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)

Eicosanoids were discovered as "prostaglandins" in the mid-1930s. The discovery that eicosanoids were ubiquitous in mammalian cells and that nonsteroidal anti-inflammatory drugs worked by inhibiting enzymes that synthesized these chemicals heralded their extensive investigation in all fields of biology. Precursor fatty acids (arachidonic acids) are stored in cell phospholipids, acted on by two enzymes (cyclooxygenase and lipooxygenase) that yield prostaglandins, thromboxane, prostacyclin, and leukotrienes. Knowledge of their biochemical processes continue to unfold, but it is now believed that eicosanoids are part of a larger group of agents termed phospholipid mediators. Eicosanoids are intimately involved with cardiovascular function as well as central and peripheral vascular disease processes and ischemia. In the gastrointestinal tract, these potent lipids not only participate in many normal functions (eg, acid secretion and motility) but also in disease states (eg, inflammatory bowel disease and peptic ulcer disease). In shocklike states of sepsis and/or endotoxemia, eicosanoids have assumed a major role in many events that occur. Recently, discoveries have demonstrated that platelet-activating and tumor necrosis factors exert their effects in part through eicosanoids. The future will demonstrate these compounds to be critical not only in intracellular (molecular) events but also in the effects they produce that are far from the source of origin.
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PMID:Eicosanoids. Critical agents in the physiological process and cellular injury. 823 81

Potassium channel opener's (KCOs) were originally thought of as nonselective smooth muscle relaxants. However, recent investigations in animal models of both peripheral vascular disease (PVD) and asthma have revealed interesting effects of these drugs as unexpectedly low doses. Hemodynamically, KCOs are interesting in PVD since they have little effect on blood supply to normally perfused skeletal muscle, but enhance perfusion to chronically ligated ischemic tissue. In animal PVD models, SDZ PCO-400 and cromakalim have been shown to improve recovery of muscle energy stores from ischemia or to preserve performance under conditions of ischemic contracture. Beneficial effects in rat PVD models were manifest at doses below those affecting systemic blood pressure and may be attributable to a selective dilatation of collateral vessels. With regard to the airways, the apparent efficacy of KCOs as antiasthmatic drugs seems not to be attributable solely to their bronchodilator activity. Although KCOs elicit no antiinflammatory effect in animal models, studies with SDZ PCO-400 in guinea pigs sensitized to antigen or treated with immune complexes have revealed that expression of airway hyperreactivity is significantly inhibited at drug doses exhibiting only modest bronchodilator activity. At least part of this action can be attributed to inhibition at the level of neural innervation of the airways, possibly through attenuation of nonadrenergic noncholinergic (NANC) transmission.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Therapeutic potential of potassium channel openers in peripheral vascular disease and asthma. 825 25

Acute arterial ischemia of the lower extremities is a major cause of mortality and limb loss in patients with peripheral vascular disease. Patients with acute limb ischemia secondary to embolus or in situ thrombosis usually require emergency revascularization, either surgically or with the use of thrombolytic agents. It is commonly assumed that heparin therapy alone, without disobliterative intervention, can produce clinical improvement through continued patency and enlargement of the collateral circulation. The occurrence of spontaneous thrombolysis of major limb vessels is not generally accepted. We describe three patients, all with confirmed occlusion of either the iliac or superficial femoral arteries, who had spontaneous thrombolysis of occluded vessels. These experiences document that spontaneous resolution of arterial occlusion does occur, although it may be infrequent.
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PMID:Spontaneous thrombolysis of native artery occlusions. 826 92

To assess the effect of ticlopidine on the cutaneous circulation, 25 patients with lower limb ischemia were investigated just before and at two hours after being given a 200 mg oral dose of ticlopidine. The transcutaneous partial pressure of oxygen (PtcO2) and the skin temperature were determined at 35 limb sites and 9 chest walls sites. Both the PtcO2 and the skin temperature were significantly increased at two hours after the administration of ticlopidine (p < 0.01). The findings suggest that ticlopidine can improve the cutaneous microcirculation in patients with peripheral vascular disease.
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PMID:Effect of ticlopidine on the cutaneous circulation in peripheral vascular disease. 834 79

A retrospective review during a 5-year period (1987 to 1992) was conducted of all patients manifesting leg ischemia after major cardiac surgery. There were 7,620 procedures performed, and 65 (0.85%) patients (mean age: 65 years) were identified with acute ischemia. Diagnosis was made by physical examination, during which a cool pulseless extremity without pedal Doppler signals was noted in 63 of 65 patients (97%). An intra-aortic balloon pump (IABP) was inserted in 56 patients (86%). Treatment regimens included medical management (17), IABP removal (4), IABP removal and thromboembolectomy (24), thromboembolectomy and endarterectomy with patch angioplasty (10), femoral-femoral bypass (17), other bypasses (6), fasciotomy (10), and amputation (16). Morbidity was 92% and mortality was 46%. Mortality was 11% in those patients developing ischemia without an IABP. Acute leg ischemia after cardiac surgery is predictive of high morbidity and mortality. This reflects the compromised cardiac status and multi-system disease. Treatment alternatives are based on the overall clinical status, degree of arterial insufficiency, and distribution of pre-existing peripheral vascular disease. However, ultimate limb salvage had no influence on overall patient survival in our study.
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PMID:Acute lower extremity ischemia after cardiac surgery. 835 2

