Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0004153 (atherosclerosis)
 77,401 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

To examine the efficacy and usefulness of captopril-enhanced renal vein renin (RVR) measurements in detecting the functional significance of renal artery stenosis found in hypertensives, we compared these values in 22 patients with arteriographically documented renovascular hypertension due to unilateral (URVH: 14 patients) or bilateral renal artery stenosis (BRVH: 8 patients) and 12 patients with high renin essential hypertension (EHT). Before captopril administration, RVR ratio was less than 1.5 in 8 patients (36.4%) with renovascular hypertension and all patients (100%) with EHT. Captopril enhanced the lateralization of renal vein renin in renovascular hypertension; the postcaptopril RVR ratio was greater than 2.0 in 18 patients (81.8%) and greater than 1.5 in all the patients (100%). On the other hand, RVR ratio remained unchanged in most patients with EHT. There was no significant difference in the postcaptopril RVR ratios between URVH and BRVH. However, the postcaptopril RVR ratio was higher in atherosclerosis (10 patients) than in fibromuscular dysplasia (11 patients) (P less than .05). Captopril also elucidated contralateral renin suppression as expressed by a contralateral/peripheral renin ratio of less than 1.0, which was associated with a favorable outcome of unilateral surgical intervention. Captopril-stimulated RVR indices were valuable in detecting the functionally significant renal artery stenosis and predicting surgical curability in renovascular hypertension.
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PMID:Captopril-stimulated renal vein renin in hypertensive patients with or without renal artery stenosis. 208 Oct 13

From 1980 to 1989, 53 patients with renovascular hypertension underwent surgical treatment after initial unsuccessful management with percutaneous transluminal angioplasty. Renal artery stenosis was due to fibrous dysplasia in 17 patients and atherosclerosis in 36. The reasons for failure of percutaneous transluminal angioplasty were inability to dilate the stenotic lesion (32 patients), acute renal arterial occlusion (2) or dissection (8) from attempted percutaneous transluminal angioplasty, and the development of recurrent renal artery stenosis after initially successful percutaneous transluminal angioplasty (11). Three patients underwent nephrectomy due to the finding of a nonviable kidney at operation. Successful surgical revascularization was achieved in 50 patients. There was no significant fibrosis or inflammation around the previously dilated renal artery. Percutaneous transluminal angioplasty necessitated performance of a more complicated revascularization operation in only 1 patient. If the kidney is viable at operation in patients treated by percutaneous transluminal angioplasty renovascular reconstruction is not more technically difficult than when done primarily and the same excellent results can be achieved.
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PMID:Surgical treatment of renal artery stenosis after failed percutaneous transluminal angioplasty. 214 3

Apart from those suffering from vascular trauma, 334 patients with cervicomediastinal lesions have been treated at Durban Metropolitan Hospitals over a period of 8 years. Sixty-seven of these were black (20%), 79 Indian (24%), 10 coloured (3%) and 178 white (53%). Atherosclerotic disease was found in 50% of black, 80% of Indian and 99% of white patients; the remaining patients suffered from miscellaneous conditions, such as arteritis, fibromuscular dysplasia, mucoid degeneration and radiation. Aneurysmal disease was found in 33% of blacks, but only 2% of Indians and 0.6% of whites; the remainder had occlusive lesions. More blacks presented with complete stroke (16%) than in the other population groups, who presented most frequently with episodic neurological dysfunction. It is concluded that atherosclerosis is as common as arteritis in blacks, while it is the most common precipitating factor for cervicomediastinal lesions in the other two groups. Aneurysms and complete stroke are also common in blacks.
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PMID:Non-traumatic cervicomediastinal vascular lesions. A clinicopathological study in the different populations of Natal. 218 89

