Chronic Vascular Disorders Research Articles

Cannabinoid hyperemesis syndrome co-occurring with superior mesenteric artery syndrome in adolescents.

Both superior mesenteric artery syndrome (SMAS) and cannabinoid hyperemesis syndrome (CHS) may present with abdominal pain, nausea, and emesis - making them difficult to differentiate or determine when they co-occur in adolescents who regularly use cannabis. Here, we present nine cases of CHS co-occurring with SMAS and characterize their clinical courses. Patients admitted at Children's Hospital of Colorado between January 1, 2015, and March 23, 2023, who had both cannabis use (F12.1-F12.99) and chronic vascular disorders of the intestine (K55.1) on their problem lists were identified from the electronic medical recordusing ICD 10 codes. Nine met criteria for SMAS and chronic cannabis use. Six of nine patients were female. The most common presenting symptoms were nausea (9), vomiting (9), and weight loss (9). Four patients received cannabis cessation support. Patients lost a mean of 6.0 kg, had an average body mass index (BMI) of 15.61percentile(17.7 kg/m2) and BMI Z-scores of -1.5. Symptoms were present for a mean of 19.6 weeks before diagnosis. Adolescents who experience nausea, vomiting, abdominal pain, and weight loss in association with chronic cannabis use and/or SMAS can present with confusing and overlapping symptoms. Our cohort was described as having CHS with co-occurring SMAS on imaging. Although the etiology of weight loss cannot be definitively ascertained, we postulate that the recurring emetic attacks from CHS led to weight loss resulting in SMAS. Improvement in diagnostic criteria for this population as well as cannabis cessation programming may aid in deceasing morbidity from these co-occurring conditions.

Clinical Evaluation and Management of Varicose Veins of Lower Limb at a Tertiary Care Hospital in India

Objectives Varicose veins are defined as dilated, tortuous and elongated veins in the lower limbs. Being one of the most common chronic vascular disorders of the lower limb, the varicose veins affect approximately 10% of the population. If left untreated, the patient may end up with complications like ulceration. The present study is aimed at evaluating the demography, risk factors, clinical features and management of varicose vein patients attending the Department of General Surgery at a tertiary care hospital. Material and Methods This is a prospective observational study conducted at a tertiary care hospital involving patients with lower limb varicose veins. Demographic factors like age, gender, etiology, clinical features, site of incompetence, type of surgical procedure and postoperative complications were studied. Results Out of 74 patients, majority of them (47.2%) were between 41 and 50 years of age, with a predominance of males (51 cases). Analysis of the history of the patients showed that many were chronic alcoholics (72.9%) and chronic smokers (66.2%). Nearly, 91.8% of them presented with visible dilated veins and pain (60.8%) in the affected limb. The long saphenous vein was greatly involved, and majority of them were managed by saphenofemoral flush ligation + subfascial ligation of perforators (SFFL + SFLP) with minimal postoperative complications. Conclusion Varicosity of the veins of the lower limb is common in patients with long-standing jobs, chronic alcoholics and smokers. Involvement of the long saphenous vein is observed in majority of the patients. Duplex ultrasound is the most sensitive diagnostic procedure and surgery is the primary modality of the treatment.

