Peripheral vascular surgical procedures in Ilorin, Nigeria: indications and outcome

Background

Data on peripheral vascular surgical interventions from Nigeria is scanty. Reports form Western and Eastern Nigeria dates back about twodecades. This study therefore analyses the various etiological conditions necessitating intervention, and their outcome.

Methods

A retrospective analysis of patients requiring surgical intervention on peripheral vessels from a prospectively collected single surgeon database over a two-year period was conducted. Data were analysed using SPSS version 15.0 windows statistical package.

Results

Fourteen peripheral vascular surgical procedures were performed. The age range was 2–70years (24.4±16.3) with five cases (35.7%) in 20–29year group. Trauma accounted for 11 (73.3%) cases. Upper limb involvement occurred in 7 (63.6%) of the traumatic cases whereas all 2 true aneurysm occurred in the lower limb. Direct repair was possible in re-establishing anatomic continuity in about 64% of cases. Of the six morbidities, wound infection accounted for 50% followed by failure of re-vascularizaton (33.3%) and there was one mortality.

Conclusion

Trauma is the leading cause of peripheral vascular condition necessitating surgery from our study. Young adults predominate. Though direct repair are often feasible, there is a need for the availability of graft options. Wound infection constitutes the highest post-operative morbidity.     

微小RNA与血管钙化

血管钙化是糖尿病、慢性肾疾病、高血压病等普遍存在的病理改变,与心血管疾病的高发病率和病死率密切相关。近来发现微小RNA（microRNA,miRNA）能够通过调控血管平滑肌细胞的表型改变从而影响血管钙化的发生和发展。本文综述miRNA在调节血管平滑肌细胞的表型改变及血管钙化方面的新进展,并探讨miRNA作为血管钙化诊断标志分子和治疗靶点应用于临床的可能。     

血管平滑肌细胞凋亡在血管再狭窄中作用的研究进展

血管平滑肌细胞构成新生内膜增生的重要部分,且在血管腔内治疗术后再狭窄的心血管疾病的发生和发展中具有重要作用。血管平滑肌细胞凋亡能有效抑制血管球囊损伤和血管旁路移植术后新生内膜增生,从而可为血管术后再狭窄提供治疗手段。     

Vascular alterations in schwannoma

Schwannomas or neurilemmoma are benign peripheral nerve sheath tumors, which most frequently occur at the cerebellopontine angle. This morphologic study examines vascular alterations in these tumors, comparing them to other benign spindle cell neoplasms of the nervous system, while correlating these findings with evidence of vascular permeability. Thirty-four nervous system spindle cell neoplasms, sixteen schwannomas, nine fibroblastic/transitional meningiomas and nine peripheral neurofibromas were stained with H&E, Prussian-blue stain, and immunoreacted for factor VIII-related antigen and interstitial albumin. Schwannomas had focal clusters of vascular proliferation including groups of small thin-walled vessels, as well as larger vessels with extensive hyalinization. Neurofibromas and meningiomas almost uniformly had modest numbers of well-defined, thin walled individual vessels. Free hemosiderin and hemosiderin-laden macrophages were frequently identified in schwannomas. Prussian-blue stain for iron revealed focal or fairly widespread positivity in almost all schwannomas, only one meningioma and none of the neurofibromas. Immunoreaction for albumin demonstrated leakage of vascular proteins into the interstitium confirming tumor vessel permeability in schwannomas. Neither neurofibromas nor meningiomas displayed any detectable interstitial albumin. The above findings confirm a degree of reactive proliferation of vessels in schwannoma along with functional deficits in their vascular integrity with permeability to protein and blood. The presence of hyalinized vessels, hemosiderin, both free and within macrophages, and more readily evident Prussian blue staining, may provide an additional diagnostic clue in discriminating between histologically similar spindle cell lesions. The study however raises the possibility that these changes likely precede or facilitate the degenerative ‘ancient change’ seen in some schwannoma.     

