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At least 1,063 records · Page 59Linked to original sources
PubMed1989

Consequences of breast irradiation in patients with pre-existing collagen vascular diseases.

Exaggerated acute and late effects were observed in three of four women with pre-existing collagen vascular disease (CVD) within 2 years after definitive megavoltage radiation therapy for breast carcinoma. Five women with breast carcinoma, who developed CVD 3 months to 10 years after radiation therapy, had no complications. An abnormally severe reaction was observed during treatment of one patient with discoid lupus. The patient developed moist desquamation that persisted for a month, requiring early termination of treatment. One year after treatment, the patient developed paresthesias in the ipsilateral arm. A planned reduction of the prescribed dose in a second patient with progressive systemic sclerosis did not prevent intense erythema at the end of treatment, followed 14 months later by chest wall necrosis, which eventually required multiple surgeries including chest wall resections. The third patient, who had systemic lupus erythematosis, developed necrosis 2 years after treatment, which progressed over 12 years to osteoradionecrosis of the clavicle, sternum and rib cage. Multiple surgeries to repair the defect were complicated by flap necrosis and pleurocutaneous fistulas. The fourth patient died 6 months after radiotherapy without apparent sequelae. None of the patients had evidence of recurrent carcinoma. A history of collagen vascular disease appears to be a contraindication to breast conservation or for elective irradiation for breast cancer.

Adult↗
PubMed1977

Conjunctival microangiopathy. An early sign of degenerative vascular disease?

Biomicroscopic examination of the bulbar conjunctival vessels regularly discloses degenerative microangiopathy in patients with overt arteriosclerotic cerebral vascular disease. Examination of a group of normotensive nondiabetic adults aged 21 to 39 years disclosed similar but less severe changes in 56 per cent of the men and 26 per cent of the women. The incidence was higher (88 per cent of the men and 45 per cent of the women) in those with a strong family history of early death from arteriosclerotic disease. There was no consistent correlation between the severity of the microangiopathy and the values for hematocrit, cholesterol, triglycerides or blood pressure. Conjunctival microangiopathy, like atherosclerosis of larger vessels, starts in the second and third decades and advances with age. We suggest that microangiopathic changes in the conjunctival vessels may provide the first readily detectable evidence of degenerative vascular disease.

Adult↗
PubMed1998

[Snoring and vascular diseases].

The aim of this study is to review the evidence linking snoring with vascular disease. This has been a topic of numerous investigations with divergent results, mainly because of the differences in methodology employed in various studies, such as inclusion of confounding factors, methods of measures, etc. While some studies shows that snoring is a risk factor for vascular disease, another reached the opposite conclusion. Consequently, based on the available information, it s very difficult to conclude that snoring is an independent risk factor for vascular complications as hypertension and cardiovascular and cerebrovascular disease.

Adult↗
PubMed1980

Intravenous regional guanethidine treatment in peripheral vascular disease.

Twenty-eight patients with spastic and obstructive vascular disease were treated with intravenous regional guanethidine (IRG). The drug was injected into the affected hand or foot in doses of 10 or 20 mg, respectively. Temperature and strain-gauge plethysmography curves of the extremity were recorded before treatment, and three to four times during the subsequent 10 days. The effects of IRG, as observed by clinical laboratory examinations, were good in 8 of 12 patients. But in patients suffering from Bürger's disease or from major vessel obstructive disease, the results were not as good. However, in most patients IRG proved beneficial in relieving pain, an effect which sometimes outlasted objective improvements. IRG treatment is a simple and safe method for prolonged chemical sympathectomy.

Adult↗
PubMed2001

Prx1 controls vascular smooth muscle cell proliferation and tenascin-C expression and is upregulated with Prx2 in pulmonary vascular disease.

