Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0162871 (abdominal aortic aneurysm)
 8,664 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

In 27 patients (mean age at death 72 +/- 9 years) with abdominal aortic aneurysm (AAA) > or = 5.0 cm in its widest transverse diameter, the amounts of narrowing at necropsy in the 4 major (left main, left anterior descending, left circumflex, and right) epicardial coronary arteries were determined. During life, 12 of the 27 patients (44%) had symptoms of myocardial ischemia: angina pectoris alone in 2, acute myocardial infarction alone in 3, angina pectoris and acute myocardial infarction in 5, and sudden coronary death in 2. Ten of the 27 patients (37%) died from consequences of myocardial ischemia. Six (22%) died from rupture of the AAA. Grossly visible left ventricular necrosis or fibrosis, or both, was present in 15 patients (56%). Of the 27 patients, 23 (85%) had narrowing 76 to 100% in cross-sectional area of 1 or more major coronary arteries by atherosclerotic plaque. The mean number of coronary arteries per patient severely (> 75%) narrowed was 2.0 +/- 1.3/4.0. Of the 108 major coronary arteries in the 27 patients, 55 (51%) were narrowed > 75% in cross-sectional area by plaque. The 4 major coronary arteries in the 27 patients were divided into 5-mm segments and a histologic section, stained by the Movat method, was prepared from each segment. The mean percentages of the resulting 1,475 five-mm segments narrowed in cross-sectional area 0 to 25%, 26 to 50%, 51 to 75%, 76 to 95% and 96 to 100% were 17, 37, 28, 15 and 3%, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Degrees of coronary arterial narrowing at necropsy in men with large fusiform abdominal aortic aneurysm. 141 36

Sensitive and highly specific ELISA assays were developed to determine humoral immune response against actin and myosin in 122 patients suffering from various cardiovascular diseases: acute viral myocarditis (n = 10, MYO), acute myocardial infarction (n = 28, AMI), valve surgery (n = 35, VALVE), coronary bypass surgery (n = 35, CABG), and peripheral vascular surgery (n = 14, VASC). Anti-actin and anti-myosin antibodies were determined on admission and serially during a period of 90 days. Anti-actin and anti-myosin immune response (IgG, IgM) was expressed comparing absorbance of the patients' serum with a reference serum. In the different patient groups significantly (P less than 0.01) higher anti-actin and anti-myosin antibody concentrations were found on admission compared with age-matched control groups. During follow-up, all patient groups except the vascular surgery group showed a significant immune response against actin and myosin, with an immune response ratio (peak/admission) for AMA IgG and IgM respectively of 2.12 and 2.40 in the VALVE group, 1.30 and 1.99 in the CABG group, 1.42 and 1.48 in the AMI group and 1.66 and 1.25 in the MYO group; and for AAA IgG and IgM respectively of 1.57 and 3.00 in the VALVE group, 1.54 and 1.64 in the CABG group, 1.25 and 1.07 in the AMI group, and 1.42 and 1.42 in the MYO group. A significant correlation between pre-cardiac injury and peak post-cardiac injury anti-myosin and anti-actin autoantibody levels could be demonstrated suggesting that pre-injury sensitization to these antigens plays an important role in evoking post-cardiac injury immune response.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Humoral immune response against contractile proteins (actin and myosin) during cardiovascular disease. 191 62

A retrospective study was undertaken to assess the influence of known ischaemic heart disease on the operative and the long-term survival of patients undergoing elective repair of an abdominal aortic aneurysm. One hundred and seventy-one patients underwent elective surgery between June 1977 and December 1983. The patients were divided on routine clinical grounds into cardiac and noncardiac groups. Ninety-five patients had a history of heart disease and/or an abnormal resting pre-operative ECG. Seventy-six patients had no history of heart disease and a normal pre-operative resting ECG. Two of the seven operative deaths were due to myocardial infarction with one each from the cardiac and noncardiac groups. Eight patients suffered an acute myocardial infarction with five from the cardiac and three from the noncardiac group and this was not significantly different. The overall survival of 95% at 1 year and 76% at 5 years closely follows the age/sex matched Australian population. The survival at 1 year in the cardiac group was 97% and 95% in the noncardiac group. The 5 year survival was 72% and 79% respectively. During follow-up to December 1984, 11 patients died from ischaemic heart disease with six from the cardiac and five from the noncardiac group. No significant difference was found between the two groups in the incidence of myocardial infarction or the short- and long-term survival. This study does not support a more aggressive approach to coronary artery disease in the pre-operative management of patients with abdominal aortic aneurysm.
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PMID:Abdominal aortic aneurysms and coronary artery disease: is a more aggressive approach indicated? 347 78

