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

We report a patient with epidermal nevus syndrome and right hemispheric infarct and review 3 others with neurologic manifestations best explained by ischemia or hemorrhage. Each had a significant vascular abnormality such as occlusion or blood vessel dysplasia. None had hemimegalencephaly. We hypothesize that underlying vascular dysplasia is the cause of the neurologic lesions in these patients.
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PMID:Vascular abnormalities in epidermal nevus syndrome. 199 75

External iliac fibromuscular dysplasia is a rare and usually asymptomatic disorder. We report eight symptomatic patients seen over a 15-year period and review pathophysiologic mechanisms accounting for the three following distinct lower extremity ischemic sequelae: (1) Emboli--episodic focal digital ischemia (blue toe) was seen in three patients. Resection and primary anastomosis of focal iliac ulcerative fibromuscular dysplasia (one patient) or resection and replacement (two patients) removed the embolic source and relieved the symptoms. (2) Chronic ischemia--gradual onset of full leg claudication in four patients was treated by operative graduated intraluminal dilation in three patients and prosthetic bypass in one. Arteriography subsequently showed a remodeled lumen in the three patients who underwent dilation. (3) Dissection--acute onset leg ischemia resulted from presumed dissection of the external iliac segment. After 4 months of conservative management of antiplatelet agents and exercise, symptoms resolved completely, and arteriogram showed spontaneous restoration of a normal lumen in the dissected segment. The clinical presentation of fibromuscular dysplasia may mimic other arterial processes such as atherosclerosis. Diagnosis is made only by arteriography with specific magnification views of the external iliac arteries and careful surveillance of the renal arteries. Appropriate treatment should be tailored to the clinical presenting symptom. For microembolic disease, resection and replacement are required. For chronic ischemia, intraluminal dilation is generally sufficient and durable and has proved to be a simpler and acceptable alternative to replacement or bypass. In acute dissection, surgical intervention may be deferred if the limb is viable to allow spontaneous healing and remodeling. Persistent symptoms may be the only indication for intervention in this ischemic manifestation of external iliac fibromuscular dysplasia.
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PMID:Clinical spectrum of symptomatic external iliac fibromuscular dysplasia. 221 43

338 patients with aorto iliac aneurysms were operated in the Department of vascular surgery (Hosp. E.-Herriot-University A.-Carrel Lyon). Retrospective evaluation found 20 solitary iliac artery aneurysms (AAIS) in 18 patients (2 bilateral AAIS). 77% of aneurysms were on the common iliac artery, 17% on the internal iliac artery, and one case of mycotic aneurysm on the external iliac artery. 8 patients (44.4%) were asymptomatic, 5 (27.8%) had non specific complaints. Rupture or acute ischemia occurred in 5 cases (27.8%). The incidence of non atherosclerotic cause (dysplasia 33.3%, infection 16.7%) in this series shows a real difference with AAA (atherosclerotic dominant etiologic factor). The value of C.T. scanning and sonographic evaluation and their extensive use in vascular and non vascular diagnostic problems are an obvious explanation for increasing AAIS reports. The risk of rupture is probably higher than in AAA because of the incidence of arterial dysplasias (1/3 in this study) and mycotic origin. This occurrence suggests an aggressive surgical management. Aneurysmorrhaphy with graft interposition by intraperitoneal approach is the routine technique for most of surgeons. An alternative procedure (retroperitoneal approach) was performed on ten of our patients (55.5%). No perioperative mortality and low morbidity rate (one case of phlebitis) in our cases support this surgical management. The survival rate based on actuarial method is estimated 64% at five years (all grafts patent).
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PMID:[Aneurysm of iliac arteries. Is it anatomo-clinical entity? Report of 18 cases]. 227 27

