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

Stenosis of the rectum after surgery is a rare complication of low anastomosis. Infection, ischemia, foreign body reaction, technical faults or recurrence of neoplasms are the most important causes. Dilatation is attempted either manually or by instrument, if the stenosis causes discomfort and in particular if diarrhea results. Rarely resection of the stenosed segment is necessary. Stenosis in conjunction with incontinence is the most feared complication of anorectal surgery. It develops exceptionally after scarring of a large mucocutaneous defect after hemorrhoidectomy, correction of an anal fistula, a mucosal prolapse, electro-resection, infection or trauma. Anal stenosis leads to increasing constipation, a reduction of stool volume, abdominal cramps and rectal bleeding.
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PMID:[Postoperative anorectal stenosis]. 236 80

PTA is an established method of revascularization in a variety of medical conditions. It is performed for specific morphologic and clinical indications. PTA is the procedure of choice in Fontaine stage IIB through IV lower extremity ischemia due to iliac and/or femoropopliteal stenosis or short occlusion. Its role is less certain in infrapopliteal disease, although current studies have begun to establish long-term effectiveness. PTA is the procedure of choice for renal revascularization in renovascular hypertension due to fibromuscular disease or non-ostial atherosclerosis, selected cases of renal artery stenosis associated with renal insufficiency, and transplant renal artery stenosis. It is also useful in treating the renovascular component of complex hypertension and may be indicated in severe renal artery stenosis (75%-99%), even in the absence of clinically demonstrable RVHTN. PTA has limited applications in the venous system and only short-term success in the treatment of stenoses in dialysis access fistulas. PTA often serves as an important adjunct to surgical revascularization by providing improved inflow or outflow. PTA is the procedure of choice when anatomically feasible in subclavian steal syndrome. The role of PTA in carotid artery disease, particularly atheromatous disease of the internal carotid artery, is uncertain. The same may be said of PTA for vertebral artery stenosis, although the overwhelming majority of vertebral artery stenoses are morphologically suitable for PTA. PTA and surgery are both effective in the treatment of abdominal angina. There are more data available to verify the long-term patency of thromboendarterectomy and bypass grafts than PTA for mesenteric ischemia. However, since the technical success for PTA is high and since coronary co-morbidity is the most common cause of perioperative mortality in surgical series, PTA should be seriously considered as the procedure of first choice. Serious complications of PTA occur in approximately 5% of cases. Two to three percent of PTA patients have complications requiring surgery or causing a prolongation or alteration of hospital course. The morbidity, mortality, and cost associated with PTA are low. The discomfort is minor, and postprocedural recovery rapid. The major limitations of PTA include its unsuitability for some lesions (long-segment occlusions and stenoses, orifice lesions, eccentric lesions) and postangioplasty restenosis. These problems are being addressed by ongoing laboratory and clinical research. In the near future, it is likely that endoluminal transmural sonography of the vessel wall will help guide our interventions.
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PMID:Noncoronary angioplasty. 252 45

In patients with recurrent chest pain in the immediate postinfarction state, one must determine whether the recurrent chest discomfort is related to myocardial ischemia or not. If recurrent ischemia is present then it may be due to either (1) transient increase of myocardial oxygen demand over a fixed coronary reserve, (2) transient decrease of myocardial oxygen supply, or (3) a combination of both. Coronary angiography reveals that most patients have double or triple vessel disease. The presence of postinfarction angina portends a poor prognosis. Reinfarction rate has been reported as high as 28% during initial hospitalization and mortality has been as high as 57% at six months follow-up. Intravenous nitroglycerin seems to be an important foundation therapy for the management of postinfarction angina. The use of beta blockers has reduced mortality by 24% compared to placebo in this patient subgroup. Calcium antagonists have proven efficacious in patients with non-Q-wave myocardial infarction and postinfarction angina. Thrombolytic therapy, chronic anticoagulation and antiplatelet therapy are not proven efficacious at this time. Coronary angioplasty is usually successful initially but is associated with an early myocardial infarction rate varying from 1.4 to 13%. Mortality rate is usually low as is late myocardial infarction rate. Recurrent angina occurs commonly in these patients. Surgical therapy in the early infarction state should be offered to those patients who have a poor response to maximal medical therapy whose coronary artery obstructions are not amenable to PTCA. At the time of coronary angiography if partially occlusive thrombus is identified, intravenous heparin and aspirin should be given to prevent more thrombus formation and total occlusion.
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PMID:Early postinfarction angina: therapeutic strategies. 269 Nov 42

