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)

Electrical spinal neuromodulation in the form of spinal cord stimulation is currently used for treating chronic painful conditions such as complex regional pain syndrome, diabetic neuropathy, postherpetic neuralgia, peripheral ischemia, low back pain, and other conditions refractory to more conservative treatments. To date, there are very few published reports documenting the use of spinal cord stimulation in the treatment of head/neck and upper limb pain. This paper reports a case series of 5 consecutive patients outlining the use of spinal cord stimulation to treat upper extremity pain. All subjects had previously undergone cervical fusion surgery to treat chronic neck and upper limb pain. Patients were referred following failure of the surgery to manage their painful conditions. Spinal cord stimulators were placed in the cervical epidural space through a thoracic needle placement. Stimulation parameters were adjusted to capture as much of the painful area(s) as possible. In total, 4 out of 5 patients moved to implantation. In all cases, patients reported significant (70-90%) reductions in pain, including axial neck pain and upper extremity pain. Interestingly, 2 patients with associated headache and lower extremity pain obtained relief after paresthesia-steering reportedly covered those areas. Moreover, 2 patients reported that cervical spinal cord stimulation significantly improved axial low back pain. Patients continue to report excellent pain relief up to 9 months following implantation. This case series documents the successful treatment of neck and upper extremity pain following unsuccessful cervical spine fusion surgery. Given this initial success, prospective, controlled studies are warranted to more adequately assess the long term utility and cost effectiveness of electrical neuromodulation treatment of chronic neck and upper extremity pain.
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PMID:Neuromodulation of the cervical spinal cord in the treatment of chronic intractable neck and upper extremity pain: a case series and review of the literature. 1752 88

Pain and disability associated with diabetic neuropathy have economic, social, and emotional consequences. Because these complications impact patients during the prime of their lives, physicians should screen and manage patients at risk. Improvement in glycemic and lipid management, glycemic variability, and lifestyle interventions such as smoking cessation should limit disease progression. Patients who have symptomatic disease should be treated, targeting a 50% improvement in pain within 4 weeks. Physicians should also strive to improve function and comorbidities such as sleep disorders, depression, and anxiety. Patient education is critical for treatment adherence and prevention of serious complications. Consequences associated with diabetic neuropathy include nontraumatic amputations and silent ischemia; thus proper foot care and education regarding "warning signs" of silent ischemia are necessary.
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PMID:Recognition and management of diabetic neuropathy. 1806 22

Reactive oxygen species (ROS) have been involved in the induction and progression of damage of many human disorders, such as: heart infarction, cerebral ischemia, diabetic neuropathy, Alzheimer's disease, etc. In several studies, the synergism between alpha-lipoic acid and vitamin E has been described and potent antioxidant effects can be obtained when both antioxidants are simultaneously used. This review highlights recent findings showing that the combination of alpha-lipoic acid plus vitamin E effectively reduces oxidative damage in brain and cardiac ischemia as well as in other pathological events related to ROS increasing. These antioxidants are present in a broad variety of foods, are also available in several dietary supplements and their side effects are very rare. Therefore, alpha-lipoic acid and vitamin E may play an important role in clinical preventive medicine and human nutrition.
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PMID:[Alpha-tocopherol and alpha-lipoic acid. An antioxidant synergy with potential for preventive medicine]. 1858 88

