ABSTRACT
AIM: Intermittent pneumatic compression (IPC) increases systemic fibrinolytic activity but may also injure endothelial cells and thereby induce coagulation. The safety and utility of IPC in patients with peripheral arterial disease (PAD) therefore remains uncertain. The aim of this study was to determine whether IPC is associated with coagulation activation and endothelial cell damage, platelet factor 4 (PF4), thrombin-antithrombin complex (TAT), total nitrate and nitrite level and von Willebrand factor (VWF) concentration. METHODS: PF4, TAT, total nitrate, nitrite level and VWF were analyzed before and after first, 5th, 15th session (1 hour/day) of IPC and then 3 weeks after completion of therapy in 25 claudicants and compared to 11 healthy volunteers of similar age and sex. RESULTS: PF4, a measure of platelet activation/secretion, was significantly higher in claudicants (55+/-50 IU/mL) compared to healthy controls (22+/-14 IU/mL) (P<0.05). In PAD patients PF4 has decreased steadily and significantly throughout the time of compressive therapy (to 33+/-42 IU/mL) and further more at the end of the follow-up period (23+/-26 IU/mL). TAT concentration was low in PAD patients but further decreased during IPC therapy. There was a tendency of nitrite and nitrate concentration to increase during the course of IPC therapy, but in PAD patients it did not reached statistical significance (P=0.2), while in healthy controls this increase was significant (up to 79+/-14 mmol/L, P<0.05) and persisted 3 weeks after completion of IPC (up to 82+/-7 mmol/L, P<0.05). VWF antigen concentration remained stable in claudicants during IPC therapy and 3 weeks later but significantly decreased during IPC therapy (after fifth and fifteenth IPC session, P=0.04) and stayed decreased 3 weeks after treatment termination in control group. Pain-free walking distance (PWD) had increased continuously during treatment period from 55+/-23 to 63+/-32 meters after fifth IPC treatment, to 81+/-43 (P<0.05) after the last session of therapy, and slightly decreased to 77+/-28 meters 3 weeks after completion of IPC. CONCLUSIONS: IPC is safe for PAD patients, does not activate coagulation, but decreases platelet activation and improves endothelial health; this coincides with significant prolongation of walking distance.
Subject(s)
Endothelium, Vascular/metabolism , Hemostasis , Intermittent Claudication/therapy , Intermittent Pneumatic Compression Devices , Adult , Aged , Antithrombin III , Biomarkers/blood , Blood Coagulation , Endothelium, Vascular/pathology , Endothelium, Vascular/physiopathology , Exercise Tolerance , Female , Humans , Intermittent Claudication/blood , Intermittent Claudication/pathology , Intermittent Claudication/physiopathology , Male , Middle Aged , Nitrates/blood , Nitrites/blood , Peptide Hydrolases/blood , Platelet Activation , Platelet Factor 4/blood , Poland , Prospective Studies , Recovery of Function , Time Factors , Treatment Outcome , Walking , von Willebrand Factor/metabolismABSTRACT
BACKGROUND/AIMS: Relation between cancer of the exocrine part of the pancreas and chronic pancreatitis has not been clearly defined and the problem of carcinogens based on long-lasting chronic pancreatitis is still a matter of discussion. METHODOLOGY: The aim of the study was analysis of postoperative material of patients who in the years 1999-2003 underwent either drainage procedures (n=49) in the course of chronic pancreatitis or resectional procedures (n=36) for chronic pancreatitis or pancreatic cancer. RESULTS: In the group of patients with drainage procedures pancreatic cancer was histologically detected in postoperative material (specimens collected from the wall of pancreatic pseudocyst or dilated main pancreatic duct) in 3 patients (6.1%). In the group of patients with long-lasting chronic pancreatitis who underwent a resectional procedure pancreatic cancer was postoperatively detected in 4 cases (30.7%). CONCLUSIONS: Analysis of presented material confirms that long-lasting chronic pancreatitis predisposes to cancer of the exocrine part of the pancreas. This indicates that risk of pancreatic cancer should be taken into consideration in each patient with long lasting chronic pancreatitis.
Subject(s)
Pancreatic Neoplasms/surgery , Adult , Aged , Anastomosis, Surgical , Diagnosis, Differential , Female , Gastrostomy , Humans , Jejunostomy , Male , Middle Aged , Pancreas/pathology , Pancreas, Exocrine/pathology , Pancreas, Exocrine/surgery , Pancreatic Ducts/pathology , Pancreatic Ducts/surgery , Pancreatic Neoplasms/diagnosis , Pancreatic Neoplasms/pathology , Pancreatic Pseudocyst/diagnosis , Pancreatic Pseudocyst/pathology , Pancreatic Pseudocyst/surgery , Pancreaticojejunostomy , Pancreatitis, Chronic/diagnosis , Pancreatitis, Chronic/pathology , Pancreatitis, Chronic/surgery , Tomography, X-Ray ComputedABSTRACT
A description of the life cycle, appearance and daily habits of the headlouse is followed by guidance on eradication. The psychological effects of infestation on both child and parent are considered as a background to the relevant health education programmes.
