Hyperhomocysteinemia modulates VEGF plasma levels and its expression in leucocytes in healthy subjects and in patients with peripheral arterial disease and diabetes mellitus

Aim: both homocysteine and vascular endothelial growth factor [VEGF] are implicated in development and progression of atherothrombotic vascular disease. We sought to determine whether there is a relationship between homocysteine and VEGF in healthy individuals and in patients with peripheral arterial disease [PAD] or diabetes mellitus [DM]

Methods: measurements of plasma homocysteine and VEGF and expression of VEGF in leucocytes were performed before and after intervention. Twelve healthy individual were evaluated before and 4h after methionine loading, whereas 10 patients with PAD and 15 patients with DM were evaluated before and 6 weeks after oral administration of B vitamins and folate

Results: basal homocysteine was elevated in patients with PAD and DM [21. 5 +/- 9 and 19.9 +/ l micro mol/l, respectively]. Methionine resulted in significant elevation, while B vitamins resulted in significant reduction of homocysteine and VEGF and there was a significant correlation between homocysteine and VEGF changes [r = 0.73, p < 0.01]. Moreover, VEGF mRNA expression in leucocytes was upregulated after methionine loading and was downregulated after B vitamins and folate treatment

Conclusion: these findings demonstrate that B vitamins and folate can successfully lower plasma homocysteine and VEGF expression in leucocytes in patients with PAD and DM

Perioperative interventions enhances survival and liver regeneration following extensive portal branch ligation of rabbit liver

Aim: the purpose of this study was to evaluate the effect of pharmacologic interventions in preventing liver injury, enhancing liver regeneration and prolonging survival following portal vein ligation to 80% of the liver parenchyma

Methods: rabbits underwent ligation of the portal vein branches to 80% liver parenchyma. One group of animals served as a control. The other group received pharmacologic interventions. Interventions consisted of postoperative oral 20% glucose supplementation to prevent postoperative hypoglycemia, perioperative low-molecular-weight heparin to prevent intrasinusoidal thrombosis and oral antibiotic to prevent bacterial translocation with their injurious effect on liver remnant and hepatocyte proliferation. Outcome measurements included serum liver function tests, glucose levels, and histological assessment of hepatocyte necrosis, apoptosis, mitosis and intrasinusoidal fibrin deposition and length of postoperative survival

Results: interventions improved survival in the treated group [1.07 +/- 0.07 days versus 0.71 +/- 0.1 days]. Hepatocyte necrosis [31.1 +/- 0.02 versus 51.5 +/- 0.02], apoptosis [30.4 +/- 0.02 versus 40.7 +/- 0.03] and intrasinusoidal fibrin deposition [5.6 +/- 0.8 versus 8.7 +/- 1.0] were significantly decreased and mitotic figures [29.1 +/- 2.7 versus 15.7 +/- 1.2] significantly increased in the treated group compared to control group. Biochemical markers of hepatocyte injury were not different among groups

Conclusion: pharmacologic interventions improve survival and histological evidence of remnant liver regeneration in animals subjected to portal branch ligation to 80% of rabbit liver

Endovascular treatment of infra-aortic atherosclerotic arterial disease

Endovascular therapy has an important and definitive role for patients with critical limb ischemia. It easily revascularizes inflow and outflow lesions with minimal morbidity and mortality. One hundred and thirteen patients with critical limb ischemia underwent endovascular procedures either alone or combined with surgical bypass [n=29] with no procedure-related mortality. All patients had angioplasty while 8 of 12 patients with aortic bifurcation disease, 22 of 28 with iliac disease, and 28 of 44 with femoropopliteal disease had stent placement as well. Initial success rates were 100% for the aortic bifurcation group, 96.3% for the iliac group, and 90.7% for the femoropopliteal group. Two-year patency rates were 83.3% for the aortic bifurcation group, 85.2% for the iliac group, and 72.1% for the femoropopliteal group. Twenty nine patients underwent simultaneous iliac endovascular and infrainguinal bypass procedures. This group included 21 angioplasty of the common iliac artery with stent placement in 16 patients and 8 angioplasties of the external iliac artery with stent placement in 4. Pemoropopliteal bypass was performed in 18 patients using vein grafts in 14 patients and synthetic polytetrafluoroethylene grafts in 4 patients. Femorotibial bypass was performed in 11 patients using vein grafts. The initial success rate for this simultaneous endovascular and surgical bypass was 93.1% and the 2-year patency rate was 75.9%. Our results demonstrate that endovascular therapy is a low-risk procedure with satisfactory initial and 2-year success rates