bluuebunny/crossref_metadata_2025 huggingface dataset:
Vitamin A Deficiency Aggravates Rotavirus Infection in CD-1 Mice Through Extensive Involvement of the Gut
Authors: Reifen  , Mor  , Nyska
Published: January 2006

Rotavirus (RV) is one of the leading causes of life-threatening viral gastroenteritis in infants and animals. More than 100 million children live in endemic areas where they are at risk of rotavirus infection. In the western world, rotavirus is usually a self-limiting disease that involves no major sequelae; however, in the developing world it often leads to morbidity and mortality. One of the major components influencing the prognosis of rotavirus-infected children is their nutritional status. The prevalence of vitamin A deficiency in developing countries, where RV infection can be fatal, encompasses up to 40% of preschool children. We hypothesized, therefore, that vitamin A deficiency in an animal model would aggravate the course of rotavirus disease. CD-1 mice were infected with RV and fed either vitamin A-sufficient or vitamin A-deficient diets. Histological components of the small intestine and colon, stool samples from which rotavirus was recovered, and vitamin A levels were examined. Flattening of the villi along the duodenum was observed in both rotavirus-infected and non-infected vitamin A-deficient mice. Maximal effect was obtained with a combination of vitamin A deficiency and RV infection. The colon of vitamin A-deficient, infected mice displayed a significantly (p < 0.05) smaller glandular area and higher level of mucin, and viral excretion in the stool became significantly (p < 0.01) increased and lasted longer than in controls. We conclude that vitamin A deficiency aggravates the course of RV infection through both small intestinal and colonic damage.
Intellectual Development of Children Born of Mothers who Fasted in Ramadan during Pregnancy
Authors: Azizi  , Sadeghipour  , Siahkolah  , Rezaei-Ghaleh
Published: January 2006

The long-term effects of Ramadan fasting during pregnancy on the brain development of the fetus are still not clear. The aim of this study was to evaluate the effects of maternal fasting during Ramadan on the intelligence quotient of their progeny. A historical cohort study was conducted on 191 children aged between 4 to 13 years, 98 whose mothers fasted throughout Ramadan when they were pregnant with their children (case group) and 93 children whose mothers did not fast (control group). The children were selected from 15 schools via a questionnaire filled out by their mothers. Detailed demographic, medical history, and socioeconomic status data were collected by interviewing the mothers. All children aged between 6 to 13 were administered the Wechsler Intelligence Scale for Children-Revised (WISC-R), and those aged between 4 to 6 were administered Wechsler Preschool and Primary Scales of Intelligence (WPPSI), and intelligence quotient was estimated. Cases included 47 boys and 51 girls aged 8.5 ± 2.5 years and controls included 44 boys and 49 girls aged 8.7 ± 2.5 years. There were no significant differences in sex and age between two groups. Among background and confounder variables, the percentage of Caesarean section and the duration of breast-feeding were significantly different between case and control groups; 29% Caesarean section in cases vs. 45% in controls (p < 0.05) and 17.2 ± 9 months breast-feeding for cases vs. 14.5 ± 9 months for controls (p < 0.05). There were no significant differences in socioeconomic status of families between the groups whereas socioeconomic status accounted for approximately 17% of the variances in the average of full-scale intelligence quotient scores. Adjusted mean and standard deviation of full-scale intelligence quotient scores, performance and verbal, were 111 ± 10, 109 ± 11 and 110 ± 11 for the case group and 112 ± 10, 110 ± 11 and 110 ± 11 for the control group respectively. No significant differences were observed between the IQ scores of the two groups. Fasting during gestation did not adversely affect IQ of children whose mothers had fasted during Ramadan while being pregnant.
Iron and Zinc Fortification of Corn Tortilla Made Either at the Household or at Industrial Scale
Authors: Tovar  , Larios-Saldaña
Published: January 2006

Fe and Zn deficiencies among the Mexican population are widespread, and one-third of children and women of childbearing age are anemic. Since diets that are Fe-deficient are most probably also Zn-deficient, a proprietary process was developed to fortify corn tortilla with these trace elements at the first stage of treatment with lime. Phytic acid (PA), Ca, Fe, and Zn content were determined, as well as the molar ratios of phytate/Fe, phytate/Zn, and Ca x phytate to Zn in traditional and fortified tortillas; the Student’s t-test was used to detect differences between the treatments (p < 0.001). Contents of Fe and Zn in the fortified tortilla relative to the traditional tortilla were 1.9 and 3.4 times greater than the latter, whereas PA contents showed the opposite result, i.e. traditional tortillas had 1.65 times more PA than the fortified tortilla. Consequently the calculated molar ratios were statistically more favorable for fortified than for traditional tortillas (p < 0.001). The process developed allows making iron- and zinc-fortified tortillas by lime-treating or nixtamalizing corn either at the household, at small-scale tortilla shops, or at industrial scale by using lime fortified with both trace elements. The cost of this fortification is negligible.
Carotenoids from Malanga (Xanthosoma Sagittifolium) Leaves Protect Cells Against Oxidative Stress in Rats
Authors: Arruda  , Souza  , Siqueira
Published: January 2006

