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)

Serial liver biopsy and close clinical monitoring in 55 consecutive hepatic allografts have disclosed a syndrome of cholestatic jaundice that simulates rejection. This syndrome is associated with distinct histologic findings and resolves spontaneously without modification of immunosuppressive management. The cause of the cholestasis is probably related to subcellular organelle damage produced by cold ischemia, and its importance stems from the confusion it creates with regard to rejection diagnosis. Recognition of this syndrome can result in decreased immunosuppression in hepatic allograft recipients, a secondary decrease in infectious complications, and improvement in the survival rate.
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PMID:Cholestatic jaundice after hepatic transplantation. A nonimmunologically mediated event. 351 56

A variety of infectious processes produce cutaneous and soft-tissue involvement of the lower extremities. Patients with conditions leading to ischemia and devitalized tissues, and those with diabetes mellitus are predisposed to developing these infections. The signs and symptoms and bacteriology of many of these infections may overlap, leading to confusion in diagnosis and subsequent management. Very often the progression of some of these infections is rapid and life-threatening, although mutilating-type infections are not uncommon. Optimal management requires a multidisciplinary approach, with the surgeon, microbiologist, pathologist, internist, and infectious disease specialist working in close cooperation with each other.
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PMID:Infections involving the skin and soft tissues of the lower extremities. 355 52

Transient global amnesia is a benign condition of sudden onset that resolves spontaneously. Retrograde amnesia prevents recall of events antedating the episode by hours to years, and anterograde amnesia produces the characteristic features of inability to learn new material and repetitious questioning. Laboratory investigation of these patients is generally unrewarding. Transient global amnesia is easily distinguished from amnesia caused by head trauma or transient ischemic attack, confusional state, and functional amnesia. Although transient global amnesia is most likely caused by transient ischemia of brain structures important for memory, thromboembolic cerebrovascular disease is not the cause. The patient with transient global amnesia should be treated conservatively.
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PMID:Transient global amnesia. When memory temporarily disappears. 360 46

Myocardial protection and the control of ischemic injury has been highly successful clinically in the field of cardiac surgery where hearts are made globally ischemic. By contrast, protection of the regionally ischemic myocardium, as found during evolving myocardial infarction, has been less successful and, despite numerous experimental and clinical studies, very controversial. Confusion over the feasibility of infarct size reduction can be attributed to a number of factors including: (1) uncertainty over the nature of the interface between normal and ischemic tissue (the 'border zone controversy'), (2) the inadequacy of many indices of tissue injury and protection. (3) the failure of most studies to make the critical distinction between delaying and reducing injury, (4) the adequacy or inadequacy of many experimental models of human ischemia. In this article some of these problems are reviewed and advantages and disadvantages of a variety of experimental models considered.
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PMID:Models and problems in the study of myocardial ischemia and tissue protection. 635 70

Nontraumatic perforation of the small bowel is rare. A 71-year-old man presented with a perforated jejunum 8 weeks after receiving streptokinase therapy for acute myocardial infarction. This was complicated by a bleeding duodenal ulcer, renal failure, ischemia of one toe and confusion. Renal biopsy showed cholesterol emboli. Examination of the resected specimen of jejunum revealed multiple cholesterol emboli but no other disorder. Cholesterol embolization has been associated with angiography, vascular surgery and thrombolytic therapy for myocardial infarction. Acute renal failure and ischemia of the digits as seen in this patient is also a common presentation of cholesterol embolization syndrome.
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PMID:Perforation of the small bowel: a case report. 778 8

Ischemic preconditioning in the rabbit is initiated by adenosine A1-receptor stimulation, which activates protein kinase C (PKC). Additionally, alpha 1-adrenergic agonists can similarly protect ischemic myocardium, but there has been confusion about the role adenosine receptors play in this protection. To characterize the interaction between adrenergic and adenosine receptors and to study the possible role of PKC in this protection, we used isolated rabbit hearts perfused with oxygenated Krebs' buffer. All hearts were subjected to 30 minutes of regional myocardial ischemia and 2 hours of reperfusion. Infarct size was determined by triphenyltetrazolium staining. Pharmacologic preconditioning in hearts with a 5-minute phenylephrine (PE) infusion 10 minutes before the prolonged regional ischemia resulted in significantly smaller infarcts (9.7 +/- 1.3% of risk area) than in control hearts (31.0 +/- 2.6%, P < .05). This protection could be effectively blocked by administration of the alpha-adrenergic blocker phenoxybenzamine. Methoxamine, an alpha 1a-selective agonist, failed to protect, whereas the alpha 1b-selective antagonist chloroethylclonidine aborted the protective effect of PE. Polymyxin B, an inhibitor of PKC, also blocked the protective effect of PE, implying that PKC has an important role in preconditioning. The adenosine receptor blocker 8-(p-sulfophenyl)theophylline (SPT) given at the same time as the PE infusion did not affect the protection, implying that an alpha 1-agonist could initiate protection independent of adenosine, presumably by direct coupling to PKC. However, the protective effect of PE could be blocked if SPT were administered during the 30-minute regional ischemia. This observation suggested that adenosine receptor occupancy is necessary during long ischemia to reactivate PKC and mediate the protection. However, the addition of a second PE infusion beginning 5 minutes before and continuing throughout the long ischemic period restored the protective effect of PE despite the presence of SPT. Thus, as long as at least one of the receptors (alpha 1-adrenegic or adenosine A1) is activated during long ischemia, protection will be realized. These data indicate that alpha 1 receptors do not precondition through an adenosine intermediate but that alpha 1-adrenergic and adenosine receptors activate parallel pathways within the myocyte that can trigger and mediate protection.
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PMID:alpha 1-adrenergic agonists precondition rabbit ischemic myocardium independent of adenosine by direct activation of protein kinase C. 791 39

