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Query: UMLS:C0042373 (vascular disease)
 17,070 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Endothelial cells can produce contracting factors; endothelin, a 21-amino acid peptide that can control local vascular tone, is the most potent of these factors. Of the three isoforms of endothelin, endothelial cells appear to release primarily endothelin-1. The peptide is formed from its precursor big endothelin via the activity of the endothelin converting enzyme. The basal production of the peptide is stimulated by epinephrine, angiotensin II, arginine vasopressin, transforming growth factor beta, thrombin, interleukin-1, and the calcium ionophore A23187. In vascular smooth muscle cells, endothelin binds to a specific receptor that activates phospholipase C and leads to the formation of inositol trisphosphate, diacylglycerol, and increased intracellular calcium levels. In certain blood vessels, the endothelin receptor is linked to a voltage-operated calcium channel via a Gi protein. This may explain why calcium antagonists inhibit endothelin-induced contractions only in certain blood vessels. In the human forearm circulation, calcium antagonists of different classes prevent endothelin-induced contractions. In hypertension, the circulating endothelin levels appear to be normal, whereas the vascular sensitivity to the peptide is reduced in most vascular tissues, but normal and enhanced responses have also been reported. In atherosclerosis and other forms of vascular disease, circulating endothelin levels are augmented, a phenomenon that may be related to an increased formation of the peptide induced by modified forms of low-density lipoproteins.
J Cardiovasc Pharmacol 1991
PMID:Endothelin. 172 99

Plasma endothelin-1 (ET-1) concentrations were measured in 25 patients with non-insulin-dependent diabetes mellitus (11 with angiopathy and 14 without angiopathy) and 21 normal subjects using radioimmunoassay specific to ET-1. Basal plasma immunoreactive (ir) ET-1 levels in diabetic patients with and without angiopathy were 1.73 +/- 0.29 and 1.68 +/- 0.20 pg/ml, respectively. Although high glucose levels may stimulate ET-1 release from vascular endothelial cells in vitro, our data suggest that circulating ET-1 may not be elevated in most diabetic patients with or without angiopathy.
J Cardiovasc Pharmacol 1991
PMID:Plasma endothelin-1 levels in patients with diabetes mellitus with or without vascular complication. 172 17

Corrective surgery for complete atrioventricular canal was performed over a 15-year period on 72 patients, 49 of whom had Down's syndrome: 46 were without major associated cardiac anomalies and 15 had previously undergone pulmonary artery banding. The pressures in the right and left ventricles equilibrated in 77% of the patients. The early mortality rate was 18% and the late mortality 7%. At follow-up 4% of the patients had severe mitral incompetence and 6% had severe tricuspid incompetence. The mean reduction of pulmonary artery pressure was 40 mmHg. The mean peak systolic pressure ratio between pulmonary artery and aorta was 0.73 before repair and had fallen to 0.38 at follow-up catheterization, when 88% of the patients were asymptomatic. Early repair in the first year of life is nowadays preferred in order to avoid progressive pulmonary vascular disease. Although the alternative of first-stage pulmonary artery banding gave lower (13%) mortality at the corrective operation, it cannot be recommended if atrioventricular valvular incompetence is significant.
Scand J Thorac Cardiovasc Surg 1991
PMID:Repair of complete atrioventricular canal. 15 year's experience. 183 30

This study was undertaken to determine the rehabilitation potential of patients undergoing amputation for vascular disease. A total of 101 patients were studied with a mean age of 69 +/- 14 years, 26 of whom were over age 80. Operative indications were gangrene or ulceration in 80% with rest pain in 20%. Eighteen patients were bilateral amputees. Fifty per cent of the patient population had previous vascular operations. The operative mortality was 13% and was not affected by the age of the patients or the presence of diabetes. Most operative deaths were due to cardiac or septic respiratory complications. Twenty-four of 88 surviving patients were not considered candidates for rehabilitation and the major determining factor was the occurrence of a remote or perioperative stroke. None of these 24 patients was discharged from institutional care. Sixty-four patients were considered rehabilitation candidates with equal distribution in all age groups. Ninety-five per cent of these patients were discharged home with 80% of those patients over 80 being discharged. Eighty-seven per cent of the elderly rehabilitation candidates were fitted with prostheses which compares favourably to other age groups. Seventy-three per cent of the elderly reached their rehabilitation goals (most frequently ambulation with the aid of a walker) which is only slightly less than the younger amputation group. From this study we conclude that amputations which are done for ease of nursing care and patient comfort in debilitated patients have a high mortality rate and rehabilitation goals are unlikely to be met. We have demonstrated high success rates with rehabilitation including patients over age 80. The majority of these patients may be discharged home after a period of aggressive rehabilitation.
J Cardiovasc Surg (Torino)
PMID:Rehabilitation potential of elderly patients with major amputations. 186 73

Neurological dysfunction following cardiac surgical procedures is now well recognized. In order to minimise this serious complication, we instituted various protocols related to the potential causes of perioperative stroke such as: (1) components and use of the heart-lung machine; (2) air embolization; (3) intrinsic cerebro-vascular disease; (4) atheroemboli from the ascending aorta and (5) clot emboli from the left ventricle. We employed certain methods of operation of the heart-lung machine, air evacuation manoeuvres and a pharmacological brain protection protocol. These protocols were applied in a series of 1487 consecutive cardiac surgical procedures performed between 1984 and 1989; 127 patients died (8.54% mortality) and 16 patients (1.08%) suffered major neurological syndromes. Among the latter patients, 4 distinct groups were identified. Group A consisted of 6 patients who remained unresponsive after operation. In group B were 6 patients who awakened after operation but had clinical evidence of focal cerebral infarction. Group C included 3 patients who were initially intact neurologically but in whom neurological deficits developed later. Group D contained 1 patient who had severe mental aberration but no focal neurological deficits. Causative factors, including atheromatous embolism, perioperative hypotension and air embolism, were suspected in 12 of these 16 patients (75%) in groups A, B and C. The outcome was poor for unresponsive patients and 9 out of the 16 died or remained comatose (56.6%).
J Cardiovasc Surg (Torino)
PMID:Prevention of perioperative neurological dysfunction. A six year perspective of cardiac surgery. 193 17

