Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0022116 (ischemia)
 91,303 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Coagulation activation and fibrinolysis parameters were studied in eleven cases of thrombotic microangiopathy concerning eight adult patients. In addition to routine coagulation tests, antithrombin III, von Willebrand factor (vWF), prothrombin fragment 1+2 (F1+2), thrombin-antithrombin complex (TAT), D-dimer (DD), and plasminogen activator inhibitor type 1 (PAI-1) were measured in the plasma at the time of diagnosis and as soon as remission was achieved after therapy with plasma exchange and Iloprost. In the acute phase all patients showed normal aPTT, normal or slightly prolonged prothrombin time, normal or enhanced plasma levels of fibrinogen and antithrombin III, at variance with results in patients affected by disseminated intravascular coagulation. Mean F1+2, TAT, DD, vWF and PAI-1 were elevated in the acute phase, but decreased significantly in the early phase of remission. Our data provide evidence of increased thrombin generation rate which takes place in the acute phase of the disease and does not result in consumption coagulopathy, due to appropriate inhibition by antithrombin III; blood coagulation activation promptly decreased as soon as remission was achieved. Cross-linked fibrin deposition together with PAI-1 may consolidate the platelet plug, eventually resulting in microvascular occlusion and ischemia.
 ...
PMID:Plasmatic parameters of coagulation activation in thrombotic microangiopathy. 895 55

In a placebo-controlled trial skeletal muscle biopsies were taken proximal and distal to the site of arterial stenosis, before cross-clamp and 20 min following reperfusion, in 8 well-matched critical limb ischaemia patients undergoing femorodistal bypass. Capillary endothelial swelling-a sign of reperfusion injury-was assessed following infusion with iloprost, a prostacyclin analogue, the prolonged beneficial effect of which on vascular graft flow rates has been demonstrated previously. Electron microscopy and image analysis of calf capillaries confirmed that critical limb ischemia patients had endothelial cell swelling before bypass, and that cross-clamp ischaemia caused further endothelial swelling in the placebo group. Samples from muscles proximal to the site of the bypass showed similar changes, indicating that systemic capillary damage occurs in muscle remote from the area of ischaemia. Iloprost treatment prevented endothelial swelling and increased the mean capillary lumen cross-sectional area. Iloprost, therefore, has a potentially beneficial effect on capillary function by limiting reperfusion injury during femorodistal bypass.
 ...
PMID:Effect of muscle ischaemia and iloprost during femorodistal reconstruction on capillary endothelial swelling. 904 6

The effects of ZK-118.182, a stable analogue of PGD2, were evaluated in an endothelin-1-induced cerebral ischemia rabbit model. Ischemia was induced by endothelin-1 injection (0.25 ng bolus) into subcavian artery and ischemic changes were assessed histologically by the number of ischemic neurons in the brain stem. ZK-118.182 (2 micrograms/kg, bolus into subclavian artery) reduced the number of ischemic neurons when injected 20 min after endothelin-1 injection, Iloprost, a stable analogue of PGI2, was also effective in reducing the number of ischemic neurons in a dose of 0.5 microgram/kg (bolus into subclavian artery). The results suggested that ZK-118.182 has a potent antiischemic effect which is comparable to that of iloprost in rabbits.
 ...
PMID:Antiischemic effect of ZK-118.182 in rabbits: a comparative study with iloprost. 965 84

A total of 12 mongrel dogs were divided into two equal groups. Six animals received IIoprost and the other 6 animals did not receive any additional treatment. In the Iloprost group, Iloprost was added to the cardioplegic solution (25 ng). Also, Iloprost was used (10 ng/kg/min.) 5 min. before and after cross-clamping. All cardiac output and biochemical measurements were evaluated before cross-clamp and 15 min., 1 h, and 4 h after cross-clamp. The measured dp/dt shows that the hearts treated with Iloprost preserved left ventricular function. Comparison of contractility indices between the groups revealed that contractile recovery was 59% in the control group and 71% in the Iloprost group (p < 0.05). Tumor necrosis factor (TNF) alpha level was significantly elevated in the control group (p < 0.001). Its level was 22.2 +/- 2.2 pg/mL in the control group and 13.8 +/- 1.0 pg/mL in the Iloprost group. E- and P-selectin levels were elevated in the control group (p < 0.001). ICAM-1 level was also elevated in the control group. ICAM-1 level was 17.7 +/- 1.8 ng/mL in the control group and 8.5 +/- 1.8 ng/mL in the Iloprost group. The Iloprost that was added to the cardioplegic solution and low dose administration during the pre- and post-ischemic period inhibits the toxic mediator release from endothelium-leukocyte interaction and reduces the severity of ischemia-reperfusion injury.
 ...
PMID:Iloprost added to the cardioplegic solutions improves myocardial performance. 966 Dec 18

