Low vaspin levels are related to endothelial dysfunction in patients with ankylosing spondylitis

Vaspin is a novel adipocytokine associated with glucose tolerance and chronic inflammation. Some studies reveal that vaspin may be involved in cardiovascular diseases. Our objective was to investigate the relationship between serum vaspin levels and endothelial function in patients with ankylosing spondylitis. One hundred and twenty patients with newly diagnosed ankylosing spondylitis and 100 healthy subjects were studied. Serum vaspin levels were measured with enzyme-linked immunosorbent assay. High resolution ultrasound was used to measure brachial artery diameter at rest, after reactive hyperemia (flow-mediated dilation, FMD) and after sublingual glyceryltrinitrate. Serum vaspin level in patients was 1.92±1.03 ng/mL, which was significantly lower than that in healthy subjects (2.88±0.81 ng/mL). By dividing the distribution of serum vaspin levels into quartiles, FMD levels increased gradually with the increase of serum vaspin levels in patients (P<0.01). Univariate analysis showed a correlation between vaspin and FMD (r=0.73, P=0.003), low-density lipoprotein cholesterol (r=-0.45, P=0.033), high-density lipoprotein cholesterol (r=0.63, P=0.025), fasting blood glucose (r=-0.79, P=0.006), triglycerides (TG) (r=-0.68, P=0.036), systolic blood pressure (r=-0.35, P=0.021), C-reactive protein (r=-0.67, P=0.011), homeostatic model assessment of insulin resistance (HOMA-IR) (r=-0.77, P=0.023) and erythrocyte sedimentation rate (r=-0.88, P=0.039) in patients. Multivariate analysis indicated that serum vaspin levels were independently associated with FMD, HOMA-IR and TG in patients. Our study found that serum vaspin levels were decreased in patients with ankylosing spondylitis and were associated with FMD levels. Vaspin may serve as an independent marker for detecting early stage atherosclerosis in patients with ankylosing spondylitis.

Assessment of endothelial function by flow-mediated dilation of the brachial artery in adolescents with a history of preeclampsia or a normotensive pregnancy / Avaliação da função endotelial através da dilatação mediada por fluxo da artéria braquial em adolescentes com história de pré-eclâmpsia ou de gestação normotensa

To determine the prevalence of endothelial dysfunction and its association with a history of mild and severe preeclampsia in adolescents. Methods: a cross-sectional study was carried out at the MEAC-UFC with 103 primiparous adolescents postpartum. The assessment of endothelial function was performed by way of flow-mediated dilatation of the brachial artery. Variables (age, body mass index, gestational age at delivery, systolic and diastolic blood pressure and flow-mediated dilation) were compared between groups. p<0.05 was considered to be statistically significant. Results: twenty-four (23.3 percent) patients had preeclampsia (PE): 11 mild and 13 severe. The overall prevalence of endothelial dysfunction was 23.3 percent (21.5 percent of patients with normotensive pregnancies and 29.2 percent of the PE patients: 18.2 percent of those with mild PE and 38.5 percent of those with severe PE). The figures were statistically significant for systolic blood pressure, p=0.007. Conclusions: patients with a history of PE have higher systolic blood pressure than patients with a history of normotensive pregnancy, but did not have more endothelial dysfunction...

Determinar a prevalência de disfunção endotelial e a associação com o antecedente de pré-eclâmpsia leve e grave em adolescentes. Métodos: estudo transversal conduzido na MEAC - UFC com 103 adolescentes primíparas no pós-parto. A avaliação da função endotelial foi realizada pela dilatação mediada por fluxo da artéria braquial. As variáveis (idade, índice de massa corporal, idade gestacional no parto, pressão arterial sistólica e diastólica e dilatação mediada por fluxo) foram comparadas entre os grupos. Considerou-se p<0,05 significância estatística. Resultados: vinte e quarto (23,3 por cento) pacientes tiveram pré-eclâmpsia (PE): 11 PE leve e 13 PE grave. A prevalência geral de disfunção endotelial foi de 23,3 por cento (21,5 por cento das pacientes com gestações normotensas e 29,2 por cento das PE: 18,2 por cento daquelas com PE leve e 38,5 por cento daquelas com PE grave). Houve significância estatística para pressão arterial sistólica, p=0,007. Conclusões: pacientes com história de PE apresentam pressão sistólica maior que pacientes com antecedente de gestação normotensa, mas não houve mais disfunção endotelial...

