Radial artery hypertrophy occurs in coronary atherosclerosis and is independent of blood pressure

Endothelial dysfunction, believed to underlie the structural changes of atherosclerosis, is a systemic phenomenon. Despite this, the radial artery has been considered as devoid of atherosclerosis and is commonly used as a conduit in coronary artery bypass grafting (CABG). Recently, histological study has shown intimal hyperplasia and other structural changes consistent with early atherosclerosis in the radial artery. The objective of the present study was to determine if structural changes in the radial artery could be detected in vivo in patients with coronary atherosclerosis. Using high resolution echo-tracking, measurements of radial artery internal diameter, wall thickness and wall cross-sectional area were made in 25 patients awaiting CABG and in 20 controls. Digital and brachial blood pressures were also recorded. Mean arterial pressures did not differ between the patient and control groups. All measures of wall thickness were greater in the patient than the control group. Neither current arterial pressures nor past history of hypertension correlated with wall thickness. Using a model of analysis of covariance, coronary artery disease was the best single predictor of intima-media thickness, R(2)=48%, n=44, P<0.0005. We concluded that increased radial artery wall thickness can be demonstrated in vivo in patients with coronary atherosclerosis. This is a novel observation which seems to be independent of blood pressure, and is consistent both with the hypothesis of systemic endothelial dysfunction leading to systemic structural changes and also to the recent histological evidence for atherosclerotic changes in this vessel.     

A Novel in‐Frame 18‐bp Microdeletion in MT‐CYB Causes a Multisystem Disorder with Prominent Exercise Intolerance

A novel heteroplasmic mitochondrial DNA (mtDNA) microdeletion affecting the cytochrome b gene (MT‐CYB) was identified in an Italian female patient with a multisystem disease characterized by sensorineural deafness, cataracts, retinal pigmentary dystrophy, dysphagia, postural and gait instability, and myopathy with prominent exercise intolerance. The deletion is 18‐base pair long and encompasses nucleotide positions 15,649–15,666, causing the loss of six amino acids (Ile‐Leu‐Ala‐Met‐Ile‐Pro) in the protein, but leaving the remaining of the MT‐CYB sequence in frame. The defective complex III function was cotransferred with mutant mtDNA in cybrids, thus unequivocally establishing its pathogenic role. Maternal relatives failed to show detectable levels of the deletion in blood and urinary epithelium, suggesting a de novo mutational event. This is the second report of an in‐frame intragenic deletion in MT‐CYB, which most likely occurred in early stages of embryonic development, associated with a severe multisystem disorder with prominent exercise intolerance.     

The role of uterine artery embolization in the management of uterine fibroids

PURPOSE OF REVIEW: Uterine artery embolization is increasingly being offered as an alternative to hysterectomy and myomectomy for the treatment of symptomatic uterine fibroids. This review is intended to evaluate the role of this technique in the management of uterine fibroids using information provided from recently published literature. RECENT FINDINGS: A growing body of literature supports the efficacy of uterine artery embolization in relieving fibroid-related menorrhagia, pelvic pain and pressure symptoms and in substantially reducing the fibroid size in most patients. Recent publications also show significant improvements in health-related quality of life and high long-term satisfaction rates. The procedure is associated with shorter hospitalization and recovery times and lower morbidity rates compared with conventional surgical treatments. However, serious complications, such as uterine infarction or infection leading to emergency hysterectomy, have been reported in a few cases, and considerable work is currently underway to determine how the safety of the procedure can be enhanced. Although no long-term data on subsequent fertility are yet available, early reports on ovarian function and pregnancy outcomes after uterine artery embolization are encouraging. SUMMARY: Based on current evidence, uterine artery embolization can be considered a valuable alternative to surgical therapy in the management of well-selected women with symptomatic uterine fibroids. Additional research is needed to help define the place of this technique for women who desire future pregnancy.     

