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PubMedDate not supplied

Carbohydrate metabolism and plasma levels of insulin and glucagon in patients with atherosclerotic vascular disease.

In non-obese, non-diabetic patients suffering acute myocardial infarction, angina pectoris, previous myocardial infarction and peripheral vascular disease, the plasma levels of glucose, insulin, C-peptide and glucagon were determined in basal condition and during an intravenous glucose tolerance test. In the four groups there was a high frequency of glucose intolerance. Basal hyperinsulinism was present in all groups; in groups; in those which maintained normal glucose tolerance there was a high B-cell response to the sugar. Basal hyperglucagonemia was found in the early stage of acute ischemic heart disease, in patients with previous myocardial infarction and in those with peripheral vascular disease. The elevated plasma glucagon levels may play a role in the complex disturbance of carbohydrate metabolism present in patients with atherosclerotic vascular disease.

Adult↗
PubMed1993

Treatment of peripheral vascular diseases--basic data from the nationwide vascular registry FINNVASC.

A national vascular registry, the FINNVASC registry, was introduced in Finland in the beginning of 1991. The registry covers the whole country--Finland has a population of 5.0 million habitants. During the first two years 8047 procedures were registered together with a 30-day follow-up. The number of surgical operations amounted to 5494 (68.3%), while the remaining 2553 procedures were endovascular. 22% of the surgical and 6.9% of the endovascular procedures were made as emergencies; about 10% of any procedure were reoperations. The indications for surgery were chronic limb ischaemia in 40.2% and acute limb ischaemia in 11.9%. Surgery of abdominal aortic aneurysm was indicated in 13.1% and surgical procedures in the aortocervical region in 13.3%. Access surgery was performed in 8.0% of the patients. Chronic limb ischaemia was the main indication, 92.1%, for the endovascular procedures, and renal artery stenosis was the second most frequent endovascular procedure, 2.7%. The mean length of hospital stay for surgical patients was 10.7 days and for patients treated with endovascular procedures 4.7 days. Patient outcome of 30 days of follow-up was comparable with the reports from other centres.

Adolescent↗
PubMed1988

Prevalence, risk factors and rheological profile of arterial vascular disease; first results of the Aachen study.

During a prospective cohort-study of several year's duration the results of a survey regarding prevalence of arterial occlusive disease, as well as classical risk factors and rheological profile of patients suffering from vascular disease were examined. 364 patients out of a total of 2,498 individuals suffered from vascular disease. 168 (6.7%) had cardiovascular, 151 (6.0%) cerebrovascular and 109 (4.4%) peripheral vascular disease. Compared to to healthy individuals, the patients showed a significant accumulation of classical risk factors (elevated cholesterol and triglyceride values, decreased HDL-cholesterol concentration, obesity, smoking, high blood pressure, gout or diabetes mellitus). Only 30.2% of the healthy controls presented two or more risk factors, whereas the angiological patients showed two or more risk factors in 71.9%. Rheological parameters measured in the survey were: Plasma viscosity, erythrocyte and platelet aggregation, erythrocyte rigidity and hematocrit. Only 14.2% of the healthy individuals had two or more rheological parameters exceeding the 1-s range, whereas 56.6% of the patients showed two or more elevated rheological parameters.

Aged↗
PubMed1990

[Usefulness of ventilation and perfusion scans in patients with collagen-vascular diseases].

We studied 32 patients with collagen-vascular diseases with Xe-133 ventilation scans (V) and Tc-99m MAA perfusion scans (Q). Five patients underwent sequential studies at intervals of more than 3 months. Mean transit time (MTT) was calculated from the Xe-133 wash-out curve. V, Q images and MTT were compared with chest X-ray films and the values of %DLco. Of 32 patients, 17 had no abnormal finding on the chest X-ray films. Of the 17 patients, however, V and/or Q abnormalities were found in 10 (59%), 14 patients (82%), respectively. Every patient with abnormal findings on the chest X-ray film showed both V and Q abnormalities. Overall, Q abnormality was more frequent and severer than V one. Of the 5 patients with the sequential studies, 3 showed prolongation of MTT in concordance with deterioration of pulmonary fibrosis. V and Q abnormalities were not necessarily relevant to %DLco. In conclusion, ventilation and perfusion studies are useful in assessing the regional pulmonary function in patients with collagen-vascular diseases.