We investigated whether antithrombin (AT) can reduce ischemia/reperfusion (I/R)-induced injury of rat liver by promoting prostacyclin release from endothelial cells. Although intravenous administration of AT (250 U/kg) markedly reduced hepatic injury, neither dansyl-Glu-Gly-Arg-chloromethyl ketone-treated factor Xa (DEGR-Xa), a selective inhibitor of thrombin generation, nor Trp49-modified AT, which lacks affinity for heparin, had any effect. Hepatic levels of 6-keto-PGF1, a stable prostacyclin (PGI2) metabolite, were increased significantly after I/R of the rat liver. AT significantly increased the hepatic level of 6-keto-PGF1, whereas neither DEGR-Xa nor Trp49-modified AT increased it. Hepatic tissue blood flow was markedly reduced after I/R. Although AT significantly increased the hepatic tissue blood flow after I/R, neither DEGR-Xa nor Trp49-modified AT increased the blood flow. Hepatic levels of cytokine-induced neutrophil chemoattractant (CINC) and myeloperoxidase (MPO) were significantly increased after hepatic I/R. The levels of these two indicators were reduced by AT but were unaffected by either DEGR-Xa or Trp49-modified AT. Pretreatment of animals with indomethacin (IM) completely inhibited the protective effects of AT on the I/R-induced hepatic damage and the leukocyte activation as well as the AT-induced increase in hepatic 6-keto-PGF1 levels after I/R. Iloprost, a stable analog of PGI2, exhibited effects similar to those of AT and also significantly inhibited the exacerbation of liver injury, the decrease in hepatic tissue blood flow, and the increases in hepatic CINC and MPO levels seen in rats subjected to I/R but pretreated with IM. These findings suggest that AT may prevent I/R-induced hepatic injury by increasing the hepatic levels of PGI2 through the interaction of AT with cell-surface glycosaminoglycans, thus increasing hepatic tissue blood flow and inhibiting leukocyte activation in animals subjected to I/R.
 ...
PMID:Antithrombin reduces ischemia/reperfusion injury of rat liver by increasing the hepatic level of prostacyclin. 986 57

Iloprost was used in experiments with dogs to investigate its ultrastructure-preserving effects on the myocardium during ischemia and reperfusion, focussed especially on the mitochondria. Ischemia was performed by ligation of the left anterior descending coronary artery (LAD) for 90 min followed by reperfusion of 180 min. Samples were taken from the ischemic and non-ischemic area before ligation of LAD, immediately after ischemia and reperfusion. Iloprost was applicated into the left femoral vein after the end of LAD ligation. Ultrastructural-morphometric analysis revealed that iloprost was able to diminish damages of the mitochondria after ischemia and reperfusion as well. Mitochondrial oedema and intramitochondrial structure degenerations (destruction of cristae and matrix) were minimized in contrast to results of unprotected animals, which had to undergo the same procedure as indicated by volume, volume densities of mitochondria, and of the intramitochondrial compartments, confirmed by independent secondary morphometric parameters. There were no remarkable differences between the corresponding parameters of mitochondria in the ischemic and non-ischemic area.
 ...
PMID:The protective effect of iloprost, a PGL2 analogue, on ultratructure of ischemic and reperfused myocardial myocytes. 1004 18

A SERIOUS CONDITION: Critical ischemia results when severe chronic ischemia worsens, creating a threatening situation for tissue survival in the lower limbs. The degree of ischemia is related to the extent of impairment in microcirculation, adding further deleterious effects to stenoses and/or obstructions of the large vessels. MANAGEMENT DIFFICULTIES: Surgery is the mainstay therapy for critical ischemia of the lower limbs. Medical therapy is indicated as first intention treatment in only 10 to 15% of the patients and in a small proportion after partial or total surgical failure when immediate secondary amputation appears to be avoidable. TREATMENTS USED: Antithrombosis agents and drugs with a hemorrheologic effect are used in case of surgical failure or non-indication for surgery. Iloprost is one of the most extensively studied hemorrheology agents. Its use improves the chances of avoiding amputation within a mid-term delay. BUERGER DISEASE: Buerger disease is a specific condition different from the two other major causes (artherothrombosis and diabetes mellitus). The therapeutic management and functional prognosis are much different.
 ...
PMID:[The role of drug therapy in the treatment of critical ischemia of the lower limbs]. 1022 68

