Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0030193 (pain)
 261,466 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

We have obtained long term follow-up on 58 patients in whom the superficial femoral artery was used as a donor site for bypass to the proximal popliteal artery. The indication for the reconstructive procedure was intermittent claudication 36%, rest pain 34%, and gangrene 26%. All patients had angiographic evidence of a patent proximal superficial femoral artery and many had relative indications for short bypass such as limited saphenous vein availability or compromised medical condition. There was a cumulative patency rate of 79% by life table method for the series with a six year follow-up. We have observed that the superficial femoral artery is a satisfactory inflow site for proximal popliteal bypass grafts in selected patients. The procedure can maximize use of a limited segment of vein with minimal operative time and morbidity. Inflow stenosis can be revised or long bypass procedures can be offered in the event of graft failure.
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PMID:Superficial femoral artery as inflow for bypass to the proximal popliteal artery. 226 97

For the assessment of the indication for surgical intervention in chronic arterial occlusive disease, the patients complaints (clinical necessity), local operability and operative risk for the patient have to be considered. In stage II disease (intermittent claudication) the patients demand for symptom-free walking distance is decisive. A young, sporting patient will not accept a distance of 500 m whereas an old patient limited by cardiopulmonary insufficiency will accept less than 50 m. Stages III and IV mean marginal perfusion and endanger the extremity acutely. Persistent severe pain or trophic lesions force to surgical intervention. If vascular reconstruction is impossible amputation will become necessary although lumbar sympathectomy might be attempted before amputation. Because of better collaterals proximal arterial occlusions endanger the extremity less than more peripheral ones, even in the case of operative failure. At the pelvic level endarterectomy or prosthetic replacement are the choice procedures. Allografts are equivalent to autografts. Bypass is best used for the cruro-femoral region. The material of choice is the autologous great saphenous vein. Below the knee it can be used as "in situ" bypass. Artificial prostheses give less favorable results. Inhibitors of platelet aggregation are used for protection of the arterial wall, anticoagulants for prevention of venous thrombosis and arterial re-embolization.
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PMID:[Vascular surgery reconstruction in chronic arterial occlusive disease of the lower extremities]. 227 Mar 78

We studied the effect of external application of 35-45 mmHg negative pressure around the thigh on toe blood pressure and skin blood flow in nine patients with occlusion of the superficial femoral artery and rest pain/severe intermittent claudication. The systolic toe blood pressure increased from 32 (range 5-70) mmHg before treatment to 57 (42-75) mmHg (p less than 0.05) during negative thigh pressure and 44 (range 10-88) mmHg after treatment. In addition, the gain in toe blood pressure tended to be greater the lower the pre-test toe pressure was, correlation coefficient r = 0.52 (p greater than 0.05). Relative skin blood flow, measured in the first toe interstice by the 133Xe wash-out method, increased by 304 (range 86-767) percent (p less than 0.05) during the test period compared to the mean wash-out rate obtained before and following the test period. Heart rate, systemic blood pressure, skin temperature, serum protein and haematocrit measured during each phase of the study were similar. We conclude that 35-45 mmHg negative pressure around the thigh in patients with occlusion of the superficial femoral artery induce increased blood perfusion in the foot, possibly due to changes in collateral arterial resistance in the thigh.
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PMID:External negative thigh pressure. Effect upon blood flow and pressure in the foot in patients with occlusive arterial disease. 227 12

A highly selected group of patients younger than 50 years of age operated on for isolated aorto-iliac arteriosclerotic disease over a 7 year period has been investigated. The group has a significant dominance of females, and the patients are further characterised by being apparently otherwise "healthy" individuals. The indication for surgery was intermittent claudication in 80% and rest pain/gangrene in the remainder, with a low postoperative morbidity and no mortality. The overall cumulative patency rate is 89% at 4 years. At follow-up, a large majority of the patients were free of symptoms and the long-term results were significantly better in females. The question arises whether our group of patients, especially the young females with isolated aorto-iliac arteriosclerotic lesion, represent a separate disease entity which, when properly treated, is a benign and curable condition.
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PMID:Aorto-iliac arteriosclerotic disease in young human adults. 227 67

The purpose of this article was to describe popliteal artery entrapment syndrome, which is a cause of intermittent claudication in a young person, and to illustrate the importance of early diagnosis for successful treatment of this entity. A case report of a 28-year-old man with popliteal artery entrapment syndrome is presented. This patient had a classic history of calf pain that worsened with walking and was relieved by rest, running, or bicycle riding. Physical examination revealed evidence of ischemia in the distal extremity, and arteriography demonstrated signs of chronic occlusive disease. Early treatment might have included surgical release of the popliteal artery and arterial grafting. Due to extensive vascular disease, grafting was not possible and a below-knee amputation was performed. It is therefore essential to diagnose popliteal artery syndrome early for appropriate management.
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PMID:Popliteal artery entrapment syndrome. 236 99