Normothermic blood cardioplegia was developed originally to be used during cardioplegic induction and reperfusion as an adjunct for enhancing metabolic reversal of biochemical alterations occurring before, during, and after total myocardial ischemia. This adjunct was introduced clinically after extensive experimental testing. By contrast, continuous normothermic blood cardioplegia without hypothermia was introduced clinically without a scientific infrastructure and has generated great interest because of its simplicity and encouraging early results, but has caused substantial confusion. This report is written to (1) clarify the role of normothermic blood cardioplegia as an adjunct to available hypothermic and antegrade and retrograde methods of myocardial protection, rather than as an alternative to them, (2) call attention to the misconception that continuous coronary perfusion avoids ischemia inasmuch as "unintentional ischemia" may occur despite continuous coronary perfusion, (3) identify theoretic and practical limitations of warm continuous retrograde blood cardioplegia exposed by testing after its clinical introduction, (4) enumerate the unanswered questions posed after clinical use of this method, and (5) focus on the self-imposed inflexibility created by adoption of adversarial positions in regard to cardioprotective strategies that impedes our ability to combine, rationally, the spectrum of approaches to myocardial protection that have evolved from the recognized limitations of individual methods.
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PMID:Normothermic blood cardioplegia. Alternative or adjunct? 812 15

Olfactory dysfunction has been reported in individuals with diabetes mellitus, but the etiology is unknown. Diabetes is often complicated by serious medical conditions which could be related to the development of decreased olfactory ability. Overall, our 111 subjects with diabetes showed deficiencies in their ability to identify odorants measured with the Odorant Confusion Matrix (mean = 67.8% correct). The presence of macrovascular disease was found to be associated with olfactory dysfunction. Glycemic control as well as the type and duration of diabetes were not related to olfactory ability. Also, there was no distinct association with the presence of neuropathy, retinopathy, nephropathy, hypertension, or impotence. Consistent with previous studies utilizing measures of odorant identification, performance decreased with increased age, females were somewhat superior to males, and smoking had a deleterious effect. Other nondiabetes-related medical conditions and medications had no apparent effect on the olfactory ability of our subjects. These results suggest that the sequelae associated with macrovascular disease, such as perhaps, ischemia, to the olfactory area, impact negatively on olfactory ability.
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PMID:Olfactory dysfunction in diabetes mellitus. 843 58

The early detection of acute mesenteric ischemia is crucial for the preservation of bowel viability. The emergency physician must have a high index of suspicion to identify mesenteric ischemia when there is a paucity of physical examination findings. We discuss the case of a patient who presented to the emergency department with confusion, hyperglycemia, abdominal tenderness, and metabolic acidosis who also developed mesenteric ischemia.
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PMID:An unusual case of mesenteric ischemia in a patient with new-onset diabetes mellitus. 914 88

Extracranial-intracranial (EC-IC) bypass grafting procedures were specially designed for treatment of bilateral internal carotid artery occlusion. When performed in an expeditious manner, EC-IC bypass procedures have produced effective and durable results, despite the recent disfavor given to this procedure. This communication reports a 68-year-old white man who developed generalized cerebral ischemia manifested as confusion, incoherence, disorientation, ataxia, and numerous episodes of syncope daily. A cerebral angiogram revealed bilateral external carotid arteries and left solitary vertebral artery critical stenosis. Transcranial Doppler study demonstrated reduction of cerebral and vertebral-basilar perfusion. However, the patient's EC-IC bypass graft had remained patent since 1985. The patient's recurrent symptoms of global ischemia and syncope resolved after carotid endarterectomy, vein patch external carotid artery, and vertebral-to-common carotid artery transposition. This report reiterates the value of the EC-IC bypass procedure and presents the surgical management of symptomatic external carotid and vertebral artery stenosis in patients after EC-IC bypass procedures.
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PMID:Revascularization of cerebral ischemia after previous bilateral extracranial-intracranial bypass procedures. 947 4


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