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Irradiation for intimal hyperplasia: Implications for peripheral arterial bypass

JOURNAL OF THE AMERICAN COLLEGE OF SURGEONS 2000年第3期190卷 364-370页

作者： Illig, KA Soni, AB Williams, J Shortell, CK Okunieff, P Schell, M Rubin, P Green, RM Univ Rochester Med Ctr Div Vasc Surg Rochester NY 14642 USA Univ Rochester Med Ctr Dept Radiat Oncol Rochester NY 14642 USA

Intimal hyperplasia is the abnormal proliferative response to endothelial injury that occurs after almost any manipulation of the interior of a blood vessel. A certain amount of intimal hyperplasia after angioplasty, stenting, and operation is inevitable and innocuous, but if excessive, can narrow the lumen enough to decrease blood flow. Irradiation of the endothelium to inhibit restenosis after coronary angioplasty and stenting has been extensively studied by interventional cardiologists and radiation oncologists over the past decade. Essentially no attention has been directed to radiation inhibition of the anastomotic intimal hyperplasia that normally occurs after conventional peripheral arterial bypass grafting.

关键词：血管成形术气囊动脉硬化/外科学增生/放射疗法肌平滑血管/病理学血管内膜/病理学血管疾病/病理学血管疾病/外科学血管外科手术动物人类

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Volumetric remodeling of the proximal left coronary artery: Early versus late after heart transplantation

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JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY 1999年第1期34卷 197-203页

作者： Pethig, K Heublein, B Meliss, RR Haverich, A Hannover Med Sch Dept Cardiovasc & Thorac Surg Div Surg D-30623 Hannover Germany

OBJECTIVES The aim of this study was to characterize progression of cardiac allograft vasculopathy (CAV) with special respect to coronary artery geometry. BACKGROUND As previously shown by intravascular ultrasound (IVUS), CAV is characterized by a multifocal intimal hyperplasia. Little is known, however, about vascular remodeling processes influencing vessel geometry and luminal narrowing. METHOD In 30 heart transplant recipients serial IVUS studies were performed at baseline (BL) and after a mean follow-up period of 12.5 +/- 2.5 months. Changes in plaque, lumen and vessel volume were assessed in the proximal left anterior descending artery. Pattern of remodeling was analyzed in patients "early" (n = 15, BL study 1.4 +/- 0.7 months after heart transplantation [HTX]) compared with "late" after HTX (n = 15, BL 46.1 +/- 29.1 months). RESULTS Plaque volume was found to increase by a mean of 23.8 +/- 25.9 mm(3), not significantly different within and beyond the Ist year after HTX. Significant differences, however, were observed in changes in vessel volume with a mean decrease of -52.8 +/- 70.9 mm(3) in the early group, whereas late follow-up group presented with an enlargement of 32.3 +/- 45.0 mm(3). Based on these changes, lumen volume decreased by -73.2 +/- 69.8 mm(3) early, in contrast to a slight increase of 5.2 +/- 32.6 mm(3) in the late group. CONCLUSIONS Progression of CAV is a complex process, modified by changes in the vascular geometry. Especially within the Ist year after HTX, luminal loss is influenced not only by an increase in plaque area but by a decrease in total vessel volume as well. (C) 1999 by the American College of Cardiology.

关键词：冠状血管/病理学疾病恶化心脏移植/病理学增生图像处理计算机辅助手术后期间时间因素移植同种血管内膜/病理学血管疾病/病理学成年人女(雌)性人类男(雄)性中年人

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UNUSUAL INTRAVASCULAR MATERIAL IN BRAIN - AUTOPSY FINDINGS IN A PATIENT TREATED WITH ANTIHEMOPHILIC-FACTOR CONCENTRATES

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AMERICAN JOURNAL OF CLINICAL PATHOLOGY 1976年第4期65卷 508-512页

作者： GHATAK, NR HUSAIN, MM MONTEFIORE HOSP & MED CTR DEPT PATHOLBRONXNY BOWMAN GRAY SCH MED WINSTON SALEMNC 27103 MONTEFIORE HOSP & MED CTR DEPT NEUROPATHOLBRONXNY

Widespread vascular occlusion caused by unusual particulate material in the brain of a patient who was intensively treated with antihemophilic factor (AHF) concentrates prior to death is described. The intravascular particles were seen partially or completely occluding both veins and arteries of small caliber in the brain and also to a much lesser extent in other organs. The resultant small focal infarcts were predominantly distributed in the cerebral white matter. The pathogenesis of this apparently unique vascular occlusive phenomenon and its relationship, if any, to the massive AHF concentrate infusion in this patient remain unknown.

