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Arterial pulse wave velocity and risk factors for peripheral vascular disease.

Non-invasive measurement of arterial pulse wave velocity (PWV) is used to diagnose peripheral vascular disease. We examined the relationship between PWV and risk factors related to peripheral vascular disease [body mass index (BMI), systolic blood pressure (SBP), diastolic blood pressure (DBP), serum total cholesterol (TC), high-density lipoprotein-cholesterol (HDL-C), atherogenic index (AI) and blood glucose (GLU)] in 45 healthy male volunteers, aged 25-85 years. The correlation coefficient of PWV with age was r = 0.46, and the correlation coefficients of PWV with DBP, AI and GLU were r = 0.71, 0.56, and 0.22, respectively (P < 0.05). Multiple linear regression analysis revealed that 67% of the variance in PWV could be accounted for by these three variables. The relative contributions of DBP, AI and GLU to PWV were 66%, 26% and 8%, respectively. To test the applicability of PWV for clinical use, a multiple regression equation of PWV derived from these three variables was then applied to male patients with hypertension (n = 53), hyperlipidaemia (n = 35) or hyperglycaemia (n = 39). The results suggest that the multiple regression equation of PWV is an indicator that discriminates between these patient categories and healthy men.

Adult↗

Ultrasonography and focal vascular disease.

The major vascular structures in the retroperitoneum are valuable landmarks for the ultrasonographer. Two cases of focal disease, one involving the pancreatic region (an aneurysm of the superior mesenteric artery) and another involving the kidney (a renal arteriovenous fistula) are presented to emphasize the importance of considering a vascular origin in the differential diagnosis of obscure sonolucent masses.

Aged↗

Fatal lung scan in a case of pulmonary hypertension due to obliterative pulmonary vascular disease.

A young woman with pulmonary hypertension due to sclerodermatous pulmonary vascular disease died immediately following the injection of macroaggregated albumin labeled with 99-TC for a perfusion lung scan. Review of the literature suggests that patients with chronic pulmonary hypertension due to an obliterative pulmonary vascular disease are at risk of developing a serious reaction to perfusion lung scanning. Important factors which predispose to an adverse reaction to lung scanning are the size and dose of macroaggregated albumin particles in relation to the total cross-sectional area of the pulmonary vascular bed and a critical arteriolar lumen size.

Adult↗

[Extracranial arterial occlusive disease in arteriopathies with peripheral vascular disease (author's transl)].

Aortography and angiography of the aortic arch were carried out in 176 patients with peripheral arterial occlusive disease. In 63,6% there were haemodynamically relevant stenoses or occlusions of the supraaortic vessels, the carotid arteries with 39,2% and the vertebral arteries with 35,2%, being the most commonly involved. Peripheral arterial disease included haemodynamically relevant changes in the femoro-popliteal arteries in 83%, in the aorto-iliac region in 67,1% and in the calf vessels in 58,5%. There was a statistically significant correlation between the clinical severity of the cerebrovascular insufficiency and of the Frontaine stages with the angiographically demonstrable extent of the arteriosclerosis. In addition there was an increasing statistical risk of extracranial arterial occlusion if the disease affected more than one arterial level.

Aorta, Abdominal↗

Pulmonary involvement in mixed connective tissue disease: comparison with other collagen vascular diseases using high resolution CT.

PURPOSE: The purpose of this work was to compare the CT findings of lung involvement in patients with mixed connective tissue disease (MCTD) with those in patients with other CTDs: systemic lupus erythematosus (SLE), systemic sclerosis (SSc), and polymyositis and dermatomyositis (PM-DM). METHOD: CT scans of 35 patients with interstitial lung disease and associated MCTD were evaluated retrospectively. The CT assessment included determination of the findings and evaluation of whether the findings in MCTD were different from those in other CTDs. RESULTS: The frequency of ground-glass opacity in MCTD was significantly lower than in CTDs (p < 0.05). The frequency of honeycombing in MCTD was lower than in SSc (p < 0.05) and higher than in PM-DM (p < 0.005). Regarding the predominant CT patterns, the frequency of septal thickening in MCTD was significantly higher than in CTDs (p < 0.05). CONCLUSION: CT findings in MCTD were a combination of those in other CTDs.

Adolescent↗

Lobar emphysema associated with patient ductus arteriosus and pulmonary obstructive vascular disease.

Three cases of respiratory distress with patent ductus arteriosus are presented. The left-to-right shunt across the ductus arteriosus produced dilated pulmonary arteries and secondary bronchial compression, leading to lobar emphysema. The increase of blood flow across the ductus arteriosus causes structural changes of the wall of the preacinar and intra-acinar arteries. All three patients died, most probably from the association of parenchymatous pulmonary disease and pulmonary obstructive vascular disease.

