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F Sigala

Publications and source records attributed to F Sigala.

18 recordsLinked to original sources
PubMed2006

Heregulin, cysteine rich-61 and matrix metalloproteinase 9 expression in human carotid atherosclerotic plaques: relationship with clinical data.

OBJECTIVES: Heregulins (HRGs) are known to induce expression of angiogenic factors such as cysteine rich-61 (CYR61) and collectively to promote neoangiogenesis. Along with extracellular matrix remodelling, mediated by matrix metalloproteinases (MMPs), these factors are important in atherogenesis. The aim of the present study was to investigate HRG, CYR61 and MMP-9 expression and their relationship with clinical and histopathological findings in carotid occlusive disease. MATERIALS AND METHODS: Specimens of human carotid atherosclerotic plaque (n=90) were obtained by endarterectomy. Expression of HRG, CYR61 and MMP-9 was assessed by immunohistochemical and Western blot analysis. Associations between protein expression and degree of carotid stenosis, presence of symptoms, presence of an infarct in CT scan and carotid plaque histopathology were investigated. RESULTS: An increase in HRG, CYR61 and MMP-9 expression was found, particularly in neovascularized regions of the plaques. High HRG expression was associated with the degree of carotid stenosis (p=0.028) and plaque histopathology (p=0.002). More than half of specimens from plaques with >90% stenosis had intense expression of CYR61 (p=0.047). Increased expression of MMP-9 was associated with degree of stenosis and presence of cerebral infarct on CT scan (p=0.05). CONCLUSION: HRG, CYR61 and MMP-9 are highly expressed in human atherosclerotic carotid plaques. The association with the degree of stenosis and/or plaque histopathology implies an involvement in lesion progression.

Blotting, Western↗
PubMed2006

Outcome of infrainguinal revascularization for critical limb ischemia in diabetics with end stage renal disease.

BACKGROUND: End stage renal disease [ESRD] and diabetes have a negative effect on outcome of arterial reconstructions, because they are associated with a vulnerability to infection, an infrageniculate arterial occlusive disease and an increased perioperative risk. The combination of both in critically ischemic patients is traditionally considered a great threat to their limb or life. The risk/benefit ratio of revascularization in this clinical setting is marginal and therefore the decision making is controversial. This study was undertaken to determine the results of arterial reconstruction in patients with end-stage renal disease and diabetes mellitus. PATIENTS AND METHODS: The outcome of 97 patients undergoing 121 arterial reconstructions due to lower limb threatening ischemia were reviewed. Primary and secondary patency rates as well as survival and limb salvage were estimated. RESULTS: Thirty-day operative mortality rate was 10.3%. At one month, one year and 2 year follow-up, the survival rate was 89.7%, 77.6% and 44.2% respectively. Limb salvage at 6 months was 85.6%, at 12 months 75.3% and at 2 years 56.3%. The primary and secondary patency was 92.4% and 93.2% at 6 months and 71.7% and 72.7% at 12 months, respectively. CONCLUSIONS: Diabeticpatients with ESRD attained an acceptable graft patency and limb salvage but they sustained higher perioperative mortality and morbidity and reduced survival.

Adult↗
PubMed2006

Inguinal anastomotic aneurysm due to salmonellosis treated with orthotopic reconstruction.

Femoral anastomosis following either an aortofemoral or femoropopliteal bypass, is a common site for anastomotic aneurysms occurring with an incidence of 2% to 5%. Among the factors contributing to the pathogenesis of such aneurysms, graft infection should be considered as a major one. We report the case of a 74 years old woman with history of an aorto-femoral right and -iliac left bypass with a Dacron Y-prosthetic graft due to abdominal aneurysm. The patient presented with a painful, inflammatory, and pulsating mass in her right inguinal region. She was treated surgically with wide radical resection of infected tissues including the anastomotic aneurysm, and in situ bypass reconstruction using a Silver-Dacron graft. Cultures of inflamed wound tissue, graft, and stools were positive for Salmonella typhimurium. In the postoperative period the patient was submitted to subtotal colectomy due to colon cancer and later to an iliofemoral crossover-bypass from right to left due to acute ischaemia of the left limb. Her postoperative follow up has been insignificant. Infected femoral anastomotic aneurysms due to salmonellosis are a rarity. Although their treatment of choice consist in an extra-anatomic bypass, under specific conditions in situ reconstruction may be adopted as a feasible and effective surgical technique to treat these infected aneurysms.