The present study investigated the effect of malanga leaf powder and its carotenoids oil extract on oxidative damage in rat tissues. A group of rats received AIN-93G diet devoid of vitamin A (AD) and three other groups were treated with AD diet supplied with synthetic beta-carotene (beta-car) or malanga leaf powder (MP) or malanga carotenoids extract (CE). The diets’ carotenoids bioavailability was determined through carotenoids intake/liver retinol content. Lipid thiobarbituric acid reactive substances (TBARS) and protein (carbonyl) oxidation, and reduced (GSH) and oxidized (GSSG) glutathione concentrations were determined in liver, heart, and brain. Synthetic beta-carotene bioavailability was higher than that of pro-vitamin A carotenoids from MP and CE diets, and no difference was observed between the latter two groups. Liver and heart lipid peroxidation was lower in the beta-car and CE groups than the AD group, while no difference was observed for the MP group. The beta-car, MP, and CE groups showed lower liver protein oxidation than the AD group, and only the CE group had lower heart protein oxidation in relation to AD. The MP group had a lower liver GSSG concentration and higher GSH/GSSG ratio than the AD group, while no difference was observed for heart glutathione concentration among the groups. The results indicate that at physiological levels, beta-car, malanga carotenoids extract, and malanga leaf powder have antioxidant effects in rats.
Coexistence of Osteoporosis and Cardiovascular Disease Risk Factors in Apparently Healthy, Untreated Postmenopausal Women
Authors: Massé  , Tranchant  , Dosy  , Donovan
Published: January 2006

This study aimed to determine whether apparently healthy, untreated postmenopausal women at risk of osteoporosis relative to nonmenopausal women are concomitantly at risk of cardiovascular disease (CVD) in terms of various aspects of lifestyle, personality, body shape and composition, and blood chemistry. Two homogeneous groups of 30 women having reached menopause for 3–5 years and 30 nonmenopausal controls, all non-estrogen users without apparent CVD risk factors, were compared in a cross-sectional design. Data related to physical activity, dietary intakes, personality type, anthropometry, and skinfold-thickness were collected. Plasma insulin-like growth factor (IGF-1) and serum lipids were measured and used as biochemical predictors of osteoporosis and CVD, respectively. Compared to nonmenopausal controls, postmenopausal women were at greater risk of bone loss given their lower plasma IGF-1, lower physical activity level, and even given their higher serum lipids, as recent literature suggests. Moreover, their dietary calcium intake fulfilled only 70% of the current recommendation, which may reduce protection against osteoporosis and CVD (particularly hypertension) as well. The two groups did not differ regarding energy intake, body weight and frame size, body mass index (BMI), waist circumference, and waist-hip ratio (WHR). However, postmenopausal subjects had more adipose tissue and differed in terms of lifestyle factors (lower dietary lipids and greater alcohol consumption). While neither group was at particular risk of CVD according to waist circumference, WHR, and serum triglycerides, postmenopausal women were at risk according to percent body adiposity and serum cholesterol. This study shows that several risk factors for osteoporosis and CVD can coexist in apparently healthy postmenopausal women after a few years of natural menopause. It emphasizes the need for a timely screening that would stress both heart and bone risk factors.
Efficacy and Safety of Regular Vitamin and Mineral Supplement Use in France: Results from the ECCA Study
Authors: Touvier  , Boutron-Ruault  , Volatier  , Martin
Published: January 2006

This study investigated the prevalence of inadequate micronutrient intake and the proportion of subjects who exceed Tolerable Upper Intake Levels a) with food only, and b) with food+supplements, in a population of French regular supplement users (n = 259). Assessment tools were seven-day records for supplements, three-day records for food intake, and a questionnaire about supplement use. Most subjects were recruited in retail outlets that sold supplements. They were recent users of vitamin/mineral supplements, aged over 15 years, and normo-energy reporters. The prevalence (%) of inadequate intake decreased with the inclusion of mean annual supplements, from 68.0 to 54.8 for magnesium, 55.9 to 40.7 for vitamin C, 53.4 to 43.9 for folic acid, 37.5 to 27.5 for iron, and 40.1 to 29.7 for pantothenic acid. Few subjects exceeded upper intake levels when mean annual intake of supplements was considered. When supplement consumption was considered during the studied week only, the proportion of subjects who were in excess of the upper intake levels was higher (maximum: 9.6% for magnesium). Supplement use brought a nutritional benefit for some targeted nutrients. It was not associated with excessive intake in this study, but could become hazardous if the annual frequency of use were to increase.
Smoking during Pregnancy and Plasma Concentrations of beta-Carotene and alpha-Tocopherol in the Immediate Postpartum Period in Brazilian Women
Authors: Silmara  , Rondó  , Bergamaschi  , Mastroeni
Published: January 2006

This study investigated the relationship between plasma concentrations of beta-carotene and the alpha-tocopherol/lipid ratio, and smoking in 233 postpartum women, from July to November 2002, in the city of Joinville, Brazil. Thirty-seven percent (37%) of the women included in this study had low concentrations of alpha-tocopherol (< 11.63 mumol/L) and 61% of the women presented low concentrations of beta-carotene (< 0.39 mumol/L). Multivariate regression analysis investigated the relationship between smoking and the concentration of the vitamins, adjusting by confounding variables. The final regression model showed inverse associations between beta-carotene concentrations and smoking (p = 0.036), and beta-carotene concentrations and triglyceride levels (p = 0.021). There was an association between the plasma alpha-tocopherol/lipid ratio and per capita income (p = 0.003), but no association with smoking. We advise further studies to evaluate the impact of smoking and oxidative stress on the concentrations of these vitamins.
Dietary Calcium and Vitamin D Intake in an Adult Middle Eastern Population: Food Sources and Relation to Lifestyle and PTH
Authors: Gannagé-Yared  , Chemali  , Sfeir  , Maalouf  , Halaby
Published: January 2006

