Levels of the inhibitor of PMN-elastase in venous blood reflowing from chronically affected veins: the role of venous stasis.

BACKGROUND: Attention has recently been paid to the cell and biochemical disorders involved in chronic venous insufficiency (CVI) and to their possible relationship to the endothelium. METHODS: In the present study, carried out in 14 patients with CVI, we evaluated the levels of the inhibitor of elastase (I-EL) generated by polymorphonucleate cells in the blood reflowing from affected superficial veins of legs both at rest and after prolonged venous stasis (1 hour in standing position). RESULTS: We evaluated the I-EL both as percentage of activity (baseline 82.3+/-24.5%; after stasis 100.7+/-37.8%) and as absolute values (0.67+/-0.26 U/ml; after stasis 0.79+/-0.39 U/ml). In blood samples taken after venous stasis we found a tendency toward a trapping of white blood cells and an increase of the haematocrit over baseline. The difference in the percentages of activity of I-EL was statistically significant, but only a trend was observed for the absolute values. CONCLUSIONS: We believe that the typical haemodynamic disorders of patient with CVI increased by prolonged venous stasis can modify the function of white blood cells, which are closely linked with venous hypertension, thus playing an important role in the pathogenesis of skin ulcers.

[Analysis of risk factors in patients operated for abdominal aortic aneurysm]. / Analisi dei fattori di rischio in pazienti operati per aneurisma dell'aorta addominale.

BACKGROUND: The incidence of the associated risk factors on the early results of elective repair of abdominal aortic aneurysms has been evaluated in a series of 270 consecutive patients. Clinical, hematological and instrumental data concerning cardiovascular, pulmonary and metabolic diseases have been collected for each patient, as well as the type and the results of the surgical procedure. METHODS: The graft was straight aortic in 82 cases (30.3%), aorto-bisiliac in 130 (48.1%) and aorto-bifemoral in 58 cases (21.6%); the 237 uneventful patients (87.8%) have been discharged 8 days after the operation (mean) and 24 (8.9%) underwent to coronary-aortic bypass graft (CABG) previously. RESULTS: Postoperative complications have been observed in 33 patients (12.2%): 24.3% pulmonary, 21.2% cardiac and 15.1% renal and among these 13 patients died (4.8% of the complete series and 39.4% of those with complications) because of pulmonary (38.4%), cardiac (30.7%) and renal causes (23.3%) mainly. Despite the complications occurred mainly in patients with associated risk factors, the multivariate analysis has shown that only the chronic obstructive pulmonary disease (COPD) plays a fundamental role (p < 0.005). On the contrary, among the patients died not one single risk factor reached statistical significance, although the COPD was close (p = 0.1). CONCLUSIONS: These data underline the need of a careful evaluation and treatment of associated diseases in patients undergoing elective repair for an AAA; namely a screening for asymptomatic coronary artery disease, since the CABG can significantly reduce morbility and mortality rates, and for COPD. In addition a more careful monitoring of patients with long clamping time could reduce the possible related renal complications. Up to now, since the surgical procedures is already standardized, the precise diagnosis and treatment of associated risk factors represent the winning strategy for the achievement of better results.