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)

The reestablishment of anal function by transposition of the gracilis muscle, combined with the implantation of electrodes and a neuromuscular stimulator (dynamic graciloplasty), has recently been developed. With this method, the transposed muscle maintains contraction by electrical stimulation to maintain neoanal pressure without fatigue. It is necessary to convert the fatigue-prone gracilis muscle to fatigue-resistant muscle by long-term electrical stimulation (conditioning). In most patients receiving dynamic graciloplasty, the conditioning is accomplished after the transposition. However, conditioning before graciloplasty should reduce the risk of ischemia in the transposed muscle after the graciloplasty and improve the outcome. This new sequence of procedures is described, in combination with J-pouch construction, in a patient who required abdominoperineal excision of the rectum for lower rectal cancer. The graciloplasty was performed after conditioning of the gracilis muscle in situ; the conditioning did not cause the patient discomfort and resulted in good anal function.
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PMID:A new approach to dynamic graciloplasty. 949 33

The ultimate goal of replantation and microsurgical reconstructive operations is to regain or improve impaired function of the tissue. However, the data related to the influence of NO on tissue function are limited. This study evaluated the effects of the NO donor S-nitroso-N-acetylcysteine (SNAC) on contractile function of skeletal muscle during reperfusion. Forty-nine rats were divided into six groups. The extensor digitorum longus (EDL) muscles in groups I and II were not subjected to ischemia-reperfusion but were treated with a low (100 nmol/min) or high (1 mumol/min) dose of SNAC. In groups III-V, the EDL underwent 3 h of ischemia and 3 h of reperfusion and was also treated with low (100 nmol/min) or high doses (1 or 5 mumol/min) of SNAC. Group VI was a phosphate-buffered saline (PBS)-treated control group. Twenty additional animals were used to document systemic effects of SNAC and PBS only. SNAC or PBS was infused for 6.5 h, beginning 30 min before ischemia and continuing throughout the duration of reperfusion. Contractile testing compared the maximal twitch force, isometric tetanic contractile forces, fatigue, and fatigue half time of the experimental EDL and the contralateral nontreated EDL. The findings indicate that 1) SNAC does not influence contractile function of EDL muscle not subjected to ischemia-reperfusion, 2) SNAC significantly protects the contractile function of ischemic skeletal muscle against reperfusion injury in the early reperfusion period, and 3) the protective role of SNAC is critically dosage dependent; protection is lost at higher doses. The conclusion from this study is that supplementation with exogenous NO exerts a protective effect on the tissue against reperfusion injury.
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PMID:Effects of S-nitroso-N-acetylcysteine on contractile function of reperfused skeletal muscle. 953 Feb 51

Lower extremity symptoms are caused by lesions at any level of the neuraxis, from cortex to muscle. HIV affects virtually every level of the nervous system, either directly or indirectly. The presence of pathology at multiple levels and by multiple processes further complicates the bedside diagnosis of a patient with AIDS and neurologic symptoms. Many neuropathies and other conditions that affect the lower extremities can be identified with careful history and physical examination, confirmed with limited testing, and can be treated successfully. Distal symmetric polyneuropathy is the most common lower extremity disorder, but it must be distinguished from similar-appearing neuropathies caused by medications, B12 deficiency, or vasculitis. Diffuse infiltrative lymphocytosis syndrome also causes a painful peripheral neuropathy that must be distinguished from distal symmetric polyneuropathy. Inflammatory demyelinating polyneuropathies are characterized by muscle weakness. They occur in early, asymptomatic HIV infection and respond to plasmapheresis or steroids. Mononeuropathies in patients with CD4 counts more than 200 often resolve on their own. Multiple mononeuropathies, which occur in patients with CD4 counts less than 50, are often associated with cytomegalovirus infection and may follow a rapidly progressive course unless treated promptly and aggressively. Progressive polyradiculopathy occurs late in the course of AIDS, is often caused by cytomegalovirus, is rapidly progressive, and generally is fatal unless recognized and treated promptly. Muscle weakness, myalgia, and fatigue are common in HIV and have multiple causes. Lower extremity spasticity may be caused by treatable etiologies such as spinal cord abscess, tumor, disc compression, B12 deficiency, or ischemia. Gait disturbances are common but nonspecific and may be caused by treatable neurologic disorders at any level of the neuraxis.
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PMID:Neurologic problems of the lower extremity associated with HIV and AIDS. 957 54