Aged↗
PubMed2006

[Angioplasty of the distal anastomosis und runoff arteries of occluded infrainguinal bypasses].

BACKGROUND: We investigated the clinical results of transluminal angioplasty performed through infrainguinal bypass grafts for stenotic or occlusive lesions at the distal anastomosis and/or in the runoff arteries in high risk patients and the influence of different parameters on limb salvage, primary and secondary patency rate. PATIENTS AND METHODS: Between January 2001 and March 2005 we performed 49 transluminal angioplasties on stenotic or occlusive lesions at the distal anastomosis and/or in the runoff arteries in 49 (16 female, 23 male, mean age 71.1 years) patients with occluded infrainguinal bypass. 20 angioplasties occurred in the runoff arteries, 5 at the distal anastomosis and 24 at both locations at a median of 11.3 months (range 2-85 months) after infrainguinal bypass grafting). 20 procedures were on popliteal artery above the knee, 21 below the knee and 8 on crural arteries. RESULTS: Kaplan-Meier analysis showed a cumulative limb salvage of 87.6 and 76.4 % after 6 months and two years, respectively. Patients with gangrenous lesions had a 5 times higher risk of amputation (Cox-regression model). Primary and secondary patency rates were at 6 months 85.1 and 91.1 % respectively and were at one year 73.3 and 78.8 % respectively. Patients with end stage renal disease were in 4 times hazard to primary occlusion and patients with gangrenous lesions 5 times to secondary occlusion (Cox-regression model). CONCLUSION: Even if the long-term results of angioplasty on stenotic or occluded lesions at the distal anastomosis and/or in the runoff arteries are inferior to the results of surgical revisions reported in literature, angioplasty in high risk patients with absence af a vein may be the first line alternative intervention for limb salvage.

Aged↗
PubMed2006

Femoral anastomotic aneurysms in the modern era: a reappraisal of a continuing challenge.

AIM: Despite improvement in the operative technique and graft and suture material, femoral anastomotic aneurysms (FAAs) represent a continuing problem for patients undergoing lower extremity revascularization. The present retrospective study investigates the clinical presentation, the infection as a cause of FAAs, the interval between the original operation and the development of FAAs. It also evaluates the mortality and amputation rate of patients with FAAs. METHODS: We reviewed the records of 124 patients (thrombendarterectomy in 9, femoro-femoral bypass in 3 and axillofemoral bypass in 1). RESULTS: There were 13 infected and 14 recurrent FAAs. The overall mean time elapsing between the initial operation and the development of FAAs was 56.9 months (range 1-219). This interval was 62 months for the noninfected FAAs, while it was only 8 months for the infected FAAs. The mean time interval in which a recurrence of FAAs occurred was 39 months. The most common type of repair was an interposition prosthetic graft from the proximal prosthesis to the profunda femoral artery (100 cases). In the postoperative period local complications occurred in 21 (15.4%) cases and systemic in 7 (5.1%). The postoperative mortality was 3.7%. The overall survival at 1 year was 91.3% (standard error: +/-2.5%) and at 2 years 85.4% (standard error: +/-3.3%). Kaplan-Meier analysis showed a cumulative limb salvage of 94.2%, 93.3 % and 89.2% after 6 months, 1 and 2 years, respectively. A significant relationship was demonstrated between amputation and the following parameters: infected FAAs (Log rank test: 26.1, P-value <0.001), diabetes (Log-rank test: 12.9, P-value <0.01), peripheral arterial occlusive disease (Log-rank test: 3.1, P-value =0.08), and prior limb amputation (Log-rank test: 9.9, P-value <0.01). The mean time to amputation for the infected FAAs was 49.6 months (95% CI: 24.3-74.8), while for the noninfected it was 98.8 months (95% CI: 93.4-104.2). CONCLUSIONS: Complicated FAAs are still responsible for significant morbidity and mortality. Elective treatment produce the maximum benefit.

Aged↗
PubMed2005

Relationship between iNOS expression and aortic cell proliferation and apoptosis in an elastase-induced model of aorta aneurysm and the effect of 1400 W administration.

