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Quantitative analysis of pulmonary vascular disease in complete transposition of the great arteries.

Forty autopsy cases of complete transposition of the great arteries (TGA) and 22 autopsy cases of ventricular septal defect (VSD) were analyzed histologically for evidence of vascular damage due to pulmonary vascular disease (PVD). Positive correlations were generally observed between an index of pulmonary vascular disease (IPVD) and blood pressure of pulmonary circulation. No significant difference in IPVD was found between TGA and VSD in the first five months of life, when cases of each disease were compared at similar blood pressure levels. After that age, however, IPVD was much higher in TGA, and particularly severe PVD in this disease was demonstrated histologically. Morphometrical analysis of the pulmonary artery revealed hypertrophy of the muscular cost in response to elevated blood pressure. However, the progress of medial hypertrophy was retarded in TGA in the first five months, and medial thickness in arteries of cases of TGA older than five months was only 70% of that in VSD at the same blood pressure levels. Suppression of this process of reinforcement of the arterial wall in response to the stress of high pulmonary pressure was regarded as one of the important factors precipitating severe pulmonary vascular disease in transposition of the great arteries.

Adolescent↗

[Diagnostic value of digital subtraction angiography (DSA) using Toshiba Digiformer X in the cerebrospinal vascular diseases].

Using TOSHIBA Digiformer X, digital subtraction angiography (DSA) was performed in 286 patients, in whom 229 patients of cerebro-spinal vascular disease was included. The authors emphasize the usefulness of DSA in cerebro-spinal vascular disease in relation to conventional angiography. DSA taken by single small dose injection of contrast medium into the ascending aorta clearly demonstrates not only aortic arch and thoracic major vessels, but also cervical vessels and all intracranial vessels. Therefore, we could rapidly understand gross dynamics of the circulation and obtain useful informations prior to catheterization to the selective artery. This advantage of DSA was particularly useful for occlusive vascular diseases. Gradual injection of small dose of contrast medium obviously reduced recoiling of the catheter tip, which enabled the selective angiography with setting of the tip of the catheter at the entrance of cervical major vessels without its sufficient insertion into the selective vessels. This advantage is particularly beneficial for the patients with severe arteriosclerosis who was found to be difficult for selective catheterization. In our experience, demonstration of a presence of aneurysm by DSA was possible in almost all cases of subarachnoid hemorrhage, although spatial resolution of DSA is said to be inferior to the conventional angiography. Real time display of DSA decreased the time required for examination and enabled repeated angiography. This advantage of DSA is especially useful for the patients with spinal arterio-venous malformation and thoracic outlet syndrome.

Cerebral Angiography↗

Selection criteria for breast conservation. The impact of young and old age and collagen vascular disease.

BACKGROUND: Selection criteria applicable to women desiring breast-conserving surgery and radiation for early invasive breast cancer have evolved over the last decade. The presence of active collagen vascular disease has emerged as a contraindication for this treatment. The roles of both young and old age have been debated by many authors, although a growing body of literature supports the impact of age on both local control and disease free survival. METHODS: This is a review of the literature addressing these selection criteria. RESULTS: A consensus exists regarding the impact of preexisting collagen vascular disease on the anticipated complications with breast-conserving radiation, despite small numbers reported. A young age, although not always a statistically significant factor, emerges as a consistent predictor for both local and distant failures. This is true not only for patients who opt for breast conservation but also those who are treated with mastectomy. To the contrary, preliminary data suggests that older age is emerging as a predictor for improved local and regional control. CONCLUSIONS: Preexisting collagen vascular disease is a contraindication for the use of breast-conserving radiation and surgery. Extremes of age must be considered in terms of recommending not so much a specific local regional treatment, but an overall strategy. For the very young patient with breast cancer, more aggressive systemic therapy should be considered in addition to the appropriate local regional therapy. For the elderly, preliminary pilot studies suggest that tamoxifen may play a role in local as well systemic control, perhaps opening the door for future trials examining the need for radiation in selected elderly patients.

Adult↗

Cervical paraspinal calcification in collagen vascular diseases.

