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

In addition to the determination of the presenting symptom of patients with peripheral vascular occlusive disease, evaluation of these patients may include the noninvasive measurements of ankle/arm pressure ratio, limb blood flow, and treadmill testing to evaluate the severity of the reduction in blood flow. We have included metabolic studies to assess the effect of this reduced blood flow in patients with stable intermittent claudication (n = 20), and with end-stage ischemia (night and rest pain) (n = 11), and in a control group without vascular disease (n = 8). No correlations were found between the resting limb blood flow, ankle/arm pressure ratios, maximum walking distance, and stated walking distance for the patients with stable claudication. Although the oxygen consumption was reduced only in the patients with end-stage ischemia, the percent oxygen extraction was increased to the same level in the patients with stable claudication and those with end-stage ischemia. Intramuscular stores of high-energy phosphates and glycogen were maintained in all groups with the lactate/pyruvate ratio increased only in the patients with end-stage ischemia. The complex interrelationships between the rate and distribution of blood flow with exercise and enzyme adaptation in patients with vascular disease make current resting hemodynamic and metabolic evaluations a poor reflection of the severity of the clinical condition within each patient group. Therefore laboratory testing may offer no advantage over clinical presentation in the overall evaluation of these patients.
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PMID:Laboratory evaluation of patients with vascular occlusive disease. 405 49

Three labile diabetic patients had recurring episodes of altered sensorium. Each had severe cerebrovascular disease with superimposed metabolic derangements, including ketoacidosis, hyperglycemia without ketosis, mild uremia, and possibly cerebral edema. Two of the patients were examined postmortem. Severe leptomeningeal scarring, basal ganglial calcification and destruction of small intracerebral vessels without evidence of large vessel atherosclerosis were found unexpectedly in one patient, a rare occurrence in this country although recently reported from Europe. The other patient had large vessel atherosclerosis only. The clinical expression of the vascular disease was modified by concurrent abnormalities and reflected the sum total of the complexities which coexisted. The pathophysiology of the unconscious state necessarily depends on the inciting factors. Ketoacidotic coma is associated with depressed cerebral oxygen consumption. Spinal fluid pH is usually maintained during ketosis but is sometimes lowered inadvertently during bicarbonate therapy, with resultant coma. Other variables influencing the clinical expression, with or without ketosis, would include, among others, blood viscosity alterations, rapid decrements in blood sugar, and existing degrees of lactic acidosis. The increasing life-span of the juvenile diabetics, favorably influenced by improved management and recently by hemodialysis, may uncover vascular complications heretofore rarely seen and create additional diagnostic and therapeutic enigmas.
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PMID:Cerebral syndromes of diabetes mellitus. 579 97

Several groups of rats were treated with dipyridamol and dihydroergotoxine methane sulphonate and their association. Their clinical constants were then monitored and their brain tissue examined by optical microscopy. This study indicates that the association has a remarkable effect on the pO2, maintaining the level of 2,3-diphosphoglycerate concentration, and moreover a vasodilatory action, facilitating a better supply of oxygen to the cerebral cells. The results show the advantage of these drugs in treating cerebral vascular disease.
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PMID:Effects of the dipyridamol-dihydroergotoxine methane sulphonate associations on pO2 and its incidence in brain tissue. 642 Feb 25