Adult↗
PubMed1999

A cholesteryl ester transfer protein gene mutation and vascular disease in dialysis patients.

Among patients undergoing maintenance hemodialysis, a decreased high-density lipoprotein cholesterol (HDL-C) concentration is among the most common abnormalities of lipid metabolism and apparently is an independent risk factor for vascular disease. A common missense mutation of cholesteryl ester transfer protein gene, D442G (Asp 442 to Gly), increases HDL-C levels through the reduced activity of cholesteryl ester transfer from HDL to VLDL, but the mutation also may lead to reduced activity of reverse cholesterol transport. To investigate the effect of the D442G polymorphism on atherosclerotic complications in dialysis patients, the genotype and allele frequency of the polymorphism were determined in 414 unselected dialysis patients and 220 control subjects, and postprandial serum lipid levels were measured in the dialysis patients. A similar genotype distribution was found between hemodialysis patients and healthy control subjects, and in dialysis patients with and without vascular disease. Serum levels of total cholesterol and HDL-C did not differ between patients with and without the mutation and in patients with and without vascular disease. However, patients with sub-median HDL-C levels (<45 mg/dl) had an independent odds ratio of 1.8 for vascular disease (95% confidence interval, 1.04 to 3.2; P < 0.05). In this low-HDL-C subgroup, patients with the D442G mutation had a significantly higher prevalence of vascular disease than those with no mutation (54.5% versus 24.4%; P < 0.05), and an independent odds ratio of 4.9 (95% confidence interval, 1.05 to 22.65; P < 0.05). In conclusion, the D442G mutation is an independent risk factor for atherosclerotic complications in dialysis patients with HDL-C levels below 45 mg/dl.

Adolescent↗
PubMed1989

Therapy of lower extremity infections with ciprofloxacin in patients with diabetes mellitus, peripheral vascular disease, or both.

PURPOSE: Lower extremity infections in the presence vascular insufficiency are difficult and costly to treat. Few well-controlled clinical trials evaluating the management of these infections exist. We decided to investigate the ability of a new fluoroquinolone, ciprofloxacin, to reduce the morbidity associated with these infections and the amount of in-hospital time required for the administration of antibiotic therapy. PATIENTS AND METHODS: Forty-eight patients with peripheral vascular disease (46 with diabetes mellitus) who presented to the hospital for treatment of lower extremity infections were randomized in a blinded fashion to receive oral ciprofloxacin at a dosage of either 750 mg or 1,000 mg twice daily. Patients with osteomyelitis received three months of therapy and those with infections limited to soft tissues, three weeks of ciprofloxacin treatment. All subjects were followed for one year. RESULTS: One patient received an amputation 24 hours after enrollment, and two patients discontinued therapy after 20 and 34 days because of adverse effects and were not evaluable. At the one-year follow-up, 27 of the 45 (60 percent) evaluable patients had a fully successful outcome defined as not requiring either repeat antimicrobial therapy for their initial infection or amputation of the involved extremity. In the group of 18 patients in whom therapy failed, a total of only nine amputations were required. In the 15 patients whose lesion closed during therapy, 93% (14 patients) experienced a long-term successful outcome. CONCLUSION: Treatment with this new fluoroquinolone offers promise for the improved outcome of patients with the serious infectious complication of infected lower extremity ulcerations in peripheral vascular disease, diabetes mellitus, or both.

Adult↗
PubMed1987

Relationship between vascular disease and age-associated changes in the human kidney.