Surgical management of varicose veins and its complications

Background: Varicose veins affects at least 1 out of 5 in world. Varicose veins and their associated symptoms and complications constitute chronic vascular disorders requiring surgical treatment. In developing countries like India, studies encompassing the clinical evaluation and management of varicose veins on the conventional lines seems a necessity to improve the quality of care with the available resources. Objectives: To study the clinical presentations, surgical management and its outcome and complications associated with varicose veins in lower limbs. Methods: A total of 30 patients with primary varicose veins were sourced from cases admitted to Kamineni Institute of Medical Sciences from October 2019 to August 2021. They were investigated, operated and followed up, and the final outcome evaluated. All the information was taken down in the proforma designed for the study. Results: In the study, it was noted that the varicose veins affect the young adult and middle age population (20-50yrs). Most of the patients were males (60%) and majority of patients sought medical help for one or the other complications (92%). Long saphenous vein involvement was seen in 93.3% of patients and both LSV & SSV involvement in 20%. A great number of patients had perforator incompetence (80%). Duplex Ultrasound of the venous system proved to be a crucial and clinching investigation. Sapheno-femoral flush ligation with stripping was the most commonly performed surgery (46.7%), with addition of Subfascial ligation in a few cases. Most patients had uneventful recovery, with a few cases suffering complications such as hematoma, seroma and wound infection. These resolved in follow-up, however, saphenous neuritis was a persistent complication in 3 patients. Conclusion: Majority of the patients with varicose veins were associated with complications and surgical management with stripping of path of incompetence (i.e. LSV trunk) with incompetent perforator ligation appear to be best option for lower limb varicose veins under our settings.

Assessment of serum nitric oxide level in cigarette smoking

Background: Cigarette smoke has been implicated as a major risk factor in various diseases associated with endothelial dysfunction like essential hypertension, atherosclerosis and related cardiovascular dysfunction. Nitric oxide, an important second messanger plays a pivotal role in maintaining vasomotor tone and its level is also found to be altered in many chronic vascular disorders. The particulates in cigarette smoke is presumed to affect the production NO in vascular endothelium. Hence, it is proposed to study the effect of cigarette smoking in influencing Nitric oxide level. The study sample comprised of 138 chronic smokers and144 apparently healthy nonsmokers . Plasma glucose, total cholesterol (TC), high density lipoprotein cholesterol (HDL-c) and triglyceride concentration (TGL) were determined enzymatically and serum NO index (NOx) estimated by Griess method. It was found that serum NOx level was not influenced by biochemical parameters like plasma glucose and lipid profile. The estimated mean NOx levels was slightly lower in smokers(15.92 with SD 5.4) than in nonsmokers (16.66with SD 6.73) . However the difference was not statistically significant ( P= 0.31). It is concluded that there is no significant correlation between serum nitric oxide level and smoking, based on this study.

Clinical features and socio-demography of varicose veins of lower limbs

Background: Varicose veins and their associated symptoms and complications constitute the most common chronic vascular disorders leading to surgical treatment. Objective: to study the clinical features and socio-demography of varicose veins of lower limbs. Setting: This was a prospective study involving 40 patients who presented with signs and symptoms of primary varicose veins to CG hospital and Bapuji hospital attached to J.J.M. Medical College, Davangere during June 2009 to May 2011. Result: The commonest age group of over patients was between 31 to 40 yrs (27.5 %.). 33 were male and 07 were female. Right limb was more affected 19 cases (47.5%) than left limb 17 cases (42.5%). In 4 of the cases (10%), both the limbs were involved. 5 patients had family history of similar complaints (12.5%). Our patients presented with varied symptoms, out of which dilated veins was most common 37 (92.5%) patients followed by aching pain 22 patients (55%). Long saphenous system is the most common venous system affected by varicosity (64.7%). A greater portion of the patients had combined valvular incompetence (60%). The most common was the above ankle group with 24 followed by below knee with 21 cases. Conclusion: It was concluded that varicosity of the lower limb is a fairly common clinical entity. Disease is prevalent in the young adult and middle aged individuals (21-40 years). The most common presenting symptom was dilated veins followed by aching pain.