Little is known about calcium and vitamin D intakes in Middle Eastern countries, where the prevalence of hypovitaminosis D is high. This study identifies major sources of calcium and vitamin D in the Lebanese diet, examines lifestyle factors that may influence intake of these nutrients and investigates the relationship between nutritional or lifestyle factors and parathyroid hormone (PTH). Three hundred sixteen young healthy volunteers aged 30 to 50 (men, non-veiled and veiled women) were recruited from different rural and urban Lebanese community centers. Food frequency questionnaire was used to evaluate the consumption of vitamin D and calcium-rich foods. We also measured serum PTH levels. Mean daily calcium and vitamin D intake were respectively 683.8 ± 281.2 mg and 100.6 ± 71.0 IU. Daily vitamin D sources were divided as follows: 30.4 ± 46.4 IU from milk and dairy products, 28.2 ± 26.3 IU from meat and poultry, 25.8 ± 25 IU from fish, 8.5 ± 8.6 IU from eggs, and 7.8 ± 14.3 IU from sweets (respectively 30.2%, 28%, 25.6%, 8.4% and 7.7% of the total vitamin D intake). Mean daily calcium from animal and vegetable sources were respectively 376.3 ± 233.6 mg and 307.9 ± 118.5 mg. Animal/total calcium intake ratio was 52% and was only statistically significantly higher in urban people compared to rural ones. Multivariate analysis showed that male sex and urban residence were independent predictors of both vitamin D and calcium intakes (p < 0.01 and p < 0.01 respectively). In addition, veiling was an independent predictor of low vitamin D intake (p < 0.05) and a high body mass index (BMI) was an independent predictor of low calcium intake (p < 0.05). Finally, PTH was inversely correlated with vitamin D intake and the animal/total calcium intake ratio ( r = –0.18 and r = –0.22, p < 0.01), while no significant results were achieved for the vegetable calcium. In a multivariate model, urban living, female gender, low vitamin D and calcium intakes, low animal/total calcium intake ratio, and high BMI, are independent predictors of hyperparathyroidism. The deficient nutritional status of vitamin D and calcium in Lebanon justify the implementation of dietary public health measures. People at most risk for secondary hyperparathyroidism should be advised to increase their dietary calcium (mostly animal calcium) and vitamin D, to take supplements, or to increase their sun exposure.
Plasma Folate Levels in Men with Type 2 Diabetes
Authors: Sakuta  , Suzuki  , Yasuda  , Ito
Published: January 2006

Limited data suggest that folate levels are higher in patients with type 2 diabetes than in subjects with normal glucose tolerance (NGT). We compared the fasting plasma folate, glucose (FPG), body mass index (BMI), and supplementary vitamin use among male subjects with NGT, those with impaired glucose tolerance (IGT), those with newly diagnosed type 2 diabetes, and those with previously diagnosed type 2 diabetes. Plasma folate of patients with newly diagnosed diabetes and that of patients with previously diagnosed diabetes was significantly higher than that of NGT subjects (p < 0.001). Prevalence of vitamin use was lower in newly diagnosed or previously diagnosed diabetic patients compared with non-diabetic subjects. Self-rated vegetable intake was similar among the four groups. FPG, BMI, triglycerides, and systolic blood pressure correlated with plasma folate levels independently of lifestyle factors studied. These results suggest that plasma folate levels are elevated in male diabetic patients independently of health-conscious behavior that is recommended for diabetic people.
Nutrient Intake Adequacy in Schoolchildren from a Mediterranean Area (Southern Spain). Influence of the Use of the School Canteen
Authors: López-Frías  , Nestares  , Iañez  , de la Higuera  , Mataix  , Llopis
Published: January 2006

The aim of the present study was to compare dietary adequacy in 521 schoolchildren in Granada (Spain) with national recommendations and to determine possible differences regarding gender or the use of the school canteen. A food record was used for four consecutive days to evaluate the intake of nutrients and foods. With regard to boys’ and girls’ intake of the main groups of foods, we observed a tendency for the boys to consume greater quantities of dairy products, cereals, potatoes, and fruit, although the differences were not statistically significant. The children who lunched at school consumed fish, eggs, dairy products, vegetables, and cereals more frequently than those who did so at home. The mean daily intake of energy and nutrients indicates that the studied population exceeded the recommended limits in the proportion of energy derived from protein and fat, while carbohydrate intake was slightly deficient. The children who lunched at school showed a more favorable profile for energy and nutrient intake, with a significantly higher intake of energy, carbohydrates, total fat, polyunsaturated fatty acids (PUFA), monounsaturated fatty acids (MUFA), vitamins B1 and E, and calcium, with respect to the children who had lunch at home.
Einfluß verschiedener Kompressionstherapien auf den Reflux in den tiefen Venen beim postthrombotischen Syndrom
Authors: Evers  , Wuppermann
Published: January 2006

Background: Reflux in deep veins is an important pathophysiological factor of post-thrombotic syndrome which can be demonstrated by colour-coded duplexsonography. This study investigates the effect of different compression therapies on the reflux velocity in deep veins in patients with a post-thrombotic syndrome. Patients and methods: Sixty patients with a post-thrombotic syndrome – confirmed by phlebography, in the deep veins of the calf and the thigh were investigated in two groups: In group A, 30 patients (mean age 58 ± 10 years) received compression stockings (calf compression class II and III, thigh compression class II) and in group B 30 patients (mean age 58 ± 14 years) received a Sigg short traction bandage of the calf. The velocity at the time of the greatest reflux in the popliteal vein was determined as reflux parameter with the colour-coded duplex sonography using a cuff applied at the calf. All patients stood upright and were measured with and without different kinds of compression therapies. The reflux velocities were graded as low, moderate and high. Results: A significant decrease of the reflux velocity by about more than 45% with compression therapy was found in both groups. The decrease of the refluxes in group A (mean 47.9%) did not differ significantly from the decrease of refluxes in group B (mean 55.8%). The greatest decrease of the reflux velocity under compression therapy was found in high-grade refluxes in both groups. Conclusion: A significant decrease of the reflux velocity in post-thrombotic syndrome can be readily demonstrated with different kinds of compression stockings as well as with bandages by means of colour-coded duplex sonography.
Die Bedeutung der Klaudikationsstrecke für Patienten mit arterieller Verschlußkrankheit der Beine
Authors: Müller-Bühl  , Kirchberger  , Wiesemann
Published: January 2006