To investigate the relationship between atherosclerotic vascular disease and age-associated changes in the normal human kidney, autopsy findings and renal histology from 57 individuals with mild systemic atherosclerosis (group I), were compared to 57 sex- and age-matched individuals with moderate-to-severe atherosclerosis (group II). Age, sex, body build, the presence or absence of hypertension, semiquantitative aorta and coronary-artery atherosclerosis scores, organ weights, and the percent of globally sclerotic glomeruli were determined in each. Glomerular area, arcuate/interlobular arteries, and percent interstitial fibrosis were measured using standard morphometric techniques. Group I individuals had a 8.3 +/- 7.0% incidence of sclerotic glomeruli, compared to 15.4 +/- 16.3% in group II (mean +/- SD, P less than 0.01). Relative intrarenal arterial wall area was increased in group II (60 +/- 12%) compared to group I (55 +/- 11%, P less than 0.05). The mean glomerular area of nonsclerotic glomeruli was greater in group II (23,700 +/- 6,000 sq mu) than in group I (19,600 +/- 3,700 sq mu, P less than 0.01), suggesting that there were compensatory increases in glomerular size in group II. Interstitial fibrosis was similar in both groups. The relative impact of age, sex, body build, hypertension, systemic atherosclerosis, intrarenal vascular disease and interstitial fibrosis on glomerulosclerosis and glomerular size was investigated using multiple linear regression. Both age and intrarenal vascular disease exhibited highly significant, independent associations with glomerulosclerosis. Glomerular area was positively correlated with heart weight and coronary artery atherosclerosis. In contrast, there was no independent correlation between glomerular area and glomerulosclerosis.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1998

Inhibition of neointimal cell bcl-x expression induces apoptosis and regression of vascular disease.

We postulated that activation of a genetic program that tonically inhibits intimal cell death is a necessary condition for the pathogenesis of vascular disease. Studies of vascular lesions in humans and animal models documented increased expression of the anti-apoptotic gene product Bcl-xL within intimal cells. Downregulation of intimal cell bcl-xL expression with the use of antisense oligonucleotides induced apoptosis and acute regression of vascular lesions. These findings indicate that apoptosis regulatory genes such as bcl-xL are critical determinants of intimal lesion formation and that targeted apoptosis may be a novel therapy for intimal vascular disease.

Animals↗
PubMed1999

Collagen vascular diseases and radiation therapy: a critical review.

PURPOSE: Although many oncologists have the impression that patients with collagen vascular disease tolerate radiotherapy less well than other patients, until now this was never described in a review article. METHODS AND RESULTS: The principal objective was to determine whether patients with collagen vascular diseases have a greater risk of severe radiation therapy complications, than those without a collagen vascular disease. However, most of the publications found on this topic are short anecdotal case reports of patients with increased toxicity after radiation. Consequently, the true incidence of these side effects is unknown. CONCLUSIONS: Unless further studies on this subject are reported, each radiation oncologist should be cautious in treating these patients.

Adult↗
PubMed1958

Cerebral vascular diseases; certain clinical and electroencephalographic aspects.

In a preliminary study of 52 patients with cerebral vascular disease, clinical and electroencephalographic evaluations were compared. Most of the patients were in the sixth and seventh decade of life and had had symptoms of cerebral vascular disease for over a year. Seventeen of the patients had clinical evidence of intermittent cerebral ischemia. When routine electroencephalographic techniques were used, 47 per cent of the records were within normal limits. Twenty patients with cerebral vascular disease, eight of whom had clinical cerebral vascular insufficiency, were studied during posturally induced hypotension. No activation was detected in any of these 20 patients. It would appear that other methods of activation, including tilt-table studies, and serial recordings should be further explored and evaluated in these disorders if more clinically useful information is to be gained.

Brain↗
PubMed2003

Fibroblastic foci in usual interstitial pneumonia: idiopathic versus collagen vascular disease.

