Abdominal obesity is a major risk factor for hypertension. However, different distributions of abdominal adipose tissue may affect hypertension risk differently. The main purpose of this study was to explore the association of subcutaneous abdominal adipose tissue (SAT) and visceral adipose tissue (VAT) with incident hypertension in a population-based setting. We hypothesized that VAT, rather than SAT, would be associated with incident hypertension. VAT and SAT were determined by ultrasound imagining in 3363 randomly selected Danes (mean age 49 years, 56% women, mean body mass index 25.8 kg/m(2)). We constructed multiple logistic regression models to compute standardized odds ratios with 95% confidence intervals per SD increase in SAT and VAT. Of the 2119 normotensive participants at baseline, 1432, with mean SAT of 2.8 cm and mean VAT of 5.7 cm, returned 5 years later for a follow-up examination and among them 203 had developed hypertension. In models including both VAT and SAT, the Framingham Hypertension Risk Score variables (age, sex, smoking status, family history of hypertension, and baseline blood pressure) and glycated hemoglobin, odds ratio (95% confidence interval) for incident hypertension for 1 SD increase in VAT and SAT was 1.27 (1.08-1.50, P=0.004) and 0.97 (0.81-1.15, P=0.70), respectively. Adjusting for body mass index instead of SAT attenuated the association between VAT and incident hypertension, but it was still significant (odds ratio, 1.22 [1.01-1.48, P=0.041] for each SD increase in VAT). In conclusion, ultrasound-determined VAT, but not SAT, was associated with incident hypertension in a random sample of Danish adults.
Peripheral arterial disease and vascular calcifications contribute significantly to the outcome of dialysis patients. The aim of this study was to evaluate the prognostic role of severity of abdominal aortic calcifications and peripheral arterial disease on outcome of peritoneal dialysis (PD) patients using methods easily available in everyday clinical practice.
We enrolled 249 PD patients (mean age 61 years, 67% male) in this prospective, observational, multicenter study from 2009 to 2013. The abdominal aortic calcification score (AACS) was assessed using lateral lumbar X ray, and the ankle-brachial index (ABI) using a Doppler device.
The median AACS was 11 (range 0 - 24). In 58% of the patients, all 4 segments of the abdominal aorta showed deposits, while 19% of patients had no visible deposits (AACS 0). Ankle-brachial index was normal in 49%, low ( 1.3) in 34% of patients. Altogether 91 patients (37%) died during the median follow-up of 46 months. Only 2 patients (5%) with AACS 0 died compared with 50% of the patients with AACS = 7 (p
Venous reconstructions after iatrogenic injuries are rarely performed and are associated with a relatively high risk of complications. We present our experiences with venous reconstructive surgery to the iliofemoral vein segment.
We reviewed ten patients with venous injuries evaluating clinical characteristics, operative and postoperative data including location and type of venous injury, operative repair and outcome. Venous injuries either occurred during varicose vein surgery or other kinds of procedures in the region. The injuries were repaired by interposition with a polytetrafluorethylene graft, and after surgery they were treated with an intermittent pneumatic compression device and anticoagulation medicine. Subsequently, patients were evaluated both clinically and by colour duplex scan.
The mean patient age was 42.5 years (range 26-61 years) with no reported co-morbidity. The median follow-up was 16 months (range 12-157 months). The 30-day patency rate was 70% and the morbidity rate 40%. At the latest follow-up, the venous patency rate was 90% after supplementary treatment.
The study shows a satisfactory outcome despite severe iatrogenic injuries to the iliofemoral vein segment. Venous reconstructive surgery should be a centralized task.
Dipartimento di Discipline Medico-Chirurgiche, Sezione di Anestesiologia e Rianimazione, Ospedale S. Giovanni Battista, Università di Torino, Corso Dogliotti 14, 10126, Torino, Italy. firstname.lastname@example.org
To examine the accuracy of transcranial Doppler to detect cerebral vasospasm in a patient population with aneurysmal subarachnoid hemorrhage.
