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Query: UMLS:C0022116 (ischemia)
 91,303 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Macrovascular and microvascular complications of diabetes may be associated with different environmental factors. To investigate this further, a prevalence study of 503 Mexican type II diabetic subjects was carried out while their patterns of nutrition were constrained by government food subsidies. Average daily dietary intakes were 1866 kcal; 46.5% as carbohydrate, 13.7 mmol cholesterol, 8.7 g fiber, and a polyunsaturated/saturated fat ratio of 0.98. With respect to macrovascular disease, 49.3% of patients had evidence of peripheral vascular disease, and 21.6% myocardial ischemia, 6.0% angina, 10.8% EKG evidence of ischemia, 4.8% EKG evidence of myocardial infarction. Only 1.2% (six patients) had a clear history of completed stroke, and all were hypertensive. Six patients had also undergone amputations for diabetic gangrene. Tabulation of the means of clinical characteristics according to presence or absence of myocardial ischemia showed that higher cholesterol, calorie, and fat intake, higher mean blood pressure, higher serum cholesterol, and serum triglyceride levels were found in those with myocardial ischemia. Patients with peripheral vascular disease were more commonly smokers. Stepwise logistic regression revealed significant positive associations between myocardial ischemia and dietary cholesterol, serum cholesterol, and mean blood pressure. In contrast, the presence of peripheral vascular disease was significantly related only to smoking and retinopathy. There were no associations between macrovascular complications and duration of diabetes in the multivariate analysis, and they occurred with equal frequency in men and women. Prospective studies of atherosclerosis in maturity-onset diabetes should assess and seek to modify dietary cholesterol, serum cholesterol, and hypertension.
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PMID:Association of differing dietary, metabolic, and clinical risk factors with macrovascular complications of diabetes: a prevalence study of 503 Mexican type II diabetic subjects. I. 609 28

Our current understanding of the pathophysiology of angina and myocardial ischemia includes both anatomic and dynamic mechanisms. The relative contribution made by hemodynamically important atherosclerotic obstruction and dynamic coronary artery obstruction, either by arterial spasm or arteriolar constriction, to the pathophysiology of ischemia in any given patient should be delineated. This information appears to be useful in identifying patients likely to achieve major benefit from vasodilators on the one hand or beta-adrenergic blocking agents on the other. A number of agents are now available within these two pharmacologic classes. There are some differences in action of these various agents that require thorough familiarity of effects of these drugs so that their action can be optimized. Practically speaking, the large majority of patients with an angina syndrome will respond to nitrates. Nitrates are extremely safe and cheap; thus, their use for relief or prevention of the acute ischemic episode remains the initial treatment of choice. When symptoms are more than mild to moderate in severity, or unacceptably controlled in frequency using nitrates alone, other pharmacologic measures are needed (Fig. 2). In patients with a predominant symptom of effort angina, suggesting that a hemodynamically important atherosclerotic-type obstruction is responsible for the syndrome, beta-adrenergic blocking drugs can be very helpful. If effort angina remains unacceptably controlled or adverse effects occur, a calcium-channel antagonist may be added or substituted. These latter agents do not exacerbate bronchospasm or peripheral vascular disease, and they offer a distinct advantage over beta-adrenergic blocking agents in patients with angina who have such disorders. Where the predominant symptom is rest angina, or the patient has other evidence suggesting coronary spasm or arteriolar vasoconstriction, a calcium-channel antagonist may result in a very favorable response. This therapy should be extended not only to patients in whom coronary spasm occurs spontaneously but to those in whom it can be provoked by stimuli such as effort or cold. When spasm is superimposed upon hemodynamically important atherosclerotic obstruction, the favorable response does not seem to be as great as that seen when spasm exists alone. In these cases, coronary bypass surgery, plexectomy , and other nonpharmacologic approaches may have to be added to the pharmacologic regimen.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Comprehensive drug management of angina pectoris. 614 88

A method for assessing peripheral vascular disease (PVD) was developed from the pattern of transcutaneous oxygen (PtcO2) changes after temporary limb ischemia induced by pneumatic blood pressure cuff occlusion. The transcutaneous oxygen recovery half-time (TORT) was defined as the time required to recover half of the decrease in the limb/chest PtcO2 ratio produced by temporary limb ischemia. TORT was examined in subjects with and without significant PVD. Patients who underwent operative therapy for symptomatic PVD were studied before and after operation. Comparison was also made of the values of patients in whom therapy was successful in resolving symptoms vs. those in whom it was not. TORT was found to improve the diagnostic accuracy of PtcO2 measurements to differentiate normal vs. PVD limbs and successful vs. unsuccessful results of therapy. Normal subjects uniformly had TORT values less than or equal to 1.5 minutes at both calf and foot positions; limbs with symptomatic PVD consistently had TORT values that were significantly longer in duration (p less than 0.001). Limbs with PVD that received successful therapy had a significant improvement in calf and foot TORT values after surgery (p less than 0.01); postoperative values were usually slightly longer than those of normal subjects, probably reflecting some residual disease. Postoperatively, limbs with PVD that had received unsuccessful therapy either had only slight improvement or worsening of their TORT values, which were significantly greater than the TORT values of limbs that received successful therapy (p less than 0.001). We conclude that measurement of postocclusive TORT is a reliable method for diagnosing PVD and for quantitatively evaluating residual disease after operative therapy.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Assessment of peripheral vascular disease by postocclusive transcutaneous oxygen recovery time. 650 32

