Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0151744 (myocardial ischemia)
 31,282 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The aim of this study was to assess the prognostic role of co-morbidity in severe chronic obstructive pulmonary disease (COPD). A cohort of 270 COPD patients, mean (+/-SD) age 67+/-9 yrs, consecutively discharged from a University Hospital after an acute exacerbation was studied. Mean (+/-SD) forced expiratory volume in one second (FEV1) was 34+/-16% of predicted and FEV1/forced vital capacity (FVC) was 40.5+/-13.8%. The most common co-morbid diseases were: hypertension (28%), diabetes mellitus (14%), and ischaemic heart disease (10%). Clinical, electrocardiogram (ECG), and respiratory function data taken at the time of discharge were collected from the clinical records. The Charlson's index was used to quantify co-morbidity. Follow-up was conducted by means of telephone calls. Multivariate survival analysis was used to identify the independent predictors of death. The median survival of the cohort was 3.1 yrs. Death was predicted by the following variables: age (hazard rate (HR) 1.04; 95% confidence intervals (95% CI) 1.02-1.05), ECG signs of right ventricular hypertrophy (HR 1.76; 95% CI 1.30-2.38), chronic renal failure (HR 1.79; 95% CI 1.05-3.02), ECG signs of myocardial infarction or ischaemia (HR 1.42; 95% CI 1.02-1.96), FEV1 < 590 mL (HR 1.49; 95% CI 0.97-2.27). A score based upon these variables predicted mortality at 5 yrs with a sensitivity of 63% and a specificity of 77%. Selected co-morbid diseases and electrocardiogram signs of right ventricular hypertrophy play a major prognostic role in advanced chronic obstructive pulmonary disease. The clinical assessment of patients with chronic obstructive pulmonary disease should include these important and easily measurable variables.
 ...
PMID:Co-morbidity contributes to predict mortality of patients with chronic obstructive pulmonary disease. 949 63

Methemoglobinemia may occur after the administration of various drugs, including some local anesthetics. We report a patient with chronic renal failure and ischemic heart disease who developed clinically significant methemoglobinemia after an axillary block with bupivacaine and additional injection of lidocaine in the operative field. Although the two local anesthetics usually do not cause methemoglobinemia, we suspect that the displacement of lidocaine from protein binding by bupivacaine, in combination with metabolic acidosis and treatment with other oxidants, was the reason for the development of methemoglobinemia.
 ...
PMID:Methemoglobinemia after axillary block with bupivacaine and additional injection of lidocaine in the operative field. 1022 85

It has been suggested that normalization of haemoglobin with epoetin in anaemic chronic renal failure (CRF) patients might result in even greater benefits than those currently achieved with partial haemoglobin correction. Four prospective randomized trials recently examined this hypothesis. The Scandinavian Multicentre Trial, which was completed in February 1998, included 416 haemodialysis, continuous ambulatory peritoneal dialysis and pre-dialysis patients. Preliminary analysis of the data found no differences with respect to safety between patients treated to achieve subnormal haemoglobin (9.0-12.0 g/dl) and those in whom haemoglobin was normalized (13.5-16.0 g/dl). The Canadian Multicentre Trial included 159 haemodialysis patients with asymptomatic left ventricular (LV) dysfunction. In patients with a normal LV cavity volume at enrolment, the change in LV cavity volume at 48 weeks was significantly greater in the control group (target haemoglobin 9.5-10.5 g/dl) than in the intervention group (target haemoglobin 13.0-14.0 g/dl). The Normal Hematocrit Cardiac Trial in the US included 1233 haemodialysis patients with clinically evident ischaemic heart disease or congestive heart failure. The trial was stopped in 1996 after an interim analysis showed increased mortality in the intervention group (target haematocrit 42%) compared with the control group (target haematocrit 30%). The higher haematocrit values themselves, however, did not appear to be responsible for the differences in mortality, as the mortality rates within each group decreased with increasing haematocrit. Nonetheless, until evidence is available from other trials demonstrating a benefit of normalizing haemoglobin, it has been recommended that a target haematocrit value of 42% be avoided in haemodialysis patients with clinically evident ischaemic heart disease or congestive heart failure. Further studies are also required to determine whether increasing haemoglobin to normal may prove to be beneficial in other patient groups. The Spanish Quality of Life Study of 134 haemodialysis patients found a significant improvement in all quality-of-life parameters when haemoglobin was increased to a mean of 12.5 g/dl. The investigators suggested that in patients without severe co-morbidity, the target haemoglobin should be as close to normal as possible.
 ...
PMID:Normalization of haemoglobin: why not? 1033 71

