Complications ischemic

Biliary complications, ischemic or non-isch-emic, occur in up to 25% of transplant recipients (Letorneau and Castaneda-Zuniga 1990). Complications include leaks, strictures, stones or sludge, dysfunction of the sphincter of Oddi, malposition-ing of the T-tube, and recurrent disease. 

The neuromuscular complications of diabetes mellitus are most often neuropathic in origin, with distal sensorimotor polyneuropathies being the most common. In addition, ischemic infarction of skeletal muscle may occur due to occlusive vascular disease, with small and medium-sized arterioles particularly affected. This occurs in poorly-controlled diabetes and affects thigh, muscles in most cases. In acute stages, muscle biopsy findings are those of widespread muscle necrosis, edema, and phagocytic cell infiltration. Muscle regeneration may be incomplete and increased fibrous connective tissue may replace lost muscle tissue. 

Three large randomized trials, the European Cooperative Acute Stroke Study (ECASS) parts I and II, and the Alteplase Thrombolysis for Acute Noninterven-tional Therapy in Ischemic Stroke (ATLANTIS), have investigated the efficacy of IV rt-PA in acute stroke beyond the 3-hour window. All three studies showed high rates of sICH complicating rt-PA treatment, and no overall efficacy of rt-PA. 

Gralla J, Schroth G, Remonda L, Nedeltchev K, Slotboom J, Brekenfeld C. Mechanical thrombectomy for acute ischemic stroke thrombus-device interaction, efficiency, and complications in vivo. Stroke 2006 37 3019-3024. 

The timing of CEA after ischemic stroke has been a controversial issue. In 1969, the Joint Study of Extracranial Arterial Occlusion reported 42% mortality after CEA in patients with neurological deficits of less than 2 weeks duration, compared with 5% mortality in patients with more than 2 weeks of symptoms. Early evidence also demonstrated an increased risk of intracerebral hemorrhage after early CEA in patients with acute stroke. This led to the conclusion that most complications occurred with early surgical intervention, and resulted in a traditional 4-6 week delay for CEA after an acute stroke. In retrospect, however, there were major problems with patient selection in these earlier reports. Many of the patients... 

Short-term desired outcomes in a patient with ACS are (1) early restoration of blood flow to the infarct-related artery to prevent infarct expansion (in the case of MI) or prevent complete occlusion and MI (in unstable angina) (2) prevention of death and other complications (3) prevention of coronary artery reocclusion and (4) relief of ischemic chest discomfort. 

Chronic transfusion therapy is warranted to prevent serious complications from SCD, including stroke and recurrence. Especially in children, chronic transfusions have been shown to decrease stroke recurrence from approximately 50% to 10% over 3 years. Without chronic transfusions, approximately 70% of ischemic stroke patients will have another stroke. Chronic transfusion therapy also may be used to prevent vaso-occlusive pain and ACS, as well as prevent progression of... 

VF is electrical anarchy of the ventricle resulting in no cardiac output and cardiovascular collapse. Sudden cardiac death occurs most commonly in patients with ischemic heart disease and primary myocardial disease associated with LV dysfunction. VF associated with acute MI may be classified as either (1) primary (an uncomplicated MI not associated with heart failure [HF]) or (2) secondary or complicated (an MI complicated by HF). 

Cardiac index and blood pressure must be sufficient to ensure adequate organ perfusion, as assessed by alert mental status, creatinine clearance sufficient to prevent metabolic azotemic complications, hepatic function adequate to maintain synthetic and excretory functions, a stable heart rate and rhythm, absence of ongoing myocardial ischemia or infarction, skeletal muscle and skin blood flow sufficient to prevent ischemic injury, and normal arterial pH (7.34 to 7.47) with a normal serum lactate concentration. These goals are most often achieved with a cardiac index greater than 2.2 L/min/m2, a mean arterial blood pressure greater than 60 mm Hg, and PAOP of 25 mm Hg or greater. 

Ischemic acute renal failure (ARF), characterized by a sharp decline of glomerular filtration rate, is a very common complication in hospitalized patients and particularly in patients with multiorgan failure. Although it develops most frequently in multimorbid patients, its occurrence per se increases the risk of death by 10- to 15-fold (Ghertow et al, 1998). This unacceptable situation in both diseases warrants the urgent development of new treatment modalities. 

Prophylaxis of ischemic complications in unstable angina and non-Q-wave Ml- —... 

CYP3A4 inhibitors (eg, macrolide antibiotics, protease inhibitors) There have been rare reports of serious adverse events in connection with the coadministration. Fibrotic complications There have been reports of pleural and retroperitoneal fibrosis in patients following prolonged daily use of injectable dihydroergotamine. Risk of myocardial Ischemia and/or Ml and other adverse cardiac events Do not use dihydroergotamine in patients with documented ischemic or vasospastic coronary artery disease. 

Serious Gl adverse events, some fatal, have been reported with the use of alosetron. These events, including ischemic colitis and serious complications of constipation, have resulted in hospitalization, blood transfusion, surgery, and death. 

Mark DB, Talley JD, Topol EJ, Bowman L, Lam LC, Anderson KM et al. Economic assessment of platelet glycoprotein Ilb/IIIa inhibition for prevention of ischemic complications of high-risk coronary angioplasty. EPIC Investigators. Circulation 1996 94 629-35. 

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