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)

Although long-term use of cyclosporine has been implicated in the pathogenesis of arteriolar hyalinosis, interstitial fibrosis, and glomerulosclerosis observed in the native kidneys of heart transplant recipients, it is not clear that these histologic abnormalities are entirely specific for a drug-induced toxic nephropathy. The purpose of this study was to determine whether long-standing congestive heart failure, particularly when complicated by disease processes such as atherosclerosis and hypertension, may independently predispose to the development of similar renal histopathology. Records and specimens were selected from autopsy files for evaluation of clinical profiles and kidney histology in 16 patients who died of end-stage cardiomyopathy of varying causes without having recourse to heart transplantation. The study cohort consisted of 12 men and four women. Cardiomyopathies were the result of coronary artery disease in six patients and nonischemic causes in the other 10 patients. The mean age at the time of death was 53 +/- 3 years (range 28 to 74 years). Thirteen (81%) of 16 patients had a history of hypertension. Nadir serum creatinine concentrations during the month before death were 1.7 +/- 0.2 mg/dl (range 1.2 to 3.5 mg/dl). Interstitial fibrosis, tubular atrophy, and glomerulosclerosis were present in 15 (94%) of 16 patients. Arteriosclerosis and arteriolosclerosis were found in 13 (81%) of 16 and 14 (88%) of 16 patients, respectively. A nodular pattern of arteriolar hyalinosis was observed in two patients with ischemic disease.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Evaluation of chronic renal disease in heart transplant recipients: importance of pretransplantation native kidney histologic evaluation. 806 Oct 12

The prevalence of hyperlipidemia in adolescents and young adults who are long-term survivors of pediatric renal transplantation with stable graft function has not previously been examined. We studied 33 renal transplant recipients aged 5 to 23 years, who were an average of 7.4 years (range 3 to 11 years) post-transplant. We found hypercholesterolemia in 17 (total cholesterol (TC) > 5.18 mmol/l). Both low-density lipoprotein cholesterol (LDL-C) and high-density lipoprotein cholesterol (HDL-C) levels were increased, such that the mean TC/HDL-C and apolipoprotein B/apolipoprotein A1 (Apo B/Apo A1) ratios were below levels associated with increased coronary artery disease risk. Subjects with hypercholesterolemia did not differ from those with normal cholesterol values in current age or age at transplant, serum creatinine, serum albumin, serum triglycerides, HDL-C, TC/HDL-C ratio, Apo B/Apo A1 ratio, prednisone dose, body mass index, gender, use of thiazides or beta blockers, or family history of premature atherosclerosis. Coronary risk factors appear to cluster in these patients, with hypertension in 53% of those with hypercholesterolemia. Lipid profiles were not different in patients treated with prednisone-azathioprine vs. prednisone-azathioprine-cyclosporine A immunosuppression. A significant correlation was found between prednisone dose (mg/m2) and TC, LDL-C and TC/HDL-C. According to National Cholesterol Education Program guidelines, 32% of these long-term survivors of pediatric renal transplantation warrant at least dietary intervention and 10% are candidates for treatment with lipid-lowering drugs. This proportion is likely to increase as the safety of lipid-lowering agents is established in younger children.
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PMID:Hyperlipidemia in long-term survivors of pediatric renal transplantation. 806 64

Thromboxane A2 biosynthesis was studied in healthy subjects, in patients in whom the extent of carotid atherosclerosis was determined, and in patients receiving chronic aspirin treatment, to determine what factors activate platelets to develop carotid atherosclerosis. Urinary 11-dehydrothromboxane B2, a major metabolite of thromboxane A2, was measured by radioimmunoassay after purification by reverse-phase HPLC. The extent of carotid atherosclerosis was determined by real-time B-mode ultrasonography. The severity of carotid atherosclerosis in each subject was evaluated by plaque score, which was computed by summing the maximum thickness of plaque measured in millimeters. Urinary excretion of 11-dehydrothromboxane B2 in healthy subjects was higher (P < 0.01) in cigarette smokers (1063 +/- 244 ng/g creatinine) than in non-smokers (815 +/- 183 ng/g creatinine). Aspirin significantly suppressed 11-dehydrothromboxane B2 excretion (266 +/- 114 ng/g creatinine). In the 24 patients in whom the plaque score was measured, multivariate analysis indicated a significant positive correlation between urinary excretion of 11-dehydrothromboxane B2 and plaque score, age, smoking and hypercholesteremia. Our results indicate that risk factors such as age, hypercholesteremia, atherosclerosis and smoking activate platelets in vivo to develop carotid atherosclerosis.
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PMID:Risk factors for carotid atherosclerosis and platelet activation. 806 12

