RESUMEN
Whilst both cardiac output (CO) and total peripheral resistance (TPR) determine mean arterial blood pressure (MAP), their relative importance in the pressor response to isometric exercise remains unclear. This study aimed to elucidate the relative importance of these two different factors by examining pressor responses during cardiopulmonary unloading leading to step-wise reductions in CO. Hemodynamics were investigated in 11 healthy individuals before, during and after two-minute isometric exercise during lower body negative pressure (LBNP; -20mmHg and -40mmHg). The blood pressure response to isometric exercise was similar during normal and reduced preload, despite a step-wise reduction in CO during LBNP (-20mmHg and -40mmHg). During -20mmHg LBNP, the decreased stroke volume, and consequently CO, was counteracted by an increased TPR, while heart rate (HR) was unaffected. HR was increased during -40 mmHg LBNP, although insufficient to maintain CO; the drop in CO was perfectly compensated by an increased TPR to maintain MAP. Likewise, transient application of LBNP (-20mmHg and -40mmHg) resulted in a short transient drop in MAP, caused by a decrease in CO, which was compensated by an increase in TPR. This study suggests that, in case of reductions of CO, changes in TPR are primarily responsible for maintaining the pressor response during isometric exercise. This highlights the relative importance of TPR compared to CO in mediating the pressor response during isometric exercise.
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Ejercicio Físico , Hemodinámica , Contracción Isométrica , Presión Negativa de la Región Corporal Inferior , Adulto , Presión Sanguínea , Gasto Cardíaco , Femenino , Fuerza de la Mano/fisiología , Voluntarios Sanos , Frecuencia Cardíaca , Humanos , Masculino , Volumen Sistólico , Resistencia Vascular , Adulto JovenRESUMEN
INTRODUCTION: Poorly defined musculoskeletal disorders are a common clinical problem and have considerable psychosocial impact. Chronic compartment syndrome (CCS) of the legs has primarily been noted in young athletes and soldiers. The epidemiology of CCS in the general population has not been studied previously. The aim of this study was to establish the prevalence of CCS of the legs in the general population and to study its association with possible etiological factors. METHODS: A two-stage population survey was performed, using a questionnaire followed by clinical examination. A sample of 3000 individuals aged 25-75 years was randomly selected from the general population. A clinical examination was offered to those answering "Yes" to the following question: "Do you wake up at nights due to leg pains or cramps, causing you to walk around?" Intracompartmental pressures in the leg were measured in 13 persons randomly selected from among those diagnosed with CCS after the clinical examination. RESULTS: Of the 3000 persons contacted, 2308 (76.9%) responders were included in the study. Leg pain or cramps at night was reported by 24% of the respondents. Age, rheumatic disease, use of hormone medication, heart failure, leg oedema, and peripheral arterial disease were all significantly associated with leg pain or cramps (P<0.05). Among 286 persons with leg pain who underwent a subsequent clinical examination, 91 persons (31.9%) were classified as definite CCS. This suggests a CCS prevalence of 7.6% in the total sample ([24%×31.9%/100]). In 13 of the individuals with CCS intracompartmental pressure was measured before and after performance of the step test exercise. One individual had a post-exercise pressure >15mmHg. None had post-exercise pressure past the conventional threshold of >30mmHg. CONCLUSION: Nocturnal leg pain or cramps is a common symptom. A significant part of the general population (7.6%) may have CCS of the legs, with symptoms ranging from very mild to severe. IMPLICATIONS: Considering the high prevalence of CCS found in this study, it is likely that a large proportion of those presenting with muscular pain actually have CCS. These persons are usually advised to increase their physical training to achieve some degree of pain relief. However, CCS patients may instead experience both increased leg pain and a proximal myalgia, which is possibly a referred pain. A demanding "gold standard" test (requiring identification of elevated of intracompartmental pressures), unclear diagnostic criteria, poor long-term results from incomplete surgery, and an uncertain explanation for what may be termed referred pain seem to have delayed the acceptance of CCS as a common cause of leg pain/cramps and numbness. At the same time, the enormous costs to society and the reduced quality of life of patients require that such disease entities are correctly diagnosed as they can be effectively treated by simple, low-risk surgical procedures.