The authors investigated 100 patients (55 males and 45 females) aged 16 to 45 years who experienced cerebral ischemic attack, excluding venous thrombosis. Transient ischemic attacks accounted for 12% only. Attacks were related to usual causes of brain ischemia in 49 cases (premature atherosclerosis in 26, cardiopathy in 20 and lacunar stroke in 3). Thirty-eight events were attributed to most uncommon etiologies. Nonatherosclerotic arteriopathies (10 cases) such as spontaneous dissection, dysplasia or megadolichoarteries were easily diagnosed by angiography. Oral contraceptives (14 cases) and migraine (2 cases) were diagnosis of exclusion. Hematological disorders were a possible cause in 10 patients. Etiology remained undetermined in 13 cases. Four patients died acutely. Follow-up data were obtained in 93 survivors with a mean duration of 26 months (range, 6 to 60 months). Four subjects died during follow-up and 6 experienced recurrent stroke (annual recurrence rate: 3%). In activities of daily living, 64% of patients had complete autonomy while 13% had mild residual disability and 23% had severe handicap.
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PMID:[Cerebral arterial ischemic complications in young adults. Etiology and prognosis]. 232 55

An 11-year-old boy with slowly progressive gangrene caused by vasculopathy similar to that of neurofibromatosis (NF) type 1 (NF I; von Recklinghausen disease [NFvR]) and a newborn girl with idiopathic gangrene with vascular changes resembling those of NFvR prompted the analysis of all 105 propositi with NF (NF I and NF II) evaluated between January 2, 1982, and December 31, 1986, at the genetics clinic of University of South Florida. They were analyzed for renal hypertension, symptomatic ischemia, and known vascular changes. One additional 27-month-old boy with NFvR was found to have extensive vascular changes with renal hypertension. The vasculopathy indicated asymmetric over/undergrowth of cellular and extracellular components of the vascular wall and implied dysregulation of the paracrine growth mechanism. Immunocytochemical studies of affected vessels were done only in the 11-year-old boy and showed positive neuron-specific enolase, S-100 protein, and glial fibrillary acidic protein (GFAP) reactions indicative of Schwann cell involvement. The vascular changes in children with NFvR are mostly asymptomatic; however hypertension secondary to renal artery stenosis and/or Moya-moya disease have been reported infrequently. Our patients with vasculopathies provoked thoughts in regard to the so-called vascular NF, its place in current NF nomenclature and classification, relationship to fibromuscular dysplasia (FMD), and possible role in infantile gangrene.
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PMID:"Vascular neurofibromatosis" and infantile gangrene. 251 May 17

Renal atherosclerosis and fibromuscular dysplasia are the most common causes of curable human renovascular hypertension and renal failure. Vascular reconstruction often preserves renal function, but renal failure is rarely reversed, especially after days of anuria. We report a case of a 23-year-old woman who as a child underwent a nephrectomy for congenital hydroureter and renal hypoplasia. She later experienced fibromuscular dysplasia of the remaining renal artery, which ultimately progressed to a complete occlusion and 31 days of total anuria. The patient was revascularized, and within 2 months renal function returned with a blood urea nitrogen and creatinine of 9.0 and 1.0 mg/dl, respectively. After a follow-up of 6 months the patient's blood pressure remained 120/80 to 130/80 mm Hg without administration of hypertension medication. In this report we emphasize that under selected circumstances a kidney can survive prolonged ischemia and that delayed revascularization may reestablish renal function.
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PMID:Successful revascularization of an occluded renal artery after prolonged anuria. 272 67

A total of 512 colectomy and endoscopic biopsy specimens were reviewed to define the prevalence and possibly the significance of dystrophic goblet cells (DGCs) in neoplastic and nonneoplastic colonic diseases. As compared with an incidence of 1% in disease-free specimens, DGCs were observed in 38% of cases of inflammatory bowel disease, 23% of colonic malignancies, 30% of nonneoplastic polyps, 22% of adenomas, and 8% of cases showing acute self-limited colitis. In contrast, no dystrophic cells were seen in a group of miscellaneous diseases including diverticulitis, diverticulosis, abscesses, fistulas, ischemia, pseudomembranous colitis, melanosis coli, amyloidosis, shock, and mechanical trauma. Although dystrophic cells occur in association with dysplasia and carcinoma, their presence in nonpremalignant lesions, including acute self-limited colitis, raises doubt as to their diagnostic significance. Histochemical studies of the mucin composition in DGCs were unrevealing, failing to show any differences between DGCs and their morphologically normal counterparts in the same region of the colon.
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PMID:The incidence and carbohydrate histochemistry of dystrophic goblet cells in colon. 323 12

