac region. Lowered mortality with an extraperitoneal approach]. / Gefässrekonstruktive Eingriffe im aorto-iliakalen Bereich. Senkung der Letalität durch extraperitonealen Zugang.

From 1962 to 1978 1938 reconstructions because of arterial occlusive disease were performed at the Department of Surgery, Städt. Klinikum Karlsruhe. Of these 297 were primary aorto-iliac reconstructions. All latter cases were classified according to morphologic characteristics. The ratio of men to women was 8 : 1, the average age 58,9 years. A comparison of the results in these 227 patients with reconstruction either by endarteriectomy or dacron bypass was made regarding the way of incision. The results show a lower letality of 4,6% when extraperitoneal exposition is used compared to 14,1% when transperitoneal exposition was performed. As there was no difference found in the late results after either method of reconstruction (123 patients were reexamined), extraperitoneal exposition is preferred except in cases with aneurysm and aortic occlusion up to the renal arteries.

[Intestinal gas gangrene originating from the gallbladder: diagnosis, therapy, report of 2 cases]. / Intestinaeler Gasbrand ausgehend von der Gallenblase: Diagnose, Therapie, Darstellung von 2 eigenen Fälen.

The problems of diagnosis and therapy of gas gangrene of the gastrointestinal tube and the gallbladder are discussed. 2 cases of gas edema of the gallbladder due to clostridium perfringens are reported. One of the patients survived. The early diagnosis of gas gangrene is important because of the extraordinary way of infection and the necessary early surgical and medicamentous therapy.

[Intrapulmonary teratoma: case report and review of the literature]. / Intrapulmonales teratom: Fallbericht und Literaturübersicht.

A case of a malignant intrapulmonary teratoma is described. 21 other cases published in the literature are reviewed. The third pharyngeal pouch is suggested to be the origin of these teratomata.