The long term course of thromboangiitis obliterans as well as frequency and extent of major or minor limb amputations depend almost exclusively on the smoking behaviour of the patients. Superficial phlebitis accompanying an acute relapse responds well to high-dose aspirin or NSAIDs. Critical limb ischemia is treated by intra-arterial or intravenous prostaglandins (Alprostadil, Iloprost). Lokal measures for finger, toe, or foot gangrene do not differ from comparable sequelae of atherosclerotic vascular disease. Revascularisation procedures (angioplasty, surgery) have a high rate of technical failure and are indicated only in rare atypical situations. Corticosteroids are the therapy of choice for both vasculitides of large muscular arteries, i.e. temporal arteritis (M. Horton) and Takayasu arteritis. Combination therapy is restricted to steroid refractory disease; while this is the exception in temporal arteritis, it occurs in up to 50% of patients with Takayasu arteritis. Critical limb ischemia due to giant cell arteritis may persist even if the inflammatory activity of the disease is well controlled. Revascularisation procedures in Takayasu arteritis may have good results; as with all other therapeutic measures in this disease, they should be provided by specialized centers. Treatment of Raynaud's phenomenon requires patient evaluation for signs or symptoms of an underlying disease, i.e. some kind of connective tissue disease. Strength and frequency of attacks depend on a number of different factors (triggers) which in a given patient may not be completely understood. Exposition prophylaxis for known triggers and vasodilator drugs are the main therapeutic measures in Raynaud's phenomenon. Careful documentation of disease activity provided, non-classical remedies (behavioural psychotherapy, acupuncture) may be attempted.
 ...
PMID:[Special aspects of therapy of non-atherosclerotic vascular diseases]. 1066 28

The potential role of Iloprost, a stable analogue of prostocyclin, in treating spinal cord ischemia was investigated in rabbits subjected to aortic occlusion for 15 minutes. Ten adult rabbits weighing 2-2.5 kg received an intravenous infusion of saline (SF) as a control group and 14 rabbits received an intravenous infusion of Iloprost, 25 microg/kg/h. Iloprost infusion was started immediately after clamping of the aorta and continued 60 minutes thereafter. Cortical somatosensorial evoked potentials (CSEP) were recorded during the pre-ischemic period as a baseline and post-ischemic readings were taken at 15, 30 and 60 minutes. There was no statistically significant difference between CSEP of the saline and Iloprost treated groups (p < 0.05). All animals were examined neurologically by using a modification of Tarlov scale and all subjects were then deeply anesthetized and their spinal cords were removed for light and electron microscopic examinations at 24 h after spinal cord ischemia. In order to obtain an accurate comparison of ultrastructural changes between saline treated and Iloprost treated groups, a grading scale was performed. The light microscopic and ultrastructural analysis of the Iloprost treated group revealed that there was moderate protection of the myelin and axons and edema was attenuated. Findings of this study suggest that Iloprost exerts a protective effect on spinal cord ischemia. However, further studies are needed to reveal possible mechanisms of protection provided by Iloprost.
 ...
PMID:Early protective effects of iloprost after experimental spinal cord ischemia in rabbits. 1112 37

Optimal medical treatment of ischemic diabetic ulcers is multifactorial. Infection is very common and it is necessary to distinguish between limb or life threatening infections and non-limb-threatening infections. The major pathogen associated with non-limb-threatening infection is staphylococcus aureus; oral antibiotics such as amoxicillin/clavulanate or clindamycin can be used. For severe infection, empiric antibiotic therapy is broader-spectrum covering staphylococci, streptococci, gram-negative bacilli and enterococci; intravenous administration is the rule. Duration of antibiotic therapy depends on severity and depth of infection, and on requirement of surgical debridment. Granulocyte colony-stimulating factor is a growth factor stimulating proliferation and function of neutrophils. As an adjunctive therapy for limb-threatening infections, it is associated with a lower rate of amputation. Increasing arterial perfusion if the patient is unsuitable for reconstructive surgery or angioplasty is desirable. Iloprost is an analogue of epoprostenol with effects on platelet aggregability and vasodilatation. It improves ulcer healing, decreases pain, slightly diminishes the rate of amputation. Systemic hyperbaric oxygen therapy can perhaps improve clinical outcome but additional research is needed to define the specific indications and benefits of this treatment modality. Local care is not rationalized and depends on local habits. Debridment is required. Non necrotic wounds can be covered by modern dressing (hydrophilic dressing, alginates, hydrocolloid). Necrotic wounds are dryed until surgical revascularization, or excised if they are limited and superficial. Pinch grafts are very useful for arterial ulcers. The place of topical growth factor like PDGF (platelet derived growth factor) and of living skin equivalents (dermagraft, apligraf) is not defined in ischaemic diabetic ulcers. Treatment of edema is necessary, because it retards or complicates healing. Inelastic bandages can be useful with good tolerance if ischemia is not critical. Pneumatic foot compression is under evaluation. Electric stimulation could be an adjuncting treatment, but with a problem of compliance. Reducing plantar pressure is always necessary.
 ...
PMID:[Local care and medical treatment for ischemic diabetic ulcers]. 1223 32


<< Previous 1 2 3 4 5 6 7 Next >>