External venous valve plasty (EVVP) in patients with primary chronic venous insufficiency (PCVI).

OBJECTIVES: To evaluate the patency of EVVP and its effect in symptom relief, ulcer healing and ulcer-free period in patients with PCVI. METHODS: Between 1993 and 2004, 1800 patients with CVI were evaluated and seventeen with PCVI were selected for EVVP. They were all investigated with ambulatory venous pressure measurement (AVP), colour duplex ultrasound (CDU), ascending venography and descending video venography. The CEAP classification was used to group the patients. Six patients were C4, four C5 and seven C6. All had deep reflux and high levels of AVP. RESULTS: All procedures were technically successful. The ulcer healing rate was 4/7 (57%) within 3 months. All C4 patients experienced symptom improvement postoperatively and had a median recurrence free period of 72 (range 60-122) months. The C5 group had an median ulcer free period of 61 months (12-72) and the C6 of median 48 (12-72) months. Single valve plasties (4) reached a median competence period of 48 months (12-72), 12 multiple valve plasties at the same level show a median 78 months (63-122) and 10 multilevel repairs median 54 months (12-96). Multiple valve plasties at the same level (multi-station plasties) performed on the C4 group seemed to yield the longest durability with a median of 103 months (84-122). CONCLUSION: EVVP with an ulcer healing rate of 57% and satisfactory symptom improvement seems to be an alternative of surgical treatment for selected patients with PCVI. The durability of this technique seems to be related to clinical severity and the multiplicity of repairs.     

Effects of mechanical irritation on the autonomic part of the median nerve

The diagnosis of median nerve compression is generally based upon a prolonged nerve conduction velocity although this frequently is preceded by clinical symptoms for years. The present study was designed to identify indicators for early decompression of the median nerve in patients exhibiting symptoms compatible with carpal tunnel syndrome (CTS). Microvascular perfusion in finger tip skin and skin temperature were studied during dorsiflexion of the hand prior to and following a manual exercise test in control subjects and in patients with clinical symptoms and signs of CTS. Evaluation of the microcirculation was performed using photoplethysmography (PPG) and laser Doppler fluxmetry (LDF). Fingertip skin temperature was measured by thermography and was significantly reduced in patients after exercise ( P  < 0.001), whereas no significant change occurred in control subjects. During increasing degrees of dorsiflexion (0–75°) and after manual exercise, fingertip skin perfusion remained unchanged in both patients and control subjects. In conclusion, patients with low-grade CTS experience skin temperature reduction, presumably caused by increased sweating as opposed to a generally suspected vasoconstriction. These autonomic median nerve dysfunctions provide the physiological basis for the use of thermography in confirming low-grade CTS.     

Edema in the lower limb of patients operated on for proximal femoral fractures

BACKGROUND: Patients with proximal femoral fracture (PFF) often develop postoperative edema in the operated limb. This may lead to reduced mobilization, increasing the length of hospitalization. It is therefore relevant to gain information about the extent and pathogenesis of this edema formation. METHODS: Forty-one patients with PFF (30 women and 11 men) were studied pre- and postoperatively. Patients were grouped into pertrochanteric fractures and femoral cervical fractures, according to the AO/ASIF classification of PFF. Thigh and calf volumes were calculated in both fractured and contralateral limbs preoperatively and on postoperative days 3, 5, 7, and 30. RESULTS: All patients with PFF developed edema in the operated limb. The greatest volume increase occurred on postoperative day 7 (p < 0.0005). The magnitude of edema in the thigh and the leg of patients with pertrochanteric fractures as compared with the nonoperative side was approximately twice as great as in those with femoral cervical fractures (p < 0.0001). There was a statistically significant daily increase in the volume of the operative limb as compared with the nonoperative side. Age and sex were not correlated with the extent of edema formation. Functionally significant deep venous thrombosis and local infection could be excluded as causative factors. CONCLUSIONS: Postoperative edema in the thigh and leg of the operated limb was considerable. The magnitude of edema formation was related to the severity of primary trauma and the type of osteosynthesis. Therefore, the operation performed for PFF should be minimally traumatic.     