Prospective blind comparison of transcranial Doppler with cerebral angiography. Diagnostic accuracy of transcranial Doppler was assessed using receiver operating characteristic (ROC) analysis and likelihood ratios. Sensitivity and specificity were calculated using directly measured middle cerebral artery diameter as reference standard.
Intensive Care Unit of a large university teaching hospital.
Twenty-two patients with subarachnoid hemorrhage were included. Patients underwent angiography on admission and after 8 days to diagnose vasospasm and were defined as having clinical vasospasm, angiographic vasospasm, or no vasospasm.
Sensitivity and specificity were 1.00 and 0.75 for angiographic vasospasm and both equal to 1.00 for clinical vasospasm diagnosis. A transcranial Doppler mean velocity threshold value of 100 cm/s for angiographic vasospasm and 160 cm/s for clinical vasospasm detection were chosen by ROC analysis.
A Transcranial Doppler mean velocity threshold of 160 cm/s, calculated by the ROC analysis, accurately detects clinical vasospasm. A daily transcranial Doppler examination performed by a trained operator should be routinely used to provide early identification of patients at high risk and to orient therapeutic decisions.
The authors analyse herein the reasonable use of ultrasonographic methods of examination of carotid arteries for diagnosis of stenosing pathology in hypertensive patients. At the stage of primary medical care of the city of Chelyabinsk, a non-selective referral of patients presenting with elevated arterial pressure to duplex ultrasonography of the carotid artery is not uncommon. Doubtful criteria of selecting the hypertensive patients who really require undergoing ultrasonography of the carotid artery result in low efficacy of the examination.
A questionnaire revealed that nearly 40 000 examinations of clinically suspected deep venous thrombosis (DVT) were performed in Sweden in 2001, with a slight predominance of phlebographies. In about two thirds of all cases the deep muscle veins of the calf were included in the interpretation when phlebography was performed, but in less than one fifth when Doppler sonography (CDU) was used. In more than half of the cases a negative CDU was not followed by phlebograghy. On the other hand, the combination of CDU and phlebography was routinely used in nearly two thirds of all ambiguous cases. The interpretation of nonfiling of contrast medium in vein segments on phlebography varied from DVT to no DVT. Most of the phlebographies were performed with digital X-ray technique.
Comment In: Lakartidningen. 2002 Nov 21;99(47):477412523059
In the intersaphenous vein (ISV) there may take place the so-called "antegrade" or "paradoxical" reflux. This type of blood flow is revealed in a series of patients during muscular diastole and is a link of the pathogenesis of varicose disease, but has, as distinct from the "classical" reflux, an antegrade direction. An incompetent saphenopopliteal junction (SPJ) is a source of the antegrade diastolic blood flow (ADBF) through the ISV. Descriptions of possible variants of impaired blood flow through the ISV are fragmentary and their interpretations are controversial. Prevalence and pathogenesis of these disorders impairments have not yet been studied.
A cross-sectional study: over 4 years three centres examined a total of 1,413 patients diagnosed with class C2-C6 varicose veins according the CEAP classification. All patients underwent ultrasound duplex scanning of lower limb veins. The ADBF was determined as a unidirectional antegrade blood flow with the duration of not more than 0.5 second, observed after the crus was relived of compression (in the diastole). Of the patients included into the study who had no varicose veins on the contralateral extremity with the ISV being spotted we sequentially selected 40 subjects including them into the Study Group for the analysis of blood flow and the diameter of the ISV in health.
