Mechanisms of oxidative stress in human aortic aneurysms — association with clinical risk factors for atherosclerosis and disease severity

Aortic abdominal aneurysms (AAA) are important causes of cardiovascular morbidity and mortality. Oxidative stress may link multiple mechanisms of AAA including vascular inflammation and increased metalloproteinase activity. However, the mechanisms of vascular free radical production remain unknown. Accordingly, we aimed to determine sources and molecular regulation of vascular superoxide (O2radical dot−) production in human AAA. Methods and results: AAA segments and matched non-dilated aortic samples were obtained from 40 subjects undergoing AAA repair. MDA levels (determined by HPLC/MS) were greater in plasma of AAA subjects (n = 16) than in risk factor matched controls (n = 16). Similarly, superoxide production, measured by lucigenin chemiluminescence and dihydroethidium fluorescence, was increased in aneurysmatic segments compared to non-dilated aortic specimens. NADPH oxidases and iNOS are the primary sources of O2radical dot− in AAA. Xanthine oxidase, mitochondrial oxidases and cyclooxygenase inhibition had minor or no effect. Protein kinase C inhibition had no effect on superoxide production in AAA. NADPH oxidase subunit mRNA levels for p22phox, nox2 and nox5 were significantly increased in AAAs while nox4 mRNA expression was lower. Superoxide production was higher in subjects with increased AAA repair risk Vanzetto score and was significantly associated with smoking, hypercholesterolemia and presence of CAD in AAA cohort. Basal superoxide production and NADPH oxidase activity were correlated to aneurysm size. Conclusions: Increased expression and activity of NADPH oxidases are important mechanisms underlying oxidative stress in human aortic abdominal aneurysm. Uncoupled iNOS may link oxidative stress to inflammation in AAA. Oxidative stress is related to aneurysm size and major clinical risk factors in AAA patients

Związek między grubością błony wewnętrznej i środkowej (IMT) tętnicy szyjnej a powikłaniami w układzie sercowo-naczyniowym

Early signs of target organ damage are one of the main topics of recent research in hypertension. These include endothelial dysfunction, microalbuminuria, increased renal resistance index and increased thickness of intima-media complex (IMT). Results of IMT measurements performed with Doppler ultrasonography correlates very well with those from necropsy studies. Moreover, IMT assessment is relatively easy, noninvasive, does not require very sophisticated equipment and correlates with cardiovascular risk factors and clinical outcome. Therefore it is feasible to use IMT as an endpoint in large scale population based studies as well as a tool in potential screening projects. The aim of our review is to discuss the methodology, results of clinical trials and the role of IMT measurements in current clinical practice.Na przestrzeni ostatnich lat wiele uwagi - zwłaszcza w badaniach klinicznych - poświęca się ocenie wczesnych powikłań narządowych rozwijających się w przebiegu nadciśnienia tętniczego. Obok dysfunkcji śródbłonka, mikroalbuminurii oraz podwyższonego oporu w naczyniach wewnątrznerkowych (RRI), do wczesnych zmian zalicza się również podwyższoną grubość kompleksu błony wewnętrznej i środkowej tętnicy szyjnej (IMT). Metodą służącą do nieinwazyjnej oceny IMT jest ultrasonografia doplerowska, a wyniki pomiarów IMT uzyskane na podstawie badania ultrasonograficznego wykazują korelację z badaniami określającymi zmiany strukturalne w obrębie naczyń. Należy podkreślić, że ocena IMT jest stosunkowo mało skomplikowana, a niezbędna aparatura stosunkowo powszechnie dostępna, co pozwala na wykonywanie tego badania w ramach szeroko zakrojonych badań populacyjnych lub przesiewowych. W niniejszym opracowaniu omówiono związek między IMT a częstością występowania incydentów w układzie sercowo-naczyniowym

The influence of motor ability rehabilitation on temporal-spatial parameters of gait in Huntington's disease patients on the basis of a three-dimensional motion analysis system: An experimental trial

Objective There is no existing standard, evidence-based, scientific model for motor ability improvement in Huntington's Disease (HD) patients aimed at maintaining independent gait for as long as possible, or performing activities of daily living, the effectiveness of which would be supported by the results of studies using objective research tools. Under these circumstances, the aim of this study was to analyze the influence of motor ability rehabilitation on the spatial-temporal parameters of gait in HD patients. Design It was an experimental trial. The studied group consisted of 30 patients (17 women and 13 men) with HD. In hospital conditions, the patients participated in the 3-week motor ability l rehabilitation programme tailored to individual needs. The study group was tested using the Vicon 250 three-dimensional gait analysis system before and after the physical exercise programme. Results Walking speed after therapy increased for the left lower limb from 1.06 (SD 0.24) [m/s] to 1.21 (SD 0.23) [m/s], and for the right lower limb from 1.07 (SD 0.25) [m/s] to 1.20 (SD 0.25) [m/s]. The cycle length increased after the applied therapy for the left lower limb from 1.17 (SD 0.20) [m] to 1.23 (SD 0.19) [m]. Conclusion The three-week motor ability rehabilitation programme positively influences spatial-temporal gait parameters in HD patients

Crossectomy as a method of pulmonary embolism prevention : could it be a hazardous treatment?