Pseudoaneurysm of the brachial artery in a four-month-old boy: diagnosis and treatment

Pseudoaneurysms arise from a disruption in the arterial wall and blood dissecting into the tissues around the damaged artery creating a perfused sac that communicates with the arterial lumen. Trauma to the wall of the artery may lead to the development of a pseudoaneurysm. Post-traumatic pseudoaneurysm development is very rare in the peripheral artery and often is a consequence of venipuncture. We have reported the case of the four-month-old boy who developed a pseudoaneurysm following an accidental arterial puncture. In the antecubital area we noticed a pulsative mass and palpable thrill. The patient underwent a Doppler ultrasound examination and CT with contrast. Surgery was indicated. Following excision of the pseudoaneurysm, an end-to-end anastomosis was performed. Follow-up for four years revealed palpable peripheral pulsation at the wrist level. In the postoperative period, all ultrasound findings were normal. End-to-end anastomosis is preferable if it can be performed without tension or damage to the major collateral vessels

Ácidos grasos omega 3 en la dilatación mediada por flujo de la arteria braquial en individuos con disfunción endotelial / Omega 3 fatty acids in flow-mediated dilation of the brachial artery in patients with endothelial dysfunction

Las enfermedades cardiovasculares son la principal causa de muerte en Venezuela. La disfunción endotelial (DE) puede ser medida con la dilatación mediada por flujo de la arteria braquial (DMFAB). Se ha afirmado que los ácidos grasos omega 3 ayudan a regular la disfunción endotelial. Establecer la relación existente entre los ácidos grados omega 3 y la disfunción endotelial, al administrar 1 gramo al día por 2 semanas y evaluar la variación en la prueba de dilatación mediada por flujo de la arteria braquial. 25 individuos con prueba positiva para disfunción endotelial al tener DMFAB menor al 10%. Los pacientes recibieron ácidos grasos omega 3 a dosis de 1000 mg diario por dos semanas y se repitió la prueba. Se midieron los niveles séricos de fibrinógeno, proteína C reactiva (PCR) y ácido úrico entre otros, antes y después del tratamiento. El porcentaje de dilatación en la prueba de DMFAB, aumentó posterior al tratamiento con ácidos grasos omega 3. De igual forma los niveles séricos de PCR, fibrinógeno y ácido úrico disminuyeron posterior al tratamiento. Los suplementos de ácidos grasos omega 3 a razón de 1000 mg diario por 2 semanas mejoran la disfunción endotelial en pacientes con factores de riesgo cardiovascular. A su vez, los marcadores serológicos disminuyen con la administración de ácidos grasos omega 3...

Cardiovascular diseases are the leading cause of death in Venezuela. When there is an Endothelial dysfunction (ED) can be measured with flow-mediated dilatation of the brachial artery (DMFAB). Omega 3 fatty acids have been associated with the regulation of this entity. 25 subjects with positive test for endothelial dysfunction measured by DMFAB of less than 10%. The patients were given omega-3 fatty acids 1000 mg daily for two weeks. Serum tests performed were fibrinogen, CRP and uric acid among others, before and after treatment. The rate of expansion by DMFAB test increased after treatment with omega-3 fatty acids. Similarly serum levels of CRP, fibrinogen and uric acid decreased after treatment. Omega 3 fatty acids at a rate of 1000 mg daily for 2 weeks improved endothelial dysfunction in patients with CRF. Serological markers decrease with the administration of omega 3 fatty acids to the mentioned dose...