Local pulse pressure is a major determinant of large artery remodelling

1. The aim of the present brief review is to show that the pulsatile component of blood pressure is a stronger determinant of large artery remodelling than the steady component (i.e. mean blood pressure). 2. Pulse pressure, which is a strong determinant of cardiovascular events, including coronary heart disease and stroke, is increased when large arteries stiffen. Local pulse pressure, measured with applanation tonometry in normotensives and patients with essential hypertension, explains a significant part of the variance of intima-media thickness at the site of the carotid artery, a proximal elastic artery, whereas mean blood pressure does not contribute. Local pulse pressure has no influence on intima-media thickness at the site of the radial artery, a distal muscular artery that undergoes very little stroke change in diameter. 3. The decrease in carotid pulse pressure is also a major determinant of the regression of carotid intima-media thickness after antihypertensive treatment. Local pulse pressure can influence not only intima-media thickness, but also internal diameter. Indeed, there is a significant association between the lumen enlargement of the ascending aorta in patients with Marfan syndrome and pulse pressure. In addition, carotid pulse pressure is positively correlated with carotid internal diameter in normotensives and hypertensives, and the decrease in carotid internal diameter during long-term antihypertensive treatment is influenced by the decrease in carotid pulse pressure and not by the reduction in mean blood pressure. 4. We suggest that the effects of pulse pressure on large artery remodelling may explain part of its predictive value on cardiovascular events.     

Ultrasonic and endocrinologic aspects in gonadotropin releasing hormone induction of ovulation

Ovarian growth, follicular size, 17 beta-estradiol (E2), androstenedione (A) and testosterone (T) peripheral levels were evaluated in 12 hypogonadotropic patients during the follicular phase on 12 cycles of pulsatile GnRH iv administration. During GnRH therapy, significant correlations between E2 plasma levels and volume of the dominant follicle (p less than 0.001) as well as total follicular volume (p less than 0.001) and total ovarian volume (p less than 0.01) were found. Plasma A was significantly related to the ultrasonic changes of ovarian stroma and those follicles which usually fail to ovulate. Plasma T showed a significant correlation with ovarian stroma (p less than 0.05). Significant correlations of E2/A and E2/T peripheral ratios with volume of the dominant follicle (p less than 0.01) were also found. In spontaneous ovulatory cycles, similar correlations between endocrine and morphological parameters have been already published. The findings of the present investigation indicate that in spontaneous and GnRH-induced cycles the endocrine events associated to the follicular development are quite similar. In hypogonadotropic patients, a "normal" follicular maturation may be obtained by means of this therapy.     

Non-surgical management of uterine fibroids

BACKGROUND: Efforts to develop alternatives to surgery for managementof symptomatic uterine fibroids have provided new techniquesand new medications. This review summarizes the existing literatureon uterine artery embolization (UAE) and investigational studieson four newer approaches. METHODS: PubMed, Cochrane and Embasewere searched up to December 2007. Studies reporting side-effectsand complications and presenting numerical data on at leastone outcome measure were included. RESULTS: Case studies report50–60% reduction in fibroid size and 85–95% reliefof symptoms following UAE. The largest of these studies reportedan in-hospital complication rate of 2.7% (90 of 3041 patients)and a post-discharge complication rate of 26% (710 of 2729 patients).Eight studies compared UAE with conventional surgery. Best evidencesuggested that UAE offered shorter hospital stays (1–2days UAE versus 5–5.8 days surgery, 3 randomized controlledtrials (RCTs)) and recovery times (9.5–28 days UAE versus36.2–63 days surgery, 3 RCTs) and similar major complicationrates (2–15% UAE versus 2.7–20% surgery, 3 RCTs).Four studies analysing cost-effectiveness found UAE more cost-effectivethan surgery. There is insufficient evidence regarding fertilityand pregnancy outcome after UAE. Five feasibility studies aftertransvaginal temporary uterine artery occlusion in 75 womenshowed a 40–50% reduction in fibroid volume and two earlystudies using magnetic resonance guided–focused ultrasoundshowed symptom relief at 6 months in 71% of 109 women. Two smallRCTs assessing mifepristone and asoprisnil showed promisingresults. CONCLUSIONS: Good quality evidence supports the safetyand effectiveness of UAE for women with symptomatic fibroids.The current available data are insufficient to routinely offerUAE to women who wish to preserve or enhance their fertility.Newer treatments are still investigational.     