Prx1 and Prx2 are homeobox transcription factors expressed during vasculogenesis. To begin to elucidate how Prx1 and Prx2 are regulated and function in the adult vasculature, in situ hybridization studies were performed. Prx1 and Prx2 mRNAs were not detected in normal adult rat pulmonary arteries; however, both genes were induced with vascular disease, colocalizing to sites of tenascin-C (TN-C) expression. Because catabolism of the extracellular matrix (ECM) is a critical step in the development of vascular disease, we investigated whether changes in vascular smooth muscle cell (SMC)-ECM interactions regulate Prx1 and Prx2. A10 SMCs cultured on native type I collagen showed low levels of Prx1 and Prx2 mRNA expression, whereas cells cultured on denatured collagen showed higher levels of expression of both genes. At a functional level, transfection of SMCs with a Prx1 expression plasmid significantly increased their growth. Because TN-C also promotes SMC growth and its expression is also upregulated by denatured collagen, we tested and thereafter showed that Prx1 expression significantly enhances TN-C gene promoter activity 20-fold. Similar experiments conducted with truncated Prx1 proteins showed that the N-terminal portion and the homeodomain of Prx1 were necessary to induce the bulk of TN-C promoter activity. These findings support the hypothesis that Prx genes are regulated by changes in SMC adhesion and play key morphoregulatory roles during the development and progression of pulmonary vascular disease in adults.

Animals↗
PubMed1981

[What is a microcirculatory disorder in chronic degenerative vascular disease? (author's transl)].

At present, it is generally accepted that "microcirculatory disorders" are important, sometimes decisive complications of degenerative vascular diseases. In an attempt to sharpen the profile of these sometimes vaguely defined abnormalities, new definitions of "microcirculatory disorders" are proposed. After describing the normal circulation on the basis of the normal vascular integrity, the normal composition of blood and interstitial fluid, the normal rheological behavior of blood cells (in their natural habitat, the flowing blood) and the normal vascular tone, it becomes possible to define abnormalities. These abnormalities are not only quantitatively (as hypoperfusion) but also qualitatively different from the normal state of microcirculation. A microcirculatory disorder is therefore defined as a consequence of autonomous and autochthonous abnormalities of vascular wall, blood, and interstitial cells and fluids, which are basically independent of the macrocirculatory abnormalities but highly effective in complicating them. Proposals for therapeutic consequences of such concepts are given and criteria for the classification of drugs effective in the microcirculation are delineated. Lastly, in vitro and in vivo tests allowing to classify the success of the therapy are proposed. In the complex, chronic and multifacetted obliterative vascular diseases a pharmacological goal short of "clinical efficacy" is defined: a "useful therapeutic effect".

Arterial Occlusive Diseases↗
PubMed2001

Peripheral vascular disease: perspectives on aortoiliac, renal, and femoral treatments using catheter-based techniques.

The percutaneous treatment of peripheral vascular disease has advanced over the past two decades and is fast becoming the preferred treatment of choice. Stents have positively altered the clinical outcomes in peripheral revascularizations. Anatomic variability is an important factor in determining if the patient is an ideal percutaneous interventional candidate. Future technological developments in percutaneous interventions will help include new patients with peripheral vascular disease previously considered nonideal percutaneous candidates.

Aorta↗
PubMed1993

Pulmonary vascular disease and operative indications in complete atrioventricular canal defect in early infancy.

Pulmonary vascular disease was morphometrically analyzed in 67 patients (mean age, 19 months) with isolated complete atrioventricular canal defect. Complete obstruction of the small pulmonary arterial lumen resulting from acute fibrous proliferation and atrophy of the peripheral arterial media, which were considered absolute operative contraindications, were characteristic in six patients with Down's syndrome. Morphometric analysis of medial thickness revealed that thinning of the media of the small pulmonary arteries is generally observed at around 6 months of age in patients with complete atrioventricular canal defect and that the media in patients who have complete atrioventricular canal defect and Down's syndrome was thinner than that in such patients without Down's syndrome. These results suggest that thinning of the media as a result of two factors--Down's syndrome and aging--facilitates the rapid occurrence of fibrous intimal proliferation. Therefore intracardiac repair is desirable within 6 months of life, before medial thinning, in patients with complete atrioventricular canal defect and Down's syndrome. Excluding patients with absolute operative contraindications, the scores of the index of pulmonary vascular disease in operative survivors were below 2.0 and death occurred when scores were more than 2.2. The pulmonary vascular resistances measured in room air and by the oxygen inhalation and tolazoline tests in patients with operative contraindications were more than 7.3, 3.8, and 6.6 units.m2, respectively. We thus conclude that lung biopsy should be undertaken for patients in whom pulmonary vascular resistance is beyond these values to determine the appropriateness of surgical intervention.

Child↗
PubMed2002

Expression of angiogenesis and angiogenic factors in human aortic vascular disease.