Obesidade e alteração da estrutura arterial em mulheres jovens com síndrome dos ovários micropolicísticos / Obesity and altered arterial structure in young women with micropolycystic ovary syndrome

OBJETIVO: comparar os fatores ecográficos de risco cardiovascular em pacientes obesas e não obesas, com síndrome dos ovários micropolicísticos (SOMP). MÉTODOS: foram incluídas 30 pacientes obesas com SOMP (Índice de massa corporal, IMC>30 kg/m²) e 60 não obesas (IMC<30 kg/m²), com idade entre 18 e 35 anos neste estudo transversal. Foram avaliados: a dilatação mediada por fluxo (DMF) da artéria braquial, espessura íntima-média da artéria carótida (IMT), o índice de rigidez da artéria carótida (β), as medidas antropométricas, pressão sanguínea sistólica (PAS) e diastólica (PAD). As mulheres estavam sem nenhum tratamento prévio e nenhuma delas apresentava qualquer comorbidade (além da SOMP e/ou da obesidade).Na análise estatística, foram utilizados os testes t não-pareado ou de Mann-Whitney. RESULTADOS: as pacientes obesas com SOMP apresentaram maior peso em relação às não obesas (92,1±11,7 kg versus 61,4±10,7 kg, p<0,0001), bem como a medida da cintura que também, foi mais elevada nas pacientes obesas (105,0±10,4 cm versus 78,5±9,8 cm, p<0,0001). A PAS das pacientes obesas foi superior quando comparadas às não obesas (126,1±10,9 mmHg versus 115,8±9,0 mmHg, p<0,0001) e a IMT também foi maior nas obesas (0,51±0,07 mm versus 0,44±0,09 mm, p<0,0001). Não houve diferença entre os grupos quanto à dilatação mediada por fluxo (DMF) da artéria braquial ou ao índice de rigidez da artéria carótida (β). CONCLUSÕES: a obesidade em portadoras jovens de SOMP está associada a níveis pressóricos mais elevados e à alteração da estrutura arterial, representada pela maior espessura íntima-média da artéria carótida.

PURPOSE: to compare echographical cardiovascular risk factors between obese and non-obese patients with micropolycystic ovarian syndrome (MPOS). METHODS: in this transversal study, 30 obese (Body Mass Index, BMI>30 kg/m²) and 60 non-obese (BMI<30 kg/m²) MPOS patients, aging between 18 and 35 years old, were included. The following variables were measured: flow-mediated dilatation (FMD) of the brachial artery, thickness of the intima-media of the carotid artery (IMT), anthropometric data, systolic arterial pressure (SAP) and diastolic arterial pressure (DAP). The women had no previous medical treatment and no comorbidity besides MPOS and obesity. For statistical analysis, the non-paired tand Mann-Whitney's tests were used. RESULTS: obese weighted more than non-obese patients (92.1±11.7 kg versus 61.4±10.7 kg, p<0.0001) and had a larger waist circumference (105.0±10.4 cm versus 78.5±9.8 cm, p<0.0001). The SBP of obese patients was higher than that of the non-obese ones (126.1±10.9 mmHg versus 115.8±9.0 mmHg, p<0.0001) and the IMT was also bigger (0.51±0.07 mm versus 0.44±0.09 mm, p<0.0001). There was no significant difference between the groups as to FMD and carotid rigidity index (β). CONCLUSIONS: obesity in young women with MPOS is associated with higher blood pressure and alteration of arterial structure, represented by a thicker intima-media of the carotid artery.

Normal flow-mediated vasodilatation of the brachial artery and carotid artery intima-media thickness in subclinical hypothyroidism

