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

Surgery of the suprarenal segment of abdominal aorta is characterized by specific problems of operative techniques and of circulatory support during operative procedure. Ischaemic time of kidneys and other viscera has to be limited and use of femoro-femoral bypass allows perfusion of distal aortic branches during performance of the proximal anastomose. Replacement of the suprarenal abdominal aortic segment was performed in 57 consecutive patients (45 with aneurysm and 12 with para- or suprarenal atherosclerosis). Emergent operation was performed in 10 patients (9 with aortic rupture and 1 with acute renal failure by occlusion of the pararenal aortic segment) with early mortality of 50%. Elective operation was much safer with early mortality of 4.3% (2/47 patients). Following procedures were performed to revascularize the kidney and the other visceral arteries: direct replantation with or without endarterectomy (80%), bypass with prosthetic material or saphenous vein (15%), other procedures (5%). Nephrectomy was done in 3 patients. Overall 6-year survival was 64% in patients with aneurysm and 48% in patients with aortic atherosclerosis. 6-year survival was significant (p less than 0.01) higher in patients with normal renal function postoperatively than patients with persisting creatinine value over 200 micromol/l 3 months after operation (68% vs 15%).
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PMID:[Surgery of the suprarenal subdiaphragmatic aorta: early and long-term results]. 164

We have previously shown the safety and efficacy of University of Wisconsin solution for hypothermic preservation of the human donor heart in a pilot group of 16 transplant recipients. The present study is a randomized clinical trial comparing University of Wisconsin solution to conventional preservation using crystalloid cardioplegia and saline storage within a 4-hour limit of ischemia. Heart transplant recipients (n = 42) were randomized into two groups: those receiving hearts preserved by University of Wisconsin solution, the UWS group (n = 22), and those receiving hearts preserved in the conventional manner, the CCS group (n = 20). Recipient age, gender, heart disease, and preoperative inotropic support and donor age, gender, and mean ischemic time in hours (UWS 2 hours 36 minutes, range 1 hour 36 minutes to 2 hours 53 minutes; CCS 2 hours 20 minutes, range 1 hour 20 minutes to 2 hours 44 minutes; p = not significant) were similar. Significant differences observed between the two groups included (1) mean time (minutes) from reperfusion to achieve a stable rhythm, (2) need for intraoperative defibrillations, (3) need for transient cardiac pacing, and (4) integrated postoperative creatinine kinase and aspartate aminotransferase release over 48 hours. There was no difference in postoperative electrocardiogram, endomyocardial biopsy, or hemodynamics. One UWS patient died of sepsis and another of a ruptured cerebral aneurysm. UWS is safe for donor organ arrest and preservation despite high viscosity and potassium concentration. When compared with CCS hearts, hearts preserved in UWS regained electrical activity more rapidly and had better myocardial protection as demonstrated by enzymatic analysis. Further investigation is required to determine the effects of UWS preservation on long-term survival, to determine the prevalence of rejection and graft atherosclerosis, and to test the ability of UWS to extend donor ischemic time in human cardiac transplantation.
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PMID:University of Wisconsin solution versus crystalloid cardioplegia for human donor heart preservation. A randomized blinded prospective clinical trial. 173 83

Hyperlipidemia is a major risk factor for atherosclerosis and probably contributes to the increased cardiovascular mortality following renal transplantation. We studied the lipid profiles of 62 adults (29 males) with stable renal function (mean plasma creatinine 0.14 mmol/l, SD 0.07), 7 months to 21 years after renal transplantation. Fifteen patients (24%) were above the age- and sex-adjusted 95th percentile for total triglyceride and 10 (16%) for total cholesterol concentrations when compared with a local reference population. The most common lipoprotein abnormalities were type IIa (19%) and type IIb (13%). Multiple regression analysis demonstrated that the use of diuretics and angiotensin-converting enzyme inhibitors were significant factors determining plasma triglyceride concentrations. There were significant bivariate associations between plasma triglyceride concentration and duration since transplantation, plasma creatinine concentration and the use of ciclosporin and diuretics. Duration since transplantation and ciclosporin use were significant factors determining lower plasma cholesterol concentrations. The use of ciclosporin and diuretics was associated with a significantly higher apolipoprotein (apo) B concentration. The cholesterol/HDL cholesterol risk ratio correlated poorly with the apo B/apo A-1 ratio. The value of these ratios as predictors of coronary artery disease need to be established in renal transplant recipients.
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PMID:Hyperlipidemia in stable renal transplant recipients. 175 32

