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PubMed2001

The role of infectious agents in pulmonary and systemic vascular disease.

With emphasis on the pulmonary circulation, three general types of vascular disease are discussed: fibroproliferative (atherosclerosis), cellular proliferative (endothelial neoplasms) and inflammatory (granulomatous vasculitis). The causes of these phenotypic responses are invariably multifactorial, but infectious agents including viruses, Chlamydia, Helicobacter, Rickettsia, mycobacteria and other infectious agents have been increasingly implicated in the pathophysiology. The classifications of vascular diseases are complicated and confusing and many eponymous diseases are specific variations of more general disease processes. The pivotal role of the monocyte/macrophage and T-cells is discussed, particularly with regard to intracellular infections. In addition to antimicrobial therapy, modifications of macrophage function by IFN-gamma and blockade of TNF are attractive areas for therapeutic research. Diseases with many synergistic causes will probably also require multifaceted therapeutic interventions.

Animals↗
PubMed1993

Occult retinal and choroidal vascular disease. The value of timed and directed fluorescein angiography.

BACKGROUND: Acute vascular disease of the choroid or large vessels of the retina is usually accompanied by funduscopic signs. In instances of monocular visual loss, such objective signs are important diagnostic clues that the pathology is in the eye and not in the optic nerve. METHODS: Fluorescein angiography was timed in a consistent manner, and photographs were taken at two frames per second. Orientation of the camera was customized for each patient based on the location of the visual field defect. RESULTS: Eight patients with monocular visual loss were referred because the cause of the visual loss was not evident. In each patient, fluorescein angiography showed vascular disease of either the choroid or retina, despite normal-appearing fundi. CONCLUSIONS: Fluorescein angiography can detect otherwise occult vascular disease of the retina or choroid. In eyes with monocular scotomas, the angiogram should be performed with the camera oriented with respect to the location of the visual field defect. Accurately timed, rapid sequence photography provides additional information about rate and symmetry of flow. Focal areas of hypoperfusion often are incidental but deserve added consideration when they correspond to the location of a scotoma.

Adult↗
PubMed1994

Vascular disease outcome and thrombocytosis in diabetic and nondiabetic end-stage renal disease patients on peritoneal dialysis.

STUDY OBJECTIVE: to evaluate vascular disease and its outcome in association with thrombocytosis in chronic peritoneal dialysis (PD) patients. DESIGN: the study was designed to investigate possible correlations between severity of vascular disease and thrombocytosis in PD patients. SETTING: tertiary-referral university hospital. PATIENTS AND METHODS: serial blood platelet levels were measured in 53 stable PD patients (32 male, 21 female; mean age 55 years; mean duration of PD 19 months) between January 1991 and July 1992. Twenty-four patients were diabetic and 29 were nondiabetic. Mean duration of PD was 23 and 36 months in diabetic and nondiabetic patients, respectively. Severity of coronary arterial disease (CAD), carotid arterial disease (CNS), and peripheral arterial disease (PAD) was assessed using the Craven et al. (1991) ESRD Severity Index, a measure of organ dysfunction. Functional status was assessed using the Karnofsky Performance Status Index (KPSI). RESULTS: eighteen out of 53 PD patients (34%) had platelet counts exceeding 300,000/mm3 for six months or longer. Thirteen of 24 diabetic PD patients (54%) had thrombocytosis. Blood platelets were significantly (p < 0.01) higher in diabetic (324,000 +/- 27,000/mm3) than in nondiabetic PD (236,000 +/- 11,000/mm3) patients. In the PD group as a whole, a positive correlation was observed between blood platelet and serum cholesterol (r = 0.5, p < 0.001), blood platelet and PAD (r = 0.5, p < 0.001), and blood platelet and CAD (r = 0.35, p < 0.05). No correlation was found with age or duration of PD. In diabetic PD patients, blood platelet counts correlated significantly with PAD (r = +0.5, p < 0.01) and CAD (r = +0.4, p < 0.05) indexes. No correlation was observed between blood platelet and CNS or KPS indexes. In nondiabetics, no correlation was observed between blood platelet and CAD, PAD, CNS, or KPS indexes. CAD, PAD, and KPS indexes were significantly higher in diabetics compared to nondiabetics. CONCLUSIONS: thrombocytosis, particularly in diabetic PD patients, appears to be associated with the severity of PAD and CAD.

Cholesterol↗
PubMed2003

Relation of C-reactive protein and other cardiovascular risk factors to penile vascular disease in men with erectile dysfunction.

Erectile dysfunction (ED) may be an early sign or symptom of cardiovascular disease (CVD). We examined the relation of traditional and emerging risk factors for CVD to the severity of penile vascular disease in men with ED and without clinical coronary artery disease (CAD). In total, 137 men with ED were evaluated for penile vascular disease severity by penile Doppler ultrasound. These men were divided into the following groups based on ultrasound results: normal, cavernous venous occlusive disease, mild arterial insufficiency, and severe arterial insufficiency. Traditional (fasting lipid panel, fasting glucose, age, BMI, smoking, Framingham coronary artery disease risk score) and emerging (C-reactive protein, Lp(a), homocysteine) risk factors for CVD were correlated to severity of penile vascular disease in men with ED and without clinical CAD. Using univariate analysis, penile Doppler groups showed significant positive correlation to CRP (r=0.21; < or = 0.05) and age (r=0.30; < or = 0.01). For CRP, this correlation remained significant even when adjusted for age (< or = 0.05). Men displaying evidence of penile arterial disease (mild and severe arterial insufficiency) were characterized by elevated CRP levels (0.17 mg/dl) compared to men with no evidence of arterial abnormalities in the penis (0.04 mg/dl). CRP levels correlate significantly with increasing severity of penile vascular disease as measured by penile Doppler.

Adult↗