BACKGROUND: In the present study, we employed an elastase infusion-dependent abdominal aortic aneurysm (AAA) model to examine inducible nitric oxide synthase (iNOS) expression in relation to cellular proliferation and apoptosis in this pathologic condition. Furthermore, we employed N-(3-(aminomethyl)benzyl)acetamidine (1400 W), a previously shown selective iNOS inhibitor, to further explore this relationship. METHODS: Adult male Wistar rats were randomized into separate groups. Group A served as a control and received an intra-aortic saline infusion, while groups B, C, and D received an intra-aortic elastase infusion according to standard protocols. The animals in group C were administered postoperatively the highly selective iNOS inhibitor, 1400 W, while rats in group D received regularly the same compound preoperatively and postoperatively. The animals were killed at postoperative days 7 and 14. Aorta diameter and nitric oxide (NO), nitrite/nitrate, and MDA levels were measured. iNOS expression was assessed by immunohistochemistry and Western blot analysis, while Ki-67 immunohistochemistry and TUNEL assay were used to evaluate cellular proliferation and apoptosis, respectively. RESULTS: Increased iNOS and NO levels accompanied aneurysm development in groups B, C, and D, but these levels were significantly lower in groups C and D, compared with group B. Interestingly, very low but detectable levels of iNOS were found in the control group, indicating a basal constitutive level. Cell growth parameters were augmented in group B compared with group A. In contrast, groups C and D exhibited a significant decrease of the cellular growth parameters but did not attain normal values. CONCLUSIONS: iNOS-derived NO is associated with the cellular growth parameters of the vessel cells, predominantly smooth muscle cells. Selective iNOS blockage ameliorates the cellular remodeling in AAAs.

Animals↗
PubMed2005

Transluminal angioplasty of isolated crural arterial lesions in diabetics with critical limb ischemia.

BACKGROUND: We investigated the long-term clinical results of transluminal angioplasty of isolated infrapopliteal arteries in diabetic patients with severe ischaemic foot lesions and the influence of different parameters on primary success, the long-term outcome and the survival rate. PATIENTS AND METHODS: Between January 2001 and May 2004 we performed 50 transluminal angioplasties in 52 (10 female, 42 male, mean age 69.3 years) diabetics with isolated lesions of crural arteries (tibio-peroneal trunk 41, anterior tibial 13, posterior tibial 5, peroneal artery 14) and limb threatening ischaemia (rest pain 12, tissue loss 40). In two patients the dilatation could not be performed due to vessel perforation and impossibility to catheter localization. The morphological classification of infrapopliteal lesions was determined according to guidelines provided by TransAtlantic Inter-Society Consensus (TASC) (17 type A, 16 type B, 13 type C, 4 type D). RESULTS: Initial technical success after angioplasty of crural arteries could be obtained in 96%. Kaplan-Meier analysis showed a cumulative limb salvage of 92%, 85% and 68,9% after 6 months, one and two years, respectively. Patients falling in TASC group C had significantly higher risk of amputation. Overall survival at I year was calculated at 85% and at 2 years at 65%. CONCLUSION: Our results suggest that depending on the extent of lesions transluminal angioplasty of infrapopliteal artery stenoses and occlusions is considered as an effective and save therapy modality to avoid limb loss in diabetics with critical ischemia.

Aged↗
PubMed2005

Management of massive presacral bleeding during low pelvic surgery -- an alternative technique.

Although massive presacral bleeding during rectal mobilization is uncommon, it can rapidly destabilize a patient. So, effective hemostasis is critical in severe presacral hemorrhage due to the fatal course of this complication. Among the reported methods are packing, thumbtacks, inflatable devices, muscle tamponade, muscle fragment welding and application of endoscopic staplers. Local hemostatic agents in conjunction with other methods such as diathermy, cyanoacrylate tissue adhesives and application of bone wax are among other alternatives which may help to treat this serious complication. The aim of this study is to describe the anatomic and physiologic basis of our mode of treatment, which is new in the literature approach, treating two patients with presacral bleeding during low anterior resection for rectal cancer. The technique is the early clamping of the infrarenal aorta and suture ligation of the bleeding points from the presacral plexus.

Aorta, Abdominal↗
PubMed2005

Retroperitoneal perforation of a duodenal diverticulum with colonic necrosis -- report of a case.