Although soft-tissue calcification is common in collagen vascular disease, paraspinal calcification in the cervical spine has not been described before. We studied five women with large, lobulated, predominantly homogeneous calcific masses centered on synovial articulations in the neck. Changes consisting of either osteolysis or erosions were evident. All patients had radiculopathy, focal pain, or stiffness. In two patients, the presence of hydroxyapatite crystals was confirmed on biopsy. Symptomatic cervical paraspinal calcifications in patients with collagen vascular disease cause large soft-tissue masses that mimic tumoral calcinosis.

Aged↗

Pulmonary endocrine cells in hypertensive pulmonary vascular disease.

A study was made of the number of pulmonary endocrine cells, immunoreactive for gastrin-releasing peptide (bombesin) or calcitonin, in the terminal bronchioles of 39 cases of pulmonary vascular disease. In 25 of these, the form of vascular disease was plexogenic pulmonary arteriopathy, primary in 12 and secondary in 13, while the remaining 14 subjects had a wide range of other varieties of hypertensive pulmonary vascular disease. We found that pulmonary endocrine cells, especially those containing bombesin, were increased in number in both the primary and secondary forms of plexogenic pulmonary arteriopathy but not in other varieties of pulmonary hypertension. The prominent bombesin-containing cells were found in cases with cellular plexiform lesions but occurred even more prominently at an earlier stage when vascular smooth muscle cells were migrating from the inner media into the intima.

Adult↗

Calcified plaque is common in the carotid and femoral arteries of dialysis patients without clinical vascular disease.

BACKGROUND: Cardiac and vascular mortality are common in end-stage renal disease (ERSD) and are often attributed to accelerated atherosclerosis. SUBJECTS AND METHODS: We studied 24 non-diabetic ESRD patients without cardiac or vascular disease (M = 12, F = 12) and 24 age-, sex- and race-matched healthy controls. All underwent B-mode ultrasound for carotid and femoral intima media thickness (IMT) and plaque (% stenosis) together with blood pressure (BP), and echocardiograms to determine left ventricular mass. RESULTS: Both BP and mean IMT were similar in patients and controls. However, discrete plaque was present in 71% (17/24) of patients compared with 21% (5/24) of controls (P = 0.001), and % stenosis was greater in patients (carotid 12.2 +/- 11% vs 2.3 +/- 5.9%, P < 0.0004; femoral 16.4 +/- 19.1% vs 3.1 +/- 6.4%, P < 0.003). Plaque was soft/atheromatous in 3 of the 5 controls, but not in any of the 17 patients (P = 0.007), all of whom had calcified lesions. BP and cholesterol were not correlated with IMT or plaque in patients, but in control subjects carotid IMT was correlated with systolic BP (r = 0.66, P < 0.0005) and diastolic BP (r = 0.45, P < 0.03). In patients, the only independent variables related to vascular morphology were serum albumin which was inversely related to IMT (P < 0.03) and to plaque (carotid P < 0.05, femoral P < 0.02) and age, which was related to femoral plaque only (P < 0.04). Left ventricular end-diastolic internal dimension, not LVMI, correlated positively with carotid IMT (P < 0.04). CONCLUSION: Our results show that calcified plaque is common in ESRD patients and hypoalbuminaemia may be an associated factor.

Adult↗

Associations of serologic markers of infection and inflammation with vascular disease events and mortality in American dialysis patients.

BACKGROUND: Inflammatory markers predict cardiovascular risk and mortality in endstage renal disease. The relationship of chronic infections to inflammation and vascular disease events has not been reported among American dialysis patients. METHODS: We performed a cross-sectional and prospective study of a multiracial cohort of 97 chronic hemodialysis patients in California. Anti-Chlamydia pneumoniae IgA and IgG antibodies (Cp-IgA and Cp-IgG), anti-Helicobacter pylori antibodies (Hp-IgG), and highly sensitive C-reactive protein (hsCRP) levels were measured at enrollment. We ascertained the prevalence of atherosclerotic vascular (coronary artery, cerebrovascular, and peripheral vascular) disease (AVD) events, and observed participants for at least 1 year for incident events and mortality. We defined statistical significance as P < 0.01. RESULTS: Elevated hsCRP levels (77%) and seropositivity to C. pneumoniae were common (Cp-IgA, 49%; Cp-IgG, 64%), whereas the seroprevalence of Hp-IgG was relatively low (25%). The hsCRP levels did not vary with infection status. In bivariate analysis, Cp-IgA and Cp-IgG were each associated with approximately fourfold higher odds of prevalent AVD (P < 0.01). Although anti-chlamydial antibodies maintained nearly significant associations with AVD after covariate adjustment (P < 0.05), antibodies did not predict outcomes over the period of observation. However, hsCRP was a nearly significant independent predictor of prevalent AVD (P = 0.02) and of mortality during follow-up (P = 0.01). We did not detect an association of Hp-IgG with any study outcome. CONCLUSIONS: Our findings generalize a possible link between C. pneumoniae and prevalent atherosclerosis in American hemodialysis patients and confirm the importance of hsCRP as a prognostic indicator. Our work does not support H. pylori as an important mediator of cardiovascular risk in dialysis patients.