Ovarian vein incompetence: a potential cause of chronic pelvic pain in women

OBJECTIVE(S): To evaluate whether ovarian vein incompetence may be a source of chronic pelvic pain (CPP) in women. STUDY DESIGN: Twenty-two women, aged 19-50 years, with chronic pelvic pain, no laparoscopically detected pelvic pathology, and evidence of reflux in dilated pelvic veins on transvaginal color Doppler ultrasound underwent retrograde ovarian venography and sclerotherapy of the ovarian vein(s) if incompetent. The primary outcome was symptom change as assessed by a symptom questionnaire and visual analog pain scales (VAS) at 3, 6, and 12 months of follow-up. Changes in pelvic circulations after sclerotherapy procedure were also evaluated by serial ultrasound examinations. Differences between baseline and post-procedural VAS scores were analysed using the Wilcoxon signed-rank test. RESULTS: Twenty (91%) of the 22 women had venographic evidence of incompetent ovarian vein(s) and received sclerotherapy. There were no immediate or late complications. Variable symptom relief was observed in 17 (85%) of the 20 treated women, with follow-up at 12 months showing marked-to-complete relief in 15 patients and mild-to-moderate relief in the remaining 2 patients. Three (15%) women had no improvement in symptoms. Median VAS scores at 3 (2.0), 6 (2.5), and 12 months (3.0) were significantly lower than at baseline (8.0) (P<.001). Follow-up ultrasound examinations showed absence of pelvic venous reflux in all but 3 patients, in whom recurrence of reflux was seen at 3 months. CONCLUSION(S): Ovarian vein sclerotherapy provided symptomatic relief and improved pelvic circulation in most patients. These findings suggest that ovarian vein incompetence was the likely source of chronic pain in these women, and that sclerotherapy was a safe and effective treatment for this condition. CONDENSATION: Ovarian vein incompetence leading to pelvic circulatory changes may be a cause of chronic pelvic pain in women.     

Different effects of ambulatory blood pressure monitoring on subjective and objective sleep quality

OBJECTIVE: To determine whether ambulatory blood pressure monitoring affects objective and subjective sleep quality in patients tested at home. METHODS: Seventy consecutive patients (40 women and 30 men, aged 53+/-15 years), having ambulatory blood pressure monitoring to monitor the efficacy of antihypertensive treatment or to distinguish between hypertension or white-coat hypertension had an evaluation of their sleep quality on a first night with ambulatory blood pressure monitoring and the three following nights without ambulatory blood pressure monitoring. Ambulatory blood pressure monitoring was performed with an auscultatory device with a measure every 15 min during 24 h. Sleep evaluation criteria were both subjective (sleep quality score and sleep questionnaire) and objective (wrist actigraphy monitoring). Sleep parameters during night 1 with ambulatory blood pressure monitoring were compared with those during night 4 without ambulatory blood pressure monitoring. Usual quality of sleep of the patients was assessed by the mean sleep quality score over 7 consecutive days. RESULTS: The sleep quality score was significantly higher for night 4 than for night 1 (7.3+/-2.1 vs. 5.3+/-2.3; P<0.0001). In contrast, actigraphy parameters (actual sleep time, mean activity score, and fragmentation index) were similar on night 1 and night 4 (6.7+/-1.2 vs. 6.9+/-1.2, 13.2+/-9.8 vs. 12.1+/-8.4, and 31.0+/-14.5 vs. 29.9+/-14.3, respectively). Subjective sleep quality was significantly altered by ambulatory blood pressure monitoring in good sleepers (mean sleep quality score > or =7, 73% of patients) but not in poor sleepers. The effect of ambulatory blood pressure monitoring on subjective sleep quality did not differ between dippers and nondippers. CONCLUSIONS: Objective sleep quality as assessed by wrist actigraphy is not significantly altered by ambulatory blood pressure monitoring, whereas subjective sleep quality is adversely affected in good sleepers.