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Query: UMLS:C0004153 (atherosclerosis)
 77,401 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Animal studies have consistently shown increased heart strength, size, and vascularity in wild animals compared to domestic animals. While exercise has not been shown to decrease atherosclerosis in either animals or humans, it has been theorized that exercise makes the heart more resistant to ischemia through stimulation of collateral vessel formation and enlargement of already existent coronary arteries. In humans, the benefits and dangers of exercise have been researched with morphological, hemodynamic, and epidemiological studies. Many of these are discussed here as well as the national fitness recommendations made by various health organizations. A summary of the cardiovascular benefits of exercise as supported by the literature is then presented.
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PMID:Cardiovascular benefits of physical activity. 191 18

The endothelium is increasingly recognized as a modulator of vascular tone, and evidence also is accumulating for an important role of the endothelium in humans in vivo. Endothelial release of prostacylin appears to regulate hyperemic blood flow after ischemia and muscle exercise, and the potent vasodilating properties of endothelium-derived relaxing factor (EDRF) are well established. Tonic release of EDRF plays an important role in the regulation of vascular tone in normal subjects, and a reduction of EDRF release in response to muscarinergic stimulation has been described in subjects with uncomplicated hypertension and also in hyperlipidemic patients. These observations point toward an early disturbance of endothelial function in disorders known as risk factors for the development of atherosclerosis. Furthermore, altered EDRF release and responsiveness to stimuli may be involved in the disturbed regulation of peripheral vascular tone in congestive heart failure. The physiological role of the vasoconstricting peptide endothelin-1 is not yet defined, but the study of the vascular actions of the peptide in humans has shown a vasodilating effect (for low dosages or when the vasconstricting effects are blocked), as well as a marked and long-lasting vasoconstricting effect. Although the mechanisms leading to vasodilation are not clear in humans, endothelin-1-induced vasoconstriction appears to be completely dependent on the activity of voltage-operated calcium channels and can be blocked by organic calcium antagonists but not by nitrovasodilators or EDRF. Further clarification of the role of the endothelium will provide a better understanding of circulatory physiology and pathophysiology and eventually may lead to the development of new therapeutic modalities.
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PMID:Endothelial function in humans. Studies of forearm resistance vessels. 191 1

Apolipoproteins were measured in a prospective blinded fashion in blood specimens from patients with chest pain in the emergency department. A definitive diagnosis for the chest pain (non-cardiac-related in 32% and angina or myocardial infarction in 68%) was available in 136 of the 162 patients originally enrolled in the study. Logistic regression and multivariate analysis failed to show any usefulness of apolipoprotein determinations in distinguishing patients with cardiac ischemia from those without it. The clinician's initial impression of the chest pain, the electrocardiogram, a history of previous angina, myocardial infarction, or peripheral atherosclerosis, and male sex were strongly associated with the final diagnosis. We conclude that, although apolipoprotein analysis has proved useful in epidemiologic studies, the most reliable indicators of ischemic pain remain the medical history, the electrocardiogram, and the clinician's overall initial impression.
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PMID:Lipoprotein analysis in the evaluation of chest pain in the emergency department. 192 7

Symptomatic visceral atherosclerosis is a major surgical challenge because of its life-threatening course and the complexity of its definitive operative treatment. Evolution in the operative approach to the visceral aorta and progress in the intraoperative management of patients undergoing complex vascular reconstructions prompted a review of the authors' cumulative experience in the surgical management of chronic visceral ischemia. Among all patients undergoing visceral revascularization at the University of California, San Francisco during the past three decades, 74 patients were identified whose primary reconstruction used transaortic endarterectomy (TA TEA) (n = 48) or antegrade bypass (AB) (n = 26), the authors' preferred revascularization techniques. The two treatment groups were comparable in gender distribution, age, presenting symptoms, and physical findings, although the amount of preoperative weight loss was greater in the AB group (35.8 +/- 19.5 versus 22.4 +/- 12.0, p = 0.003). The groups were also comparable in the prevalence of atherosclerosis risk factors, symptomatic vascular disease at other sites, and previous vascular operations. However associated renal artery atherosclerosis was slightly greater in the TA TEA group (58.3% versus 23.1%, p = 0.07) when compared to the AB group. Antegrade bypass was usually performed transabdominally (88.5%), while TA TEA was approached thoracoretroperitoneally (75.0%). Celiac revascularization was almost universal in both treatment groups, but the TA TEA group underwent significantly more frequent superior mesenteric artery (SMA) revascularization (93.8% versus 46.2%, p = 0.0001) and slightly more frequent inferior mesenteric repair (18.8% versus 3.8%, p = 0.07) than the AB group. In addition the frequency of combined renal and visceral repair (25.0% versus 0.0%, p = 0.01) as well as combined aortic, renal, and visceral repair (22.9% versus 3.8%, p = 0.03) was significantly greater in the TA TEA group. The obligatory interval of renal and visceral ischemia did not differ between the two approaches. The perioperative mortality rate was 12.2% and was the same for TA TEA (14.6%) and AB (7.7%). Overall the incidence of complications was the same with either operative approach, although patients in the TA TEA group tended to have multiple complications (17.1% versus 0.0, p = 0.03) and all significant pulmonary complications occurred in this group. Two patients were lost to follow-up. The cumulative percentage of patients who remained asymptomatic following AB or TA TEA was (respectively) 95.8% and 97.3% at 1 year and 86.5% and 86.1% at 5 years. Both of these operative approaches provide durable symptom relief with acceptable operative morbidity and mortality rates.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Chronic visceral ischemia. Three decades of progress. 192 9

