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

Peripheral vascular disease of the extremities causes ischemic pain and, at times, skin ulcerations and gangrene. It has been suggested that epidural spinal electrical stimulation (ESES) could improve peripheral circulation. Since 1978 we have used ESES in 34 patients with severe limb ischemia; all had resting pain and most had ischemic ulcers. Arterial surgery was technically impossible. Twenty-six patients had arteriosclerotic disease, one had Buerger's disease, and seven had severe vasospastic disorders. Ninety-four per cent of the patients experienced pain relief. ESES healed ulcers in 50% of those with preoperative nonhealing skin ulcerations. Seventy per cent of the patients showed improved skin temperature recordings. Only 38% of the stimulated arteriosclerotic patients underwent amputations during a mean followup period of 16 months, as compared to 90% of a comparable group of unstimulated patients. ESES is very promising in severe limb ischemia where reconstructive surgery is impossible or has failed.
 ...
PMID:Epidural electrical stimulation in severe limb ischemia. Pain relief, increased blood flow, and a possible limb-saving effect. 387 10

A 47-year-old male smoker with chronic eosinophilia developed progressive ischemia in his extremities. Pathologic examination of vessels in amputated limbs revealed changes of thromboangiitis obliterans. Focal segments of some arteries, however, revealed infiltration of thrombus and vessel wall by eosinophils. Furthermore, the patient developed a totally occluded right temporal artery, which on biopsy specimen showed marked infiltration by eosinophils within the vessel wall. In contrast to most patients with the hypereosinophilic syndrome, however, this patient had no evidence of endomyocardial thrombosis or fibrosis. In view of recent evidence that eosinophil granule proteins are toxic to endothelial cells, the findings in this patient suggest the possibility that eosinophils may be involved in the pathogenesis of thromboangiitis obliterans.
 ...
PMID:Thromboangiitis obliterans associated with idiopathic hypereosinophilia. 402 3

General and vascular surgeons are consulted occasionally to evaluate young adults with ischemia of the lower extremity. Between 1975 and 1985, 51 adults under 40 years of age who had arterial occlusive disease of the lower limb were managed. Although premature atherosclerosis was the most common problem (50%), claudication or limb-threatening ischemia also resulted from other sources (thromboembolism, popliteal artery entrapment, Buerger's disease, collagen vascular disease, and Takayasu's arteritis). Identifying the exact cause was sometimes difficult. The authors were impressed with the number of young adults who had delay in diagnosis and treatment (30 patients, 59%) before referral for a surgical opinion. In this paper, the attempt has been made to uncover the reasons for delayed diagnosis and to suggest a systematic approach that should lead to early recognition of lower extremity ischemia in this age group.
 ...
PMID:Lower extremity arterial disease in young adults. A systematic approach to early diagnosis. 405 11

The occlusive arterial lesions of the upper extremity in Takayasu's arteritis is estimated in 72.3% in the left and in 45.6% in the right subclavian arteries, respectively. Buerger's disease also involves the arteries distal to the elbow and the digital arteries in about 22% of total cases. In Takayasu's arteritis, the surgical treatment for the upper extremity ischemia is rarely indicated, except for the cases with aneurysm, because the occlusive lesion involves exclusively the aorta and its branches, and severe ischemia of the upper digital arteries in Buerger's disease frequently causes severe ischemic symptoms of hand and fingers, such as rest pain, trophic changes and tissue loss. Therefore, the surgical treatment, including upper thoracic sympathectomy and amputation, is mandatory in some cases.
 ...
PMID:Arterial insufficiency of the upper extremity with special reference to Takayasu's arteritis and Buerger's disease. 612 15

Fifty patients (41 men and nine women) less than 36 years of age were evaluated for lower limb ischemia. Claudication was the presenting symptom in 30 patients (60%) and distal ulceration in 20 (40%). The mean age was 28.3 years. Premature atherosclerosis was present in 24 patients (48%) and thromboangiitis obliterans in 12 (24%). Other causes included a variety of unusual etiologies. Risk factors were analyzed. Twenty-two patients with claudication underwent arterial reconstruction; three had sympathectomy. Arterial reconstruction was possible in only three patients with ulceration; 17 had sympathectomy. No operative deaths or early amputations occurred. Follow-up averaged 13.5 years. Twenty-four patients with claudication were improved, three were unchanged, one developed ulceration, one required late amputation, and one was lost to follow-up. Four patients with ulceration were improved, one was unchanged, 14 required late amputation, and one was lost to follow-up. Ten patients, all with atherosclerosis obliterans, developed coronary artery disease; five died of myocardial infarction. No patient developed cerebrovascular disease. We conclude that reconstructive arterial surgery for claudication can be performed with low risk and a strong likelihood of long-term improvement. Most patients presenting with ulceration, however, will ultimately require amputation. Patients with atherosclerosis obliterans are at risk for coronary artery disease and death of myocardial infarction.
 ...
PMID:Lower limb ischemia in young adults: prognostic implications. 648 97