Targeted ultrasound enhanced drug delivery to foam cell spheroids

Atherosclerosis is a chronic vascular disorder marked by the accumulation of foam cells in the intimal space of the artery. Foam cells are macrophages that reside in the arterial wall after internalizing excessive cholesterol. Though many strategies to remove cholesterol from foam cells have been put forward, delivering these agents at the site of the lesion remains a challenge. Here, we investigated the ability of our previously reported multi-cavity poly-co-lactic-co-glycolic acid microparticles (mc-PLGA MPs) to penetrate into a model for early stage atherosclerosis, a 3D foam cell spheroid, and deliver hydroxyl beta cyclodextrin (HBCD) and sirolimus. HBCD is a polysaccharide that solubilizes cholesterol and promotes cholesterol efflux from foam cells. First, the drug release capability of mcPLGA MPs was tested using DAPI dye as a model drug. Sustained release of DAPI from mcPLGA MPs was observed in foam cell nuclei three days after implantation. We found that DAPI released from mcPLGA MPs distributed evenly throughout the spheroid even though mcPLGA MPs were implanted predominantly at the periphery. FITC conjugated HBCD was co-administered with sirolimus loaded mc-PLGA MPs and was also found to be implanted only under ultrasound exposure. Foam cell viability and the inflammatory response of the ultrasound treatment were also monitored across a week. In conclusion, this study shows the possibility of atherosclerosis treatment with targeted ultrasound enhanced drug delivery.

Shexiang Baoxin Pill Alleviates the Atherosclerotic Lesions in Mice via Improving Inflammation Response and Inhibiting Lipid Accumulation in the Arterial Wall.

Epidemiological studies have demonstrated that cardiovascular diseases (CVDs) are the leading cause of death in the world. Atherosclerosis, a kind of chronic vascular disorder related to multiple pathogenic processes, has been reported to be an underlying cause of CVDs. Shexiang Baoxin Pill (SBP) is a traditional Chinese medicine formulation and has been broadly used for the treatment of CVDs in East Asia. However, whether SBP affects the development of atherosclerosis is poorly understood. The aim of this study was to investigate the antiatherosclerotic roles and relevant mechanisms of SBP in apolipoprotein E knockout mice. Our results showed that SBP treatment markedly decreased the size of atherosclerotic plaques of the entire aorta and the aortic sinus. Biochemical analyses indicated that SBP gavage improved oxidative stress in vivo, as seen by the level elevation of SOD, CAT, and GSH and the level reduction of MDA, H2O2, and MPO. Moreover, the concentration of MCP-1, IFN-γ, and IL-17A was reduced, and the content of IL-10 and TGF-β1 was increased in the serum from SBP-treated mice. We discovered that the expression levels of inflammatory factors including VCAM-1, ICAM-1, IL-6, and IL-2 in the vascular wall of the SBP group were also decreased in comparison with those of the normal saline group. Moreover, we found that SBP alleviated the activation of inflammation-related pathways in the aorta tissue, as seen by the level elevation of Mfn2 and reduced phosphorylation of p38, JNK, and NF-κB. Furthermore, western blot showed that SBP administration reduced the level of SR-A and LOX-1 and elevated the content of LXRα, ABCA1, and ABCG1 in the arterial wall, indicating that SBP was capable of alleviating lipid influx and facilitating lipid efflux. In conclusion, our data suggested that SBP exerted antiatherosclerotic effects via improving inflammation response and inhibiting lipid accumulation.

Platelet-Neutrophil Interplay: Insights Into Neutrophil Extracellular Trap (NET)-Driven Coagulation in Infection.

Well established for their central role in hemostasis, platelets have increasingly been appreciated as immune cells in recent years. This emerging role should not come as a surprise as the central immune cells of invertebrates, hemocytes, are able to phagocytose, secrete soluble mediators and promote coagulation of hemolymph, blurring the line between immunity and hemostasis. The undeniable evolutionary link between coagulation and immunity becomes even clearer as the role of platelets in inflammation is better understood. Platelets exert a range of immune-related functions, many of which involve an intimate interplay with leukocytes. Platelets promote leukocyte recruitment via endothelial activation and can serve as “landing pads” for leukocytes, facilitating cellular adhesion in vascular beds devoid of classic adhesion molecules. Moreover, platelets enhance leukocyte function both through direct interactions and through release of soluble mediators. Among neutrophil-platelets interactions, the modulation of neutrophil extracellular traps (NETs) is of great interest. Platelets have been shown to induce NET formation; and, in turn, NET components further regulate platelet and neutrophil function. While NETs have been shown to ensnare and kill pathogens, they also initiate coagulation via thrombin activation. In fact, increased NET formation has been associated with hypercoagulability in septic patients as well as in chronic vascular disorders. This review will delve into current knowledge of platelet-neutrophil interactions, with a focus on NET-driven coagulation, in the context of infectious diseases. A better understanding of these mechanisms will shed a light on the therapeutic potential of uncoupling immunity and coagulation through targeting of NETs.

