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)

The article addresses the opportunity for companion studies as challenging instrument for the development of nursing research. Three models of study actually being conducted in Italy are presented and discussed for their specific technical aspects and with respect ot their broader implications: a) on quality of life for myocardial infarction patients (GISSI-Nursing); b) on the presence and evolution of some problems: pain, leg ulcers, treatments side effects and quality of life for chronic limb ischemia patients (i.c.a.i. Nursing); c) on epidemiology of nursing intervention for stroke patients (MAST-Nursing).
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PMID:[Nurses and medical research]. 817 Dec 43

Six thalassaemic patients had a distinct clinical syndrome characterized by progressive ischemia of the lower extremities, with ascending arteritis and thrombosis of the main arteries of the lower limbs. With periodic acid Schiff and Gomori's methenamine silver staining a large number of hyphae were revealed in the arterial wall and the outer part of the thrombus. Pythium insidiosum was isolated from 3 patients. The clinical course of the disease was progressive gangrene of the extremities and the patients invariably died when the infectious process reached the bifurcation of the aorta. There is no effective antimicrobial agent for the syndrome and radical amputation was the only method to ensure survival of the patients. P. insidiosum infection should be considered in thalassaemic patients with leg ulcers or arterial occlusion of the lower limbs.
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PMID:Fatal arteritis due to Pythium insidiosum infection in patients with thalassaemia. 823 97

We performed 31P magnetic resonance spectroscopy of gastrocnemius muscle at rest in 7 normal volunteers and 12 patients with sickle cell disease (7 with leg ulcers and 5 without leg ulcers but with painful crises). We measured intracellular pH and ratios of Pi to ATP, PCr to ATP and PCr to Pi (Pi = inorganic phosphate, ATP = adenosine triphosphate, and PCr = phosphocreatine). Magnetic resonance arteriograms were also performed. Significant differences were found for PCr/Pi ratios between normals and sickle cell disease patients with leg ulcers (p < 0.008). Magnetic resonance arteriograms were normal in volunteers and patients with sickle cell disease. The altered high energy phosphate metabolism in sickle cell disease with leg ulcers is consistent with muscle ischemia or hypoxia.
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PMID:Altered muscle metabolism shown by magnetic resonance spectroscopy in sickle cell disease with leg ulcers. 842 14

The age-adjusted prevalence of peripheral arterial disease (PAD) in the U.S. population has been estimated to approach 12%. The clinical consequences of occlusive peripheral arterial disease (PAD) include pain on walking (claudication), pain at rest, and loss of tissue integrity in the distal limbs; the latter may ultimately lead to amputation of a portion of the lower extremity. Surgical bypass techniques and percutaneous catheter-based interventions may be used to successfully revascularize the limbs of certain patients with PAD. In many patients, however, the anatomic extent and distribution of arterial occlusion is too severe to permit relief of pain and/or healing of ischemic ulcers. No effective medical therapy is available for the treatment of such patients. The purpose of this clinical protocol is to document the safety of therapeutic angiogenesis achieved in this case by percutaneous catheter-based delivery of the gene encoding vascular endothelial growth factor (VEGF) in patients with PAD; and, as secondary objectives, investigate the bioactivity of this strategy to relieve rest pain and heal ischemic ulcers of the lower extremities. The rationale for this human protocol is based upon preclinical studies performed in a rabbit model of hindlimb ischemia. These studies are described in detail below and in the manuscripts enclosed in the Appendix to this proposal. In brief, a single intra-arterial bolus of VEGF recombinant human protein, delivered percutaneously to the ischemic limb via an intravascular catheter, resulted in angiographic, hemodynamic, physiologic, and histologic evidence of augmented collateral artery development. Subsequently, similar results were achieved using an angioplasty catheter with a hydrogel-coated balloon to deliver 400 micrograms of a plasmid containing the cDNA for VEGF to the internal iliac artery in the same animal model. Accordingly, we propose to administer arterial gene (VEGF) therapy to patients with rest pain and/or ischemic leg ulcers considered not to be candidates for conventional revascularization techniques. The dose of plasmid to be administered will be progressively escalated beginning with 500 micrograms for the first four patients, 1000 micrograms for the following six patients, 2000 micrograms for the third group of six patients, and 400 micrograms for the fourth group of six patients.
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PMID:Arterial gene transfer for therapeutic angiogenesis in patients with peripheral artery disease. 872 9