The effect of vascular surgical reconstruction or Buerger's exercises upon average subcutaneous blood flow for a 24-h period was studied in 14 patients with severe leg ischemia due to occlusive arterial disease. Blood flow was estimated proximally in the calf and in the foot by a 133Xe washout technique. Seven patients underwent vascular surgery. Postoperatively subcutaneous blood flow increased in the calf and the foot in all patients except one in whom a decrease in blood flow in the foot was seen. In this case a decrease in systolic blood pressure occurred following the operation. Buerger's exercises did not alter subcutaneous blood flow either in the calf or in the foot in the seven patients studied. Buerger's exercises seem to be of no value for these patients. The measurement of blood flow in subcutaneous tissue over a period of 24 h seems to be a useful test of the effect of different treatments.
 ...
PMID:Effect of therapy on 24-h subcutaneous blood flow in the leg in patients with severe ischemia. 649 75

Although membranocystic changes of adipose tissue, characteristic of membranous lipodystrophy, can be found in some cases of limb ischemic necrosis caused by arteriosclerotic obstruction, the incidence of the lesions in several forms of limb ischemia is not known. Subcutaneous fat of 53 patients with limb ischemic necrosis was studied histologically and ultrastructurally for the presence of membranocystic changes. The lesions were found in 11 (38%) of 29 cases of thromboangiitis obliterans, 15 (75%) of 20 cases of arteriosclerotic obstruction, and two (50%) of four cases of progressive systemic sclerosis. The membranous lipodystrophy-like changes can be produced by several forms of chronic circulatory disturbance and they are one of the nonspecific changes of adipose tissue.
 ...
PMID:Incidence of membranous lipodystrophy-like change among patients with limb necrosis caused by chronic arterial obstruction. 654 23

Out of sixty patients with thromboangitis obliterans from January 1966 to December 1981, 50 cases underwent such surgery as sympathetic ganglionectomy, thromboendarterectomy and arterial bypass. The remaining 10 cases received conservative therapies such as intravenous infusion of Prostaglandin E1 (60 micrograms in 5% glucose 500 ml) and epidural sympathetic ganglion block using 1% xylocaine. Good results were obtained in 29 operative cases and in 5 cases with non-surgical therapies. Among the operative cases, the subjective symptoms after discharge improved in forty-one patients (82%) unchanged in three (6%) and remained poor in six (12%). While, those of non-surgical group improved in eight and unchanged in two. In twelve of twenty-nine operative patients whose subjective symptoms improved immediately after discharge, their subjective distress turned worse again. However, the subjective symptoms of 5 patients in non-surgical group remained well in follow-up studies. Many patients who were diagnosed unchanged during follow-up period, had underwent the lumbar and/or thoracic sympathetic gangloinectomy. It is thus concluded that the effects of the sympathetic ganglionectomy are not permanent. The arterial reconstructive surgery is very effective for relief of peripheral ischemia in the follow-up studies if good function of the grafts was obtained in the early postoperative period.
 ...
PMID:[Evaluation of surgical therapy for thromboangitis obliterans, with special reference to follow-up studies]. 667 98

Embolic disease is often overlooked as a cause of digital ischemia. Unilateral symptoms, in particular, should suggest the possibility of emboli arising from the subclavian or more distal upper extremity vessels. Emboli may originate in the subclavian artery as the result of atherosclerosis at its origin or arterial injury secondary to thoracic outlet compression. Arteriography can be useful in the identification of upper extremity emboli and their source, and should include studies of the aortic arch, proximal subclavian artery, and digital arteries. Retrograde subclavian injections may be required to adequately demonstrate the origin of the subclavian artery. Magnification technique is often essential in differentiating small digital artery emboli from primary arterial diseases, such as Buerger disease or scleroderma.
 ...
PMID:Digital ischemia: angiographic differentiation of embolism from primary arterial disease. 697 89

Severe extremity ischemia frequently cannot be relieved by surgical means and failure of current drug therapy may then result in prolonged disability or amputation. Prostaglandins E1 (PGE1) and I2 (prostacyclin, PGI2) are potent vasodilators and inhibitors of platelet aggregation which have been reported to be of value in the treatment of peripheral ischemia. Nineteen patents with severe extremity ischemia and one with vasculitic leg ulceration were treated on 25 occasions by intravascular infusion of PGE1 or PGI2 for 72 to 96 hours. Causes of ischemia were arteriosclerosis, Raynaud's phenomenon (secondary), Buerger's disease, and "trash" foot. Prolonged pain relief and promotion of tissue healing occurred mainly in patents with patent proximal axial arteries. Patency of the superficial femoral artery was associated with a good clinical response in eight of nine cases of foot ischemia, and mean hallux temperature rose 4.6 +/- 2.5 degrees C. In contrast, occlusion of the artery was associated with failure in eight of nine cases, and hallux temperature rose 0.6 degrees +/- 1.3 degrees C. PGE1 or PGI2 administered intravenously may be the treatment of choice for severe ischemia in distal arteriopathy, although the exact mechanisms by which these prostaglandins act are far from clear.
 ...
PMID:Preliminary experience with prostaglandins E1 and I2 in peripheral vascular disease. 700 84


<< Previous 1 2 3 4 5 6 7 8 9 10 Next >>