Biomedical subjects
Publications and source records attributed to J Spácil.
A case of patient with choriocarcinoma, most likely of ovarian origin, with lung metastasis is presented. The disease manifested by recurrent embolism into peripheral arteries. Publications on this topic are reviewed.
In the nineties of the previous century the overall and cardiovascular mortality significantly decreased. It was probably caused by positive changes in the food habits. However, during the last five years the mortality decrease has stopped despite of the further progress of medical care. Main risk factors of atherosclerosis have not been developing as favourable as they were at the beginning of nineties. It is partly due to less appropriate nutrition in comparison with primary countries of the European Union and the smoking habits.
Basic treatment of patients with carotid stenosis is a permanent complex treatment (lowering of risk factors of atherosclerosis, antiplatelets treatment and the potential use of the inhibitor of angiotensive converting enzyme). Symptomatic stenosis (over 85% in European classification of arteriography) are indicated for the surgery. In smaller stenoses (75-85%), only selected patients are indicated for such treatment. Surgery in asymptomatic stenoses over 75% should be done in strictly indicated cases only. Operation should be performed at clinics with sufficient experience only. In cases without preoperative angiography, indication for surgery should be based on duplex sonography and some other non-invasive method. Endovascular treatment by primary stent is indicated for the most serious cases at the best clinics.
In recent years some specialists recommend to treat patients with cardiovascular diseases with maximal doses of drugs and refer to the results of extensive clinical studies. On critical evaluation of some it seems that the results are not interpreted accurately and that the highest doses of drugs (or combined treatment) do not produce better results than the use of smaller doses. This applies e.g. to the study HOT with felodipine in hypertensive patients and patients with cardiac insufficiency in the ATLAS study with lisinopril and the MERIT-HF study with metoprolol. It applies also the HOPE study with ramipril in secondary prevention in subjects with cardiovascular diseases. Efforts to achieve as low as possible lipid values has also some pitfalls. The author recommends to treat comprehensively all patients and to select maximal doses only in selected subjects.
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BACKGROUND: Intima-media thickness of the common carotid artery (IMT ACC) and flow-mediated vasodilatation (FMD) of the brachial artery is considered an early marker of atherosclerosis. This study was undertaken to elucidate whether endothelial dysfunction in the popliteal artery, pronoun to atherosclerosis, is related to IMT ACC. METHODS AND RESULTS: Twenty-nine control subjects, 29 asymptomatic patients with hyperlipoproteinemia (without therapy) and 26 patients with coronary artery disease were examined. Using ultrasound with a linear-array probe (7.5 MHz), we measured IMT ACC and diameter of the popliteal artery (PA) at rest and during reactive hyperaemia after release of 5-minute arterial occlusion. In control subjects we found thicker IMT ACC and greater FMD than did the patients (p<0.001, ANOVA test). A significant negative correlation between the IMT ACC and percent FMD was found in all of the subjects (p<0.001). On multiple regression analysis, percent FMD showed a significant negative correlation with the IMT ACC, total cholesterol, triacylglyceroles, body mass index, age, and diastolic blood pressure. CONCLUSION: We found significant negative correlation between IMT common carotid artery and FMD popliteal artery.
OBJECTIVE: More than 35 years ago, during 1965-1968, in the former Czechoslovakia, approximately 80 persons became ill due to occupational exposure to 2,3,7,8-tetrachlordibenzo- p-dioxin (2,3,7,8-TCDD). The objective of this study was to investigate the incidence of disorders related to occupational exposure to 2,3,7,8-TCDD. METHODS: Most subjects in the group of 12 former 2,3,7,8-TCDD workers (mean age 56.8 years, exposure 10 days to 23 months) still suffer from disturbances of lipid metabolism, psychic disorders, chloracne, and/or nervous system lesions. All workers were given internal, neuropsychological and ophthalmological examinations. Blood cholesterol and triglycerides were measured, and the common carotid artery was examined by ultrasound (B-mode), with the intima-media thickness (IMT) also being measured. Findings were compared with the 2,3,7,8-TCDD level in 1996. RESULTS: Nine of the 12 previously exposed workers had elevated plasma lipids, and hyperlipidaemia was statistically more frequent in patients with higher 2,3,7,8-TCDD levels ( P=0.03). Subject 1, with the highest 2,3,7,8-TCDD plasma level, had 80% stenosis of the diameter of the carotid artery, which needed acute surgery. Besides him, seven persons had atherosclerotic plaques in the carotid arteries. The mean IMT in the group was 0.85 mm (SD+/-0.19); the normal value is 0.62 mm. Eight subjects had degenerative changes of the ocular fundus. Chloracne was still present in two persons. Neuropsychological findings were assessed as normal only in three persons with lower 2,3,7,8-TCDD plasma levels in 1996. Mean 2,3,7,8-TCDD plasma level in 1996 was 256 pg g(-1) fat (range 14-760). CONCLUSION: Hyperlipidaemia, atherosclerotic plaques, increased IMT, ischaemic heart disease and neuropsychological disturbances were frequent in this group of former 2,3,7,8-TCDD workers. Hyperlipidaemia might have played an important role in most of these disorders. The level of 2,3,7,8-TCDD correlated with the highest level of triglycerides ( P=0.02) and cholesterol ( P=0.01) that was found during the 35-year follow-up. This group belongs to the most heavily 2,3,7,8-TCDD-exposed groups of workers, because the mean estimated concentration at the time of intoxication was approximately 5000 pg g(-1) plasma fat.