Primary duodenal diverticula are usually asymptomatic. About 115 perforations have been reported, but none with right colon necrosis. We report a 45-year-old woman, with a five days history of high fever along with epigastric and periumbilical pain. Physical examination revealed right upper and lower quadrant tenderness with peritoneal signs. White blood cell count was 11 500/mm (3) while biochemical and hepatic biology tests were normal. Abdominal radiographs showed no pathologic findings. Ultrasound disclosed fluid in the lower pelvis. Computerized tomography revealed fluid collection in the right hepatorenal space. Intraoperative findings included purulent fluid in the lower pelvis, segmental necrotic changes of the right colon, and a perforated diverticulum on the antimesenteric border of the third part of the duodenum. Surgery consisted of right hemicolectomy and ileo-transverse anastomosis, diverticulectomy, and decompressive lateral duodenostomy at the second duodenal portion. The patient had an uneventful postoperative course. A contrast study from the duodenostomy tube on the 6 (th) postoperative day showed no leakage or obstruction. Duodenostomy tube was removed on the 14 (th) postoperative day. Histology confirmed the diagnosis of a primary duodenal diverticulum.

Abdomen, Acute↗
PubMed2005

Presternal gastric bypass for late postpneumonectomy esophagopleural fistula.

SUMMARY: A 71-year-old diabetic patient underwent right pneumonectomy with wide mediastinal lymph node dissection for lung cancer (right upper lobe). Postoperatively he developed pleura empyema that was successfully treated - drainage and Eloesser window, followed by adjuvant radiotherapy. Two months later he developed an esophagopleural fistula. Due to the patient's physical condition primary repair of the esophageal rupture was considered a high-risk operation. Stenting was also considered as inappropriate due to the existing contamination. Bypassing with the use of the stomach as conduit was preferred due to its simplicity compared to the colon. In order to avoid mediastinum after the postradiation alterations and because of the Eloesser window we adopted a presternal subcutaneous position. Twenty-eight months after the by pass procedure the patient is in good health being able to eat and drink, has gained weight and shows no evidence of malignancy. Presternal gastric esophageal bypass has never been reported as a treatment for esophagopleural fistula. This case report indicates its possible successful use in this debilitating setting, although more experience is needed.

Aged↗
PubMed2004

Absence of association with cancer risk and low frequency of alterations at a p53 responsive PIG3 gene polymorphism in breast and lung carcinomas.

The mechanisms of p53-dependent apoptosis involve a set of genes that possess the ability to modulate oxidative stress. One of them PIG3, is induced by p53 through a microsatellite in its promoter region. This microsatellite was found to acquire its full structure and p53-functional dependence only in Hominoidea (apes and humans) and has been proposed to represent an evolutionary adaptation of tumor suppressor mechanisms. Microsatellite instability and genetic constitution, comprising the presence of the low repetition allele (10 TGYCC repeats), at this locus have been hypothesized to provide an increased risk for cancer development. Therefore, in the present analysis we examined this polymorphism in two common human cancers, lung and breast and compared it with corresponding control cases. Furthermore, for lung cancer we employed two different ethnic groups, Greek and British. Analysis of this locus in this types of tumors showed: (1) a very low frequency of microsatellite instability and loss of heterozygosity (1.4% and 4%, respectively) in the examined carcinomas, (2) the homozygous presence of the 10 repeats allele only in the control cases, and (3) a non-significant increase of the most frequent allele (15 repeats) in the cancer groups as compared to control ones. The last two observations were found in both Greek and British populations. Taken together, these data do not support the notion that this PIG3 polymorphism is associated with an increased risk for cancer susceptibility. Larger studies including other types of cancer should also be performed.

Base Sequence↗
PubMed2004

Radiofrequency tissue ablation in an experimental model of grade IV renal trauma: a preliminary report.

