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At least 1,153 records · Page 64Linked to original sources
PubMed1978

The excretion of free cortisol, cortisone, cortisol sulfate and cortisone sulfate in peripheral vascular disease, diabetes mellitus and hyperthyroidism.

In four groups of persons, 1/healthy individuals, 2/ patients with diabetes mellitus, 3/ patients with peripheral vascular disease, and 4/ patients with hyperthyroidism, the urinary excretion of free cortisol, cortisone, cortisol sulfate and cortisone sulfate was estimated. In groups 2 and 3 the excretion of all four substances was elevated. In hyperthyroidism a preponderance of free cortisone over cortisol was registered. The ratios of the followed substances suggest in patients with peripheral vascular disease a detoriation in the normal excretion of the followed corticoids, based on a preponderance of 11-OH-corticosteroids over their 11-oxo-derivatives. This observation could be implicated in the mild hyperglycemia or decreased glucose tolerance, that is often found in atherosclerotic disease.

Adult↗
PubMed1997

Role of Gritti-Stokes amputation in peripheral vascular disease.

The perigenicula lower limb amputations performed for peripheral vascular disease in Nottingham between April 1987 and September 1992 were reviewed. Of the 434 amputations, 173 were below-knee amputations (BKA), 144 Gritti-Stokes amputations (GSA) and 117 above-knee amputations (AKA). The 30-day mortality was significantly greater for AKA patients than either GSA or BKA patients. There was no difference in mortality within 30 days of amputation between GSA and BKA. Re-amputation rate to a more proximal level was significantly higher in BKA compared with GSA. Mobility after prosthetic rehabilitation was assessed using the Stanmore grading. A greater number of patients achieved mobility grade III and above in the GSA and BKA groups when compared with the AKA group, but there was no significant difference between GSA and BKA groups. At follow-up, a median of 23 months after amputation, there was a tendency for more patients to have given up using their limb prosthesis in the GSA group than either the BKA or AKA groups. However, there remained no significant difference between the BKA and GSA groups in the numbers of patients who remained successfully rehabilitated to Stanmore grade III or above. When a BKA is not possible, GSA offers a better prospect for rehabilitation compared with AKA in patients with occlusive arterial disease.

Adult↗
PubMedDate not supplied

Is screening for vascular disease a valuable proposition?

The value of health screening among the general population has been well-documented, with testing for hypertension, diabetes, and glaucoma now commonplace. It was the purpose of our study to determine the efficacy of a screening program for peripheral vascular disease and carotid artery disease using the noninvasive laboratory diagnostic tools. In the screening for peripheral disease, there were 496 participants with a mean age of 35 (range 17 to 63) years. All participants had an ankle:brachial index (ABI) of 0.95 or greater except one (0.47). Risk factors included smoking (350), history of cardiac disease (19), family history of vascular disease (204), and pain in the legs on walking (39). The risk factors could not be correlated with any objective vascular findings (abnormal ABIs). A Doppler ultrasound device, including an inflatable ankle cuff, was used to measure the ABI of the dorsalis pedis and posterior tibial vessels. Testing was performed on a volunteer basis after the participant completed a check-off sheet of risk factors. In screening for carotid artery disease 1338 women, whose average age was 31 years, had an less than 1% incidence of cardiac disease, and 803 men, whose average age was 40 years, had a 4% incidence. Less than 1% of the group had diabetes mellitus. All patients were asymptomatic referable to the extra-cranial vascular system. Two men of the 2141 persons tested had a lesion meriting further evaluation. The role of Health Fairs may be more effective as an educational resource than a diagnostic interventional tool.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed2004

Chemokines in the pathogenesis of vascular disease.