Bronchi↗

Magnetic resonance imaging of peripheral vascular disease. The state of the artery.

Peripheral vascular disease is a term often used to describe the manifestation of atherosclerosis below the bifurcation of the abdominal aorta. Peripheral atherosclerosis is a major cause of morbidity in the developed countries and 2% of adults in late middle age have intermittent claudication, which is severe enough in some patients to warrant hospital admission. The disease produces problems either by reducing blood flow or by the release of emboli from ulcerated plaques. The morphology and composition of arterial segments containing atheroma is of considerable importance. Plaques of different morphology have different effects on the arterial wall, such as the potential for thrombosis and the effect of arterial spasm. The lipid content may also affect the propensity for fissuring, ulceration, and thrombosis. In addition to discrete atherotic lesions, a localized and generalized sclerosis occurs. Sclerosis, or stiffness, can be demonstrated in experimental disease in animals and in man, and regression leads to reduced stiffness. Magnetic resonance imaging promises a comprehensive assessment of peripheral atherosclerosis noninvasively and without the use of ionizing radiation. Atheroma can be imaged directly, its size can be measured, its shape can be described, its lipid content can be assessed, and its effects upon vascular hemodynamics can be studied. In addition, arterial compliance, pulse wave velocity, and the pattern of flow within the vessel can be studied. It is thus a potential tool not only for the detection of disease but also for studying its natural history, risk factors, and the effects of pharmacological or surgical interventions.

Angiography↗

Buflomedil. A review of its pharmacodynamic and pharmacokinetic properties, and therapeutic efficacy in peripheral and cerebral vascular diseases.

Buflomedil hydrochloride is a vasoactive drug with a variety of pharmacodynamic properties. Importantly, it seems to improve nutritional blood flow in ischaemic tissue of patients with peripheral and/or cerebral vascular disease by a combination of pharmacological effects: inhibition of alpha-adrenoceptors, inhibition of platelet aggregation, improved erythrocyte deformability, nonspecific and weak calcium antagonistic effects, and oxygen sparing activity. Therapeutic trials with buflomedil in patients with peripheral vascular diseases have shown that it increases walking distances in those with intermittent claudication and heals trophic lesions and reduces rest pain in many patients with more severe vasculopathies. In open clinical trials a good to very good clinical response was achieved in 57 to 87% of those treated. In comparative studies buflomedil 600 mg/day orally was shown to be significantly superior to placebo and comparable in efficacy to pentoxifylline (oxpentifylline) and naftidrofuryl. In patients with symptoms presumed to be due to cerebrovascular insufficiencies and elderly patients with senile dementia, buflomedil 450 to 600 mg/day alleviated symptoms associated with impairment of cognitive and psychometric function and was significantly superior to placebo and slightly more effective than drugs such as cinnarizine, flunarizine and co-dergocrine mesylate. Overall, buflomedil at dosages of up to 600 mg/day has been very well tolerated and discontinuation of therapy has rarely been necessary. Thus, buflomedil would seem to be a useful adjunct to conservative treatment in patients with mild-to-moderate peripheral vascular disease and/or cerebrovascular insufficiency, and well worth a try in patients with more severe peripheral disease unable to undergo surgery. However, a few well-designed long term studies are needed to fully define its overall place in therapy.

Adult↗

The patency of the retinal vasculature to erythrocytes in retinal vascular disease.

This paper presents the first evidence that in retinas with experimentally induced vascular disease some vessels contain only plasma. This was demonstrated by a histologic technique developed specifically to test the hypothesis that at some stage in retinal vascular disease, vessel patency to erythrocytes is lost before vessels close to plasma. Using this technique, we visualized three major components of the circulation at all retinal locations: the erythrocytes; the plasma as marked by the presence of 0.2-micron fluorescent microspheres; and all functioning endothelial cell nuclei, which were marked by the fluorochrome bis-Benzimide. It was assumed that the distributions of the erythrocytes and small particles in retinal whole mounts reflected accurately the true in vivo distributions at the moment of circulation arrest. Postenucleation the retina can be viewed and photographed within 45 min of circulation arrest. The technique was used on normal rats and on rats induced with a fast-developing model of retinal vasculopathy. With this model, we demonstrated retinal vascular segments perfused by plasma but containing no erythrocytes with functioning endothelial cells in the vessel walls. This may mean that an early factor in some retinal vascular pathologies is tissue hypoxia caused by reduced erythrocyte perfusion.

Alloxan↗

The potential benefit of pre-operative assessment of amputation wound healing potential in peripheral vascular disease.

Choosing the most distal amputation level that will heal is difficult in patients with peripheral vascular disease. From 1984 to 1988, 965 patients underwent 1,563 amputations for lower limb peripheral vascular disease at King Edward VIII Hospital, Durban. The primary amputation revision rate was 51% with a mortality rate of 23.1%. Random pre-operative assessment of amputation wound healing potential using a transcutaneous oxygen pressure index was investigated over the 4-year period, 1987-1990. This was responsible for a reduction in the amputation revision rate to 8.2% in patients tested.