Ultrasound of carotid arteries belongs to non-invasive, safe, and comparatively inexpensive methods of the subclinical phase arteriosclerosis detection. It allows identification of atherosclerosis plaques, which can be found in higher numbers in elderly persons. Measurement of intima-media thickness (IMT) belongs to the time-proven methods and it represents an independent indicator of the risk of the cerebro-vascular event, coronary event including the myocardial infarction, and lower limbs ischaemic disease. In asymptomatic forms in persons over 45 years, the meticulous IMT examination can bring an additional information on the traditional risk factors, specify further the risks of cardio-vascular events, and help to elaborate the extent of preventive measures.
The risk of venal thrombosis and pulmonary embolia during aviation is rather small. The risk markedly rises during long flights (over 7500 km) and namely in elderly persons. Danger of the disease can be lowered by lower limbs exercising, liberal intake of soft drinks, and by elastic calf bandages. Persons of the high risk are candidates for low-molecular heparin administration.
Contemporary methods of assessment of possible cardiovascular disease based on traditional risk factors are not perfect. Therefore new ways are sought. Simple and cheap methods include assessment of the blood pressure on the lower extremities above the ankles. The finding of a reduced index of ankle pressure (ratio of blood pressure above the ankles and pressure on the arm) indicates affection of the arteries of the lower extremities and a significantly increased risk of cardiovascular diseases (in particular myocardial infarction and stroke), independently on other risk factors. Therefore this simple examination should be made in middle aged and elderly subjects with a medium and high cardiovascular risk in order to define more accurately the health status, and in case of a reduced ankle pressure similar provisions should be made as in patients with secondary preventive care.
Non-invasive measurement of the intima-media thickness (IMT) of the carotid artery and flow-mediated dilatation (FMD) of the brachial artery are increasingly used as surrogate markers of vascular disease. Using ultrasound, we measured the diameter of the popliteal artery at rest and during reactive hyperaemia after release of 5-minute arterial occlusion. We also measured IMT of the common carotid artery. In 29 control subjects (average age 35 years) we demonstrated an increase in the diameter by 6.0 +/- 3.3% (p < 0.05), in 29 asymptomatic patients with hyperlipidemia (without therapy, average age 46 years) only by 0.9 +/- 3.0% and in patients with coronary heart disease (average age 50 years) only by 0.2 +/- 2.7%. The difference between patients and control subjects was highly significant (p < 0.001). IMT was 0.58 +/- 0.10 mm, 0.78 +/- 0.17 mm and 1.03 +/- 0.25 mm respectively (p < 0.001). We conclude that in patients FMD of the popliteal artery is smaller and IMT of the common carotid artery is thicker than in controls.
This study was designed to assess a possible correlation between flow-mediated endothelium-dependent vasodilation in the popliteal artery and the intima-media thickness of the common carotid artery. Impaired vasodilation is one of early markers of atherosclerosis that has not been studied on the popliteal artery. An increase in intima-media thickness of the common carotid artery is also considered to be an indication of early stages of atherosclerosis. With use of ultrasound, the diameter of the popliteal artery was measured at rest and during reactive hyperemia after 5-minute arterial occlusion. Subsequently, the intima-media thickness was measured in left common carotid arteries in 27 patients with hyperlipidemia, in 10 patients with confirmed coronary artery disease, and in 20 healthy individuals. In healthy individuals, popliteal artery diameter increased by mean of 6.6 +/- 3.5% (p < 0.01) in relation to hyperemia. In patients with hyperlipidemia before therapy and in patients with coronary disease, no increase in diameter occurred (mean, 0.44% and -1.6%, respectively). The difference between healthy individuals and patients was statistically significant at p < 0.001. The popliteal artery seems to respond similarly to the brachial artery. When comparing the change in popliteal artery diameter and intima-media thickness of common carotid arteries, a strong negative correlation (r = -0.5713, p < 0.001) was observed in all subjects.