Lp(a) has recently begun to attract attention as a risk factor of atherosclerotic disease, especially of ischemic heart disease. The Lp(a) concentration in the serum was shown to be important for chronic hemodialysis patients who have high mortality due to cardiovascular disease. Nicotinic acid derivatives, which are recognized for their capacity to lower the serum Lp(a) concentration, are effective against a high Lp(a) concentration in hemodialysis patients. In this study, niceritrol which is a nicotinic acid derivative was tested on hemodialysis patients and healthy controls by investigating the serum nicotinic acid level. Serum nicotinic acid concentration was also measured by the severity of renal dysfunction of patients untreated by niceritrol. The blood nicotinic acid concentration in healthy controls (n = 4) was changed after 2 hrs by the administration of niceritrol from 9.8 +/- 1.4 ng/ml to 192.7 +/- 23.1 ng/ml then slowly decreased. Chronic hemodialysis patients who take niceritrol every day showed the highest nicotinic acid serum concentration (500-1,000 ng/ml) on the day without hemodialysis and the serum level decreased with dialysis for 4 hrs to 25-80%. There was no significant difference in the nicotinic acid level in the serum between healthy controls (n = 10), chronic glomerulonephritis patients (n = 7), chronic renal failure patients (n = 8) and chronic hemodialysis patients (n = 17). Lp(a) concentration in the serum, however, was increased with greater severity of renal dysfunction, The side effect was not observed in any cases administered niceritrol. These data suggest nicotinate derivatives are effective for hemodialysis patients. High nicotinic acid level in the serum after treatment with niceritrol was lowered by dialysis. It is plausible that the nicotinate level in patients without niceritrol treatment did not influence the Lp(a) concentration, because there was no increase in the nicotinate level of the serum even if the patients had renal dysfunction.
 ...
PMID:[Plasma nicotinic acid levels in hemodialysis patients after the administration of niceritrol]. 1044 92

Hyperhomocyst(e)inemia is now recognized as an independent risk factor for atherosclerotic cardiovascular disease in patients with normal renal function. Hyperhomocyst(e)inemia is common in patients with chronic renal failure. This study is designed to look for an association between hyperhomocyst(e)inemia and atherosclerotic vascular disease in patients with end-stage renal disease (ESRD). Two hundred eighteen patients undergoing hemodialysis were enrolled onto the study and had predialysis bloodwork performed for total homocyst(e)ine, red blood cell folate, and vitamin B(12) levels. A history of clinically significant atherosclerotic vascular disease (ischemic heart disease, cerebrovascular disease, or peripheral vascular disease) was elicited by patient questionnaire and verified by careful inpatient and outpatient chart review. Atherosclerotic vascular disease was present in 45.9% of patients. Mean homocyst(e)ine concentration was 26.7 micromol/L (95% confidence interval [CI], 25.0 to 28.4) overall. Mean homocyst(e)ine concentration was 28.6 micromol/L (95% CI, 25.6 to 31.7) and 25.0 micromol/L (95% CI, 23.2 to 26.8) in patients with and without atherosclerotic disease, respectively (P = 0.036). The adjusted odds ratio for atherosclerotic disease was 2.12 (95% CI, 1.03 to 4.39) for those subjects with a homocyst(e)ine level in the highest quartile compared with the lowest 3 quartiles. In the 126 men, the adjusted odds ratio for atherosclerotic disease was 3.4 (95% CI, 1. 24 to 9.42) for those with homocyst(e)ine levels in the highest quartile compared with the lowest 3 quartiles. No association was found between homocyst(e)ine level and atherosclerotic disease in women. In conclusion, there is an association between hyperhomocyst(e)inemia and atherosclerotic vascular disease in patients undergoing dialysis. Prospective studies need to further examine the relationship between homocyst(e)ine level and atherosclerosis in women with ESRD.
 ...
PMID:Hyperhomocyst(e)inemia and the prevalence of atherosclerotic vascular disease in patients with end-stage renal disease. 1051 48

