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)

A case of an adult patient with intra-abdominal mass syndrome and acute surgical abdomen due to chronic intestinal ischemia with localized perforation and ileal necrosis associated to hepatic granulomatosis and mesenteric adenitis produced by Buerger's disease (thromboangiitis obliterans) is presented herein. The clinical presentation, diagnosis, handling and prognosis of this rare entity were examined.
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PMID:[Intestinal effects of Buerger's disease (thromboangiitis obliterans) case report]. 1285 91

Buerger's disease (thromboangiitis obliterans or TAO) is a clinical syndrome characterized by the development of segmental thrombotic occlusions of the medium and small arteries of the extremities. It is clinically and pathologically distinguishable from arteriosclerosis and necrotizing arteritis. Afflicted patients are mostly young, male, inveterate tobacco smokers who present with distal extremity ischemia, ischemic ulcers, or frank gangrene of the toes or fingers. Large arteries are typically spared, as are the coronary, cerebral, and visceral circulations. While mortality is not increased, patients with Buerger's disease often suffer from severe ischemic pain and tissue loss culminating in minor and major limb amputation. Clinical diagnostic criteria generally include the following: (1) history of smoking or tobacco abuse; (2) age of onset less than 45 to 50 years; (3) infrapopliteal, segmental arterial occlusions with sparing of the proximal vasculature; (4) frequent distal upper extremity arterial involvement (Raynaud's syndrome or digital ulceration); (5) superficial phlebitis; and (6) exclusion of arteriosclerosis, diabetes, true arteritis, proximal embolic source, and hypercoagulable states. Typical arteriographic patterns have been described that are suggestive, but not pathognomonic. While the cause of Buerger's disease remains unknown, the disease onset and clinical course are inextricably linked to tobacco abuse. Acute Buerger's disease is characterized histopathologically by intensely cellular vessel wall inflammation, giant cell foci, and hypercellular thrombi, but with preservation of the elastic lamina and the overall vascular wall architecture. Most investigators feel that Buerger's disease is an immune-mediated endarteritis; recent immunocytochemical studies have identified the linear deposition of immunoglobulins and complement factors along the elastic lamina. The inciting antigen has not been discovered. Tobacco abstinence generally results in disease quiescence and remains the mainstay of treatment.
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PMID:Buerger's disease in the 21st century: diagnosis, clinical features, and therapy. 1297 57

Although traditionally regarded as a disease of distal extremities, mesenteric vasculature can also manifest thromboangiitis obliterans (TAO). There are 31 cases of intestinal TAO in the English literature and the majority of subjects are male. However, cases of women with TAO are becoming more common, coinciding with an increased incidence of smoking in this sex. We describe the sixth case of a female patient with classic extremity manifestations paralleled by paroxysms of abdominal angina. Intestinal TAO can mimic extremity disease of smoldering chronic ischemia punctuated by unpredictable acute episodes of gangrene. In the present case, chronic ischemia manifested as partial bowel obstruction due to stricture deformity of the ileum and profound adipocyte atrophy of mesentery.
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PMID:Intestinal thromboangiitis obliterans in a woman: a case report and discussion of chronic ischemic changes. 1453 31

The hemorheologic abnormalities were studied in patients suffering from thromboangiitis obliterans (TAO) and compared findings with those of patients suffering from critical limb ischemia because of peripheral atherosclerotic obstructive disease (PAOD) and the healthy subjects. This prospective study included 20 patients with TAO, 20 patients with PAOD, and 20 healthy subjects. Hematocrit, plasma fibrinogen, red blood cell rigidity, and blood and plasma viscosity were determined in all groups. Hematocrit values of the TAO group were significantly higher than those of the PAOD group and the control group (p < 0.001 and p < 0.001, respectively). BV at a shear rate of 6.00 sec(-1) was higher in TAO than the PAOD and control (p < 0.01 and p < 0.05, respectively). BV at a shear rate of 225 sec(-1) was higher in the TAO and PAOD than the control (p < 0.001 and p < 0.001, respectively) and also PAOD values were higher than the TAO (p < 0.05). RBC rigidity was higher in the TAO and PAOD than the control (p < 0.001 and p < 0.05, respectively) and these values were higher in PAOD than the TAO (p < 0.05). These results show the impairment in hemorheologic parameters in TAO may provide a new insight into the treatment of patients with TAO in the active period of the disease.
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PMID:The altered hemorheologic parameters in thromboangiitis obliterans: a new insight. 1497 4