Subclinical hypothyroidism (SHT) is a disease for which exact therapeutic approaches have not yet been established. Previous studies have suggested an association between SHT and coronary heart disease. Whether this association is related to SHT-induced changes in serum lipid levels or to endothelial dysfunction is unclear. The aim of this study was to determine endothelial function measured by the flow-mediated vasodilatation of the brachial artery and the carotid artery intima-media thickness (IMT) in a group of women with SHT compared with euthyroid subjects. Triglycerides, total cholesterol, HDL-C, LDL-C, apoprotein A (apo A), apo B, and lipoprotein(a) were also determined. Twenty-one patients with SHT (mean age: 42.4 ± 10.8 years and mean thyroid-stimulating hormone (TSH) levels: 8.2 ± 2.7 µIU/mL) and 21 euthyroid controls matched for body mass index, age and atherosclerotic risk factors (mean age: 44.2 ± 8.5 years and mean TSH levels: 1.4 ± 0.6 µIU/mL) participated in the study. Lipid parameters (except HDL-C and apo A, which were lower) and IMT values were higher in the common carotid and carotid bifurcation of SHT patients with positive serum thyroid peroxidase antibodies (TPO-Ab) (0.62 ± 0.2 and 0.62 ± 0.16 mm for the common carotid and carotid bifurcation, respectively) when compared with the negative TPO-Ab group (0.55 ± 0.24 and 0.58 ± 0.13 mm, for common carotid and carotid bifurcation, respectively). The difference was not statistically significant. We conclude that minimal thyroid dysfunction had no adverse effects on endothelial function in the population studied. Further investigation is warranted to assess whether subclinical hypothyroidism, with and without TPO-Ab-positive serology, has any effect on endothelial function.

Un año de experiencia en colgajos perforantes / One year of experience in perforator flap

El avance de la cirugía reconstructiva y especialmente de la microcirugía, nacida hace solamente tres décadas, ha sido exponencial. Hoy no sólo se busca cubrir defectos sin complicaciones vasculares, sino que el nuevo desafío es tratar de recuperar función y estética y, al mismo tiempo, conseguir la mínima morbilidad en el sitio donante. El mejor ejemplo de este desarrollo son los colgajos perforantes. Un colgajo perforante es un colgajo fascio cutáneo pediculizado únicamente por sus vasos perforantes. Su confiabilidad ha sido puesta en duda durante la última década por múltiples publicaciones que los catalogan como difíciles de realizar por el tamaño de los vasos así como por su errática anatomía. Este mito ha caído principalmente a punto de partida de publicaciones orientales y una mayor experiencia en occidente. Actualmente, el índice de supervivencia casi alcanza el 98 % debido al refinamiento de las técnicas y los instrumentos...La intención de este trabajo es mostrar nuestra experiencia en la utilización de estos colgajos, habiéndolos utilizado en una variedad de defectos tanto en reconstrucción de cabeza y cuello como de partes blandas. En el último año se han realizado en nuestra institución un total de 16 colgajos perforantes, entre ellos el más común fue el ALT (antero lateral thigh) y con menor frecuencia el DIEP (deep inferior epigastric artery perforator flap), el TAP (thoraco dorsal artery perforator flap) y el TFLP (tensor fascia lata perforator flap). La tasa de éxito fue del 94 %, con mínima morbilidad en la zona dadora.

The avance of reconstructive surgery and specially of microsurgery, born only three decades ago has been exponential. Today we not only try to cover defects without vascular complications but we try to recover function and aesthetics with minimal door site morbidity. The best example of this development have been perforator flaps. A perforator flap is fascio cutaneos flap only vascularized by it's perforators. Their viability has been doubtged because of multiple publications that catalog then as dificult to perform because of the small pedicles and their erratic anatomy. This myth has fallen mainly because of asiatic publications and more experience in western countries. Today the succes rate reaches 98 %. The intention of this paper is to show our experience performing this kind of flaps, in a variety of defects. During the past year we have perfomed at our institution a total of 16 perforator flaps, among them the most common was the ALT (antero lateral thigh) and with less frecuency DIEP (deep inferior epigastric artery perforator flap), the TAP (thoraco dorsal artery perforator flap) and the TFLP (tensor fascia lata perforator flap). The succes rate was of 94 % with minimal donor site morbidity.