Wstęp: Wstępujące zapalenie żyły odpiszczelowej, zlokalizowane w jej bliższym odcinku, może być stanem zagrażającym życiu. Przecięcie i podwiązanie żyły w ujściu zapobiega propagacji zakrzepu do żyły udowej głębokiej i pozwala zapobiec zatorowości płucnej. Celem badania było określenie, jak często takie postępowanie samo w sobie stwarza ryzyko wywołania zatorowości płucnej. Materiał i metody: Analizie poddano 59 kolejnych chorych (22 mężczyzn, 37 kobiet), o średniej wieku 62 lata (29–77), u których rozpoznano wstępujące zapalenie żyły odpiszczelowej. Badanie ultrasonograficzne układu żylnego we wszystkich przypadkach wykonał ten sam lekarz. W 4 przypadkach wykryto towarzyszącą zakrzepicę żył układu głębokiego w tej samej kończynie na poziomie podudziowym. W przypadku stwierdzenia procesu zakrzepowego w obrębie żyły udowej lub biodrowej chorych dyskwalifikowano od leczenia operacyjnego. Zabieg przecięcia i podwiązania żyły odpiszczelowej przeprowadzano w znieczuleniu miejscowym. Wyniki: U 50 chorych (85%) bliższy odcinek żyły odpiszczelowej wolny był od zakrzepu, a sam zabieg określano jako łatwy do przeprowadzenia. Ocena śródoperacyjna pozwoliła wykryć obecność zakrzepu w obrębie połączenia odpiszczelowo-udowego w 9 przypadkach (15%), podczas gdy w badaniu USG zakrzep w okolicy ujścia udokumentowano jedynie u 5 chorych (8%). Przecięcie żyły i usunięcie zakrzepu na tym poziomie były obarczone dużym ryzykiem fragmentacji skrzepliny. W trakcie zabiegu rutynowo stosowano cewnik Fogarty’ego. Wśród operowanych chorych nie stwierdzono żadnego przypadku zatorowości płucnej. Wnioski: U 15% operowanych chorych zabieg przecięcia i podwiązania żyły odpiszczelowej w przypadku jej wstępującego zapalenia jest ryzykowny. Równocześnie w doświadczonych rękach jest to zalecana i bezpieczna metoda zapobiegania wystąpieniu zatorowości płucnej w przebiegu tego schorzenia.Background: Ascending saphenous phlebitis (ASPh) located in the proximal part of the long saphenous vein (LSV) may be a life-threatening condition. Crossectomy preventing propagation of the thrombus to the femoral vein is a valuable method in order to avoid pulmonary embolisation. The purpose of this study was to assess how often such a treatment, instead of preventing the danger of embolisation, may in fact create it. Material and methods: 59 patients (22 men, 37 women), mean age 62 years (29–77) suffering from ASPh were analyzed. All Doppler duplex examinations were carried out by one investigator. In 4 cases, concomitant DVT of the same limb on crural level was found. A crossectomy was performed under local anaesthesia. If a thrombus was present in the deep veins (femoral, iliac), the patients were excluded from crossectomy Results: In 50 patients (85%) crossectomy was easy to perform because no thrombus was found in the most proximal part of LSV. An intraoperative evaluation revealed the presence of a thrombus at the sapheno-femoral junction in 9 cases (15%) but this had been recognized by previous doppler duplex in 5 cases (8%) only. In those patients, a thrombectomy at the saphenofemoral junction level and a crossectomy was defined as having a high risk of fragmentation during the procedure. A Fogarty catheter was routinely used. We did not notice any case of pulmonary embolisation perioperatvely. Conclusion: A crossectomy in ascending saphenous phlebitis is hazardous in 15% of cases. A crossectomy is recommended as a safe and advisable method, in experienced hands of preventing pulmonary embolism

Causes and consequences of falls in Parkinson disease patients in a prospective study

Background and purpose: Falls are common events in Parkinson disease (PD) but only a few prospective studies have focused on causes and consequences of falls in PD patients. The aim of the study was prospective analysis of direct causes and consequences of falls in PD patients in comparison to the control group. Material and methods: One hundred PD patients and 55 age-matched controls were enrolled in the study. The diagnostic workup in all patients included neurological examination, Unified Parkinson’s Disease Rating Scale, magnetic resonance imaging, electroencephalography, ultrasonography, otolaryngological, ophthalmological and autonomic function examination. During 12 months of follow-up, falls were registered in both groups, direct causes were classified according to the St. Louis and Olanow classification, and consequences were established. Results: Falls occurred in 54% of PD patients and in 18% of control subjects. Analysis of direct causes of falls revealed that sudden falls were the most common (31%), followed by episodes of freezing and festination (19.6%), neurological and sensory disturbances (mostly vertigo) (12%), environmental factors (12%), postural instability (11%), orthostatic hypotension (4%), and severe dyskinesia (3.6%); 6.19% of falls were unclassified; 22% of patients had the same etiology of subsequent falls. In PD patients, intrinsic factors were dominant, whereas in the control group intrinsic and extrinsic factors occurred with the same frequency. Every third fall intensified fear of walking. 34% of falls caused injuries; among them bruises of body parts other than the head were most frequent. Conclusions: Intrinsic factors are the most common causes of falls in PD. Every third fall intensifies fear of walking and causes injuries