Perioperative myocardial infarction as well as other major cardiac events induced by myocardial ischemia during and after a more complex or long-lasting operation represents a permanent threat for a successful outcome. High number of cardiac ischemic events especially following major vascular surgery and in elder subjects requires early, sensitive and specific diagnostic markers. This review paper presents conventional as well as novel biochemical methods fulfilling the above mentioned criteria. Until now used estimations of traditional enzyme activities (aspartate aminotransferase and lactate dehydrogenase) are either entirely discarded or subsequently lose their importance (i.e. activities of total creatine kinase and its MB-isoenzyme) an instead modern methods that estimate the amounts of specific cardiac proteins--troponins T and I, constituents of myocardial contractile apparatus--released from ischemized heart are used. Patient's monitoring by means of these cardiac markers allows an early, rapid and reliable estimation of perioperative myocardial infarction enabling possible to arrange an immediate effective treatment. Recently the myocardial regulatory protein troponin I is considered the most specific cardiac marker the plasma level of which does not increase in acute damage and chronic diseases of skeletal muscles, nor in chronic renal failure. (Ref. 52.)
 ...
PMID:[Biochemical markers of perioperative myocardial infarct in non-cardiac surgery]. 1057 43

In order to clarify the characteristics of myocardial ischemia in patients with chronic renal failure (CRF), we performed exercise stress myocardial perfusion imaging with 99mTc-MIBI in 36 patients with CRF. In 18 patients myocardial imaging with 123I-MIBG (MIBG) and 201Tl was performed at rest to evaluate myocardial sympathetic activities: cardiac uptake of MIBG normalized by myocardial perfusion (Uptake Ratio, UR) and myocardial washout rate of MIBG (WO). Exercise-induced perfusion abnormality was observed in 25 patients, and coronary angiography was performed in 19 of them. Among 25 diseased coronary arteries, 18 developed perfusion abnormalities in the myocardial segments which were supplied by each coronary artery. However in 5 patients without coronary artery stenosis and 2 patients with left anterior descending coronary artery disease, transient perfusion abnormalities were observed in the inferior segments. In 6 of them, MIBG imaging was obtained (Group A). MIBG imaging was also performed in 5 patients with transient inferior perfusion abnormality with coronary artery stenosis which supplied the inferior wall (Group B), and 7 patients without perfusion abnormality (Group C). In the patients of Group B, inferior UR was significantly lower than in Group C (0.58 +/- 0.07 vs. 0.68 +/- 0.08, p = 0.0485) and inferior WO was more accelerated than in Group C (18.6 +/- 7.7 vs. 12.1 +/- 6.0%, NS). However anterior UR and Wo levels were identical with those in Group C. In Group A, inferior UR (0.43 +/- 0.05) was significantly lower than in Group B and C, and WO in Group A (27.2 +/- 8.3%) was accelerated significantly compared to that in Group C. Besides in Group A, anterior UR was significantly smaller and WO was greater than in Group B and C. These findings suggested that in some patients with CRF, myocardial ischemia could arise without coronary artery stenosis, and this phenomenon might be related to abnormalities of cardiac sympathetic activity.
 ...
PMID:[Characteristics of myocardial ischemia in patients with chronic renal failure and its relation to cardiac sympathetic activity]. 1065 82

Factors driving inpatient and outpatient utilization were studied among patients who began dialysis for chronic renal failure at the New England Medical Center (NEMC) between 1992 and 1997. Clinical, laboratory, and hospital resource utilization data were obtained from patient records and electronic databases. There were 2.2 hospitalizations and 14.8 hospital days per patient year at risk (PYAR). The number of hospitalizations and hospital days per PYAR were higher in the first 3 mo of initiating dialysis (4.3 and 28.3, respectively) compared to after 3 mo (1.9 and 12.9, respectively). Factors associated with increased risk of hospital days within the first 3 mo included non-health maintenance organization insurance, ischemic heart disease, late referral to the nephrologist, and use of temporary vascular access for the first dialysis. Patients with ischemic heart disease and who received dialysis during the years 1992-1994 compared with 1996-1997 had an increased risk of hospital days after 3 mo of initiating dialysis. There were 16.6 outpatient visits per PYAR, with significant differences in utilization between the first 3 mo and after 3 mo of initiating dialysis. Thus, hospital utilization was significantly higher in the first 3 mo compared to after 3 mo, and factors associated with hospital utilization depended on duration of dialysis. In particular, delayed referral to the nephrologist and lack of permanent vascular access were independently associated with increased risk of hospital utilization in the first 3 mo of dialysis. Greater attention to timely referral to the nephrologist and timely placement of vascular access could result in reduced utilization and cost savings.
 ...
PMID:Hospital utilization among chronic dialysis patients. 1075 33

