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Query: UMLS:C0022116 (ischemia)
 91,303 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

This report presents a case of aortic valvular dysfunction and right coronary artery disease following radiation therapy on the mediastinum. A 61-year-old woman had received mediastinal radiation for the treatment of right mammary cancer 20 years previously. She developed symptoms of congestive heart failure 6 months ago. The patient was found to have aortic valvular dysfunction and proximal stenosis of the right coronary artery. Surgical aortic valve replacement improved cardiac status, and vasodilator treatment reduced ischemia due to right coronary artery stenosis.
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PMID:Aortic valvular disease and right coronary artery stenosis induced by mediastinal irradiation--report of a case. 851 Mar 16

In 42 patients with thoracic aortic disease, a selective cerebral perfusion with 16 degrees C cold blood was applied for the brain protection during the repair of the thoracic aorta. The surgical repair consisted of the replacement of the ascending aorta (9 cases), the ascending aorta and aortic arch (12 cases), the aortic arch (18 cases), and the aortic arch and descending aorta (3 cases). Twenty-two patients of them (52%) required emergency surgery and four patients died due to postoperative complications including visceral organ ischemia (2 cases) and multiple organ failure (2 cases). The mortality rate of this group was 18.2% (4/22 cases). In elective surgical classes, one patient died due to intraoperative coronary embolism. The mortality rate of this group was 5.0% (1/20 cases). No postoperative obvious brain defect was observed except one old patient (85-year-old female) with ruptured aortic arch who already had the brain infarction preoperatively. She died due to multiple organ failure with unconsciousness. Other patients including the patients with long cerebral perfusion (> 180 min) recovered well and returned to normal daily life. The selective cerebral perfusion with cold blood was easy to prepare and demonstrated the superb efficacy of brain protection in the patient.
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PMID:[Clinical significance of selective cerebral perfusion with cold blood on the brain protection]. 853 Aug 45

Dobutamine stress echocardiography was used in the diagnosis of myocardial ischemia in patients with implanted VVI pacemakers. A 69-year-old woman received a pacemaker for Mobitz II type AV block in October 1992. She had suffered from chest pain during effort since January 1993 and underwent dobutamine stress echocardiography in April 1993. Although the electrocardiogram failed to identify ischemia because of the pacemaker rhythm, ischemia of the anterior wall was revealed as a worsening of the wall motion on the echocardiogram. The coronary angiogram showed 99% stenosis of the left descending artery. A direct coronary atherectomy was performed on the lesion. A 68-year-old man received a pacemaker for sick sinus syndrome in August 1993. He had suffered from chest oppression during effort since May 1992 and underwent dobutamine stress echocardiography in October 1993. Spontaneous rhythm appeared with dobutamine infusion, but the electrocardiogram could not demonstrate ischemia because of incomparability with the rhythm at rest. Echocardiography detected a new wall motion abnormality of the inferior wall caused by dobutamine. The coronary angiogram showed 90% stenosis of the right coronary artery. PTCA was performed on the lesion. Dobutamine stress echocardiography is useful for the diagnosis of myocardial ischemia in patients with implanted pacemakers.
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PMID:[Dobutamine stress echocardiography in the diagnosis of myocardial ischemia in patients with implanted pacemakers: report of two cases]. 855 15

Ergot's derivatives are widely used in the treatment of migraine and in the prophylaxy of deep venous thrombosis in association with heparin. Clinical ergotism is rarely observed and can affect all the arteries, especially of the inferior limbs. Vasospasm of the peripheral arteries and collateral formation are specific findings on angiography. We report the illustrative case of a 38 years old woman hospitalized for a small bowel occlusion. She suffers from chronic migraine treated by ergotamine tartrate. During her hospitalization, she develops an acute ischemia of the lower limbs. An ergotism was clinically suspected and confirmed by Duplex sonography which demonstrate multiple vasospasm. Under iv sodium nitroprusside and peridural analgesia the spasm resolved in 24 hours. The control Duplex sonography confirm the normality of the lower limb arteries. This examination modality allow a non-invasive diagnosis and evolution control of arteriospasm.
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PMID:[Value of duplex ultrasound in diagnosis of ergotism of the legs]. 858 19

