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)

Aortic intramural hematoma (IMH) is an acute, potentially lethal disorder that is similar to but pathologically distinct from acute aortic dissection. Although hemorrhage into the aortic media occurs in both disorders, an intimal tear with resultant false lumen is not present in IMH. Instead, hemorrhage occurs within the aortic wall either due to rupture of the vasa vasorum or, less commonly, because of an atherosclerotic penetrating aortic ulcer. The most common risk factors associated with IMH are hypertension, atherosclerosis, and advanced age. IMH is life-threatening because the hematoma may extend along or rupture through the aorta, leading to hemothorax, cardiac tamponade, stroke, mesenteric ischemia, or renal insufficiency. Optimal treatment is still somewhat controversial; however, there is no question that hypertension must be treated effectively and immediately. This is usually best accomplished by intravenous infusion of beta-blocking agents, with or without the addition of sodium nitroprusside. Recent studies support surgical treatment (ie, aortic root replacement) for IMH involving the ascending aorta, although some subsets of this population may be at lower risk and may benefit from medical therapy alone. In patients with IMH involving only the descending aorta, medical therapy alone is recommended (unless impending rupture, aortic aneurysm, or end-organ ischemia occurs). Patients who survive the acute event require intensive treatment of hypertension and frequent follow-up examinations. Because this population (especially the subset with penetrating aortic ulceration) is at high risk for aortic aneurysm and rupture, serial imaging studies of the aorta are essential.
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PMID:Aortic Intramural Hematoma: Current Diagnostic and Therapeutic Recommendations. 1506 38

Improvements in MRI techniques widen the indications for fetal brain imaging and fetal brain injury represents the third indication of fetal brain magnetic resonance imaging (MRI) after the evaluation of suspected central nervous system (CNS) malformations and ventricular dilatation. Optimal MR imaging technique is necessary in order to collect as much data as possible about the fetal brain. Diffusion images can be used routinely in addition to the standard protocol of fetal brain MRI that consists of T1 and T2 weighted images of the fetal brain. Monovoxel proton magnetic resonance spectroscopy can also be performed in utero, but this technique is still more part of research protocol than of routine clinical protocol. Fetal brain injury includes hypoxia-ischemia, congenital infections (especially toxoplasmosis and cytomegalovirus infections), brain damage due to malformation such as vascular brain malformation and heart malformation, pregnancies at risk of fetal brain damage, and even inherited metabolic diseases, especially mitochondrial diseases. MRI findings in fetal brain injury consist of acute or chronic lesions that can be seen alone or in combination. Acute response of the fetal brain is less commonly seen than the chronic response compared to the brain response encountered in the postnatal period.
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PMID:Fetal brain injury. 1509 50

Optimal treatment of patients who present with chest pain is predicated on accurate identification of those patients with a cardiac etiology of their discomfort. Serial troponins and electrocardiograms are very sensitive for the detection of myocardial infarction but they are insensitive for the detection of ischemia. There are many analytes that are being actively evaluated for routine use to facilitate the identification of patients with myocardial ischemia. At present, only one assay is US Food and Drug Administration-approved for the exclusion of ischemia; many other analytes are under clinical evaluation and are briefly reviewed. At present, none of these analytes are yet appropriate for routine clinical use.
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PMID:Markers to define ischemia: are they ready for prime time use in patients with acute coronary syndromes? 1518 99

