Modification of plasma glycosaminoglycans in long distance runners.

BACKGROUND: It is well documented that exercise reduces the risk of thromboembolic disease, possibly by increasing the plasma concentration of anticoagulant-antithrombotic compounds. OBJECTIVES: As plasma glycosaminoglycans (GAGs) play a role in the anticoagulant-antithrombotic potential of plasma, to examine the concentration and profile of these compounds in well trained, long distance runners and sedentary subjects. METHODS: Plasma GAGs were measured in 10 male, long distance runners and 10 sedentary counterparts before and after ergometric tests. GAGs were extracted, purified, and identified by electrophoretic and enzymatic methods, and measured as hexosamine. RESULTS: Plasma GAGs found in sedentary subjects were slow migrating heparan sulphates I and II, keratan sulphate I, and chondroitin 4-6-sulphate. Those found in trained athletes were slow migrating heparan sulphate I, chondroitin 4-6-sulphate (or keratan sulphate I), and fast migrating heparan sulphate. Total plasma concentrations of GAGs were higher in athletes than in sedentary subjects at rest. In sedentary subjects, plasma GAGs did not change after cycle ergometric exercise at 80% of their anaerobic threshold. However, the appearance of a novel band of heparan sulphate migrating faster than fast migrating heparan sulphate was observed in athletes after exercise. CONCLUSIONS: Exercise changes the amount and profile of plasma GAGs; these changes may play a role in protecting subjects who practise aerobic sports against developing cardiovascular disease.

Collateral circulation in internal carotid artery occlusion. A study by duplex scan and magnetic resonance angiography.

BACKGROUND: Clinical effects of internal carotid artery (ICA) occlusion may range from the absolute absence of symptoms to lethal hemispheric stroke. In this paper symptoms of patients with ICA occlusion have been related to the development of collateral circulation, different types of developed collateral circulation have been assessed, and the degree of sensitivity and specificity of duplex scan has been appraised. METHODS: Forty-eight patients with ICA occlusion or subocclusion, 24 males and 24 females, aged between 50 and 83 years (67.7+/-7.15), underwent duplex scan and magnetic resonance (MR) angiography. Nineteen patients were completely asymptomatic, 20 patients showed permanent neurological symptoms and 9 patients had shown transient symptoms. RESULTS: Twelve patients (25%) did not show any collateral circulation, 29 patients (60%) showed collateral circulation through homolateral external carotid artery branches and 7 patients (15%) showed collateral circulation through other circuits. Of the 20 patients with permanent symptoms only 8 showed collateral circulation. On the contrary, all the 19 asymptomatic patients and the 9 patients with transient symptoms showed collateral circulation. Eventually, duplex scan showed 78% sensitivity, 100%, specificity and 83% diagnostic accuracy. CONCLUSIONS: Our data show: 1) a clear-cut prevalence of collateral circulation through homolateral external carotid artery branches with respect to other possible collateral circulation; 2) an inverse relationship between the development of collateral circulation and the appearance of permanent symptoms; 3) a good diagnostic accuracy of duplex scan in revealing collateral circulation in the case of ICA occlusion.

Macroscopic anatomy of the superficial veins of the lower limb: a systematic review based upon echography.

Saphenous Veins are described in Anatomy textbooks as superficial veins running in the amorphous fatty layer of the lower limbs. Recent papers have demonstrated the complex fascial relationship of Saphenous Veins with the connective framework of the lower limb hypodermis. The aim of the present paper was to systematically review the anatomy of lower limb superficial veins, based upon echographic findings, in a series of normal subject. Our results offer new insight into lower limbs superficial veins anatomy, with important clinical and surgical implications.

A comparison between the heart of young athletes and of young healthy sedentary subjects: a morphometric and morpho-functional study by echo-color-doppler method.