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Síndromes Compartimentales/diagnóstico , Pierna/patología , Adulto , Anciano , Enfermedad Crónica , Síndromes Compartimentales/epidemiología , Síndromes Compartimentales/cirugía , Fasciotomía , Femenino , Humanos , Masculino , Persona de Mediana Edad , Calambre Muscular , Presión , Prevalencia , Calidad de VidaRESUMEN
We sought to investigate the effect of reduced preload on left ventricle (LV) untwist and early diastolic filling in healthy individuals. Twelve healthy men, 22 (22, 23) years of age, were examined at rest and during applied lower body negative pressure (LBNP) of -20 mmHg and -40 mmHg, respectively. Regional untwist and untwist rate during IVRT were calculated at LV basal, papillary, subpapillary, and apical short axis levels by two dimensional speckle tracking echocardiography. Left ventricle early diastolic filling was assessed by transmitral E-wave (E) peak velocity by pulsed Doppler and flow propagation velocity (Vp) by color M-mode Doppler and early diastolic pulsed Doppler tissue velocities (E') from septal and lateral mitral annulus. From rest to LBNP -40 mmHg, the LV untwist and untwist rate at subpapillary level increased from 2.3 (1.4, 3.5) to 4.5 (3.1, 7.6) degrees and from -36 (-51, -25) to -69 (-127, -42) °/s (P < 0.001, P = 0.003), respectively, while apical untwist and untwist rate increased from 3.9 (2.3, 4.3) to 7.6 (6.4, 10.5) degrees and from -51 (-69, -40) to -118 (-170, -84) °/s (P < 0.001, P < 0.001), respectively. Since untwist and untwist rate at the basal level were unchanged, this created markedly larger base to apical untwist and untwist rate gradients from rest to LBNP -40 mmHg. E, Vp, and E' were reduced by 34, 32, and 39%, respectively. LV untwist and untwist rate during IVRT were increased at apical levels, which might be a physiological mechanism to minimize the impairment in LV early diastolic filling during preload reduction.
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BACKGROUND AND PURPOSE: This study aimed to assess the effects of supervised exercise training (SET) after percutaneous transluminal angioplasty (PTA) compared with PTA alone on physical function, limb hemodynamics and health-related quality of life in patients with intermittent claudication. METHODS: Fifty patients who all underwent PTA for intermittent claudication were included in the study. Both groups received usual post-operative care. In addition, the intervention group performed two sessions of hospital-based SET and one home-based exercise session per week for 12 weeks after PTA. The control group did not receive any additional follow-up regarding exercise. The primary outcome was the result of a standardized 6-minute walk test. Secondary outcomes were the treadmill maximum walking distance, treadmill pain-free walking distance, ankle-brachial index, pulse volume recording on the leg and ultrasound scanning. Health-related quality of life was measured using the Short Form 36 and the Claudication Scale. RESULTS: All measures, except for the Short Form 36 domain of mental health, showed statistically significant positive changes from baseline to 3 months for both groups (p < 0.05). At 3 months, there was a trend towards better results for the intervention group compared with the control group. The median improvement from baseline to 3 months for the 6-minute walk test was 66 m for the intervention group and 45 m for the control group. For maximum walking distance, the median improvement was 251 m for the intervention group and 93 m for the control group. DISCUSSION: Supervised exercise training after endovascular treatment for patients with intermittent claudication led to greater positive changes after 3 months in the intervention group compared with the control group. The present study's trends of better results with SET after PTA add to the emerging existing evidence, which should encourage physiotherapy practice to offer SET for this patient group.
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Procedimientos Endovasculares/métodos , Terapia por Ejercicio/métodos , Tolerancia al Ejercicio/fisiología , Claudicación Intermitente/rehabilitación , Enfermedad Arterial Periférica/rehabilitación , Caminata/fisiología , Anciano , Anciano de 80 o más Años , Procedimientos Endovasculares/efectos adversos , Femenino , Estudios de Seguimiento , Humanos , Claudicación Intermitente/diagnóstico por imagen , Claudicación Intermitente/terapia , Masculino , Persona de Mediana Edad , Noruega , Dimensión del Dolor , Enfermedad Arterial Periférica/diagnóstico por imagen , Enfermedad Arterial Periférica/terapia , Cuidados Posoperatorios/métodos , Flujo Sanguíneo Regional/fisiología , Medición de Riesgo , Índice de Severidad de la Enfermedad , Método Simple Ciego , Estadísticas no Paramétricas , Factores de Tiempo , Resultado del Tratamiento , Ultrasonografía DopplerRESUMEN
UNLABELLED: The aim of this study was to explore the effects during 12 months follow-up of 12 weeks of supervised exercise therapy (SET) after percutaneous transluminal angioplasty (PTA) compared to PTA alone on physical function, limb hemodynamics and health-related quality of life (HRQoL) in patients with intermittent claudication. Fifty patients were randomised to an intervention or a control group. Both groups received usual post-operative care and follow-up measurements at three, six and 12 months after PTA. The intervention group performed 12 weeks of SET after PTA. The control group did not receive any additional follow-up regarding exercise. During the 12 months' follow-up, the members of the intervention group had significantly better walking distance than the control group. The intervention group had a significantly higher HRQoL score in the physical component score of the SF-36, and the domains of physical function, bodily pain and vitality. For limb hemodynamics, there was a non-significant trend towards better results in the intervention group compared to the control group. CONCLUSION: SET after PTA yielded statistically significantly better results for walking distance and HRQoL in the intervention group than the control group during the 12 months of follow-up.
