Glutamatergic and dopaminergic contributions to rat bladder hyperactivity after cerebral artery occlusion.
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The contribution of glutamatergic and dopaminergic mechanisms to bladder hyperactivity after left middle cerebral artery occlusion was evaluated by determining the effects of intravenous cumulative doses of an N-methyl-D-aspartate (NMDA) glutamatergic antagonist (MK-801) and D1-selective (Sch-23390), D2-selective (sulpiride), or nonselective (haloperidol) dopaminergic antagonists on bladder activity in sham-operated (SO) and cerebral-infarcted (CI) rats. MK-801 (1 and 10 mg/kg) or sulpiride (3-30 mg/kg) significantly increased bladder capacity (BC) in CI but decreased or had no effect, respectively, on BC in SO. Sch-23390 (0.1-3 mg/kg) decreased BC in both SO and CI. In both CI and SO, low doses of haloperidol (0.1-1 mg/kg) increased BC, but a higher dose (3 mg/kg) reversed this effect. Administration of haloperidol (0.3 mg/kg) or sulpiride (10 mg/kg) in combination with MK-801 (0.01-10 mg/kg) markedly increased BC in CI but produced small decreases or increases in BC depending on the dose of MK-801 in SO. These results indicate that the bladder hyperactivity induced by cerebral infarction is mediated in part by NMDA glutamatergic and D2 dopaminergic excitatory mechanisms. (+info)
Incidence and importance of lower extremity nerve lesions after infrainguinal vascular surgical interventions.
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OBJECTIVES: To determine the incidence of peripheral nerve lesions after arterial vascular surgery of the lower extremity. MATERIALS AND METHODS: 436 patients who underwent peripheral vascular surgery from January 1992 until December 1996 underwent a detailed postoperative neurological examination. RESULTS: 147 patients underwent profundaplasty, 140 above-knee femoropopliteal bypasses, 106 below-knee femoropopliteal bypasses and 56 femorotibial bypasses. There were 182 women and 254 men. Peripheral nerve lesions were observed in 11 patients (4%) after primary operations. 166 patients underwent reoperations (38%) and 55 of these developed nerve lesions (33%). CONCLUSIONS: Reoperation carries an 8-fold increased risk of nerve lesions compared with patients undergoing primary surgery. Detailed explanation of the risk of peripheral nerve lesions before vascular surgery of the lower limb is advisable. (+info)
Sexual function in women suffering from aortoiliac occlusive disease.
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OBJECTIVE: To describe the sexual function in women suffering aortoiliac occlusive disease (AIOD) and in an age-matched reference group. PATIENTS AND METHODS: Thirty-six women suffering from AIOD were included. Twenty were investigated before vascular intervention (untreated) and 16 different women after treatment (treated). Eighteen age-matched women served as a reference group. The patients answered a questionnaire including sexual, social and medical questions and a gynaecological examination was performed. RESULTS: Untreated patients with AIOD have a significantly impaired physical well-being compared to the other groups (p < 0.001). A negative effect of the vascular disease and its treatment on sexual life was experienced by 69% of treated compared to 40% affected among untreated (p = 0.05). Vulval sensibility was impaired in 44% of treated, 11% of untreated and 22% of reference patients. Defective anal sphincter function was found in 33% of treated, 17% of untreated and 6% in the reference group. Those differences were not statistically significant. CONCLUSIONS: Symptomatic AIOD in women is associated with a significantly impaired physical and sexual well-being. Though limited by size and methodology, the results indicate the possibility of iatrogenic nerve damage. (+info)
Aortoiliac stenting, determinants of clinical outcome.
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OBJECTIVES: To determine predictors of clinical outcome in stenting aortoiliac disease. DESIGN: Prospective/retrospective study. MATERIALS AND METHODS: One hundred and forty patients (163 limbs) underwent iliac artery stenting in the period 1994-1997. Ninety-eight occlusions and 65 stenoses were treated, either with primary stenting (n = 129) or after failed angioplasty (n = 34). Median follow-up 18 months (1-66). Factors analysed for their effect on outcome were: gender, age, Fontaine stage, ABI, lesion type/length/site, primary or secondary stenting, stent type, BP, smoking, diabetes, aspirin, cholesterol, residual gradient, overhanging and run-off. RESULTS: The immediate success was 95%. The primary successful clinical outcome was 90% at 12 months and 84% at 36 months; the primary-assisted successful clinical outcome was 95% at 12 months and 91% at 36 months and the secondary successful clinical outcome was 92% at 12 months and 87% at 36 months. Adverse factors affecting outcome were: residual pressure gradient (> 10 mmHg) and no treatment with aspirin (p < 0.05). Major complications occurred in 18% of patients with a re-intervention in 8%. The 30-day mortality was 5.5%. CONCLUSIONS: Stenting for aortoiliac occlusive disease has good short and long term clinical success, with low morbidity and mortality. Factors that might improve results further are ensuring that patients are taking aspirin and any residual pressure gradient is abolished. (+info)
Relationship between smoking and cardiovascular risk factors in the development of peripheral arterial disease and coronary artery disease: Edinburgh Artery Study.