The procedure of discontinuous gradient ultracentrifugation (DGU) was used to characterize the influence of early diabetic nephropathy on the composition of very low density lipoprotein (VLDL, flotation density 60-400 Svedberg (Sf) units), low density lipoprotein (LDL, flotation density 0-12 Sf) and subfractions of intermediate density lipoprotein (IDL1 and IDL2, 20-60 and 12-20 Sf, respectively). Forty-six subjects with type 1 (insulin-dependent) diabetes and serum creatinine, less than 140 mumol/l were studied, of whom 23 consistently had normal rates of albumin excretion (AER less than 15 micrograms/min), and 23 had persistent albuminuria (AER 20.0-960.6 micrograms/min). The two groups were similar with respect to total serum lipids, glycaemic control, age and body mass. The composition (lipid, protein and phospholipid) and mass of VLDL, LDL and IDL2 was not appreciably altered by early nephropathy, but free and total cholesterol concentration in IDL1 (Sf 20-60) was increased (total cholesterol 0.68 (0.09) (mean (SE)) vs. 0.47 (0.07) mmol/l, and free cholesterol 0.27 (0.04) vs. 0.17 (0.03) mmol/l, both P less than 0.05). The explanation of these findings was probably an accumulation in the circulation of the remnants of chylomicron metabolism and/or intermediates in the conversion from VLDL to IDL1. In addition, there was a decrease in serum high density lipoprotein (HDL) cholesterol in early nephropathy (1.27 (0.06) vs. 1.38 (0.10) mmol/l, P less than 0.05), due to a decrease in the HDL2 cholesterol subfraction (P less than 0.05). These findings may in part explain the increased risk of premature atherosclerosis associated with the development of albuminuria.
Atherosclerosis 1991 Jul
PMID:Influence of early diabetic nephropathy on very low density lipoprotein (VLDL), intermediate density lipoprotein (IDL), and low density lipoprotein (LDL) composition. 177 71

The 3-years efficacy and safety of the 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitor simvastatin (S) (previously called synvinolin or MK-733) has been studied in single and combined therapy with cholestyramine (C) in 48 hypercholesterolaemic patients. Plasma lipids, lipoproteins and apolipoproteins A-I and B, and blood safety tests (haematology, liver function, creatine phosphokinase (CPK), creatinine, blood glucose and thyroid function) were determined regularly throughout the study. Extensive ophthalmological examinations with particular focus on the lens were done before initiation of therapy and at every 6 months during drug treatment. Maximal reductions of mean plasma total cholesterol concentration (34% with S; 47% with S + C) and low-density lipoprotein (LDL)-cholesterol concentration (42% with S; 56% with S + C) were achieved after 4 weeks on full-dose therapy. During continued treatment, years 1 through 3, the reduction of mean plasma total cholesterol was 26-29% with S alone, and 31-41% with S + C. Significant reductions of plasma triglycerides (15-27%) and very low density lipoprotein (VLDL) triglycerides (10-27%) were achieved in the group treated with S as single therapy. In this group there was also a significant increase (10-14%) of high-density lipoprotein (HDL)-cholesterol. In liver aspartate (AST) and alanine (ALT) aminotransferases, as well as alkaline phosphatase (ALP), minor and variable, but usually transient, increases were seen. Repeated ophthalmological examinations did not demonstrate any drug-related side effects. It is concluded that simvastatin is a safe and efficient cholesterol-lowering drug for long-term therapy, both as a single drug and in combination with cholestyramine.
Atherosclerosis 1991 Dec
PMID:Long-term efficacy and safety of simvastatin alone and in combination therapy in treatment of hypercholesterolaemia. 178 13

Between 1983 and 1989, 40 patients with uncontrollable hypertension underwent renal revascularization. Of these, 21 patients had simultaneous aortic and renal revascularization. Eleven of the 21 patients (52.4%) had renal insufficiency with a mean creatinine clearance of 0.61 +/- 0.23 ml/sec. Eleven patients had an aortic aneurysm; the remaining 10 patients had aortic occlusive disease of varying severity. Aortic reconstruction was done with either a straight (8 patients) or bifurcated (13 patients) Dacron graft. Renal revascularization was accomplished with either bypass (11 patients) or transaortic endarterectomy (10 patients). One patient died postoperatively secondary to myocardial infarction (operative mortality rate of 4.7%). Among the 11 patients with renal insufficiency the mean creatinine clearance of 0.61 +/- 0.23 ml/sec preoperatively improved to 0.94 +/- 0.30 ml/sec postoperatively (p less than 0.01). In the follow-up period extending to 78 months (mean 39.1 months), one late death occurred. There were no instances of worsening hypertension or deterioration in renal function. Contrary to some previous reports, our results indicate that severe aorto-renal atherosclerosis can be managed with simultaneous aortic reconstruction and renal revascularization at an acceptably low operative risk. In addition, a significant and persisting benefit in both hypertension control and renal dysfunction can be expected after surgery.
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PMID:Are simultaneous aortic reconstruction and renal revascularization safe and effective? 183 78

