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PubMed1980

Colonic manifestations of collagen vascular diseases.

Upper gastrointestinal manifestations of collagen vascular diseases have been well described. Recently our attention has been focused on the colonic complications: fibrosis and stricture resulting in obstruction, severe obstipation and recurrent fecal impactions secondary to pseudo-obstruction, progressive colonic dilatation resulting in gangrene of the colon, and sigmoid volvulus and diverticulitis in the presence of both wide- and narrow-mouth pseudodiverticula. Patients with these colonic manifestations of collagen vascular disease are disabled, if not severely ill. Recognition of the problem enables the surgeon to plan definitive surgical intervention ranging from segmental resection to total colectomy and ileoproctostomy to restore satisfactory large bowel function.

Adult↗
PubMed2000

Update on endovascular treatment of peripheral vascular disease: new tools, techniques, and indications.

The treatment of peripheral vascular disease is one of the most rapidly expanding fields of medicine today At one time, patients who had peripheral vascular disease had few medical or surgical options. Now, however, options abound. The number of peripheral interventions increased from 90,000 in 1994 to more than 200,000 in 1997 and endovascular techniques may soon replace up to 50% of traditional vascular operations. Cardiologists, interventional radiologists, and vascular surgeons bring various types of expertise to endovascular intervention; nonetheless, they seem to share similar levels of enthusiasm about this treatment option. The many advantages to the patient that such intervention offers over traditional surgery, such as the avoidance of anesthesia and other surgical risks, the rapid recovery time, and the relatively low treatment costs, provide encouragement to these specialists. Endovascular intervention requires dedication on the part of practitioners, because it demands such complete knowledge of vascular disease and of the anatomic changes experienced by the patient. The challenge is intensified by the continual introduction of new products and methods. We hope, herein, to offer pertinent information about recent advances in interventional techniques and devices, and to provide a framework for future education.

Angioplasty, Balloon↗
PubMed2003

Dipyridamole for preventing stroke and other vascular events in patients with vascular disease.

BACKGROUND: Patients with transient ischaemic attacks (TIA) and minor ischaemic strokes are at risk of serious vascular events (death from all vascular causes, non-fatal stroke, or non-fatal myocardial infarction). Their risk of vascular events lies between 4 and 11 percent per year. Aspirin only, in a daily dose of 30 mg or more, offers only modest protection in such patients: it reduces the incidence of major vascular events by 13 percent. In a single trial, adding dipyridamole (an alternative antiplatelet agent) to aspirin was associated with a 22 percent reduction in the risk of major vascular events compared with aspirin alone. However, a systematic review of all trials of antiplatelet agents by the Antithrombotic Trialists' Collaboration showed that, in high risk patients, there was virtually no difference between the aspirin-dipyridamole combination and aspirin alone. We therefore sought to assess the effects of dipyridamole in more detail. OBJECTIVES: 1) To assess the efficacy of dipyridamole versus control in the secondary prevention of vascular events in patients with vascular disease in the presence and absence of other antiplatelet drugs. 2) To assess the safety of dipyridamole versus control in the secondary prevention of vascular events in patients with vascular disease in the presence and absence of other antiplatelet drugs. SEARCH STRATEGY: The Cochrane Stroke Group Trials Register was searched and other relevant Cochrane Groups were contacted to search their specialised registers (last search 29 April 2002). In addition the Cochrane Controlled Trials Register, MEDLINE and EMBASE were searched and Dutch manufacturers of dipyridamole were contacted to identify further published and unpublished studies. SELECTION CRITERIA: Randomised long term secondary prevention trials with concealed treatment allocation, treatment for > 1 month, starting within 6 months after presentation of a arterial vascular disease were selected (coronary artery disease, myocardial infarction, angina pectoris, retinopathy, nephropathy, peripheral arterial disease, stroke, TIA, amaurosis fugax). Therapy consisted of dipyridamole in any dose in the presence or absence of other antiplatelet drugs compared with no drug or an antiplatelet drug(s) other than dipyridamole (control group). DATA COLLECTION AND ANALYSIS: Two reviewers selected trials which met the inclusion criteria and extracted details of randomisation methods, blinding of treatments and assessments, whether intention-to-treat analysis was possible from the published data, whether treatment groups were comparable with regard to major prognostic factors, the number of patients who were excluded or lost to follow-up, definition of outcome events, and entry and exclusion criteria. The methodological quality of each trial was assessed by the two reviewers on the basis of these extracted data. In addition, dose and type of antiplatelet treatments, duration of follow-up and the numbers of defined outcome events were recorded. Data published by the Antithrombotic Trialists' Collaboration were used. The remaining data were independently extracted by the same two reviewers and cross checked. Data were analysed according to the intention-to-treat principle. Relative and absolute risk reductions were calculated by means of the statistical software provided by the Cochrane Collaboration (RevMan). MAIN RESULTS: Twenty-six trials were included, with a total of 19842 patients, among whom 1399 vascular deaths and 3085 fatal and non-fatal vascular events occurred during follow-up. Compared with control, dipyridamole had no clear effect on vascular death (RR 1.02, 95% CI 0.90 to 1.17). This result was not influenced by the dose of dipyridamole or type of presenting vascular disease. Compared with control, dipyridamole appeared to reduce the risk of vascular events (RR 0.90, 95% CI 0.83 to 0.98), but this effect was only statistically significant due to a single large trial in patients presenting with cerebral ischaemia (6602 patients). Comparing dipyridamole plus aspirin with aspirin alone: there was no clear difference in vascular death, the RR was 1.03 (95% CI 0.87 to 1.22); the combination was associated with fewer vascular events with an RR of 0.90 (95% CI 0.80 to 1.00). Combination treatment of dipyridamole and aspirin compared with placebo had an RR of 0.89 (95% CI 0.79 to 1.01) for vascular death and an RR of 0.74 (95% CI 0.68 to 0.80) for vascular events. REVIEWER'S CONCLUSIONS: This review found that, for patients who presented with arterial vascular disease, there was no evidence that dipyridamole, in the presence or absence of an other antiplatelet drug (chiefly aspirin) reduced the risk of vascular death, though it may reduce the risk of further vascular events. However, this benefit was found in only a single large trial and only in patients presenting after cerebral ischaemia. There was no evidence that dipyridamole alone was more efficacious than aspirin. Further trials comparing the effects of the combination of dipyridamole with aspirin with aspirin alone are justified.

