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

Acute arterial occlusion in an extremity must be treated as a medical-surgical emergency since not only the affected limb is endangered, but the life of the patient as well. The cause of the acute occlusion is an embolism or in situ thrombosis. The most common source of embolism is the heart from which about 30% of the cardiac emboli obliterate the bifurcation of the femoral artery and about 4/5 of all emboli involve the extremities. Arterio-arterial emboli arise from aneurysms or from nonocclusive, ulcerated atheromatous plaques. Acute in situ thrombosis occurs mostly at the site of stenotic arteriosclerotic lesions. Aneurysms and dilated forms of atherosclerosis can be both the cause of in situ thrombosis as well as the source of an embolism. Differentiation between thrombosis and embolism can be extremely difficult but for acute treatment, however, it is of little relevance. There is a peak of both events in the seventh and eighth decades. On complete occlusion without adequate collaterals, the presentation is characterized by "the six Ps": pain, pallor, pulselessness, paresthesia, paralysis and prostration. With acute occlusion of central points such as the aortic bifurcation or the femoral artery bifurcation, there is complete ischemia with onset of rhabdomyolysis after four to six hours which can lead to severe local and generalized symptoms due to the dangerous metabolites released. In contrast, occlusion of isolated lower leg arteries usually only lead to transient symptoms. If arterial occlusion is suspected, prior to transportation to the hospital, 5000 I.E. heparin should be given intravenously. Acute thrombotic occlusion of large arteries is the surgical domain.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Therapy of acute peripheral arterial occlusion]. 183 82

On clinical grounds, ulcers of the leg of vascular origin can fairly easily be separated into venous and arterial origins; 85% of ulcers of the leg are caused by venous insufficiency. The ulcers occur mainly around the medial malleolus, are covered by moist granulation tissue, and are surrounded by varying degrees of stasis dermatitis and brown hemosiderin pigmentation. The limb is usually edematous and improves with elevation. In contrast, arterial ulcers of the leg develop more distally on the toes or feet, severe pain is a prominent feature, and the dry crusted ulcers usually lack granulation tissue. Elevation of the leg aggravated the pain of ischemic ulcers, whereas dependency of the limb provides some relief. Both types of ulcers heal faster with occlusive dressings that furnish a moist wound environment. Patients with ulcers caused by venous insufficiency can have coexisting peripheral atherosclerosis. Compression elastic stockings used for venous insufficiency should not be so tight that they induce necrosis of the skin in patients with occult arterial disease.
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PMID:Vascular skin ulcers of limbs. 191 34

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

To assess the clinical effectiveness of pentoxifylline (Trental) in the treatment of intermittent claudication and ischemic rest pain, 129 patients were retrospectively interviewed with respect to compliance and improvement of symptoms. Risk factors for the development of atherosclerosis were tabulated, as was the severity of symptomatic lower extremity peripheral vascular insufficiency. The duration of pentoxifylline treatment was 35.8 +/- 45.0 weeks (mean +/- 1 S.D.). Forty-eight percent of the patients discontinued pentoxifylline on their own, most commonly because of side effects (13%) or perceived lack of improvement (23%). Of those patients taking pentoxifylline for eight weeks or more (n = 110), 64% noted some improvement, with 31% reporting increased claudication distance and 52% reduced claudication pain. Pentoxifylline provided pain relief in 52% of patients with ischemic rest pain (n = 27). Neither diabetes, hypertension, concomitant antiplatelet therapy, the severity of claudication, nor pretreatment ankle-brachial Doppler pressures were related to treatment outcome. Increased daily walking exercise during treatment was associated with successful outcome (p = 0.04). Clinical response to pentoxifylline was inversely related to the number of cigarettes smoked daily in those with 1 block claudication (n = 71, p = 0.05). Pentoxifylline was not very effective in increasing reported claudication distance. This review suggests that pentoxifylline may be of value for patients with ischemic rest pain when arterial reconstruction is not possible. Whether pentoxifylline is useful adjunctive therapy for intermittent claudication requires further scrutiny.
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PMID:Pentoxifylline in the nonoperative management of intermittent claudication. 199 79

Plasmapheresis was applied to treat 67 patients with lower extremity vessel atherosclerosis obliterans. A total of 92 therapy courses were performed, which involved 250 sessions of plasmapheresis (205 with a PF-0.5 apparatus and 45 with plastic bags and centrifuge). During the course, an average of 160% volume of circulating plasma were removed to be replaced with crystalloids and dextrans. A positive effect shown by a 6.9-fold increase in the distance covered by patients who experienced no pains and by resting pain relief was achieved in 93.8% with Stage II circulatory failure and 75% with Stage III, regardless of the severity of vascular lesions. It was shown that it was necessary to make a "programmed" plasmapheresis when the patient received 2 plasmapheresis courses a year. The mechanism of a positive effect of plasmapheresis remains unclear. A significant plasmapheresis-induced decrease was observed in the concentration of "acute phase proteins" (plasma fibrinogen and globulins), which plays the leading role in improving blood rheology, which seems to affect clinical outcomes.
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PMID:[Immediate and long-term results of the use of plasmapheresis in obliterating atherosclerosis of the vessels of the lower limbs]. 225 49