BACKGROUND: This paper presents an investigation into the expression of endothelial cells and vascular endothelial growth factor (VEGF) in the aortic wall in vascular diseases such as atherosclerotic abdominal aortic aneurysm (AAAA), inflammatory abdominal aortic aneurysm (IAAA), and aortic occlusive disease (AOD) to determine whether the differences in both neovascularization and angiogenic factor expression are related to the pathogenesis of aortic vascular disease. MATERIALS AND METHODS: Surgical specimens of aorta (10 IAAA, 13 AAAA, 6 AOD) were studied pathologically and immunohistochemically. Representative sections of aorta were stained with hematoxylin-eosin, elastica von Gieson, CD34, and VEGF antibody. CD34-positive microvessels and VEGF-positive cells in the media and adventitia were counted, respectively. RESULTS: CD34-positive microvessels were detected in IAAA > AAAA > AOD (one-way analysis of variance (ANOVA), P < 0.0001). VEGF expression was widely detected in macrophages, monocytes, and smooth muscle cells of IAAA and AAAA; however, it was hardly recognized in AOD. VEGF-positive cells were detected in IAAA > AAAA > AOD specimens (ANOVA, P < 0.0001). CONCLUSIONS: VEGF is known to be a regulator of angiogenesis and to simultaneously stimulate elastolytic proteinases. The results of this study suggest that an angiogenic factor, such as VEGF, may play an important role in the degeneration of the aortic wall and could be strongly related to the pathogenesis of IAAA, AAAA, and AOD.

Aged↗
PubMed2004

Multi-bed vascular disease and atherothrombosis: scope of the problem.

While atherosclerosis has traditionally been divided into three types of disease, coronary artery or coronary heart disease (CHD), cerebrovascular disease, and peripheral vascular or peripheral arterial disease (PAD), it is now clear that atherosclerosis is a systemic disease caused by the same pathologic processes regardless of the vascular bed involved. The burden of disease is enormous both in the US and around the world with 61,800,000 Americans affected with one or more types of CVD, responsible for 958,775 deaths annually at a cost of approximately US 329.2 billion dollars annually. Despite trends of decreasing cardiovascular mortality, the global burden of cardiovascular disease is expected to rise, with CHD and stroke becoming the first and fourth most common causes of mortality and morbidity globally. Atherosclerosis is a multibed process with a substantial portion of patients afflicted with disease in more than one bed, although often assymptomatic. Now that there are multiple therapies available to modify and treat atherosclerosis and atherosclerotic risk factors, identification and treatment of these patients are important since their leading cause of death is from co-existing cardiovascular disease.

Arteriosclerosis↗
PubMed2005

Is progressive osteoarthritis an atheromatous vascular disease?

Growing evidence from epidemiological studies suggests that osteoarthritis (OA) is linked to atheromatous vascular disease. This hypothesis article proposes that OA, or at least OA structural progression, may be an atheromatous vascular disease of subchondral bone. Further epidemiological studies, imaging investigations of relevant blood vessels, and trials of the effects of statins on the prevention and treatment of OA are needed to examine this hypothesis.

Atherosclerosis↗
PubMed2001

[Pulmonary vascular disease].

This review article discusses three topics related to pulmonary vascular disease: 1) pulmonary vascular changes associated with portal hypertension, 2) ANCA-associated pulmonary vasculitis, and 3) Takayasu's arteritis. Hepatopulmonary syndrome and pulmonary hypertension have recently been reported as pulmonary vascular changes accompanied with portal hypertension. Endogenous vasoactive agents that reach the pulmonary circulation through porto-systemic shunt vessels are thought to contribute to these vascular changes. In ANCA-associated vasculitis, hemorrhage, interstitial pneumonitis, and nodular lesions are common manifestations in the lung. In Takayasu's arteritis, CT occasionally demonstrates mosaic attenuation owing to pulmonary arteritis and peripheral reticulolinear changes probably due to thromboembolism.

Antibodies, Antineutrophil Cytoplasmic↗
PubMed1996

The association of leukocyte count, fibrinogen and C-reactive protein with vascular risk factors and ischemic vascular diseases.