Our increasing appreciation of the importance of inflammation in vascular disease has focused attention on the molecules that direct the migration of leukocytes from the blood stream to the vessel wall. In this review, we summarize roles of the chemokines, a family of small secreted proteins that selectively recruit monocytes, neutrophils, and lymphocytes to sites of vascular injury, inflammation, and developing atherosclerosis. Chemokines induce chemotaxis through the activation of G-protein-coupled receptors, and the receptors that a given leukocyte expresses determines the chemokines to which it will respond. Monocyte chemoattractant protein 1 (MCP-1), acting through its receptor CCR2, appears to play an early and important role in the recruitment of monocytes to atherosclerotic lesions and in the formation of intimal hyperplasia after arterial injury. Acute thrombosis is an often fatal complication of atherosclerotic plaque rupture, and recent evidence suggests that MCP-1 contributes to thrombin generation and thrombus formation by generating tissue factor. Because of their critical roles in monocyte recruitment in vascular and nonvascular diseases, MCP-1 and CCR2 have become important therapeutic targets, and efforts are underway to develop potent and specific antagonists of these and related chemokines.

Animals↗
PubMed2000

MR angiography in the evaluation of atherosclerotic peripheral vascular disease.

Magnetic resonance (MR) angiography of lower extremity occlusive vascular disease has evolved into a feasible diagnostic imaging option. The previous emphasis on time-of-flight techniques was associated with lengthy acquisition times and artifactual signal losses. Those limitations presented an obstacle to widespread clinical implementation. However, the emergence of rapid imaging sequences combined with gadolinium chelate enhancement offers time-efficient alternatives that can yield a truer representation of the vascular anatomic structure. The technology is now poised to serve as a routine screening study, provided that radiologists understand all factors needed to generate clinically relevant MR angiograms. This article is intended to provide a useful resource directed toward achieving that understanding.

Arteriosclerosis↗
PubMed1979

Aortoiliac occlusive vascular disease: a prospective study of patients treated by endarterectomy and bypass procedures.

Aortiliac occlusive vascular disease is very common and very disabling. A prospective study of 150 patients with the disease causing severe claudication and rest pain was begun in 1972, with a mimimum follow-up period of three years. An operative mortality of 2% and hospital morbidity of 14% can be obtained with attention to the broad principles of arterial reconstruction and a meticulous technique, provided that there is excellent anaesthetic, operative, and postoperative support. Severe complications or adverse episodes have occurred in 44% of patients who continued to smoke after their operation, as opposed to 28% in those who stopped. Frequent follow-up visits of 96% of patients have led to the early detection of significant vascular disease elsewhere in some patients, and this may be of importance in determining the eventual prognosis of this serious disease.

Aorta, Abdominal↗
PubMed1985

Effect of beta-adrenergic blockers on the peripheral circulation in patients with peripheral vascular disease.

Beta-Adrenergic blockers have not been widely used in patients with peripheral vascular disease because these drugs have been reported to worsen the symptoms of intermittent claudication. To test this assumption we studied the effects of a beta 1-selective and a nonselective beta-adrenergic blocker on postexercise calf blood flow and symptoms of claudication in 19 patients with mild-to-moderate peripheral vascular disease. Subjects received placebo for 3 weeks, and then were randomized to 120 mg/day propranolol or 150 mg/day metoprolol with the use of a crossover design. Blood flow in the calf was measured by strain-gauge plethysmography at rest and immediately after exercise on a bicycle ergometer at a low and a high workload. The symptoms of claudication were monitored during bicycle exercise and by patient diaries maintained between visits. Maximal exercise heart rate was reduced an equivalent amount by metoprolol (19 beats/min) and propranolol (16 beats/min). Mean arterial pressure was reduced by propranolol at rest and by both drugs with exercise. Calf blood flow was not affected by either drug compared with placebo at rest or at either workload. In addition, the symptoms of claudication were not worsened by either drug. We conclude that despite evidence of beta 1-adrenergic blockade and a lowering of arterial pressure, neither beta-adrenergic blocker adversely affected the peripheral circulation.

Adrenergic beta-Antagonists↗
PubMed2000

Correlation between plasma total homocysteine and copper in patients with peripheral vascular disease.

