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

The surgical treatment of traumatic injuries of the thoracic aorta is controversial because a number of technical approaches have been recommended. Despite the technique employed, spinal cord ischemia continues to be a persistent problem. Nineteen patients with confirmed aortic injuries secondary to blunt trauma were treated at the Yale-New Haven (Conn) Medical Center from 1984 to 1991. The patients were analyzed in two groups: group 1 (n = 10) underwent repair using mechanical circulatory support and group 2 (n = 9) underwent repair without mechanical circulatory support. Sixteen patients survived. Three patients died of complications of multiple trauma. The groups were comparable with respect to aortic cross-clamp time, preoperative systolic blood pressure, and Injury Severity Score. Three patients in the nonmechanical support group developed neurologic complications (P less than .05). No patient in the mechanical support group had a neurologic complication. We believe that mechanical circulatory support reduces the incidence of neurologic complications following traumatic injuries of the thoracic aorta and should be used whenever clinically feasible.
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PMID:Mechanical circulatory support decreases neurologic complications in the treatment of traumatic injuries of the thoracic aorta. 157 20

Currently lumbar sympathectomies are infrequently performed because the effectiveness of the procedure is unclear. The previous indication of limb-threatening ischemia has been usurped by distal arterial reconstruction. Some vascular surgeons feel there is no remaining clinical role. This paper suggests four categories of patients, represented by five case reports, where lumbar sympathectomy may prove beneficial: 1) Hypertensive patients with painful leg ulcers; 2) Toe and foot amputations in which arterial reconstruction is not feasible; 3) Posttraumatic causalgia (sympathetic dystrophy); 4) As an adjunct to distal graft bypass.
Conn Med 1989 Dec
PMID:Lumbar sympathectomy: a place in clinical medicine. 261 43

The heart is the most susceptible of all the organs to premature aging and free radical oxidative stress. Clinical research has clearly documented the role of free radical damage and the progression of numerous degenerative diseases, particularly cardiovascular disease. This may be the result of acute ischemia-reperfusion injury, endothelial damage of hyperhomocysteinemia, as well as chronic oxidative damage secondary to lipid peroxidation. Fortunately, although highly responsive, and therefore vulnerable to the effects of oxidative stress, the heart is also receptive to the benefits of targeted phytonutrients, antioxidants, and nutritionals. The effects of antioxidant nutrients have been extensively evaluated in epidemiological, population, and clinical studies. Phytonutrients such as the natural flavonoids and carotenoids found in fresh fruits and vegetables or vitamins C, E, and beta-carotene have powerful antioxidant effects. In addition, minerals like selenium and nutrients such as coenzyme Q10 will minimize free radical risk and optimize a favorable outcome from the ubiquitous presence of oxidative stress on the cardiovascular system. The B complex, particularly folic acid, B12, and B6 are also essential in the prevention of hyperhomocysteinemia, another major risk factor for the circulatory system. Measures to minimize accumulation of heavy metals in the body, especially iron and copper, which are capable of initiating adverse free radical reactions, will also help to assuage oxidative stress. Thus, the combination of a healthy diet supplemented with antioxidants and phytonutrients may be useful in the prevention and promotion of optimum cardiovascular health.
Conn Med 1995 Oct
PMID:Free radicals, oxidative stress, oxidized low density lipoprotein (LDL), and the heart: antioxidants and other strategies to limit cardiovascular damage. 758 73

Extended ischemia results in organ infarction which limits the availability of donor hearts. Hypothermic storage extends heart preservation by effectively stopping cellular metabolism, thereby preventing toxic accumulations of metabolic wastes and depletion of energy stores. However, cell swelling as a result of ion concentration changes and cell laceration due to ice crystal growth are consequences of hypothermic ischemia. Supercooling successfully preserves hearts for an extended time without associated myocardial necrosis. The efficacies of four supercooling preservative solutions, containing hypertonic glucose, polyethylene glycol, and or winter flounder antifreeze protein, are assessed using the Langendorff isolated organ perfusion apparatus and transmission electron microscopy. Polyethylene glycol seems the most effective in preventing myocardial necrosis possibly by dehydrating, minimizing cellular ice formation, protecting against cell swelling, and functioning as an antioxidant. Hypertonic glucose seems the most effective in reducing cell swelling; it may also depress solution freezing points, bind water, adjust both intra- and extracellular osmolarities, stabilize proteins, and assist in adenosine triphosphate (ATP) production. Antifreeze protein seems to bind effectively to ice and inhibit its growth; it may also reduce membrane permeabilities to Ca2+ and K+ ions.
Conn Med 1995 Jul
PMID:The effects of supercooling chemicals on myocardial ultrastructure: a transmission electron microscopy case study. 767 97

Researchers have continued to search for therapeutic agents to protect the heart during ischemia and reperfusion. Recent studies have suggested that harnessing the heart's endogenous systems for self-preservation may provide improved protection from ischemic injury. Two such phenomena, preconditioning and heat-shock protein synthesis, have been shown to uniformly reduce myocardial damage. This review highlights the newest research in myocardial protective strategies and suggests avenues of future investigation.
Conn Med 1995 Jul
PMID:New frontiers in myocardial protection: harnessing the heart's endogenous protective systems. 767 98

