[FLIGHT CERTIFICATION OF CIVILIAN PILOTS FOLLOWING SURGERY OF BRACHIOCEPHALIC ATHEROSCLEROTIC STENOSES].

The paper presents cases of surgery of brachiocephalic atherosclerotic lesions with asymptomatic stenosis in civilian pilots reviewed by a Flight Certification Board. Cerebrovascular diseases varying in their clinical presentation (syncopes, transitory ischemic attacks or strokes) may culminate in acute conditions and, consequently, threaten flight safety. There is an exigent need of law-guided regulations for flight certification boards on how to manage cases of pilots with a history of cerebrovascular disease.

Lower extremities peripheral arterial disease among patients admitted to cardiac rehabilitation: the THINKPAD registry.

BACKGROUND/OBJECTIVES: Lower extremities peripheral arterial disease (LE-PAD) across the wide range of conditions for Cardiac Rehabilitation (CR) is poorly understood. The "ATHerosclerosis of the lower extremIties as a liNKed comorbidity in Patients Admitted for carDiac rehabilitation" (THINKPAD) registry explored LE-PAD in CR patients in terms of prevalence and interventions delivered. METHODS: Multicenter, consecutive case series of 1506 patients discharged from 16 CR Units in Italy from May 1 to June 30, 2012. RESULTS: LE-PAD constituted a primary indication for CR and a comorbidity on admission in 2.6% and 9.3% of patients respectively. LE-PAD patients were significantly older (72 ± 9 vs. 67 ± 12 years, p<0.001) and displayed a worse cardiovascular risk profile (diabetes 38% vs. 23%, hypertension 86% vs. 63%, hypercholesterolemia 74% vs. 52%, smoking 72% vs. 50%, low level of physical activity 84% vs. 69%, impaired diet habits 69% vs. 55%, p<0.01 for all). COPD (17% vs. 11%, p<0.05), CKD (20% vs. 10%, p<0.01), and past history of coronary revascularization (29% vs. 14%, p<0.001) were also more represented in the LE-PAD group. Half of LE-PAD patients received a formal staging, with low provision of ABI (18%) and color Doppler (48%) investigation. Secondary prevention targets at the end of CR for blood pressure and lipid control were accomplished in 83% and 46% of patients respectively (strongly correlated with the presence of CAD), while other guideline-recommended drugs for LE-PAD were prescribed in less than 4% of cases. CONCLUSION: LE-PAD represents an uncommon referral indication for CR. Our data confirm its systematic underassessment and undertreatment.

Aterosclerose: diagnóstico macroscópico nas autópsias / Atherosclerosis: macroscopic diagnosis at autopsy

O diagnóstico macroscópico da aterosclerose nas autópsias é essencial; por ser um processo inflamatório crônico do leito arterial, tem graves consequências para o aparelho circulatório, tendo como resultado o infarto cerebral isquêmico, hemorragias encefálicas, infarto agudo do miocárdio, arteropatias, aneurismas, cardiopatias isquêmicas e morte súbita. Fatores de risco genéticos e ambientais influenciam fortemente seu surgimento. Seu diagnóstico macroscópico durante as autópsias é condição sine qua non para entender a sequência de eventos fisiopatológicos que levaram ao óbito, permitindo a identificação da causa mortis.

Marcha de pacientes com doença arterial obstrutiva periférica e claudicação intermitente / Gait of patients with peripheral obstructive arterial disease and intermittent claudication

INTRODUÇÃO: Pacientes com doença arterial obstrutiva periférica (DAOP) e claudicação intermitente (CI) apresentam prejuízo no desempenho de caminhada e alterações nos parâmetros espaço-temporais da marcha, mesmo na ausência de dor. OBJETIVO: Analisar os parâmetros espaço-temporais da marcha de pacientes com DAOP e CI participantes de programa de reabilitação. MÉTODOS: A amostra foi constituída por 12 pacientes com DAOP e CI, sendo 75 por cento do sexo masculino e idade média de 63,3 ± 8,6 anos. Todos os pacientes participavam de programa de reabilitação e apresentavam melhora no desempenho de caminhada após os tratamentos; sete foram avaliados em longo prazo (de seis a 24 meses) e cinco em curto prazo (dois meses). Velocidade, comprimento da passada e cadência foram analisados antes e logo após o início da claudicação em pista de 6m de papel. A claudicação foi induzida por meio de caminhada em esteira ergométrica. As avaliações foram realizadas ao final dos tratamentos e analisadas inter e intragrupos. RESULTADOS: Velocidade de marcha (1,06m/s ± 0,29 vs 1,10m/s ± 0,06), comprimento da passada (1,34m ± 0,27 vs 1,33m ± 0,11) e cadência (93,81 passos/min ± 7,20 vs 99,84 passos/min ± 8,99) foram similares entre os grupos tratados em curto e em longo prazos (p > 0,05). Na avaliação intragrupos, ocorreu diminuição significativa no comprimento da passada dos pacientes tratados em curto prazo após a indução da claudicação (1,34m ± 0,27 vs 1,09m ± 0,03), com p = 0,05. CONCLUSÃO: Não ocorreram diferenças significativas nos parâmetros espaço-temporais da marcha entre os grupos. As características da marcha persistem, inclusive na ausência da dor e com a melhora do desempenho de caminhada, em pacientes participantes de programa de reabilitação.