Detection of high molecular weight DNA fragments characteristic of early stage apoptosis in cerebellar granule cells exposed to glutamate

In cerebellar granule cells a rapid necrotic cell death has been observed during and immediately after glutamate exposure, followed by a delayed apoptotic type of neuronal death in a subpopulation of the surviving neurons. In some experimental models the DNA fragmentation characteristic of apoptosis is readily detected. In other systems apoptosis may occur only in a limited number of cells, rendering DNA fragmentation undetectable using conventional DNA-staining techniques (e.g., ethidium bromide). We have used a sensitive and non-radioactive method for labeling, detection, and quantification of high molecular weight (HMW) DNA fragments. This method is based on the introduction of thymine dimers into DNA after separation by pulse field gel electrophoresis, followed by detection with thymine dimer specific antibodies. Applying this method to cerebellar granule cells in culture, we detected an increase in the amount of HMW DNA fragments characteristic of apoptosis as early as 4 h after glutamate exposure. The N-methyl-D-aspartic acid (NMDA)-receptor antagonist MK801 protected against the fragmentation, whereas no protection was observed using the non-NMDA-receptor antagonist CNQX.     

Remote ischemic preconditioning preserves mitochondrial function and activates pro-survival protein kinase Akt in the left ventricle during cardiac surgery: A randomized trial

Background

Understanding the intracellular mechanisms induced by remote ischemic preconditioning (RIPC) in the human left ventricle opens new possibilities for development of pharmacological cardioprotection against ischemia and reperfusion injury. In this study we investigated the effects of RIPC on mitochondrial function, activation of pro-survival protein kinase Akt and microRNA expression in left ventricular biopsies from patients undergoing coronary artery bypass surgery (CABG).

Methods

Sixty patients were randomized to control (n = 30) or RIPC (n = 30). A blood pressure cuff was applied to the arm of all patients preoperatively. The cuff remained deflated in control group, whereas RIPC was performed by 3 cycles of cuff inflation to 200 mm Hg for 5 min, separated by 5 min deflation intervals. Left ventricular biopsies were obtained before and 15 min after aortic declamping. The primary outcome was mitochondrial respiration measured in situ. Secondary outcomes were activation of protein kinase Akt, assessed by western immunoblotting, and expression of microRNAs assessed by array and real-time polymerase chain reaction.

Results

Mitochondrial respiration was preserved during surgery in patients receiving RIPC (+ 0.2 μmol O₂/min/g, p = 0.69), and reduced by 15% in controls (− 1.5 μmol O₂/min/g, p = 0.02). Furthermore, RIPC activated protein kinase Akt before aortic clamping (difference from control + 43.3%, p = 0.04), followed by increased phosphorylation of Akt substrates at reperfusion (+ 26.8%, p < 0.01). No differences were observed in microRNA expression.

Conclusions

RIPC preserves mitochondrial function and activates pro-survival protein kinase Akt in left ventricle of patients undergoing CABG. Modulation of mitochondrial function and Akt activation should be further explored as cardioprotective drug targets.Clinical Trial Registration: http://www.clinicaltrials.gov, unique identifier: NCT01308138.     

Pre- and postischemic transcutaneous oxygen tension measurements and the determination of amputation level in ischemic limbs

The value of transcutaneous pO2 (TCpO2) measurements in determining amputation levels was studied in patients with atherosclerotic lower limb ischemia. A postischemic TCpO2 response did not predict healing of the amputation stump better than measurements at rest. No minimal resting or postischemic TCpO2 was found below which healing could not occur. However high TCpO2 values probably are indicative of a good healing potential. In patients with poor skin viability, assessed clinically, the method may be of value; in some cases TCpO2 values compatible with healing may be found. Attention should be paid to the TCpO2 sensor as its characteristics may influence the measurements in patients with critical ischemia causing underestimation of tissue pO2.