Increased vascular permeability precedes cellular inflammation as asthma control deteriorates

Background Airway microcirculation is abnormal in asthma but the role of vascular changes in asthma deteriorations remains poorly defined. We prospectively assessed the vascular changes accompanying worsening of asthma control by using an inhaled corticosteroid (ICS) dose-reduction model.
Objectives To evaluate airway vascularity, vascular permeability and expression of vascular endothelial growth factor (VEGF) in early asthma deterioration induced by ICS back-titration.
Methods Twenty mild-to-moderate persistent symptomatic asthmatics on low-to-moderate ICS were recruited and treated with 4 weeks of high-dose fluticasone propionate (1000 μg/day) to achieve symptom control. This was followed by dose reduction to half of the pre-study doses for 4–8 weeks until the symptoms began to return. Endobronchial biopsy and bronchoalveolar lavage (BAL) samples were obtained after both treatment periods.
Results Vascularity as measured by the number and size of blood vessels, as well as VEGF expression did not change following ICS reduction. Even on high-dose ICS, perivascular albumin staining and BAL microalbumin levels in asthmatic subjects, as markers of permeability, were elevated when compared with normal subjects and both further increased significantly after ICS reduction. There was a significant association between changes in vascular leakiness and clinical deterioration. Increases in airway albumin correlated with previously reported increases in airway wall infiltration with T lymphocytes.
Conclusions Our results suggest that airway vascular leakage is a major pathophysiologic feature of early asthma deterioration, occurring before recrudescence of cellular inflammation.     

煤矿掘进工血浆血管内皮活性物质的测定及意义

目的 :探讨手臂振动对血管内皮活性物质的影响及其意义。方法 :应用放射免疫分析 ,对不同接振时间的煤矿掘进工进行血浆内皮素 (ET)、血管紧张素Ⅱ(AngⅡ)、降钙素基因相关肽 (CGRP)的测定 ,并同对照组进行比较分析。结果 :ET、AngⅡ随接振时间延长有明显增高趋势 (p <0 0 5 ,p <0 0 1) ,CGRP随接振时间延长有显著下降趋势 (p <0 0 1)。结论 :手臂振动可导致血管内皮活性物质的改变 ,这种改变可能与振动性血管损伤、振动性白指有一定联系。     

Intravenous tufted angioma

A case of a rare vascular tumor, intravenous tufted angioma, is described. A 51-year-old Japanese man presented with a 12x8 mm solitary reddish nodule on the right foot, which had been found at birth. Histologically, the tumor was confined to a malformed vein and was characterized by nodular aggregates of plump cells. The aggregates showed a compact proliferation of round cells, including capillary-forming cells. Venous angiomatous areas were also observed. No multinucleated giant cells were seen. Immunohistochemically, the capillary-forming cells in the aggregates and the endothelial cells in the angiomatous areas were positive for endothelial markers (factor VIII-related antigen, CD31, CD34). Pericyte-like cells expressing alpha-smooth muscle actin and muscle actin, and macrophage-like cells, which stained for factor XIIIa, were intermingled in the cellular aggregates. Flow cytometric analysis showed diploidy. The tumor may be a hamartomatous lesion modified by secondary reactive changes, and it may represent a distinctive clinicopathological entity that is closely related histogenetically and perhaps pathologically to tufted angioma and the recently described "giant cell angioblastoma".     

冠状动脉血管直径测量方法的研究

心脏是人体生命活动的重要器官，能否正常工作主要是由心血管系和心传导系决定。冠状动脉是给心脏供血的唯一途径，心肌能否得到足够的营养、保持连续有节奏地运动，完全取决于冠状动脉是否能不断地供给其营养。冠状动脉直径的测量以及血管直径参数对于反映心脏功能和疾病的诊断具有重要意义。文中提出一种新型的、简便的血管直径测量方法，利用计算得到的血管直径，我们就可以判别心血管狭窄位置。     

球囊损伤血管内皮后平滑肌细胞凋亡及相关基因表达的变化

目的:探讨球囊损伤血管内皮后平滑肌细胞(SMC)凋亡的机制。方法:采用末端脱氧核苷酸转移酶介导的三磷酸脱氧尿嘧啶缺口末端标记法(TUNEL)和免疫组织化学技术检测球囊损伤内皮后血管平滑肌细胞(VSMC)凋亡及Bax/Bcl-2蛋白的变化。结果:球囊损伤内皮后第3d,血管中层出现凋亡的SMC;损伤后第7d,内膜和中层SMC凋亡率最高,凋亡的SMC主要分布在内膜层;以后逐渐降低,至损伤后第28d,仅内膜层有少量凋亡的SMC。Irbesartan显著增加SMC凋亡(P＜0.01)。球囊损伤内皮后第3d,血管中层Bax/Bcl-2表达显著高于假手术组(P＜0.01);损伤后第7d血管中Bax表达最高,是假手术组的3倍,以后表达减少。球囊损伤内皮后Bcl-2表达逐渐增多,至第28d表达最高。Bax/Bcl-2也在损伤后第7d达最高,至第28d降至基础水平以下。Irbesartan使Bax表达增高、Bcl-2表达降低、Bax/Bcl-2升高。结论:Bax/Bcl-2参与了球囊损伤内皮后VSMC凋亡的调节。     