Background: Determination of both the pain-free and the maximum walking distances is part of a routine program in the angiological examination of patients with PAOD. It is however as yet not clear which of these two parameters is more relevant in determing a patient’s pathological condition. Patients and methods: In 150 patients with stable intermittent claudication, the claudication pain distance (CPD) and the maximum pain distance (MPD) were determined on a treadmill at 3,0 km/h and 12% inclination. The results were compared with the angiographic findings, the Doppler pressure values and the subjective quality of life (PAVK-86-Questionnaire). Results: The average pain-free walking distance was 89 ± 71m, and the maximum walking distance was 198 ± 141 m. There was no correlation between both walking distances and the angiographic extent of PAOD. Only the MPD correlated with the ankle systolic Doppler pressure and the ankle/brachial pressure index of the claudicating leg (r = 0.16, p < 0.05 and r = 0.20, p < 0.01). Both the CPD and the MDP had a significant influence on the life quality of the patients (CPD: r = –0.41, p < 0.001; MPD: r = –0.47, p < 0.001). In the multiple regression analysis, beside the body mass index, the MPD was found to be the greatest predictor for the pathologically relevant quality of life dimensions pain, complaints and functional status. Conclusions: The maximum walking distance correlated in a better way than pain-free walking distance with the objective and subjective assessment criteria of PAOD. Therefore, as regards the stage of the disease and the life quality of the patient, this parameter has a greater importance. This fact deserves to receive greater attention in everyday clinical practice and when conducting clinical trials.
Veränderungen des fibrinolytischen Systems bei Patienten mit peripheren arteriellen Durchblutungsstörungen
Authors: Poredos  , Stegnar  , Gacnik
Published: January 2006

Background: The fibrinolytic system may play an important role in the development and progression of peripheral arterial occlusive disease. Patients and methods: The fibrinolytic system of the whole blood and a diseased leg was investigated in twenty men with chronic peripheral atherosclerotic occlusive arterial disease (PAOD, clinical stage II according to Fontaine), aged from 46 to 66 years (mean age = 55.3 years). The diagnosis of PAOD was established by clinical examination and segmental systolic blood pressure measurements using a Doppler ultrasound detector. Twenty age-matched (mean age = 53.4 years) male volunteers with normal arterial circulation of the lower limbs and without risk factors of atherosclerosis, served as controls. In both groups fibrinolytic system was investigated in basal conditions and during provocation. Release of tissue-type plasminogen activator (t-PA) was provoked by 20 min venous occlusion of the arm and the leg and by infusion of DDAVP (1-desamino-8-D-arginine-vasopressin, 0.4 ug/kg of body weight). Blood samples were obtained from the arm and the leg before and after each stimulus. The fibrinolytic parameters: euglobulin clot lysis time, t-PA activity (amidolytic assay) and antigen (ELISA) and t-PA inhibitor (PAI) activity (amidolytic assay) were determined. Results: With the exception of a boderline increase in PAI activity in patients, no other differences between the two groups were observed in basal conditions. The most prominent deterioration of the fibrinolytic system detected in male PAOD patients was a significantly higher residual PAI activity registered during venous occlusion of the arm and two minutes after combined stimulation. Two minutes after combined stimulation (DDAVP and venous occlusion of the arm) significantly lower t-PA activity was observed in patients. In patients t-PA antigen response to venous occlusion and DDAVP was not significantly different from the response observed in healthy volunteers. The fibrinolytic response of the leg to venous occlusion was poor and after DDAVP application it was comparable to the arm. The fibrinolytic response of the diseased leg in men was not significantly different from the healthy leg. Conclusion: The results of our study indicate that alteration of the fibrinolytic system in atherosclerotic disease is predominantly a generalised phenomenon and is not directly related to a local atherosclerotic process.
Ergotamin-induzierte Claudicatio intermittens
Authors: Bräunlich  , Kröger  , Massalha  , Rudofsky
Published: January 2006

We report about a female patient with intermittent claudication caused by ergotamine. She used ergotamine as a treatment for migraine headaches for more than 4 years. The claudication began 7 month before admission. Colour Doppler sonography and angiography showed severe stenosis of the left external iliac and superficial femoral artery. The patient was treated with phenprocoumon for one year after withdrawal of ergotamine. After that the superficial femoral stenosis disappeared completely, but the external iliac stenosis was still present and was consequently successfully treated by atherectomy. The histology showed a fibrosis of the intima and a hypertrophy of the media.
Aneurysma der Mesenterialarterien
Authors: Ersoz  , Ozbas  , Basaran  , Pehlivan  , Hazinedaroglu  , Anadol
Published: January 2006