It is well recognized that patients with abdominal aortic aneurysms have a high incidence of coronary artery disease, and that the major cause of death in patients undergoing aneurysmectomy has been acute myocardial infarction. In order to assess the incidence of significant coronary artery disease, cardiac catheterization was performed on 42 consecutive patients with abdominal aortic aneurysms. Thirty-six patients (85.7%) had significant anatomic coronary artery disease. Interestingly, all 8 patients with ejection fractions of less than 50% had triple vessel disease or left main disease, and 12 of 34 patients with ejection fractions greater than or equal to 50% had triple vessel disease or left main disease. Of the 30 patients who were NYHA Class I or Class II, 14 (46.7%) had triple vessel disease or left main disease. All 20 patients with triple vessel disease or left main disease underwent myocardial revascularization 7 to 10 days prior to abdominal aneurysmectomy. No patients had a perioperative myocardial infarction either following coronary artery bypass surgery or abdominal aortic aneurysm resection, and there were no operative mortalities. Although this was not a randomized study, it would seem from these results that in selected patients, myocardial revascularization prior to abdominal aneurysmectomy can decrease the incidence of acute myocardial infarction and also decrease operative mortality. It is presently recommended that all symptomatic patients, patients with ejection fractions of less than 50%, and asymptomatic patients with ejection fractions of greater than or equal to 50% with positive exercise radionuclide angiography undergo cardiac catheterization prior to aneurysmectomy, and those patients with left main disease or severe coronary artery disease undergo myocardial revascularization prior to aneurysm resection.
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PMID:Role of coronary angiography and coronary artery bypass surgery prior to abdominal aortic aneurysmectomy. 349 24

To assess the intraoperative and postoperative hemodynamic effects of beta-blockade and its benefits in limiting myocardial ischemia and infarction, a group of 32 patients scheduled for abdominal aortic aneurysm (AAA) surgery (group 1) was treated with oral metoprolol immediately before surgery and with intravenous metoprolol during the postoperative period. Mean age was 71 years, and mean ejection fraction was 56% (range 36% to 83%). Eight patients had a preoperative history of angina, 13 had a history of myocardial infarction, and five had electrocardiographic evidence of prior myocardial infarction. A group of 51 closely matched patients with AAA who did not receive metoprolol served as controls (group 2). In group 1, overall hemodynamic tolerance of metoprolol intraoperatively and postoperatively was good, and there was no incidence of congestive heart failure, hypotension, or asthma. Furthermore, in group 1 significant reduction of systolic blood pressure and heart rate was consistently noted at frequent intraoperative intervals and for 48 hr after surgery, with only a transient reduction of cardiac index. In group 1, only one patient (3%) suffered an acute myocardial infarction. In contrast, nine group 2 patients (18%; p less than .05) suffered perioperative myocardial infarction. Furthermore, only four (12.5%) group 1 patients developed significant cardiac arrhythmias as opposed to 29 group 2 patients (56.9%; p less than .001). These data demonstrate that beta-blockade with metoprolol is effective in controlling systolic blood pressure and heart rate both intraoperatively and postoperatively in patients undergoing repair of AAA and can significantly reduce the incidence of perioperative myocardial infarction and arrhythmias.
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PMID:The hemodynamics of beta-blockade in patients undergoing abdominal aortic aneurysm repair. 362 32

330 patients operated on for infrarenal abdominal aortic aneurysm (AAA) or aortoiliac occlusive disease (AIOD) between 1976-85 were retrospectively reviewed for early mortality and long-term survival. Data were analysed by crosstabulation and stepwise logistic regression methods for early mortality and by Kaplan-Meyer and Cox proportional hazard model for late survival. The 30-day mortality for elective AAA-patients was 9.6% and for ruptures 64.6%. For the AIOD-patients it was 2.0%. The principal cause of early death in the elective patients was acute myocardial infarction. The five-year survival rates for elective and ruptured AAA and AIOD-patients were 68%, 56% and 74%, respectively. The major late cause of death was coronary heart disease followed by pulmonary cancer. The risk factors for 30-day mortality were coronary heart disease, rupture, preoperative shock, excessive bleeding and aortic crossclamping time for the AAA-patients. In the rupture group the specialization of the surgeon had a significant impact on early mortality. Factors affecting the late survival were age, chronic cardiac failure, operation year, chronic pulmonary disease and previous malignancy in the whole study population. The late survival of both AAA and AIOD-patients after a successful operation was significantly shorter than that of an age- and sexmatched normal population. The late survival of AAA-patients was worse than that of AIOD-patients.
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PMID:Infrarenal aortofemoral bypass surgery: risk factors and mortality in 330 patients with abdominal aortic aneurysm or aortoiliac occlusive disease. 873 30

