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)

Episodic digital ischemia may be an isolated abnormality, a symptom of systemic illness or the result of trauma, pharmacologic toxicity, atherosclerosis or Buerger's disease. A complete history and physical examination often provide adequate information for diagnosis. Laboratory evaluation usually confirms the presence of a systemic process, such as one of the rheumatologic disorders or a monoclonal gammopathy. Approaches to therapy differ, depending on the underlying process. In Raynaud's vasospasm, the results of pharmacologic therapy and/or sympathectomy are disappointing; avoidance of smoking and conservation of body heat are essential.
 ...
PMID:Raynaud's disease and phenomenon. 735 Jul 41

Epidural infiltration easily causes without surgical intervention, paralysis of the sympathetic nervous system and analgesia. In this way, spasm and vasoconstriction are inhibited and the use of collateral vessels which are still permeable is facilitated. The antalgesic position of the dropped foot, which is a cause of oedema and hemodynamic disconfort, is eliminated. Out of 17 patients showing an acute ischemia of the lower limbs treated by this method, seven were cured, 3 of whom already having trophic disorders, 7 underwent local amputations and 3 had leg and thigh level amputations. Six months later 10 of these patients were doing well. The best therapeutic conditions of this treatment are non-atheromatous arteritis: angiospasm, toxic or inflammatory acute ischemia and Buerger's disease. On the other hand, the results are mediocre with atheromatous arteritis.
 ...
PMID:[Contribution of epidural infiltration in the treatment of acute ischemia in the lower inoperable limbs (author's transl)]. 742 23

Iloprost is a synthetic stable analogue of prostacyclin (PGI2), which shares its antiaggregating and vasodilating properties. Iloprost has been administered by i.v. route to patients with critical limb ischaemia (CLI) of different origin (maximal dosage: 2 ng/kg/min 6 hours/day infusion for 14-28 days). In patients with claudicatio intermittens (Fontaine stage II) iloprost improved the time to claudication and the maximal walking distance on treadmill, with an effect still lasting 60 days after suspension. This benefit was not related to a significant improvement in blood flow. Five multicentric, perspective, randomized versus placebo studies in patients with more severe CLI (Fontaine stage III-IV) susceptible to surgical treatment, showed that iloprost was able to reduce pain and ulcer dimensions. Furthermore, tha amputation rate of the ischemic limb was significantly lower in patients treated with iloprost during a 6 month follow-up (p < 0.01). Iloprost was also more effective than aspirin in causing pain relief and ulcer healing in patients with thromboangiitis obliterans and more effective than nifedipine in reducing frequency, intensity and duration of ischemic episodes in patients with Raynaud's phenomenon. Minor side effects of iloprost administration are represented by facial flushing, tachycardia, headache, nausea, vomiting, abdominal cramping, diarrhoea, whose frequency ranges from 16% to 70%; major collateral effects, occurring in less than 5% of patients, are above all represented by severe hypotension and angina pectoris. Clinical data indicate therefore that iloprost treatment can allow to improve the clinical conditions and the prognosis in patients with critical ischemia of the limbs, not candidate to surgical revascularization, by causing a relief of pain, a reduction in ulcer dimensions and deferring amputation.
 ...
PMID:[The role of iloprost in the treatment of critical ischemia of the limbs]. 750 14

Thromboangiitis obliterans (Buerger's disease) is an inflammatory obliterative, nonatherosclerotic, vascular disease that affects the small- and medium-sized arteries, veins, and nerves. It is causally related to tobacco use, although the exact mechanism is unknown. Its clinical presentation is manifested by distal arterial ischemia and superficial thrombophlebitis. Thromboangiitis obliterans usually becomes quiescent if the patient is able to stop smoking cigarettes. However, if smoking continues, amputation commonly results.
 ...
PMID:Thromboangiitis obliterans. 751 38