We investigated the possibility of preventing further aggravation of muscle ischemia and necrosis in newly mobilized, unconditioned latissimus dorsi muscle (LDM) by utilizing short increments of stimulation with intervening rest periods. Adult St. Croix sheep (N = 12) weighing 30 +/- 8 kg were used in this study. Fatigue tests (30 min) using different stimulation regimens before and after LDM mobilization were performed on all animals; the length of time to return to baseline levels was also measured. Our investigation yielded results that contradict the conventional wisdom that any electrical stimulation damages newly mobilized LDM and will cause a considerable decrease in contractile force (CF). Stimulation regimens using continuous contractions at 30 and 60 contractions per minute (CPM) for 30 minutes were damaging to the LDM. CF also dropped significantly and returned slowly to baseline values: at 60 CPM, CF dropped to 50 +/- 4% and did not return to baseline even after 90 minutes of rest; at 30 CPM, CF dropped to 61 +/- 4% and baseline was restored after 80 minutes of rest. Electrical stimulation using continuous contractions at a slower rate (15 CPM) was tolerable, although a 23% decrease in CF was noted (p < 0.05 when compared to 60 CPM). These results did not satisfy us that such a regimen would be useful for cardiac assistance immediately after cardiomyoplasty. The work-rest regimen at 30 CPM also gave poor results: CF decreased to 75 +/- 2% and baseline was restored after 80 minutes of rest. Promising results were seen when utilizing a work-rest regimen at 15 CPM. The newly mobilized LDM showed no visible signs of fatigue: CF decreased minimally to 92 +/- 3% (p < 0.05 when compared to 30 CPM), and light microscopic analysis of biopsies revealed no morphological damage exceeding that typically seen after subtotal mobilization. Such results open avenues for future investigations: beginning electrical stimulation immediately after cardiomyoplasty (using a single impulse and a slow rate of contraction); decreasing the length of time necessary to obtain full cardiac assistance; and beginning partial cardiac assistance immediately after cardiomyoplasty (if needed) for approximately 30 minutes several times a day.
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PMID:Comparison of different regimens of electrical stimulation applied to nonmobilized and newly mobilized latissimus dorsi muscle. 963 73

In electrically stimulated (dynamic) graciloplasty for urinary incontinence, the gracilis muscle is transposed into the pelvis, and the distal part is used to reconstruct a neosphincter. Clinical outcomes using this technique have been disappointing due to stricture of the urethra caused by ischemia in the distal part of the gracilis and limited gracilis length available for neosphincter construction. Furthermore, the urethra is twisted by the contracting gracilis, rather than circumferentially squeezed. The purpose of the present study was to test the anatomical and functional feasibility of a new surgical approach to reconstruct a urinary sphincter, using the gracilis muscle as a free flap. In 12 human cadavers, the anatomical feasibility for creating a neosphincter by using the gracilis free flap was determined. In all cases, transfer of the gracilis muscle into the pelvis as a free flap (with the nerve intact) was feasible, and ample muscle was available to construct a neosphincter around the bladder neck. Gracilis neosphincter function was studied in seven dogs. The left gracilis muscle was subjected to transfer into the pelvis as an innervated free flap to create a neosphincter around the urethra. The right (control) gracilis muscle was lifted as a single pedicle flap, remained in situ, and was wrapped around a stent to mimic the urethra. Function (expressed as peak pressure generation and fatigue rate) and surface perfusion were determined for all gracilis muscles. In each dog, both sides were compared using the paired Student's t test for statistical analysis, and no significant difference was measured for the two groups. In conclusion, an innervated gracilis free flap can be used to create a neosphincter around the bladder neck. In an acute study in dogs, function and perfusion of the innervated gracilis free flap are not compromised.
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PMID:Electrically stimulated free-flap graciloplasty for urinary sphincter reconstruction: a new surgical procedure. 965 11