Within the grant project patients with familial hyperlipoproteinaemias have been examined. The examination was performed in the oldest lipid clinic and research laboratory in the world. The classification of lipid metabolism disorders was based upon a detailed biochemical analysis of plasma lipids including electrophoresis and assessment of apolipoprotein levels. Then optimal treatment regimen could be established. The project was aimed to evaluate the efficacy of different treatment regimens in different types of hyperlipoproteinaemias. Biochemical parameters and mainly the impact of treatment of hyperlipoproteinaemia on morphology and function of the vessel wall was monitored. The non-invasive ultrasound measurement of the intima thickness of carotid arteries was used. For more precise diagnosis of genetically determined disorders of lipid metabolism a large scale of methods of molecular biology was introduced. These methods enable confirmation of familial hypercholesterolaemia, familial defective apolipoprotein B-100 or studying polymorphism of apolipoprotein E. The effort of the authors of the project was to maximally utilise the results of basic and applied research in formulating recommendations for everyday practice of physicians.
BACKGROUND: Apolipoprotein E (apoE) plays a key role in lipoprotein metabolism. It occurs in three isoforms E2, E3 and E4. These isoforms have different impacts on plasma lipoprotein levels. The allele, or gene, coding apoE4 is considered a candidate for premature atherosclerosis development while the apoE2 gene is assumed to be protective. Lipoprotein(a) is also atherogenic and its increased plasma concentration is presumed to be an independent risk factor for premature atherosclerosis. Lipoprotein(a) is a protein depositing directly into the atheromatous plaques, enhancing cholesterol oxidation, competitively inhibiting plasminogen formation and thus having a prothrombogenic effect. The aim of our study was to establish a relationship between common carotid artery intima thickness and two independent risk factors, apoE polymorphism and elevation of plasma lipoprotein(a) levels. METHODS: A cross-sectional study was performed on 114 patients who were referred to the lipid clinic for primary hyperlipoproteinaemia. The patients received no treatment prior to examination. Plasma levels of total cholesterol, triglycerides, HDL-cholesterol, LDL-cholesterol, apoA, apoB, lipoprotein(a) and the apoE genotype were determined and the carotid artery intima thickness was measured using ultrasonography. RESULTS: The relative frequencies of apoE2, E3 and E4 were 0.049, 0.830 and 0.121. The equality of carotid intima thickness was tested using the Kruskal-Wallis test. Medians of intima thickness in a subgroup with the allele E2 were 0.72 mm, in a subgroup with the E3/E3 genotype 0.70 mm and in a subgroup with the E4 allele 0.80 mm. The relationship between carotid intima thickness and lipoprotein(a) levels was tested using Spearman's correlation coefficient. CONCLUSIONS: No statistically significant differences of carotid intima thickness among subgroups divided according to their apoE genotype were found. No relationship between carotid intima thickness and lipoprotein(a) levels was found. On the contrary a close relationship between carotid intima thickness and age and also some of the plasma lipid variables was recorded using the method of multivariate linear regression.
BACKGROUND: Cholesterol lowering in patients with above-average cholesterol levels has been shown to reduce the progression of atherosclerosis. We assess the effects of lipid lowering therapy on the progression of early, preintrusive carotid arterial atherosclerosis in high risk patients with familial hyperlipidaemia free of symptomatic cardiovascular disease. METHODS: Fifty-two patients with familial hyperlipidaemia by were treated by diet and various hypolipidaemic drugs. Eighteen individuals were not taking hypolipidaemic drugs. In a prospective study by B-mode ultrasound we assessed the intima-media thickness of the distal common carotid arterial (CCA) far wall at baseline and after 4 years. RESULTS: In a subgroup of 25 patients with familial hypercholesterolaemia there was a significant decrease in total and LDL cholesterol and reduction in the intima-media thickness (IMT) of the common carotid artery from 0.78+/-0.22 mm to 0.69+/-0.17 mm (p=0.004). In a subgroup of 27 patients with familial combined hyperlipidaemia significant decreases in total and LDL cholesterol and triglycerides were associated with a decrease in the IMT of common carotid. artery from 0.72+/-0.22 mm to 0.67+/-0.15 mm (p=0.044). In 18 individuals, who were not taking hypolipidaemic drugs, there were no significant changes in the levels of cholesterol and triglycerides and in the IMT of the common carotid artery (increase from 0.58+/-0.18 mm to 0.62+/-0.13 mm, p>0.05). CONCLUSIONS: Lipid-lowering therapy in patients with familial hyperlipidaemia free of symptomatic cardiovascular disease reverses the progression of early, preintrusive atherosclerosis of the carotid artery. It is a beneficial sign indicating the possibility for atherosclerosis regression.