The superficial ulnar artery: development and clinical significance

The principal arteries of the upper limb show a wide range of variation that is of considerable interest to orthopedic surgeons, plastic surgeons, radiologists and anatomists. We present here a case of superficial ulnar artery found during the routine dissection of right upper limb of a 50-year-old male cadaver. The superficial ulnar artery originated from the brachial artery, crossed the median nerve anteriorly and ran lateral to this nerve and the brachial artery. The superficial ulnar artery in the arm gave rise to a narrow muscular branch to the biceps brachii. At the elbow level the artery ran superficial to the bicipital aponeurosis where it was crossed by the median cubital vein. It then ran downward and medially superficial to the forearm flexor muscles, and then downward to enter the hand. At the palm, it formed the superficial and deep palmar arches together with the branches of the radial artery. The presence of a superficial ulnar artery is clinically important when raising forearm flaps in reconstructive surgery. The embryology and clinical significance of the variation are discussed.

As principais artérias do membro superior apresentam uma ampla variação, que é relativamente importante a cirurgiões ortopédicos e plásticos, radiologistas e anatomistas.Apresentamosumcaso de artéria ulnar superficial encontrada durante dissecção de rotina de membro superior direito de um cadáver masculino de 50 anos de idade.Aartéria ulnar superficial originava-se da artéria braquial, cruzava o nervo mediano anteriormente e percorria lateralmente esse nervo e a artéria braquial. A artéria ulnar superficial no braço deu origem a um ramo muscular estreito do músculo bíceps braquial. Ao nível do cotovelo, a artéria percorria superficialmente a aponeurose bicipital, onde era cruzada pela veia cubital mediana. Percorria, então, em sentido descendente e medialmente superficial aos músculos flexores do antebraço, e então descendia para entrar na mão. Na palma, essa artéria formava os arcos palmares superficial e profundo junto com os ramos da artéria radial.Apresença de uma artéria ulnar superficial é clinicamente importante ao levantar retalhos do antebraço em cirurgias reconstrutivas.Aembriologia e relevância clínica da variação são discutidas.

Avaliação da função endotelial pela reatividade braquial em pacientes com cardiopatia isquêmica documentada, antes e após a utilização de suplementos vitamínicos / Evaluation of endothelial function by braquial reactivity in patients with documented ischemic heart disease, before and after using vitamin supplements

Introdução: Várias drogas e substâncias vêm sendo testadas visando melhorar a função endotelial, porém a utilização de suplementos vitamínicos em pacientes portadores de doença ateromatosa ainda é controversa, Método: Para avaliar a resposta da função endotelial antes e após a utilização de suplementos vitamínicos (vitaminas C,E e C mais E)foi utilizada a técnica de reatividade braquial em 21 pacientes com doença ateromatosa coronariana documentada pela cinecoronariografia. Foram comparados os percentuais de dilatação da artéria braquial antes e após a a utilização dos suplementos vitamínicos. Resultados: Após a utilização da E, o percentual de dilatação da artéria elevou-se de 8,24 por cento para 9,48 por cento (variação de 1,23 por cento), após a utilização da vitamina C, o percentual de dilatação elevou-se de 8,24 por cento para 10,29 por cento(variação de 2,05 por cento) e após a utilização de vitamina E associada a vitamina C, o percentual de dilatação elevou-se de 8,24 por cento para 10,81 por cento (variação de 2,57 por cento). Conclusão A vitamina C administrada na forma isolada ou em associação com a vitamina E, promoveu a melhora da função endotelial avaliada pela técnica da reatividade braquial pelo ultra-som

Non-invasive assessment of arterial stiffness by pulse-wave velocity correlates with endothelial dysfunction.