We present our experience in the treatment of life-threatening ventricular tachycardia using electrophysiologically guided surgery (97 patients), automatic implantable cardioverter defibrillator (AICD) (42 patients), and orthotopic heart transplantation (15 patients). Eighty-three percent of these patients had ischemic and 17%, nonischemic heart disease. Our results of electrophysiologically directed surgery show an early mortality of 10% and a recurrence of 5% in the ischemic group. In the nonischemic group, the recurrence was 45%. The AICD was implanted in 31 patients with ischemic heart disease, in 5 with ventricular dysplasia, and in 6 with dilative cardiomyopathy, the ejection fractions ranging from 12% to 65%, with a mean of 30%. Early and late mortalities were 5% and 19%, respectively. The AICD was effective in all patients. Survival rate at 1 year was 83% +/- 6.4%. Thirteen of 15 patients have survived heart transplantation for 3-20 months (mean: 11 months). Ejection fractions prior to transplantation ranged from less than 10% to 34% (mean: 16%). We conclude that electrophysiologically guided surgery is highly effective in most cases of ischemia-related ventricular tachycardia. The AICD is considered a palliative alternative in patients with either poor ventricular function, no electrophysiological substrate, or multimorphological tachycardia. Heart transplantation has to be considered especially in young patients in whom progression of the underlying disease can be anticipated. Bridging by AICD is possible when transplantation is not immediately available or recommendable.
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PMID:Surgical alternatives in the treatment of life-threatening ventricular arrhythmias. 327 24

Clinical and radiologic findings in 13 patients (11 women, 2 men) with extracranial vertebral artery dissection are reported. Dissection was spontaneous in 8 patients, occurred after neck manipulation in 2 and after a potential minor injury to the neck in 3. Six had a history of common migraine, 4 were using oral contraceptives at the time of dissection, and 3 had fibromuscular dysplasia. Dissection was bilateral in 8 patients and associated with carotid dissection in 3. It usually presented with neck or occipital pain preceding basilar ischemic symptoms by a few minutes to 1 month. In 3 patients, transient ischemic attacks were the only manifestation of basilar ischemia, and in 1 patient there was no symptom of basilar ischemia despite bilateral vertebral dissection. In 19 of the 21 dissected vertebral arteries, the angiographic appearance was that of an irregular stenosis, which was associated in 6 arteries with pseudoaneurysmal formation. In 2 patients, 1 vertebral artery was occluded but the contralateral artery showed the typical irregular stenosis. The dissection involved only the third segment in 33%, only the second segment in 24%, and 2 or more segments in 38%. Eleven patients were treated with anticoagulants and 2 with aspirin; 11 recovered without sequelae and 2 had residual deficit. No recurrence was observed (mean follow-up 34 months). At control angiography (n = 12) or ultrasonic study (n = 1), 63% of dissected vertebral arteries had returned to normal, 26% showed marked improvement, and 11% were occluded. Our patient characteristics are compared with those of previously published cases. The validity of the distinction between spontaneous dissection and dissection associated with minor trauma is discussed.
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PMID:Extracranial vertebral artery dissections: a review of 13 cases. 331 2

A case is reported of bilateral congenital popliteal aneurysms in a 10-year-old girl. Spontaneous thrombosis of the left aneurysm resulted in acute ischemia of the left leg below the knee, and the aneurysm was bypassed with an autogenous saphenous vein graft. Elective resection of the right aneurysm revealed fibromuscular dysplasia, of the medial hyperplasia type, as the cause of the aneurysm. One year after operation, the grafts remained patent, and the patient was asymptomatic.
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PMID:Fibromuscular dysplasia and thrombosed aneurysm of the popliteal artery in a child. 357 18


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