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)

Determination of serum cholesterol values in three populations of children and adolescents, totalling 4013 subjects aged 1 month to 20 years, revealed 16 cases of primary hyperbetalipoproteinemia (overall frequency, 1:251) and led to the detection of the disorder in 12 asymptomatic siblings. The upper limit of normal for serum cholesterol concentration was approximately 200 mg/dl at all ages studied. Dietary treatment was instituted in patients whose serum cholesterol value exceeded this limit and in whom a primary lipid defect was confirmed; the serum cholesterol value decreased in all patients who adhered to the diet. However, since the potential hazards and long-term results of dietary treatment, with or without drug therapy, in growing children are not known, such treatment should be reserved for affected children with a family history of premature atherosclerosis, and follow-up is essential.
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PMID:Primary hyperlipoproteinemia in childhood and adolescence: identification and treatment of persons at risk for premature atherosclerosis. 18 9

Despite adequate diagnostic evaluation and prolonged follow-up, the causes of epilepsy in the elderly patient frequently remain unknown. Some of these may be of occult, degenerative or vascular central nervous system disease origin--entities which are often difficult to incriminate specifically. Unquestionably, in a few cases, seizures occur at the time of the initial cerebrovascular accident, although in some patients seizures may follow such an episode after a latent interval, particularly when cortical motor areas have been damaged by the initial vascular insult. It is important to differentiate this group from those with recurrent vascular episodes, in whom diagnostic studies and treatment may differ. Brain tumour is as prominent a cause of seizures in the seventh decade as it is in younger adults, but probably is of lower incidence thereafter. Focal, clinical and electroencephalographic findings and a progressive clinical course are particularly common in this group. A heterogeneous group of causes, a few of which are liable to affect the ageing patient, are responsible for some of the seizures in old age and should be searched for when the etiology is obscure. Diagnostic studies will vary with the individual problem and, whenever possible, should be restricted to non-invasive studies such as electroencephalography and computer-assisted tomography, after initial baseline clinical assessment and laboratory studies have been performed. Contrast procedures such as angiography are sometimes hazardous to patients with atherosclerosis and should be reserved for selected patients. Treatment follows conventional guidelines with some modifications due to the vulnerability of the ageing patient to degenerative disease and complications of immobilization.
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PMID:Seizures after the age of sixty. 99 28

The study of 148 retinal venous obliterations have shown 81 occlusions of central vein and 67 of I and II venous branch. A number of 90 was for the feminine gender (sex) and 59 for the masculine sex. The average age for the appearance of the venous occlusions was 62 years old, having extreme limits between 36-84 years old. Bilaterality has been for 3 cases. Concerning the associated medical affections, hypertension was for 67 patients, myocardiosclerosis have been mentioned for 67 patients, atherosclerosis for 21 patients, pulmonary scleroemphisis for 12 patients. Arterial hypertension with its aspersion that is arteriosclerosis are the main factors that have generated retinal circulation modifyings and have led to a degree of arterial insufficiency. Comparing the ophthalmological aspect to the pressure in the ophthalmic artery, most of the patients had a concordance of TACR and the retinal and choroidal angiosclerosis. The oscillometric examination to the inferior members has been effectuated for 21 patients and it has shown diminished values only for 3 cases. The forecast of the disease is still reserved. Following a group of 40 patients having OVR between 5 and 15 years old it has been established an average survival of 6.2 years. It is mentioned that 26% between these have dyed during the first six years.
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PMID:[Retinal venous obliteration and general pathology]. 152 Jun 68

Fourteen patients with renovascular hypertension complicated by renal impairment and/or a nonfunctioning kidney underwent percutaneous transluminal angioplasty of the remaining kidney(s) for the purpose of improving blood pressure control and/or renal function. The outcome of percutaneous transluminal angioplasty in these individuals was evaluated over periods ranging from 1 to 72 months. All patients had atherosclerotic renovascular hypertension as judged by the X-ray appearance of the stenotic lesions of the renal artery as well as evidence of aortic atherosclerosis. Four of the 14 subjects demonstrated a decrease in serum creatinine greater than or equal to 20% following the procedure, and an equal number showed a similar increase in serum creatinine. In the 1st month following the procedure, 5 patients required dialysis because of deterioration of renal function, 4 of whom subsequently died. Over the entire population, only 4 subjects showed improvement in blood pressure and renal function which persisted for 18 to 72 months. One of these subjects had a recurrence of renovascular hypertension and underwent successful repeat dilatation for bilateral disease after 2 years following the initial angioplasty. This patient remains improved. These observations confirm that when renovascular hypertension occurs in an older population with cardiac and renal disease or occurs in a solitary functioning kidney, the remote prognosis is not good. The improvement rate of 29% with dilatation alone in this population appears to be less than that observed following surgical intervention in a similar population. Thus, transluminal angioplasty should be reserved for those subjects who are not surgical candidates or who refuse surgical intervention.
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PMID:Percutaneous transluminal angioplasty in complicated renal vascular hypertension. 294 15