Infection is a devastating complication of synthetic aortic graft surgery. Patients with significant occlusive atherosclerosis of the internal iliac arteries undergoing aortic graft removal for graft infection may be at risk of pelvic and midbody necrosis. An unusual and fatal complication of this nature associated with the management of synthetic aortic graft infection has been encountered in two patients treated by extra-anatomic revascularization and staged removal of the infected aortic prosthesis. The hallmark of their presentation was pelvic and midbody necrosis in the presence of excellent distal perfusion with palpable pulses. Marginal pelvic circulation was therefore compromised further by graft removal and absence of retrograde pelvic perfusion. The finding of focal ischemic changes in the pelvic area of a patient with increasing serum creatinine phosphokinase activity, leukocytosis, myoglobinuria and paraplegia following infected aortic graft removal signals a grave and fatal prognosis.
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PMID:Pelvic necrosis: a complication of infected aortic graft excision. 807 36

The data of the first 100 patients undergoing heart transplantation in the period between January 1984 and May 1993 were analyzed. Of this group, 57 patients are alive. Out of the total of 43 deaths, 14 patients died from graft failure within the first postoperative days, 6 died from surgical complications, 11 from infection, 10 deaths were due to accelerated coronary atherosclerosis, and 2 patients died from tumours. Early mortality rates (within 30 days since surgery) were 37% and 17% in patients operated on between 1984-88 and between 1989-93, respectively. The health condition of heart transplant recipients is affected by side effects of immunosuppressive therapy. Forty per cent of patients re-develop systemic hypertension within the first post-transplantation year. Five years after transplantation, hypertension is detected in 60% of patients. Elevated serum creatinine levels are present in 70% of patients by the end of the first post-transplantation year. In the ensuing period, there is no progression in renal function impairment, which does not require cyclosporin withdrawal and is not associated with the development of hypertension. In the first post-transplantation year, 45% of patients are markedly obese. All patients with overweight and obesity show markedly raised levels of serum cholesterol. Another undesirable effect (mainly due to corticosteroid therapy) is the development of ulcers in 16% of patients. Heart transplantation has become an established method at the Institute for Clinical and Experimental Medicine in Prague. Despite the above pitfalls, heart transplantation substantially prolongs the life of patients and dramatically alters the quality of their life.
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PMID:[The patient after heart transplantation]. 814 61

We report the within-person, between-person, and methodological variances of a number of chemical analytes for free-living, middle-aged adults who participated in the Atherosclerosis Risk in Communities Study's Intraindividual Variability Study. The Atherosclerosis Risk in Communities Study is a National Institutes of Health-sponsored multicenter study of atherosclerotic risk factors. In the Atherosclerosis Risk in Communities Study and its Intraindividual Variability Study, concentrations of the following 12 chemical analytes were measured in serum from fasting individuals: sodium, calcium, potassium, creatinine, albumin, total protein, magnesium, phosphorus, urea, insulin, glucose, and urate. The analytes are listed in order of the increasing reliability coefficient (ie, the fraction that between-person variance represents of the total observed population variance), which ranged from .59 for sodium to .91 for urate. The reliability coefficient is a strong predictor of the possibility of finding statistical correlations between measured analyte concentrations and disease occurrence in an epidemiological study like the Atherosclerosis Risk in Communities Study. The within-person variance and methodological variance are also useful in computing confidence intervals for sequential laboratory test results in patients and evaluating limits for internal quality control and proficiency testing programs.
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PMID:Short-term, within-person variability in clinical chemistry test results. Experience from the Atherosclerosis Risk in Communities Study. 819 58

Patients with primary hyperparathyroidism have increased bone turnover, but it is less well documented how brief periods of excess parathyroid hormone (PTH) (endogenous or exogenous) affect bone metabolism. In the present double blind study, we examined the effect of either ethylenediaminetetraacetatic acid (EDTA) or placebo on serum levels of PTH and biochemical markers of bone turnover in 15 women and 39 men (aged 41 to 81 years) suffering intermittent claudication due to atherosclerosis. Disodium EDTA was administered as 20 repeated infusions of 3 grams during a period of 5-9 weeks. Serum calcium and serum phosphate decreased following treatment (p < 0.001) and remained unchanged in the placebo group. However, the differences between the groups were insignificant (ANOVA p = 0.13 and p < 0.10, respectively). PTH increased 2 1/2 fold following EDTA treatment (p < 0.001, ANOVA). The change in serum PTH was inversely correlated with the change in serum calcium (r = -0.53, p < 0.01). In the EDTA group, urinary hydroxyproline/creatinine and calcium/creatinine increased after treatment (ANOVA p < 0.001 and p < 0.05, respectively). Serum bone alkaline phosphatase decreased significantly in the EDTA group immediately after treatment (p < 0.001, ANOVA) and returned to baseline level at three months while only an insignificant decrease in serum osteocalcin was seen following treatment. We conclude that EDTA treatment increases endogenous PTH secretion considerably and leads to increased bone resorption. However, no changes in osteoblastic markers indicating increased activation of bone remodeling could be demonstrated. Our findings support that chelation therapy with EDTA is accompanied by bone loss.
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PMID:Effects of intravenous EDTA treatment on serum parathyroid hormone (1-84) and biochemical markers of bone turnover. 829 6

