Case Report Absence of Clinical and Hemodynamic Consequences due to Posterior Tibial Artery Congenital Aplasia

The exact knowledge of popliteal artery and its branches' anatomic variations is important for the clinical practice of angiology, vascular surgery, and interventional procedures. Congenital absence of the artery leads, in some cases, to early malformations of the extremity in the childhood; however, it may also remain asymptomatic. We present an unusual case of a 76-year-old male patient complaining of paraesthesia in both limbs and bilateral aplasia of posterior tibial artery (PTA). Physical examination, ankle-brachial indexes, before and after exercise, arterial duplex scan, and magnetic resonance arteriography were performed. Arterial pulses for PTA at the level of the ankle were normal; arterial duplex study showed biphasic arterial flow at the level of the ankle. Color duplex ultrasound as well as magnetic resonance arteriography revealed the absence of the PTA in both limbs. The vascularization of the fibula was bilaterally normal. The patient underwent also neurological examination and electromyography, which were normal. The evaluation of the possible clinical signs and symptoms and the hemodynamic consequences of this condition are further discussed

Contribution to the study of apoptosis in atherosclerotic lesions in carotid plaques

Objectives: to investigate the distribution of apoptotic cell death and apoptosis - related proteins in early and advanced atherosclerotic lesions in carotid plaques and to correlate apoptosis to the presence of risk factors that included hypertension, smoking, hyperlipidemia and diabetes mellitus. Materials and methods: Fifty-five specimens of human carotid atherosclerotic plaque obtained by endarterectomy and 20 normal postmortem (control group) were studied. The immunohistochemical expression of two genes, BAX, which induces apoptosis and BCL-2, which inhibits apoptosis and apoptosis as detected by Terminal deoxynucleotidyl transferace-mediated dUTP Nick End Labeling (TUNEL) were examined and correlated to the presence of above mentioned risk factors. The distribution of smooth muscle cells (SMCs) and macrophage infiltration in apoptotic atherosclerotic lesions were investigated by immunohistochemical detection of the α- SMC actin and CD 68 antigenes. Results: BAX expression and TUNEL+ cells were found in 15 (27, 3%) and 21 (38, 2%) out of 55 carotid plaques, respectively, and no immunoreactivity was found in the normal carotid specimens. In all cases which we observed expression of BAX gene we demonstrated the exist of TUNEL+cells. In none of the examined tissues BCL-2 expression was found. Among the 15 plaques that expressed the BAX gene, 13 (86, 7 %) belonged to hypertensive patients, while hypertention was present in 14 (35%) out of 40 plaques that did not express the BAX gene (p<0, 01).No similar odservation was found in TUNEL+ cells. In addition, no significant correlation was found between the expression of the BAX gene or TUNEL+ cells and the other risk factors. The fatty streaks differed from adaptive intimal thickenings by the presense of BAX protein while both regions were composed mainly of SMCs and macrophage infiltration was low. Apoptosis as detected by TUNEL was not present in these regions. Apoptosis of SMCs and macrophages and TUNEL+ cells were present in advanced atherosclerotic lesions, where the infiltration of macrophages was dense. Conclusions: In a significant number of atherosclerotic carotid plaques, we found evidence of apoptosis suggested by the presence of BAX expression and TUNEL+ cells. Hypertension was more prevalent in those patients with BAX gene expression. Apoptosis of SMCs and