In recent years cardiology has opened new chapters in the treatment of acute coronary syndrome (ACS). The acute therapeutic procedures include antianginal, anticoagulant and revascularization therapy. Optimal therapeutic procedure in ACS has two objectives: 1) quick removal of the factors causing ischemia, and 2) prevention of death or myocardial infarction, i.e. reinfarction. Nitrates have been present in pharmacotherapy for more than 150 years. They are used exclusively to efficiently suppress the symptoms, but there is no proof of their positive effect on the disease prognosis. The effect of nitrates is manifested as vasodilatation in the arterial, and particularly in the venous vascular basin (central and peripheral effects) thus increasing the capacity of venous blood. Besides the peripheral effect, nitrates have an important central effect, i.e. they dilate epicardial coronary arteries, both the healthy ones and those damaged by atherosclerosis, in this way increasing the collateral blood circulation. Organic nitrates, although the oldest antianginal drug, play one of the leading roels in the treatment of ACS even today. Beta-adrenergic blocking agents have been used since 1960 in the treatment of arterial hypertension, coronary disease and cardiac arrhythmias, and later their efficacy in the prevention of secondary myocardial infarction was noted. Beta blockers (BB) reduce heart rate, systemic blood pressure and myocardial oxygen requirements, reduce myocardial contractility, thus alleviating precordial pain in ACS, decreasing the rate of threatening infarction, and reducing ventricular arrhythmias. Numerous clinical studies have shown that BB in ACS improve the disease prognosis and play an important role in long-term secondary prevention after myocardial infarction. Antagonists of calcium channel blockers are a group of therapeutic agents successfully used in numerous cardiac and noncardiac indications. Potential benefits of calcium antagonists in ACS are the result of various combinations, such as dilation of coronary arteries and arterioles, reduction of heart rate and myocardial oxygen requirements, and beneficial effect on left ventricular function and elasticity. The use of calcium channel blockers in ACS reduces or prevents the symptoms and accompanying ischemia, but there is no evidence that these agents prolong survival in patients with heart failure. In recent years the treatment of an ACS has significantly changed owing to better understanding of the pathogenesis of the disease as well as progress in medicinal and interventional treatment. Antianginal therapy, which includes nitrates analgesics, calcium channel blockers and antiadrenergic therapy using beta-blockers in treatment of ACS, takes a significant place.
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PMID:[Antianginal and antiadrenergic therapy in acute coronary syndrome]. 1520 97

Superficial femoral artery disease presents a complex challenge for therapy. The extent of vascular involvement may vary from focal disease with symptoms of intermittent claudication to long total occlusions manifest as critical limb ischemia. Optimal therapy requires understanding the available options including exercise programs, pharmacologic medical therapy, surgery and interventional endovascular therapy. Rapidly advancing endovascular technology for enabling safe intervention in complex, long occlusive segments of the superficial femoral artery continues to emerge. New devices like the SafeCross wire, Excimer laser, Silverhawk Atherectomy catheter, Cryoplasty catheter and new generations of bare metal and drug-eluting nitinol stents are shifting the paradigm for therapy from surgical to more endovascular treatment even for the most complex disease presentation.
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PMID:Optimal therapeutic approaches to femoropopliteal artery intervention. 1534 63

Although most patients with acute type B aortic dissection are treated medically, emergency surgery is needed for patients with complications, such as rupture, uncontrollable pain, refractory hypertension, a huge pseudo-lumen or organ ischemia. Optimal surgery should be selected according to each condition. An emergent descending aortic replacement is applied mainly for ruptures or impending ruptures, while a surgical bypass, fenestration or thrombectomy is used for visceral organ or leg ischemia. In our data, 9 (23%) out of 40 patients with acute type B aortic dissection underwent emergent surgical treatment. In-hospital mortality was 11.1%. Because it is difficult to diagnose visceral ischemia, patients who might be affected with one must be treated promptly. Although catheter intervention is expected to improve the results of these high-risk patients, more investigation is needed to discover a new therapeutic strategy for acute type B aortic dissection.
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PMID:[Acute type B aortic dissection]. 1536 35

The incidence of peripheral arterial disease is rising and despite advances in clinical management, many problems remain unsolved. Better knowledge of the mechanisms and consequences associated with chronic muscle ischemia has opened the way for development of new treatment strategies, including therapeutic angiogenesis. Therapeutic angiogenesis is a promising technique based on experimental studies showing that growth factors or genes able to increase capillary density can be used to reduce the impact of muscle ischemia and increase blood flow to ischemic tissue. Enthusiasm for this technique has prompted numerous clinical trials with encouraging results, but data are still inconclusive. Optimal indications for gene therapy must be defined and further experimental progress is needed to respond to ethical issues. Therapeutic angiogenesis should be viewed as an adjunct to rather than as a competitor of current surgical revascularization techniques.
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PMID:Gene therapy for chronic peripheral arterial disease: what role for the vascular surgeon? 1559 38