Patient care and research in clinical vascular surgery have traditionally and appropriately focused on the complications of atherosclerosis. Without question, however, the clinical field of vascular surgery encompasses a number of areas other than clinical vasospasm as exemplified by Raynaud's syndrome. At the Clinical Research Center at the Oregon Health Sciences University, during the past 20 years the vascular surgery unit has maintained an active research program in Raynaud's syndrome and to date has enrolled and longitudinally followed more than 1000 patients with this affliction. There has been an opportunity to participate in the long-term management of this large population with emphasis both on natural history and vascular laboratory diagnosis and treatment. Raynaud's syndrome is a condition characterized by episodic digital ischemia in response to cold or emotional stimuli. The incidence is greater in women, and it is more frequent in areas with a cool, damp climate. Raynaud's usually affects the hands and fingers, but it may affect the feet and toes as well. The classical Raynaud's attack is tricolor and consists of blanching of the digits resulting from cessation of arterial flow, then cyanosis upon rewarming. This is followed by reactive hyperemia, which causes the digits to turn red. Raynaud's syndrome is classified into two groups: vasospastic or obstructive. Vasospastic Raynaud's is generally cold-induced. Nicotine, stress, and caffeine are associated with vasospasm. Obstructive Raynaud's is observed in association with other diseases such as connective tissue disorders, atherosclerosis, traumatic occlusion, Buerger's disease, and occupational related disorders. The diagnosis of Raynaud's is based on differentiating between vasospasm and obstruction and detecting the presence of associated disease.(ABSTRACT TRUNCATED AT 250 WORDS)
 ...
PMID:Raynaud's syndrome: diagnosis and treatment. 774 70

Acute dysvascular limb in young adults is a rare entity. Diagnosis is often difficult because symptoms are not recognized as ischemic. The most common causes of this condition are premature atherosclerosis, thromboangiitis obliterans, microemboli, popliteal entrapment syndrome, collagen vascular disease, Takaysu's arteritis, and coagulopathy. A case study is presented to illustrate the disease process. A systematic approach to diagnosis, consisting of history and physical examination, palpation and auscultation of peripheral pulses at rest and following exercise, and noninvasive vascular examination at rest and following exercise, is recommended. Suggestion of an ischemic condition following noninvasive studies should be followed up with an arteriogram. The prognosis is dependent on the underlying etiology of the ischemia, early detection, and appropriate treatment.
 ...
PMID:Acute dysvascular limb in a young adult. A case study. 785 53

Acute lower limb ischemia secondary to Buerger's disease in a young patient responded to thrombolysis and subsequent popliteal and anterior artery angioplasty. The value of angioplasty in non-limb-threatening ischemia in Buerger's disease has not been established but this case illustrates a role for thrombolysis and angioplasty in acute ischemia.
 ...
PMID:Thrombolysis and angioplasty for acute lower limb ischemia in Buerger's disease. 788 1

Since the incidence of inflammatory arterial disease has been higher in Japan, its surgical treatment has been one of the main themes of vascular surgery from its beginning in this country. Buerger disease has been the main cause of chronic occlusive arterial disease before the middle of 1970s. and many patients suffered from intractable ischemic leg ulcer with severe pain. Reconstructive surgery, however, has been so much limited that number of the candidates for bypass surgery were around 10% of the patients, because of distal nature of the disease. We have developed a new technique in distal bypass surgery named as Esmarch's rubber bandage method, which was intended to minimize surgical injury to the host artery, and the results of its application to Buerger disease is very encouraging, and we have confirmed that this technique enables a bypass to the collateral arteries and muscular branches in place of the diseased tibio-peroneal artery. We expect this technique will clear a new avenue to surgical treatment of Buerger disease with limb threatening ischemia. In Takayasu's arteritis, the carotid reconstruction was popular between the late 1950s and 1960s and, at the same time atypical coarctation, renovascular hypertension, and aneurysm, along with their combined lesion became the objects of vascular surgery. This expansion of surgical indication contributed to the improvement of the prognosis and rehabilitation of the patients. Long term function of the reconstruction has been also confirmed. On the other hand, several problems emerged with the widespread application of vascular reconstruction which were peculiar to the disease state. Among them, the most important problems were neurological complications due to sudden increase in the intracranial blood pressure after carotid reconstruction, and anastomotic aneurysm as the delayed complication affecting eventual outcome which are inherent to the inflammation and extensive destruction of the medial component in this disease. A new method to prevent the postoperative neurological complications is discussed in this report. To improve the long term survival, meticulous observation of postoperative course is essential in Takayasu's arteritis. Recently, abdominal aortic aneurysms showing the peculiar gross appearance and clinical presentation have become the subject of discussion as inflammatory abdominal aortic aneurysm because of remarkable thickening of the aneurysmal wall and a severe inflammatory change, and some difficulties of its surgical treatment have been stressed in the most of the reports. The recent researches offered the conclusion that etiology of the aneurysm is not inflammation, but inflammatory reaction during formation of atherosclerotic aneurysm.(ABSTRACT TRUNCATED AT 400 WORDS)
 ...
PMID:[Surgical treatment of intractable vasculitis syndromes--with special reference to Buerger disease, Takayasu arteritis, and so-called inflammatory abdominal aortic aneurysm]. 793 11