BACKGROUND: Pulse-wave velocity is the speed of the blood pressure wave to travel a given distance between two sites of the arterial system and is determined by the elasticity, wall thickness and blood density. Pulse-wave velocity correlates well with arterial distensibility and stiffness and is a useful non-invasive index to assess arteriosclerosis. Arterial endothelial dysfunction is one of the key early events in atherogenesis, preceding structural atherosclerotic changes. This study sought to establish the correlation of non-invasive estimation of arterial wall stiffness by pulse-wave velocity and its association with endothelial dysfunction in subjects at higher risk for atherosclerosis. METHODS AND RESULTS: A total of 102 subjects (60 males and 42 females, mean age 51 years), including those with hypertension (n = 39), type 2 diabetes mellitus (n = 26), concomitant type 2 diabetes mellitus and hypertension (n = 29) and primary dyslipidemia without diabetes mellitus and hypertension (n = 8). Pulse-wave velocity was measured by the Vascular Profiler 1000 (VP-1000) waveform analysis and vascular evaluation system, an automated, non-invasive, screening device. Endothelial function was assessed by flow-mediated dilation of the brachial artery. The brachial-artery diameter was measured on B-mode ultrasound images, with the use of a 7.0 MHz linear-array transducer. Mean brachial artery pulse-wave velocity on the right extremity was 1699 cm/s and on the left 1694 cm/s. Mean flow-mediated dilation in the study subjects was 3.6 +/- 8.4%. Mean brachial artery pulse-wave velocity in the right and left extremities and the higher value of brachial artery pulse-wave velocity of the two extremities showed a negative and significant correlation with flow-mediated dilation of the brachial artery (correlation coefficient r = -0.32, p = 0.001; r = -0.40 p < 0.0001; r = -0.37, p = 0.001, respectively). Mean heart-brachial pulse-wave velocity also showed a negative and significant correlation with flow-mediated dilation of the brachial artery (r = -0.23, p = 0.022). Mean arterial stiffness was 36.2 +/- 22%. Arterial stiffness in the right extremity and the higher value of the two extremities showed a negative and significant correlation with flow-mediated dilation of the brachial artery (correlation coefficient r = -0.31, p = 0.002; r = -0.32, p = 0.001, respectively). CONCLUSIONS: Increased values of pulse-wave velocity reflecting upon arterial stiffness show an excellent correlation with reduced values of brachial artery flow-mediated dilation. We propose that the non-invasive modalities of estimation of the pulse-wave velocity and endothelial function estimation by flow-mediated dilation of brachial artery be used in clinical practice in assessment of pre-clinical atherosclerosis.

Pseudoaneurysm of brachial artery complicating closed fracture of humerus with triple nerve palsy

Pseudoaneurysm of brachial artery after blunt trauma is quite rare. We report a patient with pseudoaneurysm of brachial artery complicating closed fracture of the humerus with triple nerve palsy [median, ulnar and radial]. This is the first ever reported case involving all the three nerves. A disabled 58 years old female patient, who was wheel chair- bound, fell and suffered a closed mid shaft fracture of the left humerus. She was initially managed with a collar and cuff that was changed after one week to a POP back slab. At five weeks post-injury, radiographs revealed further displacement of the fracture and the back slab was changed to hanging POP cast. No neurovascular deficit was noted at this time. Two weeks later, the patient complained of decrease sensation over the dorsum of hand and reduced wrist extension. On review three weeks later i.e. 11 weeks after the injury, examination revealed a continued hematoma at fracture site, a radial nerve palsy and decreased sensation over the ring and little fingers but no vascular deficit. She was referred for nerve conduction studies and two weeks later dusky discoloration with signs of increasing paralysis in the hand prompted removal of cast. Examination revealed a 15 x 20 cm non-pulsatile mass on the antero-lateral aspect of the arm with no demonstrable bruit or thrill. Neither the radial nor ulnar arterial pulses were palpable and there appeared to be a complete palsy of the radial, median and ulnar nerves. The patient was taken to the operating theatre for exploration and internal fixation. An antero-lateral incision made was extended proximally and distally. A large hematoma was evacuated [fist size cavity]. A posterior defect in the brachial artery was found to communicate with the hematoma [a pseudoaneurysm]. Deep dissection revealed compression of the median and ulnar nerves. The distal humerus fragment appeared to be compromising the radial nerve. All nerves were in good condition. The humerus fracture was fixed with an AO plate. A cephalic vein graft was used to repair the brachial artery after excision of the damaged segment. At the end of the operation the hand color restored with weak radial and ulnar pulse. Postoperative recovery was uneventful and the patient was discharged 10 days after surgery. Postoperative physiotherapy was arranged and wrist splint provided. At 9 months follow-up both radial and ulnar pulses were palpable. Nerve conduction study shows recovery on a steady improvement curve. The patient is still using a splint and will require more physiotherapy input