BACKGROUND: Concomitant occurrence of carotid atherosclerosis, coronary artery disease (CAD) and peripheral vascular disease (PVD) has been described in a number of studies. The objective of the present trial was to assess the degree of correlation between atherosclerosis of the carotid beds as well as PVD and the extent of CAD. METHODS AND RESULTS: Carotid morphologies of 170 patients in total (121 men, 49 women), ranging between 23 and 81 years in age were assessed ultrasonographically. Their carotid beds searched for plaques, stenoses and occlusions. In all patients intima-media thickness (IMT) of the common carotid artery (CCA) were measured ultrasonographically. In addition, case histories of PVD were taken. CAD was proved angiographically in 138 patients. Plaques in carotid beds were found in 98 patients, carotid artery stenoses > 75% were found in 4 patients whereas complete carotid occlusion was not detected in any patient. Clinically manifested PVD was found in 20 patients. A significant difference in IMT of the CCA was assessed by t-test between patients having and not having CAD (0.67 +/- 0.16 mm vs. 0.87 +/- 0.24 mm; P < 0.0001). The correlation between the IMT of the CCA and extent of CAD was weak (r = 0.30, p < 0.01). A positive correlation between carotid plaque occurrence and the number of CAD-affected arteries was statistically assessed (Trend test: P = 0.0001). The sensitivity of incidence of plaques on the carotid beds for prediction of CAD was 64%, the specificity 72%, the positive predictive value 91% and the negative predictive value 32%. The sensitivity of clinically manifested PVD for prediction of CAD was 15%, the specificity 100%, the positive predictive value 100% and the negative predictive value 21%. CONCLUSIONS: The authors confirmed a statistically significant but weak correlation between IMT of the CCA and severity of CAD. They found a positive trend between the occurrence of carotid plaques and the number of CAD-affected arteries. The presence of carotid plaques and clinically manifested PVD were confirmed as a reliable positive predictive factors for CAD.
BACKGROUND: Increased mortality of hypopituitary adults with atherosclerotic vascular disease is commonly explained by growth hormone deficiency and forms the main argument for the growth hormone replacement. At the same time it is known that the growth hormone-IGF-I axis stimulates the vessel wall proliferation as an initial step of atherosclerosis. Investigation of the arterial intima thickness in hypopituitary adults with duplex ultrasound system and its follow up during the growth hormone therapy may clarify these effects of growth hormone on the vessel wall. METHODS AND RESULTS: Luminal diameter, maximal blood flow velocity and arterial intima thickness of common carotid arteries was measured with colour duplex ultrasound system in 15 adults with hypopituitarism before and after one year therapy with recombinant growth hormone. The results were compared with healthy controls matched for gender, age, blood pressure and weight. The luminal diameter did not changed during the therapy with growth hormone and was the same in patients and controls. Maximal blood velocity in hypopituitary patients before the therapy was lower than in control subjects (74.8 +/- 13.9 cm/s vs. 94.0 +/- 21.0 cm/s), but the statistical difference was only borderline. Arterial intima thickness was significantly thinner in hypopituitary patients when compared with controls (0.56 +/- 0.1 mm vs. 0.71 +/- 0.12 mm, p < 0.001) but became thicker after the treatment and was not any more different from the controls (0.56 +/- 0.1 mm vs. 0.66 +/- 0.1 mm, p < 0.001). CONCLUSIONS: In hypopituitary adults the arterial intima thickness of common carotid arteries is less than in healthy controls. The reduced thickness was normalised after one year treatment with growth hormone. Atheromatous plaques were not found either before or after the treatment. Duplex ultrasound measurement may be one of the means of checking of the effects of growth hormone therapy.
BACKGROUND: In recent years evidence was provided that by measuring the width of the intima of the carotid artery, evaluated by sonography, it is possible to assess the development of arteriosclerosis. The authors used this method to evaluate hypolipidaemic treatment. METHODS AND RESULTS: The authors followed-up by clinical and laboratory methods and treated for a period of 47 months 63 patients with familial hyperlipoproteinaemia. At the beginning and at the end of the follow-up period they made sonographic examinations of the common carotid artery. In 31 patients treated by statins they observed statistically significant changes: cholesterol declined by 23%, LDL cholesterol by 25.3%. The maximal rate in the common carotid artery (ACC) declined from 93 +/- 22 to 73 +/- 13 cm/s. The diameters of the ACC increased from 6.0 +/- 0.8 to 6.5 +/- 0.8 mm. The intima of the ACC diminished from 0.84 +/- 0.26 to 0.75 +/- 0.20 mm. In 22 patients treated with fibrates the anticipated lipid changes occurred. The diameter of ACC did not change, the decline in the width of the intima of the ACC was not statistically significant. In 10 patients who decided that they wanted only dietary treatment the changes in the investigated parameters were small. CONCLUSIONS: In patients with familial hyperlipidaemia who were treated with statins for almost four years the authors observed a diminution of the width of the intima of the common carotid artery which is considered a sign of regressing atherosclerosis.