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Angioplastia/rehabilitación , Terapia por Ejercicio , Claudicación Intermitente , Actividad Motora , Calidad de Vida , Flujo Sanguíneo Regional , Anciano , Brazo/irrigación sanguínea , Femenino , Estudios de Seguimiento , Humanos , Claudicación Intermitente/cirugía , Extremidad Inferior/irrigación sanguínea , Masculino , Persona de Mediana Edad , Noruega , Estudios Prospectivos , Factores de TiempoRESUMEN
OBJECTIVE: Carotid plaques (CP) are predictive of acute coronary syndrome in patients with rheumatoid arthritis (RA), suggesting that atherosclerotic plaques in these patients are vulnerable. The objective of our study was to characterize vulnerability of CP in patients with RA compared to a control population, and between RA patients with different levels of disease activity. METHODS: Ultrasound examination of carotid arteries was performed in 152 patients with RA and 89 controls. CP echolucency was evaluated by the Gray-Scale Median (GSM) technique. Lower GSM values indicate higher vulnerability of plaques. CP characteristics were compared between RA patients with active disease and in remission, and between patients and controls. All analyses were performed with adjustment for confounding factors (sex, age, smoking, and blood pressure). Poisson regression analysis was used for count data, mixed modeling for GSM and area per plaque, and analysis of covariance for minimum GSM value per patient. RESULTS: Patients with RA more frequently had CP (median 2, range 0, 4) compared with controls (median 1, range 0, 3; p < 0.001), after adjustment for age and sex. Patients with active RA disease according to the Clinical Disease Activity Index (CDAI) had lower median GSM (p = 0.03), minimum GSM (p = 0.03), and a larger CP area (although the latter finding was not significant; p = 0.27), compared with patients with RA in remission. These findings were not confirmed for other disease measures (Simplified Disease Activity Index, Disease Activity Score-28, C-reactive protein, erythrocyte sedimentation rate). CONCLUSION: Patients with RA had more CP compared with controls and patients in CDAI remission, and controls had more stable CP than patients with active disease; these findings point to the importance of achieving remission in RA.
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Artritis Reumatoide/fisiopatología , Arterias Carótidas/fisiopatología , Enfermedades de las Arterias Carótidas/fisiopatología , Enfermedad de la Arteria Coronaria/fisiopatología , Placa Aterosclerótica/fisiopatología , Adulto , Factores de Edad , Anciano , Artritis Reumatoide/complicaciones , Artritis Reumatoide/diagnóstico por imagen , Arterias Carótidas/diagnóstico por imagen , Enfermedades de las Arterias Carótidas/complicaciones , Enfermedades de las Arterias Carótidas/diagnóstico por imagen , Enfermedad de la Arteria Coronaria/diagnóstico por imagen , Enfermedad de la Arteria Coronaria/etiología , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Placa Aterosclerótica/complicaciones , Placa Aterosclerótica/diagnóstico por imagen , Factores de Riesgo , Índice de Severidad de la Enfermedad , Factores Sexuales , UltrasonografíaRESUMEN
OBJECTIVE: Obstructive sleep apnoea (OSA) and obesity are both associated with endothelial dysfunction, which precedes the development of atherosclerosis. As obesity is highly prevalent in OSA, we wanted to test the hypothesis that OSA is associated with endothelial dysfunction independently of obesity. DESIGN: Cross-sectional, population-based study. SETTING: Norwegian university hospital. PATIENTS: Seventy-one subjects (median age 44 years, 35% female) were recruited from a population-based study in Norway. Participants were categorised as obese (body mass index (BMI) ≥30 kg/m(2)), non-obese (BMI<30 kg/m(2)) with OSA (apnoea-hypopnoea index (AHI)≥10), or non-obese without OSA (AHI<5). INTERVENTIONS: None. MAIN OUTCOME MEASURES: Endothelial function measured by brachial artery ultrasound and expressed as percentage of flow-mediated dilation (FMD%). RESULTS: When non-obese subjects without OSA were used as the reference (FMD% (mean±SD) 10.1±6.3), endothelial function was found to be impaired in subjects with OSA (FMD% 6.4±3.2) (p=0.003). FMD% did not differ between obese (6.0±3.4) and non-obese (6.7±3.1) OSA subjects (p=0.3). By univariate linear regression analysis, AHI, BMI, gender and baseline brachial artery diameter were significantly associated with FMD%. When these variables were entered into a multivariate model, only AHI was significantly associated with FMD%. CONCLUSIONS: OSA is associated with endothelial dysfunction independently of obesity and conventional risk factors.
