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At least 955 records · Page 53Linked to original sources
PubMed1984

Effect of anergy on short-lived suppressor cells in patients with cirrhosis or peripheral vascular disease.

In order to determine whether or not abnormal suppressor cell function correlates with the absence of a delayed hypersensitivity reaction (DHR) in anergic patients, Con A reactivity and the short-lived suppressor cell activity of peripheral blood lymphocytes (PBL) were studied in 4 groups of patients: (1) Those with peripheral vascular disease (PVD) who reacted with a normal DHR to the intradermal injection of one or more recall antigens; (2) patients with PVD who did not respond with a DHR to any of these antigens; (3) patients with alcohol-related cirrhosis and normal DHR; and (4) cirrhotics who showed no DHR. The data for both short-lived suppressor cell activity and Con A reactivity were not significantly different between anergic patients, patients with normal DHR, and a group of normal controls. Although cirrhotic patients have been reported to show abnormalities in cellular immunity, short-lived suppressor cell activity and Con A reactivity were not significantly different between cirrhotics with normal DHR, PVD patients with normal DHR, and normal controls.

Concanavalin A↗
PubMed1976

Insulin response to oral glucose in patients with a previous myocardial infarction and in patients with peripheral vascular disease. Hyperinsulinism and its relationships to hypertriglyceridemia and overweight.

The insulin response to an oral glucose load (100 gm.) in 127 patients with a previous myocardial infarction (MI) (six months to one year) and in 65 patients with surgically treated or arteriographically identified peripheral vascular disease (PVD) was compared with that of 89 controls after matching the three collectives for age, glucose tolerance, and per cent ideal body weight (% IBW). The insulin response was of greater magnitude in MI and PVD groups than in respective control groups also in the absence of hyperglycemia, hypertriglyceridemia, and obesity. This finding suggests that hyperinsulinism may represent an early metabolic alteration associated with the development of MI and PVD. The insulin secretion pattern was prevalently of the delayed type in association with impaired glucose tolerance and with hypertriglyceridemia but not with overweight. Correlations between serum insulin, triglyceride (TG) levels, and % IBW were also investigated. We found a strong correlation (p less than 0.001) between stimulated insulin levels and % IBW in MI patients and none in PVD patients; conversely, the correlation between serum insulin and TG levels was very high (p less than 0.001) in PVD patients and only weak (p less than 0.05) in MI patients. No correlation was found between cholesterol (CH) levels and any of the other parameters studied. According to these results, it seems likely that hyperinsulinism plays a major role as a closely associated factor to obesity in those subjects who develop an MI, whereas in PVD patients the raised insulin levels may favor lipid accumulation in the arterial intima and accelerate the progress of atherosclerosis.

Adult↗
PubMed1998

The effect of occult diabetic status and oral glucose intake on brachial artery vasoactivity in patients with peripheral vascular disease.