Aneurysms of the coeliac axis are rare. Up to 1997, 137 cases had been reported. Here we present a coeliac aneurysm which involved the origin of the splenic, left gastric, and common hepatic arteries. After making a midline incision, infra-diaphragmatic control of the aorta was obtained. The aorta was clamped for 25 minutes to resect the aneurysm. The defect at the origin of the coeliac axis was closed with 1.5 cm PTFE patch. The distal segments of the splenic and left gastric arteries were ligated. A 6-mm ringed PTFE graft was interposed between the infra-renal aorta and the proper hepatic artery. The control arteriogram showed a good arterial flow. The patient recovered uneventfully after surgery with normalisation of hepatic function.
Ein Stenosejet kann eine Dissektion der A. femoralis superficialis verursachen
Authors: Massalha  , Goyen  , Rudofsky
Published: January 2006

A dissection of the superficial femoral artery mainly occurs due to trauma or manipulation of the artery by means of interventional procedures. In contrast to dissections of the carotid arteries which are known to occur spontaneously we present the case of a stenosis of the superficial femoral artery that led to a dissection caused by the stenosis-jet. The dissection on the other hand caused an appositional thrombus which led to the embolic occlusion of the pedal-arteries. In case of peripheral embolisms in patients with or without history of peripheral arterial occlusion disease it is important to look for a causing arterial pathology preferably by duplex sonography.
Hyperhomocysteinemia and thrombotic vascular disease
Authors: Wuillemin  , Solenthaler
Published: January 2006

Homozystein, eine sulfhydrierte Aminosäure, ist das demethylierte Derivat von Methionin und ein wichtiger Metabolit für verschiedene Stoffwechselwege. Da das Homozystein potentiell toxisch ist, wird seine Konzentration durch verschiedene Regelmechanismen tief gehalten. Eine schwere Hyperhomozysteinämie (> 100 mumol/l) findet sich bei der Homozystinurie. Eine milde (15–30 mumol/l) oder intermediäre (> 30–100 mumol/l) Hyperhomozysteinämie ist die Folge verschiedener hereditärer Enzymdefekte und/oder erworbener Mangelzustände von Folsäure, Vitamin B12 oder Vitamin B6. Die Hyperhomozysteinämie gilt heute als etablierter Risikofaktor für venöse und arterielle thromboembolische Erkrankungen. So fand sich ein Homozysteinwert über der 95sten Perzentile assoziiert mit einem rund 2–3fach erhöhten relativen Risiko für eine tiefe Beinvenenthrombose und für eine Lungenembolie. Ebenso ist eine milde Hyperhomozysteinämie mit einem rund 2–4fach erhöhten relativen Risiko für kardiovaskuläre, zerebrovaskuläre und peripher-arterielle Erkrankungen assoziiert. Es werden verschiedene Mechanismen diskutiert, welche für die thrombogene Wirkung der Hyperhomozysteinämie verantwortlich sein könnten. Die Gabe von Vitaminen, wie Folsäure, Vitamin B12 und Vitamin B6, führt in praktisch allen Fällen zu einer Normalisierung des Homozystein-Plasmaspiegels. Klinische Interventionsstudien, welche untersuchen, ob die durch Vitamin-Gabe erreichte Senkung des Homozystein-Plasmaspiegels auch zu einer Senkung der vaskulären Morbidität und Mortalität führt, sind nun dringend angezeigt.
Zirkulierende leukozytäre Adhäsionsmoleküle bei Patienten mit chronischer venöser Insuffizienz
Authors: Ciuffetti  , Lombardini  , Pasqualini  , Vaudo  , Lupattelli
Published: January 2006

Background: Enzyme-linked immunosorbent assay (ELISA) techniques have detected the existence of circulating forms of intercellular adhesion molecule-1 (ICAM-1), vascular endothelial adhesion molecule-1 (VCAM-1) and E-selectin, all of which mediate leucocyte-endothelial adhesion. This study determined whether circulating cell adhesion molecules were increased in patients with chronic venous insufficiency (CVI) which causes venous stasis. Patients and methods: Before and after walking and upon recovery blood samples were drawn from the saphenous vein in 20 CVI patients: 10 with varicose veins (group 1), 10 with deep venous insufficiency (group 2). 10 healthy controls were enrolled. The total leucocyte count and the soluble levels of ICAM-1, VCAM-1 and E-selectin were determined. Results: After walking, the total leucocyte count decreased significantly (p < 0.01) only in group 2 and sICAM-1 and sVCAM-1 increased significantly (p < 0.01). Upon recovery, these significant differences remained in group 2. No significant modification was observed at any stage of the study in group 1 or in the control group. Conclusions: These results suggest persistently high levels of circulating adhesion molecules may contribute to worsen microvascular perfusion, which leads to the onset of trophic damage in CVI.
Der (TTA)n Repeat-Polymorphismus im HMG-CoA Reduktase-Gen und der Serumcholesterinspiegel
Authors: Hubacek  , Pistulková  , Valenta  , Poledne
Published: January 2006