Various kinds of surgical technique have been utilized for vascular reconstruction for arteriosclerotic arterial occlusive disease (ASO). In general concept, application of thromboendarterectomy is limited to the segmental occlusive aortoiliac atherosclerosis and bypass surgery can be used for almost all types of arterial occlusion. Patency result after bypass surgery are well established and the five year patency rates reveal more than 90% in aortoiliac disease, 75-80% in femoropopliteal disease, and around 70% in crural reconstruction respectively. Despite of these recent advances of reconstructive vascular surgery, there have been augmented several controversies in surgical treatment of ASO. How to treat multisegmental lesion which is characterized by high incidence of ischemic ulcer or gangrene. What is the treatment of choice for high risk patient especially with ischemic heart disease. In Japan, aged patient over 80 have been increasing and they are frequently complicated with limb threatening ischemia and usually grouped into high risk patient. Endovascular intervention, which is developed under the basis of recent technology, is the one of the topics of treatment of peripheral vascular disease. Its long term results, however, are not sufficiently evaluated and how to select the proper reconstructive procedures including the endovascular intervention for high risk patient is remained to be controversy.
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PMID:[Surgical treatment of arteriosclerotic arterial occlusive disease]. 841 80

Between 1982 and 1990, 76 patients (33 women, 43 men, mean age 71.4 +/- 10 years) affected with limb-threatening peripheral vascular disease (claudication < 20 m: 3 patients; rest pain: 10 patients; necrosis1 smaller than 3 cm2: 28 patients; necrosis2 larger than 3 cm2: 35 patients) not amenable to medical and/or surgical therapy, were treated by epidural spinal cord electrical stimulation (ESES). Effectiveness of ESES was evaluated by consideration of pain control, walking distance, and healing of ischemic lesions. At a mean follow-up of twenty-six months (range: one to seventy-six) 44 limbs (58%) were amputated (rest pain 2; necrosis1 13; necrosis2 29) and 39% of necrotic lesions smaller than 3 cm2 healed. The overall limb salvage rate was 42%. Pain control was obtained in 80% of patients at the one-year and 75% at the two-year follow-up, with infrequent use of pain relievers. Despite the poor clinical results observed, the limb salvage rate testifies to the effectiveness of ESES in limb-threatening ischemia. Moreover, the authors noticed a good ESES effect on pain relief, maximal in the early and intermediate postimplant periods. In conclusion ESES must be considered the last resort in peripheral vascular disease in patients in whom medical and/or surgical therapies are ineffective or impossible. Necrotic lesions larger than 3 cm2 contraindicate, in their opinion, ESES implant.
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PMID:Clinical results of epidural spinal cord electrical stimulation in patients affected with limb-threatening chronic arterial obstructive disease. 842 81

In-hospital and late complications related to percutaneous placement of 240 intraaortic balloon pump catheters in 231 consecutive patients from March 1985 through June 1990 were reviewed. Mean age was 64 +/- 11 years and 34% were women. Average duration of counterpulsation was 44.2 hours. Indications for counterpulsation included complications of myocardial infarction (34.6%), prophylactic placement before high-risk coronary angioplasty (20.0%) or open heart surgery (12.9%), complicated coronary angioplasty (18.3%), end-stage cardiomyopathy (5.4%) and miscellaneous (8.8%). Early major complications occurred in 11 cases (4.6%) and included limb ischemia requiring surgery (n = 9), bleeding requiring arterial repair (n = 1) and septicemia (n = 1). Other complications included hematoma requiring transfusion (n = 7), limb ischemia resolving with balloon catheter removal (n = 12), and superficial wound infection (n = 1). Overall in-hospital complication rate was 13% (31 of 240). Peripheral vascular disease and diabetes were found to be significant predictors of limb ischemia (p = 0.01 and p = 0.02, respectively). Follow-up information was obtained in 97% of patients with a mean duration of 19 months: 2 patients (1.1%) required vascular surgery for femoral false aneurysms and 1 patient experienced new onset of claudication. In conclusion, compared with previous experience, contemporary intraaortic balloon counterpulsation with percutaneous placement of smaller size (8.5Fr to 10.5Fr) catheters is associated with improved complication profile. This will further enhance the current trend for an expanding role of intraaortic balloon counterpulsation in complex interventional procedures.
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PMID:Complications associated with percutaneous placement and use of intraaortic balloon counterpulsation. 842 77

The case of a young man with an unusual presentation of thromboangiitis obliterans with ischemia of the small bowel, 2 years before peripheral vascular disease of the extremities was clinically expressed, is reported.
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PMID:Buerger's disease presenting as acute small bowel ischemia. 846 8

Incidence of vascular complications in intraaortic balloon counterpulsation is still high despite major refinements in catheter design and techniques. One hundred twenty-six patients in whom intraaortic balloon pumping was attempted were divided into two groups on the basis of insertion technique. Group 1 included 77 patients in whom the conventional percutaneous insertion was used. In group 2 (n = 45 patients), a sheathless insertion technique was used. The overall vascular complication rate was 19.6%, with the lower limb ischemia as the most common complication. The vascular complication rate was 25.9% in group 1 and 8.8% in group 2 (p < 0.01). Lower limb ischemia was noted in 17 patients in group 1 and 3 patients in group 2 (p < 0.01). These results suggest that sheathless insertion of the intraaortic balloon pump catheter can minimize vascular complications. This technique will be especially useful in patients with peripheral vascular disease, in whom the likelihood of vascular complications is high.
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PMID:Vascular complications of intraaortic balloon pumping: unsheathed versus sheathed insertion. 851 5


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