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)

Twenty-eight patients of arteriosclerosis obliterans (ASO) complaining of intermittent claudication or pain at rest underwent symptom limited exercise leg perfusion scintigraphy using 201TlCl (Tl). Regions of interest (ROI) were drawn around each buttocks, thighs, calves and feet in whole body image, and we calculated Lesion/Normal Index (LNI) which was the divided value of the average count per pixel of each ROI of the affected side by that of the normal side. The average LNI of the foot was 0.81 and was smaller than other regions (p < 0.05). Other region except foot showed Tl high uptake in affected side in some cases. Fifteen patients were compared after percutaneous transluminal angioplasty (PTA) with before PTA, and LNI of the foot was statistically improve after PTA (p < 0.005). The period suffer from disease of the group of Tl high uptake in the affected leg was statistically shorter than that of the group of Tl non-high uptake (p < 0.05). We supposed that the Tl uptake of the foot reflects ischemia of the leg sensitively, and high uptake of Tl in affected leg is concerned with compensatory change of microcirculation of ischemic leg in subacute period. This scintigraphy was thought to be useful to detect the ASO and to evaluate the effect of PTA, and was able to avail diagnosis and observation of the course of ASO patient.
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PMID:[Usefulness of the 201TlCl exercise leg perfusion scintigraphy inarteriosclerosis obliterans (ASO)--with evaluation of leg perfusion comparing before and after PTA]. 852 41

Increased blood and plasma viscosity has been described in patients with coronary and peripheral arterial disease. However, the relation of viscosity to the extent of arterial wall deterioration--the most important determinant of clinical manifestation and prognosis of the disease--is not well known. Therefore, the authors studied plasma viscosity as one of the major determinants of blood viscosity in patients with different stages of arterial disease of lower limbs (according to Fontaine) and its relation to the presence of some risk factors of atherosclerosis. The study encompassed four groups of subjects: 19 healthy volunteers (group A), 18 patients with intermittent claudication up to 200 m (stage II; group B), 15 patients with critical ischemia of lower limbs (stage III and IV; group C), and 16 patients with recanalization procedures on peripheral arteries. Venous blood samples were collected from an antecubital vein without stasis for the determination of plasma viscosity (with a rotational capillary microviscometer, PAAR), fibrinogen, total cholesterol, alpha-2-macroglobulin, and glucose concentrations. In patients with recanalization procedure local plasma viscosity was also determined from blood samples taken from a vein on the dorsum of the foot. Plasma viscosity was most significantly elevated in the patients with critical ischemia (1.78 mPa.sec) and was significantly higher than in the claudicants (1.68 mPa.sec), and the claudicants also had significantly higher viscosity than the controls (1.58 mPa.sec). In patients in whom a recanalization procedure was performed, no differences in systemic and local plasma viscosity were detected, neither before nor after recanalization of the diseased artery. In all groups plasma viscosity was correlated with fibrinogen concentration (r=0.70, P < 0.01) and total cholesterol concentration (r=0.24, P < 0.05), but in group C (critical ischemia) plasma viscosity was most closely linked to the concentration of alpha-2-macroglobulin (r=0.78, P < 0.01). These results indicate that in patients with peripheral arterial disease plasma viscosity increases with the progression of the atherosclerotic process and is correlated with the clinical stages of the disease.
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PMID:Plasma viscosity increase with progression of peripheral arterial atherosclerotic disease. 863 68

This paper deals with the possible identification of somatic and autonomic nerve damage in patients with peripheral obliterative arterial disease (POAD) at different stages of the disease, with a well-reproducible technique like electroneurographic evaluation of nerve conduction. In 64 patients with intermittent claudication, 19 patients with pain at rest, and 7 patients with trophic ulcers, electroneurographic evaluation of motor (tibial and peroneal) and sensory (superficial peroneal and sural) nerve conduction was performed. The median nerve (motor and sensory) was used as control. A severe impairment of sural and superficial peroneal nerve velocities was evident in many claudicant patients and in all patients with pain at rest and trophic ulcers, with a progression in the conduction abnormalities in advanced stages of the disease. Motor nerve conduction showed only minor reductions in patients with claudication and pain at rest, although some of them did show very poor velocity values. In 21 patients with intermittent claudication and sensory nerve abnormalities, the autonomic fibers activity, evaluated by the skin sympathetic response (SSR) test, was significantly depressed, thus suggesting an involvement of the local autonomic system in the ischemic disease. A correlation exists between the severity of the somatic nerve damage and the stage of the vascular insufficiency. However, in the group of claudicant patients, the evidence of similar ischemic threshold (claudication distance) may be associated with a marked difference in the amount of somatic nerve damage. The somatic and autonomic nerve alterations may play a relevant role in the progression of the disease toward critical limb ischemia.
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PMID:Peripheral neuropathy associated with ischemic vascular disease of the lower limbs. 867 31