BACKGROUND: Increased concentrations of both plasma total homocysteine and copper are separately associated with cardiovascular disease. Correlations between plasma total homocysteine, trace elements, and vitamins in patients with peripheral vascular disease have not been investigated. METHODS: The concentrations of trace elements in plasma were determined by the multielement analytical technique of total-reflection x-ray fluorescence spectrometry. Plasma total homocysteine was determined by HPLC. RESULTS: In the univariate and multivariate regression analyses, copper was positively correlated with plasma total homocysteine in all subjects (coefficient +/- SE, 0.347 +/- 0.113; P = 0.0026 and coefficient +/- SE, 0.422 +/- 0.108; P = 0.0002, respectively), and in patients with peripheral vascular disease (coefficient +/- SE, 0.370 +/- 0.150; P = 0.016; and coefficient +/- SE, 0.490 +/- 0.151; P = 0.0025, respectively). Correlation between copper and plasma total homocysteine was not detected in healthy control subjects. The concentration of calcium in plasma (67.5 vs 80. 8 microg/g) was significantly lower in the patients than in the control subjects (P = 0.02). When the patients were divided into groups, the patients with suprainguinal lesions had significantly higher copper concentrations (P = 0.04) and significantly lower selenium and calcium concentrations (P = 0.01 and 0.008, respectively) than the healthy subjects. Patients had higher concentrations of autoantibodies against oxidized LDL and concentrations of thiobarbituric acid-reactive substance than the healthy subjects (P <0.0001 and P = 0.001, respectively). The concentrations of plasma total homocysteine and alpha-tocopherol were significantly higher, and the concentrations of vitamin B(6) and beta-carotene were lower in the patients than the healthy subjects. CONCLUSION: Our findings suggest that the atherogenicity of homocysteine may be related to copper-dependent interactions.

Antioxidants↗
PubMed1987

Aldehyde dehydrogenase activity and vascular disease in type II diabetes--a comparison between 2 different assays for activity.

We have recently reported that type II diabetic subjects with macroangiopathy have a higher activity of aldehyde dehydrogenase (ALDH) in blood than those without clinical vascular disease. ALDH activity was measured as the elimination of acetaldehyde added to a blood homogenate in vitro. We have re-examined our clinical material with another assay of ALDH which uses indole-3-acetaldehyde as substrate and measures the formation of indole-3-acetic acid. A negative correlation between the half-life of acetaldehyde and the formation of indole-3-acetic acid was found in the group of subjects free from vascular disease (r = -0.55, p less than 0.01). Thus, a rapid elimination of acetaldehyde corresponded to a rapid formation of indole-3-acetic acid. No such correlation was found in subjects with macroangiopathy. These results suggest that the 2 groups, with and without clinical vascular disease, have differences in isoenzyme composition, in the kinetic properties of the enzyme, or in the non-enzymatic binding of acetaldehyde.

Aldehyde Dehydrogenase↗
PubMed1991

Sonographic evaluation of suspected pediatric vascular diseases.

Sonographic studies on 52 children with suspected peripheral vascular disease examined between January 1988 and December 1989 were retrospectively reviewed. A technique for examining the jugular, subclavian veins, and superior vena cava (SVC) was developed and is described. The technique for examining the extremities in the child is similar to the adult except higher frequency transducers are used. Twenty-six patients had normal examinations. Twenty-six examinations were abnormal with arterial or venous thrombosis in patients with central lines [10 patients], deep venous thrombosis in patients with painful swollen extremities [9], arterial pseudoaneurysm as a complication of vascular punctures [1], arteriovenous fistula in a renal dialysis patient [1], dilated vessel presenting as a mass [1], compression of a vessel by a mass resulting in extremity swelling [2]. Two patients had other etiologies causing their symptoms and diagnosed on sonography including an infected hematoma and a hip effusion. The advantages of sonography include no contrast material necessary, nonionizing radiation, qualitative and quantitative characterization of vascular flow is possible with Doppler, and the examination can be performed portably. Color Doppler aided in localizing the vessel, visualizing the thrombus, as well as decreasing exam time. Doppler sonography usually answered the clinical question and made further invasive procedures such as venograms and arteriograms unnecessary.