Therapeutic angiogenesis using angiogenic growth factors is expected to be a new treatment for patients with critical limb ischemia (CLI). Because hepatocyte growth factor (HGF) has potent angiogenic activity, we investigated the safety and efficiency of HGF plasmid DNA in patients with CLI as a prospective open-labeled clinical trial. Intramuscular injection of naked HGF plasmid DNA was performed in ischemic limbs of 6 CLI patients with arteriosclerosis obliterans (n=3) or Buerger disease (n=3) graded as Fontaine III or IV. The primary end points were safety and improvement of ischemic symptoms at 12 weeks after transfection. Severe complications and adverse effects caused by gene transfer were not detected in any patients. Of particular importance, no apparent edema was observed in any patient throughout the trial. In addition, serum HGF concentration was not changed throughout the therapy period in all patients. In contrast, a reduction of pain scale of more than 1 cm in visual analog pain scale was observed in 5 of 6 patients. Increase in ankle pressure index more than 0.1 was observed in 5 of 5 patients. The long diameter of 8 of 11 ischemic ulcers in 4 patients was reduced >25%. Intramuscular injection of naked HGF plasmid is safe, feasible, and can achieve successful improvement of ischemic limbs. Although the present data are conducted to demonstrate the safety as phase I/early phase IIa, the initial clinical outcome with HGF gene transfer seems to indicate usefulness as sole therapy for CLI.
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PMID:Safety evaluation of clinical gene therapy using hepatocyte growth factor to treat peripheral arterial disease. 1523 69

We aimed to evaluate the characteristics of 198 new patients with Buerger's disease treated surgically in the last decade. We also compared these results with our former series reported in 1993. The records of patients with Buerger's disease who were enrolled in an ongoing investigational protocol between 1991 and 2001 were reviewed. Sympathectomy was carried out in 161 patients and revascularization in 19 patients. The cumulative secondary patency rate was 57.9% for bypass grafts at a mean follow-up of 5.4 years. Clinical outcome following sympathectomy was considered improved in 52.3% of patients, stable in 27.8%, and worse in 19.8%. Seven major and 36 minor amputations were performed, with a limb salvage rate of 95.6%. The aggressiveness of the disease has increased compared with previous series, parallel to the expansion of cigarette consumption. Bypass surgery should be considered for patients with severe ischemia who have target vessels. Sympathectomy still has a role to improve distal flow.
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PMID:Surgical treatment of Buerger's disease. 1558 28

Thromboangiitis obliterans (or Buerger disease) is a rare vascular disease that selectively affects young males who are inveterate smokers. We report a case in a young female smoker who presented with recurrent episodes of polyarthralgia and distal extremity ischemia. The initial diagnosis was connective tissue disease, and the correct diagnosis was established only 7 years after symptom onset. Joint manifestations are common in thromboangiitis obliterans and usually antedate the diagnosis, which should be considered in patients with superficial venous thrombosis, upper limb ischemia, or Raynaud's phenomenon. This is true even in females, as shown by the case described here.
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PMID:Inflammatory joint disease and severe ischemia of the extremities revealing thromboangiitis obliterans in a female. 1568 Dec 52