BACKGROUND: The kidney is one of the most frequently injured intraabdominal organs. In this study, we investigated the efficacy and safety of radiofrequency ablation (RFA) as a kidney-preserving hemostatic technique for grade IV renal trauma. METHODS: A grade IV injury was induced in the right kidney of 12 Landrace pigs. Then RFA was applied around the injury in 10 animals until hemostasis was achieved; two animals were not treated (control group). The treated animals were killed humanely on days 0, 3, 7, 14 and 21 and examined. The kidneys were subjected to histologic and radiologic examination. RESULTS: The two untreated animals died from hypovolemic shock. Hemostasis was achieved in all treated animals. We had no operative deaths and no morbidity. No blood, pus, urine, or other fluid was found at the time of death. In one animal, a fistulous lesion leading to the collecting system was identified, but no urine leakage was observed. At histology, the ablated areas were found to consist of three zones: an inner necrotic one, a zone of neutrophils digesting necrotic tissue, and an outer zone with possibly reversible damage. CONCLUSIONS: Radiofrequency ablation is an efficient and safe hemostatic method for grade IV renal trauma. Further study is needed to investigate the possible application of this method to humans and its percutaneous or laparoscopic use.

Animals↗
PubMed2003

Vascular endothelial cadherin expression in human carotid atherosclerotic plaque and its relationship with plaque morphology and clinical data.

OBJECTIVES: To determine the relationship between Vascular Endothelial (VE)-cadherin expression in carotid plaques, carotid plaque morphology and clinical findings of carotid disease. MATERIALS AND METHODS: Fifty-three formalin-fixed, paraffin embedded specimens of human carotid atherosclerotic plaque obtained by endarterectomy and 20 normal postmortem arteries (control group) were studied. Thirty patients were symptomatic and 23 asymptomatic. The expression of VE-cadherin was examined by an avidin-biotin immunoperoxidase technique using specific monoclonal antibodies against this molecule. We used a scale for the estimation of the expression of the VE-cadherin, in which negative expression was indicated by 0, weak expression by 1, and strong expression by 2. In serial sections we also determined the cellular phenotype of atherosclerotic plaques: i.e. the endothelial cells (F8), macrophage (CD68) and smooth muscle cells. Possible relations between variables in statistical analysis were examined by the chi-square test or Fisher's exact test. RESULTS: Expression of VE-cadherin was observed in small newly established vessels, particularly in areas with intense inflammatory infiltrations by macrophages and leucocytes. A strong expression of VE-cadherin was evident particularly in symptomatic instead in asymptomatic patients (43% vs. 13%, p=0.057), in high degree stenosis group (81% vs. 0%, p=0.005), and in patients with ischaemic infarct in brain scan (71% vs. 23%, p=0.021). On the other hand, there was no relation between molecule expression and plaque ultrasonic characteristics (echogenic or echolucent, p=0.499). Finally, there was a significant statistical correlation in the expression of VE-cadherin and the histological type of the plaque, namely fibrotic and complicated plaques. Strong VE-cadherin expression was observed in 64% of complicated plaques instead of 6.5% in fibrotic plaques (p=0.001). CONCLUSION: An intense expression of VE-cadherin in carotid plaques is linked with plaque instability, high degree of stenosis and clinical events. This molecule seems to be a marker of progression of the atherosclerotic plaque.

Aged↗
PubMed2000

Pathological changes of hepatic artery and portal vein, after allyl-alcohol and carbon tetrachloride administration. An experimental study.

BACKGROUND: Allyl-alcohol (AA) and carbon tetrachloride (CC14) are known to cause peritoneal and pericentral liver necrosis, respectively. This study investigates pathological changes of hepatic artery and portal vein after simultaneous administration of AA and CC14 in rats. METHODS: The study comprised 130 male Wistar rats divided randomly into 2 groups: I (n=10) sham and II (n=120) AA injection (intraperitoneally: 0.62 mmol/kg) and rhinogastric administration of CC14 (0.66 ml/kg, 1:1 volume dilution in corn oil). After injection was completed, animals of group II were assigned in 12 categories and sacrificed 2, 4, 6, 12, 18, 24, 33, 48, 57, 81, and 153 hrs after. Tissue was obtained from the left anterior lobe and the hilum of the liver, and histological examination included H&E, silver methenamine and van Giesson stains. RESULTS: Liver sections from group II (AA+CC14) demonstrated periportal together with pericentral necrosis; the peak was 57 hrs after injection. In all 120 cases, H&E stain showed evidence of regeneration originated from zone 2, extending to zone 1 and occasionally to zone 3, and accomplished mainly by non-necrotic cell proliferation. Sections from the liver hilum showed thrombosis of the portal vein, whereas the hepatic artery and its branches developed a variety of changes. Initially (2, 4 hrs), endothelial hypertrophy was observed which was followed by focal fibrinoid necrosis of the arterial wall (6 hrs). Later on (9-153 hrs) the following findings were present: hyperplasia and non-isometric cytoplasmic vacuolisation of media, disruption of the elastic lamina, aggregation of foam cells and macrophages in intima, media, and focally in adventitia of hepatic artery; and lymphocytic inflammation of intimal and periadventitial area. In 2 cases (153 hrs) hepatic artery thrombosis was present. CONCLUSIONS: Additionally to liver parenchymal changes, simultaneous administration of allyl-alcohol and carbon tetrachloride in rats results to vascular changes mainly in the hepatic artery and its branches. During liver parenchymal regeneration, the hepatic artery and its branches develop microscopic features that morphologically resemble those of atherosclerosis. These changes may result in hepatic artery thrombosis and or obstruction.

