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PubMed1997

Advances in the understanding of diabetic vascular disease.

In summary, the articles in this Review in Depth cover some of the most important aspects in the diabetic vascular disease. The topics included microvascular disease, macrovascular disease, coronary artery disease, diminished fibrinolysis, percutaneous transluminal coronary recanalization and PTCA. The most common manifestations of diabetic vasculopathy are emphasized. Despite an enormous database, the fundamental mechanisms responsible for the diabetic vascular disease remain poorly understood and continue to be the subject of fascinating inquiry.

Angioplasty, Balloon, Coronary↗
PubMed1996

Activated protein C resistance: prevalence and implications in peripheral vascular disease.

PURPOSE: Activated protein C (APC) is a naturally occurring anticoagulant that interacts with factors V and VIII to inhibit the clotting cascade. Resistance to APC (APC-R), hypothesized to occur as a result of an abnormal factor V, has been documented in up to 40% of patients with venous thrombotic events, but its prevalence in patients with arterial disease remains ill defined. METHODS: With an assay of APC resistance that expresses the ratio of the activated partial thromboplastin time with and without the addition of exogenous APC, APC resistance ratios were quantitated in 200 individuals comprising 177 patients with vascular disease and 23 control subjects. An abnormal activated partial thromboplastin time was present in four patients who were excluded from analysis. The 173 remaining patients formed the study population and were divided into diagnostic subgroups on the basis of the most symptomatic problem. RESULTS: APC resistance was documented in 20 individuals, representing 11.6% of the study group. The highest prevalence of APC resistance was observed in patients with lower extremity occlusive disease, with the APC-R ratio below 2.0 in 13.7%. Within the subgroup of individuals with lower extremity disease, 76 patients (10 with APC-R, 13.2%) underwent infrainguinal bypass and were monitored a mean of 47 +/- 8 months. Occlusion of the arterial reconstruction occurred in 22 patients (29%). Six (60%) of the patients with APC-R had failed reconstructions, versus 16 (24%) of 66 patients without APC-R (p = 0.02). CONCLUSIONS: These findings suggest that APC-R is relatively common in patients with peripheral vascular disease, especially in those with lower extremity occlusive disease. APC-R appears to be a risk factor for failure of infrainguinal bypass. These observations suggest that screening for APC-R may be useful in patients with peripheral vascular disease, providing the opportunity to restore the normal thrombogenic balance with anticoagulant therapy in susceptible individuals.

Aged↗
PubMed1988

Differences between premenopausal women and young men in the transamination pathway of methionine catabolism, and the protection against vascular disease.

Catabolism of methionine is supposed to proceed via two known pathways: transsulphuration and transamination. In 10 premenopausal women and 13 young men we measured methionine, the transsulphuration metabolite homocysteine, and the transamination metabolites 4-methylthio-2-oxo-butryate and methanethiol mixed disulphides in the fasting state as well as after oral administration of 0.1 g L-methionine kg-1 body weight. Both in the fasting state and after methionine loading the concentrations of homocysteine in serum were significantly lower in premenopausal women than in young men. Since there is evidence that even a moderate homocysteinaemia may be a risk factor in the development of vascular disease, the low homocysteine levels could be an additional factor contributing to the lower incidence of vascular disease in premenopausal women. After oral methionine these women showed significantly higher concentrations both in serum and urine of the transamination metabolites than the group of men. This higher methionine transamination in premenopausal women may contribute to keeping the homocysteine levels low and may therefore have an impact on the protection of these women against vascular disease.

Adolescent↗
PubMed2003

Endovascular therapies for vascular disease.

Endovascular techniques including angioplasty, stenting, and endoluminal stent grafts represent important therapeutic options for the treatment of vascular disease. Technologic advances have allowed for the treatment of aneurysmal disease as well as extra-cranial carotid disease that previously required surgical methods. The success of various endovascular therapies varies based on anatomic location and extent of disease. The clinical results in different arterial segments are increasingly recognized in the published literature. The aortoiliac arterial bed appears to respond most favorably, with less favorable results observed in the infra-inguinal and infrapopliteal locations. There is increasing evidence that stent-supported carotid angioplasty using cerebral protection will play an important future role in the treatment of carotid artery stenosis. Less invasive techniques to treat abdominal aortic aneurysms with endoluminal stent grafts have dramatically changed the available therapeutic options. Improved devices and delivery systems will likely increase the number of patients who can be successfully treated in this manner. The evolution of endovascular therapies will continue to change the way we treat vascular disease.

Aneurysm↗
PubMed2004

Breast arterial calcifications as an indicator of systemic vascular disease.

PURPOSE: To evaluate the association between mammographically detected arterial calcifications and systemic vascular disease. MATERIAL AND METHODS: The medical records of 77 women who had either breast arterial calcifications or underwent surgery for carotid stenosis, abdominal aortic aneurysm, or femoropopliteal bypass (study groups A and B) were evaluated and compared with 33 women without breast arterial calcifications (group C). Patients in both arms of the study underwent additional vascular tests or mammography. RESULTS: Currently available data indicate that there is a statistically significant correlation between the presence of arterial calcifications on the mammogram and atheromatosis of the carotid or femoral arteries. CONCLUSION: Screening mammograms might be useful in the detection of women at risk for systemic vascular disease.

Adult↗
PubMed1993

Identification of a subset of patients with scleroderma with severe pulmonary and vascular disease by the presence of autoantibodies to centromere and histone.

