Prevalence of coronary artery disease in patients with symptomatic peripheral vascular disease.

BACKGROUND: Prevalence of coronary artery disease has been reported to be quite high in patients with peripheral vascular disease in western literature. Therefore, it is important to study the coronary anatomy in patients with symptomatic peripheral vascular disease. METHODS AND RESULTS: Fifty-three patients presenting with symptoms of peripheral vascular disease underwent peripheral angiography in our institute during the last 2 years. The total number of vessels involved in these patients was 117. Fifteen patients had involvement of the upper limb vessels, 46 patients had involvement of the lower limb vessels and 6 patients had involvement of the carotid/vertebral arteries. Coronary arteriography was done in all the patients. Only 8 (15%) patients were found to have coronary artery disease with involvement of 11 arteries. Eighty-four (72%) peripheral vessels out of the 117 vessels involved showed total occlusion, whereas only 2 (18%) coronary arteries out of 11 vessels involved showed total occlusion. CONCLUSIONS: This study shows that the majority of patients with symptomatic peripheral vascular disease have normal coronaries, the extent of their involvement being low despite severe peripheral vascular disease.

Successful post-cardiopulmonary resuscitation urokinase therapy for massive perioperative pulmonary embolism - a case report.

We report a case of hip arthroplasty done under epidural and general anaesthesia. The patient had two episodes of acute massive pulmonary embolism perioperatively. He received cardiopulmonary resuscitation for the cardiovascular collapse that ensued and was administered a single dose of urokinase inspite of having relative (major) contraindications to the same.

Nutrient interaction in relation to glycaemic and insulinaemic response.

Although it is known that protein, fat and fibre reduce the postprandial glycaemia following an oral carbohydrate load, the nature and extent of interaction of different nutrients with one another in this respect is not well understood. The present study was designed to explore systematically the glycaemic and insulinaemic response to glucose (G) alone, or in combination with one or more of the following: casein (CS), maize oil (MO), cellulose (CL) and pectin (P). Besides 100 g G, eleven isoenergetic and six isocarbohydrate meals were studied on healthy adult males using an incomplete block design. Addition of other nutrients to G led to a lowering of the glycaemic response. The lowest glycaemic responses were seen in case of meals containing the largest number of nutrients. P was more effective in reducing postprandial glycaemia than CL. As in case of glycaemic response, low insulinaemic responses were also associated with P-containing meals, and meals containing the largest number of nutrients. But unlike in case of glycaemic response, there was a tendency for elevation of the insulinaemic response in case of CL-containing meals. The degree of attenuation of glycaemic response observed with meals containing several nutrients was roughly predictable on the basis of the attenuation observed with meals in which only one nutrient had been added at a time to G. But the glycaemic response of natural foods is unlikely to be predictable on the basis of their nutrient composition because of the overriding influence of several other factors such as physical form, cooking, processing, storage and antinutrient content of the food.

Modulation of postprandial glycaemia and insulinaemia by dietary fat.

The present study was designed to examine the effect of corn oil (Co) on postprandial glycaemia and insulinaemia when ingested with glucose (G), casein (Cs), cellulose (Cl) and pectin (P) in various combinations. The study was conducted on six healthy male volunteers, on each of whom six meal tolerance tests were performed. The meals were isocaloric and consisted of G; G and Co; G, Co and Cs; G, Co and P; G, Co, Cs and P; and G, Co, Cs and Cl. The meals were administered after an overnight fast. In addition to a fasting blood sample, blood was collected 0.5, 1.0, 1.5 and 2.0 h after ingestion for measurement of serum glucose and insulin levels. The glycaemic response to GCo was comparable to that to G, but the insulinaemic response was significantly lower. The glycaemic response to GCoCs was significantly lower than that to G but the insulinaemic response to both was comparable. The cellulose containing meal GCoCsCl showed a further reduction in the glycaemic response but not in the insulinaemic response. The pectin containing meals GCoP and GCoCsP gave the lowest glycaemic and insulinaemic responses, the responses to the latter being lower. Corn oil by itself has only a modest effect on the postprandial metabolic response to glucose. Addition of protein and fibre, specially pectin, leads to significant attenuation of glycaemic and insulinaemic responses.

Nutrient interaction in relation to glycaemic response in isocarbohydrate and isocaloric meals.