Background: Hypercholesterolaemia is one of the main risk factors of atherosclerosis. Both environmental and genetic factors have been implicated in the development of hypercholesterolaemia. The enzyme hydroxymethylglutaryl-coenzyme A (HMG-CoA) reductase plays an important role in cholesterol synthesis. Thus we supposed that polymorphisms in this gene could influence cholesterolaemia. Patients and methods: Using PCR, we measured the (TTA)n repeat polymorphism near the Alu sequence of the gene for HMG-CoA reductase in two groups of children selected from opposite ends of the cholesterolaemia distribution curve obtained from measuring cholesterolaemia in 2000 children. Eighty-two chil-dren in high- and eighty-six children in low-cholesterolaemic groups participated on the study. Results: A significant difference was found in the frequencies of the genotypes of the 10+ odd alleles (43.9% in high-cholesterolaemic children vs 24.4% in low-cholesterolaemic children p < 0.025). No differences were demonstrated in the frequencies of other genotypes (allele 10 + even and without allele 10). No associations between lipid parameters and genotypes or genotype subgroups within the group of high- and low-cholesterolaemic children were found. Conclusion: The (TTA)n repeat polymorphism in the gene for HMG-CoA reductase could be another genetic marker that plays a role in the genetic determination of cholesterolaemia.
Einfluß von Ramipril auf den Verlauf des Plasma-Thrombomodulinspiegels bei Diabetikern
Authors: Borcea  , Morcos  , Isermann  , Henkels  , Ziegler  , Zumbach  , Amiral  , Längst  , Seiz  , Ziegler  , Wahl  , Nawroth
Published: January 2006

Background: In diabetic patients endothelial dysfunction is reflected by an increased urinary albumine excretion, which can be reduced by ACE-inhibitors. No data are available showing a endothelial-protective effect by determining a marker reflecting endothelial cell-damage. Patients and methods: The effect of angiotensin converting enzyme inhibitor (ACEI) (ramipril) treatment on the progression of endothelial cell damage, – assessed by measurement of plasma-thrombomodulin (TM), – was investigated in an open, non randomized, prospective pilot study over a period of 18 months in diabetic patients. 87 patients with an urinary albumin concentration (UAC) below 100 mg/l at baseline were included. 46 patients were treated without ACEI and served as a control group, 41 patients were treated with ACEI. Participation in this study did not affect intensity in the treatment of blood glucose, blood pressure or diet. At study entry both groups were comparable with respect to duration of diabetes, diabetic complications, vascular risk factors, body mass index, medications used to treat diabetes, presence of hypertension, glycemic control, tryglycerides, HDL cholesterol, creatinine, UAC and plasma-TM. Age, blood pressure, and total cholesterol were significantly higher in the ACEI group, compared with the control group. Results: After a follow up of 18 months a significant increase in UAC (DeltaUAC = 10.48 mg/l, p = 0.03) and plasma-TM (DeltaTM = 3.06 ng/l, p = 0.009) was observed in the control group, while in the ACEI treated group a decrease in albuminuria (DeltaUAC = –7.44 mg/l, p = 0.01) and plasma-TM (DeltaTM = –4.78 ng/l, p = 0.001) was seen. Despite a similar approach in hypertension and diabetes control in both groups, UAC and plasma-TM decreased after 18 months only in the ACEI treated group. Treatment with ACEI was the strongest predictor (p=0.0001) indicating decrease of UAC and plasma-TM (multi regression analysis). Conclusion: Plasma-thrombomodulin might be a useful marker for assessing the efficacy of drugs potentially protecting the vessel wall. While the present study was a open, non randomized study, further investigation is necessary to proof the hypothesis in a randomized, placebo-controlled, double-blind study.
Zu Inzidenz und Risikofaktoren von Phlebothrombosen
Authors: Saarinen  , Laurikka  , Sisto  , Tarkka  , Hakama
Published: January 2006

Background: To estimate the incidence and associated risk indicators of deep venous thrombosis (DVT) in the lower extremities. Patients and methods: A population-based 5-year follow-up study with self-administered questionnaire. The study included 5568 persons at the beginning, with a follow-up of 17005 person-years. A questionnaire was sent to all residents in the city of Tampere, Finland, born in 1929, 1939 and 1949. In the first survey the number of participants was 5568 and in the second questionnaire 4903. The participation rates were 83% and 88%. Results: The incidence of DVT was 140 per 100000 person-years. The life-time prevalence of DVT was 3.1%. In a univariate analysis, the appearance of a new DVT during the follow-up time (incidence) was statistically significantly associated with pre-existing varicose veins, sex-steroid therapy, heart failure and arterial insufficiency in the lower limbs. In multivariate analysis varicose veins, arterial insufficiency in the lower limbs and sex-steroid therapy remained as significant risk factors associated with DVT. Conclusions: The study confirms that the incidence of DVT in Finland is close to the estimates in other Western populations. Pre-existing varicose veins, sex-steroid therapy and arterial insufficiency in the lower limbs are independent risk factors for DVT in our population-based study.
Falsches Aneurysma der rechten A. mammaria interna
Authors: Jansen  , Lampmann  , Lohle  , van Rooy  , Pasteuning
Published: January 2006

False aneurysms of the internal mammary artery are extremely rare. A case of false aneurysm of a branch of the right internal mammary artery after median sternotomy is reported. A large right-sided mediastinal mass was seen on the thoracic radiogram. A false aneurysm was suspected on CT-scan and confirmed by angiography. In the same setting percutaneous embolization was performed.
Serologischer Nachweis von Chlamydia-pneumoniae-Lipopolysaccharid-Antikörpern bei Atherosklerosemanifestation in unterschiedlichen Gefäßregionen
Authors: Körner  , Blatz  , Wittig  , Pfeiffer  , Rühlmann
Published: January 2006