Brachial artery vasoactivity is a well known non-invasive method of assessing arterial endothelial function in vivo. Brachial artery vasoactivity has been found to be impaired in overt diabetes and in patients with coronary artery disease. Impaired brachial artery vasoactivity is felt to be an early indicator of atherosclerosis. The authors identified a group of patients with lower extremity peripheral vascular disease, who had normal fasting glucose level and were not known to be diabetics. An oral glucose tolerance test was performed in this group of patients. Brachial artery vasoactivity was assessed at each step of the oral glucose tolerance test to examine their occult diabetic status and correlate brachial artery vasoactivity to that status. The authors studied 23 randomly selected patients from the vascular surgery clinic between the ages of 50 and 79 years. Serum glucose level was assessed after a 10-h fast and at 30, 60 and 120 min after a 75-g oral glucose challenge. Any patient with two serum glucose values > 140 mg/dl was considered to have a positive oral glucose tolerance test. Using duplex ultrasound, the brachial artery diameter (cm) and blood volume (ml/min) were assessed before and after tourniquet occlusion at each step of the oral glucose tolerance test. Paired and unpaired t-tests were used to evaluate the results, P < 0.05 was considered significant. Nine patients had abnormal oral glucose tolerance test for a prevalence of 39%. There was no significant difference in fasting glucose levels between positive and negative oral glucose tolerance test patients (97.4+/-16.7 versus 88.5+/-5.8, P = 0.23). Patients with a positive oral glucose tolerance test had impaired vasoactivity at fasting and at each step of the test with no significant changes in brachial artery diameter or blood flow in response to brachial artery occlusion. Patients with a negative oral glucose tolerance test exhibited increased brachial artery diameter at fasting in response to brachial artery occlusion (0.43+/-0.02 versus 0.46+/-0.02, P = 0.03), but not after oral glucose challenge. In patients with a negative oral glucose tolerance test, brachial artery flow volume increased significantly in response to hyperemia at fasting (240+/-61 versus 578+/-262, P = 0.001) and at 30 min after glucose intake (260+/-53 versus 358+/-72, P = 0.01). At 60 and 120 min after glucose intake, brachial artery flow volume did not significantly increase in response to brachial artery occlusion. These results indicate that individuals with PVD and normal fasting glucose levels have a high prevalence of positive oral glucose tolerance test (39%). Patients with normal fasting glucose levels and abnormal oral glucose tolerance test have impaired brachial artery vasoactivity at fasting and after oral glucose challenge, this is in contrast to patients with normal oral glucose tolerance test who have normal fasting hyperemic response to brachial artery occlusion. However, this normal brachial artery vasoactivity is lost in the negative oral glucose tolerance test group in response to oral glucose load. These results suggest that endothelial function in diabetics is impaired in the early stages of the disease even before overt hyperglycemia occurs. Tight control of blood glucose level in glucose-intolerant patients prior to occurrence of overt fasting hyperglycemia may prove protective.

Aged↗
PubMed2002

Evaluation of patients with peripheral vascular disease.

Approximately 10% of people age >55 years have asymptomatic peripheral atherosclerotic disease (PAD), 5% have intermittent claudication (IC, the cardinal symptom), and 1% critical leg ischemia (rest pain or gangrene). In patients with IC, worsening occurs in approximately 16%, bypass surgery is required in approximately 7%, and amputation in approximately 4%. Disease progresses more frequently in diabetics and in tobacco smokers. Patients with PAD suffer increased cardiovascular morbidity related mainly to coronary artery disease with a mortality rate of approximately 30% after 5 years. Compared to patients without PAD, the relative risk of coronary death is approximately 6.6, overall cardiovascular mortality 5.9, and all-cause mortality 3.1. Pain at rest or ischemic gangrene indicates severe, often multilevel arterial occlusive disease and calls for aggressive management, which usually includes angiography and revascularization by percutaneous angioplasty or surgery. Critical limb ischemia results in some 150,000 amputations annually in the U.S., with perioperative mortality rates of 5-10% for below-knee and up to 50% for above-knee amputation because of comorbidities. Physical findings include trophic signs of ischemia, vascular bruits and peripheral pulse deficits. Ischemic ulcers usually involve the tips of the toes or the heel of the foot, and are typically painful on elevation and most bothersome at night. Ancillary diagnostic modalities begin with the ankle/arm systolic pressure index (ABI); a value <0.90 indicates PAD with significant prognostic implications. More precise assessment in the noninvasive vascular laboratory may involve a combination of segmental limb pressure measurements and pulse volume waveform recording, which is over 90% accurate for predicting the level and extent of PAD. Exercise testing enhances the value of these observations. Magnetic resonance imaging methods are emerging to characterize the arterial wall and atherosclerotic lesions. The diagnosis of PAD does not generally require invasive techniques, and most patients with IC do not need contrast angiography. Angiography is indicated for mapping of the extent and location of arterial pathology prior to revascularization.

Arteriosclerosis↗
PubMed1988

Increased histamine content in leukocytes and platelets of patients with peripheral vascular disease.