Arterial ulcers occur because of inadequate perfusion of skin and subcutaneous tissue at rest. Arterial occlusive disease, common among smokers, diabetics and the elderly, can lead to claudication, rest pain and gangrene, in addition to localized ulceration. Other processes, such as venous stasis, pressure, trauma, and vasculitis, can also cause ischemia. However, a thorough patient history and physical assessment can help discriminate between ischemic ulcers caused by arterial disease and other types of ulcers. The key to the diagnosis of arterial occlusive disease is the patient history. Pain while walking is the most common presenting complaint and can indicate intermittent claudication. Physical assessment should include both a general exam, looking for problems relating to lungs, heart and nervous system, and a focused exam of the affected extremities and arterial pulses. Vascular laboratory findings can also help confirm a diagnosis of arterial ischemic ulceration. The key to treatment is improvement in the vascular perfusion to the affected area. Surgical revascularization is the mainstay of treatment, with some interventional procedures becoming accepted. Medical options, in addition to correction of underlying medical problems, include good wound and supportive care, but pharmaceutical interventions have generally not proven effective, and should be considered only if interventional procedures are not possible. With an adequate blood supply reestablished, most arterial ulcers will progress to healing unless there are complicating factors.
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PMID:Arterial ulcers: assessment and diagnosis. 871 33

244 patients with ischemia of the lower limbs were treated surgically in the specialized cardiovascular center. No lethal outcomes were reported because previously derived algorithm of detecting silent myocardial ischemia in patients with intermittent claudication and load tests (bicycle ergometry and drug stress tests) had allowed the surgeons to ascertain the extent of coronary damage and detect subclinical cardiac failure. Valid assessment of cardiac factors enabled the right choice between surgical and therapeutic methods and staging of the procedures.
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PMID:[Load tests in silent myocardial ischemia and latent heart failure in patients with IHD and intermittent claudication]. 877 58

The diagnosis of arteriosclerosis obliterans of the lower extremities can be made by the history alone or by the physical examination alone in the most patients. It is very important to evaluate the hemodynamic study in determination of indication for operation and operative procedures. The two major symptoms, each of which diagnostic, are intermittent claudication and ischemic rest pain. Intermittent claudication is pain or fatigue that occurs in a muscle or muscle group on repititive use. The anatomical level of claudication is significant. When aorto-iliac artery is obstructed, pain may occur first in the hip or thighs. Pain occurs in the calf in the occlusion of the femoral artery and foot pain indicates the occlusion of distal popliteal artery. Ischemic rest pain indicates an advanced stage of the disease. Fontaine classification is usually used as the stage of ischemia on the extremity. There are many laboratory evaluations of circulatory insufficiency in the diagnosis of arteriosclerotic obliterans. Measurement of segmental blood pressure is most valuable and useful among various measurements. We can get critical informations of circulatory insufficiency in the leg using segmental blood pressure. In order to differentiate from arteriosclerotic obliterans there are thromboanyitis obliterans aortitis syndrome, popliteal arterial entrapment syndrome, spinal canal stenosis, and diabetic arterial occlusive disease.
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PMID:[Clinical diagnosis of arteriosclerosis obliterans]. 880 11

Of all modalities used for the assessment of the severity of ischemic limbs none has proved to be more simple, reliable and reproducible than Doppler ultrasonography. The critical level that endangers the leg in patients with arteriosclerosis obliterans will be defined around 0.3 of ankle brahcial index by Doppler pressure measurement. Concerning the evaluation of the severity of intermittent claudication Doppler study may provide some standards to predict the state of muscle ischemia after exercise from the value measured at resting state. Near infrared spectroscopy is capable of direct continuous monitoring for the change of the state of oxygenated haemoglobin and deoxygenated one in the ischemic calf muscle during exercise. NIRS can be a new modality to asses the muscle ischemia during exercise in ASO patients. The objective diagnostic techniques should be reproducible, capable of intrinsic standardization, easily employed, relatively rapid to perform, adaptable to current recording equipment, and applicable to studies during and after exercise.
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PMID:[Hemodynamic study for the assessment of atherosclerotic occlusive disease]. 880 13