macrophages and TUNEL+ cells were present in advanced atherosclerotic lesions. Moreover, SMCs within fatty streaks express BAX, which increases the susceptibility of these cells to undergo apoptosis. These findings could be important in our understanding of the transition of fatty streaks into atherosclerotic plaques, which are characterized by regions of cell death. Further study of apoptosis may contribute to the potential of direct modulation of its mechanisms and the development of new diagnostic and therapeutic avenues to alter the pathophysiology of atherosclerosis.Σκοπός: Η εντόπιση των αποπτωτικών κυττάρων στην αθηρωματική πλάκα της καρωτίδας αρτηρίας στα τμήματα του αθηρώματος, τα οποία περιέχουν μακροφάγα και λεία μυϊκά κύτταρα (ΛΜΚ) ή συνδυασμό αυτών, σε σχέση με το στάδιο της αθηροσκληρωτικής βλάβης και τη συνύπαρξη επιβαρυντικών παραγόντων ( υπέρταση, κάπνισμα, δυσλιπιδαιμία και σακχαρώδης διαβήτης ). Υλικά και μέθοδοι: Εξετάσαμε με ανοσοϊστοχημικές τεχνικές πενήντα πέντε παρασκευάσματα ανθρώπινης καρωτιδικής αθηρωματικής πλάκας που λήφθηκαν μετά από ενδαρτηριεκτομή και 20 νεκροτομικά δείγματα καρωτίδων αρτηριών, (ως ομάδα ελέγχου). Μελετήθηκε η απόπτωση με ανοσοϊστοχημική εντόπιση των πρωτεϊνών BAX και BCL-2 και την παρουσία TUNEL+ κυττάρων και τα αποτελέσματα συσχετίσθηκαν με την συνύπαρξη επιβαρυντικών παραγόντων. Παράλληλα, εντοπίστηκαν τα τμήματα του αθηρώματος, που περιέχουν μακροφάγα ή/και ΛΜΚ σε σχέση με τα αποπτωτικά κύτταρα με ανοσοϊστοχημική εντόπιση των αντιγόνων CD 68 και α SMC ακτίνης. Αποτελέσματα : Έκφραση του γονιδίου BAX και των TUNEL+ κυττάρων βρέθηκε σε 15 (27,3%) και 21 (38,2%) αντίστοιχα από το σύνολο των 55 καρωτιδικών πλακών που μελετήθηκαν, ενώ στις καρωτίδες-μάρτυρες δεν διαπιστώθηκε έκφραση του γονιδίου ή των TUNEL+ κυττάρων. Σε όλες τις αθηρωματικές πλάκες που είχαμε έκφραση του BAX είχαμε και ανίχνευση TUNEL+ κυττάρων. Σε καμιά από τις εξεταζόμενες καρωτίδες δεν βρέθηκε έκφραση του γονιδίου BCL-2. Βρέθηκε στατιστικά σημαντική συσχέτιση της έκφρασης του γονιδίου BAX, αλλά όχι της παρουσίας TUNEL+ κυττάρων, και της υπέρτασης. Από τις 15 καρωτιδικές πλάκες στις οποίες διαπιστώθηκε έκφραση του γονιδίου BAX οι 13 (86,7%) ανήκαν σε ασθενείς υπερτασικούς υπό αγωγή (ενώ η υπέρταση ήταν παρούσα στις 14 από τις 40 πλάκες που δεν εξέφραζαν το γονίδιο BAX, p<0,01). Δεν βρέθηκε στατιστικά σημαντική συσχέτιση μεταξύ της έκφρασης του γονιδίου BAX ή των TUNEL+ κυττάρων και των άλλων παραγόντων κινδύνου. Στα στάδια της πάχυνσης του έσω χιτώνα και των λιπωδών ταινιών, που θεωρούνται «πρώιμη» αθηροσκλήρυνση δεν διαπιστώσαμε αποπτωτικά κύτταρα και κατακερματισμό του DNA με τη μέθοδο TUNEL. Στις προχωρημένες αθηροσκληρυντικές βλάβες, η αποπτωτική διαδικασία βρέθηκε σε υψηλά επίπεδα, σε περιοχές με μεγάλη διήθηση με μακροφάγα. Επισημαίνουμε, ότι διαπιστώσαμε έκφραση του γονιδίου BAX σε περιοχές που ανήκαν στο στάδιο των λιπωδών ταινιών ενώ αυτό δεν κατέστη δυνατό σε περιοχές πάχυνσης του έσω χιτώνα . Αντιθέτως, και στα δύο αυτά πρώιμα στάδια της αθηρογένεσης, δεν διαπιστώσαμε την παρουσία TUNEL+ κυττάρων. Τα ΛΜΚ που εξέφραζαν το γονίδιο BAX, περιείχαν λιποειδή κενοτόπια, εύρημα που υποδεικνύει την πιθανή συσχέτιση μεταξύ της συγκέντρωσης του λίπους στο κυτόπλασμα των ΛΜΚ και της έκφρασης του γονιδίου BAX. Επομένως, είναι πιθανόν η συγκέντρωση του λίπους στο κυτόπλασμα των ΛΜΚ να τα καθιστά επιρρεπή στην απόπτωση. Συμπεράσματα: Η έκφραση του γονιδίου BAX και η παρουσία των TUNEL+ κυττάρων σε σημαντικό βαθμό στο αθήρωμα της καρωτίδας αρτηρίας και ιδιαίτερα στα προχωρημένα στάδια της αθηροσκλήρυνσης οδηγεί στο συμπέρασμα ότι εκτός από τον πολλαπλασιασμό των κυττάρων του αγγειακού τοιχώματος, η απόπτωση συμμετέχει στην παθογένεια της αθηροσκλήρωσης..