Transcutaneous tissue oxygen tension (PtcO2) was evaluated as a noninvasive diagnostic test for peripheral arterial insufficiency; PtcO2 was measured at rest, during exercise, and following exercise at three leg sites in 36 controls and 138 patients with exercise-induced leg pain. Resting foot PtcO2 differed significantly in controls and in patients with rest pain (32/138) and was 60.1 +/- 6.82 mmHg and 3.66 +/- 3.68 mmHg, respectively (p less than 0.001). Abnormal resting PtcO2 values occurred in 80% of claudicants (85/138) and 20% had normal values. However, all vascular claudicants exhibited a decline in PtcO2 following exercise, a finding that distinguished them from controls (p less than 0.001). The PtcO2 values in 21 patients who were subsequently shown not to have vascular disease did not differ significantly from controls (p greater than 0.5). Comparison with angiograms (48) showed that PtcO2 following exercise had a 100% sensitivity and specificity in detecting the presence of arterial disease. If resting values alone are considered, sensitivity falls to 77%. This study demonstrates that measurement of PtcO2 at rest and particularly after exercise is a simple and sensitive noninvasive diagnostic test for peripheral arterial insufficiency. This test will serve to distinguish between vascular and other causes of exercise-induced leg pain.
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PMID:The use of transcutaneous oxygen tension measurements in the diagnosis of peripheral vascular insufficiency. 646 70

Reports on hemodynamic effects of hydralazine on pulmonary hypertension (primary or secondary) usually include cases with severe disease or with mixed varieties of pulmonary vascular disease. Serious side effects and death have been reported. Effects of this drug on ventilation and gas exchange are unknown. We investigated the short-term effects of hydralazine treatment on hemodynamics, ventilation, and gas exchange in a relatively homogeneous group of patients with severe chronic obstructive pulmonary disease and moderate exertional pulmonary hypertension (mean pulmonary artery pressure, 43 +/- 3 mmHg). Hydralazine produced significant improvement in cardiac index, total pulmonary resistance, and oxygen transport. We also observed significant improvement in alveolar ventilation (mean PaCO2, decreased from 47 +/- 2 to 40 +/- 3 mmHg at rest and from 51 +/- 3 to 43 +/- 3 mmHg during exercise). The severe exertional hypoxemia of the group (mean PaO2, 48 +/- 2 mmHg) improved significantly (mean PaO2, 57 +/- 3 mmHg). Four of 11 patients showed increased exercise tolerance after hydralazine. This change is probably related to a combined improvement in hemodynamics plus a newly observed improvement in gas exchange and ventilation. Three of 14 patients could not tolerate hydralazine because of marked tachycardia. Serious side effects were not observed in the remaining group.
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PMID:Effects of hydralazine on hemodynamics, ventilation, and gas exchange in patients with chronic obstructive pulmonary disease and pulmonary hypertension. 648 60

Response to sustained (three-minute) handgrip at one-third maximum contraction was studied in 75 subjects with essential hypertension. The patients responded with an increase in heart rate, systolic and diastolic blood pressure, and double product. Chronic atenolol therapy (100 mg/day in a single administration) decreased the values of these measurements at rest and during exercise. The treatment did not prevent or attenuate the rise in heart rate with grip, but it partially inhibited the pressor response to handgrip. Chronic atenolol therapy may reduce the risk of vascular disease by decreasing blood pressure and its response to isometric exercise. Additionally, chronic beta-adrenergic blockade with decreased heart rate, double product, and, most likely, myocardial oxygen consumption is probably a further cardioprotective factor.
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PMID:Effect of chronic atenolol therapy on the cardiovascular response to handgrip in hypertensive patients. 662 89

Hypertension and obesity are two disorders that have been closely related, each occurring in greater frequency with the other than in an otherwise normal population. Although a causal relationship has not been established between the two, their coincidence carries increased risk of cardiovascular morbidity and mortality. This report summarizes the pathophysiological studies from our laboratory concerning their interrelationship and offers a rational hypothesis for the mechanisms underlying this enhanced risk. Patients with hypertension demonstrate an increased total peripheral resistance that explains hemodynamically the rising arterial pressure with advancing vascular disease. In response to this increased afterload imposed upon the heart, the left ventricle adapts itself structurally through a process of concentric hypertrophy. In addition, in most patients with essential hypertension, plasma volume progressively contracts and renal vascular resistance increases in proportion to the rise in arterial pressure and total peripheral resistance. In contrast, in obesity-hypertension there is a superimposed factor of volume overload upon the hemodynamic abnormality. The result is an additional cardiac stimulus for eccentric hypertrophy due to the increased ventricular preload. This factor enhances left ventricular stroke work and its attendant myocardial oxygen demands, thereby providing a dual overload on cardiac function that can explain the increased risk of heart failure related to these associated conditions. In contrast to the compounding adverse hemodynamic effects on the heart, there does not seem to be an additive hemodynamic effect of obesity on hypertensive renal vascular disease.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:The problem of obesity and hypertension. 662 65