Animals↗
PubMed1995

Social support, job strain and musculoskeletal pain among female health care personnel.

OBJECTIVES: This study explored the relationship between psychosocial work environment and the musculoskeletal pain among health care personnel. MATERIALS AND METHODS: Ninety registered nurses and nurse's aides working in different hospitals in or just outside Stockholm and working in different kinds of care constituted the study group. Data were collected by means of questionnaires, including questions about symptoms (low-back pain, pain in the neck, and pain in the shoulders), the perception of social support from co-workers and superiors, conflicts, feelings of isolation, poor relations with superiors, psychological demands, authority over decisions, and skill utilization (job-strain factors). RESULTS: An ordinal univariate logistic regression analysis showed that psychological demands, authority over decisions, skill utilization, and support at work had a statistically significant effect on symptoms from the lower back, while symptoms from the neck and shoulders were related to support a work only. When support at work and job strain were entered into a multivariate logistic regression model, a difference in the patterns of associations between low-back pain and symptoms from the neck and shoulders was found. Symptoms from the back were significantly related to job strain--the higher the strain, the more symptoms in the low back. Symptoms from the neck and shoulders on the other hand were more associated with social support at work--the lower the support score the more severe the symptoms. CONCLUSIONS: Low-back pain seemed to be related to job strain, while symptoms from the neck and shoulders were to a greater extent related to relational and emotional factors.

Adult↗
PubMed1993

Influence of job strain and emotion on blood pressure in female hospital personnel during workhours.

A homogeneous sample of 56 women who were between the ages of 20 and 59 years and worked in acute emergency care, child psychiatry, or a pediatric outpatient clinic comprised the subjects of this study to determine the relationship between job strain and blood pressure. Job strain was measured with a standardized questionnaire, and blood pressure during workhours with self-triggered equipment. Endocrine factors (morning concentration of plasma prolactin, cortisol, and dehydroepiandrosterone) and emotional states recorded in diaries were also studied. Significant interrelationships occurred among perceived job strain, plasma prolactin, and diastolic blood pressure during workhours even when body mass index, age, family history of hypertension, level of education, and mood state were adjusted for in a multiple regression analysis. Thus job strain of female care givers was associated with systolic and diastolic blood pressure during workhours and also with diastolic blood pressure at rest, but not with blood pressure during leisure time.

Adult↗
PubMed1988

Changes in job strain in relation to changes in physiological state. A longitudinal study.

A sample of 73 men and women aged 22-63 years and working in six different occupations (air traffic controllers, waiters, physicians, symphony orchestra musicians, baggage handlers, and airplane mechanics) participated in a longitudinal study four times during a year. The spontaneous variations in job strain (determined as the self-reported ratio between psychological demands and decision latitude) were substantial. The average difference between the occasion with the highest level of strain and the occasion with the lowest level was 25% of the total mean. Systolic blood pressure during workhours, as well as self-reported sleep disturbance, increased when demands increased in relation to decision latitude. Among men with a depressive tendency (according to a diary) morning plasma prolactin levels increased markedly with increasing job strain. Among subjects with a positive family history of hypertension the increase in systolic blood pressure at work was particularly pronounced, and among the men in this group a lower than expected level of morning cortisol was found measured during the period with the highest level of strain.

Adult↗