小檗碱改善动脉粥样硬化小鼠的血管炎性反应和钙化

目的以Apo^-/-E小鼠和HUVECs为对象研究小檗碱对动脉粥样硬化的缓解作用。方法 6~8周龄的雄性Apo^-/-E小鼠随机分为对照组、模型组(给予高脂饲料喂养4周)、小檗碱组[灌胃给予,100 mg/(kg·d)]和阿托伐他汀组[灌胃给予,5 mg/(kg·d)],每组12只。生化分析仪检测血清中TC、TG、LDL-C和HDL-C含量;ELISA检测IL-6、ALP、BMP-2和TNF-α的表达;化学发光法检测钙含量;分离主动脉并进行HE染色,免疫组化检测组织中BMP-2 OPG、OCN、RUNX2表达量;化学发光法检测主动脉组织匀浆中ALP的表达和钙含量。将HUVECs细胞分为对照组、模型组(TNF-α刺激)和小檗碱组(浓度分别为7.5,10,15,20 mg/L)。ELISA检测ICAM、VCAM和MMP-9表达量。结果与对照组相比,模型组动物血清中炎性因子和血脂4项水平明显上升(P<0.05),血管内斑块明显,血管组织中ALP、BMP-2、OPG、OCN和RUNX2表达量升高(P<0.05)。小檗碱治疗后可明显降低血清中LDL-C和TC水平(P<0.05),抑制炎性因子IL-6分泌,降低血清和组织中的ALP、BMP-2、OPG、OCN、RUNX2和钙含量(P<0.05),抑制血管炎性浸润并提高斑块稳定性。与对照组相比,模型组HUVECs细胞ICAM、VCAM和MMP-9表达上调,小檗碱抑制ICAM、VCAM和MMP-9表达。结论小檗碱能够有效调节高脂饮食动物的血清脂质水平,减少炎性介质对血管内皮的损伤并抑制血管钙化,有可能改善动脉粥样硬化发挥心血管保护作用。     

Angiogenic Factor with G-patch and FHA Domain 1 (AGGF1) Expression in Human Vascular Lesions

Angiogenic factor with G-patch and FHA domain 1 (AGGF1) is a novel angiogenic factor that was first described in Klippel-Trenaunay syndrome, a congenital vascular disease associated with capillary and venous malformations. AGGF1, similar to vascular endothelial growth factor (VEGF), has been shown to promote strong angiogenesis in chick embryos in vivo. Blocking AGGF1 expression prevented vessel formation, which suggests AGGF1 is a potent angiogenic factor linked to vascular malformations. So far, AGGF1 expression studies in human vascular lesions have not been performed. Here, we immunohistochemically investigated AGGF1 expression in venous, arteriovenous or capillary malformations, and infantile or congenital hemangioma. We found that AGGF1 was mostly expressed in endothelial cells with plump morphology. Moreover, the majority of mast cells strongly expressed AGGF1. Notwithstanding our incomplete knowledge of the molecular mechanism of AGGF1 in angiogenesis, our results show for the first time that AGGF1 is expressed in plump endothelial cells and mast cells.     

小口径人工血管构建研究现状与展望

人工血管在临床上的需求不断增长,但问题也较普遍,特别是小口径人工血管植入后再狭窄率较高,其低通畅率限制了其临床应用。本文介绍了小口径人工血管构建研究的国内外发展动态,包括人工血管支架的制备及修饰方法,细胞及细胞外微环境在人工血管构建中的作用,并对小口径人工血管构建面临的问题及研究方向进行了讨论与展望。     