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Aterosclerosis/epidemiología , Arteria Braquial/fisiopatología , Endotelio Vascular/fisiopatología , Vigilancia de la Población , Flujo Sanguíneo Regional , Apnea Obstructiva del Sueño/fisiopatología , Vasodilatación/fisiología , Adulto , Anciano , Aterosclerosis/etiología , Aterosclerosis/fisiopatología , Índice de Masa Corporal , Arteria Braquial/diagnóstico por imagen , Estudios Transversales , Femenino , Estudios de Seguimiento , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Noruega/epidemiología , Polisomnografía , Pronóstico , Estudios Retrospectivos , Medición de Riesgo/métodos , Factores de Riesgo , Apnea Obstructiva del Sueño/complicaciones , UltrasonografíaRESUMEN
PURPOSE: The main purpose of the this human study was by speckle tracking imaging to characterize the regional and temporal distribution of normal left ventricular (LV) deformation and the LV geometry during isovolumetric contraction (IVC) and the ejection phase. METHODS: Twelve healthy young men [22 (2·3) years] were included. Longitudinal and circumferential strain and local twist angle were measured at four LV short-axis levels: basal, papillary, subpapillary and apical level during IVC and ejection phases. In addition, LV length from apex to the atrio-ventricular level, two diameters at LV basal short-axis level and atrio-ventricular plane displacement (AVPD) were measured to characterize LV shape during IVC. RESULTS: During IVC, longitudinal and circumferential shortening was demonstrated at all four short-axis levels from base to apex, while the LV made a basal counterclockwise and apical clockwise rotation representing untwist. In addition, there was a reduction in LV length and changes in short-axis diameters at basal level and AVPD from end-diastole to end-IVC, reflecting that the LV changed from an oval to a more spherical shape. At end-systole, longitudinal and circumferential shortening and local twist angle were significantly increased towards apex (P<0·05). CONCLUSION: This study demonstrated that the IVC in healthy humans is characterized by regional longitudinal and circumferential shortening and LV untwist, which occurs parallel to geometric changes of the LV into a spherical shape. During ejection, increased regional gradients of LV deformation towards apex in LV longitudinal and circumferential shortening and local and net twist angle were demonstrated.
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Ecocardiografía Doppler , Ventrículos Cardíacos/diagnóstico por imagen , Contracción Miocárdica , Volumen Sistólico , Función Ventricular Izquierda , Análisis de Varianza , Fenómenos Biomecánicos , Humanos , Masculino , Noruega , Valor Predictivo de las Pruebas , Valores de Referencia , Reproducibilidad de los Resultados , Factores de Tiempo , Adulto JovenRESUMEN
INTRODUCTION: Increased carotid intima-media thickness (IMT) has been associated with increased risk of myocardial infarction (MI) and stroke. A measure of echogenicity, the grey scale median (GSM), has been shown to be inversely correlated with cardiovascular risk factors and to be predictive of mortality in a community-based cohort. We assessed the factors associated with carotid IM-GSM in younger, non-diabetic patients with a recent MI. METHODS AND RESULTS: A total of 122 patients (women, 25%) aged 31-80 years (61) were recruited 2-3 days after an acute MI. Ultrasound examinations of the carotid arteries were performed 1-12 months after the MI. IMT was 0·78 (SD 0·17) mm on the right side and 0·81 (0·20) mm on the left side (P = 0·05). GSM was 88·60 (range 46-132, SD 18·32) on the right side and 82·10 (40-126, 17·89) on the left side (P = 0·002). Triglycerides (TG) correlated with GSM on both sides (right, r = -0·27, P = 0·003; left, r = -0·18, P = 0·05). On the right side, GSM was 92·15 and 82·26 (P = 0·05) in patients with TG < and ≥1·7, and on the left side, it was 84·04 and 74·55 (P = 0·02) in patients with TG < and ≥2·3. On multivariate analysis, TG were significantly associated with GSM, both on the right side (P = 0·01) and on the left side (P = 0·009). CONCLUSION: We found a negative association between TG and carotid IM-GSM on both sides in patients with a recent MI. Our results also suggest that atherosclerosis progression may be faster on the left side in patients with coronary heart disease.
