Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0022116 (ischemia)
 91,303 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Cardiovascular disease is the leading cause of mortality in those with a spinal cord injury (SCI). As a consequence of changes in body composition and level of activity, individuals with a SCI tend to have a high prevalence of multiple risk factors for coronary artery disease (CAD). In this report, we have demonstrated the usefulness of tomographic thallium-201 myocardial perfusion imaging after intravenous dipyridamole in six clinically asymptomatic subjects with quadriplegia. The average age of the subjects was 47 +/- 2 years, and they had a duration of injury of 15 +/- 2 years. On average, the individuals had five risk factors for CAD. After intravenous administration of dipyridamole and mild upper extremity exercise, the subjects reported no adverse symptoms and had no electrocardiographic evidence suggestive of ischemia. By contrast, three of the six subjects had reversible defects noted on thallium scintigraphy, and one additional subject had a fixed defect that was suggestive of infarction. The remaining two subjects had abnormal scans with fixed defects of the inferioposterior region, which may be ascribed to diaphragmatic attenuation, perhaps a result of partial diaphragmatic paralysis. Thus, dipyridamole thallium myocardial imaging is a safe and effective noninvasive method for the detection of myocardial ischemia or infarction in individuals with quadriplegia who are at increased risk for CAD.
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PMID:Tomographic thallium-201 myocardial perfusion imaging after intravenous dipyridamole in asymptomatic subjects with quadriplegia. 832 97

Ultrasound Biopsy is a an effective screening method for detecting early, subclinical arteriosclerotic lesions. Carotid and femoral artery wall lesions are important markers of generalized cardiovascular disease. The evaluation of 4 arterial sites (both carotid and femoral arteries) gives a clue of the status of the whole cardiovascular system. In 27.9% of all patients the femoral lesions are present earlier or in a more advanced stage than carotid lesions. Different age groups have a different UB class distribution and score due to the progression with age of the disease. Early arterial lesions and small plaques are important indicators of silent coronary ischemia and cardiovascular events. The method has also an impact on patients' compliance. Subjects with early plaques shown by high resolution ultrasound are more impressed by this finding than by laboratory results.
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PMID:Screening asymptomatic subjects with subclinical arteriosclerotic lesions with arterial ultrasonic biopsy. The P.A.P. study. 837 54

We have seen two cases of a segmental ischemic colitis develop during nonsteroidal antiinflammatory drug (NSAID) treatment. No other possible etiologic factors were shown. The short-term clinical course and the follow-up were uneventful. NSAIDs have been reported to cause different lesions in the large bowel, either by worsening preexisting colonic diseases or by inducing a primary pathology. We suggest that ischemia should be considered a possible mechanism of NSAID-associated colitis. Such ischemic colitis, not triggered by severe cardiovascular disease or operation, may be related to NSAIDs more often than currently recognized.
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PMID:Segmental ischemic colitis associated with nonsteroidal antiinflammatory drugs. 842 Nov 41

The vascular endothelium is a complex modulator of a variety of biological systems and may well be the key to definitive success in the treatment of cardiovascular disorders. Surgically-induced endothelial injury may occur preoperatively during cardiac catheterization and intraoperatively from mechanical manipulation, ischemia, hypothermia, and exposure to cardioplegic solutions. The normal endothelium is antithrombogenic and yet promotes platelet aggregation and coagulation if injured. Vasospasm, occlusive intimal hyperplasia, and accelerated arteriosclerosis can also all occur as a result of endothelial injury. Furthermore, endothelial injury is harmful even in the absence of disruption of its monolayer integrity. Thus, preservation of the endothelium should be an additional objective for all cardiovascular surgeons. Synthetic vascular grafts, cardiac valves, and artificial ventricles do not spontaneously endothelialize and thus usually require some form of anticoagulation to maintain patency. Hence, endothelialization of prosthetic implants became an attractive concept. A number of different methods of obtaining an endothelial lining of prosthetic material has since been developed; these include facilitated endothelial cell migration, and endothelial cell seeding by using either venous or microvascular endothelial cells. Manipulating the endothelium might well provide the next major advancement for therapeutic and preventive measures for cardiovascular disease.
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PMID:The endothelium: a key to the future. 842 89

