Onset of peripheral arterial disease: role of endothelin in endothelial dysfunction.

OBJECTIVES: Endothelial dysfunction and inflammation are understood to contribute to the onset of peripheral arterial disease (PAD), and endothelin (ET) may play an important role in this process. This study investigated the role of ET in PAD, and its relationships with symptoms, endothelial dysfunction and inflammation. METHODS AND RESULTS: This cross-sectional study enrolled 141 participants: 66 patients with PAD and intermittent claudication, 37 patients with PAD and critical ischemia, and 38 healthy controls aged under 35 years. There were no gender distribution differences between control and diseased groups. Moreover, no differences were observed in age or cardiovascular risk factors distribution between patients with critical ischemia and patients with claudication. Plasma ET concentrations were significantly higher in patients vs. controls (8.76+/-77.1 vs. 6.45+/-0.89 pmol/l, respectively; P=0.002). Nevertheless, patients with claudication exhibited significantly higher plasma ET concentrations vs. patients with critical ischemia (10.97+/-7.9 vs. 4.82+/-2.57 pmol/l, respectively; P<0.001). Otherwise, significantly greater serum concentrations of C-reactive protein (CRP) were observed in patients with critical ischemia vs. patients with claudication (16.94 vs. 4.73 mg/l, respectively; P=0.001) and controls (0.96 mg/l; P=0.001). Plasma concentrations of ET had a modest negative correlation with serum concentrations of CRP (-0.165; P=0.095). CONCLUSION: Plasma concentrations of ET in patients with PAD are greatest in early disease; ET concentrations decrease substantially and inflammation arises as disease advances. Serum CRP concentrations exhibit a modest negative correlation with those of ET.

Arteritis ilíaca por Salmonella diferente de S. typhi en paciente con fallo hepático agudo / No typhi Salmonella-induced iliac ateritis in a patient with acute hepatic failure

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Relación del tamaño del aneurisma de aorta abdominal asintomático con los niveles plasmáticos de proteína C reactiva / Relation between the size of asymptomatic abdominal aortic aneurysms and levels of C-reactive protein in plasma

Introducción. La proteína C reactiva (PCR) es un factor de riesgo independiente conocido para el desarrollo de enfermedad cardiovascular, dentro de la teoría etiopatogénica inflamatoria sistémica crónica. Planteamos la hipótesis de un origen etiopatogénico común también para la enfermedad aneurismática. Objetivo. Determinar la posible asociación entre los niveles séricos de PCR y el diámetro máximo aneurismático en pacientes con aneurisma de aorta abdominal (AAA) asintomáticos. Pacientes y métodos. Se determinan los niveles plasmáticos de PCR mediante técnica ultrasensible (hsPCR) y el tamaño aneurismático medido por tomografía computarizada en los 67 pacientes con AAA asintomático que siguen revisión en nuestras consultas externas. Resultados. La mediana (cuartiles) de hsPCR es 4,11 (intervalo: 2,45-5,98) mg/L. El diámetro aórtico va en aumento en los cuatro grupos de pacientes que se realizan según los cuartiles de hsPCR (36 ± 3 mm, 42 ± 4 mm, 54 ± 6 mm y 65 ± 5 mm; p < 0,03). Esta asociación persiste tras corrección por factores de riesgo. La hsPCR presenta una correlación significativa con el tamaño aneurismático (r = 0,71; p < 0,02). Conclusiones. La asociación estadística de los niveles de hsPCR con el diámetro máximo en los AAA asintomáticos clasificados como degenerativos, apoya la posibilidad de puntos etiopatogénicos comunes con la enfermedad aterosclerótica oclusiva, sobre la base de una respuesta inflamatoria sistémica. Esto podría sugerir que los niveles séricos de hsPCR podrían servir como marcadores de la enfermedad aneurismática