Today hyperuricaemia and gout are likewise seen in every population of the western industrial world and have been increasing since the fifties. As known from number of studies hyperuricaemia often occurs in connection with hyperlipoproteinaemia, obesity, diabetes mellitus, arterial hypertension and atherosclerosis. Up to now it was not clear whether one disease caused the other. In 1988 Abbot could prove that among men, those afflicted by gout as compared to those without gout experienced a 60% excess of coronary heart disease. Therefore, patients with gout should receive a regular thorough cardiovascular evaluation. Furthermore risk factor levels which predispose to coronary heart disease, arterial hypertension and gout should be reduced. There is a significant positive correlation between the plasma uric acid levels and the prevalence of attacks of gouty arthritis and nephrolithiasis. It is possible to avoid gouty arthritis, tophi and nephrolithiasis with a consequent diet and medical treatment. Unfortunately, many patients interrupt therapy during intervals free of pain. The consequence is that even today the complications of hyperuricaemia cause days of inability to work and to earn one's living, despite of modern therapy. Hyperuricaemia not sufficiently treated reduces the quality of life through attacks of gout, chronic gout and nephrolithiasis as well as life expectancy caused by nephropathy, arterial hypertension and atherosclerosis. This is of special importance because of the frequency of gout and hyperuricaemia in our population. An early diagnosis, a consistent therapy and a thorough monitoring could stop an increase of this disease and prolong life expectancy for those who have gout and the other attendant diseases.
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PMID:[Hyperuricemia--does modern therapy improve life expectancy?]. 227 73

1. Cysteamine is formed by degradation of coenzyme A (CoA) and causes somatostatin (SS), prolactin and noradrenaline depletion in the brain and peripheral tissues. 2. Cysteamine influences several behavioral processes, like active and passive avoidance behavior, open-field activity, kindled seizures, pain perception and SS-induced barrel rotation. 3. Cysteamine has several established (cystinosis, radioprotection, acetaminophen poisoning) and theoretical (Huntington's disease, prolactin-secreting adenomas) indications in clinical practice. 4. Pantethine is a naturally occurring compound which is metabolized to cysteamine. 5. Pantethine depletes SS, prolactin and noradrenaline with lower efficacy compared to that of cysteamine. 6. Pantethine is well tolerated by patients and has been suggested to treatment of atherosclerosis. The other possible clinical indications (alcoholism, Parkinson's disease, instead of cysteamine) are discussed.
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PMID:Preclinical and clinical studies with cysteamine and pantethine related to the central nervous system. 227 50

Clonidine and its Soviet-made analogue clopheline (10 micrograms) after epidural administration to rats equally inhibited nociceptive reactions and changes in arterial blood pressure in the somatic and visceral pain tests. In patients with obliterating atherosclerosis of the lower extremities clopheline (100 and 200 micrograms) relieved the pain syndrome and shifts of II-hydroxycorticosteroids in blood, induced bradycardia and the background arterial blood pressure-dependent antihypertensive effect.
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PMID:[An experimental and clinical study of the analgesic action of clofelin when administered epidurally]. 236 46

The paper presents the results of examination of 149 patients with ischemic heart disease. All the patients underwent 24-hour Holter monitoring; selective coronary angiography according to M. Judkins was performed in 142 patients, 29 patients were subjected to a bicycle ergometric test adopted in the All-Union Cardiology Research Center, USSR Academy of Medical Sciences. In the patients with ischemic heart disease, features and rates for detecting the painless episodes of ST-segment depression from the data of 24-hour Holter monitoring. Painless episodes of ST-segment depression were revealed in 82% patients with sclerosing atherosclerosis of the coronary bed. These were most frequently found in patients with three diseased vessels in the coronary bed or impaired left coronary trunk. Painful episodes of ST-segment depression were more pronounced and prolonged in the majority of patients.
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PMID:[Value of 24-hour ECG Holter monitoring in the evaluation of painless episodes of ST segment depression in patients with ischemic heart disease]. 239 67

In recent years double-blind trials have proved the effectiveness of nonsurgical therapy in the treatment of peripheral obstructive arterial disease (POAD). Among the non-pharmacologic measures taken, walking distance was increased by 40% in subjects who stopped smoking and by more than 100% in those who undertook physical exercise. Drug treatment reduces the atherosclerotic process and brings about an improvement in the symptoms of the disease. In subjects given hypolipidemic treatment the progression of the disease was reduced by two thirds. Two separate studies suggest that antiplatelet drugs, taken over a period of two to four years, significantly slow the progression of atherosclerosis in lower extremity arteries. In the treatment of claudication, two vasodilating drugs, naftidrofuryl and buflomedil, have shown a significant improvement in painfree walking distance and/or total walking distance, compared with treatment with placebo. Another effective approach is in the treatment of blood rheology through drugs such as pentoxifylline or by hemodilution. Double-blind trials with pentoxifylline demonstrated an average increase of 66% in maximum walking distance as compared with 22% with placebo. The effectiveness of hemodilution was demonstrated by two controlled trials, during which the reduction of the hematocrit to values of 40-42 for periods of four to six weeks increased both walking distance and resting blood flow. When introduced intraarterially in low doses in the vicinity of the occluding thrombus, thrombolytic agents have been found to be helpful in the treatment of acute and chronic POAD. This therapy should, however, be regarded as a substitute for surgical treatment only in high-risk patients. Further, after having produced the lysis of thrombi, the treatment permits the underlying parietal lesions to be accurately identified; at this point the appropriate therapy can be decided upon, either an operative procedure or a balloon dilation. In conclusion the many controlled clinical trials carried out over the past few years have clearly demonstrated that conservative treatment can alleviate clinical signs and symptoms in patients with claudication and pain at rest.
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PMID:Current therapy of peripheral obstructive arterial disease. The non-surgical approach. 240 52


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