External iliac fibromuscular dysplasia is a rare and usually asymptomatic disorder. We report eight symptomatic patients seen over a 15-year period and review pathophysiologic mechanisms accounting for the three following distinct lower extremity ischemic sequelae: (1) Emboli--episodic focal digital ischemia (blue toe) was seen in three patients. Resection and primary anastomosis of focal iliac ulcerative fibromuscular dysplasia (one patient) or resection and replacement (two patients) removed the embolic source and relieved the symptoms. (2) Chronic ischemia--gradual onset of full leg claudication in four patients was treated by operative graduated intraluminal dilation in three patients and prosthetic bypass in one. Arteriography subsequently showed a remodeled lumen in the three patients who underwent dilation. (3) Dissection--acute onset leg ischemia resulted from presumed dissection of the external iliac segment. After 4 months of conservative management of antiplatelet agents and exercise, symptoms resolved completely, and arteriogram showed spontaneous restoration of a normal lumen in the dissected segment. The clinical presentation of fibromuscular dysplasia may mimic other arterial processes such as atherosclerosis. Diagnosis is made only by arteriography with specific magnification views of the external iliac arteries and careful surveillance of the renal arteries. Appropriate treatment should be tailored to the clinical presenting symptom. For microembolic disease, resection and replacement are required. For chronic ischemia, intraluminal dilation is generally sufficient and durable and has proved to be a simpler and acceptable alternative to replacement or bypass. In acute dissection, surgical intervention may be deferred if the limb is viable to allow spontaneous healing and remodeling. Persistent symptoms may be the only indication for intervention in this ischemic manifestation of external iliac fibromuscular dysplasia.
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PMID:Clinical spectrum of symptomatic external iliac fibromuscular dysplasia. 221 43

The authors investigated 100 patients (55 males and 45 females) aged 16 to 45 years who experienced cerebral ischemic attack, excluding venous thrombosis. Transient ischemic attacks accounted for 12% only. Attacks were related to usual causes of brain ischemia in 49 cases (premature atherosclerosis in 26, cardiopathy in 20 and lacunar stroke in 3). Thirty-eight events were attributed to most uncommon etiologies. Nonatherosclerotic arteriopathies (10 cases) such as spontaneous dissection, dysplasia or megadolichoarteries were easily diagnosed by angiography. Oral contraceptives (14 cases) and migraine (2 cases) were diagnosis of exclusion. Hematological disorders were a possible cause in 10 patients. Etiology remained undetermined in 13 cases. Four patients died acutely. Follow-up data were obtained in 93 survivors with a mean duration of 26 months (range, 6 to 60 months). Four subjects died during follow-up and 6 experienced recurrent stroke (annual recurrence rate: 3%). In activities of daily living, 64% of patients had complete autonomy while 13% had mild residual disability and 23% had severe handicap.
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PMID:[Cerebral arterial ischemic complications in young adults. Etiology and prognosis]. 232 55

We investigated 663 patients with renovascular hypertension (349 males and 314 females), who were surgically treated at 73 institutions of Urology or Surgery in Japan from 1963 to 1988. There were 294 cases with fibromuscular dysplasia (FMD), 178 with atherosclerosis (SC), 104 with aortitis syndrome (AO) and 87 with other causes. The mean age was 27 years old for FMD, 52 years for SC and 29 years for AO. Thirteen % of FMD, 19% of SC and 38% of AO had stenoses in both renal arteries. Since percutaneous transluminal angioplasty (PTA) has begun in early 1980's, the number of operative cases has been decreased, especially in the case of FMD due to a good result by PTA. Nephrectomy was done in 38% of 704 operations. Aortorenal bypass and autotransplantation were performed in 49% and 26% of the rest, respectively. Recently, autotransplantation has increasingly been applied for complicated vascular lesions. As regards prognosis of the surgical treatment, 77% of FMD, 59% of SC and 50% of AO presented normal blood pressure with or without antihypertensive drugs at least for 10 years after an operation. However, among the patients with normal blood pressure who were observed for more than 5 years, 30% of FMD, 56% of SC and 44% of AO had taken antihypertensive drugs. Eleven patients (1.7% of all) died within one month after the operation, 5 patient of whom had bilateral stenoses. In conclusion, PTA is the first choice for renovascular hypertension and surgery has been done for more difficult and complicated cases in which PTA is ineffective.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Renovascular hypertension. Changes and prognosis of the surgical treatment]. 240 14