Adult↗

Peripheral vascular disease and one-year mortality following percutaneous coronary revascularization.

The association between peripheral vascular disease and outcomes after percutaneous coronary intervention was examined in the Do Tirofiban and Reopro Give Similar Efficacy Outcome Trial (TARGET). After adjustments in a multivariate model, a history of peripheral vascular disease was found to be associated with a two- to threefold increase in mortality at 1 year after coronary stent placement.

Aged↗

The knowledge of hospital patients about vascular diseases and their risk factors.

The knowledge of 28 stroke patients on the nature, consequences, treatment and risk factors of stroke and ischaemic heart disease was examined using a questionnaire and compared with that of 26 patients with ischaemic heart disease and 41 controls without evidence of vascular disease. Information was also collected on the patients' willingness to change their life-style, the information and advice they had received and their desire for more information. It was found that about half of the elderly stroke and heart disease patients had a reasonable knowledge of the condition and its related risk factors. Only eight (14%) patients remembered receiving information and advice in relation to their condition during their hospital stay compared with one (2%) control. There was a significant difference between the number of stroke and heart disease patients who wanted to know more about their condition compared with the control group (32 vs 14; p = 0.03). A quarter of the patients and half of the controls knew that fruit and vegetables were good for you and excessive fat and alcohol were less inducive to good health. Most patients with a risk factor were willing to exercise more, stop smoking, cut down on their drinking, or lose weight. These results suggest that elderly hospital patients have a reasonable basic knowledge about vascular diseases, but that a significant number want to know more and would be willing to change their life-style.

Aged↗

Epidemiological evidence for the association of hyperglycaemia and atherosclerotic vascular disease in non-insulin-dependent diabetes mellitus.

Non-insulin-dependent diabetes mellitus (NIDDM) increases the risk for all manifestations of atherosclerotic vascular disease, coronary heart disease (CHD), cerebrovascular disease and peripheral vascular disease. Only a small proportion of this excess risk can be explained by the effects of conventional cardiovascular risk factors, which implies that the diabetic state or factors related to it have to play a significant role in the pathogenesis of macrovascular disease in NIDDM. Six recent prospective population-based studies including a large number of NIDDM patients have indicated that poor glycaemic control evaluated by fasting hyperglycaemia or glycosylated haemoglobin levels increases the risk for CHD, stroke and amputation independently of other risk factors. A dose-response relationship between markers of glycaemic control and the incidence of cardiovascular mortality and morbidity has been demonstrated in all these studies. However, there is so far no direct proof that strict glycaemic control would delay or prevent atherosclerotic complications.

Adult↗

Does arsenic exposure increase the risk of development of peripheral vascular diseases in humans?

Arsenic has been well documented as a major risk factor in the development of blackfoot disease (BFD), a unique peripheral vascular disease (PVD) endemic to the southwestern coast of Taiwan, where residents imbibed artesian well water containing excessive amounts of arsenic for more than 50 yr. Long-term arsenic exposure was also reported to be associated with mortality attributed to PVD. A tap-water supply system was implemented in the early 1960s in the BFD endemic areas. Artesian well water was no longer used for drinking and cooking after the mid-1970s. The objective of this study was to examine whether mortality attributed to PVD decreased after the consumption of artesian well water containing high concentrations of arsenic ceased and, if so, when the reduction occurred. Standardized mortality ratios (SMRs) for PVD were calculated for the BFD endemic area for the years 1971-2003. Cumulative-sum techniques were used to detect the occurrence of changes in the SMRs. Data showed that mortality due to PVD declined gradually for approximately 25 to 27 yr following cessation of consumption of this arsenic artesian well water. Based on the reversibility criterion, the association between arsenic exposure and PVD-attributed mortality is likely to be causal.