The two pivotal U.S. trials of drug-eluting stents do not establish the principle that these stents are superior to thin-strut bare-metal stents for preventing repeat revascularization in patients with diabetes. Neither study was adequately powered to make this determination. Moreover, both studies used thick-strut stents known to have high restenosis rates as controls. Low angiographic follow-up underestimates the true target lesion revascularization rate in the Polymer-Based Paclitaxel-Eluting Stent in Patients with Coronary Artery Disease (TAXUS-IV) trial because of the high incidence of silent ischemia in patients with diabetes. Optimal therapy for diabetic coronary disease should include a comprehensive approach directed toward metabolic normalization in addition to local stent-based therapy.
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PMID:Drug-eluting stents for diabetes mellitus: a rush to judgment? 1570 89

Optimal management of patients presenting with chest pain to the emergency department is a major challenge, both in terms of a diagnostic dilemma and consumption of resources. The triage of such patients can be aided vastly by the appropriate use of noninvasive imaging. Noninvasive imaging modalities such as echocardiogram, radionuclide perfusion studies, positron emission tomography, cardiac magnetic resonance imaging and computed tomography have all been demonstrated to have favorable diagnostic and prognostic value, with an enhanced sensitivity to detect acute ischemia. A normal noninvasive evaluation in the appropriate clinical setting presents a strong argument against acute ischemia as an etiology of the chest pain. Randomized trials of both rest and stress imaging in the emergency department have confirmed a reduction in unnecessary hospitalizations and cost savings without compromising the safety of the patient. Cardiac magnetic resonance and computed tomography would provide an insight into subendocardial ischemia, the detection of which has previously been difficult, using single-photon emission tomography and echocardiography. In this review, novel hot-spot imaging modalities are discussed including infarct-avid imaging agents and ischemia-avid imaging agents, thus elucidating the pathophysiology of reperfusion-induced cell death. These agents represent work in evolution and are likely to be used routinely in the future as understanding of coronary syndromes and coronary artery disease becomes clearer.
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PMID:Noninvasive cardiac imaging in the evaluation of suspected acute coronary syndromes. 1588 75

Renal transplantation is by far the best therapeutic option for end-stage kidney disease with respect to quality of life, psychosocial rehabilitation, and even patient survival. Optimal immunosuppressive therapy should provide effective prophylaxis of both acute rejection and chronic allograft dysfunction. Thus immunosuppressive therapy should help to maintain good renal function and could help to prevent premature death of the recipient. With the introduction of new immunosuppressants over the last decade a dramatic reduction of acute rejection rates from approximately 50% to 15-30% could be achieved. However, the search for novel immunosuppressive drugs continues, drugs which not only lead to effective prevention of acute rejection, but also have an impact on chronic allograft dysfunction and prevent further deterioration of this multifactorial process. Based on a short presentation of the "three signal model" of immunoactivation, the most important mechanisms and characteristics of the presently available immunosuppressants are described. Because the immunosuppressive objectives change over time, a phase-dependent adaptation is necessary. At present, most centers in Germany use an immunosuppressive combination therapy, consisting of a calcineurin inhibitor (CNI; cyclosporine or tacrolimus), a glucocorticoid (prednisolone or methylprednisolone), and mycophenolic acid (MPA), which is eventually combined with an antibody (e.g., IL-2R antibody) for induction. In contrast to the clear situation 10 years ago, highly specialized knowledge is required today with respect to mechanism of action, side effects, and potential interactions. This may enable the physician to adopt patient-oriented optimal immunosuppression. In the near future more individualized treatment options will be employed, which are adapted to the characteristics and side effects of the immunosuppressant, as well as to the characteristics of the donor, the recipient, and the transplanted organ such as immunology and ischemia. Another aspect is the reduction or elimination of some immunosuppressants at the earliest possible time. With new diagnostic and genetic markers the relationship between recipient and transplanted organ will be characterized better in the future and therapy will become more individualized. Altogether, these measures as well as optimized supportive therapy will help to further improve the longevity of the transplanted organ.
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PMID:[Modern immunosuppression following renal transplantation. Standard or tailor made?]. 1632 15


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