In the present study we report our long-term experience in 82 patients with renovascular hypertension (48 with atherosclerotic stenosis, 34 with fibromuscular dysplasia) who were followed up for a mean observation period of 23.6 months after percutaneous transluminal angioplasty (PTA) of renal artery stenosis. Our results show a highly significant decrease in mean systolic and diastolic blood pressure. Cure rates were slightly higher in patients with fibromuscular dysplasia (41% cured, 47% improved) than in those with atherosclerosis (23% cured, 54% improved). Kidney function significantly improved in patients with cure, remained stable in those with improvement and worsened in cases classified as unimproved. These results document the good long-term effect of PTA on blood pressure and kidney function in patients with renal artery stenosis.
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PMID:Cure and improvement of renovascular hypertension after percutaneous transluminal angioplasty of renal artery stenosis. 252 25

Renal artery stenosis in 201 patients with hypertension was treated with percutaneous transluminal renal angioplasty (PTRA). A total of 213 procedures were performed as treatment of 262 separate stenosis. The stenosis was caused by atherosclerosis in 134 cases and by fibromuscular dysplasia (FMD) in 52 cases; the cause was indeterminate in 27 cases. Of the 213 procedures, 172 were successful or resulted in improvement, for a technical success rate of 80.8%. The initial clinical results could be evaluated in 210 cases; cure or improvement was achieved in 80%. There were 23 cases in which neither technical nor clinical success was achieved. Data on the remaining 187 cases were the basis of this long-term follow-up study. The cumulative patency rate at 5 years was 80% in the atherosclerosis group, 89% in the FMD group, and 74% in the indeterminate group. The mortality was less than 1%. Because spasm occurred in 33 cases, causing an infarction in ten instances, antispasmodic medication seems warranted. These long-term results indicate that PTRA is the treatment of choice in patients with renovascular hypertension.
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PMID:Percutaneous transluminal renal angioplasty: initial and long-term results. 252 80

The results of the treatment with surgery and percutaneous transluminal angioplasty of the renal artery were evaluated in 63 adult patients of both sex, from 16 to 60 years old with renovascular hypertension due to fibromuscular dysplasia in 48 and to atherosclerosis in 15. The stenosis of the renal artery was unilateral in 47 patients and bilateral in 16. The surgical procedures more used were the aorto-renal bypass with saphenous vein in 22 patients and unilateral nephrectomy in 16. From 41 patients treated with surgery, the arterial hypertension was cure or improved after one year in 30 (73.1%). From 22 patients treated with angioplasty, cure or improved was obtained in 17 (77.2%). Satisfactory results were obtained in patients with fibromuscular dysplasia and unilateral stenosis, and poor results in atherosclerosis and bilateral stenosis, with both methods. It is concluded, that surgery and angioplasty are satisfactory therapeutic methods in the renovascular hypertension, principally when is unilateral and due to fibromuscular dysplasia.
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PMID:[Results of surgery and percutaneous transluminal angioplasty in renovascular hypertension]. 253 82

Renal artery stenosis is an uncommon, but curable cause of systemic hypertension. The most common causes of stenosis are atherosclerosis, and fibromuscular dysplasia. Diagnosis may be difficult due to the lack of a suitable screening test, and a high index of suspicion needs to be maintained. Treatment may be with pharmacotherapy, renal angioplasty, or surgery and the choice of therapy needs to be tailored to the individual patient. Once a stenotic lesion is discovered in a hypertensive patient, the functional significance is not always clear cut. Fibromuscular dysplasia may be a systemic disease in some cases, and may affect the central nervous system.
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PMID:Renovascular hypertension and demyelimating disease in a young woman. 259 48


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