OBJECTIVES: The role of autoantibodies in the investigation and management of rheumatic diseases is well recognised. The objective of this study was to determine the clinical significance of the co-occurrence of antibodies to centromere and histone in serum samples from patients investigated for systemic rheumatic diseases. METHODS: Serum samples from 1316 consecutive patients were screened for antinuclear antibodies and the clinical findings in patients with antibodies to centromere alone were compared with those with antibodies to both centromere and histone. RESULTS: Twenty six patients had antibodies to centromere. Fourteen patients had antibodies to centromere alone and 12 patients had antibodies to centromere and histone. Four of the 12 patients with antibodies to centromere and histone had diffuse scleroderma with severe pulmonary or vascular disease. CONCLUSIONS: A subset of patients with scleroderma with antibodies to centromere and histone has been identified retrospectively, who have severe pulmonary or vascular disease. It will be of interest to follow up the clinical course of other patients with scleroderma who have both antibodies for the development of pulmonary or vascular disease.

Adult↗
PubMed2000

Vascular disease risk markers in diabetes: monitoring & intervention.

Identifying and treating risk markers for vascular disease in diabetes is significant in preventing long-term disabilities and containing health care costs. Current research recommends maintaining normal blood glucose levels in all diabetes patients. Blood glucose that is elevated for several years is a major factor in the development and progression of microvascular diabetes complications. Patients play a key role in monitoring vascular disease risk markers. This article provides information on the risk markers to monitor, microvascular and macrovascular complications, and current therapies to combat complication progression.

Algorithms↗
PubMed2004

Complement and complement regulatory proteins as potential molecular targets for vascular diseases.

By-products of complement activation and complement regulatory proteins are increasingly recognized to play an important pathogenic role in a variety of vascular diseases including atherosclerosis, ischemia and reperfusion injury, hyperacute graft rejection, vasculitis, and the vascular complications of human diabetes. "Self" damage by autologous complement is mediated by activation products of the complement cascades or by direct insertion of the membrane attack complex (MAC) into cell membranes. Specifically, insertion of MAC complexes into endothelial cells results in the release of an array of growth factors and cytokines that induces proliferation, inflammation and thrombosis in the vascular wall. This paper reviews complement and complement regulatory proteins with specific focus on the vasculature and vascular diseases; it highlights complement and its regulators as potential targets for the rational design of mechanism-specific drugs for the treatment of some of the most prevalent human diseases.

Animals↗
PubMed1999

[Pulmonary lesion associated with collagen vascular diseases: interstitial pneumonia].

Various pulmonary lesions can be found in patients with collagen vascular diseases. Not only the diseases but also treatment with various drugs relate to an occurrence of the pulmonary lesions such as infection, drug reaction, bronchiolitis and interstitial pneumonias. We focused on interstitial pneumonias based on our own experiences with patients whose lesions were diagnosed by surgical lung biopsy. Incidence of the interstitial pneumonias and diagnostic problems before biopsy using HRCT and BAL were evaluated. Comparison of interstitial pneumonias between idiopathic and associated with collagen vascular diseases is a problem to be solved.

Bronchoalveolar Lavage Fluid↗
PubMedDate not supplied

The non-healing leg ulcer: peripheral vascular disease, chronic venous insufficiency, and ischemic vasculitis.

The non-healing leg ulcer is examined by discussing three disease processes: peripheral vascular occlusive disease (PVOD), chronic venous insufficiency (CVI), and vasculitis. For PVOD, management decisions are based on risk factors and disease history. Comprehensive management includes the discontinuation of smoking, exercise conditioning and regulation of diabetes, hyperlipidemia, hypertension, and the appropriate application of anticoagulant/antiplatelet drugs. Methods of surgical management include bypass with autogenous or synthetic material in addition to reconstructive surgery with patch angioplasty or extra-anatomic bypass, amputation, percutaneous transluminal angioplasty/stents, thrombolytic infusion, atherectomy, intraluminal ultrasound, and angioscopy. The optimal healing environment for all ulcers prevents contamination, pain, and fluid loss. In CVI, higher venous pressure in the veins of the lower limb during exercise results in ambulatory venous hypertension and ulceration. Various theories are associated with the disease and ulceration process; the classic treatment of elevation, ambulation, and compression for venous disease remains unchallenged. Diagnosis is based on history, physical examination, invasive venography, and/or non-invasive studies. Two groups of vasculitic disorders that share varying degrees of vascular inflammation and necrosis are arteritis (lupus, erythematosus, periarteritis nodosa, dermatomyositis) and blood dyscrasias (sickle cell disease, thalassemia). Leg ulcers associated with vasculitis are due to inadequate tissue oxygenation at the local level, are typically chronic, slow to heal, and commonly recur.

Education, Nursing, Continuing↗
PubMed1989

Resting ankle-arm pressure index in vascular diseases of the lower extremities.

The authors calculated 442 values of resting ankle-arm indices in 222 patients, of whom 114 reported exercise pain of the lower extremities (51.3%) and 34 reported rest pain (15.3%). Tissue necrosis was diagnosed in 55 patients (24.8%) and other disorders in 19 (8.6%). Obliterating atherosclerosis was found in 186 patients (83.8%), Buerger's disease in 16 (7.2%), and other vascular diseases in 20 patients (9%). The studied index value in 262 examined lower extremities was 1.3-1.0 in 54, 0.9-0.8 in 29, 0.7-0.6 in 66, 0.5-0.4 in 55, and 0.3-0.0 in 58 lower extremities. Respective values for contralateral lower extremities (180) were the following: 69, 54, 33, 14, and 10.

Adult↗