Anticoagulants↗
PubMed1989

Dose-response relation between arsenic concentration in well water and mortality from cancers and vascular diseases.

Age-adjusted mortality rates were analyzed to examine the dose-response relation between ingested arsenic levels and risk of cancers and vascular diseases among residents in the endemic area of blackfoot disease, a unique peripheral vascular disease associated with long-term exposure to high-arsenic artesian well water and confined to the southwestern coast of Taiwan. The arsenic levels in well water determined in 1964-1966 were available in 42 villages of the study area, while mortality and population data during 1973-1986 were obtained from the local household registration offices and Taiwan Provincial Department of Health. Age-adjusted mortality rates from various cancers and vascular diseases by sex were calculated using the 1976 world population as the standard population. A significant dose-response relation was observed between arsenic levels in well water and cancers of the bladder, kidney, skin, and lung in both males and females, and cancers of the prostate and liver in males. However, there was no association for cancers of the nasopharynx, esophagus, stomach, colon, and uterine cervix, and for leukemia. Arsenic levels in well water were also associated with peripheral vascular diseases and cardiovascular diseases in a dose-response pattern, but not with cerebrovascular accidents. The dual effect of arsenic on carcinogenesis and arteriosclerosis and the interrelation between these two pathogenic mechanisms deserve more intensive study.

Adolescent↗
PubMed1976

Osteomyelitis associated with peripheral vascular disease secondary to diabetes mellitus.

Diabetes mellitus and arteriosclerotic vascular disease have been found to be the predisposing factors of osteomyelitis associated with peripheral vascular disease (10). A diabetic person is more susceptible to osteomyelitis because of the microangiopathy, peripheral neuropathy and decreased resistance to infection. In diabetes mellitus there can be microangiopathy which results from the proliferation of the endothelium of the intima and thickening of the basement membrane. This further contributes to a sluggish blood flow. In the patient with arteriosclerotic vascular disease, the lumens of the arterioles and arterioles are compromised by the atheromatous plaques. The anatomic structure of the blood supply to bone along with the pathologic membrane thickening, allows for slowing of blood. This slowing of blood flow causes micro-thrombi and enhances bacterial growth. In diabetes mellitus it has been shown that there is a decreased immunologic response which, along with the above, contributes to the sheltering and proliferation of bacteria in the small bones of the foot.

Adolescent↗
PubMed2004

MDCT angiography of pediatric vascular diseases of the abdomen, pelvis, and extremities.

Multi-detector-row computed tomography (MDCT) enables rapid, noninvasive, high-resolution, and three-dimensional imaging of pediatric vascular diseases. In this paper, we explore the adaptation of the MDCT angiographic principles to pediatric patients for vascular diseases of the abdomen, pelvis, and extremities. Special emphasis is placed on the practical aspects of how to perform these studies. Optimizations of scan parameters, contrast medium usage, radiation dose, and three-dimensional image processing are discussed in detail. We provide practical guidance on how to choose between MR angiography and CT angiography. Finally, we review important pediatric vascular diseases, categorized into traumatic injuries, inherited vascular diseases, congenital vascular diseases, vasculitides, and surgical planning and assessment. In each category, we discuss how CT angiography can be tailored to maximize its clinical benefits.