Morphologic and morpho-functional heart differences between healthy young athletes and healthy young subjects who do not practice agonistic sport have been studied using Color Doppler Echography (CDE). Overall, 68 subjects were enrolled in the study (age range: 19-26 yrs). Of them, 34 subjects (17 men and 17 women) were practicing sport agonistically; the 34 controls (17 men and 17 women) did not practice any sport on a regular basis. In each subject, age, height, weight, body mass index, practiced sport, systolic and diastolic blood pressure were recorded. CDE measures included telediastolic left and right ventricular diameters (LVDd and RVDd, respectively), interventricular septum thickness (IVSd), posterior wall thickness of the left ventricle (PLVWd), left and right atrium diameters during ventricular systole (LAD and RAD respectively), and continence of each heart valve (mitral; tricuspid; aortic; pulmonic). In women, LADd was significantly higher in the athletes than in the controls (35.04+/-4.13 vs 31.81+/-3.34; p<0.02). Physiological regurgitation in at least one heart valve was observed in 15 out of 17 (88.2%) of the athletes; in 12 cases only one valve was involved: the mitral valve presented physiological regurgitation in 8 women, the tricuspid in 4, the aortic in 2 and the pulmonic in 6. In the control female population (17 persons), only 2 women showed evidence of regurgitation. In men, except for RVDd, CDE measurements were all significantly higher in the athletes than in the controls: LVDd (49.4+/-3.13 vs 46.02+/-4.46; p<0.02); IVSd (9.79+/-1.24 vs 8.59+/-0.91; p<0.003); PLVWd (8.63+/-1.29 vs 7.48+/-0.66; p<0.002). Physiological regurgitation through one or more heart valves was demonstrated in all the 17 male athletes studied; in 9 cases (52.9%) only one valve was involved. Mitral regurgitation was ob- served in 8 cases (47%); tricuspid in 6 (35.3%). No physiological regurgitation through the aortic valve was found, while 15 cases (88.2%) presented a pulmonic regurgitation. Among male controls, physiological regurgitation was demonstrated only in 2 persons out of 17 (11.8%), both involving the pulmonic and the aortic valve. In the total population of athletes compared to controls, analyzing men and women jointly, we found that LAD (p<0.001),RAD (p<0.001), LIVD (p<0.01) were significantly larger in cases than in controls, while for RVD, IVSd and PLVWd such a difference did not reach statistical significance. No relationship was fouhd between CDE data and either age, height, weight or blood pressure.

Descriptive and morphometric anatomy of the architectural framework of microcirculation: a Videocapillaroscopic study on healthy adult subjects.

Conventional Capillaroscopy allows the observation of a limited number of areas, classically the fingernail-fold. Videocapillaroscopy, on the contrary, can be performed on any part of the skin and of clinically accessible mucosae. The aim of the present paper was to investigate the architectural frameworks of microcirculation in the various regions of the body and their morphometric parameters in healthy adult subjects. Our findings showed four basic architectural patterns plus two special patterns. The calibre of capillary loops ranged from 15 to 20 micrometers, and capillary density ranged from 14 to 30 capillary loops each square millimetre. These findings might be used as normal reference data for future studies.

Kinking of the human internal carotid artery: a statistical study in 100 healthy subjects by echocolor Doppler.

BACKGROUND: Kinking of the internal carotid artery is a rather frequent anomaly. It is still controversial whether it has a clinical relevance, causing cerebral vascular disturbances, or if it is a mere morphologic anomaly. A study concerning its frequency in asymptomatic subjects and an evaluation of its possible correlations were, therefore, considered interesting. METHODS: The internal carotid artery was studied in 100 apparently healthy subjects (50 men and 50 women; age range: 18 to 98 years) with no history of atherosclerotic disease of the supra-aortic trunks, or diabetes mellitus, or hypertension. Each patient underwent color Doppler ultrasonography. RESULTS: In 38 subjects out of 100, and in 53 out of 200 examined arteries (100 right and 100 left arteries), a kinking was found (26.5%). In 23 kinkings (43% of all the kinkings), the maximal systolic velocity (MSV) was greater than 1 m/sec at the level of the kinking. The kinkings were more frequent in women; such prevalence was statistically significant. The frequency of kinkings was uncorrelated with the side of the artery, the age, the body weight, the height and the length of the neck. Moreover, the presence of the kinkings was not significantly correlated with the lumen of the internal carotid artery. CONCLUSIONS: Hypotheses regarding the genesis of the kinkings were discussed, and the embryogenic hypothesis was emphasized. The importance of the MSV in the diagnosis of kinkings was stressed.

