title: 31P nuclear magnetic resonance spectroscopy of acutely ischaemic limbs: the extent of changes and progress after reconstructive surgery.
abstract: 31P Nuclear magnetic resonance (NMR) spectroscopy of the tibialis anterior muscle was carried out on nine acutely ischaemic  limbs in eight patients before and after revascularization, in 15 limbs of 13 claudicants at rest, in 17 patients with normal lower limb circulation suffering chronic renal failure, and in six healthy subjects. Claudicants, renal failure and healthy limbs showed similar inorganic phosphate/phosphocreatine ratios (Pi/PCr). Healthy volunteers after 30-min tourniquet ischaemia and patients with acutely ischaemic limbs showed significantly raised Pi/PCr ratios (P < 0.05). There was an association between Pi/PCr ratios and the systolic ankle:brachial pressure index in acutely ischaemic limbs. In the acute patients, the Pi/PCr ratios returned to normal after successful revascularization, the time course varying between 3 days and 3 months. Intracellular acidosis was observed in one patient who was also the only individual to develop reperfusion injury following reconstructive surgery. Acidosis may be a sign of muscle changes which lead to reperfusion injury.
authors.affiliation: University College London Vascular Unit, UK.
authors.forename: P Z
authors.initials: PZ
authors.lastname: Brotzakis
authors.forename: P
authors.initials: P
authors.lastname: Sacco
authors.forename: D A
authors.initials: DA
authors.lastname: Jones
authors.forename: D B
authors.initials: DB
authors.lastname: McIntyre
authors.forename: R
authors.initials: R
authors.lastname: Williams
authors.forename: M
authors.initials: M
authors.lastname: Adiseshiah
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004734:Energy Metabolism / Q000502:physiology*; D005260:Female; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D007511:Ischemia / Q000503:physiopathology / Q000601:surgery*; D007866:Leg / Q000098:blood supply*; D009682:Magnetic Resonance Spectroscopy; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000098:blood supply / Q000378:metabolism; D010710:Phosphates / Q000378:metabolism; D010725:Phosphocreatine / Q000378:metabolism; D011183:Postoperative Complications / Q000503:physiopathology*; D012016:Reference Values; D013927:Thrombosis / Q000503:physiopathology / Q000601:surgery
chemical_list: D010710:Phosphates; D010725:Phosphocreatine