Adolescent↗
PubMed1984

The acute-phase reaction and haematological stress syndrome in vascular disease.

Both acute and chronic phases of vascular disease are associated with a stress response that includes increased hepatic synthesis of fibrinogen and increased bone marrow release of leucocytes and platelets. A likely humoral mediator of the stress response is interleukin-1 released by reticulo-endothelial cells following their stimulation by fibrinogen degradation fragments D and E. Rheological consequences of the stress response include hyperviscosity of plasma and whole blood and decreased blood filterability. Since blood filterability is influenced by both the plasma fibrinogen concentration and the leucocyte count, it is essential to completely remove these extrinsic contaminants by a pre-filtration step before a true measurement of erythrocyte deformability can be made. Understanding of the pathogenesis of these stress syndromes is also a prerequisite to successful therapeutic control of the rheological abnormality of vascular disease.

Arteriosclerosis↗
PubMed1999

[Cytomegalovirus infection associated with immunosuppressive therapy in collagen vascular diseases].

OBJECTIVE: We investigated the frequency of cytomegalovirus (CMV) infection during immunosuppressive therapy in collagen vascular disease by using CMV antigenemia assay. METHODS: CMV antigenemia in fifteen patients with collagen vascular disease were analyzed before and one month after immunosuppressive therapy with more than 30 mg/day of prednisolone. RESULTS: CMV antigenemia were detected in 9 patients (60%), however no CMV antigenemia detected in all patients before treatment. In 7 of 9 patients CMV infection occurred such as fever, leucocytopenia, thrombocytopenia, liver injury, interstitial pneumonia. In 2 patients of polymyositis/dermatomyositis, creatine phosphokinase (CPK) levels which had decreased once just after treatment started, elevated again although initial dose of prednisolone continued. After ganciclovir administration because of the positive results of CMV antigenemia, elevated CPK levels were normalized immediately. CONCLUSION: Our results showed that CMV infection occurred with high frequency during immunosuppressive therapy, and might mimic the exacerbation of collagen vascular disease. It is important to differentiate CMV infection from increased activity of collagen vascular disease during the treatment.

Adult↗
PubMed1999

G beta gamma-mediated signaling: new therapeutic target for proliferative vascular disease.

Proliferation of vascular smooth muscle (VSM) severely affects the outcome of coronary artery bypass and angioplasty procedures, causing the failure of venous grafts or restenosis of the reopened vessel. Investigation into the mechanisms underlying the process of VSM cellular proliferation has provided evidence that intracellular signaling mechanisms triggered by extracellular hormonal factors acting through G protein-coupled receptors, can mediate and sustain this pathological process. Inhibition of common pathways of G protein-coupled receptor signaling has recently proven effective in preventing VSM cellular activation and proliferation. In particular, inhibition of the G beta gamma-mediated mitogen-activated protein (MAP) kinase signaling pathway results in the inhibition of VSM proliferation in vitro. Moreover, use of adenoviral vectors to deliver a peptide inhibitor of G beta gamma signaling in vivo has resulted in inhibition of intimal hyperplasia in experimental models of vein-graft failure and restenosis.

Animals↗
PubMed2004

Consensus statement for the prevention of vascular disease.

This consensus statement for the prevention of vascular disease in people over 50 years of age aims to consolidate key messages from a number of evidence based guidelines and studies. It addresses the assessment and principles of management of risk factors for vascular disease, including those developed by Diabetes Australia, Kidney Health Australia, the National Heart Foundation of Australia, and the National Stroke Foundation of Australia. For more detailed information, particularly concerning treatments and levels of evidence to support the recommendations outlined in this statement, refer to the source guidelines and literature (see References).

Aged↗
PubMed1991

Effect of sulodexide on blood viscosity in patients with peripheral vascular disease.

Thirty patients with Stage II peripheral vascular disease were treated with sulodexide, a new, medium molecular weight glycosaminoglycan, and placebo using a double-blind, crossover study design. After a 1-month wash-out period, patients were treated for 1 month with one or other trial medication and then crossed over to the alternative preparation for a further month. Measurements were made at baseline and at the end of each treatment period of serum, plasma and whole blood viscosities (at various shear rates), fibrinogen levels and red cell filterability. Tolerance parameters were also assessed at the same times. The results showed that there were statistically significant reductions in plasma and whole blood viscosity and in fibrinogen levels after sulodexide, but not after placebo. Neither treatment had any marked effect on red blood cell filterability. Local and systemic tolerance of the treatment was excellent, and some patients reported an improvement in symptoms whilst they were taking sulodexide; this, however, could not be quantified in this study. It is suggested that the viscosity and fibrinogen reducing effect of sulodexide make it a useful form of treatment in patients with atheromatous vascular diseases of the lower limbs.

Adult↗