Background: The role of Chlamydia pneumoniae in the pathogenesis of atherosclerosis has so far mainly been investigated in patients suffering from coronary heart disease; the other vascular regions have virtually been ignored. The aim of this study was to carry out a statistical survey of serological markers of a C. pneumoniae infection in patients with different patterns of atherosclerosis manifestation. Patients and methods: 340 patients were examined for the atherosclerotic alteration of peripheral arteries of the lower limbs, carotid arteries and coronary arteries by ultrasound scan and/or angiography. Immunoglobulin(Ig)G and IgA-rELISA were used to measure chlamydial lipopolysaccharide antibodies. Species determination was performed using the IgG micro-immunofluorescence test. Results: 24.0% of atherosclerotic cases (A) and 52.3% of controls (C) were negative for C. pneumo-niae lipopolysaccharide antibodies (p = 0.00002). By contrast, 45.1% of atherosclerotic cases and 16.9% of controls were positive for both IgG and IgA (p = 0.00002). The mean antibody titers of the atherosclerosis group were higher than in the control group (IgG positive chiAIgG = 344, chiCIgG = 272; IgG and IgA positive chiAIgG = 576, chiCIgG = 486 and chiAIgA = 120, chiCIgA = 91). Concerning atherosclerosis manifestation in various vascular regions, no significant differences were found between IgG and IgA antibody titers and prevalence. Conclusions: The results show that a persistent C. pneumoniae infection with evidence of lipopolysaccharide immunoglobulin G and A is equally associated with the atherosclerotic alteration of coronary arteries, carotid arteries and peripheral arterial occlusive disease, irrespective of the severity of atherosclerosis and with no predisposition to any particular vascular region.
Deep phlebothromboses of iliacal vein and aplasia of the inferior vena cava
Authors: Mirzaie  , Schorn  , Meyer  , Lotfi  , Dalichau
Published: January 2006

Die Koinzidenz von tiefer Phlebothrombose der Bein- und Beckenetage und Aplasie der Vena cava inferior stellt eine zwar seltene, für die weitere Therapieplanung aber bedeutsame Befundkonstellation dar. Anhand zweier Kasuistiken werden die Komplikationen und Therapieoptionen beim Vorliegen dieser Achsenanomalie eingehend dargestellt. Wir berichten von unseren Erfahrungen mit venösen Thrombektomien und der Anlage von arteriovenösen Fisteln zur Erhöhung des venösen Blutflusses in den Kollateralen bei Aplasie der V. cava inferior.
Diagnostik und Therapie einer traumatischen sowie einer iatrogenen arteriovenösen Fistel im Halsbereich
Authors: Bürger  , Tautenhahn  , Grote  , Halloul
Published: January 2006

Trauma-induced arteriovenous (av) communications in the cervical region involving the external carotid artery and the jugular vein are exceptionally rare. Moreover, an iatrogenic av fistula between the vertebral artery and the vein after insertion of a venous catheter into the internal jugular vein is described. The discussion includes the clinical presentation, diagnosis and management of such rare av fistulas.
Outpatient treatment in proximal deep vein thrombosis
Authors: Schwarz Thomas , Schröder  , Schellong
Published: January 2006

Die ambulante Therapie der proximalen tiefen Venenthrombose mit niedermolekularem Heparin hat sich gegenüber der stationären Krankenhausbehandlung in ersten Studien als ebenso sicher und effektiv erwiesen: Neue thromboembolische Ereignisse treten in einem ambulanten Setting nicht häufiger auf, das Blutungsrisiko unter Antikoagulation und die Mortalität liegen nicht höher. Der Patientenkomfort überwiegt deutlich bei der ambulanten Therapie, die anfallenden Kosten sind geringer. Die vorliegende Übersicht diskutiert, welche Voraussetzungen für die Durchführung einer ambulanten Therapie vorliegen müssen und welche Patienten wahrscheinlich für eine ambulante Thrombosetherapie in Frage kommen.
Die histomorphologischen Veränderungen der Crosse bei der Varikosis der V. saphena magna
Authors: Stücker Markus , Krey  , Röchling  , Schultz-Ehrenbur  , Altmeyer
Published: January 2006

Background: Insufficiency of the greater saphenous vein starts at its junction with the femoral vein, so that the histomorphologic changes at the saphenofemoral junction are of special interest. Methods: In this study we examined which histologic changes occur in the vein walls 5 cm distal to the junction of the greater saphenous vein into the femoral vein and whether these changes correlate to the clinical severity of venous disease. For this the morphologic changes of 28 venous specimens were described qualitatively and the two layers of the media were measured at their thickest and thinnest points. Results: The three-layered structure of the vessel wall with intima, media and adventitia was destroyed in 21% of the cases, the intima and media were fused into one another due to loss of the membrana elastica interna. In 93% the intima was thickened at circumscribed areas. Sprouting of capillaries into the intima was found only if varicosis lasted for longer than 15 years. Aneurysms were found in 29% of the specimen. In parts of severe aneurysms the media was completely missing. The thickness of the circular muscle layer of the media varied more than that of the longitudinal muscle layer (difference between minimal and maximal thickness 400 ± 130 mum compared to 190 ± 90 mum). With increasing clinical severity of the chronic venous insufficiency the difference between minimal and maximal thickness of the circular muscle layer increased (330 ± 90 mum at stage I according to Widmer, 490 ± 130 at stage III). Conclusion: The coexistence of muscular hypertrophy and atrophy in varicose veins is regarded by us as a reaction to altered perfusion and pressure in the veins. Considering the frequently severe damage to the veins, indication for a vein sparing therapy has to be viewed with care.
Inzidenz kutaner Vasoaktivität bei Patienten mit Anämie und pulmonaler Hypoxie
Authors: Schmidt-Lucke  , Glattkowski-Schäfer  , Kirchhof  , von Bierbrauer  , Klein  , Schmidt-Lucke Jan André
Published: January 2006