Arsenic Poisoning↗

The prevalence of peripheral vascular disease in type 2 diabetic patients with and without proteinuria.

It has been reported that albumin excretion rate may reflect not only an indication of renal disease but also a widespread vascular damage. We studied the relationship between overnight albumin excretion rate (AER) and peripheral vascular disease (PVD), using Doppler ultrasound, and its major risk factors in 80 Type 2 (non-insulin-dependent) diabetic patients. Thirty-eight of these patients had normoalbuminuria (AER < 30 micrograms/min), 22 had microalbuminuria (30-200 micrograms/min) and 20 had macroalbuminuria (> 200 micrograms/min). Patients with macroalbuminuria were older than those with normoalbuminuria (p < 0.01) and they also had a longer duration of diabetes (p < 0.05). Patients with elevated albumin excretion rates had elevated prevalence of PVD (macroalbuminuric 40%, p < 0.01; microalbuminuric 27.2%, p < 0.05; vs normoalbuminuric 7.8%). Among the risk factors analysed, hypertension and triglyceride concentrations were higher in the proteinuric diabetics (macroalbuminuric p < 0.001, p < 0.01; microalbuminuric p = NS, p < 0.01 respectively), while HDL-C levels were found to be significantly lower in this group (p < 0.05). In the diabetic group as a whole, raised AER was correlated with PVD (p < 0.05), duration of diabetes and systolic blood pressure (p < 0.01). We conclude that the prevalence of PVD was significantly higher in Type 2 diabetic patients with elevated albumin excretion rate. Furthermore, these patients had higher blood pressure and low HDL-C.

Aged↗

[Clinical significance of the determination of several hemostatic parameters in the lacrimal fluid of patients with vascular diseases of the retina].

Clinicolaboratory studies of 92 patients with vascular diseases of the retina (retinal vein thrombosis, central chorioretinal dystrophy, retinal hypertensive angiosclerosis) were carried out to assess hemorheologic parameters (platelet and red cell aggregation coefficients, blood viscosity). In parallel with this, lacrimal fluid was analyzed for hemostatic parameters, plasminogen and antithrombin III. A marked increase of plasminogen and antithrombin III levels was found in the lacrimal fluid of patients with retinal vein thrombosis, this increase correlating with pathologic shifts in the studied rheologic characteristics. Central chorioretinal dystrophy and retinal hypertensive angiosclerosis were associated with shifts in some rheologic characteristics. Hence, measurements of lacrimal fluid hemostatic parameters plasminogen and antithrombin III in patients with retinal vascular diseases help assess blood rheology.

Adult↗

Abnormal markers of endothelial cell activation and oxidative stress in children, adolescents and young adults with type 1 diabetes with no clinical vascular disease.

BACKGROUND: Endothelial cell dysfunction is an early feature of vascular disease and oxidative stress may be involved in its pathogenesis. METHODS: Fifty-one children, adolescents and young people with Type 1 diabetes with no clinical diabetic angiopathy, mean age+/-SD of 16+/-4 years, diabetes duration of 8+/-5 years, and HbA(1c) of 8.5+/-1.6%, and 29 age, sex matched normal controls had blood samples assayed for E-selectin, intercellular cell adhesion molecule-1, von Willebrand Factor, red cell superoxide dismutase, plasma thiol and red cell glutathione. RESULTS: E-selectin and ICAM-1 levels were significantly higher in the diabetic patients at 72+/-24 ng/ml and 287+/-57 ng/ml, respectively vs 43+/-16 ng/ml and 248+/-71 ng/ml in the normal controls (p<0.0002 and p<0.013). Von Willebrand Factor levels were not different between the two groups. Superoxide dismutase activity was significantly higher in the diabetic group at 220+/-58 micro/ml vs 175+/-24 micro/ml in the normal controls p<0.001, and those of plasma thiol and red cell glutathione were significantly lower in the diabetic group, at 1267+/-202 micromol/l and 458+/-38 micromol/l, respectively vs 1403+/-278 micromol/l and 487+/-70 micromol/l in the controls p<0.02 and p<0.03. Levels of superoxide dismutase correlated negatively with plasma thiol, age and diabetes duration r=-0.318, p<0.02; r=-0. 328, p<0.02; and r=-0.286, p<0.05, respectively. CONCLUSION: These results confirm evidence of endothelial perturbation in young people with diabetes mellitus, and they also suggest that free radical generation may contribute to this dysfunction. This supports the hypothesis that vascular disease starts early in the course of childhood diabetes, akin to the situation in adults with diabetes.