Tourniquets frequently used during surgery involve tissue ischemia followed by postoperative reperfusion. However, little information is available on the functional consequences of this procedure in skeletal muscle. The goal of this study was to use skeletal muscles of C57BL/6 adult male mice to assess functional, structural, and biochemical characteristics after hindlimb vessel occlusion. Experimental manipulation involved application of a tourniquet to the hindlimb for a 3-hour period (n = 65). Muscles were then excised after various periods of reperfusion. Soleus and extensor digitorum longus muscles were chosen as representative of slow oxidative and fast glycolytic muscle fiber types, respectively. The most striking functional change found after ischemia-reperfusion injury was markedly improved endurance of extensor digitorum longus muscles. These fast-twitch glycolytic muscle fibers became much more resistant to fatigue during recovery from ischemia-reperfusion injury. There was a progressive increase in force generation in both muscles during recovery; however, soleus muscles recovered function more quickly after ischemia-reperfusion than extensor digitorum longus muscles. Also, extensor digitorum longus muscles recovered mass more slowly than soleus muscles at 7 and 14 days after ischemia. Structurally, extensor digitorum longus muscles had more severely damaged mitochondria, sarcoplasmic reticulum, and myofibrils. Surprisingly, no differences in oxidative enzyme activity (citrate synthase) and oxidative damage (in protein and lipids) were found after ischemia-reperfusion. The results indicate that muscle fiber type has a significant impact on the nature of ischemia-reperfusion injury in skeletal muscle. Thus, muscle fiber composition would be expected to affect recovery from the clinical use of tourniquets and other ischemic procedures. Furthermore, the results suggest that damage to structures involved in energy transduction and excitation-contraction coupling may play a role in the effects.
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PMID:Effects of fiber type on ischemia-reperfusion injury in mouse skeletal muscle. 981 Oct 3

The purpose of this study was to determine the effects of concentric (Con) and eccentric (Ecc) muscle actions on leg muscle sympathetic nerve activity (MSNA). Two protocols were utilized. In protocol 1, eight subjects performed Con and Ecc arm curls for 2 min, with a resistance representing 50% of one-repetition maximum for Con curls. Heart rate (HR) and mean arterial pressure (MAP) were greater (P < 0. 05) during Con than during Ecc curls. Similarly, the MSNA was greater (P < 0.05) during Con than during Ecc curls. In protocol 2, eight different subjects performed Con and Ecc arm curls to fatigue, followed by postexercise muscle ischemia, by using the same resistance as in protocol 1. Endurance time was significantly greater for Ecc than for Con curls. The increase in HR, MAP, and MSNA was greater (P < 0.05) during Con than during Ecc curls. However, when the data were normalized as a function of endurance time, the differences in HR, MAP, and MSNA between Con and Ecc curls were no longer present. HR, MAP, and MSNA responses during postexercise muscle ischemia were similar for Con and Ecc curls. Con curls elicited greater increase (P < 0.05) in blood lactate concentration than did Ecc curls. In summary, Con actions contribute significantly more to the increase in cardiovascular and MSNA responses during brief, submaximal exercise than do Ecc actions. However, when performed to a similar level of effort (i.e., fatigue), Con and Ecc muscle actions elicit similar cardiovascular and MSNA responses. These results indicate that the increase in MSNA during a typical bout of submaximal dynamic exercise is primarily mediated by the muscle metaboreflex, which is stimulated by metabolites produced predominantly during Con muscle action.
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PMID:Effect of concentric and eccentric muscle actions on muscle sympathetic nerve activity. 993 Nov 91