The melanocortins (alpha, beta and gamma-melanocyte-stimulating hormones: MSHs; adrenocorticotrophic hormone: ACTH), a family of pro-opiomelanocortin (POMC)-derived peptides having in common the tetrapeptide sequence His-Phe-Arg-Trp, have progressively revealed an incredibly wide range of extra-hormonal effects, so to become one of the most promising source of innovative drugs for many, important and widespread pathological conditions. The discovery of their effects on some brain functions, independently made by William Ferrari and David De Wied about half a century ago, led to the formulation of the term "neuropeptide" at a time when no demonstration of the actual production of peptide molecules by neurons, in the brain, was still available, and there were no receptors characterized for these molecules. In the course of the subsequent decades it came out that melanocortins, besides inducing one of the most complex and bizarre behavioural syndromes (excessive grooming, crises of stretchings and yawnings, repeated episodes of spontaneous penile erection and ejaculation, increased sexual receptivity), play a key role in functions of fundamental physiological importance as well as impressive therapeutic effects in different pathological conditions. If serendipity had been an important determinant in the discovery of the above-mentioned first-noticed extra-hormonal effects of melanocortins, many of the subsequent discoveries in the pharmacology of these peptides (feeding inhibition, shock reversal, role in opiate tolerance/withdrawal, etc.) have been the result of a planned research, aimed at testing the "pro-nociceptive/anti-nociceptive homeostatic system" hypothesis. The discovery of melanocortin receptors, and the ensuing synthesis of selective ligands with agonist or antagonist activity, is generating completely innovative drugs for the treatment of a potentially very long list of important and widespread pathological conditions: sexual impotence, frigidity, overweight/obesity, anorexia, cachexia, haemorrhagic shock, other forms of shock, myocardial infarction, ischemia/reperfusion-induced brain damage, neuropathic pain, rheumathoid arthritis, inflammatory bowel disease, nerve injury, toxic neuropathies, diabetic neuropathy, etc. This review recalls the history of these researches and outlines the pharmacology of the extra-hormonal effects of melanocortins which are produced by an action at the brain level (or mainly at the brain level). In our opinion the picture is still incomplete, in spite of being already so incredibly vast and complex. So, for example, several of their effects and preliminary animal data suggest that melanocortins might be of concrete effectiveness in one of the areas of most increasing concern, i.e., that of neurodegenerative diseases.
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PMID:Brain effects of melanocortins. 1899 99

Patients with diabetic neuropathy are subject to ulcerations that may be complicated by infection and gangrene, with subsequent risk of amputation. It is the job of the foot specialist to identify and manage these problems early to avoid the unfortunate complication of amputation regardless of the presenting condition of the patient's limb. We shed light on the hypothesis that suggests that infection and gangrene in a diabetic patient aggravate the degree of ischemia (microvascular, macrovascular, or both) already present enough to endanger the viability of the surrounding tissues unless urgent drainage with decompression and debridement of the necrotic sloughs is performed, with consequent reduction of tissue pressure and improvement in circulation to the area. We present cases with severe infections leading to gangrene and ischemia, which were improved following surgical management with consequent improvement in tissue viability. In these cases, we demonstrate that immediate treatment of the wound despite the delayed presentation of the patients resulted in limb salvage with much less soft-tissue loss than expected before treatment.
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PMID:Diabetic foot infections: time to change the prognostic concept. 1976 55

In the past few years, a growing interest has been given to the possible antioxidant functions of a natural acid, synthesized in human tissues: alpha-lipoic acid (ALA). Both the oxidized (disulfide) and reduced (dithiol: dihydrolipoic acid, DHLA) forms of ALA show antioxidant properties. ALA administered in the diet accumulates in tissues, and a substantial part is converted to DHLA via a lipoamide dehydrogenase. Commercial ALA is usually a racemic mixture of the R and S forms. Chemical studies have indicated that ALA scavenges hydroxyl radicals, hypochlorous acid, and singlet oxygen. ALA exerts antioxidant effects in biological systems not only through direct ROS quenching but also via transition metal chelation. ALA has been shown to possess a number of beneficial effects both in the prevention and treatment of diabetes in experimental conditions. ALA presents beneficial effects in the management of symptomatic diabetic neuropathy and has been used in this context in Germany for more than 30 years. In cardiovascular disease, dietary supplementation with ALA has been successfully employed in a variety of in vivo models: ischemia-reperfusion, heart failure, and hypertension. More mechanistic and human in vivo studies are needed to determine whether optimizing the dietary intake of ALA can help to decrease cardiovascular diseases. A more complete understanding of cellular biochemical events that influence oxidative damage is required to guide future therapeutic advances.
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PMID:Antioxidant properties of an endogenous thiol: Alpha-lipoic acid, useful in the prevention of cardiovascular diseases. 1999 23

