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)

At the present time ergotism is due primarily to excessive use or abuse of ergot preparations for migraine headaches. The diagnosis may be made with the evidence of vascular ischemia in the presence of a history of migraines and its treatment with this drug. The therapy for the vasospasm is directed chiefly at the discontinuation of the ergot preparation, with further treatment aimed at the relief of symptoms or prevention of complications. A case is presented of lower extremity ischemia with impending gangrene of both feet in a patient with a history of chronic schizophrenia. Arteriograms revealed symmetrical vasospasm in the lower extremities as well as spasm of the superior mesenteric artery and its intestinal branches. This is believed to be the first documented case of mesenteric vasospasm due to ergotism. Treatment was instituted with low molecular weight dextran, tolazoline, and reserpine with rapid and complete resolution. Caution is advised in the use of ergot preparations in neuropsychiatric disorders.
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PMID:Mesenteric and peripheral vascular ischemia secondary to ergotism. 83 86

Angina with "normal coronary arteries" might best be thought of as "angina with coronary dysfunction". It seems likely that this syndrome is due to inadequate regional myocardial perfusion with manifestations similar to those seen when ischemia results from occlusive coronary artery disease. The prognosis of the disorder is favorable, but occasional catastrophic events occur. It appears likely that maldistribution of perfusion results from dynamic changes affecting proximal, and perhaps distal coronary vessels, potentially mediated by vasoactive substances released from platelets precipitating or exacerbating coronary arterial spasm. Clarification of the pathogenesis of the syndrome should permit implementation of more effective therapy and prevention of the rare malignant sequelae of this disorder.
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PMID:Angina with "normal coronary arteries". A misnomer. 84 83

To assess the accuracy of angiographic determinations of disease of coronary arteries and left ventricular myocardium we compared clinical with postmortem coronary arteriograms and left ventriculograms with myocardial pathology in 28 patients, all of whom died postoperatively and within three months of angiography; 19 had ischemic heart disease, four valvular heart disease, and five both. Comparison of pre and postmortem lumenal occlusion in 315 epicardial coronary segments, excluding those operated upon, showed greater than 50% narrowing discrepancies in 21 (7%). Significant coronary artery lesions were overestimated in six and underestimated in 15. Of the six overestimations, three appeared to be due to coronary spasm; of the 15 underestimations, 12 were due to overlapping images; six discrepancies were unexplained. Comparison of wall motion in 140 ventriculogram segments with myocardial pathology, excluding any post-study or perioperative injury, showed good correlation of reduced motion with 48 (34%) infarcted and 10 (7%) aneurysmal segments. However, 58 (41%) other segments had poor or absent ventriculogram motion, with structurally normal myocardium and patent coronary artery supply; 19 were on infarct margins and 39 in dilated or hypertrophied hearts. Thus, premortem coronary arteriographic occlusions generally indicate atherosclerotic narrowing; but decreased or absent segmental wall motion frequently does not indicate a myocardial lesion. It may be attributable to ischemia in the distribution of a critically narrowed coronary artery or it could be due to abnormal ventricular topography.
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PMID:Correlation of coronary arteriograms and left ventriculograms with postmortem studies. 86 69

The major regulatory factors in the mesenteric circulation include general hemodynamic forces, the autonomic nervous system, circulating vasoactive substances, tissue metabolites and intrinsic characteristics of vascular smooth muscle. During mesenteric ischemic states smooth muscle spasm elevates resistance to blood flow and aggravates intestinal tissue hypoxia leading to mucosal necrosis. Close intraarterial infusion of potent vasodilator drugs holds the promise of reversing intestinal ischemia and preserving viability of the gut.
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PMID:Control of the splanchnic circulation. 88 58

Prinzmetal's variant angina is commonly referred to as a syndrome apart from the usual spectrum of atherosclerotic disease. 2 well-studied patients with this form of angina gave past histories compatible with classical angina. They were found to have, in addition to severe atheromatous lesions, coronary artery spasm resulting in complete obstruction of the vessel during Prinzmetal attacks. The concomitant electrocardiographic ST segment elevations are probably the reflection of transmural ischemia injury resulting from the transient complete occlusion of the corresponding coronary artery. Electrocardiograms taken during milder resting anginal attacks showed minimal nonspecific changes of the electrocardiogram or T wave inversions which may possibly reflect less severe ischemia, secondary to milder coronary spasm. These observations support the possibility that at least in some cases, Prinzmetal's angina may just be a phase in the life history of patients with atherosclerotic disease, during which recurrent severe coronary spasms may occur.
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PMID:Another look at Prinzmetal's variant angina. 91 86

