What Constitutes Best Medical Therapy for Peripheral Arterial Disease?

AbstractPeripheral arterial disease (PAD) is associated with a high morbidity and mortality, largely from coronary and cerebrovascular disease, which often overshadows the PAD itself. Best Medical Therapy (BMT), comprising smoking cessation, antiplatelet agent use, cholesterol reduction, exercise therapy, and the diagnosis and treatment of hypertension and diabetes mellitus; is evidenced based and can result in significant reductions in cardiovascular risk, as well as some improvement in PAD. Previous data have largely been restricted to patients with coronary artery disease, and their relevance to PAD has been extrapolated. However, data are now starting to become available, such as the Heart Protection Study, with data specific to PAD patients. This article reviews the data regarding the use of BMT in patients with PAD, and based on this, makes recommendations for the use of BMT in this group of patients

Patients' Expectations before and Satisfaction after Ultrasound Guided Foam Sclerotherapy for Varicose Veins

AbstractObjectivesUltrasound guided foam sclerotherapy (UGFS) is a minimally invasive treatment for varicose veins (VV) whose clinical and cost-effectiveness remains incompletely defined. The aim of the current study was to examine patients' expectations before and satisfaction after UGFS for VV in terms of relief of lower limb symptoms, improvement in appearance, and beneficial effect on life-style.MethodsA consecutive series of 351 patients (464 limbs) undergoing UGFS for VV completed questionnaires one week prior to and six months after treatment.ResultsPre and post-treatment response rates were 80%; 60% returned both questionnaires. Virtually all patients were expecting improvement in lower limb symptoms; these were exceeded in a third. Most patients expected cosmetic improvement and these were largely met. Two-thirds of patients expected significant life-style (clothes, work, social) benefits and outcomes were slightly less than expected. A quarter expected improvement in their interpersonal relationships. This benefit was greater than expected occurring in one-third of patients. Overall, a quarter of patients had their expectations exceeded and 10% (appearance and relationships) to 25% (clothing, work and social and leisure activities) were left with unmet expectations.DiscussionWhen specifically asked most patients admit to having a wide range of expectations in relation to their VV treatment, many of them probably unanticipated by the clinician. However, present data indicate that UGFS is usually able to meet, and often exceeds, these physical and psychosocial needs and expectations. UGFS is, therefore, a highly effective treatment for VV from the patients' perspective

Multiwavelength observations of a TeV-Flare from W comae

We report results from an intensive multiwavelength campaign on the intermediate-frequency-peaked BL Lacertae object W Com (z = 0.102) during a strong outburst of very high energy gamma-ray emission in 2008 June. The very high energy gamma-ray signal was detected by VERITAS on 2008 June 7-8 with a flux F(>200 GeV) =(5.7 0.6) × 10-11 cm-2 s -1, about three times brighter than during the discovery of gamma-ray emission from W Com by VERITAS in 2008 March. The initial detection of this flare by VERITAS at energies above 200 GeV was followed by observations in high-energy gamma rays (AGILE; E γ≥ 100 MeV), X-rays (Swift and XMM-Newton), and at UV, and ground-based optical and radio monitoring through the GASP-WEBT consortium and other observatories. Here we describe the multiwavelength data and derive the spectral energy distribution of the source from contemporaneous data taken throughout the flare. © 2009. The American Astronomical Society. All rights reserved

Insights into the high-energy γ-ray emission of Markarian 501 from extensive multifrequency observations in the Fermi era

We report on the γ-ray activity of the blazar Mrk 501 during the first 480 days of Fermi operation. We find that the average Large Area Telescope (LAT) γ-ray spectrum of Mrk 501 can be well described by a single power-law function with a photon index of 1.78 ± 0.03. While we observe relatively mild flux variations with the Fermi-LAT (within less than a factor of two), we detect remarkable spectral variability where the hardest observed spectral index within the LAT energy range is 1.52 ± 0.14, and the softest one is 2.51 ± 0.20. These unexpected spectral changes do not correlate with the measured flux variations above 0.3 GeV. In this paper, we also present the first results from the 4.5 month long multifrequency campaign (2009 March 15-August 1) on Mrk 501, which included the Very Long Baseline Array (VLBA), Swift, RXTE, MAGIC, and VERITAS, the F-GAMMA, GASP-WEBT, and other collaborations and instruments which provided excellent temporal and energy coverage of the source throughout the entire campaign. The extensive radio to TeV data set from this campaign provides us with the most detailed spectral energy distribution yet collected for this source during its relatively low activity. The average spectral energy distribution of Mrk 501 is well described by the standard one-zone synchrotron self-Compton (SSC) model. In the framework of this model, we find that the dominant emission region is characterized by a size ≲0.1 pc (comparable within a factor of few to the size of the partially resolved VLBA core at 15-43 GHz), and that the total jet power (≃1044 erg s-1) constitutes only a small fraction (∼10-3) of the Eddington luminosity. The energy distribution of the freshly accelerated radiating electrons required to fit the time-averaged data has a broken power-law form in the energy range 0.3 GeV-10 TeV, with spectral indices 2.2 and 2.7 below and above the break energy of 20 GeV. We argue that such a form is consistent with a scenario in which the bulk of the energy dissipation within the dominant emission zone of Mrk 501 is due to relativistic, proton-mediated shocks. We find that the ultrarelativistic electrons and mildly relativistic protons within the blazar zone, if comparable in number, are in approximate energy equipartition, with their energy dominating the jet magnetic field energy by about two orders of magnitude. © 2011. The American Astronomical Society

Ethnicity and peripheral arterial disease

AbstractIntroduction: the prevalence of peripheral arterial disease (PAD) is relatively well defined for the Caucasian population. Given the susceptibility of Asians and Afro-Caribbeans to coronary heart disease and stroke respectively, and the high prevalence of cardiovascular risk factors in both groups, one would expect a high prevalence of peripheral arterial disease. Methods: a search of MEDLINE (1966-2002) was undertaken for studies on the incidence and prevalence of PAD, abdominal aortic aneurysms (AAA) and cerebrovascular disease in different ethnic groups. Results: there are very few population-based prevalence studies assessing PAD, AAA or cerebrovascular disease in non-Caucasians. A review of hospital-based series demonstrates different patterns of PAD between ethnic groups. Blacks and Asians have a tendency towards more distal occlusive disease and AAA appear to be predominantly a disease of Caucasians. It is not clear whether these studies provide a true representation of the prevalence of arterial disease in various ethnic groups or are the result of an unmet health care need. Conclusions: further studies are required to establish the prevalence, natural history and response to treatment of PAD, AAA and cerebrovascular disease in non-Caucasians. Only when this has been achieved, can clinically and cost-effective health care be delivered to affected individuals from different ethnic groups.Eur J Vasc Endovasc Surg 25, 505-512 (2003