Introduction. C-reactive protein (CRP) is a known independent risk factor for the development of cardiovascular disease, within the chronic systemic inflammatory etiopathogenic theory. We hypothesise that aneurysmal disease also has a common etiopathogenic origin. Aim. To determine the possible association between CRP levels in serum and the maximum aneurysmal diameter in patients with asymptomatic abdominal aortic aneurysms (AAA). Patients and methods. CRP levels in plasma were determined by means of a high-sensitivity technique (hsCRP) and sizes of the aneurysms were measured by computerised tomography in 67 patients with asymptomatic AAA who were being clinically monitored in our outpatient department. Results. The median (quartiles) of hsCRP is 4.11 (interval: 2.45- 5.98) mg/L. The aortic diameter increases in the four groups of patients that are produced according to the hsCRP quartiles (36 ± 3 mm, 42 ± 4 mm, 54 ± 6 mm and 65 ± 5 mm; p < 0.03). This association persists after correcting for risk factors. There is a significant correlation between the hsCRP and aneurysmal size (r = 0.71; p < 0.02). Conclusions. The statistical association between hsCRP levels and the maximum diameter of the asymptomatic AAA that are classified as degenerative enhances the likelihood of there being etiopathogenic points in common with occlusive atherosclerotic disease, based on a systemic inflammatory response. This seems to suggest that levels of hsCRP in serum could be useful as markers for aneurysmal disease

Aneurisma de aorta abdominal roto e hiperostosis esquelética idiopática difusa / Ruptured abdominal aortic aneurysm and diffuse idiopathic skeletal hyperostosis

Introducción. El aneurisma de aorta abdominal (AAA) roto crónico es una forma de presentación poco frecuente de los AAA. Menos aún lo son las publicaciones que asocian el AAA roto crónico con síndromes de hiperostosis vertebral. Presentamos un caso de AAA roto crónico e hiperostosis esquelética idiopática difusa y describimos su relación eventual. Caso clínico. Varón de 84 años que acudió a urgencias por un cuadro de debilidad muscular de ambos muslos de 20 días de evolución acompañado de síndrome febril, anemia y cifras normales de presión arterial. Se evidenció una masa pulsátil no dolorosa de 6 cm en el mesogastrio. La radiografía lateral de columna demostró osteofitos prominentes en cara anterior de los cuerpos de L3-L5; estos hallazgos fueron sugerentes de hiperostosis esquelética idiopática difusa. La tomografía axial computarizada evidenció un AAA roto crónico infrarrenal de 5 cm de diámetro máximo, que se extendía hasta la bifurcación ilíaca, con rotura aórtica contenida en el retroperitoneo y en ambos compartimentos del psoas. Durante el estudio preoperatorio el paciente sufrió descompensación hemodinámica. Fue intervenido de urgencia y en la apertura del aneurisma se evidenció ausencia de pared aórtica posterior; la rotura estaba contenida por los cuerpos vertebrales lumbares. Fue dado de alta sin incidencias y en revisiones posteriores no se observaron complicaciones postoperatorias. Conclusión. El presente caso sugiere que, en pacientes con AAA y marcadas hiperostosis vertebrales, el diámetro de dicho aneurisma es un factor de riesgo de rotura menos importante que en pacientes sin hiperostosis; debe contemplarse en estos casos un tratamiento más precoz (AU)

INTRODUCTION. Chronic rupture of an abdominal aortic aneurysm (AAA) is a rare presenting symptom of AAA. However, even fewer cases of chronic rupture of an AAA associated with vertebral hyperostosis have been reported in the literature. We give details of a case of chronic rupture of an AAA and diffuse idiopathic skeletal hyperostosis and describe their possible relation. CASE REPORT. We describe the case of an 84-year-old male who visited the emergency department because of a 20-day history of symptoms of muscle weakness accompanied by a high temperature, anaemia and normal blood pressure. A 6-centimetre pulsatile mass that was not painful when palpated was found in the umbilical region. A lateral X-ray of the spine revealed prominent osteophytes on the anterior side of the L3-L5 bodies; these findings suggested the existence of diffuse idiopathic skeletal hyperostosis. A computerised axial tomography scan showed the presence of an infrarenal chronic rupture of an AAA with a maximum diameter of 5 cm, which extended as far as the iliac bifurcation, with contained aortic rupture in the retroperitoneum and in both psoas compartments. During the preoperative study the patient suffered haemodynamic failure. Emergency surgery was performed and on opening the aneurysm no posterior aortic wall was found; the rupture was being contained by the lumbar vertebral bodies. The patient was discharged from hospital with no further incidences and in later check-ups no postoperative complications were observed. CONCLUSIONS. This case suggests that, in patients with AAA and evident vertebral hyperostosis, the diameter of the AAA is a risk factor for rupture that is less important than in patients without hyperostosis; earlier treatment should be considered in these cases (AU)