Adolescent↗
PubMed2005

Differentiating hemodynamic compromise by the OEF response to acetazolamide in occlusive vascular disease.

Identification of increased stroke risk in a population of symptomatic patients with occlusive vascular disease (OVD) is presently accomplished by measurement of oxygen extraction fraction (OEF) or cerebrovascular reserve (CVR). However, many regions identified by compromised CVR are not identified by OEF. Our aim was to determine whether the response of OEF to acetazolamide, namely, oxygen extraction fraction response (OEFR) would identify those hemispheres in hemodynamic compromise with normal OEF. Nine patients symptomatic with transient ischemic attacks and strokes, and with occlusive vascular disease were studied. Anatomical MRI scans and T2-weighted images were used to identify and grade subcortical white matter infarcts. PET cerebral blood flow (CBF) and OEF were measured after acetazolamide. The relationship between CVR and oxygen extraction fraction response (OEFR) showed that positive OEFR occurred after acetazolamide despite normal baseline OEF values. The two hemispheres with positive OEFR were also associated with severe (> 3 cm) subcortical white matter infarcts. We found that the OEFR was highly correlated with CVR and identified hemispheres that were hemodynamically compromised despite normal baseline OEF.

Acetazolamide↗
PubMed2001

Depression in older people with mild stroke, carotid stenosis and peripheral vascular disease: a comparison with healthy controls.

BACKGROUND: Although depression has a recognised association with stroke, the role of "silent" cerebrovascular pathology associated with carotid stenosis and peripheral vascular disease remains unexplored. METHODS: Four groups of 25 community residents aged 65 and over were recruited, comprising first anterior circulation stroke, carotid stenosis accompanied by transient ischaemic attack, peripheral vascular disease and a non-vascular control group. All participants were interviewed using the Hamilton Rating Scale for Depression [HRSD] (including a modified version) and Geriatric Depression Scale. DSM IV criteria for major depression and measures of handicap, social support and physical illness were also administered. Head computerised tomography (CT) scans were performed on stroke patients to examine the relationship between lesion location and depression. RESULTS: One hundred patients were interviewed. Stroke patients were more likely to live in a nursing home and had less social support than other groups. Mean scores on the modified Hamilton and Geriatric Depression Scales were higher in stroke and carotid stenosis groups than controls. Patients with stroke did not show a higher prevalence of DSM IV major depressive disorder than those with carotid stenosis. There was no relationship between the presence of lesions affecting the frontal/subcortical system and prevalence/severity of depression. LIMITATIONS: Small numbers, mortality of stroke patients in hospital, possible selection bias in the control group and use of a previously unvalidated depression rating scale all limit the study. CONCLUSIONS: A possible role for carotid stenosis in the pathogenesis of depressive disorder is suggested. Larger studies incorporating brain imaging may be required to examine the mechanism of this association more closely. The use of a shorter version of the HRSD in older people with cerebrovascular disease may warrant further exploration.

Aged↗
PubMed1995

Collagen vascular diseases.

Systemic lupus erythematosus, polymyositis/dermatomyositis, connective tissue disease, and polyarteritis nodosa are the collagen vascular diseases (CVDs) most likely to mimic pneumonia. All can be associated with an acute illness characterized by fever, cough, dyspnea, pleural symptoms, and an abnormal chest roentgenogram. Recognition of the CVD-associated pulmonary process requires sophisticated serological testing and chemical pleural fluid analysis coupled with the exclusion of pulmonary infection and pulmonary embolization. This review emphasizes the clinical characteristics of these CVDs, the diagnostic tests most helpful in recognizing them, and the differential diagnosis of pleuroparenchymal disorders that occur in these patients.

Adult↗