The combined transplantation of heart and lungs, first done successfully by the Stanford Team (USA) in 1982, at present seems to be superseding lung transplantation alone, and has broadened the indications of heart transplantation to include terminal heart failure with fixed pulmonary arterial hypertension. After reviewing the causes for failure in lung transplants, the authors stress the superiority of heart-lung transplants compared to isolated lung transplantations: healing of the tracheal anastomosis, ease of detection of rejects by endomyocardial biopsy and the lack of inhomogeneity of the ventilation/perfusion ratios. This operation still poses problems of surgical technique as the mediastinal nerves need to be preserved and the risk of haemorrhage linked to the mediastinal dissection or to the eventual pulmonary separation under cardiopulmonary bypass is important. Donor subjects for cardiopulmonary transplantation are rare as they ought to have a thoracic cage of matching size to the recipient and to be free of pulmonary infection and trauma. The post-operative complications are essentially those of immediate haemorrhage, graft rejection, pulmonary oedema and infection. The late complications are coronary atherosclerosis and bronchiolitis obliterans. The indications of such a transplant are currently reserved for primary or secondary pulmonary hypertension and to respiratory failure with a normal thoracic cage and ventilatory mechanics.
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PMID:[Heart-lung transplantation]. 310 71

Therapeutic results in 102 hypertensive patients were evaluated after either renal artery percutaneous transluminal angioplasty (PTA) or surgical bypass procedures for renovascular hypertension. A minimum of 6 months of follow-up was accepted to evaluate therapeutic success or failure. Renal angioplasty had a beneficial result in each of 13 patients with fibromuscular dysplasia and in 10 (83%) of 12 patients with atherosclerotic lesions that did not involve the origin of the renal artery. Although surgery was also beneficial in each of six patients with fibromuscular dysplasia, it helped only five of 10 patients with atherosclerosis of the renal artery. Angioplasty results were similar to surgical results for atherosclerotic lesions that involved the origin of the renal artery. Angioplasty was unsuccessful in two cases of neurofibromatosis because of the firm nature of the lesions, where a bypass procedure was successful in one case. Major complications were more common in surgical cases than in angioplasty. PTA is recommended for all renal artery lesions; surgery should be reserved for failed PTA or recurrent renal artery stenosis after PTA.
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PMID:Percutaneous transluminal angioplasty vs. surgery for renovascular hypertension. 315 91

Based on the retrospective analysis of 38 cases of renovascular hypertension treated by surgical intervention, the following indications are proposed for arterial reconstructive surgery: younger age of patient, short duration of hypertension, renin-mediated hypertension and extent and functional significance of the obstructing arterial lesion, favorable level of renal function in the affected side, and renal function threatened by advanced progressive vascular disease, surgically correctable lesion, and focal, unilateral renal arterial atherosclerosis without generalized atherosclerosis, good surgical risk, and hypertension not responding to medical treatment. Although the clinical use of the angiotensin I converting enzyme inhibitor and induction of percutaneous transluminal angioplasty can provide a new approach to non-surgical treatment for renovascular hypertension, the long-term use of antihypertensive drugs induces gradual decrease in renal function. Surgical treatment is best reserved for the patient on whom the available data meet the above criteria for vascular surgery.
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PMID:[Surgical treatment of renovascular hypertension with special reference to the indications for reconstructive surgery]. 637 7

Effort angina is the result of acute myocardial ischemia on exercise due to an imbalance between myocardial oxygen demand and supply. During exercise, ischemia is provoked by an increase in myocardial oxygen needs (tachycardia, increased blood pressure, etc.) which cannot be met by increased coronary blood flow. The commonest cause of insufficient flow is coronary atherosclerosis. Coronary spasm does, however, play a role, whether it occurs during exercise on normal or atheromatous coronary vessels. Classical anti-anginal therapy is directed towards a reduction in the intense adrenergic activity associated with exercise, and to the limitation of myocardial oxygen consumption. Calcium inhibitors which cause peripheral vasodilation, decrease ventricular wall tension and coronary resistance, are usually reserved for unstable or resistant angina. We studied 10 patients with stable effort angina for over 2 years with significant (greater than 70 per cent) atheromatous lesions on coronary angiography unsuitable for surgical treatment. The patients underwent a randomised double blind trial to compare the effects of propranolol, diltiazem and placebo. Exercise ECG was performed after a treatment period of one week, 3 hours after drug administration. The results showed a significant improvement of work capacity with propranolol and diltiazem as compared to placebo. Propranolol (160 mg/day) was more effective than diltiazem (180 mg/day) in 6 patients. In 4 cases, the improvement with diltiazem and propranolol was the same. The association of the two drugs in one open study in 5 patients was even more effective in 3 patients. The small number of patients studied makes it impossible to draw any firm conclusions. Although calcium inhibitors are the treatment of choice in coronary spasm and betablockers in effort angina, diltiazem exerts an anti-anginal effect by reduction of myocardial oxygen consumption without depression of myocardial contractility, as other workers have shown.
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PMID:[Are calcium inhibitors useful in the treatment of effort angina pectoris]. 640 53