Laparoscopic Adrenalectomy: Where Do We Stand Now?

Laparoscopic adrenalectomy (LA) has become the procedure of choice for the surgical removal of the vast majority of small sized adrenal tumors (&lt;= 6 cm), because of its significant and multiple advantages: reduced hospital stay and wound morbidity, decreased transfusion requirements, postoperative pain and complications. The role of LA in patients with large adrenal lesions or potential malignancy remains controversial. The aim of this article is to review the current and up-to-date surgical approaches for LA, which include: 1) transabdominal anterior or flank approach and 2) retroperitoneal technique with the patient in either lateral or prone position. Specific advantages and disadvantages are referred to for each of them. The choice of each of these techniques is determined particularly by the preference and the experience of the surgeon, but other objective criteria must be taken into consideration, such as the size of the adrenal and history of previous abdominal surgeries

Erratum: Combined use of web-based and in-person education on ill health self-management skills in adults with bipolar disorder: Protocol for a mixed methods study

In “Combined Use of Web-Based and In-Person Education on Ill Health Self-management Skills in Adults With Bipolar Disorder: Protocol for a Mixed Methods Study” (JMIR Res Protoc 2021;10(9):e25168) one error was noted. One author's name was displayed as: Andreas Hatzittofis It has now been corrected to: Andreas Chatzittofis The correction will appear in the online version of the paper on the JMIR Publications website on September 15, 2021, together with the publication of this correction notice. Because this was made after submission to PubMed, PubMed Central, and other full-text repositories, the corrected article has also been resubmitted to those repositories

Qualitative inquiry into the experience of suicide loss, aftereffects and coping strategies of suicide-bereaved Greek-speaking parents in Cyprus

Purpose Studies on suicide-bereaved parents are scarce in South European and Eastern Mediterranean countries. We explored the experiences of Greek-speaking suicide-bereaved parents in Cyprus, with emphasis on the interpretations of their child’s suicide, its aftereffects and their coping strategies. Methods A qualitative methodology based on inductive content analysis of the interviews of ten mothers and two fathers was applied. Results The participants described their efforts to make sense of the senseless, reporting numerous interpretations of their child’s suicide. Some participants had achieved to move on by trying to keep the remaining family together. Others felt detached from their social network. The different coping strategies and support systems described, reflected participants’ efforts to escape from obsessive, enduring and deeply traumatizing thoughts about their child’s suicide. The analysis mirrored participants’ ultimate desire to find existential relief and serenity through the management of distressing reminders of their child’s suicide, and alleviate the burden of their own negative self-judgement and the criticism of others. They sought physical and emotional comfort in the inner realm of their psyche, through spiritual and psychological coping processes. Conclusion Further exploration is suggested about intervention planning aiming to strengthen effective coping strategies and external supportive resources in mourning parents