An overview is given over etiology and prognosis of cerebral ischemias until the age of 40. In a time period of 19 years, 168 patients were diagnosed with cerebral ischemia until the age of 40 (91 females, 77 males). The most frequent etiology is premature atherosclerosis in patients with vascular risk factors (up to 50%). Cardiogenic embolism is responsible for 1 to 34% of the cases: cardiac valve diseases and endocarditis being the most frequent sources. In 2 to 19% a vasculitis is diagnosed. While infectious arteritis is especially frequent in countries of the third world, immunovasculitides are common in Europe and the USA. Noninflammatory vasculopathies include spontaneous or traumatic dissection, fibromuscular dysplasia and vascular malformations. A migrainous stroke is especially frequent in female smokers with intake of oral contraceptives. During pregnancy both sinus thrombosis and arterial ischemia occur. Hematologic causes for ischemia are polycythemia, thrombocytosis and genetic diseases (sickle cell anemia, AT3-deficiency). Cerebral ischemia may occur in connection with the ingestion of ergot-derivates. The prognosis of cerebral ischemia in young adults is better than in older stroke-patients.
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PMID:[Cerebral ischemia in young adults]. 193 40

Heart muscle perfusion was studied by exertion scintigraphy Tal-201 in 24 patients, 16M and 8F, aged 16-45 years, means--28 +/- 7.4 years with hypertrophic cardiomyopathy. The relationship between perfusion disturbances and sudden death risk factors occurring in this group of patients was evaluated. Disturbances of heart muscle perfusion were found in 20 pts (83%); 2 pts had permanent perfusion defects, in 18 pts these defects were completely or partially reversible at rest. Only 4 pts (17%) had normal heart muscle perfusion. In patients with perfusion disturbances there was found a significantly more frequent occurrence of the following sudden death risk factors: 1. syncope (p less than .01) 2. ventricular arrhythmia of IV b class according to Lown (p less than .01) 3. advanced hypertrophy of intraventricular septum (p less than .01) 4. sudden death in patients families (p less than .05) The evaluation of the heart muscle perfusion confirmed the occurrence of myocardial ischemia in most of the examined patients. Normal coronaro-angiography in all the patients over 35 years as well as the young age of the other patients exclude atherosclerosis as the cause of myocardiac ischemia in the group under study. This is a confirmation of nonatherosclerotic etiology of myocardiac ischemia in hypertrophic cardiomyopathy patients. The correlation between perfusion disturbances and sudden death risk factors points to the role of ischemia in the natural course of disease and the value of exertion scintigraphy TI-201 in prognosing patients with hypertrophic cardiomyopathy.
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PMID:[Disturbances of myocardial perfusion by exertion scintigraphy in patients with hypertrophic cardiomyopathy and their relationship with sudden death risk factors]. 194 60