Amputation, Surgical↗

Arsenic in drinking water and mortality from vascular disease: an ecologic analysis in 30 counties in the United States.

Chronic arsenic consumption can cause vascular diseases. Adverse vascular effects of arsenic in drinking water in the United States have not been studied. This study investigated the ecological relationship between the population-weighted mean arsenic concentration in public drinking water supplies and mortality from circulatory diseases in 30 U.S. counties from 1968 to 1984. Mean arsenic levels ranged from 5.4 to 91.5 micrograms/l. Standardized mortality ratios (SMRs) for diseases of arteries, arterioles, and capillaries (DAAC) (ICD 8th/9th revision, 440-448) for counties exceeding 20 micrograms/l were 1.9 (90% confidence interval [CI] = 1.7-2.1) for females and 1.6 (90% CI = 1.5-1.8) for males. The SMRs for the three subgroups of DAAC--arteriosclerosis, aortic aneurysm, and all other DAAC--tended to be elevated. With respect to the same arsenic group, the SMRs for congenital anomalies of the heart (ICD-8/9, 746/745-746) and circulatory system (ICD-8/9, 747) also tended to be elevated. Two competing interpretations emerge as possibilities: either there are spurious associations resulting from invalid outcome data or causal associations.

Adult↗

Homocysteine lowering with folic acid and B vitamins in vascular disease.

BACKGROUND: In observational studies, lower homocysteine levels are associated with lower rates of coronary heart disease and stroke. Folic acid and vitamins B6 and B12 lower homocysteine levels. We assessed whether supplementation reduced the risk of major cardiovascular events in patients with vascular disease. METHODS: We randomly assigned 5522 patients 55 years of age or older who had vascular disease or diabetes to daily treatment either with the combination of 2.5 mg of folic acid, 50 mg of vitamin B6, and 1 mg of vitamin B12 or with placebo for an average of five years. The primary outcome was a composite of death from cardiovascular causes, myocardial infarction, and stroke. RESULTS: Mean plasma homocysteine levels decreased by 2.4 micromol per liter (0.3 mg per liter) in the active-treatment group and increased by 0.8 micromol per liter (0.1 mg per liter) in the placebo group. Primary outcome events occurred in 519 patients (18.8 percent) assigned to active therapy and 547 (19.8 percent) assigned to placebo (relative risk, 0.95; 95 percent confidence interval, 0.84 to 1.07; P=0.41). As compared with placebo, active treatment did not significantly decrease the risk of death from cardiovascular causes (relative risk, 0.96; 95 percent confidence interval, 0.81 to 1.13), myocardial infarction (relative risk, 0.98; 95 percent confidence interval, 0.85 to 1.14), or any of the secondary outcomes. Fewer patients assigned to active treatment than to placebo had a stroke (relative risk, 0.75; 95 percent confidence interval, 0.59 to 0.97). More patients in the active-treatment group were hospitalized for unstable angina (relative risk, 1.24; 95 percent confidence interval, 1.04 to 1.49). CONCLUSIONS: Supplements combining folic acid and vitamins B6 and B12 did not reduce the risk of major cardiovascular events in patients with vascular disease. (ClinicalTrials.gov number, NCT00106886; Current Controlled Trials number, ISRCTN14017017.).

Aged↗

Abnormal membrane concentrations of 20 and 22-carbon essential fatty acids: a common link between risk factors and coronary and peripheral vascular disease?

Although elevated levels of cholesterol are associated with increased risks of coronary and peripheral vascular disease, the association frequently fails to provide a causative explanation at the individual level. New hypotheses are required which, whether or not they are correct, will provide new lines of research. It is proposed here that the causes of vascular disease are abnormal membrane phospholipid concentrations of the 20-carbon and 22-carbon essential fatty acids (EFAs) of the n-6 and n-3 series. These levels become abnormal with ageing, with stress and in response to smoking, high cholesterol levels and high saturated fat intakes. They are also abnormal in patients with diabetes and hypertension. The effects of these EFAs and their metabolites include lowering of triglycerides, elevation of high-density lipoprotein (HDL)-cholesterol, reduction of blood pressure, vasodilatation, reduction of fibrinogen levels and inhibition of platelet aggregation and of cardiac arrhythmias. Prospective studies have shown that abnormal levels of these fatty acids are predictive of future coronary death. Controlled trials of treatment have demonstrated that provision of the fatty acids reduces both coronary and total mortality. Further experimental and clinical investigations of the roles of appropriate membrane concentrations of these fatty acids are justified.

Animals↗