Dermatomyositis and vasculitic neuropathies are disorders with immune mediated ischemic injuries. Cellular responses to hypoxia include the hypoxia-inducible factor-1 (HIF-1)-induced transcription of genes involved in angiogenesis. To study their possible roles in those disorders, the immunohistochemical expression of HIF-1alpha, HIF-1beta, HIF-2alpha, vascular endothelial growth factor (VEGF), VEGF-receptor (VEGF-R) and erythropoietin-receptor was investigated. Cases of normal nerves, diabetic neuropathy, normal muscles, polymyositis and inclusion-body-myositis served as controls. The latter were chosen because they represent comparable inflammatory disorders, however, in these ischemia/hypoxia is not supposed to play such a prominent pathogenetic role. Hypoxia-related proteins were not detected in normal controls. In polymyositis and inclusion-body-myositis, there was VEGF-R-expression in muscle fibers and HIF-2alpha reactivity in endothelial cells. In dermatomyositis, HIF-1alpha and HIF-1beta were found in endothelial cells, whereas HIF-2alpha, erythropoietin-receptor, VEGF and VEGF-R additionally were observed in muscle fibers. In vasculitic and diabetic neuropathies, a variable focal expression of hypoxia-inducible factors, VEGF, VEGF-R and erythropoietin-receptor was seen in vessels. These observations suggest that the upregulation of hypoxia-related proteins may represent an adaptation mechanism of neuromuscular tissues to immune mediated deprivation of the blood supply.
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PMID:Microvasculopathic neuromuscular diseases: lessons from hypoxia-inducible factors. 2012 29

The objective of this review is to identify and review publications describing the impact of reduced somatosensation on balance. Based on knowledge of the association between specific somatosensory loss and deterioration of balance, conclusions can be made about role of somatosensation in standing balance. A systematic literature review is presented in which publications from the years 1993 through 2007 were searched in Medline and Embase. Medical Subject Headings (MESH) terms and free text words (related to balance, somatosensory loss, and lower limb) were used to perform the searches. Fifteen articles were selected for detailed review based on predetermined inclusion criteria, and three of the included articles described the effect of experimentally reduced somatosensation on balance in healthy subjects. Ten of the articles described balance in diabetic neuropathy (DN). The last two included articles described balance in Charcot-Marie-Tooth (CMT) disease type 1A (CMT1A) or type 2 (CMT2). The literature indicates that the tactile sensation is reduced in DN, CMT1A, and CMT2 and when the plantar surface of the feet was hypothermically anesthetized. Joint motion sensation seems to be impaired in patients with DN, and passive joint position sensation appears to be reduced in healthy subjects with anesthesia of ankle and foot from prolonged ischemia. This reduced somatosensation seems to have a negative effect on balance in patients with DN and CMT2; however, this appeared not to be the case in patients with CMT1A and in healthy subjects.
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PMID:The effect of reduced somatosensation on standing balance: a systematic review. 2014 43

Numerous studies have demonstrated that insulin resistance, impaired glucose tolerance, and diabetes mellitus closely correlate with cardiovascular disease. Diabetic patients frequently have multi-vessel disease, and their coronary arteries show segmental, narrow and complex stenoses with calcified plaques. The features of diabetes mellitus, such as hyperglycemia, insulin resistance and diabetic nephropathy, induce these complicated pathological conditions. In addition, diabetic patients often show silent ischemia due to diabetic neuropathy, which accounts for advanced atherosclerosis in diabetic patients. Therefore, both evaluating cardiovascular disease using non-invasive methods, such as multi-slice CT coronary angiography, and providing an appropriate treatment from an early stage of diabetes mellitus are important to prevent the development of macrovascular disease in diabetic subjects.
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PMID:[Ischemic heart disease]. 2044 92

We sought to investigate the peripheral nerve excitability property of early diabetic neuropathy (DN) and provide a logical hypothesis regarding the pathophysiology of subclinical/early stage of DN. The automated nerve excitability test (NET) utilizing the threshold tracking technique (TTT) was performed to measure multiple excitability indices in 30 early DN and 30 normal subjects. Early DN was defined as N0 or N1 stage of Dyck's staging method. The protocols calculated strength-duration time constant (SDTC) from duration-charge curve, parameters of threshold electrotonus (TE) and current-threshold relationship (CTR) from sequential sub-threshold current, and recovery cycle (RC) from double supra-threshold stimulation. Each parameter of test was co-analyzed with clinical and laboratory data including age, sex, BMI, HgbA1c, lipid profile, and estimated glomerular filtration rate (eGFR). Compared to normal or N0 groups, N1 group had 'fanning-in' phenomenon in TE, increased refractory period, and decreased supernormality/subnormality. Linear regression showed that parameters associated with vascular factor were significantly related with STDC: absolute TG values were positively associated with STDC, whereas eGFR values were inversely related with STDC. Nerve excitability can be altered even in the early mild DN. The pattern of alteration suggests depolarizing nerve or nerve ischemia in pathophysiology of subclinical/early DN.
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PMID:Altered nerve excitability in subclinical/early diabetic neuropathy: evidence for early neurovascular process in diabetes mellitus? 2113 May 14


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