A histologic feature of usual interstitial pneumonia is the presence of fibroblastic foci. As some patients with usual interstitial pneumonia and an underlying collagen vascular disease have a better prognosis, we hypothesized that they would have fewer fibroblastic foci. Pathologists reviewed surgical lung biopsies from 108 patients with usual interstitial pneumonia (nine with collagen vascular disease) and assigned a score (absent 0, mild 1, moderate 2, and marked 3) for fibroblastic foci. Patients with idiopathic usual interstitial pneumonia had a higher median profusion of fibroblastic foci (1.75 vs. 1.0, p = 0.003). Baseline characteristics were similar, although patients with a collagen vascular disease were younger, had a shorter duration of symptoms, and had a higher percentage of predicted total lung capacity. Profusion of fibroblastic foci was the most discriminative feature for separating idiopathic from collagen vascular disease-associated usual interstitial pneumonia (odds ratio 8.31; 95% confidence interval, 1.98, 59.42; p = 0.002 for a one-unit increase in fibroblastic foci score). No deaths were noted in the collagen vascular disease-associated usual interstitial pneumonia group; 52 deaths occurred in the idiopathic usual interstitial pneumonia group (log rank; p = 0.005). We conclude that patients with collagen vascular disease-associated usual interstitial pneumonia have fewer fibroblastic foci and improved survival.

Analysis of Variance↗
PubMedDate not supplied

Cost-efficacy issues in the treatment of peripheral vascular disease: primary amputation or revascularization for limb-threatening ischemia.

Controlling rising health care costs represents a major challenge to our society. Due to the aging of the population and the increasing number of patients with vascular disease, vascular specialists will be under mounting pressure by the managed care industry to provide the most cost-effective care for these patients. One particular controversy is whether to attempt revascularization in the patient with limb-threatening ischemia or to proceed directly with primary amputation. Although it has been assumed that the operative risk for revascularization procedures is high in elderly patients with a severely ischemic limb, mortality rates in the sickest patients are actually higher for amputation. It is also incorrect to assume that the duration of hospitalization is shorter for patients undergoing amputation than for patients undergoing revascularization. For both types of procedures, it is complications that prolong the length of hospital stay, and the rate of secondary amputation following a revascularization attempt is low (8.5%), compared with the rate of operative revision in patients following primary below-knee amputation (23%). The costs for revascularization and primary amputation are similar when the costs of a prosthesis and rehabilitative therapy are included in the calculations for amputation. The rationale for primary amputation assumes that patients will ambulate successfully with a prosthesis; however, many do not, and thus costs for institutionalization must be included in the equation. Long-term costs following revascularization were $28,374 in patients with a viable limb, compared with $56,809 in those undergoing secondary revascularization. The key to minimizing health care costs in this population is careful patient selection for initial revascularization, with aggressive long-term surveillance to ensure graft patency and limb viability.

Activities of Daily Living↗
PubMed1993

Does crossing the legs decrease arterial pressure in diabetic patients with peripheral vascular disease?

OBJECTIVE: To evaluate the effect of crossing the legs at the knee and the ankle on peripheral arterial pressures. RESEARCH DESIGN AND METHODS: A prospective study of 6 diabetic patients with known peripheral vascular disease and 5 nondiabetic control subjects without peripheral vascular disease was conducted. Peripheral arterial pressures were taken at the ankle and at the great toe before and after crossing the legs at the knees and ankles. Comparisons were made of measurements obtained in the supine and sitting positions. All crossed leg measurements were taken in the sitting position. RESULTS: Ankle arm indexes and digital arm indexes pressures taken in the sitting position were equal to or higher than supine pressures, with the exception of one subject, GB. In this patient, ankle arm indexes and digital arm indexes on the right extremity were lower in the sitting position, but increased with the legs crossed at the knees and ankles compared with the uncrossed sitting position. In all patients, lower extremity pressures that decreased slightly with crossing the legs remained higher than pressures obtained in the supine position. Statistical analyses showed no significant differences. Wave forms did not change even when there was a slight decrease in ankle arm indexes or digital arm indexes. Control subjects without peripheral vascular disease showed no change in pressures with crossing the legs. CONCLUSIONS: Crossing the legs at the knees and ankles does not result in a significant decrease in peripheral arterial pressures in diabetic patients with peripheral vascular disease.

Analysis of Variance↗