In 154 subjects (age 63 +/- 11 years; 63 women and 91 men) randomly selected from the population, we tested the hypothesis that inflammatory parameters are associated with vascular risk factors and particularly with a history of ischemic vascular diseases. The subjects were part of the control group (n = 197) in a case-control study investigating recent infection as a risk factor for acute cerebrovascular ischemia and had been matched for sex and age with patients suffering from acute ischemic stroke or transient ischemic attack. Subjects with malignant or inflammatory diseases, with recent trauma, surgery or vascular diseases (n = 43) were excluded from the present analysis. In multivariate analysis, current smoking, diabetes mellitus, age > or = 65 years, and a history of stroke independently increased the leukocyte count. Hypertriglyceridemia, peripheral arterial disease, and diabetes mellitus were positively associated with C -reactive protein (CRP). Age > or = 65 years and diabetes mellitus independently increased fibrinogen. (p < 0.05, respectively) Subjects with a history of cerebrovascular, cardiovascular or peripheral arterial disease had higher leukocyte counts, fibrinogen and CRP than subjects without vascular risk factors and higher leukocytes and fibrinogen than subjects with one or more risk factors. Subjects under the age of 65 with vascular risk factors but without ischemic diseases had higher leukocyte count, fibrinogen and CRP and subjects older than 65 with risk factors had higher CRP than subjects without risk factors or ischemic diseases in the same age group. (p < 0.05, respectively) These results support the hypotheses that low-grade inflammation is associated with vascular risk factors and that inflammatory mechanisms may contribute to the risk of organ ischemia.

Adolescent↗
PubMed1998

Lower extremity manifestations of vascular disease.

All podiatrists are required to know the anatomy and pathophysiology of vascular pathology because it is the leading cause of morbidity and mortality in the western world and a frequent complaint of podiatry patients. Podiatrists have a unique opportunity to reduce the risk of lower extremity vascular pathology, specifically PVD, by encouraging proper diet and exercise in the podiatric patient. Because the next century will bring a population explosion of older people, particular attention must be paid to the multiple and complex disorders that impair functional independence and compromise quality of life--one of the most important disorders being vascular disease. Successful treatment depends on recognition of lower extremity pathology (whether it be arterial, venous, or lymphatic) and the possible suprastructural causes and timely referrals to a vascular specialist when indicated.

Arterial Occlusive Diseases↗
PubMed1997

Transradial artery coronary angiography and intervention in patients with severe peripheral vascular disease.

BACKGROUND: Traditionally, cardiac catheterization in patients with severe aorto-iliac disease has been performed using a brachial arteriotomy. This approach is associated with significant vascular and neuronal complications and requires considerable training to achieve an adequate level of expertise. Improvement and miniaturization of catheter equipment now allows the radial artery to be used for coronary investigation and intervention. The lack of important structures close to the radial artery, a good collateral ulnar artery circulation and its superficial position suggests that these procedures should have a low complication rate. The purpose of this study was to assess the efficacy and safety of percutaneous transradial diagnostic and interventional coronary catheterization in patients with severe peripheral vascular disease. PATIENTS AND METHODS: We undertook a non-randomized prospective analysis of 75 patients who had transradial artery diagnostic and interventional coronary catheterization in whom femoral angiography was impossible or relatively contraindicated (22 patients with severe claudication and absent femoral pulses, 24 patients with previous aorto-iliac surgery or intervention, 20 patients with a failed femoral approach, 9 patients with an aortic aneurysm). Three patients had an absent ulnar artery and were excluded. RESULTS: Radial artery cannulation was successful in 73/75 (97%) cases. Seventy-one (95%) patients had a successful diagnostic study. There was a high incidence of 3 vessel disease (73%), and the majority of patients (64%) were referred for coronary bypass surgery. Twelve patients underwent successful follow-on intervention including the insertion of 9 intracoronary stents. Adequate haemostasis was achieved within 20 min after diagnostic angiography and 60 min after interventional procedures. One patient had a forearm haematoma with paraesthesia of the hand which settled with conservative treatment. At 4-6 weeks, all patients had normal hand sensation and function (100%) with a palpable pulse present in 59/62 (96%). All patients undergoing diagnostic angiography were discharged on the same day, and patients undergoing intervention were discharged the following day. CONCLUSIONS: Transradial coronary investigation and intervention can be performed with a high degree of success and a low complication rate with early mobilization and discharge in patients with severe peripheral vascular disease. We suggest that the percutaneous transradial technique should be considered as an alternative to the Sones' technique in these patients.

Angioplasty, Balloon, Coronary↗