Layered compression therapy for venous leg ulcers and ulcers associated with chronic leg edema has been shown to be an effective treatment in patients with adequate arterial circulation. However, no study has looked specifically at compression therapy in the diabetic population. This clinical case review examines outcomes in two groups of diabetic patients with edema and either venous ulcers or preulcerative conditions. Patients in Group 1 had clinically adequate arterial circulation and were treated with a four-layer compression bandage system. The highly elastic third layer was eliminated in the Group 2 patients, who had compromised peripheral arterial circulation. Healing occurred in 81% of patients in Group 1 and 67% of patients in Group 2. There was no acute progression of lower limb ischemia. Layered compression therapy was an effective and safe treatment in this diabetic population with adequate arterial circulation. Reduced compression also can be helpful in some patients with arterial compromise.
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PMID:Use of layered compression bandages in diabetic patients. Experience in patients with lower leg ulceration, peripheral edema, and features of venous and arterial disease. 972 44

Plasmodium falciparum malaria, a parasitic disease, and sickle cell anemia, a hereditary disease, are two diseases affecting erythrocyte cycle, occurring with a high prevalence in tropical Africa. They may induce microthrombosis inducing vaso-occlusion, organ dysfunction and flap necrosis. During the acute phase of Plasmodium falciparum malaria, destruction of parasitized and healthy erythrocytes, release of parasite and erythrocyte material into the circulation, and secondary host reaction occur. Plasmodium falciparum infected erythrocytes also sequester in the microcirculation of vital organs and may interfere with microcirculatory flow in the flap during the postoperative period. The lower legs of homozygous sickle cell anemia patients are areas of marginal vascularity where minor abrasions become foci of inflammation. Inflammation results in decreased local oxygen tension, sickling of erythrocytes, increased blood viscosity and thrombosis with consequent ischemia, tissue breakdown and leg ulcer. Tissue transfer has become the procedure of choice for reconstruction of the lower third of the leg although flaps may become necrotic. The aim of this study is to analyse circumstances predisposing to surgical complications and to define preventive and therapeutic measures. A review of the literature will describe the current research and the new perspectives to treat sickle cell anemia, for example hydroxyurea and vasoactive substances (pentoxifylline, naftidrofuryl, buflomedil).
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PMID:[Falciform anemia and Plasmodium falciparum malaria: a threat to flap survival?]. 1018 98

We present our initial experience with retroperitoneoscopic lumbar sympathectomy in a series of 5 men aged 25-45 years. 3 suffered from ischemia of the lower limbs due to Buerger's disease, 1 had severe reflex sympathetic dystrophy and 1 had vasculitis with severe, non-healing lower leg ulcers. The right retroperitoneal space was developed with a dissecting balloon-trocar introduced via a small lateral muscle-splitting flank incision. 2 additional 5 mm trocars were used for instrumentation and clipping. L2-L3 or L3-L4 ganglia were resected; mean operating time was 120 minutes. Only oral analgesics were needed for postoperative pain control and oral food intake was resumed the following morning. The procedure was successful in all and was without complications. Mean hospital stay was 2 days. All patients reported significant relief of ischemia or dystrophic pain and/or improvement in trophic changes in the extremities. In the patient with leg ulcers, the largest was successfully covered with a skin graft. The retroperitoneoscopic approach to lumbar sympathectomy successfully combines the advantages of minimal invasive surgery and the reliability and effectiveness of well-established open sympathectomy.
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PMID:[First experiences with retroperitoneoscopic lumbar sympathectomy]. 1095 25

The standard treatments for venous diseases of the lower limb include compression bandaging and stockings as well as surgical removal of varicose veins. There is a number of conditions in which these conventional treatments are ineffective, particularly in the management of leg ulceration. Drug treatments for healing venous leg ulcers have yet to be developed to the stage of good clinical efficacy, but may assist in the management of patients. Flavonoid drugs have been widely used in the management of the symptoms of venous disease for many years and have recently been studied in some detail to assess their effects on the microcirculation. Work in animal models of ischemia/reperfusion (I/R) show that micronized purified flavonoid fraction (MPFF) modulates leukocyte adhesion and prevents endothelial damage. Similar biochemical effects have been observed in patients with venous disease and may explain the efficacy of this drug in the management of edema and other symptoms of venous disease. There is some evidence that MPFF promotes venous leg ulcer healing.
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PMID:Micronized purified flavonoid fraction and the treatment of chronic venous insufficiency: microcirculatory mechanisms. 1115 70

