ABSTRACT
AIMS: The deleterious nature of peripheral arterial disease (PAD) is compounded by a status of underdiagnosed and undertreated disease. We evaluated the prevalence and predictive factors of PAD in high-risk patients using the ankle-brachial index (ABI). METHODS: The ABI was measured by general practitioners in France (May 2005-February 2006) in 5679 adults aged 55 years or older and considered at high risk. The primary outcome was prevalence of PAD (ABI strictly below 0.90). RESULTS: In all, 21.3% patients had signs or symptoms suggestive of PAD, 42.1% had previous history of atherothrombotic disease and 36.6% had two or more cardiovascular risk factors. Prevalence of PAD was 27.8% overall, ranging from 10.4% in patients with cardiovascular risk factors only to approximately 38% in each other subgroup. Prevalence differed depending on the localization of atherothrombotic events: it was 57.1-75.0% in patients with past history of symptomatic PAD; 24.6-31.1% in those who had experienced cerebrovascular and/or coronary events. Regarding the classical cardiovascular risk factors, PAD was more frequent when smoking and hypercholesterolemia history were reported. PAD prevalence was also higher in patients with history of abdominal aortic aneurysm, renal hypertension or atherothrombotic event. Intermittent claudication, lack of one pulse in the lower limbs, smoking, diabetes and renovascular hypertension were the main factors predictive of low ABI. CONCLUSIONS: Given the elevated prevalence of PAD in high-risk patients and easiness of diagnosis using ABI in primary care, undoubtedly better awareness would help preserve individual cardiovascular health and achieve public health goals.
Subject(s)
Ankle Brachial Index , Cardiovascular Diseases/prevention & control , Peripheral Vascular Diseases/diagnosis , Aged , Cardiovascular Diseases/epidemiology , Epidemiologic Methods , Family Practice , Female , France/epidemiology , Humans , Male , Middle Aged , Peripheral Vascular Diseases/epidemiology , Prevalence , Risk FactorsABSTRACT
BACKGROUND: Intima-media thickness (IMT) is associated with an increased risk of cardiovascular and cerebral ischemic events, but its correlation with the absolute cardiovascular risk is not known in large populations. The Paroi Arterielle et Risque Cardiovasculaire (PARC) Study is an epidemiological study designed to correlate conventional assessment of cardiovascular risk with the mean IMT of the common carotid. METHODS: In the PARC study, 6,416 subjects were enrolled, including 80.7% subjects with cardiovascular risk factors and 19.3% without. A specific methodology was designed to harmonize the acquisition and processing of data at the 283 centers. Interreader agreement on image quality and IMT measurement of the common carotid artery (CCAIMT) was assessed from a random sample of 10% of the PARC study population. RESULTS: The intraclass correlation coefficient was 0.98 (95% CI 0.966-0.985), and the accuracy was high (standard deviation of the error measurement: 0.0185 mm). CONCLUSIONS: The reproducibility of the measurements assessed by means of the intraclass correlation coefficient and the accuracy of the CCAIMT measurement obtained in the PARC Study demonstrate the feasibility of large multicenter studies of IMT measurement.
Subject(s)
Carotid Arteries/diagnostic imaging , Carotid Artery Diseases/diagnostic imaging , Carotid Artery Diseases/epidemiology , Ultrasonography/standards , Adult , Aged , Blood Pressure , Cholesterol, LDL/blood , Female , Humans , Incidence , Male , Middle Aged , Predictive Value of Tests , Reproducibility of Results , Risk Factors , Tunica Intima/diagnostic imaging , Tunica Media/diagnostic imagingABSTRACT
Popliteal artery entrapment and its various anatomical type I, II, III and IV has been perfectly described in previous studies. The only test that diagnoses true entrapment due to an anatomical abnormality in the course of the popliteal artery, where it is tied by an embryonic anomaly, is passive dorsiflexion of the foot on the extended leg the deviation then observed at ultrasonography and angiography and the disappearance of downstream signal at doppler examination are pathognomonic. Ultrasonography, computerized tomography (CT) and, more recently, nuclear magnetic resonance (NMR) provide detailed information on the abnormality: separation of the artery from the vein by a muscular bridge is the hallmark of true popliteal entrapment. On the other hand, there is a functional pathology due to dynamic compression of the popliteal artery by the medial gastrocnemius muscle, which raises difficult diagnostic and therapeutic problems, especially in high-level sportsmen for whom the leg muscle activity is very important. In these subjects with a developed muscular mass the medial gastrocnemius muscle crushes the popliteal artery against the femoral condyle without deviation of the artery, particularly in active dorsiflexion and activity hyperextension of the foot on the extended leg. In such case, the popliteal artery and vein remain close to each other, as demonstrated by ultrasounds, CT and NMR. True popliteal artery entrapment can be cured by surgery with subsequent resumption of sporting activities, but whether false entrapment must be operated is difficult to decide. Surgery has been performed with success in some cases of highly disabling false entrapment due to compression of the artery by the medical gastrocnemius muscle.(ABSTRACT TRUNCATED AT 250 WORDS)
Subject(s)
Arterial Occlusive Diseases/diagnosis , Popliteal Artery/abnormalities , Sports , Adult , Arterial Occlusive Diseases/etiology , Constriction, Pathologic/diagnosis , Constriction, Pathologic/etiology , Female , Humans , Male , Syndrome , UltrasonographySubject(s)
Esophageal Diseases/diagnostic imaging , Hematoma/diagnostic imaging , Adult , Aged , Anticoagulants/adverse effects , Esophagoscopy , Female , Humans , Male , Middle Aged , RadiographyABSTRACT
A case of lithium poisoning with lithium salts in a man of 66 years is reported. Sinus node dysfunction and conduction-tissue modifications were found. The responsibility of lithium in these disoredrs is discussed. The literature and the cellular mode of action of lithium are reviewed.
Subject(s)
Arrhythmia, Sinus/chemically induced , Bundle of His/drug effects , Heart Conduction System/drug effects , Lithium/poisoning , Aged , Bipolar Disorder/drug therapy , Humans , Lithium/therapeutic use , MaleABSTRACT
Pretreatment by benserazide (50 mg/kg i.p.) and L-Dopa (100 mg/kg i.p.) in rats induces a reduction of the diminution of motility after hypoxia and a stabilization of cerebral blood flow during and after hypoxia. An overload of cerebral dopamine and norepinephrine seems to be the original process of this phenomenon.
Subject(s)
Benserazide/therapeutic use , Hydrazines/therapeutic use , Hypoxia/drug therapy , Levodopa/therapeutic use , Animals , Benserazide/pharmacology , Brain Chemistry , Carbon Dioxide/blood , Cerebrovascular Circulation/drug effects , Dopamine/analysis , Female , Hypoxia/physiopathology , Levodopa/pharmacology , Motor Activity/drug effects , Norepinephrine/analysis , Oxygen/blood , RatsABSTRACT
Pretreatment by benserazide (50 mg/kg) and L.dopa (100 mg/kg) reduces functionnal deficiency produced by hypoxic hypoxia in rats reduces hemodynamic modifications in relation to it (rheoencephalogram) without any effect on ventilation.