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AIMS: The aim was to determine whether the effect of smoking on the development of peripheral or coronary artery disease might be mediated by other cardiovascular risk factors, including dietary antioxidant vitamin intake, serum low and high density lipoproteins, blood pressure, plasma fibrinogen, blood viscosity and markers of endothelial disturbance and fibrin turnover. METHODS AND RESULTS: 1592 men and women aged 55-74 years were selected at random from 11 general practices in Edinburgh, Scotland and followed-up for 5 years. The incidences of peripheral arterial disease and coronary artery disease were 5.1% and 11.1%, respectively. Both conditions were more common in moderate and heavy smokers than in never smokers: cigarette smoking was a stronger risk factor for peripheral arterial disease than for coronary artery disease. Smoking was associated with reduced dietary antioxidant vitamin intake, serum high density lipoprotein cholesterol and diastolic blood pressure and with increased alcohol intake, serum triglycerides, blood viscosity, plasma fibrinogen, and markers of endothelial disturbance (tissue plasminogen activator and von Willebrand factor antigens). Simultaneous adjustment for these risk factors reduced the relative risk of peripheral arterial disease only slightly, from 3.94 (95% CI 2.04, 7.62) to 2.72 (95% CI 1.13, 6.53) in heavy smokers and from 1.87 (95% CI 0.91, 3.85) to 1.70 (95% CI 0.72, 3.99) in moderate smokers. Similar adjustment also had little effect on the risk of coronary artery disease associated with smoking. CONCLUSION: The combined effect of smoking on the cardiovascular risk factors studied may explain part of its influence on peripheral and coronary arterial disease, but the majority of the effect appears to be due to other mechanisms. (+info)
Compensatory mechanisms for chronic cerebral hypoperfusion in patients with carotid occlusion.
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BACKGROUND AND PURPOSE: The purpose of this experiment was to assess long-term cerebral hemodynamic and metabolic changes in patients with increased oxygen extraction fraction (OEF) in the hemisphere distal to an occluded carotid artery who remain free of stroke. Methods--Ten patients with increased OEF and no interval stroke underwent repeated positron emission tomography examinations 12 to 59 months after the initial examination. Quantitative regional measurements of cerebral blood flow, cerebral blood volume, cerebral rate of oxygen metabolism (CMRO2), and OEF were obtained. Regional measurements of the cerebral rate of glucose metabolism (CMRGlc) were made on follow-up in 5 patients. Statistical significance (P<0.05) was measured with t tests and linear regression analysis. RESULTS: The ipsilateral/contralateral OEF ratio declined from a mean of 1.16 to 1.08 (P=0.022). Greater reductions were seen with longer duration of follow-up (P=0.023, r=0.707). The cerebral blood flow ratio improved from 0.81 to 0.85 (P=0.021). No change in cerebral blood volume or CMRO2 was observed. CMRGlc was reduced in the ipsilateral hemisphere (P=0.001 compared with normal), but the CMRO2/CMRGlc ratio was normal. CONCLUSIONS: Increased OEF improves in patients with carotid occlusion and no interval stroke. This improvement in OEF is due to an improvement in collateral blood flow. (+info)
Lack of correlation between pattern of collateralization and misery perfusion in patients with carotid occlusion.
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BACKGROUND AND PURPOSE: Misery perfusion, identified by increased oxygen extraction fraction (OEF), predicts subsequent stroke in patients with carotid occlusion. The purpose of this investigation was to determine the relationship of angiographic findings to increased OEF in these patients. METHODS: Forty-seven patients with carotid occlusion were studied with cerebral angiography and positron emission tomography (PET). The following angiographic data were collected blind to PET results: (1) pial collateralization, defined as retrograde filling of the MCA branches to the level of the insula; (2) presence of border zone shift; (3) presence of delayed venous phase; and (4) measurement of posterior communicating artery size. Patients were divided into 2 groups based on the PET measurement of normal or increased OEF. RESULTS: Seventeen of 47 patients had increased OEF distal to the occluded carotid artery. No significant relationship between increased OEF and any angiographic finding was found. Pial collateralization was present in only 2 patients, both with increased OEF (P=0.105). Border zone shift was equally distributed between the 2 groups (12 of 30 with normal OEF and 6 of 15 with increased OEF). Delayed venous phase was present in 4 patients, 3 of whom had increased OEF (P=0.073). The relationship between the size of the posterior communicating artery and OEF was not significant by linear regression analysis (P=0.242). CONCLUSIONS: With the possible but infrequent exceptions of delayed venous phase and pial collateralization, anatomic findings made on routine angiographic studies of patients with carotid occlusion do not correlate with increased OEF. (+info)
Outcome of angioplasty for atherosclerotic intracranial stenosis.
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BACKGROUND AND PURPOSE: We sought to assess the long-term outcome and efficacy of percutaneous transluminal angioplasty in the treatment of symptomatic intracranial atherosclerotic stenoses. METHODS: Twenty-three patients with fixed symptomatic intracranial stenoses were treated over a 5-year period with percutaneous transluminal angioplasty. Patients who underwent successful angioplasty were followed up for 16 to 74 months (mean, 35.4 months). RESULTS: An angioplasty that resulted in decreased stenosis was performed in 21 of 23 patients (91.3%). In 1 case a stenosis could not be safely crossed, and in another balloon dilatation resulted in vessel rupture. This vessel rupture resulted in the 1 periprocedural death in the series. In follow-up there was 1 stroke in the same vascular territory as the angioplasty and 2 strokes in the series overall. This yielded an annual stroke rate of 3.2% for strokes in the territory appropriate to the site of angioplasty. CONCLUSIONS: Intracranial angioplasty can be performed with a high degree of technical success. The long-term clinical follow-up available in this series suggests that it may reduce the risk of future stroke in patients with symptomatic intracranial stenoses. (+info)