Detailed review of the literature for chest discomfort evaluation in the Emergency Department leaves the clinician without a precise guideline as to whom to admit or send home. It is clear that the seasoned physician's instinct (the sum total of the history, physician examination, and ancillary laboratory tests) is as good an indicator as existing statistical decision models. Current decision rules appear most helpful as teaching aids for physicians-in-training and for providing reassurance to seasoned physicians. Although ancillary tests such as echocardiography and rapid myoglobin analysis may play more important roles in the future, emergency physicians must now rely primarily upon their clinical impression to guide admission decisions. Vigorous attempts to minimize the admission of patients without ischemia to the CCU will increase the incidence of infarction patients released from the Emergency Department. The liberal use of intermediate care unit beds may represent one future disposition alternative. Nonetheless, each physician must establish his or her own threshold for admission. Several studies have found a 5 per cent unintentional release of infarction patients from the Emergency Department. Decreasing the admission threshold may lower this rate substantially. Patients with chest discomfort who are released from the Emergency Department require close followup. At urban teaching hospitals, where private physician referral is often limited, the institution may need to establish a clinic specifically for this purpose. Unrecognized myocardial ischemia is one rationale for close followup; however, the pursuit of alternative diagnoses including gastrointestinal and psychiatric (e.g., panic disorders) etiologies may minimize subsequent morbidity in the released population.
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PMID:Detection of myocardial ischemia/infarction in the emergency department patient with chest discomfort. 328 Mar 3

One hundred eight consecutive patients with proved coronary artery disease and reproducible exercise-induced myocardial ischemia were studied. During repeated exercise testing, 52 patients (Group I) had myocardial ischemia in the absence of pain (silent ischemia) whereas 56 patients (Group II) experienced anginal symptoms in the presence of electrocardiographic signs of ischemia. A pulpal test was carried out in all patients using an electrical dental stimulator commonly used in dentistry. Electrical current was delivered in increasing intensity from 10 to 500 mA, and the dental pain threshold and the reaction of the patients to maximal stimulation were determined. During the pulpal test, 71.2% of the patients in Group I did not experience pain, even at maximal stimulation (threshold 0), 11.5% were sensitive at threshold I (10 to 200 mA) and 17.3% felt pain at threshold II (210 to 500 mA). In Group II, 69.7% of the patients complained of dental pain at the low intensity test current (threshold I), 10.7% at threshold II and 19.6% at threshold 0. In Group I, 71.2% of patients did not have discomfort (reaction -), even at maximal stimulation, 21.1% had a mild reaction (reaction +) and 7.7% had an intense painful reaction (reaction ++). In Group II, 80.4% of patients were sensitive to the pulpar test (67.9% reported intense painful sensation at maximal stimulation, 12.5% had a mild reaction); 19.6% of patients had no reaction. The two groups of patients were similar with respect to age, sex and angiographic features.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Dental pain threshold and angina pectoris in patients with coronary artery disease. 339 25