Collateral circulation in distal occlusion of lower limb arteries: an anatomical study and statistical research in 40 elderly subjects by echo-color-Doppler method.

The collateral circles and their hemodynamic significance in distal lower limb arterial occlusion have been described in an elderly population. Overall 40 subjects (20 men and 20 women; age range 66-83) with symptomatic lower limb arteriopathy (Fontaine's stage II) have been studied combing Contrast Angiography and Color Doppler Echography of the lower limb arterial district. In our population, the results showed that the tibialis arteries were the vessels most often involved in arterial occlusion (posterior tibialis a., 15 cases = 37.5%, posterior tibialis a., 12 cases = 30%), followed by the peroneal a. (8 cases = 20%) and by the popliteal a. (5 cases, 12.5%). In the occlusion of the popliteal artery the collateral circle was mainly established through the deep femoral a., the great anastomotic a., the recurrent posterior tibialis a., and from the articular supero-lateral a. In the occlusion of the anterior tibialis artery the collateral circulation was ensured through the collateral posterior tibialis as. and through the collateral perineal as. In the occlusion of the posterior tibialis a., the collateral circle was established through the great anastomotic a., through the branchers of the arterial circle of the ankle and from the perforating plantar as. (anterior tibial a.). Finally, in the occlusion of the peroneal a., the collateral circulation was only represented by branches of the arterial circle of the ankle. The hemodynamic compromission, measured by the Windsor Index, was the highest for popliteal occlusions (mean IW = 34.3%). Occlusions of the anterior tibialis a. (mean IW. = 35.48%), of the peroneal a. (mean IW = 44.71%), and of the posterior tibialis a. (mean IW = 55.44%) showed progressively lower hemodynamic compromission. Gender differences in hemodynamic significance at each level of occlusion were not significant.

The inner diameter of human intracranial vertebral artery by color Doppler method.

In 50 healthy subjects the internal diameter of the intracranial vertebral artery were measured by echocolor doppler method. The diameter of left vertebral a. was greater than that of the right in most subjects (58%); the mean left/right difference was statistically significant (p < 0.05). Analyzing men and women separately, the difference remained significant only in women (p < 0.05). A significant correlation was found between vertebral a. diameter and sex (p < 0.01). The vertebral a. diameter had a tendency to increase with age, that reached significance only for the left vertebral one. No significant correlation was found between body surface area and vertebral a. diameter.

Magnetic resonance angiographic evaluation of circulus arteriosus cerebri (circle of Willis): a morphologic study in 100 human healthy subjects.

The Circle of Willis was studied by Magnetic Resonance Angiography in 100 healthy subjects. In 41% of these cases, the arteries were arranged in the classically described way. In 21%, hypoplasia of the posterior communicating as. was noted, while in 13% the posterior cerebral as were found to originate from the internal carotid a.. In 9% of these cases, three anterior cerebral as. were present. In 3% the anterior communicating artery could not be identified, while the left posterior communicating artery was hypoplastic. In 2% the absence of a posterior communicating artery was associated with the origin of a posterior cerebral a. from the internal carotid. In another 2% the anterior cerebral as. were partially fused, and in yet another 2%, hypoplasia of both an anterior and a posterior cerebral a. was present. The remaining seven cases (7%), all different from each other, represented combinations of the above described variations. Statistical analysis indicated that anomalies occurred more commonly on the left than on the right side. The morphology of the Circle of Willis could not be correlated with either sex or Body Index.

The blood-flow velocity analysis as a possible method for arterial calibre discovery. A statistical investigation in 108 human subjects by color-Doppler method.

Using Echocolordoppler, we have examined 108 subjects with stenosis of the Internal Carotid Artery (ICA). For each subject, age, sex, body weight, height, systolic and diastolic arterial pressure, as well as measures of original caliber of ICA, residual lumen and maximal systolic velocity (MSV) at the stenosis were recorded. In both sexes there was a highly significant correlation (p < 0.001) between MSV, percentage of stenosis, and residual lumen, while there was no correlation between MSV and arterial pressure, which could have modified interpretation of data. Linear regression analysis was performed to calculate total vessel caliber, whenever not directly measurable, from MSV and residual lumen.

