[Gene therapy for atherosclerosis].
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Animals↗
Biomedical subjects
Dorde Radak
Publications and source records attributed to Dorde Radak.
[Asymptomatic carotid stenosis: ACS].
Asymptomatic carotid stenosis (ACS) is the lesion located in the vicinity of the common carotid artery branching, without neurological symptoms caused by insufficient blood flow to the brain. Cerebrovascular diseases represent an important medical as well as social problem, since this is one of the leading causes of mortality and serious invalidity worldwide. Majority of brain insults are caused by stenosing atherosclerotic lesions of the carotid arteries. Thus, early surgical treatment may contribute to lessen this problem. Routine diagnosis of ACS include auscultation and ultra-sonographic examination of carotid arteries. Early detection of the disease enables proper medical prophylaxis and decision for surgical treatment (providing that expected benefit for the patient exceeds possible operative risk, i.e. < 3% of complication rate in experienced surgical wards). That's why of particular importance is to formulate multidisciplinary programs of insult prevention and to conduct multiinstitutional studies in order to establish clear cut indications for surgical treatment, particularly for the group of asymptomatic patients.
Carotid Stenosis↗
Popliteal traumatic arteriovenous fistula.
Popliteal trauma requires particular attention because blood vessel injuries in that zone might cause serious complications. Popliteal traumatic arteriovenous fistula (AVF) should be considered for serious leg amputation, and long-standing fistulae produce cardiac overload. The diagnosis is usually made after clinical examination, finding palpable thrill and audible bruit over the injury site, and is confirmed after duplex ultrasonography and/or angiography. We present a case of popliteal traumatic arteriovenous fistula with false aneurysm (pseudoaneurysm) (PSA), in which duplex ultrasonography and angiography findings proved inconsistent with the findings at surgery, thus resulting in an unnecessary extensive dissection of a major artery and vein, whereas the fistula and the PSA were found in minor vessels (genicular artery and vein).
Adult↗
[Endothelial dysfunction and diabetes].
ENDOTHELIAL FUNCTION AND DYSFUNCTION: During the past two decades, there has been an increasing recognition of the importance of normal endothelial function in the maintenance of vascular homeostasis and vascular health. Abnormalities in the function of endothelium have been recognized in a number of conditions. One of the most important abnormalities of endothelial dysfunction appears to be changes in the bioavailability of nitric oxide. It now appears clear that abnormalities in endothelial dysfunction are associated with abnormalities in the production of nitric oxide and/or abnormalities in the rate of its degragation. Either way, loss of the functional availability of nitric oxide appears to be an important characteristic of endothelial dysfunction. ENDOTHELIAL DYSFUNCTION AND DIABETES: Impaired endothelial-dependent vasodilatation has been described in patients with type 1 and type 2 diabetes, and the degree of impairment may correlate with glycemic control. Hyperglycemia itself appears to affect multiple mechanisms that increase atherosclerosis. Hyperglycemia enhances oxidation, thrombosis, inflammation, matrix production, and the formation of advanced glycation end-products and other metabolites that can potentially damage the vasculature. TREATMENT OF ENDOTHELIAL DYSFUNCTION: A number of trials have demonstrated that therapy with lipid lowering agents (statins) as well as angiotensin converting enzyme inhibitors is associated with improvements in endothelial function in diabetes. These agents have also been shown to improve prognosis in patients with a number of underlying cardiac diseases and risk factors for cardiac disease. Therefore, it seems that interventions that lead to improvement in endothelial function can be associated with improvements in cardiovascular outcome. The role of antioxidant therapy is controversial. No data have been published regarding the effects of hormonal replacement therapy on endothelial dysfunction in postmenopausal women with type 2 diabetes.
Diabetes Mellitus↗
[The role of oxidative stress in the pathogenesis of pulmonary emphysema].
