[Atherosclerosis. Description and mechanisms. Part 2: mechanisms].
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Biomedical subjects
Publications and source records attributed to L Capron.
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Retrospective analysis of the records of 86 patients with Takayasu's disease confirmed that the condition is more common in women, that it is frequently associated with a history of tuberculosis and that angiography is of considerable help in showing vascular lesions that are characteristic by their location (common carotid artery, post-vertebral subclavian artery) and by their diffusion to various areas. Histological examination of 20 surgical specimens confirmed the diagnostic value of sclerosis of the media and adventitia (associated or not with inflammatory lesions) and therefore radically different from the lesions of the intima observed in Horton's disease. Diagnostic criteria based on clinical, radiological and histological data are proposed.
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The concentrations of immunoglobulins (Ig) A, G and M were measured in saliva using an electro-immunodiffusion technique at pH 5 with carbamylation of the antisera. Thirty-one controls and 20 patients with generalised scleroderma (10 with and 10 without Sjögren's syndrome) were studied. The three classes of immunoglobulins were in normal saliva. A concentration of IgG greater than 55 mg/l in whole saliva was associated with Sjörgren's syndrome. This is the consequence of the reduction of the rate of saliva production, as well as an increased local synthesis of IgG. The measurement of IgG in unconcentrated saliva could be useful in the detection of Sjögren's syndrome.
Sixty nine patients were treated with local intra-arterial urokinase (37,500 U/CTA. hr-1) for recent severe ischemia of lower limbs: 27 (40%) ultimately required amputation. The difference of amputation rate between the groups with and without thrombolysis was not significant (33% v. 42%). A biological study in 6 patients showed that local arterial plasminemia occurred in only 1 patient. Local urokinase does not strongly stimulate "endogenous" thrombolysis and enhances "exogenous" thrombolysis only very inconstantly. A better adaptation of urokinase dosage or the use of an agent with higher affinity for fibrin might improve the efficiency of local thrombolytic therapy.
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We have studied the effect of insulin upon the accumulation of glucose carbon into the intima-media and the adventitia of rat aorta following in vitro exposure by adding insulin to the incubation medium, and in vivo exposure by producing relative hyperinsulinemia during life and subsequently incubating excised tissue in a medium containing no insulin. Hyperinsulinemia in vivo was either (1) endogenous--following 1.5-2 hr of refeeding after a 48-hr fast--or (2) exogenous--following an i.v. injection of insulin. For adventitia, a significant stimulation was found after both in vitro (+ 53%, p < 0.001) and in vivo exposure to insulin (+ 96%, p < 0.01 with endogenous insulin; + 75%, p < 0.05 with a dosage of 2 U/kg of exogenous insulin). For intima-media, the stimulation was weak and insignificant after in vitro exposure (+ 11%, p > 0.30), but became important and significant after in vivo exposure to insulin (+ 100%, p < 0.001 with endogenous insulin; + 50%, p < 0.05 with a dosage of 0.5 U/kg and + 49%, p < 0.05 with a dosage of 2 U/kg of exogenous insulin). For the in vivo exposure experiments, we found a significant linear correlation (r = 0.611, p < 0.005) between plasma insulin concentrations and glucose carbon accumulations into intima-medias of control and refed rats. These results establish the insulin sensitivity of the adventitia and show a sensitivity of intima-media only to in vivo insulin exposure. These different behaviors of intima-media in vivo and in vitro may have a hemodynamic basis.
The authors describe three patients presenting several episodes of paralysis of the motor and sensory cranial nerves and discuss possible aetiological factors. The paralytic attacks were regressive and were repeated at irregular intervals over a period of several years. It was confirmed that no local or general cause for the symptoms existed and the conclusion was reached that they were part of an autonomous clinical syndrome of unknown aetiology. Other cases have been reported in the published literature in which a non-specific inflammatory mechanism is suggested but no biological or pathological basis exists to support this physiopathological hypothesis. The clinical syndrome follows a benign course, the paralysis being regressive and the affection remaining confined to the peripheral nervous system of mesencephalic origin.
Vascular disease in diabetics could arise in part from altered vessel wall catebolism. Specific activities of hydrolases in aortic smooth muscle cells from rats with streptozotocin-induced diabetes were measured. Enyzmes included: neutral alpha-glucosidase, alpha-mannosidase, and lysosomal N-acetyl beta-glucosaminidase, beta-galactosidase, cathepsin C, acid alpha-glucosidase, and acid cholesteryl esterase. After 4,8, and 11 weeks of diabetes, activities of all enzymes studied were decreased significantly in diabetic vessels, decreases ranging from 15% for cathepsin C to 62% for alpha-mannosidase. After 3 weeks of diabetes, insulin treatment for 1 week restored enzyme levels to normal. After 7 weeks of diabetes, 1 week of insulin treatment did not restore enzyme levels fully to normal (acid cholesteryl esterase was unchanged); 4 weeks of insulin did. Acid phosphatase and N-acetyl beta-glucosaminidase activities were reduced markedly in histochemical studies of diabetic aortas at all time periods and were restored by insulin treatment. Alloxan-induced diabetes gave results similar to those with streptozotocin. Significant decreases of aortic hydrolase activities, including those of lysosomes, occur in experimental diabetes mellitus and could contribute to accumulation of substrates in vascular smooth muscle cells.
Hypertension is an important risk factor for atherosclerosis and often occurs in association with diabetes mellitus. Specific activities of hydrolases in homogenates of aortas from rats with renal-clip hypertension, normotension following a period of hypertension, and hypertension combined with streptozotocin-induced diabetes mellitus were measured. Enzymes included: neutral alpha-glucosidase, and lysosomal N-acetyl-beta-glucosaminidase, beta-galactosidase, cathepsin C, acid alpha-glucosidase, and acid cholesteryl esterase. After 6 or 12 weeks of hypertension, specific activities of all enzymes measured were significantly increased, levels ranging from 24% above normal for cathepsin C to 351% above normal for N-acetyl-beta-glucosaminidase. Six weeks of normotension following 6 weeks of hypertension resulted in restoration to normal of four of the six enzyme activities; the remaining two enzymes were significantly below normal levels. Combined hypertension and diabetes mellitus showed smooth muscle cell levels of four of the five hydrolases measured to be significantly lower than those present with hypertension alone. In every instance, histochemical studies of aortas showed acid phosphatase and N-acetyl-beta-glucosaminidase activities which corresponded to the biochemical findings. These findings indicate profound and discrete effects of two clinical risk factors on vascular smooth muscle cell lysosomes.
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When added in vitro, insulin exerts little or no effect on the metabolism of arterial media. However, indirect evidence suggests that an in vivo exposure of arterial tissue to insulin stimulates its metabolism. To evaluate the possibility that hemodynamic forces existing only in vivo may account for this difference, we studied the effect of brief (9-minute) exposures to insulin of isolated rat thoracic aorta perfused in situ at low (34 mm Hg = 4.6 kPa) and high (70 mm Hg = 9.4 kPa) static pressures. After perfusion, incorporation of glucose-derived 14C into CO2 and lipids, and production of lactate by incubated aortic tissue, were measured. At low perfusion pressure, insulin did not affect the metabolism of the media but strongly stimulated all aspects of the glucose metabolism of the adventitia. At high pressure, insulin again stimulated the adventitia but now also significantly stimulated (+66%) the synthesis of glucose-derived lipids by the media; production of CO2 and lactate by the media did not increase significantly. These results indicate that insulin directly stimulates at least one pathway of glucose metabolism by the media; and that hemodynamic forces are an important factor in determining the response of aortic media to insulin.