关键词：尸体解剖脑/血液供给脑疾病/病因学脑疾病/病理学弥漫性血管内凝血/病理学因子Ⅷ/副作用因子Ⅷ/治疗应用血友病A/药物疗法梗死/病因学梗死/病理学血管疾病/病因学血管疾病/病理学人类男(雄)性中年人

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Behcet's disease in the Middle East

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CLINICS IN DERMATOLOGY 1999年第2期17卷 209-223页

作者： Saylan, T Mat, C Fresko, I Melikoglu, M Istanbul Fac Med Dept Dermatol Istanbul Turkey

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PULMONARY VASCULAR-DISEASE IN SYSTEMIC LUPUS-ERYTHEMATOSUS

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AMERICAN JOURNAL OF CLINICAL PATHOLOGY 1976年第3期65卷 284-290页

作者： FAYEMI, AO CITY UNIV NEW YORK MT SINAI SCH MEDDEPT PATHOLNEW YORKNY 10029

The pulmonary vascular changes in systemic lupus erythematosus (SLE) have been investigated from 20 autopsies performed at the Mount Sinai Hospiral from 1964 to 1973. Acute lesions included fibrinoid necrosis and vasculitis. Chronic lesions consisted of intimal fibrosis, medial hypertrophy, alteration of elastic laminae, periadventitial fibrosis, and, in one case, aneruysmal dilatation. These changes were found variously in arterioles, arteries and veins. The fibrotic and occlusive vascular lesions may account for the syndrome of "unexplained breathlessness" that occurs in SLE. These lesions may progress in certain individuals to overt pulmonary hypertension; the concept of coexisting primary pulmonary hypertension and SLE should be re-examined.

关键词：高血压肺性/病因学肺/血液供给肺疾病/并发症肺疾病/病理学红斑狼疮系统性/并发症红斑狼疮系统性/病理学肺动脉/病理学肺静脉/病理学血管疾病/并发症血管疾病/病理学青少年成年人老年人女(雌)性人类中年人

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Peritoneal dialysis: Diabetes of the peritoneal cavity

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JOURNAL OF LABORATORY AND CLINICAL MEDICINE 1999年第2期134卷 103-104页

作者： Rosenberg, ME Univ Minnesota Dept Med Div Renal Dis & Hypertens Minneapolis MN 55455 USA

Options for renal replacement therapy in end-stage renal disease include renal transplantation, hemodialysis, or peritoneal dialysis. As of the end of 1996, 13% of the end-stage renal disease population in the United States (approximately 30,000 patients) were undergoing peritoneal dialysis. This percentage is higher in other countries, reaching over 50% in New Zealand. In this form of dialysis, solute and fluid exchange is dependent on diffusive and convective forces acting across the visceral and parietal peritoneal membrane. This membrane is composed of a single layer of mesothelial cells, a discontinuous basement membrane, and an interstitial matrix containing blood vessels and lymphatics. To drive fluid removal, an osmotic gradient is set up by instilling a hypertonic glucose-containing dialysis solution into the peritoneal cavity. This results in the ultrafiltration of fluid from peritoneal membrane capillaries into the peritoneal cavity. The amount of ultrafiltrate can be adjusted by varying the concentration of glucose monohydrate in the dialysis solution from 1.5% (76 mmol/L) to 4.25% (215 mmol/L). Because the glucose will eventually be absorbed, the peritoneal dialysis prescription consists of four to five exchanges of fluid, either manually during the day or by an automatic cycler at night.

关键词：糖尿病血管病变/血液糖尿病血管病变/化学诱导葡萄糖/代谢肾功能衰竭慢性/代谢肾功能衰竭慢性/治疗腹膜腔/血液供给腹膜腔/病理学腹膜透析腹膜炎/化学诱导腹膜炎/代谢腹膜炎/病理学血管疾病/化学诱导血管疾病/病理学人类

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Association of anticardiolipin antibodies with vascular injury: possible mechanisms

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POSTGRADUATE MEDICAL JOURNAL 2000年第900期76卷 625-628页