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Enfermedades de las Arterias Carótidas/diagnóstico por imagen , Arteria Carótida Común/diagnóstico por imagen , Grosor Intima-Media Carotídeo , Enfermedad de la Arteria Coronaria/epidemiología , Infarto del Miocardio/epidemiología , Adulto , Anciano , Anciano de 80 o más Años , Biomarcadores/sangre , Enfermedades de las Arterias Carótidas/sangre , Enfermedades de las Arterias Carótidas/epidemiología , Enfermedad de la Arteria Coronaria/sangre , Progresión de la Enfermedad , Femenino , Humanos , Modelos Lineales , Masculino , Persona de Mediana Edad , Análisis Multivariante , Infarto del Miocardio/sangre , Valor Predictivo de las Pruebas , Pronóstico , Medición de Riesgo , Factores de Riesgo , Suecia/epidemiología , Factores de Tiempo , Triglicéridos/sangreRESUMEN
BACKGROUND: In normal left ventricles (LV), counterclockwise rotation (CCR) and net twist angle (NTA) have shown important roles during ejection. We investigated the effect of reduced preload by lower body negative pressure (LBNP) on CCR and NTA. METHODS AND RESULTS: Twelve healthy men were examined at rest, LBNP -20 and -40 mmHg. By two-dimensional speckle-tracking imaging, we measured rotation at four short-axis levels: basal, papillary, sub-papillary and apical. LV NTA was calculated as apex-to-base difference in rotation. Additionally, regional end-diastolic (EDA) and end-systolic area (ESA) were measured and regional area fraction (RAF) calculated [(EDA-ESA)/EDA] × 100). From rest to LBNP -40 mmHg, rotation at basal and papillary levels was unchanged. At sub-papillary level, rotation increased from 3·2 ± 3·6 to 5·8 ± 4·7° (P<0·05), while apical rotation increased from 9·3 ± 3·4 to 12·8 ± 4·7° (P<0·05). Correspondingly, LV NTA increased for each load reduction by 1·6 ± 1·8° (P<0·05) and 4·2 ± 2·3° (P<0·05). RAF increased at sub-papillary and apical levels from 57·6 ± 3·7 to 64·7 ± 8·8% and from 63·4 ± 8·8 to 74·8 ± 10·1%, respectively (P<0·05). From rest to LBNP -40 mmHg, changes in rotation and RAF correlated significantly at sub-papillary and apical levels (r = 0·94, P<0·01, and r = 0·63, P<0·05, respectively). CONCLUSIONS: Preload reduction in normal LV elicits increased systolic CCR and regional area fraction at sub-papillary and apical levels as well as net twist angle. These findings might be of physiological importance to minimize reduction in stroke volume and maintain arterial blood pressure.
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Ventrículos Cardíacos/diagnóstico por imagen , Presión Negativa de la Región Corporal Inferior , Función Ventricular Izquierda , Adulto , Análisis de Varianza , Fenómenos Biomecánicos , Presión Sanguínea , Humanos , Masculino , Contracción Miocárdica , Rotación , Volumen Sistólico , Ultrasonografía , Adulto JovenRESUMEN
OBJECTIVES: To compare markers of cardiovascular disease (CVD) risk between patients with rheumatoid arthritis (RA) in an active disease state and those with RA in remission, and to compare both groups with community controls. METHODS: 113 patients with RA and 86 community controls were assessed across a panel of biomarkers for CVD. RA in remission was defined as Clinical Disease Activity Index ≤2.8. Community controls were selected at random by Statistics Norway, and controls were matched with patients in the cohorts in strata using details of age, sex and residential area. A panel of biomarkers (N-terminal pro-brain natriuretic peptide (NT-proBNP), total cholesterol, reactive hyperaemia index (RHI), pressure measurements, measures of arterial stiffness and intima-media thickness) were compared between patients with active RA and those with RA in remission. Both groups were compared with controls. In addition, biomarker levels were compared across subgroups based on anticyclic citrullinated peptide status, level of joint destruction and presence of extra-articular manifestations. RESULTS: Patients with active RA had significantly higher levels of NT-proBNP, brachial systolic pressure, augmentation index and central systolic pressure but lower cholesterol than patients in remission and controls. In addition, patients with active RA had significantly higher levels of pulse wave velocity and worse RHI than patients in remission. Comparison across other subgroups gave less consistent differentiations in levels of CVD risk markers. CONCLUSION: Patients with active RA, but not those in remission, had significantly increased levels of CVD risk markers. These results link inflammatory activity to markers of CVD risk in patients with RA and may indirectly support the notion that remission in RA confers diminished cardiovascular morbidity.
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Artritis Reumatoide/complicaciones , Enfermedades Cardiovasculares/etiología , Adulto , Anciano , Antirreumáticos/uso terapéutico , Artritis Reumatoide/tratamiento farmacológico , Autoanticuerpos/sangre , Biomarcadores/sangre , Enfermedades Cardiovasculares/prevención & control , Métodos Epidemiológicos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Péptidos Cíclicos/inmunología , Inducción de Remisión , Gestión de Riesgos/métodosRESUMEN
OBJECTIVES: The aims of this study were to measure plasma IL 6 and IL 8 in patients with proximal femoral fracture (PFF) during the early phases of trauma and operation and to find out if there was any correlation between these ILs and the post-operative lower limb oedema. MATERIAL AND METHODS: Thirty patients with a median age of 81 years were grouped into pertrochanteric fracture (PTF) (n = 16) and femoral cervical fracture (FCF) (n = 14). Plasma interleukin levels were determined on blood samples obtained from the common femoral vein, immediately after hospital admission, 1 h before operation, and post-operatively at 1, 6, 12, 24, 48 h and on the 7th day. Thigh oedema was calculated by the frustum method. RESULTS: In the patients with PTF, maximum mean plasma IL-6 and IL-8 values were found, respectively at 24 h (45.12 pg/mL) and 6 hours (21.7 pg/mL) postoperatively. Whereas, in the patients with FCF, it was respectively, at 12 h (33.1 pg/mL) and 6 h (17.0 pg/mL), for IL-6 and IL-8 post operatively. The patients with PTF and FCF had respectively, 34.1% and 27.4% more thigh oedema in the operated limb on the 7th post-operative day as compared to the preoperative oedema volume (p<0.001). No significant correlation could be found between the plasma IL-6 and IL-8 levels and oedema in the operated limb. CONCLUSION: Increased levels of IL 6 and IL 8 suggest ongoing inflammation.