The concepts of chronobiology and chronopharmacology have become more and more important in medical practice nowadays. Today, the circadian variation in blood pressure and heart rate as well as in the occurrence of acute cardiovascular disease is quite obvious (ischemia, infarction, stroke and sudden death). However, biological rhythms are also present in episodes of dyspnoea in nocturnal asthma, in hormonal pulses, in the organization of the immunological system and in the processes of cellular proliferation. These acknowledgments have been leading to changes in our therapeutical approaches implying the definition of correct anti-hypertensive and anti-ischemic strategy was well as in the use of xanthins, corticosteroids, immunomodulators and cytostatics.
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PMID:[Biological rhythms in man. Particular aspects in medicine]. 848 69

Myocardial ischemia followed by reperfusion promotes a complex series of inflammatory reactions as noted in a variety of large animal studies. With development of genetically altered mice, there is intense interest in developing murine models to study mechanisms operative in cardiovascular disease. We developed a mouse model to study coronary artery occlusion and reperfusion effects and the method required to perform these studies both acutely and chronically. In mice, we applied a left anterior descending coronary artery occlusion either permanently or for 30 or 60 min followed by reperfusion allowing flow through the previously occluded coronary artery bed. Reperfusion was documented visually as well as by using Doppler ultrasound and histopathological techniques. The area at risk (AAR) and infarct size (IS) were assessed by EVans blue dye and triphenyltetrazolium chloride staining with computerized planimetry using an image analysis software program. The infarct as percentage of AAR and IS as percentage of the left ventricle in 13 mice with permanent occlusion was 68.6 +/- 4.4 and 28.0 +/- 2.8%, respectively. Reperfusion after occlusions of 60 and 30 min resulted in a significant decrease in IS as a percentage of the AAR compared with permanent occlusion. Histological examination of the ischemic and reperfused myocardium shows infiltration of leukocytes into the ischemic region as well as contraction bands classically associated with reperfusion. This new model allows assessment of AAR, IS, cardiac function, and pathophysiology in the mouse. With the current technology to develop genetically altered mice for overexpression or targeted mutations of various genes, this model is used to understand the complex pathophysiology of ischemia and reperfusion injury.
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PMID:Myocardial ischemia and reperfusion: a murine model. 859 26

Sumatriptan, a 5-hydroxytryptamine1, (5-HT1) receptor agonist is an effective abortive agent for migraine headaches. A common side effect in 3% to 7.9% of patients is chest pain. Although most cases of chest pain are not thought to be of cardiac origin, its mechanism is not entirely understood. Rare examples of electrocardiogram changes consistent with transient ischemia have been reported. Isolated instances of angina, arrhythmia, myocardial infarction, and death have been temporally associated with sumatriptan administration. In most cases, it is unclear whether underlying cardiovascular disease existed or contributed to this adverse event. We report the history of a 56-year-old female patient with migraine who experienced a myocardial infarction shortly after using sumatriptan, despite having had a normal cardiovascular evaluation. As she had a normal cardiac catheterization after the event, we find it probable that sumatriptan induced coronary vasospasm and myocardial infarction.
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PMID:Vasospasm-induced myocardial infarction with sumatriptan. 868 77