Clinical importance of the supra-isthmic anastomosis between the superior thyroid arteries in six cases of occlusion of the common carotid artery.

In six cases of occlusion of a single common carotid artery, antegrade blood flow was demonstrable in the ipsilateral internal carotid artery by doppler ultrasonography. Antegrade blood flow was also observed in the intracranial portion of the internal carotid artery, comparatively reduced and irregular with respect to that of the corresponding contralateral artery. Studies by color doppler ultrasound and digital subtraction angiography revealed the presence of a collateral arch that passed through the supra-isthmic anastomosis between the superior thyroid arteries. All six subjects examined had presented with neurological deficits that subsequently almost completely regressed. The regression of symptomatology indicates the clinical importance of the collateral circle.

Circadian patterns in histamine concentrations and mast cell number in the rat thyroid gland.

We carried out a cross-sectional chronobiological investigation on blood histamine, thyroid histamine and thyroid mast cell number in Wistar rats. Daily, blood histamine varied from 0.38 +/- 0.01 (12.00 h) to 0.60 +/- 0.01 mg/g wet weight (20.00 h) and thyroid histamine from 21.2 +/- 1.19 (04.00 h) to 38.3 +/- 1.54 mg/g wet weight (08.00 h). The number of mast cells per microscopic field ranged from 10.8 +/- 0.6 (16.00 h) to 14.6 +/- 0.6 (12.00 h) in males and from 8.3 +/- 0.2 (04.00 h) to 14 +/- 0.4 (12.00 h) in females. Chronobiologic analysis indicates that the levels of all three variables follow a circadian pattern with a period of 12 h. Peak levels were noted at 07.36 h and 19.36 h for the blood histamine concentration, at 09.00 and 21.00 h for the tissue histamine concentration, and at 11.00 and 23.00 h for the mast cell number. The consistent, consecutive relationship of these data supports the hypothesis that thyroid mast cell number is conditioned by the blood histamine level and thyroid histamine concentration.

The original calibre of the lower limbs arteries as a possible risk factor for complications of atherosclerosis: a statistical investigation in 90 subjects by echocolor-doppler.

Ninety subjects with emodynamically significant atherosclerotic disease of the lower limbs were examined. They had no history of diabetes mellitus or hypertension. Each subject underwent a color Doppler ultrasonographic study of the common iliac, superficial femoral, and popliteal arteries. In each arterial segment, diameter and blood flow velocity were measured. In evaluating the hemodynamic significance of the stenoses, we used the Windsor method. In a comparison of the calibers of the arteries significant relationship emerged in each given subject in two sexes. Males: a statistically significant difference was found only in the iliac artery, in which the calibre and Windsor indices were greater in the right as compared to the left; right: 1) There was a statistically significant relationship between mean caliber and Windsor indices, (p < 0.01); 2) there was a statistically significant correlation between mean calibre and age (p < 0.05); Left: 1) There was a statistically significant correlation between mean calibre and Windsor indices calculated at the levels of both the posterior tibialis (p < 0.05) and dorsalis pedis arteries (p < 0.01); 2) there was a statistically significant correlation between mean calibre and age (p < 0.05). Females: Student's t test for paired samples of the three arteries did not reveal a statistically significant predominance of one side over the other. With respect to the coefficients of correlation between mean calibre and Windsor indices, the results were as follows. Right: 1) There was a statistically significant correlation between mean calibre and Windsor indices calculated at the levels of both the posterior tibialis and dorsalis pedis arteries (p < 0.01); 2) there was a statistically significant correlation between age and mean calibre (p < 0.05); Left: 1) There was a statistically significant correlation between mean calibre and Windsor indices calculated at the levels of both the posterior tibialis (p < 0.05) and dorsalis pedis arteries (p < 0.01); 2) there was a statistically significant correlation between mean calibre and age (p < 0.05).