Mean corpuscular volume and Red Blood Cell 2-3, diphosphoglycerate in insulin dependent diabetics and in non insulin dependent diabetics were evaluated. Only in insulin dependent diabetics an increased mean corpuscular volume was found while in non insulin dependent diabetics red blood cell 2-3, DPG level appears to be reduced. These findings were not correlated with the metabolic parameters neither they seemed to be dependent upon sex, age or vascular disease. The Authors suggest that the increase of mean corpuscular volume might be indicative of a tendency to macromegaloblastosis in insulin dependent diabetics; with regard to RBC 2-3, DPG level it seems to be extremely variable in dependence on oxygen request at the tissue level.
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PMID:[Changes in mean erythrocyte volume and 2,3-diphosphoglycerate in two groups of diabetic subjects]. 666 18

Hydralazine was administered to eight patients (mean age, 69 +/- 2 years) who had stable, advanced chronic obstructive pulmonary disease (COPD), pulmonary arterial hypertension (mean pulmonary arterial pressure, 31 +/- 3 mm Hg), and cor pulmonale. All of the patients were studied at rest and during exercise. After intravenous administration of hydralazine at rest, there were statistically significant increases in pulmonary arterial pressure (p less than 0.05), cardiac index (p less than 0.005), arterial oxygen saturation (p less than 0.01), and mixed venous saturation (SvO2) (p less than 0.005). Pulmonary vascular resistance did not change, and systemic resistance decreased (p less than 0.005). During exercise, pulmonary arterial pressure increased in all patients, and this increase was not blunted by hydralazine; however, cardiac index (p less than 0.005), arterial oxygen pressure (p less than 0.005), and SvO2 (p less than 0.001) increased further during exercise. The increase in pulmonary vascular resistance was significantly blunted by hydralazine (p less than 0.005). Therapy with the drug was continued orally in seven patients because one patient showed a deleterious response in pulmonary hemodynamics. After seven days of oral hydralazine, pulmonary arterial pressure and pulmonary vascular resistance were not statistically different from control. There were statistically significant increases in cardiac index (p less than 0.005) and SvO2 (p less than 0.05), systemic resistance decreased (p less than 0.01). The same condition was found during exercise; however, only two patients showed pulmonary gas exchange and pulmonary hemodynamic benefit at rest and during exercise with hydralazine therapy. Our results suggest that it is unlikely that vasodilator therapy with hydralazine will be useful in patients with advanced stable COPD and cor pulmonale who seem to have fixed pulmonary vascular disease.
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PMID:Hemodynamic effect of hydralazine in advanced, stable chronic obstructive pulmonary disease with cor pulmonale. Immediate and short-term evaluation at rest and during exercise. 669 95

The maximal oxygen uptake and anaerobic threshold can be determined in patients with pulmonary vascular disease from noninvasive gas exchange measurements during progressive exercise. Maximal O2 utilization correlates directly with the maximal level of cardiac output and is inversely proportional to the pulmonary vascular resistance and the level of pulmonary arterial pressure. The accuracy of predicting the hemodynamic profile from noninvasive gas exchange measurements will obviously improve as more such patients are evaluated. Therefore, the determination of VO2 max has the potential of becoming a practical screening technique for detecting and predicting the severity of pulmonary vascular disease.
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PMID:Exercise testing to evaluate patients with pulmonary vascular disease. 669 52


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