肝门阻断和再开放对兔胰腺功能的影响

目的：观察肝门阻断（HVO）及再开放（HVR）后胰腺内外分泌功能的改变。方法：选择健康日本大耳白兔25只，体重2.3-3.0 kg，分别于HVO前、HVO 10、20 min及HVR后（10、30、60、120 min）不同时点取血，并在HVO前、HVO 20 min、HVR后120 min 3个时点取胰腺组织，电镜下观察其超微结构的变化。结果：HVO时，血浆葡萄糖、胰岛素水平及一氧化氮代谢产物（NO₂^-/NO₃^-）含量均明显低于阻断前，胰高血糖素/胰岛素及丙二醛（MDA）浓度显著高于阻断前（P<0.05或P<0.01），并随阻断时间延长而加重；血浆淀粉酶、脂肪酶、游离脂肪酸水平则无明显差异（P>0.05）；胰岛细胞的线粒体肿胀、粗面内质网扩张，细胞核形态、结构基本正常，而胰腺腺泡细胞变化则不明显。HVR后上述差异逐渐不明显，至120min才接近阻断前水平。结论：急性肝门阻断和再开放对胰腺内分泌功能有较大的影响。     

基于弹性小球动态平衡的血管中心线和直径的测量

血管中心线及直径的测量是血管类疾病诊断和微创介入治疗的重要依据.当前研究主要依据图像细化算法,但是细化算法缺乏计算结果的一致性.提出一种基于弹性小球动态平衡的血管中心线和直径的测量方法.首先在血管内部以交互的方式输入一条多段线(polyline)来确定感兴趣的血管部位,然后对多段线离散化为一组点,通过对离散点逐步膨胀为小球以及在小球与血管壁碰撞的两个力影响下,对小球和多段线同时变形,最后在平衡状态下得到的多段线即是血管中心线,小球直径就是该处血管直径.实验中,通过对模拟血管图像和临床DSA图像的量化测量及与常用方法对比,表明所提出算法能够精确地得到血管中心线与血管直径.     

Wnt信号通路在血管钙化中作用的研究进展

血管钙化是一种主动的可调控的类似于骨或软骨性发育的复杂过程，涉及许多疾病的发病过程，如动脉粥样硬化、高血压、糖尿病及慢性肾病等。研究发现Wnt信号通路以旁分泌或自分泌的方式参与心脏发育、心肌肥厚、动脉粥样硬化及血管再生等病理生理过程。近年来，Wnt信号通路在血管钙化发病过程中的作用亦日益受到重视。     

血管内皮生长因子基因的表达及血管生成作用

构建新的血管内皮生长因子（ＶＥＧＦ）高效真核表达载体ｐｃＤ２／ＶＥＧＦ,体外转染ＶＳＭＣ〈发现其在ＶＳＭＣ中的表达效率较ｐｃＤＮＡ３／ＶＥＧＦ明显增高,体外和体内实验证实ＶＥＧＦ基因具有显著促进血管生成的作用。     

Vascular abnormalities at the site of limb deficiency

A case is presented of a child born with a left forearm deficiency and a cavernous hemangioma covering the tip of the forearm and left elbow. Points relative to the potential associations of vascular abnormalities and limb deficiencies are discussed. © 1992 Wiley-Liss, Inc. © 1992 Wiley-Liss, Inc.     

2型糖尿病患者血清VEGF与sVCAM-1水平的变化及其临床意义

目的探讨2型糖尿病（type Ⅱ diabetes mellitus,T2DM）血清中血管内皮细胞生长因子（VEGF）与可溶性血管细胞黏附分子-1（sVCAM-1）的水平及其临床意义。结论采用双抗体夹心酶联免疫吸附法（ELISA）检测20例2型糖尿病患者和25例正常人血清VEGF与sVCAM-1水平。结果 2型糖尿病患者血清VEGF和sVCAM-1水平（389.64±54.60）pg/ml和（1443.87±422.33）ng/ml较正常对照组（100.60±22.81）pg/ml和（648.26±173.66）ng/ml明显升高（P〈0.05）。结论 2型糖尿病患者血清VEGF、sVCAM-1含量增高,可能与2型糖尿病的发病机制有关。     

血管P2受体的功能及其与某些血管疾病的关系

P2受体分为配体门控离子通道型P2X受体和G蛋白偶联型P2Y受体。血管内皮细胞及平滑肌细胞有多种P2X和P2Y受体亚型表达。嘌呤信号与动脉粥样硬化、脑血管老化及血管重塑等血管疾病有关,并可能为治疗与血管有关疾病提供新的治疗靶点。