To determine whether an above-knee polytetrafluoroethylene (AK-PTFE) femoropopliteal bypass graft might be an acceptable alternative to a below-knee reversed autogenous saphenous vein (BK-ASV) bypass graft, we compared 51 AK-PTFE grafts to 39 concurrently performed BK-ASV grafts. All patients were staged by preoperative noninvasive vascular laboratory criteria into limiting claudication or limb salvage groups and by intraoperative arteriography according to degree of runoff. There was no significant difference in the primary graft patency at 36 months between the AK-PTFE group (63%) and the BK-ASV group (72%). Secondary graft patency among the AK-PTFE group was improved by minor distal graft revision to 88% at 36 months. The preoperative noninvasive hemodynamic evaluation status was an influential factor; the graft patency rate among the patients with limiting claudication was superior to that among the limb salvage group, but the degree of runoff as shown by intraoperative angiography did not appear to have an effect on cumulative patency. Resting Doppler ankle/brachial artery pressure ratios did not predict subsequent occlusion of AK-PTFE grafts. Atherosclerosis is a progressive and systemic disease that frequently involves both the coronary and tibial vessels. AK-PTFE spares autogenous saphenous vein so that it can be reserved for use in coronary artery bypass or in subsequent treatment of more distal tibial vessel disease.
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PMID:Above-knee polytetrafluoroethylene femoropopliteal bypass graft: Is it a reasonable alternative to the below-knee reversed autogenous vein graft? 685 8

We reviewed a consecutive series of 90 patients undergoing concomitant resection of ascending aortic anerysm and aortic valve replacement (AVR) utilizing noncomposite "conventional" techniques in order to assess the early and late results, to define limitations of this operative approach, and thereby to clarify the indications for composite reconstruction of the aortic root. Mean age was 55 years. Twenty percent had Marfan's syndrome, and 13% had aortic dissections. The cause of the aneurysm was dissection in 13% of cases, syphilis in 11%, atherosclerosis in 9%, and degeneration (with or without cystic medionecrosis) in 67%. Follow-up averaged 3.8 years and extended to 11.5 years maximum. AVR and complete excision of the aneurysm (preserving small tongues of aortic wall circumscribing the coronary artery ostia) coupled with tubular graft replacement of the ascending aorta were performed. Nineteen percent of patients required individual technical modifications relating to the coronary arteries. Operative mortality rate was 13%, with the majority of deaths being due to cardiac causes. Contemporary (1975 to 1978) operative mortality rate was 4.3%. Seven percent required re-exploration for hemorrhage and 2.4% had perioperative myocardial infarctions. Late functional results were generally good (average N.Y.H.A. Class 1.4). Late thromboembolism, angina, myocardial infarction, and congestive heart failure occurred at linearized rates of 3.4% per patient-year, 4.9% per patient-year, 1.1% per patient-year, and 5.2% per patient-year, respectively. No prosthetic valve endocarditis, graft infection, or recurrent aneurysms of the aortic root were observed. Late reoperation was necessary in eight patients (3% per patient-year), but reoperation for disease confined to the ascending aorta accounted for only three of these cases (1.1% per patient-year). Overall actuarial survival rates were 67% +/- 5% at 5 years and 50% +/- 9% at 10 years; survival rates for the 78 operative survivors were 77% +/- 5% and 57% +/- 10% at the same time intervals, respectively. Only one late death could be attributed to complications arising in the reconstructed aortic root. These results confirm that such simple, noncomposite techniques are safe, portend minimal risk of late complications and the attendant necessity for reoperation, and provide satisfactory long-term survival. We believe that composite techniques should be primarily reserved for selected cases of advanced necrotizing prosthetic or natural endocarditis.
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PMID:Concomitant resection of ascending aortic aneurysm and replacement of the aortic valve: operative and long-term results with "conventional" techniques in ninety patients. 698 12


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