Background: In cutaneous laser Doppler flow (LDF)-recordings, various forms of flowmotion or vasoactivity can be observed. It is still a matter of dispute, whether flowmotion is a phenomenon of physiological or pathophysiological conditions. Therefore, we tested the hypothesis of increased vasoactivity being typical for patients with various degrees of acute and chronic anemia as well as with chronic obstructive pulmonary disease (COPD). Patients and methods: We examined 12 healthy controls, 14 patients with COPD with a PO2 below 60 mmHg, 16 patients with chronic and 7 patients with acute anemia with an Hb below 12 g/dl. We used a simple LDF-technique on the dorsum of the forefoot. The regularity of blood flow frequencies was determined by calculation of the coefficient of variation. Results: Periods without vasoactivity (i.e constant flow pattern) were 21% in normal controls, 7% in patients with COPD and 2% in patients with acute or chronic anemia. Mean frequencies in the four groups varied between 3.8 and 4.8 cpm, with significant changes only in the group with acute blood loss. However, vasoactivity was significantly more regular in the COPD- and anemia-groups as compared to normal controls, with coefficients of variation of 47.4% for controls, 31.8% for COPD- and 29.3% for chronic and 35.1% for acute anemia-patients. Conclusions: The present paper shows that cutaneous vasoactivity is more regular in the three examined clinical entities of systemic tissue hypo-oxygenation, i.e. chronic and acute anemia and severe COPD as compared to healthy control subjects. Therefore, we hypothesize that increased vasoactivity constitutes a regulatory defense mechanism in cases of reduced oxygenation, by improving microcirculatory blood flow distribution.
Das Einheilungsverhalten schmalkalibriger Gefäßprothesen aus Polyester mit plasminbehandelter Fibrinbeschichtung – eine experimentelle Untersuchung
Authors: Pfeiffer Thomas , Kever  , Grabitz  , Reiher  , Müller  , Hildebrand  , Sandmann
Published: January 2006

Background: The autogenous vein represents the graft material of choice in crural and pedal bypass surgery. Because of the numerous problems concerning the graft harvesting and the quality of autogenous vein material an equally good allogenous graft is urgently needed. Up to the present times no such graft material has been able to achieve the success of vein grafts. Methods: We investigated the knitted polyester prosthesis Terumo PF-V (Terumo Comp., Japan), diameter 5 mm with outer reinforce, which is characterized by a new coating of plasmin-treated fibrin. Grafts were implanted as bypass into the ligated carotid (n=10) and femoral arteries (n=10) of 10 dogs (beagles). As a control 5 mm-ePTFE-prostheses (Impra Carboflo) were implanted simultaneously on the contralateral side. Results: After 6 months, seven of 20 PF-V-grafts and 8 of 20 PTFE-grafts were patent. All prostheses presented with good macroscopic healing characteristics. In the patent grafts, angiography showed no substantial stenoses. The histological examination of the material was performed using light microscopy, transmission polarising microscopy, scanning electron microscopy, and transmission electron microscopy. Both types of prostheses showed the typical pattern of graft healing by migration of mesenchymal cells through the prosthesis, formation of capillaries, and growing of a neointima with endothelium-like cells. All failed bypass grafts presented with an occluding proliferation from the arterial wall into the anastomotic region. Conclusions: Using clinically or histologically evaluation, neither graft demonstrated superiority over the other. The results indicate that the coating plays only a minor role for graft healing if any. For proper graft function, the arterial wall proliferation at the anastomotic region, which is not dependent on the type of prosthesis, appears to be most important. The overall results concerning both types of prostheses were disappointing
Das chronische venöse Kompartmentsyndrom
Authors: Hach Wolfgang , Präve  , Hach-Wunderle  , Sterk  , Martin  , Willy  , Gerngroß
Published: January 2006

Background: A chronic exertional compartment syndrome has only been observed in athletes and soldiers. In the vast majority, the disease affects the anterior compartment and the fibular muscle group, and only rarely the lateral and dorsal muscle compartments. Muscle tissue necrosis does not occur. In the course of venous diseases with a severe chronic venous stasis syndrome, a chronic venous compartment syndrome develops that differs considerably from the familiar functional syndrome. The predominant symptom is an uncurable cuff ulceration on the lower leg. Patients and methods: From 1993 to 1996 a total of 16 patients with a chronic fascial compression syndrome underwent surgery on 18 extremities. The crural fascia was resected and a mesh graft was applied. Results: In the group of ten controls with healthy veins the average pressure in the deep compartment was 13, 6 mmHg (range 9–17 mmHg) lying down and 29, 9 mmHg (range 15–42 mmHg) standing up. ln 14 patients with chronic fascial compression syndrome, the average pressure was higher, measuring 21,1 mmHg (range 8–47 mmHg) lying down and 62,5 mmHg (range 33–87) standing up. After surgery, the pressure dropped to 15, 5 mmHg (range 5–24 mmHg) lying down and 34, 5 mmHg (range 10–58 mmHg) standing up, but did not fall as low as the average values recorded in the control group or in the patient’s healthy leg. The results from the standing up position were statistically significant (p=0, 003). Computed tomography showed major changes in the muscles indicating muscle atrophy and fatty degeneration. The crural fascia seemed to be incorporated in the scars of the subcutaneous tissue in large areas. After crural fasciectomy and healing of the ulceration, the tissue structure of the muscles recovered. Conclusions: In chronic fascial compression syndrome, the trellis arrangement of the collagen fibres becomes disordered. This results in a loss of flexibility during muscle contraction. Every step causes an increase of intracompartmental pressure and microstructural injury. The consequence is resection of the crural fascia.