Non-insulin-dependent diabetic (NIDDM) patients show a high incidence of cardiovascular disease, with greater risk of recurrent myocardial infarction and a less favourable clinical outcome than non-diabetic patients. The majority of NIDDM patients are treated with sulphonylurea (SU) derivatives. In the 1970's the University Group Diabetes Program concluded that tolbutamide treatment caused increased cardiovascular mortality; the study, which led to curtailment of oral antidiabetic treatment in the USA, was received with scepticism in Europe. Later criticism of its methodology reduced the impact of the study; however, the question of the safety of SU in NIDDM patients with cardiovascular disease has been re-opened in the face of new experimental data. The heart and vascular tissues do have prerequisites for SU action, i.e. SU receptors and ATP-dependent K+ (K+ATP) channels. These channels play an important role in the protection of the myocardium against ischaemia-reperfusion damage, and their closure by SU could lead to amplified ischaemic damage. Here we review evidence from animal and human studies for deleterious SU effects on ischaemia-induced myocardial damage, either by direct action or through diminished cardioprotective preconditioning. Closure of K+ATP channels by SU can lead to reduction of post-infarct arrhythmias; the drug has also been claimed to improve various atherosclerosis risk factors. The evidence for these beneficial effects of SU is also reviewed. We look at the major difficulties that hamper transfer of information from experimental studies to clinical decision-making: a) The affinity of SU for heart K+ATP channels is orders of magnitude lower than for beta-cell channels; is it reasonable to expect in vivo cardiac effects with therapeutic 'pancreatic' SU doses? b) Most studies utilized high doses of acutely administered SU; are effects similar in the chronic steady-state of the SU-treated diabetic patient? c) Convincing SU effects have been demonstrated in acutely induced ischaemia by acutely administering the drug; do such effects persist in the clinical situation of gradually progressive ischaemia? d) Ischaemia and modification of K+ATP channel activity induce complex events, some with opposing effects; what is the net result of SU action, and do different SU derivatives lead to different outcomes? e) In the chronic (and hence clinically relevant) situation, how can direct (deleterious or beneficial) SU effects be separated from beneficial effects mediated by the metabolic action of the drug? Only large prospective clinical studies, making use of advanced technology for assessment of cardiovascular function, can answer these questions. Millions of NIDDM patients are treated with SU derivatives; many are in the age group where cardiovascular risks are extremely high. The question of whether SU derivatives are beneficial or deleterious for these patients must finally be settle unequivocally.
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PMID:Sulphonylurea treatment of NIDDM patients with cardiovascular disease: a mixed blessing? 873 9

Angiogenic therapy using fibroblast growth factor (FGF) and vascular endothelial growth factor (VEGF) is being developed as a novel therapeutic strategy to obtain restoration of blood flow around the ischemia in cases of ischemic cardiovascular disease. In addition, arterial gene therapy through gene transfer by VEGF genes has now reached the stage of clinical application. Through in vivo animal experiments to determine the angiogenic effects of FGF and VEGF, we hope to obtain clues concerning the clinical applications of these methods. Methods-1: Twenty-three adult dogs were divided into 3 groups as follows: Group A-1: 20 micrograms of bFGF was administered intravenously simultaneously with heparin three times per week in 4 dogs. Group A-2: 20 micrograms of bFGF was administered intravenously three times a week without heparin in 4 dogs. Group B: 20 micrograms of bFGF was administered intramuscularly three times per week in 5 dogs. Group C: Sham operation control group consisting of 10 dogs. Local ischemia was created in the hind limbs of animals in groups A-1, A-2 and B through ligation of the femoral artery. Selective femoral arteriography was performed immediately after ligation at 1 week and 2 weeks postoperatively. Biopsy was also performed either at 1 week or 2 weeks after ligation. Results-1: (1) The percent increase in number of collateral vessels of the ischemic zone, as recognized on arteriography, was greater in the bFGF groups compared to group C. (2) The increase in collateral vessels peaked at 1 week. (3) No difference in angiogenic effect was observed in relation to the method of administration. (4) The combined administration of heparin had no angiogenic effect. (5) The hemoglobin content of the biopsy specimens was significantly greater in the 3 groups receiving bFGF compared to group C. Methods-2: The same study was performed using VEGF as detailed in Method-1. Results-2: As in the first experiment, a significant increase in collateral vessels was seen in the VEGF group compared to the control group. Both exogenous bFGF and VEGF significantly promote collateral vessel development and appear to be effective novel therapeutic agents for the treatment of ischemic disease.
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PMID:Angiogenesis. Angiogenic therapy using fibroblast growth factors and vascular endothelial growth factors for ischemic vascular lesions. 877 22

Angiogenic cytokines constitute a potentially novel form of therapy for patients with cardiovascular disease. The feasibility of using recombinant formulations of angiogenic growth factors to expedite and/or augment collateral artery development in animal models of myocardial and hindlimb ischemia, "therapeutic angiogenesis", has now been well established. These studies have suggested that two angiogenic growth factors in particular, basic fibroblast growth factor (bFGF) and vascular endothelial growth factor (VEGF), are sufficiently potent to merit further investigation. More recently, experiments performed in our laboratory have indicated that in the case of VEGF, a secreted protein, similar results may be achieved by percutaneous arterial gene transfer. Further laboratory and clinical studies may yield promising insights into the fundamental basis for native as well as therapeutic angiogenesis and at the same time more explicitly define the manner in which therapeutic angiogenesis may be successfully incorporated into clinical practice.
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PMID:The role of angiogenic cytokines in cardiovascular disease. 881 Oct 67


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