作者： Haviv, YS Hebrew Univ Jerusalem Hadassah Med Ctr Dept Nephrol Serv Nephrol IL-91120 Jerusalem Israel Hebrew Univ Jerusalem Hadassah Med Ctr Hypertens Serv IL-91120 Jerusalem Israel

In patients with aPL syndrome, 60% will be positive for both lupus anticoagulant and aCL, while either test will be positive in the rest of the patients. [...]recently, the most sensitive test for aPL was aCL. Anticardiolipin autoantibodies prompt a prothrombotic endothelial surface, 29 while the [beta]2GpI-aCL antibody complex activates endothelium in vitro. 30 Antiphospholipid antibody binding to endothelium induces in vitro up-regulation of adhesion molecules, such as intracellular adhesion molecule-1 and extracellular adhesion molecule-1, stimulated by an autocrine loop of interleukin (IL)-1[beta] secretion. 31 Platelet-endothelium interaction mediated by aCL may alter thromboxane A2-prostacyclin balance, leading to enhanced thrombosis and vasoconstriction. 32 Patients with renal failure may be especially prone to this effect because uraemia is associated with the inhibition of nitric oxide synthase, 33 and because of the effect of hypertension and advanced glycosylation end products on endothelial cell relaxation and proliferation, and on endothelin production in vitro. 34 35 Endothelin-1 which induces vasospasm and arterial occlusion, is released by endothelium in response to aPL. 36 The molecular mechanism may involve endothelial adhesion via [beta]2GpI lysine 286, and activation of endothelial cells by the complex of aCL and anti-[beta]2GpI, 37 resulting in inhibition of endothelial antithrombotic effect and vascular tone relaxation.

关键词：抗体抗心脂/生物合成抗体抗心脂/免疫学抗体抗磷脂/免疫学抗磷脂综合征/免疫学抗磷脂综合征/病理学细胞凋亡动脉硬化/免疫学自身免疫酶联免疫吸附测定疾病遗传易感性狼疮凝固抑制物/生物合成狼疮凝固抑制物/免疫学血栓栓塞/免疫学血管疾病/免疫学血管疾病/病理学人类

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Visualization of dermal blood vessels - capillaroscopy

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CLINICAL AND EXPERIMENTAL DERMATOLOGY 1999年第6期24卷 473-478页

作者： Hern, S Mortimer, PS St George Hosp Sch Med Div Physiol Med Dermatol Unit London SW17 0RE England

Intravital capillaroscopy is the only noninvasive method available that visualizes directly the nutritional dermal capillaries. It can determine (in vivo): capillary morphology, including size, shape and tortuosity;capillary density;intercapillary distance;volume fraction (the percentage of skin occupied by microvessels);and changes in red cell velocity within capillaries. When capillaroscopy is performed using a video recording system, this permits real-time imaging of the cutaneous capillaries with retrospective analysis of capillary dynamics. Furthermore, when fluorescent dyes are injected intravenously, plasma-perfused capillaries are delineated allowing the calculation of several perfusion indices. Intravital capillaroscopy therefore permits the assessment of static as well as dynamic aspects of the skin microcirculation.

关键词：衰老/病理学毛细血管结缔组织疾病/病理学糖尿病/病理学血管显微镜检查/方法新生血管化病理性/病理学皮肤/血液供给皮肤疾病/病理学治疗结果血管疾病/病理学人类

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Hormone replacement therapy in postmenopausal women protects against smoking-induced changes in vascular structure and function

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JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY 1999年第1期34卷 131-137页

作者： Teede, HJ Liang, YL Shiel, LM McNeil, JJ McGrath, BP Monash Med Ctr Dept Med Vasc Med Unit Clayton Vic 3168 Australia Monash Univ Alfred Hosp Dept Epidemiol & Prevent Med Melbourne Vic 3004 Australia