The aim of this study was to investigate the effect of hypertension on the regulation of limb circulation. The study group consisted of 50 patients suffering from hypertension; in 21 cases the peripheral circulation was intact, while 29 patients had peripheral obliterative arterial disease (POAD) (clinical symptoms: intermittent claudication or rest pain). The control group consisted of 67 normotensive patients. In 33 subjects of the control group the peripheral circulation was intact, while 34 patients suffered from POAD (clinical symptoms: intermittent claudication or rest pain). The total limb blood flow (LBF) was measured by using venous isotope dilution technique. In hypertensive patients the limb vascular resistance (LVR) was markedly elevated, but the LBF remained in the normal range. In patients suffering from both hypertension and POAD the LVR was pathologically elevated and the LBF markedly diminished. After acute vasodilator therapy the LBF significantly increased, despite the drop in blood pressure owing to the extensive decrease of the LVR. It appears that in hypertension the elevation of the LVR is the most characteristic change of the limb circulation. The elevation of the arterial blood pressure has no favorable effect on the limb circulation, and the LBF compared with the blood pressure is relatively low.
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PMID:Characteristics of the limb circulation in hypertension. 238 35

Patients with atherosclerotic peripheral arterial disease (PAD) of the lower extremities have impaired walking ability due to exercise-induced muscle ischemia and the resultant pain of intermittent claudication. To evaluate the benefit of exercise training as a treatment for patients with PAD, as well as possible mechanisms associated with improvement, we randomly assigned 19 men with disabling claudication to treated and control groups. Treatment consisted of supervised treadmill walking (1 hr/day, 3 days/wk, for 12 weeks) with progressive increases in speed and grade as tolerated. Graded treadmill testing was performed to maximal toleration of claudication pain on entry and after 12 weeks of training to define changes in peak exercise performance. After 12 weeks, treated subjects had increased their peak walking time 123%, peak oxygen consumption 30%, and pain-free walking time 165% (all p less than 0.05). Control subjects had no change in peak oxygen consumption, but after 12 weeks, peak walking time increased 20% (p less than 0.05). In treated subjects, maximal calf blood flow (measured by a plethysmograph) increased 38 +/- 45% (p less than 0.05), but the change in flow was not correlated to the increase in peak walking time. Elevated plasma concentrations of acylcarnitines have been associated with the functional impairment of PAD and may reflect the metabolic state of ischemic skeletal muscle. In treated subjects, a 26% decrease in resting plasma short-chain acylcarnitine concentration was correlated with improvement in peak walking time (r = -0.78, p less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Benefit of exercise conditioning for patients with peripheral arterial disease. 240 33

Blood-letting to a haematocrit of 0.40 to 0.42 was performed over a period of six weeks on 30 randomized patients with peripheral vascular disease (intermittent claudication), stage IIb (after Fontaine), in addition to standardized gymnastics and physical exercise (walking). Subsequently, 15 randomly selected patients received after each blood-letting middle-molecular hydroxyethyl starch solution, another 15 randomized patients received isotonic sodium chloride solution, both groups under a double-blind protocol, gymnastics and walking exercise being continued. At the beginning of the study both groups were comparable with respect to clinical and vascular parameters and results of laboratory tests. Those of the former group had a significantly greater increase in pain-free walking distance than the latter. Blood pressure levels remained unchanged in the former, but significantly rose in the latter. Peak flow during reactive hyperaemia increased significantly in both legs in the first group, remaining unchanged in the second. An increase in spontaneous platelet aggregation occurred only in the second group; alpha 2-macroglobulin concentration rose only in patients of the first group, while fibrinogen decreased significantly in both.
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PMID:[Isovolemic hemodilution in stage-IIb peripheral arterial occlusive diseases. Prospective randomized double-blind comparison of middle-molecule hydroxyethyl starch and electrolyte solution]. 242 1

In a 7-center Scandinavian double-blind placebo-controlled study of 179 patients with intermittent claudication, the effect of the serotonin antagonist ketanserin was evaluated on walking distance, brachial and ankle blood pressure, and symptoms. For all centers together, pain-free walking distance was significantly increased after 6 months with both ketanserin (+65%; 71 patients) and placebo (+42%; 78 patients), with no significant difference. However, there was large variability among centers. Classification of "responders" (doubling of walking distance) and patients who deteriorated (decrease of walking distance or dropout for inefficacy) showed significantly more patients responding and significantly fewer patients deteriorating with ketanserin than with placebo. Systemic blood pressure was significantly decreased by ketanserin in hypertensive, but not normotensive, patients, while ankle pressure was unaffected. The incidence and nature of side effects were equal with ketanserin and placebo, but there were more side effects causing dropout in the ketanserin group. An unexpected and possibly important observation was the occurrence of six serious cardiovascular events (myocardial infarction, cerebrovascular complications, and development of rest pain) in the placebo group but none in ketanserin-treated patients. Moreover, there were four additional similar complications in the placebo run-in period. Ketanserin appears to be beneficial in a subgroup of patients with intermittent claudication. A fortuitous finding of this study is that ketanserin might possess a protective effect against thrombovascular complications in patients with intermittent claudication.
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PMID:Ketanserin in intermittent claudication: effect on walking distance, blood pressure, and cardiovascular complications. 244 41

In a randomized patient-blind study iloprost or hydroxy-ethyl starch 200/0.5 were given i.v. 5 h daily for 2 weeks to 24 patients suffering from severe intermittent claudication due to peripheral vascular disease. An increase in pain-free walking distance of more than 50% occurred in 6 of 11 patients after the iloprost infusions and in 7 of 12 patients after HES treatment. No significant effects on haemodynamic or clinical chemistry tests were observed.
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PMID:Clinical effects of intravenous iloprost in patients with intermittent claudication. 244 77


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