Adolescent↗

Parathyroid gland function and the possibility of its correction in patients with obliterative vascular disease of the lower limbs.

Parathyroid gland function and the possibility of its correction were studied in 43 patients with obliterative vascular disease of the lower limbs, and in 24 healthy, mostly male, controls. Parathormone (PTH) concentrations in blood plasma samples were determined by radioimmunoassay. Patients with obliterative vascular diseases of the lower limbs were found to have increased activity of parathyroid gland. The role played by hyperparathyroidism in the pathogenesis of obliterative vascular diseases of the lower limbs as well as the possibility of its correction by betablocker and encephalin analogue administration is discussed.

Adult↗

[Color Doppler ultrasonography in the study of orbital and ocular vascular diseases].

Color Doppler flow imaging was performed in 10 healthy controls and in 32 patients with orbital and retinal vascular diseases in order to investigate ocular arterial supply. Abnormal changes of the orbital blood flow observed in case of dural fistula, orbital varicosis and choroidal melanoma is described. In patients with central retinal vein occlusion, substantial arterial flow disturbances were found, such as the reduction of the retinal artery systolic peak flow (p < 0.55) and absence of diastolic flow (p < 0.001). Abnormal changes of the retinal arterial blood flow (reduction of the systolic peak flow or even extinction of the Doppler signal) were also detected in patients with occlusion of the central retinal artery and in some cases of severe stenosis or occlusion of the internal carotid artery. The color Doppler flow imaging appears as a promising technique for the investigation of the vascular diseases of the eye. It may provide useful clues for the differential diagnosis of optic neuropathies and allows haemodynamic characterization of different vascular diseases of the eye such as diabetic retinopathy and glaucoma.

Aged↗

Electrocardiography to define clinical status in primary pulmonary hypertension and pulmonary arterial hypertension secondary to collagen vascular disease.

STUDY OBJECTIVES: To determine the utility of the ECG for predicting clinical status in adults with primary pulmonary hypertension (PPH) or pulmonary arterial hypertension (PAH) secondary to collagen vascular disease. DESIGN: Retrospective study. SETTING: Outpatient clinic in a tertiary referral center. PATIENTS: Adult outpatients with PPH or PAH secondary to collagen vascular disease who underwent electrocardiography within 30 days of undergoing right-heart catheterization, echocardiography, and 6-min walk testing. INTERVENTIONS: None. MEASUREMENTS AND RESULTS: The following measurements were recorded from each ECG: P-wave amplitude in lead II; mean frontal QRS axis; QRS duration; R-wave and S-wave deflections in leads I and V6; and the T-wave configurations in the precordial leads. These ECG variables were correlated with hemodynamic variables, RV size, and exercise capacity. Of the 61 patients included in this study, 56 (92%) were women. Eight of 61 patients (13%) had normal findings on ECGs. There was no significant difference in the demographics or hemodynamics when comparing groups with normal vs abnormal ECGs. All ECG parameters had no more than moderate correlation with hemodynamic variables, ventricular size measured by echocardiogram, and exercise capacity as measured by a 6-min walk. The best correlation was between mean the frontal QRS axis and cardiac index (r = -0.46). CONCLUSIONS: The ECG is an inadequate screening tool to rule out the presence of clinically relevant pulmonary hypertension, either primary or secondary to collagen vascular disease. The mean frontal QRS axis correlated best with the severity of hemodynamic impairment.

Cardiac Catheterization↗