Patients with abdominal aortic aneurysm (AAA) associated with iliofemoral occlusive disease due to arteriosclerosis obliterans (ASO) are often encountered clinically, but their clinical characteristics remain poorly defined. We divided 275 patients undergoing aneurysmectomy into 2 groups: 58 patients with both AAA and ASO (Group A) and 217 patients with AAA only (Group B). General characteristics, morphological features of the aneurysms, surgical procedures and operative results were then compared between the groups. In Group A, ruptured aneurysms were significantly less common (p = 0.005) and the aneurysms were smaller (p = 0.0009). The most common cause of death in Group A was acute myocardial infarction (3/7), in contrast to aneurysmal rupture of another arterial segment and malignancy (6/27, each) in Group B. These findings indicate that patients with AAA and ASO represent a subgroup of patients with particular clinical features.
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PMID:Clinical analysis of abdominal aortic aneurysms associated with iliofemoral occlusive disease. 907 Sep 55

The abdomen, as the largest cavity in the body, holds both fixed as well as relatively mobile organs, which when either diseased, traumatized, malfunctioning, or infected may present a wide and diverse range of signs and symptoms. Clues to the origin of abdominal pain can be well-localized or referred and quite obtuse. This article reviews the surface anatomy of the abdomen, the types of abdominal pain, approach to the patient with abdominal pain, and history-taking and physical examination. Adjunctive studies, which might help to reduce the differential diagnosis, are mentioned. The goal of this article is to help the reader formulate an accurate diagnosis in a timely manner via a complete but also well-focused physical examination; attention is paid to a comprehensive differential diagnosis to include common and not so common causes of acute abdominal pain. Intra-abdominal sources of abdominal pain include: peritonitis, bowel obstruction, and vascular disorders. Extra-abdominal sources of abdominal pain include the thorax, pelvis, and the abdominal wall. Some metabolic and neurogenic sources of abdominal pain are examined. Life-threatening causes of abdominal pain include ectopic pregnancy, acute myocardial infarction, abdominal aortic aneurysm, splenic rupture, and obstructed bowel. Discussion of these entities concentrates on the initial presentation of the patient, typical progression of symptoms, and appropriate initial treatment as well as referral. The process of ruling out emergent abdominal pain is also examined.
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PMID:Primary care diagnosis of acute abdominal pain. 923 49

Two cases of coronary artery disease coexisting with abdominal aortic aneurysm were treated with off-pump coronary artery bypass grafting combined with repair of the aneurysm. The first patient was a 67-year-old man exhibiting a large pulsating abdominal mass. Abdominal computed tomography demonstrated a 9-cm aneurysm and coronary angiogram revealed a 90% stenosis of the obtuse marginal branch for which percutaneous transluminal angioplasty could not be performed. He underwent simultaneous single coronary artery bypass grafting without cardiopulmonary bypass, and bifurcated graft replacement. The second patient was a 71-year-old man who had acute myocardial infarction, and one month later underwent coronary angiogram which revealed three vessel disease in the coronary artery. Computed tomography revealed a 4-cm aneurysm, and angiography showed a 90% stenosis of the left renal artery. He underwent a single stage operation that involved three coronary artery bypass grafting without cardiopulmonary bypass, straight graft replacement, and reconstruction of the left renal artery using the saphenous vein graft. The postoperative course was uneventful in both cases. We currently recommend a single stage operation involving off-pump coronary artery bypass grafting.
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PMID:Two cases of off-pump coronary artery bypass grafting combined with abdominal aortic aneurysm repair. 1157 70

We present 2 patients who underwent transabdominal minimally invasive direct coronary artery bypass with the right gastroepiploic artery combined with abdominal aortic aneurysm repair. The surgical procedures, both performed through a median laparotomy, proved safe and of limited invasiveness. The one-stage surgical intervention prevented catastrophic complications, such as acute myocardial infarction or rupture of abdominal aortic aneurysm. We believe that concomitant transabdominal minimally invasive direct coronary artery bypass and abdominal aortic aneurysm repair should be considered as a single combined surgical strategy in selected patients.
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PMID:Concomitant transabdominal MIDCAB and abdominal aortic aneurysm repair. 1290 23


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