Prospective evaluation of 178 radial (RAD) and 114 femoral (FEM) artery catheters inserted in 231 critically ill adults in 2 ICUs was performed. FEM catheter duration (5.8 days) was greater than RAD (3.9 days, p less than .001). Most catheters were removed when no longer needed. Complication rates of RAD (7.5%) and FEM catheters (6.9%) were similar. Digital ischemia was the most common complication (3.5%) yet no digital necrosis occurred. Peripheral vascular disease (PVD), greater age, and greater catheter duration were not associated with more complications. Difficult percutaneous and surgical cutdown insertion of RAD catheters was associated with much greater complication rates. In conclusion, FEM and RAD artery catheters have acceptably low complication rates of 7%. Percutaneous FEM catheterization is recommended as a safe alternative to difficult RAD cannulation.
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PMID:Prospective evaluation of radial and femoral artery catheterization sites in critically ill adults. 664 Dec 52

Regional transcutaneous oximetry is a new, noninvasive diagnostic technique for the investigation of peripheral vascular disease (PVD) that uses differences in limb and trunk transcutaneous PO2 to assess the adequacy of local perfusion. The application of such measurements would be of great importance in diabetes, in which limb ischemia is commonly difficult to assess. A group of diabetic subjects with symptomatic PVD was studied with regional oximetry, Doppler-assisted blood pressure measurements, and arteriography. Doppler studies correlated poorly to symptom grade and angiographic data, while oximetry clearly demonstrated limb hypoxia under the functional conditions appropriate to the patients' clinical symptomatology. The superiority of oximetry to Doppler studies was highly significant (X2 = 12.64, P less than 0.001). Regional transcutaneous oximetry should therefore be the noninvasive diagnostic test of choice in the initial evaluation of the diabetic limb for PVD. Because of its dependence on the adequacy of local oxygenation, transcutaneous oximetry is a powerful tool for investigation of the pathophysiology of PVD and will, in the future, have wide-ranging applications to the diagnosis and therapy of PVD.
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PMID:Assessment of perfusion in the diabetic foot by regional transcutaneous oximetry. 672 49

The clinical manifestations and prognosis of peripheral vascular disease (PVD) depend upon the severity of limb hypoxia. Transcutaneous oxygen tension (Ptco2) is related to tissue oxygenation, but limb Ptco2 varies with changes in systemic as well as peripheral oxygen delivery (Do2). Previously we have found that simultaneous assessment of limb and chest Ptco2 yields a ratio, or regional perfusion index (RPI), that is independent of systemic Do2 and accurately reflects the adequacy of limb perfusion. Analysis of segmental limb Ptco2, RPI, and position-induced RPI changes was performed in 24 control limbs and 14 limbs with intermittent claudication (IC), 8 limbs with rest pain (RP), and 7 limbs with gangrene (G). Control limbs had high RPI values that varied little with position. The IC group had modestly decreased RPIs in the supine position, but extremity RPIs decreased markedly during leg elevation. Patients with RP had ischemia while supine, but the RPI improved to nearly normal upon standing. Feet with G were hypoxic even in the standing position. Segmental RPI decreases correlated with the presence of significant arterial lesions. This correlation was unaffected by diabetes. Analysis of regional transcutaneous oximetry allows classification of PVD by quantitative criteria based upon the adequacy of limb perfusion under functional conditions. RPI is characteristically high in normal persons and low in persons with G. Limbs with marginally compensated perfusion may have nearly normal RPI values under some conditions, but typical ischemic changes are elicited by positional change and exercise. The ease of such provocation of RPI decreases constitutes an index of the severity of disease. Such quantitative assessments of limb hypoxia can form the basis for a physiologic approach to arterial reconstruction.
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PMID:Pathophysiologic classification of peripheral vascular disease by positional changes in regional transcutaneous oxygen tension. 672 5