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Fracturas del Fémur/sangre , Fracturas del Fémur/cirugía , Mediadores de Inflamación/sangre , Interleucina-6/sangre , Interleucina-8/sangre , Anciano , Anciano de 80 o más Años , Demografía , Edema/sangre , Femenino , Humanos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/sangre , Factores de TiempoRESUMEN
OBJECTIVES: To examine the changes in Starling components, regulating the transcapillary fluid transport, in patients with proximal femoral fractures (PFF). MATERIAL AND METHODS: Twenty-eight patients with proximal femoral fracture were classified into femoral column fracture (FCF) and pertrochanteric fracture (PTF) groups. The following measurements were made in both groups of patients on the 7th post-operative day: colloid osmotic pressure of plasma and subcutaneous interstitial fluid (COP(pl) and COP(if)), capillary filtration coefficient (CFC) and interstitial fluid pressure (P(if)) in the anterior muscle compartment of the leg and calf muscle blood flow, in both lower extremities. RESULTS: The transcapillary colloid osmotic gradient was significantly reduced (p<0.02) in patients with PTF, and they also showed a significant increase in CFC values (p=0.038). Moreover, P(if) was elevated (1.9 mmHg, SD 2.1, p=0.01) and calf muscle blood flow was significantly higher (p=0.02), than in the contralateral limb in patients with PTF. CONCLUSION: The transcapillary colloid osmotic gradient is significantly reduced in patients with PTF. This may partly explain why patients with PTF develop more oedema in the lower limb than those with FCF. CFC and calf blood flow are also significantly increased in the fractured limb, which allows increased transcapillary filtration.
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Edema/complicaciones , Edema/fisiopatología , Fracturas del Fémur/complicaciones , Fracturas del Fémur/fisiopatología , Pierna/fisiopatología , Anciano , Anciano de 80 o más Años , Vesícula/complicaciones , Vesícula/fisiopatología , Capilares/fisiopatología , Coloides , Fracturas del Fémur/cirugía , Filtración , Humanos , Presión Hidrostática , Pierna/irrigación sanguínea , Pierna/cirugía , Persona de Mediana Edad , Presión Osmótica/fisiología , Flujo Sanguíneo Regional/fisiologíaRESUMEN
During cycling blood flow is redistributed from physically inactive tissues to working leg muscles. It is unknown how long this situation persists after very intense exercise or whether it differs between intense exhausting and non-exhausting exercise. It is also not known to what extent the redistribution differs between different types of non-active tissues. Therefore nine healthy young men cycled first for 2 min at 328 W (non-exhausting exercise, mean). Blood velocity in thigh and arm (ultrasound-doppler), perfusion of forearm skin (non-acral skin) and finger tip (acral skin, with arterio-venous anastomoses) were measured for 30 min after exercise (laser-doppler). To be able to study vascular resistance and central circulation, blood pressure (Finometer), heart rate (ECG), and stroke volume (ultrasound-doppler) were measured. Thereafter the subjects cycled at the same power to exhaustion (4 min), and the measurements were repeated. After both exercises mean blood pressure was unchanged (< or = 80 mm Hg) despite increased cardiac output (> or = + 30% vs. pre-exercise). Blood velocity in the brachial artery was higher during the whole recovery period than at rest (p< or =0.02; no differences between exercises). Blood perfusion of non-acral skin was unchanged from pre-exercise level after 2 min of non-exhausting exercise, but it was twice as high after 4 min cycling to exhaustion as at rest (p=0.02). Blood perfusion of acral skin rose after both exercises and did not differ between exhausting and non-exhausting exercise. In conclusion, arm blood flow increases above the pre-exercise level in the recovery period after short-lasting, strenuous exercise.