Intermittent pneumatic leg compression (IPC) increases arterial calf inflow and foot skin blood flux in normal subjects and claudicants. Our hypothesis was that IPC could enhance foot skin blood flux after infrainguinal grafting and thus promote distal perfusion in limbs with tissue loss. The aim of this study was to compare the effects of three IPC modes [applied to the foot (IPCfoot), the calf (IPCcalf), or both (IPCfoot+calf)] on foot skin perfusion in healthy individuals, claudicants, and patients after infrainguinal arterial revascularization performed for critical or subcritical limb ischemia. Altogether, 20 healthy limbs, 22 claudicating limbs, and 36 limbs of arteriopaths with prior successful autologous femoropopliteal and femorodistal (18 each) grafts were examined. Five-minute laser Doppler recordings were obtained from the pulp of the big toe in the sitting position, at rest, and during random applications of IPCfoot, IPCcalf, and IPCfoot+calf delivered at 120 mmHg for 4 seconds three times per minute. Foot skin blood flux increased using all IPC modes (p <0.001), with IPCfoot and IPCfoot+calf generating higher flux levels than IPCcalf (p <0.01) in all groups. Intergroup differences of flux with each of the three IPC modes were not significant. IPCfoot and IPCfoot+calf similarly (p > 0.14) produced a higher percentage flux increase than IPCcalf in all groups (p <0.004). Controls had a higher percentage flux increase with both IPCcalf and IPCfoot than did claudicants (p? 0.016). No differences were documented between normal and grafted limbs (p > 0.05). The percentage flux increase with IPCfoot+calf and IPCcalf was significantly higher in femorodistal grafts than in femoropopliteal ones (p ? 0.026). IPC enhances skin blood flux in limbs with infrainguinal bypass, claudication, and normal arteries, with IPCfoot and IPCfoot+calf being more effective than IPCcalf. Our findings suggest that IPC may be beneficial in limbs with impaired distal perfusion and thus may have clinical implications in the treatment of leg ulcers either prior to or after revascularization.
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PMID:Enhancing foot skin blood flux in peripheral vascular disease using intermittent pneumatic compression: controlled study on claudicants and grafted arteriopaths. 1209 35

Venous ulceration remains a common problem and a significant challenge to the physicians treating it. Many theories have been advanced in the past to explain its causes but there is little evidence to support tissue hypoxia as the main factor, as was once thought. In recent years attention has focussed on the inflammatory events which attend venous disease and the development of venous ulceration. It has been proposed that these form a major contribution to the development of venous leg ulcers. In the arterial system an analogous series of events appears to cause damage following severe ischemia. Massive neutrophil activation in the microcirculation following reperfusion of a tissue results in severe, ischemic damage to that tissue. A similar series of events is proposed to explain venous disease. During venous hypertension leukocytes are sequestrated in the microcirculation of the lower limb. It has been shown that these undergo activation whilst they are in the leg. The exact location of leukocyte sequestration is unclear but it is suggested that this may occur in the skin. The damage caused to the lower limb skin components can be identified by measuring plasma levels of endothelial adhesion molecules, which are shed into the circulation following a period of venous hypertension. In the long term this leads to a chronic inflammatory state in the skin in some patients where venous hypertension is sustained or there is susceptibility to venous hypertension. The resulting inflammatory process is referred to as "lipodermatosclerosis" and has a number of well known clinical features. There is proliferation of the dermal capillaries eventually leading to a "glomerulus" like appearance. In the skin and subcutaneous tissues there is fibrosis. The microcirculation in the papillary dermis is surrounded by an inflammatory cellular infiltrate. The importance of understanding the mechanisms of the development of venous ulceration is in creating new treatments for this problem. Compression treatment has been effective in healing leg ulcers for thousands of years. Surgical treatment offers a possible cure in patients where superficial venous reflux is the main problem. Deep vein reconstruction is only suitable for a few patients. Many venous ulcers can be healed by compression, only to recur within a few months. Pharmacological treatments may offer the possibility of more rapid ulcer healing and the maintenance of an ulcer-free state if the correct pathophysiological mechanisms can be identified and addressed.
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PMID:Deleterious effects of white cells in the course of skin damage in CVI. 1251 77


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