Impairments of blood flow in the ISV were revealed in 61 (4.8%) of 1,265 extremities included into the study: the "classical" reflux in 9 (14.8%) limbs, ADBF was revealed in 37 (60.7%) limbs, a combination of the "classical" blood flow and ADBF - in 15 (24.6%) limbs. Hence, the patients were subdivided into three groups. Studying the nature of blood flow through the ISV in the control group on 40 lower limbs revealed no blood flow disorders. The mean ISV diameter amounted to 1.68 mm (ME=1 mm). The ISV diameter was considerably higher in all studied groups as compared with the control one (p
We examined a total of 125 patients, of whom 70 suffered from rheumatoid arthritis (RA). The comparison group was composed of 40 patients diagnosed with osteoarthrosis deformans (OD) and 15 with atherosclerosis of the major arteries of the head (MAH). The control group consisted of 40 subjects randomized by sex and age. Studied were the carotid, vertebral arteries and the cerebral blood flow by means of colour duplex scanning on the unit "Vingmed system, 5, Norway, 2002". Patients with RA as compared with those from the control group showed thickening of the vascular wall of the carotid arteries, especially manifested in patients with seropositive rheumatoid arthritis and in those suffering from RA with systemic manifestations of the disease. The findings obtained by the duplex scanning in patients with RA as compared with those of the control group and OD patients demonstrated an increased number of stenotic lesions of the carotid and vertebral arteries particularly pronounced in seropositive RA and RA with extraarticular manifestations of the disease. Statistically reliable findings were obtained while studying the deformities of the carotid arteries. Comparing the RA groups revealed significant differences: in the group of patients suffering from RA with the systemic manifestations noted was an increased percentage of the kinking along both the common carotid artery (chi(2) = 1.76; NS) and the interpal carotid artery (chi(2) = 8.44; p = 0.01). The findings obtained in the present study strongly suggest that in RA patients there take place alterations in the IMC in the form of a thickening with disordered differentiation of the intima-medial layers and the lesion of the cardiovascular system, which is characterized by an early development of atherosclerosis. The degree of atherosclerotic alterations is associated with the presence of systemic manifestations of RA, high activity of the inflammatory process, and seropositivity by the rheumatoid factor.
External hemorrhage of extremities wounds is the leading cause of soldiers' death on the battlefield. In these cases control of massive arterial bleeding require not only prompt and effective measures, but also safety procedure. We assessed on volunteers the effectiveness, application time and pain intensity during the use of construction powerful quick-grip one-handed bar clamp. In results we found that the use of improvised quick-grip clamp for hemorrhage control in axillary and popliteal areas stops arterial blood flow in an extremity in all cases proven by Doppler ultrasound examination. Application time in axillary zone was 15.3 +/- 5.2 sec, in popliteal area--27.3 +/- 8.0 sec. In the groin area, the use of this improvised device was not effective due to technical characteristics (small distance between the main frame and the pressure surfaces). There do appear to be sufficient reasons to design the universal clamp for hemorrhage control from the wounds of junctional zones as well as proximal segments of extremities on Advanced Trauma Management stage and also for civilian prehospital emergency care.
Exposure to tobacco smoke is associated with markers of preclinical atherosclerosis in adults, but its effect on arterial structure in adolescents is unknown.
Healthy 13-year-old adolescents from the atherosclerosis prevention trial STRIP were studied. Maximum carotid and aortic intima-media thickness and brachial artery flow-mediated dilation were measured in 494 adolescents using high-resolution ultrasound. Serum lipid, lipoprotein, and apolipoprotein (Apo) A-I and B concentrations were determined using standard methods. Exposure to tobacco smoke was measured annually between ages 8 and 13 years using serum cotinine concentrations, analyzed with gas chromatography. To define longitudinal exposure, cotinine values of children having serum cotinine measured 2 to 6 times during follow-up were averaged and divided into tertiles (exposure groups): low (n=160), intermediate (n=171), and high (n=163). Adolescents with higher longitudinal exposure to tobacco smoke had increased carotid intima-media thickness (exposure groups [mean+/-SD]: low, 0.502+/-0.079 mm; intermediate, 0.525+/-0.070 mm; high, 0.535+/-0.066 mm; P