Paraoxonase-1: Characteristics and Role in Atherosclerosis and Carotid Artery Disease.

Paraoxonase-1 (PON-1) is a calcium-dependent enzyme that is synthesized in the liver and then secreted in blood where it is bound to high density lipoprotein (HDL). PON-1 is a hydrolase with a wide range of substrates, including lipid peroxides. It is considered responsible for many of the antiatherogenic properties of HDL. PON-1 prevents low density lipoprotein (LDL) oxidation, a process that is considered to contribute to the initiation and development of atherosclerosis. PON-1 activity and levels are influenced by gene polymorphisms; of the 2 common variants, one is in position 192 (Q192R) and one in position 55 (M55L). Also, many drugs affect PON-1 activity. The role of PON-1 in carotid atherosclerosis is inconsistent. Some studies show an association of PON-1 polymorphisms with carotid plaque formation, whereas others do not. The aim of this review is to summarize the characteristics of PON-1, its interactions with drugs and its role in atherosclerosis and especially its relationship with carotid artery disease.

Platelet rich plasma as a minimally invasive approach to uterine prolapse.

Pelvic organ prolapse (POP) is a major health problem that affects many women with potentially severe physical and psychological impact as well as impact on their daily activities, and quality of life. Several surgical techniques have been proposed for the treatment of POP. The FDA has published documents that refer to concerns about the use of synthetic meshes for the treatment of prolapse, in view of the severe complications that may occur. These led to hesitancy in use of these meshes and partial increase in use of other biological grafts such as allografts and xenografts. Although there seems to be an increasing tendency to use grafts in pelvic floor reconstructive procedures due to lower risks of erosion than synthetic meshes, there are inconclusive data to support the routine use of biological grafts in pelvic organ prolapse treatment. In light of these observations new strategies are needed for the treatment of prolapse. Platelet rich plasma (PRP) is extremely rich in growth factors and cytokines, which regulate tissue reconstruction and has been previously used in orthopaedics and plastic surgery. To date, however, it has never been used in urogynaecology and there is no evidence to support or oppose its use in women who suffer from POP, due to uterine ligament defects. PRP is a relatively inexpensive biological material and easily produced directly from patients' blood and is, thus, superior to synthetic materials in terms of potential adverse effects such as foreign body reaction. In the present article we summarize the existing evidence, which supports the conduct of animal experimental and clinical studies to elucidate the potential role of PRP in treating POP by restoring the anatomy and function of ligament support.

Renal artery stenosis treated with stent deployment: indications, technique, and outcome for 108 patients.

From January 1993 to May 1996, 108 patients (64 men, 44 women; mean age, 72 years; age range, 37 to 87 years) underwent 125 percutaneous transluminal angioplasties and stent implantations primarily for atherosclerotic lesions of the renal artery. Sixty-four patients underwent treatment for renovascular hypertension (two antihypertensive medications or more), 32 patients underwent treatment for a combination of hypertension and renal failure (serum creatinine level >/=1.6 mg/dL), and a small group of six patients (5%) without hypertension or diminished renal function underwent treatment to prevent the progression to renal artery occlusion and kidney loss. Thirty-three patients (31%) had renovascular hypertension that was classified as severe on three or more medications, 31 patients (29%) had renovascular hypertension that was classified as moderate on two medications, and 38 patients (35%) had renovascular hypertension that was classified in the mild group on a single antihypertensive agent. Stenotic lesions were located at the ostium of the renal artery in 82 cases (65%) and were ostial-adjacent (<5 mm from renal ostium) in the other 43 cases (34%). A total of 125 stents were deployed in 125 arteries (procedural success 97.6%). Renovascular hypertension either was cured or was improved in 73 patients (68%), with 14 patients (13%) considered cured (normotensive on no medications). The conditions of 29 patients (27%) were unchanged, and 6 patients (5%) had worsening hypertension after surgery. We were unable to demonstrate a statistically significant improvement in serum creatinine levels after renal artery balloon angioplasty/stenting. Complications occurred in a total of nine cases (7.2%), six of which were related to technical problems. One patient had worsening renal insufficiency caused by contrast agent, and another patient had a perinephric hematoma develop that necessitated evacuation. There were four postoperative deaths (30-day mortality). Two of these deaths were caused by postoperative myocardial infarction. The other two patients had progressive renal failure develop that necessitated dialysis. These patients later died of the disease process despite supportive care. Follow-up renal artery duplex scan studies and angiograms were available on 96 patients (76%). The mean peak systolic renal/aortic ratio on duplex scanning was 2.2. Life-table analysis yielded a 74% primary patency rate and an 85% secondary patency rate at 36 months. This retrospective analysis showed the effectiveness of combining percutaneous transluminal angioplasty with stent deployment for significant renal artery stenosis to treat renovascular hypertension.

Changing trends in management of carotid body tumors.

UNLABELLED: The purpose of this retrospective study was to evaluate the preoperative diagnostic modalities and aggressive operating management as well as the determination of benefit of preop embolization on the course of carotid body tumor (CBT). Between 1975 and 1993, 14 patients were treated for CBT in our department. The preoperative evaluation included angiography (14/14, 100%), Duplex scanning (6/14, 43%), and CT scanning (9/14, 64%). Five tumors (36%) were type I, four (28%) type II, and five (36%) type III, according to the Shamblin classification. In twelve cases the tumors were successfully excised without ligation of the external carotid artery. One of these patients, who had a very large tumor, underwent preop embolization. In two patients the tumors were found to extend intracranially, and the patients were referred for radiation therapy. There were no deaths or cerebrovascular complications. Temporary cranial nerve injury was noted in two cases. The pathology report revealed paragangliomas without any evidence of malignancy. Follow up of patients (6 months-18 years) showed no recurrence of the tumors in the operated cases and local recurrence in the radiation group. CONCLUSION: 1. Arteriography remains the golden standard for diagnosis of CBT. Tripplex scanning and CT are helpful for postop follow-up. 2. Surgical removal is the ideal treatment. Preoperative embolization is helpful in diminishing intraoperative blood requirements. 3. CBT, although benign, should be treated as soon as it is diagnosed, before difficulty in excision arises.

Surgical treatment of extracranial carotid aneurysms.

During the past 23 years, 12 patients with aneurysm of the carotid bifurcation were treated in our department. There were 11 men and one woman between 20 and 68 years (mean age 54.2 years). In as much as 217 patients were operated on for extracranial occlusive carotid disease during the same period, the incidence of these aneurysms in our series has been estimated to be 5%. Eleven patients presented with TIAs ipsilateral to the aneurysm. One patient presented with a painful pulsatile enlarging mass in the neck (ruptured aneurysm) without any neurological complications. Eleven patients underwent surgical repair. Ligation of the common carotid artery was done in one patient, resection of the aneurysm with end-to-end anastomosis was performed in 2 patients, aneurysmorraphy in 4, excision and reconstruction with reversed saphenous vein in one, excision and reconstruction with PTFE graft in one and 2 patients underwent endarterectomy and angioplasty of the carotid bifurcation. One patient with a high internal carotid artery aneurysm (base of the skull) was classified as nonoperable. There were no deaths or strokes postoperatively. Persistent cranial nerve injury was noted in 1 case (8%). Follow-up at 6 months - 10 years (mean 5.5 years) yielded and incidence of post-op TIAs of 8% attributed to intracranial occlusive disease. Surgical correction is the treatment of choice for extracranial carotid aneurysm and can be performed with a very low morbidity and mortality and carries excellent long-term results.