The calibers of the common femoral, popliteal, and posterior tibialis arteries: a statistical investigation in 100 healthy subjects by color Doppler ultrasonography.

One hundred healthy subjects (50 men, 50 women; age range: 18 to 90 years) with no history of occlusive arterial disease of the lower extremities were examined. In each, the principal arteries of the lower extremities were measured by Doppler ultrasound. The difference between the dimensions of the arteries of the right with those of the left was generally not significant, although those of the right were consistently larger. The only exceptions were the common femoral arteries in both sexes and the posterior tibialis arteries in the men, where there was a statistically significant predominance of the right. As compared to those of the females, the arterial calibers of the male subjects were significantly larger (p < 0.01) for all the arteries examined. In both sexes, there was a statistically significant direct relationship between vessel caliber and age. There was no correlation between arterial dimension and body index.

The use of ultrasonic tomography to measure the calibers of the iliac arteries and veins and the caliber and length of the inferior vena cava and the abdominal aorta.

One hundred eighty healthy subjects (90 men, 90 women; age range: 55 to 80 years) with no known cardiovascular disease were studied by ultrasonography. In each, the following measurements were obtained: the caliber and length of the abdominal aorta and inferior vena cava, and the caliber of the common iliac arteries and veins. The mean length of the inferior vena cava was found to be 95.2 mm, its mean caliber 18.4 mm. The mean length of the aorta was 83.1 mm, and its mean caliber was 15.9 mm. The mean caliber of the common iliac veins was 9.7 mm, while that of the common iliac arteries was 8.8 mm. There was a statistically significant relationship between vessel caliber and subject age; furthermore, the vessel caliber of the male subjects was found to be larger than that of the females by a statistically significant margin. There was also a statistically significant correlation between subject height and the length of the two major vessels; however, no statistically significant correlations were noted between the measured parameters and body weight. In comparison with the values reported in the standard textbooks and by contemporary cadaveric studies, our measurements of mean aortic and vena caval calibers were significantly lower. When the two side were compared, a statistically significant difference was noted only in the iliac arteries, where the right was larger than the left.

Internal carotid artery: relationship among arterial caliber, haematocrit and cerebral vascular resistance, investigation in eighty healthy men by echodoppler.

Eighty healthy male subjects (age range: 47 to 87) with hematocrits of 48% or greater and no vascular or hematologic pathology were studied. In each subject, the following values were determined: hematocrit, blood pressure (measured in both arms by sphygmomanometry), and the calibers and blood flow velocities of both internal carotid arteries. For the last 2 measurements, doppler ultrasound was used to examine the extracranial portion of the arteries before, 20 minutes after, and 7 days after euvolemic hemodilution. Following hemodilution, all the subjects demonstrated a statistically significant increase of the diastolic blood flow velocity of the two carotid arteries (p < 0.01). This corresponded to a statistically significant reduction of the hematocrit (p < 0.01). When the data were compared, no statistically significant relationships were observed among arterial caliber, side (left or right), blood pressure, and age. After 7 days, the results were practically unchanged. The precise correlation between the decrease of the hematocrit and the increase of the diastolic blood flow velocity of the internal carotid artery indicates that the latter is a valid index of cerebral vascular resistance. Thus, measurement of the diastolic blood flow velocity is a valid method for the assessment of cerebral blood flow, since the hematocrit is the single most important factor in the determination of blood viscosity.

The valves of the internal jugular veins: a statistical investigation in 120 living subjects using ultrasonic tomography.

We examined both jugular veins of 120 healthy subjects (60 men, 60 women; age range: 18 to 90 years); thus, a total of 240 jugular veins were examined. The vessel diameter was measured by color Doppler ultrasonography, and when valves were present at the ostial level, their morphology and competence were assessed. A single valvular apparatus was detected in 206 cases (86%). It consisted of 2 cusps in 75% of these 206 cases, of one in 15%, and of three in 10%. No correlations with side or the subjects' sex, age, height, or body weight were observed. In the 34 cases in which a valvular apparatus was not visualized, we found a male predominance (22 men as compared to 12 women). The mean diameter of the jugular vein at the ostial level was 13.8 mm, with that of the men being significantly larger than that of the women (p < 0.01), and it showed a tendency to increase with age. The valves were observed to be incompetent in 95% of the cases.