The medical treatment of ASO should be approached in three ways. The first should be to minimize the risk factors of "atherosclerosis", the second should be the treatment of leg ischemia, and the third should be the management of other ischemic organs. Among the risk factors involved, cigarette smoking, diabetes mellitus and hyperlipidemia are frequently evident. Smoking must be given up and the other diseases should be controlled by diet, exercise and drug therapy respectively. In order to relieve symptoms such as cold sensation and intermittent claudication, drug therapy such as antiplatelet therapy and vasodilatory drugs are useful in the treatment of some patients with ASO. Daily physical exercises are also effective in extending the walking distance in patients with intermittent claudication. This exercise is even more effective when it is combined with drug therapy. The prevention of vascular events such as myocardial infarction and stroke and the prevention of vascular death are very important in patients with ASO. It can therefore be concluded that antiplatelet therapy is not only effective in relieving symptoms, but also in reducing the incidence of vascular events and death.
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PMID:[Medical treatment of arteriosclerosis obliterans (ASO)]. 880 15

We evaluated the effectiveness of indobufen administration in reducing neutrophil activation in a clinical model of ischemia-reperfusion. Thirty stable patients with intermittent claudication due to occlusive peripheral arterial disease of the leg were randomly assigned to two groups. Patients in group I were treated with indobufen [200 mg orally twice daily (p.o. b.i.d.) for a week]; patients in group II received a placebo. Both groups of patients were submitted to standardized treadmill exercise until onset of claudication. Plasma levels of thromboxane B2 (TxB2) and 6-keto-prostaglandin F1alpha(6-k-PGF1alpha) neutrophil filterability, and neutrophil activation (by nitro-blue tetrazolium test) were assessed in blood samples from the femoral vein draining the ischemic leg. The values were obtained at rest and 5, 30, and 60 min after onset of claudication. Urinary albumin excretion was measured at rest and 1 h after onset of claudication. Plasma levels of TxB2 and 6-k-PGF1alpha increased significantly in the placebo group 5 min after onset of claudication, whereas only a slight nonsignificant increase was observed in the indobufen-treated group at the same timepoint.
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PMID:Reduction by indobufen of neutrophil activation in peripheral arterial occlusive disease. 890 4

Peripheral occlusive arterial disease (P.O.A.D.) is one of the situations in which hemorheological abnormalities are usually described. However the clinical relevance of hemorheological measurements in angiologic practice remains to be defined. The aim of the study was to investigate whether hemorheological disturbances are associated with alterations in oxygen diffusion and prognosis of the arterial disease. Three groups of patients were included in this work. First, a study was realized on 160 nondiabetic P.O.A.D patients (suffering from intermittent claudication to critical limb ischemia) in order to evaluate the possible influence of hemorheological disturbances on oxygen diffusion in distal tissue. A control group of 30 subjects matched for age and sex was also studied. A second study was performed on 80 diabetic P.O.A.D. patients (stage III and IV of Leriche and Fontaine classification) to determinate if hemorheological parameters could be considered as prognostic factors in the P.O.A.D. course. Hemorheological parameters were determined on different devices: red blood cell (RBC) aggregation by Myrenne aggregometer, blood and plasma viscosities by MT 90 falling ball viscometer. Transcutaneous oxygen pressure was measured by Radiometer TCM2 oxygen monitor. Several rheological parameters of non diabetic patients suffering from P.O.A.D. were significantly higher than those of control group subjects : blood viscosity (p < 0.05), plasma viscosity (p < 0.001), erythrocyte rigidity index (p < 0.01) and fibrinogen level (p < 0.0001). In the nondiabetic patients TcPO2 was negatively correlated with RBC aggregation, erythrocyte rigidity index and hematocrit /viscosity ratio. The diabetic patients who needed major amputation (above or below knee) presented significantly increased hemorheological parameters (blood viscosity, RBC aggregation, RBC rigidity index, hematocrit/viscosity ratio, fibrinogen level) compared to diabetic who had not been major amputated (no amputation or only toes' amputation). Our finding suggests that hemorheological factors (1) may influence oxygen transfer to distal tissues by maldistribution of blood flow and (2) may have prognostic significance in chronic peripheral occlusive arterial disease.
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PMID:[Rheology and occlusive arterial disease of the legs]. 896 45


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