This case report describes a 22-year-old woman with severe arterial ischemia leading to claudication and ulceration of the feet, presumably due to long-term abuse of amphetamine derivates, such as "speed" or "ecstasy," and cannabis. Known causes for peripheral occlusive disease, such as atherosclerosis, vasculitis, or collagen vascular disease, were excluded. Laboratory test results did not show evidence of risk factors for thromboembolic diseases. Conventional angiography and magnetic resonance-angiography showed occlusions of medium- and small-sized arteries of both calves and feet. In the past, vasculitis-like arteriopathy was attributed to the abuse of amphetamines as well as of cannabis. However, amphetamines have been reported to be associated with necrotizing vasculitis mainly of cerebral arteries. Therefore, the abuse of methamphetamine or "ecstasy" also appears to play a role in the development of peripheral arterial occlusions and seems to have broad similarities with Buerger's disease.
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PMID:A 22-year-old woman with lower limb arteriopathy. Buerger's disease, or methamphetamine- or cannabis-induced arteritis? 1570 Feb 2

Hepatocyte growth factor is a mesenchyme-derived pleiotropic factor that regulates the growth, motility and morphogenesis of various types of cells, and is also a member of the angiogenic growth factors. Hepatocyte growth factor is secreted by vascular endothelial cells and smooth muscle cells, and the hepatocyte growth factor receptor, c-met, was also observed in these vascular cells. Treatment of human aortic endothelial cells with recombinant hepatocyte growth factor resulted in a significant increase in cell proliferation, accompanied by mitogen-activated protein kinase and Akt/protein kinase B phosphorylation. Recently, a novel therapeutic strategy for ischemic diseases using angiogenic growth factors to augment collateral artery development has been proposed. As preclinical study of gene therapy using hepatocyte growth factor to treat peripheral arterial disease, naked hepatocyte growth factor plasmid was intramuscularly injected into the ischemic hind limb of rabbits in order to evaluate its angiogenic activity. Intramuscular injection of hepatocyte growth factor plasmid once on day 10 following surgery, produced significant augmentation of collateral vessel development in the ischemic limb on day 30. In the clinical setting, the authors further investigated the safety and efficacy of hepatocyte growth factor plasmid DNA in patients with critical limb ischemia, in a prospective open-labeled trial. Intramuscular injection of naked plasmid DNA was performed in the ischemic limbs of six patients with critical limb ischemia with arteriosclerosis obliterans (n = 3) or Buerger disease (n = 3) graded as Fontaine III or IV. In the efficacy evaluation, a reduction of pain scale of more than 1 cm on a visual analog pain scale was observed in five out of six patients. An increase in ankle pressure index of more than 0.1 was observed in five out of five patients. The long diameter of eight out of 11 ischemic ulcers in four patients was reduced by more than 25%. Intramuscular injection of naked hepatocyte growth factor plasmid is safe, feasible and can achieve successful improvement of ischemic limbs. Although the present data were obtained to demonstrate safety in a Phase I/early Phase II trial, the initial clinical outcome with hepatocyte growth factor gene transfer seems to indicate its usefulness as sole therapy for critical limb ischemia. Randomized placebo-controlled clinical trials of alternative dosing regimens of gene therapy will be required to define the efficiency of this therapy.
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PMID:Hepatocyte growth factor as potential cardiovascular therapy. 1588 78

Thromboangiitis obliterans (TAO) is an inflammatory, nonocclusive, and nonatherosclerotic vascular disease. It commonly affects arteries, veins, and surrounding neural elements and is directly related to smoking. Although distal vessels of lower and upper extremities are the most commonly involved, other vessels such as intestinal arteries can be rarely affected. The authors describe a 41-year-old white male smoker who presented with abdominal pain for 3 months and developed an acute bowel ischemia. He underwent urgent surgery, and segmental enterectomy was performed. Histopathologic findings were suggestive of TAO, showing typical involvement of small-sized veins and arteries with intact internal elastic lamina, preserved media, a local nonspecific inflammatory reaction, with new and older arterial and venous thromboses associated. Although mesenteric arteries are seldom injured by TAO, this diagnosis must be considered when the usual causes of intestinal ischemia are ruled out. In this case, even without any other clinical symptoms of TAO, this rare diagnosis could be made.
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PMID:Intestinal ischemia as a single manifestation of thromboangiitis obliterans--a case report. 1632 59


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