Roentgen diagnosis of ruptured aneurysm of the abdominal aorta.
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Digital subtraction angiography (DSA) was used to study the cardiovascular system in more than 400 patients and was specifically compared with conventional angiography of the aorta and renal arteries in 30 patients. For the renal arteries, the overall accuracy of DSA was 71% (50/70). Excluding 11 cases of inadequate visualization of the renal arteries on DSA, the sensitivity of the new technique was 93% (55/59) and the specificity 91.5% (54/59). Aortic disease, including intravascular clots and occlusions, was faithfully delineated by DSA.
The optimal treatment for recurrent coarctation of the aorta remains undefined. Recurrent stenosis following surgical repair occurs in 6-48% of cases involving the thoracic aorta. Because of the high morbidity and mortality associated with surgery, an alternate approach such as transluminal angioplasty is desirable. To evaluate this possibility, the authors created several experimental lesions to test their capability for dilatation, using the percutaneous transluminal technique. The results indicate that balloon dilatation of coarctation after end-to-end anastomosis is difficult or impossible. Dilatation of other types of suture lines may also be difficult due to the large amount of fibrous tissue at the anastomotic site, which is not amenable to balloon dilatation. Thus surgery remains the preferred form of therapy.
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Arteriographic measurements were made in 73 consecutive women undergoing arterial reconstruction for aorto-iliac occlusive disease. The anatomical distribution of atherosclerosis was unaffected by arterial size. Women with isolated aorto-iliac atherosclerosis had the same size arteries as those with concomitant outflow disease. Aortic, iliac, and femoral artery diameters were distributed as a single group, with no distinct subgroup of "small arteries." However, women whose aorta was less than 1 S.D. below the mean were younger and had less cardiovascular disease even when the effects of age and body size on arterial diameter were excluded. Women with this statistical definition of "small aorta" were clinically analogous to those previously identified anecdotally. The authors propose that a "small aorta" in a women with aorto-iliac atherosclerosis be defined as less than 19 mm in diameter above and less than 13 mm below the renal arteries and less than 10 mm at the bifurcation.
CGRP is a well-known neuropeptide that has various protective effects on cardiovascular system. Our previous studies have shown that CGRP inhibits vascular smooth muscle cell (VSMC) proliferation in vitro. The present study aimed to explore the role of the CGRP in neointimal formation after balloon injury in the rat aortic wall and the underlying mechanism. Gene transfer of CGRP was performed with the use of intramuscular electroporation in a balloon-injured rat aorta model. Apoptosis in VSMCs was determined by electrophoresis assessment of DNA fragmentation and terminal deoxynucleotide transferase-mediated dUTP nick-end labeling assay. Overexpression of the CGRP gene significantly inhibited the neointimal formation after balloon injury compared with the mock transfer, as assessed by the intima-to-media ratio 14 days after balloon injury (29.2 +/- 3.7% vs. 52.7 +/- 5.4%; n = 9-12, P < 0.05). In addition, CGRP gene expression increased the number of apoptotic cells in the neointima in vivo 14 days after balloon injury. Similarly, the addition of bioactive CGRP and the nitric oxide donor induced similar apoptosis in cultured VSMCs. The antagonist of the CGRP(1) receptor and inhibitors of cAMP-PKA and nitric oxide blocked CGRP-mediated apoptosis. Furthermore, CGRP gene transfer increased inducible nitric oxide synthase and p53 but decreased PCNA and Bcl-2 protein levels in balloon-injured rat aorta. Our data demonstrated that CGRP potently inhibited neointimal thickening in the rat aorta, at least in part through its distinct effects on apoptosis and proliferation of VSMCs both in vivo and in vitro. Therefore, delivery of the CGRP gene may have therapeutic implications in limiting vascular restenosis.
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In the intima of a vein grafted into the aorta, the thromboplastic activity during the first 4 months after the operations is higher than in the artery and vein. At the same time, the plasminogen activator activity of the venous graft is also higher than that of the artery but lower than that of the vein. In the later post-operative period, both activities of the intima of the venous graft closely approaches those of the intima of the normal vein. In the media the thromboplastic activity is lower in the graft and the plasminogen activator content is higher than in the artery and vein. However, the thromboplastic and fibrinolytic activity in the adventitia of the venous graft, artery, and vein did not change significantly during the 36-month observation period of the experiment.
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