Cardiac arrhythmias are noted in a significant proportion of chronic renal failure (CRF) patients on hemodialysis (HD), and may contribute to cardiovascular mortality. A number of factors have been implicated in the genesis of these arrhythmias. The role of silent myocardial ischemia (SMI), however, has not been evaluated systematically. We prospectively studied 38 unselected CRF patients on regular HD by continuous Holter monitoring starting 24 hours before HD, lasting through the dialysis session and continued for 20 hours thereafter. The recordings were analyzed for frequency, timing and severity of supraventricular and ventricular arrhythmias and SMI as identified by ST-segment depression. Ventricular arrhythmias during HD were noted in 11 (29%) patients (group I), and were potentially life-threatening (Lown Class III and IVa) in 13%. The remaining 27 patients (group II) had no ventricular arrhythmias during HD. There was no difference in the age, sex ratio, duration of HD, blood pressure, fluctuations in weight, hematocrit, predialysis creatinine, sodium, potassium, calcium or inorganic phosphate levels between patients in the two groups. The number of patients with clinical ischemic heart disease was significantly greater in group I. SMI was noted in 72% and 33% of group I and II patients respectively (p = 0.026). 46% of those with and 25% of those without ST changes during HD developed ventricular arrhythmias during HD. Both SMI and ventricular arrhythmias were noted most frequently during the last hour of dialysis. Hypertension, diabetes mellitus and ischemic heart disease were observed more frequently amongst patients with SMI. Ventricular arrhythmias are detected in a significant proportion of CRF patients on HD. These are probably related to coronary artery disease since silent myocardial ischemia is also noted more frequently during HD in these patients. Further studies incorporating coronary angiography are needed in a larger number of patients to establish a definite causal relationship.
 ...
PMID:Cardiac arrhythmias and silent myocardial ischemia during hemodialysis. 1084 46

To confirm the significance of excretion of annexin V into the urine and the change of urinary annexin V concentration in kidney disease, a sandwich enzyme-linked immunosorbent assay (ELISA) was developed using two monoclonal antibodies. Urinary annexin V concentration was measured in healthy individuals and patients with kidney and other diseases. Urinary annexin V did not change over a range of pH between 5.0 and 8.0, and was stable during the course of the study for 24 h at room temperature and for 8 days at 4 degrees C. The mean urinary annexin V concentration in 105 normal healthy individuals was 1.5+/-1.5 ng/ml, while that in patients with nephrotic syndrome and systemic lupus erythematosis (SLE) nephritis was 9.3+/-9.1 and 6.6+/-6.7 ng/ml, respectively, and that in IgA nephropathy and chronic renal failure was 2.6+/-2.1 and 1.3+/-0.7 ng/ml, respectively. Annexin level correlated with urinary protein concentration (r=0. 717), but not the serum creatinine concentration, blood urea nitrogen (BUN) and 24-h creatinine clearance. Mean urinary annexin V concentration in patients with ischemic heart disease, hypertension, and diabetes mellitus was 1.4+/-1.0, 1.4+/-1.1, and 1.7+/-1.3 ng/ml, respectively. In one case of relapsing nephrotic syndrome, the urinary annexin V concentration was markedly increased in the early phase after admission and then decreased. This patient later required hemodialysis. These results suggest that a high urinary annexin V concentration may be an indicator of acute renal injury related to the urinary protein level.
 ...
PMID:Measurement of urinary annexin V by ELISA and its significance as a new urinary-marker of kidney disease. 1087 2


<< Previous 1 2 3 4 5 6 7 8 9 10 Next >>