Baseball pitchers appear to be prone to aneurysms of the axillary artery and its branches. The cause is probably related to repetitive compression of or tension on the vessels at the level of the pectoralis minor muscle and the humeral head, which is exacerbated by the pitching motion. The incidence of aneurysms of the axillary artery and its branches among pitchers and other athletes is not known, nor is it clear whether pitchers who are at high risk of vascular injury can be identified before irreversible damage to the vessels has occurred. Perhaps patients who have documented compression or occlusion of the vessel with the arm in the abducted, externally rotated position are at higher risk. Screening pitchers to identify those with axillary artery compression, aneurysm, or thrombosis has also not been shown to be effective. Certainly, many pitchers will have some level of compression of the axillary artery with their arm in the pitching position but will never develop any clinical abnormality requiring treatment. Screening would therefore probably lead to a high false-positive rate. It is clear, however, that pitchers who complain of ischemia-type symptoms such as early fatigue or who have evidence of emboli require a complete evaluation to rule out any abnormality of the axillary artery or one of its branches. Orthopaedic surgeons who see pitchers and other athletes involved in repetitive overhead motions need to be aware of this disorder so that they order the appropriate tests and obtain a vascular consultation--and make a prompt diagnosis. Treatment will vary depending on the type of lesion and on which vessel or vessels are involved, and should be decided on by the team of surgeons treating the patient.
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PMID:An aneurysm involving the axillary artery and its branch vessels in a major league baseball pitcher. A case report and review of the literature. 1035 76

We conducted a series of studies to develop and test a rapid, noninvasive method to measure limb venous compliance in humans. First, we measured forearm volume (mercury-in-Silastic strain gauges) and antecubital intravenous pressure during inflation of a venous collecting cuff around the upper arm. Intravenous pressure fit the regression line, -0.3 +/- 0.7 + 0.95 +/- 0.02. cuff pressure (r = 0.99 +/- 0.00), indicating cuff pressure is a good index of intravenous pressure. In subsequent studies, we measured forearm and calf venous compliance by inflating the venous collecting cuff to 60 mmHg for 4 min, then decreasing cuff pressure at 1 mmHg/s (over 1 min) to 0 mmHg, using cuff pressure as an estimate of venous pressure. This method produced pressure-volume curves fitting the quadratic regression (Deltalimb volume) = beta(0) + beta(1). (cuff pressure) + beta(2). (cuff pressure)(2), where Delta is change. Curves generated with this method were reproducible from day to day (coefficient of variation: 4.9%). In 11 subjects we measured venous compliance via this method under two conditions: with and without (in random order) superimposed sympathetic activation (ischemic handgrip exercise to fatigue followed by postexercise ischemia). Calf and forearm compliance did not differ between control and sympathetic activation (P > 0.05); however, the data suggest that unstressed volume was reduced by the maneuver. These studies demonstrate that venous pressure-volume curves can be generated both rapidly and noninvasively with this technique. Furthermore, the results suggest that although whole-limb venous compliance is under negligible sympathetic control in humans, unstressed volume can be affected by the sympathetic nervous system.
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PMID:Measurement of limb venous compliance in humans: technical considerations and physiological findings. 1051 91

Occlusal alterations may result in changes in the functional performance of masticatory muscles. In this study, we set up an experimental model in rats to examine whether masticatory muscle abnormalities occur after a malocclusion is induced. Rats underwent unilateral amputation of the molar cusps to simulate an occlusal wear situation. The masseter muscles ipsilateral and contralateral to the amputated molars were excised at different experimental times. Sham-operated rats were used as controls. The tissue samples were studied by light and electron microscopy and morphometry. Tissue calcium content, a biochemical index of muscle injury, was also determined. The results show that occlusal dysfunction leads to microvessel constriction and clear-cut morphologic damage of muscular fibers and blood capillary endothelium, as well as to elevation of tissue calcium content, in the ipsilateral masseter muscle. These changes are likely related to muscle fatigue and ischemia. The early signs of injury do not involve the entire muscle but are mostly restricted to tissue areas rich in type I (slow) muscle fibers, which are characterized by a predominantly aerobic metabolism. The muscle damage becomes more extended and severe with time. On the other hand, the contralateral muscles show only slight alterations which are reversible with time, possibly due to an adaptive response.
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PMID:Morphologic and biochemical changes of the masseter muscles induced by occlusal wear: studies in a rat model. 1057 70


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