A relationship of coronary arterial spasm to variant angina pectoris, subendocardial ischemia, major ventricular arrhythmias and myocardial infarction has been demonstrated. In 29 patients, spasm was angiographically observed in normal-appearing coronary arteries (7 patients) as well as superimposed on various degrees of coronary atherosclerotic obstruction (22 patients). All patients experienced an atypical anginal syndrome;16 patients also experienced typical exertional angina. Coronary spasm appeared to be a major contributory factor in eight occurrences of myocardial infarction and in 11 incidents of ventricular tachycardia, ventricular fibrillation and heart block. Coronary spasm in the 29 cases was distributed in the following fashion: left main trunk, 6 cases; right main trunk, 12 cases; proximal left anterior descending artery, 13 cases; proximal circumflex artery, 1 case; distal left anterior descending artery, 1 case; and distal circumflex artery, 2 cases. In 5 cases coronary spasm was noted at multiple sites.
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PMID:Spectrum of coronary arterial spasm. Clinical, angiographic and myocardial metabolic experience in 29 cases. 99 29

Report on the rare event of a complete ischemia of the right arm immediately postpartum. The infant was delivered by Caesarean Section because of cervical dystocia and fetal distress. The umbilical cord was twice around the neck and the ischemia of the right arm appeared to be due to spasm of the axillary artery. Treatment for shock and infusion of vasodilating drugs (Complamin) relieved the arterial spasm.
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PMID:[Acute occlusion of the arterial blood supply of the right arm in a newborn following entanglement of the umbilical cord (author's transl)]. 101 Mar

Notable historical aspects relating to the etiology and treatment of pes cavus have been critically examined. The characteristic features of the deformity are described and an explanation offered for the mechanism of their production. Although its etiology remains uncertain, a study of the literature and a great deal of clinical material has established certain well supported conclusions regarding the etiology and pathology of the condition. Certain aspects of cerebral palsy serve to strengthen impressions of earlier authors that the primary center of origin of pes cavus lies somewhere in the central nervous system. Localized foci of partial damage lying adjacent to tracts of nerve cells more seriously affected by a neurological disease could emit irritating stimuli capable of producing degrees of over-action of the invertor muscles varying from obvious spasm to clinically undetectable increase in muscle tone. Biral or other factors which stop short at creating nothing more than such a focus of irration could explain the insidious onset of the deformity in the idiopathic group. Over-action of invertor muscles for one reason or another, including ischemia, is almost certainly responsible for initiating the deformity, though primary contracture of the plantar fascia could possibly do so. With the appearance of supination of the heel, the calcanean tendon becomes an active invertor adding its force to that of the plantar fascia to produce structural varus of the calcaneum. Contracture of the plantar fascia and supination of the heel are regarded as features of major importance. Correction of the latter can be achieved more effectively by suitable osteotomy than by subtaloid fusion, which is regarded with great disfavor. Conservative treatment consists of exercises and shoe appliances. Surgical correction is based on calcanean osteotomy and plantar fasciotomy supplemented where necessary by suitable tendon transplantations, correction of clawing of the toes, and tarsal or metatarsal wedge resections. Preservation of the midtarsal subtaloid joint complex is essential. With the heel correctly aligned the degree of improvement to be expected in the forefoot deformity is such that any structural operation on it should be deferred until a fair period of walking has been tried.
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PMID:The present status of the problem of pes cavus. 109 4

Severe extremity ischemia developed in four patients who had ingested methysergide maleate or ergot for the relief of headache. Symptoms involved the upper extremity in two patients and the lower extremity in two. Spontaneous reversal of the ischemic picture was obtained by simple discontinuation of ergot in most instances, although intra-arterial vasodilators were used in one case. Angliography disclosed arterial spasm and was a useful adjunct in confirming the cause of ischemia in each of the patients. It was especially useful when a history or ergot ingestion was not immediately available.
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PMID:Ergotism. 115 59

The author reviews a form of management for patients deteriorating preoperatively or postoperatively from apparent ischemia attributed to progressive vasospasm after a subarachnoid hemorrhage. The clinical picture and relative frequency of this complication are considered in relationship to the status (grade) of the patient, location of the aneurysm, and ultimate neurological recovery. Experience suggests that the drug regimen reported is useful when instituted early after the onset of symptoms and is safe with proper monitoring techniques. The data do not justify early operative intervention after a subarachnoid hemorrhage, operation when there is angiographic evidence of severe spasm, or expectation of a dramatic effect in patients with a profound deficit or a fixed deficit several hours old.
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PMID:Management of ischemic complications after subarachnoid hemorrhage. 115 79


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