To help answer questions regarding the percentage of black patients catheterized for suspected cardiac ischemia who are found to have negative coronary arteriograms, and how this percentage compares with that of similarly classified white patients, the coronary arteriographic and left ventriculographic findings of 100 consecutive blacks were reviewed and compared with those of 226 contemporaneously catheterized whites. After excluding patients with prior histories of a clinical cardiac ischemic event, invasive therapeutic intervention for coronary artery disease (CAD), and nonatherosclerotic cardiac disease, a subgroup of 50 black and 104 white patients remained with undiagnosed chest discomfort that was suspicious for cardiac ischemia. Of this subgroup, 68 percent of the black patients showed no or insignificant CAD by arteriography, as compared with 21 percent of the white patients (P < .001). An incidental but note-worthy finding pertaining to this same subgroup was that 18 percent of the black patients who underwent arteriography and were found to have no CAD exhibited a subnormal left ventricular ejection fraction; in contrast, none of the white patients in the same category did so (P < .05).
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PMID:Clinical and coronary arteriographic profile of 100 black Americans: focus on subgroup with undiagnosed suspicious chest discomfort. 357 56

To assess the contribution of coronary vasospasm to chest pain in patients with nontransmural myocardial infarction, we performed a controlled trial of prophylactic antivasospastic therapy. Fifty patients with nontransmural infarction received either nifedipine or placebo in a double-blind randomized trial. Chest pain occurred in 52% of treated patients (38 episodes on 35 days) compared to 48% of control patients (42 episodes on 33 days). Concurrent therapy was comparable in the two groups. Recurrent infarction occurred in 12% and was comparable between groups. Ejection fraction was similar and was unchanged throughout the study in both groups. Logistic regression failed to identify predictors for recurrent chest discomfort. These data indicate that potent antivasospastic therapy does not reduce the incidence of recurrent chest pain or infarction. Thus, remediable coronary vasospasm is not likely to be a major cause of post infarction ischemia in patients with nontransmural infarction.
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PMID:Chest pain after nontransmural infarction: the absence of remediable coronary vasospasm. 389 94

We found silicone foam elastomer (produit by C.M.H. lab.) to be an excellent post-operative penile dressing. Although compressive the material is elastic enough to avoid ischemia and to allow slight swelling of the penis. Soft, light, it is never adherent to the wound and, thus, is removed easily without discomfort to the patient.
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PMID:[Penile dressings of C.M.H. silicone elastomer foam]. 674 1

To clarify the pathogenesis of chest pain in patients with cardiomyopathies, we compared coronary blood flow and other indicators of ischemia at rest and during pacing-induced tachycardia in nine patients with cardiomyopathy (four hypertrophic and five congestive) and in five control subjects. Coronary blood flow was reduced at rest and during pacing in cardiomyopathy patients compared with controls. In patients with hypertrophic cardiomyopathy, pacing induced chest pain in all, increased ST-segment depression in three patients and increased coronary venous lactate concentration. With pacing, two of five patients with congestive cardiomyopathy had chest discomfort and three had increased ST-segment depression, but coronary venous lactate concentration did not change significantly. In both groups of cardiomyopathies, the ratio of the systolic and diastolic pressure-time indexes tended to decrease more than in controls during pacing. Thus, myocardial perfusion is decreased in patients with cardiomyopathy, both at rest and during pacing. The changes detected during pacing point to subendocardial ischemia as the likely mechanism for angina in hypertrophic and possibly also in congestive cardiomyopathy.
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PMID:Pathophysiology of chest pain in patients with cardiomyopathies and normal coronary arteries. 719 3

A laparoscopic live-donor nephrectomy was performed on a 40-year-old man. The kidney was removed intact via a 9-cm infraumbilical midline incision. Warm ischemia was limited to less than 5 min. Immediately upon revascularization, the allograft produced urine. By the second postoperative day, the recipient's serum creatinine had decreased to 0.7 mg/dl. The donor's postoperative course was uneventful. He experienced minimal discomfort and was discharged home on the first postoperative day. We conclude that laparoscopic donor nephrectomy is feasible. It can be performed without apparent deleterious effects to either the donor or the recipient. The limited discomfort and rapid convalescence enjoyed by our patient indicate that this technique may prove to be advantageous.
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PMID:Laparoscopic live donor nephrectomy. 749 80


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