INTRODUCTION: Patients with peripheral obstructive arterial disease (POAD) and intermittent claudication (IC) present difficulty in gait performance and alterations in the spatio-temporal parameters of gait, even in the absence of pain. AIM: to assess the spatio-temporal of gait parameters of patients with POAD and IC participants in a rehabilitation program. METHODS: The sample was composed of 12 patients with POAD and IC, being 75 percent males and mean age of 63.3 8.6 years. All patients participated in a rehabilitation program and presented gait improvement after treatments; seven patients were long-term assessed (from six to 24 months) and five patients were short-term assessed (two months). Velocity, step length and cadence were assessed before and immediately after claudication began on a 6-m paper track. Claudication was induced by gait on treadmill. Evaluations were performed at the end of the treatment and inter and intra-groups assessment was carried out. RESULTS: Gait velocity (1.06 m/s 0.29 vs 1.10m/s 0.06) step length (1.34 m 0.27 vs 1.33m 0.11) and cadence (93.81 steps/min 7.20 vs 99.84 steps/min ± 8.99) were similar between groups short and long-term treated (p> 0.05). In intragroup assessment, significant decrease was observed in the step length of patients short-term treated after claudication induction (1.34m ± 0.27 vs 1.09m ± 0.03) with p = 0.05. CONCLUSION: No significant differences were observed in the spatio-temporal parameters of gait between groups. The gait characteristics remain, even in the absence of pain and with gait performance improvement with patients participating in rehabilitation programs.

Lower limb atherosclerotic disease causes various deteriorations of patients' health-related quality of life.

BACKGROUND: Lower limb atherosclerotic disease (LLAD) is a worldwide health problem. Approximately 100,000 Finns have LLAD. Currently, a large number of health-related quality of life (HRQoL) studies are available, but we still have scant comprehensive information of HRQoL of patients with LLAD. OBJECTIVES: The aim was to describe the HRQoL of women and men with LLAD in relation to the age- and sex-matched general population. In addition, the purpose was to study which demographic and relevant clinical and psychologic factors are connected with HRQoL of patients with LLAD. METHODS: Patients with LLAD (N = 180, 62 women and 118 men) were recruited to participate in this study in the Clinic of Surgery, Oulu University Hospital, from 2001 to 2004. The control sample consisted of an age- and sex-matched general population (N = 2126; 1081 women and 1045 men). The HRQoL of the women and men with LLAD was evaluated using the Nottingham Health Profile (NHP) instrument, in relation to an age- and sex-matched general population (N = 2126) as well as demographic and relevant clinical and psychologic factors. RESULTS: The HRQoL of men was significantly (P < .05) poorer on all dimensions of the NHP instrument in the age groups 55 to 74 years. HRQoL was also clearly affected in the youngest age group of men on the dimensions of pain (P < .05) and mobility (P < .05) and further in the oldest age group on the dimension of energy (P < .05). The HRQoL of women with LLAD was only significantly poorer (P < .05) on the dimension of pain in the age group of 65 to 74 years than the HRQoL of age-matched Finnish women. The most emphasized relationships between poor HRQoL and the demographic, relevant clinical and psychologic factors were male sex, lack of exercise, retirement, a short painless walking distance, other atherosclerotic disease, poor subjective health status, problems with ability to cope at home, problems with the treatment of illness, and sex life. Male patients with LLAD had poorer HRQoL than the corresponding female patients on the dimensions of energy (P = .023), emotional reaction (P = .050), social isolation (P = .028), and NHP total score (P = .023). Those who did not exercise regularly had poorer HRQoL on the dimensions of energy (P = .005), pain (P = .049), emotional reaction (P = .007), social isolation (P = .001), and physical mobility (P = .028) than those who did exercise regularly. CONCLUSIONS: The HRQoL of middle-aged men was significantly poorer than that of controls. Male sex, retirement, asymptomatic walking distance, other atherosclerotic disease, lack of exercise, and feeling incapable of performing daily activities are important causes of impaired HRQoL. Health care professionals should pay extra attention to the development of rehabilitation programs aimed at preventing patients with LLAD from experiencing a myriad of problems.