A 62-year-old woman with exertional angina underwent an exercise thallium-201 stress test. She exercised for 4 minutes on the treadmill using a modified Bruce protocol, reaching 94% of her predicted maximal heart rate, and stopped because of chest pain and fatigue. No ST-segment depression was detected at peak exercise or in the recovery period. In contrast, the thallium-201 myocardial single-photon emission computed tomography images in the short-axis, vertical long-axis, and horizontal long-axis views revealed severe myocardial ischemia involving the anterior, septal, posteroinferior, and posterolateral planes of the heart. Coronary arteriography showed severe stenosis of the left anterior descending and right coronary arteries. The information from the exercise electrocardiogram (ECG), thallium-201 myocardial scintigraphy, and a coronary angiogram suggested that the false negative ECG response was due to ischemic ST-segment counterpoise (i.e., cancellation of ischemic ST-segment vectors, generated by equally extensive and severe ischemia involving myocardial planes opposite each other.
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PMID:The paradox of negative exercise stress ECG/positive thallium scintigram. Ischemic ST-segment counterpoise as the underlying mechanism. 885 35

Nonocclusive mesenteric infarction has recently been diagnosed with increasing frequency in dialysis patients. Although most reports have concerned patients on hemodialysis, the condition has also been reported to occur in patients on continuous ambulatory peritoneal dialysis. This report describes such a case developing in a woman whose end-stage renal failure was due to adult polycystic kidney disease. Associated predisposing factors were the presence of orthostatic hypoxemia, postural hypotension and extensive atheromatous changes of the abdominal aorta. In keeping with the known difficulty of establishing the diagnosis of mesenteric ischemia, the diagnosis in our patient was also delayed. She was initially thought to suffer from an episode of peritonitis and/or colonic perforation secondary to the performance of a cleansing enema. Only upon showing pneumatosis coli of the right colon on abdominal computerized tomography was the correct diagnosis made. Laparotomy revealed extensive necrosis of the ascending and transverse colon. A total colectomy and ileorectal anastomosis were performed. The patient died on the 17th day following surgery. This case serves to illustrate that mesenteric infarction should be considered in predisposed patients on continuous ambulatory peritoneal dialysis. The presence of peritonitis may mask the underlying pathology and waylay the unwary physician.
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PMID:Nonocclusive mesenteric infarction in continuous ambulatory peritoneal dialysis. 889 66

Patients with heparin-induced thrombocytopenia (HIT) require an alternative antithrombotic treatment to heparin during arterial reconstruction. Ancrod and Iloprost have been employed but are not readily available and carry the risks of systemic side effects (depletion of fibrinogen, hypotension). A patient with HIT in whom intraoperative intraarterial urokinase (UK) was successfully utilized to enable safe arterial reconstruction is described. An 80 year old white female with diffuse arteriosclerotic cardiovascular disease and multiple vascular reconstructions had thrombotic complications following use for heparin during two of her prior operations associated with documented thrombocytopenia and anti-platelet antibodies. She presented with limb-threatening ischemia which was evaluated with angiography revealing severe stenosis of the proximal left superficial femoral artery, occlusion of both anterior tibial and peroneal arteries and several digital vessels, with intact posterior tibial runoff. A common femoral to mid-superficial femoral artery bypass was performed, utilizing contralateral reversed greater saphenous vein, while being treated with aspirin and a continuous intravenous infusion of low molecular weight dextran. During the procedure the clamped arteries were locally perfused with a high volume of dilute UK solution to prevent blood stasis, and enable local delivery of a thrombolytic agent. Although clot formation was observed in the operative field, none occurred within the clamped arteries. A total of 191,200 units of UK were employed with no bleeding complications. Following surgery the patient had a palpable pedal pulse and markedly improved perfusion of her toes. She was discharged on aspirin and coumadin on postoperative day five. It is concluded that for patients with HIT, systemic aspirin and dextran combined with local intraarterial UK are a simple and effective substitute for systemic anticoagulation with heparin during arterial reconstruction.
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PMID:Intraoperative urokinase as an alternative to heparin for patients with suspected heparin-induced thrombocytopenia requiring arterial reconstruction: report of a case and review of the literature. 894 86