Low-birth weight (LBW) remains a significant risk factor in surgery for congenital heart disease (CHD). The timing of surgery and the choice of complete repair vs palliative measures are controversial issues. Delay of surgery to achieve weight gain may result in poorer outcomes. The results of a statewide, cardiac surgery protocol in LBW infants using specific selection criteria for repair vs palliation or delay over a 42-month period are reviewed. From September 1999 through February 2003, 32 low-birth weight infants (1,320 to 2,500 grams) underwent surgery for congenital heart disease in Connecticut. The congenital heart surgery programs in the two major pediatric centers in the state (Yale-New Haven Hospital and Connecticut Children's Medical Center) were amalgamated to form a joint program, with the same surgical team involved in all cases. Median gestational age was 34 weeks with 18 (60%) premature (< or = 37 wks). Median age at operation was eight days. Fourteen infants (44%) had recognized syndromes. Primary diagnoses included variant of single ventricle (8), ventricular septal defect (VSD) (4), tetralogy of Fallot (TOF) (2), pulmonary atresia (PA) with VSD (3), simple transposition of the great arteries (TGA) (1), TGA with VSD (TGA/VSD) (2), atrioventricular canal (AVC) (4), double outlet right ventricle (DORV) (3), aortic coarctation (CoA) (2), and interrupted aortic arch with VSD (IAA/VSD) (3). Eighteen patients (56%) were able to undergo procedures resulting in normal biventricular physiology. Eight patients (25%) had palliation for single ventricle, including two Norwood procedures. Seven patients potentially suitable for biventricular repair underwent palliative surgery because of contraindications to complete repair that were unrelated to weight. Follow-up (100%) ranged from two to 41 months. There were two early deaths (6%), one cardiac related (Norwood with ischemia), and one with sepsis. There was one early reintervention (PA stenosis following arterial switch). There were seven late deaths (22%), two cardiac related (one sudden death following Blalock-Taussig (BT) shunt, one sepsis related to low output), and four noncardiac. In three patients who received pulmonary artery banding (PAB), delay of surgery may have contributed to death due to progressive pulmonary disease. Of 23 long-term survivors, five have undergone biventricular repair following palliation, and two have had further palliation for univentricular heart physiology. A strategy of early surgical intervention favoring primary repair, or surgical palliation for those patients with single ventricle, results in good overall survival in symptomatic low-birth weight neonates with congenital heart disease. Delay in surgery due to LBW may not be beneficial in most cases and could result in lower overall survival and increased cost. A program utilizing statewide resources results in excellent outcomes for this challenging group of patients.
Conn Med
PMID:Surgery for congenital heart disease in low-birth weight neonates: a comprehensive statewide Connecticut program to improve outcomes. 1295 42

Hypothenar hammer syndrome is a rare disease first described by Conn et al. in 1970. It groups together symptoms of chronic microtraumatism to the ulnar artery or its superficial palmar branch against the hamate. Manual workers using vibrating tools are the most affected by this. Diagnosis is made by echodoppler, while arteriography is the gold standard for establishing the treatment plan. Hypothenar hammer syndrome may lead to severe complications secondary to ischemia and to embolic events resulting from delayed diagnosis or maltreatment. There is no real consensus as to the place of medical or surgical treatments. Medical treatment consists of eliminating favorizing factors and long-term antiplatelet aggregation treatment. Surgical treatment depends on the vascular lesions: simple arterial ligation, resection of the thrombosed arterial segment and end-to-end anastomosis, or revascularization using a pontage venous or arterial graft. Some authors suggested an associated thoracic sympathectomy. The diagnosis must be made early; the choice of treatment must be targeted at preventing serious embolic complications.
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PMID:[Hammer hypothenar syndrome: review of the literature and case report]. 2072 99

Apical hypertrophic cardiomyopathy (HCM) is a rare variant of HCM in the non-Japanese population (1% to 2%). Diagnostic dilemma occurs when this type of HCM is newly discovered in a patient previously diagnosed with left ventricular hypertrophy (LVH) secondary to hypertension. We describe an atypical presentation of an apical HCM in the setting of chronic hypertension (HTN) and review the literature of this rare variant of HCM. Our patient presented with chest pain and was found to have apical HCM with inducible apical ischemia and an abnormal blood pressure response to exercise. Multimodality imaging approach is proposed to evaluate the LVH when both apical HCM and hypertension are present given the impact of an accurate diagnosis on prognosis and management.
Conn Med 2012 Mar
PMID:Apical hypertrophic cardiomyopathy associated with chronic hypertension: diagnostic and management implications. 2266 73

The most common etiologies of lower gastrointestinal bleeding include ischemia, diverticulosis, and angiodysplasia. A Dieulafoy's lesion, an uncommon cause of upper gastrointestinal bleeding, is even more rare as an etiology of lower gastrointestinal bleeding. We report a case of an elderly patient with abrupt hematochezia requiring stabilization and blood transfusions. The presumptive diagnosis was diverticulosis or an arteriovenous malformation, but colonoscopy revealed that the source of bleeding was a Dieulafoy's lesion in the ascending colon. The lesion was injected with epinephrine, followed by placement of clips to achieve hemostasis. There were no subsequent interventions and the patient was safely discharged.
Conn Med 2013 Oct
PMID:Dieulafoy's lesion: a rare cause of lower gastrointestinal bleeding. 2426 29

Wegener's granulomatosis (WG) is an autoimmune disease of unknown origin characterized by necrotizing granuloma of both upper and lower respiratory tracts and glomerulonephritis. Neurological manifestations in the central nervous system (CNS) and peripheral nervous system (PNS) are a rare but well-documented feature of WG in the literature. We describe a 51-old-male who presented with complaints of slurred speech and left-sided weakness, along with bilateral pulmonary nodules on initial chest x-ray, which were associated with pulmonary symptoms in the past. A repeated computed tomography (CT) scan showed ischemia in the distribution of the right-middle cerebral artery. An open lung biopsy showed vasculitis with necrosis of a vessel wall, with a multinucleated giant cell, confirming the diagnosis of WG. The patient was successfully treated with cyclophosphamide and oral prednisone and he has continued in remission for one year.
Conn Med 2013 Oct
PMID:Ischemic stroke as a presenting feature of Wegener's granulomatosis. 2426 30


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