Document Detail

A systematic approach to severe hand ischemia.
MedLine Citation:
PMID:  339388     Owner:  NLM     Status:  MEDLINE    
Because severely symptomatic hand ischemia is not common and because there are a wide variety of clinical conditions which can cause arterial insufficiency of the upper extremity, a retrospective study has been done to determine the efficacy of various diagnostic manipulations used in managing 65 patients with severe hand ischemia at the Northwestern University McGaw Medical Center, Traumatic, thermal, and iatrogenic causes of hand ischemia were diagnosed by simple history taking, as was advanced uremic arteritis. Doppler ultrasound and digital arterial pressure recording were confirmative, rather than diagnostic. These aided in defining precise degrees of ischemia and identifying proximal arterial occlusions. Invasive total extremity angiography clarified atherosclerotic, atheroembolic, and other chronic occlusive lesions while serum electrophoresis and immunoelectrophoresis defined the polyclonal and monoclonal gammopathies. When digital necrosis was present, organic arterial occlusions usually were found. These responded best to direct arterial reconstruction down to the mid-palm level. Transpleural, transthoracic sympathectomy was useful as an adjuvant or as definitive treatment for distal digital arterial occlusions. Selective vasodilator therapy was used as dictated by the cause of ischemia and its eventual outcome.
M F McNamara; H S Takaki; J S Yao; J J Bergan
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Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  Surgery     Volume:  83     ISSN:  0039-6060     ISO Abbreviation:  Surgery     Publication Date:  1978 Jan 
Date Detail:
Created Date:  1978-02-23     Completed Date:  1978-02-23     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  0417347     Medline TA:  Surgery     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  1-11     Citation Subset:  AIM; IM    
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MeSH Terms
Acute Disease
Dextrans / therapeutic use
Hand / blood supply*
Heparin / therapeutic use
Ischemia / diagnosis,  etiology*,  therapy
Medical History Taking
Middle Aged
Physical Examination
Retrospective Studies
Reg. No./Substance:
9004-54-0/Dextrans; 9005-49-6/Heparin

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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