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Arteria Braquial/fisiología , Ejercicio Físico/fisiología , Flujo Sanguíneo Regional/fisiología , Adulto , Velocidad del Flujo Sanguíneo/fisiología , Presión Sanguínea/fisiología , Arteria Femoral/fisiología , Frecuencia Cardíaca/fisiología , Humanos , Ácido Láctico/sangre , Masculino , Perfusión , Piel/irrigación sanguínea , Volumen Sistólico/fisiología , Factores de Tiempo , Vasoconstricción/fisiologíaRESUMEN
BACKGROUND: Walking exercise, smoking cessation and best medical therapy are cornerstones in all treatment of atherosclerosis. For patients with intermittent claudication or critical limb ischemia, endovascular therapy (which has developed substantially during the last decade) has become the first line treatment (when feasible). The aim of this article is to provide an overview of options for surgical treatment of peripheral atherosclerosis in the lower limbs. MATERIAL AND METHODS: The article is based on literature identified through a non-systematic search in PubMed, vascular textbooks and the authors' own clinical experience. RESULTS: When endovascular therapy has failed or is not feasible, open surgical techniques are used, such as endarterectomy and bypass surgery to the popliteal or distal arteries. Hybrid procedures, with femoral endarterectomy and distal or proximal endovascular intervention, are often used. Increased use of endovascular treatment reduces the procedural time, length of hospital stay and the rate of complications. In patients with extreme disease progression, primary amputation may still be the treatment of choice. INTERPRETATION: Surgical treatment of peripheral artery disease requires competence both within radiological intervention and open surgical treatment modalities.
Asunto(s)
Aterosclerosis/cirugía , Isquemia/cirugía , Extremidad Inferior/irrigación sanguínea , Enfermedades Vasculares Periféricas/cirugía , Procedimientos Quirúrgicos Vasculares/métodos , Angioplastia de Balón , Implantación de Prótesis Vascular , Endarterectomía , Arteria Femoral/cirugía , Humanos , Claudicación Intermitente/cirugía , Arteria Poplítea/cirugía , Stents , Resultado del TratamientoRESUMEN
BACKGROUND: Venous insufficiency is a common condition that presents with various symptoms and is often treated inadequately. The purpose of the article is to provide an overview of the prevalence, recommended investigations and indications for treatment of venous insufficiency. MATERIAL AND METHOD: The literature reviewed was identified through a non-systematic search in PubMed based on the authors' experience in research, investigations and treatment of this patient group. RESULTS: Venous insufficiency is a common condition with a prevalence of about 30 %. Some patients will develop distal dystrophic skin changes (prevalence Asunto(s)
Extremidad Inferior/irrigación sanguínea
, Insuficiencia Venosa
, Humanos
, Prevalencia
, Piel/patología
, Medias de Compresión
, Várices/diagnóstico
, Várices/terapia
, Insuficiencia Venosa/diagnóstico
, Insuficiencia Venosa/epidemiología
, Insuficiencia Venosa/terapia
RESUMEN
BACKGROUND: Patients with proximal femoral fracture (PFF) often develop postoperative edema in the operated limb. This may lead to reduced mobilization, increasing the length of hospitalization. It is therefore relevant to gain information about the extent and pathogenesis of this edema formation. METHODS: Forty-one patients with PFF (30 women and 11 men) were studied pre- and postoperatively. Patients were grouped into pertrochanteric fractures and femoral cervical fractures, according to the AO/ASIF classification of PFF. Thigh and calf volumes were calculated in both fractured and contralateral limbs preoperatively and on postoperative days 3, 5, 7, and 30. RESULTS: All patients with PFF developed edema in the operated limb. The greatest volume increase occurred on postoperative day 7 (p < 0.0005). The magnitude of edema in the thigh and the leg of patients with pertrochanteric fractures as compared with the nonoperative side was approximately twice as great as in those with femoral cervical fractures (p < 0.0001). There was a statistically significant daily increase in the volume of the operative limb as compared with the nonoperative side. Age and sex were not correlated with the extent of edema formation. Functionally significant deep venous thrombosis and local infection could be excluded as causative factors. CONCLUSIONS: Postoperative edema in the thigh and leg of the operated limb was considerable. The magnitude of edema formation was related to the severity of primary trauma and the type of osteosynthesis. Therefore, the operation performed for PFF should be minimally traumatic.