Since histamine has recently been shown to play an important role in the pathogenesis of atherosclerosis in experimental nonketotic diabetes, and since leukocytes and platelets contain most of the histamine in blood, we have determined the levels of histamine in these cells from patients with peripheral vascular disease (PVD), insulin-dependent diabetes mellitus (IDDM) and non-insulin-dependent diabetes mellitus (NIDDM). The leukocyte and platelet histamine concentration in PVDs was significantly greater than that in controls, IDDMs and NIDDMs. Histamine content of leukocytes and platelets from IDDMs and NIDDMs did not differ from that in control subjects. The higher histamine content of leukocytes and platelets in PVD may lead to a greater release of this amine at sites of vascular endothelial damage. Increased histamine release may increase endothelial permeability and contribute to further vascular injury as observed in experimental models of diabetes and hypercholesterolemia.

Adult↗
PubMed1992

Exercise and peripheral vascular disease.

The use of exercise as a nonsurgical therapy for peripheral arterial disease has been shown to be effective. Studies have demonstrated improved walking tolerances, alterations in skeletal muscle metabolism, and improved blood distribution with exercise.

Exercise Therapy↗
PubMed2000

Exercise training and peripheral vascular disease.

BACKGROUND: Conservative management is advocated as a treatment of choice for patients with intermittent claudication. This is a review of the mechanisms behind the improvement following an exercise rehabilitation programme. METHODS: All Medline articles from the National Library of Medicine, USA containing the text words 'claudication' or 'peripheral vascular disease' and 'exercise' were reviewed. Cross-referencing from relevant articles was carried out. RESULTS AND CONCLUSION: The poor physical status of a patient with intermittent claudication is not solely due to a reduction in blood flow to the lower limbs; associated factors, such as metabolic inefficiency, poor cardiorespiratory reserve and exercise-induced inflammation contribute. An exercise programme frequently improves both the physical aspect and quality of life, and the success of such exercise is multifactorial. An increase in the blood flow to the lower extremity is uncommon. Other factors, such as a redistribution of blood flow, changes in oxidative capacity of the skeletal muscles and greater utilization of oxygen, occur and the associated metabolic dysfunction of the skeletal muscles is rectified. Following exercise training, blood rheology improves and exercise-induced inflammation is ameliorated; cardiorespiratory status also benefits and the oxygen cost of exercise decreases.

Biomechanical Phenomena↗
PubMed2002

Peripheral vascular disease: combined 3D bolus chase and dynamic 2D MR angiography compared with x-ray angiography for treatment planning.

PURPOSE: To compare combined three-dimensional (3D) and two-dimensional (2D) contrast material-enhanced magnetic resonance (MR) angiography with x-ray angiography for planning treatment of peripheral vascular disease. MATERIALS AND METHODS: Three radiologists retrospectively reviewed the pretreatment x-ray angiographic and MR angiographic studies obtained in 30 consecutive patients: 15 patients (15 limbs) evaluated for limb salvage and 15 patients (20 limbs) evaluated because of claudication. MR angiography included acquisition of 2D contrast-enhanced MR digital subtraction angiograms of the area from the adductor canal to the feet and 3D spoiled gradient-recalled-echo bolus chase MR angiograms obtained in three stations from the aorta to the middle portion of the calf. Each reader reviewed the x-ray and MR angiograms to determine the inflow and outflow segments for a hypothetical bypass graft placement. RESULTS: The three readers selected identical segments for inflow at MR angiography and x-ray angiography in 32, 32, and 35 of the 35 limbs evaluated (mean percentages of agreement [95% CI ]: 91% [77%, 98%], 91% [77%, 98%], and 95% [90%, 100%], respectively). The readers selected identical segments for outflow in 32, 32, and 34 of the 35 limbs evaluated (mean percentages of agreement [95% CI]: 91% [77%, 98%], 91% [77%, 98%], and 97% [85%, 100%], respectively). CONCLUSION: Preliminary data support the combining of 2D MR digital subtraction angiography with 3D bolus chase MR angiography to extend the utility of 3D MR angiography in treatment planning to include patients being evaluated for limb salvage, as well as those being evaluated for claudication.

Adult↗