In order to develop transcutaneous oxygen tension (PtcO2) measurements into a practical method for assessing peripheral vascular disease, the relationships between extremity and chest wall PtcO2 were examined in subjects with and without systemic atherosclerotic disease. The ratio of extremity to chest PtcO2, or transcutaneous regional perfusion index (RPI) assessed limb oxygenation more reliably than did direct PtcO2 measurement by obviating the effects of changes in systemic oxygen delivery upon local PtcO2. The authors find that transcutaneous oximetry can be used during treadmill exercise testing and that the RPI is unchanged by exercise in all normal subjects. PtcO2 and RPI were then measured during rest, position change, and exercise testing in patients with intermittent claudication. Whereas normal subjects maintain a constant thigh and calf RPI during exercise, patients with intermittent claudication consistently manifested large decreases in RPI in these areas when they were exercised until symptomatic. The authors find no overlap between the responses of normal subjects and patients with claudication; positive findings are, therefore, highly specific for exercise-induced limb ischemia. Since transcutaneous RPI exercise testing is easily performed and highly reproducible, it is well suited to clinical use in the diagnosis and documentation of intermittent claudication. Furthermore, since limb ischemia can be quantified, this method lends itself both to grading the severity of disease and to evaluating clinical progression of disease. It is suggested that such a quantitative approach to evaluation of intermittent claudication may allow refinement and extension of the indications for operative intervention in patients with intermittent claudication.
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PMID:Use of a transcutaneous PO2 regional perfusion index to quantify tissue perfusion in peripheral vascular disease. 683 Mar 39

The hospital and office records of 86 patients who underwent proctectomy for cancer of inflammatory bowel disease with primary closure of the perineal wound were reviewed. Almost one fourth of all patients suffered a significant perineal wound complication, the majority of which were infections. The incidence of postoperative perineal wound complications was comparable in both groups of patients. Urinary retention occurred in 24 percent of patients who underwent abdominoperineal resection or rectal cancer, and half of these patients required transurethral resection which indicates the need for more thorough preoperative assessment of bladder function, especially in older men. The development of leg ischemia that resulted in amputation in two elderly patients who had preoperative evidence of obstructive peripheral vascular disease suggests that a synchronous two-team abdominoperineal resection with the patient in the modified lithotomy position for a prolonged period should be avoided. One third of all patients were discharged less than 10 days after surgery and two thirds within 2 weeks. Prolonged stays were more frequent in cancer patients and appeared to be related to age rather than to the development of postoperative complications. The perineal wound after abdominoperineal resection for cancer healed more rapidly and more completely than did the wound after proctectomy for inflammatory bowel disease. Fourteen percent of the inflammatory bowel disease patients did not have a healed wound 1 year after surgery. The extent of rectal cancer as determined by Duke's classification played no role in healing of the perineal wound, but women with rectal cancer healed at a slower rate than did men. The location of the exit site for wound catheters and the use of cautery and preoperative steroid therapy appeared too have no effect on the healing of the perineal wound.
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PMID:Factors influencing perineal wound healing after proctectomy. 684 90

The frequency of complications following radial artery cannulation for monitoring purposes was determined in 1,699 cardiovascular surgical patients and in 83 patients in whom cannulation was performed in another artery after failure at the radial site. Patients were examined and radial artery flow determined by a Doppler technique 1 day and 7 days after decannulation. Although partial or complete radial artery occlusion after decannulation occurred in more than 25% of the patients, no ischemic damage to the hand or disability occurred in any patient. Neither duration of cannulation nor the size or material of the cannulas were determinants of abnormal flow. Abnormal flow was significantly related to female sex, the presence of hematoma, and to the use of extracorporeal circulation. The radial arteries of 16 patients whose results of Allen's test were abnormal were cannulated and no abnormal flow or ischemia followed. In 22 patients, the ulnar artery was cannulated after multiple punctures of the ipsilateral radial artery and no ischemia followed. We conclude that in the absence of peripheral vascular disease, the Allen's test is not a predictor of ischemia of the hand during or after radial artery cannulation, that when decreased or absent radial artery flow follows cannulation it is of no clinical consequence, and that radial artery cannulation is a low-risk high-benefit monitoring technique that deserves wide clinical use.
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PMID:On the safety of radial artery cannulation. 685 11

Platelet aggregation and circulating platelet aggregates (CPAs) were evaluated in 18 patients with myeloproliferative disorders, both with and without thrombocytosis. No specific patterns of platelet aggregation were detected, but 11 of 18 patients demonstrated abnormal aggregation to epinephrine, nine of 18 had abnormal aggregation to adenosine diphosphate, and seven of 18 had abnormal aggregation to collagen. There was no definitive correlation of bleeding episodes with abnormal aggregation. However, significant bleeding was observed in a patient with a platelet count of 1,500,000/cu mm and abnormal aggregation. The aggregation defects persisted despite lowering of platelet count. Evidence of increased circulating platelet aggregates and normal platelet aggregation was seen in two patients, one of whom had transient cerebral ischemic attacks relieved by antiplatelet therapy, with return of the CPA index to normal. In two patients with digital ischemia, claudication, and angiographic evidence of peripheral vascular disease, no laboratory evidence of increased circulating platelet aggregates was observed, but one patient had regression of symptoms with antiplatelet therapy.
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PMID:Abnormal platelet function in myeloproliferative disorders. 689 52


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