Anti-Thrombotic Therapy of Peripheral Arterial Disease - A Review of Current Evidence, Practice and Outlook

Peripheral arterial occlusive disease is a frequent and chronic vascular disorder mostly affecting the lower limbs and caused by fibrous plaques in arteries that can result in stenoses and thrombi. Patients suffering from this condition show a high risk for cardiovascular complications of the complete arterial vascular system, especially post-procedural. Thus, there is a need to optimize anti-thrombotic therapy. Data on multiple antiplatelet aggregation therapy including new drug classes are expected in the coming years. In addition, recent studies showed that direct oral anticoagulation provided clinical advantages combined with a reasonable safety profile. Management of risk factors such as overweight and nicotine and correction of metabolic disorders are not to be ignored and the background to further therapy. All treating physicians should be aware of these aspects to guarantee an optimal care and motivation of their patients.

Study on clinical profile and management of varicose veins of lower limbs

Background: The venous system of the lower limbs has the burden of posture, and blood has to be forced to the heart chamber against gravity. Commonly this problem is tackled either by a conservative approach or by surgical interference, both of which have their limitations. In the present study, an attempt is being made to study various clinical presentations of varicose veins, their management and complications.Methods: The data for the study was obtained from the patients admitted and treated in Tertiary Care Hospital, Kurnool for a period of two years from November, 2015 to November, 2017. Patients presenting with signs and symptoms of varicose veins, who were diagnosed as having varicosities of the superficial veins by clinical examination, were taken up for the study, after explaining the nature of the disease and various modalities of treatment available.Results: It is found that varicose veins and their associated symptoms and complications constitute the most common chronic vascular disorders leading to surgical treatment. It is more common in middle-aged group and in males. Patients presented with spectrum of symptoms and signs, dilated and tortuous veins being more common presentations. Long saphenous system is the most common venous system affected.Conclusions: Complications are negligible if cases are meticulously selected and operated. The present procedures enable the patient to lead almost normal life after surgery and the morbidity rate is very negligible. Though the newer trends in the management of varicose veins are showing good results, they need a long term follow up.

Clinicopathological study of varicose veins (descriptive study)

Background: Varicose veins and their associated symptoms/complications constitute the most common chronic vascular disorders, affecting 20% of the adults, leading to surgical treatment. In general, this does not cause major life-threatening illness, yet the morbidity of venous ulceration places a substantial burden on community health care. Aim: The aim of our study was to evaluate various clinical presentations, management, and outcome in 50 patients who presented with varicose veins at tertiary center. Materials and Methods: This study is a descriptive review of clinical data of 50 patients diagnosed and treated for varicose veins at our tertiary center over 2 years. Results: Most commonly affected age-group was 41–60 years. Majority of patients were males, dilated veins being the most common presenting symptom. Increased incidence was observed in left leg (32%) as compared to right (26%). In unilateral leg involvement, great saphenous vein (GSV) was most commonly affected (62.06%), whereas in bilateral leg involvement, 73.8% had perforator incompetence. Patients with advanced disease had both saphenofemoral and perforator incompetence. Majority underwent Trendelenburg’s procedure with stripping of GSV and subfascial perforator ligation. Postoperative complications were minimal, and no patient developed recurrence at subsequent follow-ups. Conclusion: The use of color Doppler is an essential investigation along with clinical examination for effective treatment of varicose veins, to prevent recurrence and reduce morbidity. Operative treatment is the primary procedure in the management with minimal chance of recurrence.