The measurement of the calibers and blood-flow velocities of the arteries of the circle of Willis: a statistical investigation of 120 living subjects using transcranial color-Doppler ultrasonography.

We have examined 120 subjects (52 men, 68 women; age range: 19 to 89) with no vascular pathology. In each subject, we used transcranial color-doppler ultrasonography to measure the calibers and blood-flow velocities of the anterior, middle, and posterior cerebral arteries (ACA, MCA, and PCA, respectively). Generally, the mean measured calibers were lower than those that have been described in cadaveric studies by other investigators. The mean caliber of the MCA was found to be higher than those of the ACA or PCA; this difference was statistically significant (p < 0.05). With age, the calibers of the ACA, PCA and PCA tended to increase, but this trend was not statistically significant. We have noted a statistically significant difference between the left and right sides, the arteries of the left being larger than those of the right. However, there was no statistically significant relationship between vessel caliber and age, sex, or body weight, though the women's arteries tended to be narrower than those of the men. With respect to the maximal and mean blood-flow velocities, no statistically significant relationships with regard to side (left or right), sex, age, or body weight were demonstrable. However, the mean and maximal blood-flow velocities of the MCA were found to be statistically higher than those of the ACA or PCA (p < 0.02). This was especially true under the age of 60 (p < 0.01).

The original caliber of the carotid artery as a possible risk factor for complications of atherosclerosis.

Seventy subjects (35 men, 35 women; age range: 65 to 86 years) with an isolated 80% extracranial atherosclerotic stenosis of a single internal carotid artery were studied. Each subject was examined by color Doppler ultrasonography. The size of the carotids and the Doppler flow velocities of both healthy and diseases internal carotid arteries were measured. The original arterial calibers were also estimated, and the Doppler flow velocity was determined at the level of and proximal to the stenotic lesion. The symptomatology and occurrence of cerebrovascular events (territory and extent) were documented in all subjects with respect to the other parameters. By comparing the sizes of the common, internal, and external carotid arteries in every patient, it was observed that their calibers were consistently proportional to one another. In both the men and the women, significant, inversely proportional relationships were observed between the original vessel caliber and the extent of stenosis in the affected internal carotid artery, as well as between the original vessel caliber and the hemodynamic significance of the stenosis. Moreover, a correlation was observed among the original arterial caliber, the presence or absence of symptoms, and the frequency and extent of cerebrovascular events, in both the men and the women. In both sexes, the functional of the compensatory circulation was found to correlate with arterial caliber (p < 0.01). The correlation between the degree of stenosis and the gravity of the symptomatology, as well as the occurrence of cerebrovascular events, was observed to increase significantly when the residual luminal area (of the stenotic artery) was less than 2.5 mm2. This relationship tended to hold more for men than for women; however, the difference was not statistically significant.

The anatomy and clinical importance of the collateral circles between the vertebral arteries and the cervical, costo-cervical, and occipital branches in 52 living subjects.

In this study, 52 cases of vertebral artery obstruction, comprising 29 women and 23 men between the ages of 27 and 78 years, were taken into consideration. The relevant arterial territories of these patients, who had sought medical attention for a variety of symptoms, were studied by means of doppler ultrasound, duplex, and digital subtraction angiography. Of the original 52 patients, 38 were excluded because of the failure to demonstrate a functional collateral circle with the vertebral artery distal to the point of its obstruction. Of the 14 remaining patients (6 men, 8 women), a collateral circle through cervical branches arising from the thyrocervical and costo-cervical trunks was demonstrable in 7. Six others (3 men, 3 women) demonstrated a collateral circle through a combination of cervical and occipital artery branches. In one (female) case, a collateral circle was demonstrated through the sole occipital artery. With the exception of a single case (a 47-year-old woman), the occlusion was localized to the origin of the vertebral artery. Hemodynamically, the collateral circles were sufficient to maintain perfusion.