OBJECTIVES The purpose of this study was to investigate the role of hormone replacement therapy (HRT) in postmenopausal women who smoke. BACKGROUND Hormone replacement therapy appears to afford cardiovascular protection in postmenopausal women;however, in high risk individuals, specifically smokers, this has not been adequately studied. This question was addressed in a cross-sectional study of arterial structure, function and plasma lipids in postmenopausal smokers and nonsmokers. METHODS Vascular ultrasound was performed in two age-matched groups of postmenopausal women, 70 on HRT (35 smokers) and 70 control subjects not on HRT (35 smokers). Indexes of arterial structure (carotid intima-media thickness [IMT]) and vascular function (systemic arterial compliance [SAC]) and lipid profiles were measured. RESULTS Participant characteristics were similar in the two groups. Smokers on HRT, compared with smoking control subjects, had lower cholesterol(6.0 +/- 0.2 vs. 6.8 +/- 0.3 mmol/liter, p = 0.03) and more favorable mean values for IMT (0.64 +/- 0.02 vs. 0.74 +/- 0.03 mm, p = 0.007) and SAC (0.41 +/- 0.03 vs. 0.32 +/- 0.03 U/mm Hg, p = 0.03). Nonsmokers on HRT compared with nonsmoking control subjects had lower total cholesterol (5.7 +/- 0.2 vs. 6.5 +/- 0.2 mmol/liter, p = 0.02) and low density lipoprotein cholesterol (3.4 +/- 0.2 vs. 4.4 +/- 0.3 mmol/liter, p = 0.01). Mean IMT and SAC values in nonsmokers on HRT and control subjects were not significantly different. Multiple regression demonstrated significant correlation between HRT status and both IMT and SAC, in smokers and in those with increased cholesterol. In nonsmokers and those with lower cholesterol, HRT status was not significantly correlated with vascular parameters. CONCLUSIONS In postmenopausal women who smoke there may be a beneficial effect of long-term estrogen therapy on indexes of arterial structure and function as surrogate markers of cardiovascular disease. Long-term controlled studies are needed t

关键词：动脉/病理学动脉/病理生理学胆固醇 HDL/血液胆固醇 LDL/血液横断面研究雌激素替代疗法绝经后期/生理学吸烟/副作用吸烟/病理学吸烟/病理生理学甘油三酯类/血液血管内膜/病理学血管疾病/病因学血管疾病/病理学血管疾病/病理生理学血管疾病/预防和控制女(雌)性人类中年人

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Local paclitaxel delivery for the prevention of restenosis:: Biological effects and efficacy in vivo

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JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY 2000年第7期35卷 1969-1976页

作者： Herdeg, C Oberhoff, M Baumbach, A Blattner, A Axel, DI Schröder, S Heinle, H Karsch, KR Univ Tubingen Dept Med Div Cardiol D-72076 Tubingen Germany Univ Tubingen Dept Physiol D-72076 Tubingen Germany

OBJECTIVE The aim of this study was to evaluate the potential of paclitaxel to prevent restenosis in vivo. BACKGROUND Paclitaxel (Taxol) is a microtubule-stabilizing compound with potent antitumor activity. It influences the cytoskeleton equilibrium by increasing the assembly of altered microtubules, thereby inducing cellular modifications that result in reduced proliferation, migration and signal transduction. METHODS Before the in vivo study, delivery efficiency was determined with radiolabeled paclitaxel in porcine hearts. After induction of a defined plaque in the right carotid arteries of 76 New Zealand rabbits by electrical stimulation, 27 animals underwent balloon dilation and subsequent local paclitaxel delivery (10 ml, 10 mu mol/liter) with a double-balloon catheter. Twenty-nine animals served as control with angioplasty only, 10 animals underwent local delivery of vehicle only (0.9% NaCl solution) and 10 animals were solely electrostimulated. Vessels were excised one, four, and eight weeks after intervention. RESULTS The extent of stenosis in paclitaxel-treated animals was significantly reduced compared with balloon-dilated control animals (p = 0.0012, one, four and eight weeks after intervention: 14.6%, 24.6% and 20.5%, vs. 24.9%, 33.8% and 43.1%, respectively). Marked vessel enlargement compared with balloon-dilated control animals could be observed (p = 0.0001, total vessel area after one, four and eight weeks: paclitaxel group: 1.983, 1.700 and 1.602 mm(2), control: 1.071, 1.338 and 1.206 mm(2), respectively). Tubulin staining and electron microscopy revealed changes in microtubule assembly, which were limited to the intimal area. Vasocontractile function after paclitaxel treatment showed major impairment. CONCLUSIONS Local delivery of paclitaxel resulted in reduced neointimal stenosis and enlargement in vessel size. Both these effects contribute to a preservation of vessel shape and are likely to be caused by a structural alteration of the cytoskeleto

关键词：抗肿瘤药植物/投药和剂量缩窄病理性/病理学缩窄病理性/预防和控制紫杉酚/投药和剂量复发猪血管疾病/病理学血管疾病/预防和控制动物兔

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