MicroRNA-19a contributes to the epigenetic regulation of tissue factor in diabetes

BackgroundDiabetes mellitus is characterized by chronic vascular disorder and presents a main risk factor for cardiovascular mortality. In particular, hyperglycaemia and inflammatory cytokines induce vascular circulating tissue factor (TF) that promotes pro-thrombotic conditions in diabetes. It has recently become evident that alterations of the post-transcriptional regulation of TF via specific microRNA(miR)s, such as miR-126, contribute to the pathogenesis of diabetes and its complications. The endothelial miR-19a is involved in vascular homeostasis and atheroprotection. However, its role in diabetes-related thrombogenicity is unknown. Understanding miR-networks regulating procoagulability in diabetes may help to develop new treatment options preventing vascular complications.Methods and resultsPlasma of 44 patients with known diabetes was assessed for the expression of miR-19a, TF protein, TF activity, and markers for vascular inflammation. High miR-19a expression was associated with reduced TF protein, TF-mediated procoagulability, and vascular inflammation based on expression of vascular adhesion molecule-1 and leukocyte count. We found plasma expression of miR-19a to strongly correlate with miR-126. miR-19a reduced the TF expression on mRNA and protein level in human microvascular endothelial cells (HMEC) as well as TF activity in human monocytes (THP-1), while anti-miR-19a increased the TF expression. Interestingly, miR-19a induced VCAM expression in HMEC. However, miR-19a and miR-126 co-transfection reduced total endothelial VCAM expression and exhibited additive inhibition of a luciferase reporter construct containing the F3 3′UTR.ConclusionsWhile both miRs have differential functions on endothelial VCAM expression, miR-19a and miR-126 cooperate to exhibit anti-thrombotic properties via regulating vascular TF expression. Modulating the post-transcriptional control of TF in diabetes may provide a future anti-thrombotic and anti-inflammatory therapy.

Clinical Study of varicose veins and their management

Varicose veins and their associated symptoms and complications constitute the most common chronic vascular disorders leading to surgical treatment. Though considerable advances in understanding of venous patho physiology and modern imaging techniques have revolutionized the concept of management of varicosity of lower limb, whether these inferences hold good for our population is a pertinent question.The objective of the study is: 1) Analysis of the clinical features of varicose vein. 2) To know the various treatment modalities adapted for the management of varicose veins.Varicosity of the lower limb is a common clinical entity with, age group of 31-40 being commonly affected. The involvement of long saphenous vein is the commonest. Clinical examination has a high predictive accuracy. The use of color Doppler is a valuable supplement to clinical examination for effective treatment of varicose veins.Operative line of treatment is a primary procedure in the management of varicose veins of lower limbs. LSV stripping up to mid calf is associated with less morbidity so also non-stripping of SSV. The present procedures enable the patient to lead almost normal life after surgery and the mortality rate is very negligible.

Management of acute and chronic vascular conditions of the hand

Management of acute and chronic vascular disorders of the hand in patients with vasospastic and vaso-occlusive disorders is a complex problem and requires a multidisciplinary approach. The ischemia-related pain, skin ulcerations, and ultimately the threat of digital gangrene require a concerted effort to improve perfusion using a combination of medications and surgery. The purpose of this work is to review our experience over the past 2 decades with this cohort of patients including the variability of the clinical presentation, a method of classification, and a practical treatment philosophy.