Asunto(s)
Edema/etiología , Fracturas del Cuello Femoral/cirugía , Fijación Interna de Fracturas , Fracturas de Cadera/cirugía , Pierna/patología , Complicaciones Posoperatorias , Anciano , Anciano de 80 o más Años , Edema/patología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Tamaño de los ÓrganosRESUMEN
BACKGROUND: The purpose of this study was to compare the circulatory responses to isometric exercise in patients with peripheral atherosclerotic disease (PAD) with healthy controls. METHODS: Eleven patients with diagnosed PAD, a control group of eleven healthy young adults, and a control group of eleven healthy age-matched adults participated. Blood pressure, heart rate, stroke volume, cardiac output, blood velocity in the brachial artery, acral skin perfusion was continuously recorded and total peripheral resistance calculated before, during and after 2 min of 40% maximum voluntary contraction of the forearm. RESULTS: At rest we found a consistently higher level of mean arterial pressure (MAP) and systolic pressure (SP) in the elderly, both PAD patients and elderly controls, compared with the young controls. We found no significant difference in diastolic blood pressure. Two minutes isometric handgrip exercise induced a similar increase in MAP in all three groups (patients 32.6 (17.9) mm Hg [mean (SD)], young control group 25.3 (8.9) mm Hg, age-matched control group 36.1 (10.6) mm Hg). No significant differences were found in the other measured cardiovascular variables during isometric handgrip. Increased TPR is the main factor contributing to the increase in blood pressure in all three groups. CONCLUSION: Our study indicates that the pressor response continues to be well regulated with age, also when the cardiovascular system is altered by marked atherosclerosis. The consequence is that both PAD patients and elderly controls reach higher SP values during isometric exercise due to higher SP baseline values.
Asunto(s)
Aterosclerosis/fisiopatología , Presión Sanguínea , Ejercicio Físico , Contracción Isométrica , Músculo Esquelético/fisiopatología , Enfermedades Vasculares Periféricas/fisiopatología , Anciano , Velocidad del Flujo Sanguíneo , Arteria Braquial/fisiopatología , Gasto Cardíaco , Estudios de Casos y Controles , Femenino , Fuerza de la Mano , Frecuencia Cardíaca , Humanos , Masculino , Persona de Mediana Edad , Flujo Sanguíneo Regional , Piel/irrigación sanguínea , Sístole , Factores de Tiempo , Resistencia VascularRESUMEN
The importance of prothrombotic activity in cardiovascular disease has been well established. However, limited data exist on the relationship between prothrombotic activity and the severity of peripheral arterial occlusive disease (PAD). The objective of the present study was to investigate the relationship between markers of haemostasis and the diagnostic measures of PAD: ankle-brachial-index (ABI), maximum treadmill walking distance and angiographic score. In a cross-sectional study of 127 patients (mean age 66 years; 64% males) with angiographically verified PAD, fasting blood samples were drawn, and citrated plasma was obtained for determination of selected haemostatic variables: von Willebrand factor (vWF), thrombomodulin (sTM), thrombin-antithrombin complex (TAT), soluble tissue factor (sTF), tPA antigen (tPAag) and D-dimer were all significantly correlated with the angiographic score (p < 0.05 for all). D-dimer, tPAag and fibrinogen were inversely correlated with the maximum treadmill walking distance, (p < 0.0001, p < 0.04 and p < 0.05, respectively), whereas fibrinogen was the only variable correlating to ABI (r = -0.223, p < 0.05). After adjustment for relevant covariates, D-dimer and TAT remained statistically significantly associated with the angiographic score (p < 0.001), and fibrinogen was, independent of other risk factors, inversely related with both the maximum treadmill walking distance and the ABI (p < 0.01 for both). This rather large study in patients with PAD showed that plasma levels of D-dimer, TAT and fibrinogen significantly predicted the extent of atherosclerosis, evaluated by angiographic score, maximum treadmill walking distance and ABI, respectively. These findings demonstrate a prothrombotic state in PAD patients, which might be of importance in future diagnosis and treatment of the disease.
Asunto(s)
Arteriopatías Oclusivas/diagnóstico , Arteriopatías Oclusivas/patología , Trombina/biosíntesis , Trombosis/patología , Anciano , Angiografía , Antitrombinas/biosíntesis , Femenino , Humanos , Masculino , Persona de Mediana Edad , Trombomodulina/biosíntesis , Tromboplastina/biosíntesis , Caminata , Factor de von Willebrand/biosíntesisRESUMEN
Patients with venous leg ulcers usually have extensive symptoms both related to their venous insufficiency and to the wound itself, often combined with a reduced quality of life. Prevalence of venous leg ulcers varies from 0.1 to 1.0%. Treatment costs are high and may amount to 1.5% of a nation's total spending on health care. Venous hypertension is the common denominator for all patients with venous leg ulcers. Isolated superficial as well as deep or combined venous insufficiency with or without insufficient perforators may cause ulceration. In the microcirculation, inflammation is involved, but the exact mechanisms behind the ulcer formation remain unresolved. During the examination, a presence of superficial venous insufficiency accessible for superficial resection must be established. In addition to a clinical examination, venous pressure measurements/plethysmography and colour duplex scanning is recommended in order to locate and evaluate the significance of the venous insufficiency. The key element in the treatment of venous ulcers is to reduce oedema and venous hypertension by adequate compression and elevation. If primary superficial venous insufficiency is established, venous resection is recommended. This may improve healing and reduce recurrences. In selected patients, deep venous reconstruction is an alternative approach.