Coexistence of renal cell carcinoma and renal artery disease is an unusual and challenging problem. From 1969 to 1991, 34 patients presented with localized renal cell carcinoma and renal artery disease affecting all of the functioning renal parenchyma. These patients represented 4 categories: 1) a solitary kidney with renal cell carcinoma and renal artery disease (5), 2) bilateral renal cell carcinoma and coexistent renal artery disease (5), 3) unilateral renal cell carcinoma and contralateral renal artery disease (13), and 4) unilateral renal cell carcinoma and bilateral renal artery disease (11). Atherosclerosis was the most common cause of renal artery disease (30), followed by medial fibroplasia (2), renal artery aneurysm (1) and arteriovenous malformation (1). A total of 23 patients (68%) presented with azotemia (serum creatinine 1.5 mg./dl. or more) and 11 (32%) presented with hypertension. All patients underwent complete surgical excision of renal cell carcinoma. A nephron sparing operation was performed preferentially (30 patients) and bilateral renal cancer operations were staged. Eight patients underwent simultaneous partial (6) or radical (2) nephrectomy and surgical renal revascularization. There were no operative deaths. Postoperatively, preservation of renal function was achieved in 33 patients and 1 required chronic dialysis. At mean followup of 47 months 23 patients (68%) were alive with no evidence of malignancy and 2 were alive with recurrent renal cell carcinoma. Three patients died of metastatic renal cell carcinoma, while 6 died of unrelated causes. All of the latter 6 patients were free of renal cell carcinoma at death. Nephron sparing surgery combined occasionally with renal arterial reconstruction can yield gratifying results in this complex patient population.
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PMID:Management of renal cell carcinoma with coexistent renal artery disease. 834 89

Homocystinuria due to homozygous cystathionine beta-synthase deficiency is an inborn error of metabolism characterized by a high incidence of thrombosis and premature atherosclerosis. We evaluated TXA2 biosynthesis in vivo and several in vitro tests of platelet function in 11 homocystinuric patients and 12 healthy controls. In vitro, patients' platelet aggregation was within control values as were TXB2 formation, fibrinogen binding, and ATP secretion in response to thrombin. In contrast, the urinary excretion of 11-dehydro-TXB2, a major enzymatic derivative of TXA2, was > 2 SD of controls in all patients (1,724 +/- 828 pg/mg creatinine, mean +/- SD, in patients vs. 345 +/- 136 in controls, P < 0.001). The administration to four patients of low-dose aspirin (50 mg/d for 1 wk) reduced metabolite excretion by > 80%. The recovery of 11-dehydro-TXB2 excretion over the 10 d that followed aspirin cessation occurred with a pattern consistent with the entry into the circulation of platelets with intact cyclooxygenase activity. Prolonged partial reduction in the abnormally high excretion of both 11-dehydro-TXB2 and 2,3-dinor-TXB2, was also observed in seven patients who ingested 500 mg daily for 3 wk of the antioxidant drug probucol. These results provide evidence for enhanced thromboxane biosynthesis in homocystinuria and for its partial dependence on probucol-sensitive mechanisms. Furthermore, the elevated TXA2 formation in homocystinuria is likely to reflect, at least in part, in vivo platelet activation.
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PMID:Abnormally high thromboxane biosynthesis in homozygous homocystinuria. Evidence for platelet involvement and probucol-sensitive mechanism. 837 92

In 310 patients with carotid territory stroke, we investigated whether a history of cardiac disease was more frequent among those with major stroke (n = 169) than among those with minor stroke (n = 141), and whether the two groups differed in values for blood variables directly or indirectly associated with stroke, each variable being adjusted for age and sex. A history of angina pectoris was more frequent in the major stroke than in the minor stroke group, 16% vs. 9% (p < 0.042; odds ratio, 2.2); and among female patients, a history of atrial fibrillation was more common in those with major stroke than in those with minor stroke, 35% vs. 13% (p < 0.033; odds ratio, 2.8). ESR (erythrocyte sedimentation rate) values were higher in the major than in the minor stroke group, 21 +/- 21 (mean +/- SD) vs. 15 +/- 14 mm/h (p < 0.028), as were WBC (white blood cell) counts, 9.4 +/- 3.2 vs. 7.9 +/- 2.3 x 109/l, p < 0.001. WBC counts were also higher in stroke survivors than in non-survivors, 9.6 +/- 3 vs. 8.3 +/- 3 x 109/l (p < 0.0027), as were serum creatinine values, 115 +/- 59 vs. 95 +/- 21 mumol/l (p < 0.0094). The differences between major and minor stroke patients may reflect differences in the degree of atherosclerosis and thrombogenicity.
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PMID:Differences in cardiac disease prevalence and in blood variables between major and minor stroke patients. 837 12


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