Special problems exist in the study and intraoperative monitoring of patients with severe occlusive vascular disease involving all extremities and with symptomatic brachiocephalic or coronary artery disease. We report 3 such patients who underwent arteriography via a percutaneous translumbar aortic catheter. All patients then underwent successful arterial reconstructive procedures utilizing the same translumbar catheter for arterial pressure monitoring and blood gas analysis. Percutaneous translumbar aortic catheters provide both a safe method for studying patients with four extremity occlusive vascular disease and reliable arterial access to monitor these patients intraoperatively.
J Cardiovasc Surg (Torino)
PMID:Perioperative arterial monitoring in patients with severe occlusive disease. 193 32

The natural history of patients with complete atrioventricular canal defect is one of unrelenting development of pulmonary vascular obstructive disease. Corrective surgery, which can be performed with low mortality during infancy, reduces the time that the pulmonary vascular bed is exposed to excessively high pressure and blood flow. In some patients, however, advanced vascular disease may already be established at operation. Surgical intervention in these patients may not prevent the progression of obliterative pulmonary vascular disease and may in time even result in right ventricular failure, since after the corrective operation there is no ventricular septal defect to shunt away the right ventricular pressure overload. This article outlines a numeric method for predicting pulmonary vascular resistance after surgical correction; the method is based on age and hemodynamic data available from preoperative cardiac catheterization. Retrospective analysis of preoperative and postoperative data from 20 patients produced a regression equation in which a linear combination of inverse pulmonary/systemic blood flow ratio and age at operation predicted pulmonary vascular resistance after operation, with a multiple correlation coefficient of 0.85. This newly discovered relationship may provide valuable insight into the probable outcome of surgical intervention in cases in which pulmonary vascular obstructive disease is suspected as significant.
J Thorac Cardiovasc Surg 1991 Nov
PMID:Preoperative prediction of postoperative pulmonary arteriolar resistance after surgical repair of complete atrioventricular canal defect. 194 97

In all but a few remote and unacculturated tribes, blood pressure rises with advancing age. By the time Western adult males or females reach their 70s their probability of being hypertensive (BP greater than 140/90 mmHg) exceeds 50%. Unlike various other risk factors for vascular disease, hypertension retains its predictive power as age increases, but since the baseline risk is higher, the number of cases of disease attributable to hypertension is much higher in the elderly than in the young. The reason for the rise in blood pressure with aging is not well established, although a high lifetime intake of sodium may be a contributing factor. It now appears that the major hemodynamic abnormality is an increased peripheral resistance. It is possible that an accentuation of changes that take place with normal aging might be responsible for this phenomenon. They include a reduction in renal function, decreased baroreceptor sensitivity, or increased sympathetic activity. Up until the present time studies have been unable to isolate the mechanisms involved.
Cardiovasc Drugs Ther 1991 Jan
PMID:Hypertension in the elderly: epidemiology and pathophysiology. 200 42

The nonhemodynamic actions of nifedipine and some other calcium antagonists are reviewed with regard to their relevance to the vasculoprotective and antiarteriosclerotic action of calcium antagonists. Nifedipine, and in order of declining potency, verapamil and diltiazem were shown to inhibit vascular myocyte proliferation and migration. Also, the incorporation of cholesteryl esters into macrophages or myocytes was inhibited by dihydropyridines and verapamil but not by diltiazem. The cholesterol and calcium contents were found to be lowered in the aortae of hypercholesterinemic rabbits treated chronically with dihydropyridine calcium antagonists. Replacement of damaged vascular endothelium and internal elastic lamina was seen in hypertensive Dahl-S rats after 6 weeks of antihypertensive treatment with nifedipine. In addition to their blood-pressure lowering action, these nonhemodynamic effects might be involved in the prevention and reversal of hypertensive vascular disease and neuropathologic symptoms observed after the treatment of hypertensive rats with nifedipine or other dihydropyridine calcium antagonists, since these therapeutic effects were also seen after blood-pressure neutral doses.
Cardiovasc Drugs Ther 1990 Aug
PMID:Influence of nifedipine on experimental arteriosclerosis. 207 89

Major advances have been established in the handling of hypertensive vascular disease in recent years. However, drug compliance, drug costs, and the side effects of antihypertensive agents have prompted the question of whether intermittent therapy or even possible removal of medication represents an alternative to life-long antihypertensive therapy. Several case reports, and controlled and uncontrolled studies, have focused on this subject, delivering promising but inconsistent results. In this review the attempt is made to clarify the controversial results in order to provide possible selection criteria for patients who can be assumed to benefit from the withdrawal of antihypertensive medication. In addition, the issue of whether a genuine hypertensive can ever become normal is critically reviewed, and an evaluation of the reported success rates is performed. Factors that predicted a successful withdrawal of medication were young age, normal body weight, low salt intake, low pretreatment blood pressure, successful therapy with one drug, and only minimal signs of target organ damage. Additional modification, such as a low-salt or a weight-loss diet, were demonstrated to extend the period of nonpharmacologic treatment. Nevertheless, further studies would be of great help in elucidating how long and how intensively hypertensive patients should be treated before the discontinuation of medication can be tested.
Cardiovasc Drugs Ther 1990 Dec
PMID:When is discontinuation of antihypertensive therapy indicated? 208 Nov 40


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