To evaluate in vivo platelet activation, 11-dehydro-thromboxane B2 levels in plasma and urine were measured in 9 patients with unstable angina and 11 with stable angina using radioimmunoassay modified by the extraction method of Kawano et al. The 2 groups were matched for age, sex, coronary risk factors, medications or atherosclerotic lesions in coronary angiography. Although there was no difference in the plasma level between the 2 groups in the usual state, urinary 11-dehydro-thromboxane B2 amount in unstable angina was significantly increased compared to the stable angina group (865.5 +/- 238.7 vs 535.9 +/- 177.4 pg/mg creatinine (mean +/- SD), p < 0.01). There was no correlation between the 11-dehydro-thromboxane B2 level and the degree of coronary atherosclerosis in either group. The plasma level increased during the attacks in 2 patients with unstable angina. The amount of urinary 6-keto-PGF1 alpha did not differ between the 2 groups. These findings suggest that platelet activation in vivo is more pronounced in unstable angina than in stable angina, and that the measurement of urinary 11-dehydro-thromboxane B2 may be useful for evaluating and treating angina.
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PMID:[Elevation of 11-dehydro-thromboxane B2 levels in unstable angina]. 184 45

Percutaneous transluminal renal angioplasty was performed in a 63-year-old diabetic woman who had renovascular hypertension with solitary functioning kidney and diffuse atherosclerosis. Angioplasty was technically successful, while thereafter, fever and myalgia of legs occurred with gradual increases in blood urea nitrogen and creatinine. The patient became uremic over a month after angioplasty and was placed on dialysis. She died six months after angioplasty. Autopsy revealed cholesterol embolization in bilateral kidney, pancreas and spleen, causing subacute renal failure. It is suggested that careful assessment of the patient should be made when determining the need for renal angioplasty for renovascular hypertension with a solitary functioning kidney.
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PMID:Renal failure due to cholesterol embolization following percutaneous transluminal renal angioplasty. 186 75

Palmaz balloon-expandable stents were placed in 28 hypertensive patients with atherosclerosis involving the ostia of the renal arteries. Stents were placed to treat elastic recoil immediately after conventional angioplasty in 20 patients and restenosis after percutaneous transluminal angioplasty in eight patients. Technical success (greater than 30% residual stenosis) was achieved in 27 patients. Complications occurred in five patients. At follow-up (1-25 months), hypertension was cured in three patients and improved in 15 patients, with a cumulative cure or improvement of 64% at 6 months. Of 14 patients with a serum creatinine level of 1.5 mg/dL (132.6 mumol/L) or greater before the placement of stents, five demonstrated improved renal function, five showed stabilization of their condition, and four demonstrated deterioration. Follow-up angiography (2-18 months) was performed in 18 patients. Restenosis was present in seven patients and was accompanied by a relapse of hypertension in only three patients. Of the other four patients with restenosis, two had no initial improvement and two had an initial response without a relapse of hypertension. In this preliminary study, renal stents were beneficial in many patients with poor results from conventional angioplasty for ostial atheroma.
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PMID:Palmaz stent in atherosclerotic stenoses involving the ostia of the renal arteries: preliminary report of a multicenter study. 192 96

Chronic smoking is a major risk factor of atherosclerosis and coronary heart disease. The measurement of three major thromboxane A2 metabolites, 11-dehydrothromboxane B2, 2,3-dinorthromboxane B2 and thromboxane B2, in the urines of 13 apparently healthy smokers (average 39 years, range 27-56 years) showed significantly elevated excretion rates for all thromboxane A2 metabolites as compared to 10 apparently healthy age-matched non-smokers (average 37 years, range 26-56 years). Importantly, characteristic alterations in the thromboxane A2 metabolite pattern were found in the urines of smokers. The contribution of 2,3-dinorthromboxane B2 to total measured excretion of thromboxane A2 metabolites was 59.2% in smokers (404.0 +/- 53.0 pg/mg creatinine) versus 19.4% in non-smokers (85.2 +/- 8.3 pg/mg creatinine), that of 11-dehydrothromboxane B2 35.7% in smokers (673.2 +/- 88.9 pg/mg creatinine) as compared to 75.5% in non-smokers (332.6 +/- 30.9 pg/mg creatinine). The contribution of thromboxane B2 (57.5 +/- 7.7 pg/mg creatinine in smokers versus 21.9 +/- 1.5 pg/mg creatinine in non-smokers) was similar at 5.1%. The excretion of cotinine, the major urinary metabolite of nicotine that correlates well with the reported daily cigarette consumption (r = 0.97, P less than 0.0001), showed a good correlation to thromboxane A2 metabolite excretion (2,3-dinorthromboxane B2: r = 0.92, P less than 0.0001; 11-dehydrothromboxane B2; r = 0.87, P less than 0.0001).
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PMID:Smoking alters thromboxane metabolism in man. 199 38


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