The results of surgical correction of blood flow in the vertebrobasilar basin in 58 patients ranging in age from 32 to 65 years were analysed. In 75.9% of cases, the disease was secondary to atherosclerosis. The tortuosity of the vertebral artery was noted in 12% of the patients. Transitory symptoms of ischemia were observed in 20.6% of the patients, chronic vascular cerebral insufficiency--in 53.6%, sequelae to the ischemic insult--in 25.8%. For diagnosis, the Doppler ultrasound, rheoencephalography, computerized tomography were used. The preference was given to extracranial operative interventions: +carotid-subclavian shunting was performed in 19, +intimo-thrombectomy from the subclavian and ostium of the vertebral artery--in 22, ++aorto-subclavian shunting--in 3 patients. Plasty of the vertebral artery was accomplished in 12 patients. The positive dynamics of neurologic status was noted in 91.3% of the patients.
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PMID:[Surgical treatment of vertebrobasilar insufficiency]. 194 34

Content of 5-, 8-, 11-, 12- and 15-monohydroxyeicosatetraenoic acids was markedly increased in blood of patients with cerebral atherosclerosis accompanied by discirculatory encephalopathy and brain infarction. These values were lower in the patients with infarction as compared with healthy people. After tourniquet ischemia of limbs concentration of the eicosatetraenoic acids was altered in blood of patients: in one group the concentration of all the lipoxygenase metabolites of arachidonic acid was increased, in the other group of patients it was decreased. Development of atherosclerosis appears to be related to activation of lipoxygenases and production of monohydroxyeicosatetraenoic acids.
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PMID:[Level of monohydroxyeicosatetraenoic acid in the blood of patients with cerebral blood circulation disorders]. 194 87

Oxygen free radicals (OFR) are thought to mediate ischemia-reperfusion injury to endothelium of heart, lung, brain, liver, and kidney and contribute to development of atherosclerosis, pulmonary O2 toxicity, and adult respiratory distress syndrome. Increased cytosolic free Ca2+ (Cai2+) has been proposed as a mechanism of injury from oxidative stress, yet the pathways by which an increase in Cai2+ may cause OFR-mediated endothelial cell injury remain unknown. Using multiparameter digitized video microscopy and the fluorescent probes, fura-2 acetoxymethyl ester and propidium iodide, we measured Cai2+ and cell viability in human umbilical endothelial cells during oxidative stress with xanthine (50 microM) plus xanthine oxidase (40 mU/ml). Oxidative stress caused a sustained increase in Cai2+ from a resting level of 90-100 nM to near 500 nM, which was preceded by formation of plasma membrane blebs. The increase in Cai2+ was prevented by removal of extracellular Ca2+ (Cao2+). Prevention of the increase in Cai2+ was associated with prolonged cell viability. Readdition of Cao2+ resulted in an immediate large increase in Cai2+ and rapid onset of cell death. The protease inhibitors, leupeptin and pepstatin, delayed the increase in Cai2+ and prolonged cell viability. The results are consistent with the hypothesis that endothelial cell injury due to oxidative stress may be the result of Cai2+ influx and resultant activation of Ca(2+)-dependent proteases.
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PMID:Cytosolic free Ca2+ and proteolysis in lethal oxidative injury in endothelial cells. 195 73

Over a 40 year period (1950-1990) only 73 patients were treated surgically for brachiocephalic aneurysms. An operation was performed for 38 subclavian, 25 extracranial carotid, six innominate, three aberrant right subclavian, and one vertebral artery aneurysm. Twenty-three other associated aneurysms occurred in 14 patients. Five patients had an additional untreated brachiocephalic aneurysm, and nine patients had 18 aneurysms located in different anatomic regions. There were 40 men and 33 women with a mean age of 50.5 years (range 16 to 82 years). Forty patients (54.8%) presented with potentially life- or limb-threatening signs or symptoms, including stroke or transient ischemic attacks (31.5%), upper extremity ischemia (19.2%), and rupture (4.1%). Atherosclerosis was most common in innominate aneurysms (66.7%) but also occurred in subclavian (34.1%) and carotid aneurysms (12.0%). Thoracic outlet compression was a common etiology for subclavian aneurysms while trauma or spontaneous dissection was more frequent for carotid aneurysms. Six deaths (8.2%) occurred within 30 days of operation: two from rupture, three in association with concomitant cardiovascular operations, and one from emergency carotid ligation. There were no deaths with elective isolated surgical repair. Overall five and 10 year survival in patients with brachiocephalic aneurysms was 80.8% and 61.4%, respectively. The majority of brachiocephalic aneurysms present with life- or limb-threatening complications and are associated with a high mortality for emergency or concomitant repair. Early elective isolated surgical repair remains the optimal therapy.
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PMID:Brachiocephalic aneurysm: the case for early recognition and repair. 201 82


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