The peripheral type of Buerger's disease is unresponsive to conservative therapy when accompanied by multisegmental occlusion at the level of the ankle. Between November 1983 and April 1993, we performed 15 bypasses below the ankle for this type of thromboangiitis obliterans in 13 patients (mean age 45.7 years), including four females. Ten patients had intractable toe ulcers with severe pain, and five had foot-threatening ischemia or disabling foot claudication. Eleven patients were heavy smokers, two were passive smokers, and six had a history of sympathectomy. All patients had occlusion of the three main crural arteries or both of the tibial arteries at the ankle. Of the 15 bypasses, 10 were to the medial or lateral plantar arteries, two were to the common plantar artery, and three were to the dorsalis pedis artery. There were three early and three late graft failures. The causes of early graft failure were thrombosis at the site of cross-clamping, anastomosis to a diseased segment, and arterial spasm. The three late failures (> 3 months) were due to disease progression in patients who continued to smoke, whereas all grafts remained patent and functioned well in patients who stopped smoking. Because patients with thromboangiitis obliterans are relatively young and active, early healing of ulcers and restoration of normal limb function are important objectives in their treatment. Bypass to the foot arteries can provide an excellent outcome, although special techniques and postoperative cessation of smoking are essential for success.
 ...
PMID:Plantar or dorsalis pedis artery bypass in Buerger's disease. 804 58

Prostanoids are derivative of arachidonic acid and arising from a common endoperoxide and they possess multiple and even opposing effects. Their main function is to control haemostasis and to maintain vascular homeostasis. Among these compounds thromboxane, generated by platelets, is a powerful vasoconstrictor and an inducer of platelet aggregation; prostaglandin E1 (PGE1) and prostacyclin (PGI2) are potent vasodilator and inhibitor of platelet aggregation. For these properties PGE1 and PGE2 are object of interest for the potential therapeutical use in treatment of atherosclerotic diseases, where mechanisms of vascular defense are altered and amplified. Pharmacokinetic and pharmacodynamic characteristics of these compound have been per se a good rationale for plenty of experimental studies which generated enthusiasm and hope of new therapeutic means in patients with surgically unreconstructible peripheral arterial disease. Nevertheless clinical trials have to face many difficulties deriving from their properties themselves. PGE1 and PGI2 are unstable hormones with local action and it is difficult to employ them in clinical practice. Moreover their protean action is often implicated in not unusual adverse effects. The development of compounds with a prostacyclin-type of action, but long lasting and therefore easier to handle, undoubtedly facilitated clinical research. But we still lack firm indications for a correct therapeutic use. Limb ischemia is the condition in which prostanoids were mostly studied. Although anecdotal reports or uncontrolled studies provided encouraging results, several controlled trials failed to demonstrate a consistent efficacy of either PGE1 or PGI2, whilst metanalytic review of controlled trials on iloprost demonstrated an efficacy on critical and less severe limb ischemia, thromboangiitis obliterans and Raynaud's phenomenon.(ABSTRACT TRUNCATED AT 250 WORDS)
 ...
PMID:[The pharmacology and clinical aspects of the prostanoids]. 811 24


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