Mechanisms of Action and Chemical-Biological Interactions Between Ozone and Body Compartments: A Critical Appraisal of the Different Administration Routes

After a long initial stage obscured by empirism and misconceptions, oxygen-ozonetherapy has now become a scientific discipline where the reactions between ozone and human blood are within the realm of orthodox biochemistry, physiology and pharmacology. Most of the basic mechanisms of action have been clarified and ozone can be considered a pro-drug, which almost instantaneously reacts with antioxidants and unsaturated fatty acids. These reactions generate the actual ozone messengers represented by either hydrogen peroxide as a fast acting compound or a variety of lipid oxidation products as late effectors. While ozone is totally consumed, micromolar amounts of these messengers are able to enhance the delivery of oxygen via erythrocyte activation, the immune system by a bland leukocyte stimulation and most of the remaining body cells by up-regulating the antioxidant system. The hazard of ozone toxicity has been dispelled by using the gas only within a dose range perfectly calibrated against the potent blood antioxidant capability. Ozonetherapy can be very useful in patients with chronic vascular disorders and ischemic problems and should be extensively used by official medicine. An extraordinary facet of ozone is its medical application versatility, as represented by several administration routes, and the minimal cost of this drug.

Chronic vascular disorders of the upper extremity

This article details the presentation and evaluation of occlusive, vasospastic, and mixed vascular disorders. Indications and techniques of nonoperative management and surgical techniques of vascular reconstruction and periarterial sympathectomy are presented. Copyright © 2001 by the American Society for Surgery of the Hand

Vascular disorders of the hand: Therapist's commentary

T herapeu tic management of vascular disorders of the upper extremity complements medical and surgical care and includes evaluation, patient education, and treatment of symptoms associated with vascular insufficiency. This review focuses on the management of chronic vascular disorders by the hand therapist. Rehabilitative treatment of the acute vascular injury isbeyond the scope of this paper and is well defined elsewhere in the literature.

Quality of Life (QOL) in Chronic Vascular Disorders : Evaluation of a new self-completed questionnaire (QUIK)

Quality of Life (QOL) in Chronic Vascular Disorders : Evaluation of a new self-completed questionnaire (QUIK)

Effects of Pentoxifylline on Ca2+‐Dependent Transglutaminase in Rat Erythrocytes

We have examined the effects of pentoxifylline, a drug used to improve peripheral blood flow in patients with chronic vascular disorders, on shear-induced Ca2+ entry and Ca2+-dependent protein crosslinking in the erythrocyte. Cells were washed in isosmotic bicarbonate buffer, pH 7.5, and brought to a 20% suspension. 5 ml samples were sheared by swirling them for seconds; 45Ca2+ uptake, activation of Ca2+-dependent transglutaminase, and products of the crosslinking reaction were measured. A 5 second shear promoted 45Ca2+ entry, activation of Ca2+-dependent transglutaminase and crosslinking of proteins in the membrane-cytoskeletal fraction. Pentoxifylline, a drug that promotes erythrocyte deformability, diminished Ca2+ entry and inhibited activation of Ca2+-dependent transglutaminase, and had a prophylactic role on the effects of Ca2+ entry due to shear. Incubation of cells with 2.5 mM pentoxifylline before swirling minimized the effects of shear on 45Ca2+ entry, Ca2+-dependent transglutaminase and crosslinking of proteins. This study indicates that pentoxifylline promotes erythrocyte flexibility by minimizing shear-induced Ca2+ entry and Ca2+-dependent crosslinking.

Ascorbate status and fibrinogen concentrations after cerebrovascular accident.

Leucocyte ascorbate (LA) and serum ascorbate (SA) were measured in patients who had sustained an acute cerebrovascular accident. There was a significant fall in LA and Sa within 24 hours of the incident and this persisted for several weeks. The "stress" of the event resulted in a rise in serum cortisol concentration and depletion of both pituitary and adrenal glands of ascorbate when examined at post mortem. Serum fibrinogen concentrations also rose above normal. The role of ascorbate in pituitary and adrenal function and the relation of ascorbate to acute and chronic vascular disorders has still to be established.