Nodular regenerative hyperplasia of the liver is characterized by diffuse nodularity of the hepatic parenchyma without fibrotic septa. It may be related to venous or arterial obstruction in the portal tract. We report a case of primary antiphospholipid syndrome associated with nodular regenerative hyperplasia in a 45-year old woman. The patient had an ischemic stroke, associated with an acute arterial ischemia of the left leg. She had high titers of serum anticardiolipin antibodies. Nodular regenerative hyperplasia of the liver was histologically confirmed and was associated with anicteric cholestasis. This case provides additional evidence that a thrombotic mechanism may play a role in the pathogenesis of nodular regenerative hyperplasia of the liver.
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PMID:[Nodular regenerative hyperplasia associated with primary antiphospholipid syndrome]. 899 Nov 51

Midaortic syndrome (MAS) is a well-recognized but rare cause of renovascular hypertension (RVH). Several techniques have been described to treat RVH caused by MAS. The authors recently treated two children with MAS and RVH. In both patients the right kidney had two renal arteries. A 13-year-old boy presented with severe headaches, pain in his lower extremities with exertion, and marked hypertension (blood pressure, 170/110). An aortogram demonstrated 70% narrowing of his abdominal aorta from the suprarenal region to 5 cm above the iliac bifurcation. There was significant stenosis of the celiac axis, superior mesenteric artery, and left renal artery. The right kidney had two renal arteries, and the upper pole artery was stenotic at its origin. A 10-year-old girl, known to have hypertension for several years had an aortogram that demonstrated 70% narrowing of the abdominal aorta from the suprarenal region to 3 cm above the iliac bifurcation. There was involvement of the left renal artery at its orifice. She also had two renal arteries to the right kidney with the right upper pole artery being stenotic at its origin and in the mid-portion of the vessel. Aortic reconstruction was accomplished with a polytetrafluoroehtylene (PTFE) bypass graft in each case. The first case also involved patch angioplasty of the celiac axis. In both cases, the right kidney was autotransplanted. It was removed intraoperatively, cold perfused, and the two renal arteries reconstructed followed by transplantation to the right iliac vessels. In both cases the left renal artery was reimplanted into the PTFE graft. Both patients had uncomplicated postoperative courses. The 13-year-old boy had evidence of renal ischemia in a portion of the lower pole of the autotransplanted kidney by DTPA scan. He has mild hypertension controlled with antihypertensive medication. The 10-year-old girl has a normal DTPA scan and is normotensive. MAS is a rare and challenging congenital vascular anomaly that causes RVH. In the presence of double renal arteries the technique of autotransplantation with cold perfusion and "bench" vascular reconstruction reduces the warm ischemia time and should produce satisfactory results.
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PMID:Renal autotransplantation for renovascular hypertension caused by midaortic syndrome. 904 31

Thirty-one-year-old woman with Kawasaki disease wanted a child. She had a large coronary aneurysm on the left main coronary artery and complete obstruction of the right coronary artery, but there was no sign of ischemia. Heparin anticoagulant therapy was begun 8 weeks after the onset of pregnancy. The activated partial thromboplastin time (APTT) was successfully maintained at 1.5 to 2.0 times normal value during pregnancy and puerperium. There were no thromboembolic complications during pregnancy or after an uneventful cesarean delivery. The neonate was healthy.
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PMID:Anticoagulant therapy during successful pregnancy and delivery in a Kawasaki disease patient with coronary aneurysm--a case report. 907 Sep 77


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