OXIDATIVE PULMONARY DAMAGE: The pathogenesis of pulmonary emphysema is incompletely understood. Nearly 90% of all patients with chronic obstructive pulmonary diseases are smokers. Cigarette smoke is a rich source of oxidants. Oxidative stress increases oxidant generation, which cannot be neutralized with antioxidant defense mechanisms. Lipids, proteins and deoxyribonucleic acid are components of the cell that are most sensitive to oxidative damage. Oxygen radicals can modify amino acid side chains, form protein aggregates, cleave peptide bonds, and make proteins more susceptible to proteolytic degradation. It has been shown that neutrophils have a principal effector role in pulmonary tissue damage. Neutrophil elastase can damage air spaces by degrading elastin, and a variety of extracellular membrane proteins, proteoglycans, and glycoproteins. Neutrophil elastase can also stimulate inflammation by increasing interleukin-8 synthesis. Additionally, neutrophil elastase can activate or inactivate inhibitors of neutrophil collagenase, and secretory leukoprotease proteinase inhibitor. Apart from neutrophils, oxidative stress causes activation of other phagocytes and severe inflammatory response ensues. LIPID PEROXILATION AND PULMONARY EMPHYSEMA: Except protein oxidation and lipid peroxidation, oxidants may disturb signal transmission in the cells, as well as normal cell membrane function and function of organelles. Modified structure of deoxyribonucleic acid may cause mutations, which in absence of repairation enzyme activity lead to cell injury. IRON AND OXIDATIVE STRESS: Iron metabolism is also important in the development of pulmonary emphysema due to its role in production of some oxidants.
Humans↗
[Treatment of the infected wound with exposed silver-ring vascular graft and delayed Thiersch method of skin transplant covering ].
Although the incidence of prosthetic infection is low (1%-6%), the consequences (limb loss or death) are dramatic for a patient, with high mortality rate (25%-75%) and limb loss in 40%-75% of cases. In case of Szilagyi's grade III infection, standard procedure consists of the excision of prosthesis and wound debridement. Alternative method is medical treatment. This is a case report of a patient with prosthetic infection of Silver-ring graft, used for femoropopliteal reconstruction, in whom an extreme skin necrosis developed in early postoperative period. This complication was successfully treated medically. After repeated debridement and wound-packing, the wound was covered using Thiersch skin graft.
Blood Vessel Prosthesis↗
[Endovascular procedures in the treatment of obstructive lesions of the brachiocephalic arteries].
BACKGROUND: To assess the early effects, possible risks, and long term results of percutaneous transluminal angioplasty (PTA) of brachiocephalic trunk (BT) and subclavian arteries (SA). METHODS: During the period of 11 years, in 92 patients (57 males--62%, mean age 53.5 +/- 7.8 years) 93 PTA of SA/BT were performed; 70 (75%) lesions were stenosis, while 23 (25%) lesions were occlusions with mean diameter stenosis percent of 83.1 +/- 6.2%. Clinical indications were: vertebrobasilar insufficiency (n = 57), upper limb ischemia (n = 40), coronary steal syndrome (n = 4) and scheduled aorto-coronary bypass, using internal thoracic artery (ITA) (n = 4 asymptomatic patients). Mean lesion length was 22 +/- 8 mm. RESULTS: Eighty one (87%) out of 93 lesions were successfully dilated; all of 12 (13%) failures were due to unsuccessful recanalisation of occluded arteries. In 10 patients 10 stents were implanted (2 in BT and 8 in left SA). There were 6 (6.5%) procedural complications: 1 dissection, 1 thrombosis of the left SA, transient ischemic attack in 2 patients, and 2 cases of dislocation of atheromatous plaque from the right SA into the right common carotid artery. During the follow-up of 48 +/- 3 months, 16(20%) restenoses were treated by PTA (n = 7) or operatively (n = 9). Primary and secondary patency for all lesions treated during 11 years was 87% and 80%, respectively (stenosis: 97% and 89%; occlusions: 58% and 58%). CONCLUSION: PTA with or without stenting was relatively simple, efficient and safe procedure. It required short hospitalization with low treatment costs. If any of suboptimal results or chronic occlusions were present, the implantation of endovascular stents should have been considered.
Angioplasty, Balloon↗
[The role and significance of trace elements in the pathogenesis of atherosclerosis].
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Arteriosclerosis↗