The present study was designed to examine the effect of casein (Cs) on postprandial glycaemia when ingested with glucose (G) alone or in combination with corn oil (Co), cellulose (Cl) or pectin (P). The study was conducted on a pool of ten healthy male volunteers in two sets of five volunteers each. The meals administered in the two sets were similar in composition but were isocarbohydrate (100 g G) in one set, and isocaloric (400 kcal) in another set. The meals in each set consisted of G, G Cs, G Cs Co, G Cs Cl and G Cs P. Each of the five volunteers in a given set underwent five meal tolerance tests (MTT), once with each meal, in a Latin Square design. During the MTT, the meal was administered after an overnight fast. In addition to a fasting venous blood sample, blood was collected 0.5, 1.0, 1.5 and 2.0 h after ingestion for measurement of serum glucose and insulin levels. In both sets, the highest glycaemic response was that to G. In the isocarbohydrate set, G Cs gave a significantly lower glycaemic and insulinaemic response than G. Further addition of Co made no essential difference but both the fibre containing meals gave significantly lower glycaemic responses. The insulinaemic response was attenuated only in case of G Cs P but not in case of G Cs Cl. In the isocaloric set, Cs as G Cs was observed to stimulate insulin secretion rather than attenuate postprandial glycaemia G Cs Co gave a reduction in glycaemic as well as insulinaemic response as compared to G. Both fibre containing meals led to further reduction in both responses, P being somewhat more effective than Cl. Addition of other nutrients to G, in general, reduces postprandial glycaemia.

Induction of lactation in cattle with estradiol 17-beta and progesterone primed with progesterone.

Five parous non-pregnant, non-lactating cows were injected (sc) with progesterone (50 mg/day for 7 consecutive days) followed by estradiol (0.1 mg) plus progesterone (0.25 mg) per kg body wt/day on day 12 to 14 and with reserpine / 2 mg twice a day on day 19 to 22. All the 5 cows were successfully induced into lactation. Animals exhibiting estrus following hormonal therapy were artificially inseminated and one cow became pregnant and exhibited normal parturition. Jugular blood collected was used for estimation of progesterone by RIA technique and considerable individual variation was observed in progesterone concentration.

Modulation of postprandial glycaemia and insulinaemia by pectin in mixed nutrient combinations.

The present study was designed to examine the effect of pectin (P) on postprandial glycaemia and insulinaemia when ingested with glucose (G), casein (Cs) and corn oil (Co) in various combinations. The study was conducted on five healthy male volunteers, on each of whom five meal tolerance tests were performed. The meals were isocaloric and consisted of G; G and P; G, Cs and P; G, Co and P; and G, Cs, Co and P. The meals were administered after an overnight fast. In addition to a fasting blood sample, blood was collected 0.5, 1.0, 1.5 and 2.0 h after ingestion for measurement of serum glucose and insulin levels. The glycaemic and insulinaemic response to GP did not differ significantly from that to G. All the other meals, viz. GCsP, GCoP and GCsCoP, gave a significant reduction in postprandial glycaemia as compared to G. The corn oil containing meals, viz. GCoP and GCsCoP, in addition, gave a significant reduction in postprandial insulinaemia as compared to G. Pectin alone is not a dependable dietary constituent for reducing postprandial glycaemia. Its combination with protein and fat significantly lowers the postprandial glycaemic as well as insulinaemic response to orally administered glucose.

Relationship of examination stress to serum lipid profile.

Although mental stress as well as hypercholesterolaemia have been individually linked with atherosclerosis, the relationship between mental stress and hypercholesterolaemia is poorly understood. Serum lipid profile was studied in eight male medical student volunteers before, near and after examinations. Identical observations were also made on seven well-matched control volunteers. As compared to pre-exam levels, total serum cholesterol (T-C) increased significantly (P less than 0.05) near exams, and so did low density lipoprotein cholesterol (LDL-C) and high density lipoprotein cholesterol (HDL-C). The HDL-C/T-C and HDL-C/LDL-C ratios remained essentially constant throughout the study. Control subjects did not show any significant change in serum lipid profile. Further serial measurement in five of the subjects revealed that examination-related changes were transient. Moreover, a second examination after about 40 days did not evoke any change in the lipid profile. The response to examination stress may be related to the enhanced utilisation of cholesterol in the adrenal cortex for steroidogenesis.

Effect of sieved buckwheat (Fagopyrum esculentum) flour supplementation on lipid profile and glucose tolerance.

Buckwheat (Fagopyrum esculentum) was picked up for a study of its effects on lipid profile and glucose tolerance in view of its relatively high fibre content. In earlier studies, we demonstrated that supplementing the daily diet with 100 g whole buckwheat flour raised the high density lipoprotein cholesterol (HDL-C)/cholesterol ratio and improved glucose tolerance. In the present study, 12 human volunteers replaced part of their cereal intake at lunch by a preparation made from 100 g sieved buckwheat flour for a period of 4 weeks. At the end of 4 wk, there was a significant rise in HDL-C from 42.8 +/- 11.4 mg/100 ml to 55.2 +/- 15.3 mg/100 ml (P less than 0.05), and in HDL-C/cholesterol ratio from 26.7 +/- 7.0% to 33.8 +/- 10.2% (P less than 0.02): The other changes in lipid profile were not significant. There was also no significant change in fasting blood glucose or oral glucose tolerance in the 5 subjects on whom the test was done. Comparing the results with the observations made earlier on whole buckwheat, it is still not possible to say to what extent the effects of buckwheat on lipids may be attributed to its fibre content. The effects on glucose tolerance, on the other hand, seem to be more directly related to the fibre content.