Prevalence of Lower Extremity Arterial Disease as Measured by Low Ankle-Brachial Index in Patients with Acute Cerebral Ischemic Events.

BACKGROUND: Low ankle-brachial index (ABI) of ≤0.9 is diagnostic of lower extremity arterial disease (LEAD). It is also a strong marker of generalized atherosclerosis. The objective of this study was to assess the prevalence of low ABI in patients with acute cerebral ischemic events (ACIE): ischemic stroke (IS) or transient ischemic attack (TIA). METHODS: We compared 150 inpatients with ACIE to 50 inpatient controls and assessed risk factors, ABI measurements, and Duplex ultrasound of the cervical vessels. RESULTS: Low ABI was seen in 69 patients (46%) in the ACIE group and in 8 (16%) in the control group; p < 0.01. The mean and median ABI values in the ACIE group were 0.88 (SD = 0.22) and 0.91 (0.24-1.33), which were significantly lower than in the control group: 1.04 (SD = 0.16) and 1.0 (0.66-1.36); p < 0.0001, respectively. Coronary artery disease, carotid stenosis of ≥50% and smoking were risk factors, which were associated with significantly lower ABI in the study group; the ABI with risk factors vs. without was 0.85 vs. 0.92 (coronary artery disease); p < 0.05, 0.7 vs. 0.92; (carotid stenosis) p < 0.001 and 0.83 vs. 0.98; (smoking) p < 0.001, respectively. CONCLUSION: Our study demonstrated that patients with ACIE have significantly higher involvement of another vascular bed as LEAD. Coronary artery disease, carotid stenosis ≥50% and smoking were main risk factors associated with coexistence of LEAD and ACIE.

The prevalence of abdominal aortic aneurysms in the rural/urban population in central Poland - Gniewkowo Aortic Study.

BACKGROUND AND AIM: Abdominal aortic aneurysm (AAA) is a widening of the aorta below the renal arteries with a diameter equal to or greater than 3 cm. The prevalence of AAA is estimated at 4-8% in men aged 65 years or older and 1-2% among women over 65 years old. Participation in screening programmes has decreased the number of aortic ruptures. METHODS: All men aged 60 years and older, and women aged 65 years and older living in the rural/urban commune in central Poland were invited to participate in the study. In total 922 persons (61% of the invited population) entered the study. The men were divided into two groups: 60-64 years old, and 65 years and older. Screening abdomen ultrasound was performed and demographic data was collected. RESULTS: Among the 922 examined persons two (1.01%) AAAs were diagnosed in the group of men 60-64 years of age, three (0.82%) AAAs amongst women ≥ 65 years old, and 33 (9.29%) AAAs were found in the group of men aged 65 years and older. A positive relationship between the presence of AAA and smoking (p = 0.0048), age of men (p = 0.0009), and history of myocardial infarction/acute coronary syndrome (MI/ACS) (p = 0.0079) was found. There was no correlation between the frequency of AAA and diabetes mellitus (p = 0.46), hypertension (p = 0.38), and family history of AAA (p = 0.44). CONCLUSIONS: The prevalence of AAA in men aged 65 years and older is seemingly larger than in previously conducted studies, while among men 60-64 years of age and women aged ≥ 65 it is similar. Older age, smoking, and a history of MI/ACS were the most important risk factors of AAA occurrence.

Predicting time to healing by anatomical assessment of venous pathology.

BACKGROUND: The aim of the study was to assess the clinical effectiveness of multilayer compression in aspect of anatomical site of venous pathology and ulcers. MATERIAL/METHODS: The study was conducted between 2000 and 2006 among 112 patients with 121 ulcers treated in the Venous Ulcer Outpatient Clinic of the Chair and Clinic of Surgery, Biziel Hospital in Bydgoszcz, Poland. Patients between 31 and 89 years old (mean age - 63.6 years, median 65) were randomized into two groups treated with two- and four-layer compression system. Healing process dynamics were assessed by planimetry. Maximum period of observation was 48 weeks. RESULTS: The longest mean time of ulcer healing and the highest values of cumulated indicator of unhealed ulcers were observed among patients with simultaneous insufficiency of two venous systems - superficial and deep (p=0.0034, test log-rank) and among patients with insufficiency of deep, superficial and perforating venous system (p=0.0001, test log-rank). Significantly longer mean healing time was characteristic for localization on the back calf region (p=0.01, test log-rank). Dynamics of healing of ulcers treated by two- and four-layer systems were compared. CONCLUSIONS: Anatomical localization of venous pathology and ulcer localization were found as important prognostic factors; longer healing time and lower probability of healing was observed among patients with deep venous insufficiency and when the ulcer was localized in the atypical back calf region. No differences of healing time between groups in aspect of used system were showed.

The nutritional status of older adults with and without venous ulcers: a comparative, descriptive study.

The nutritional requirements of healthy people differ from those who have chronic wounds and while it is generally suggested that the nutritional status of persons with chronic wounds must be addressed, actual data about the nutritional status of older adults with venous ulcers is limited. The nutritional status of hospitalized older adults (n = 40, average age 77 +/- 7.4) with vascular disease was compared to randomly selected outpatients with venous insufficiency ulcers (n = 37, average age 70.4 +/- 8.13) using the Mini Nutritional Assessment instrument. Among all patients assessed, 37 (48%) were at risk for malnutrition or were malnourished. No differences between nutritional status and age or gender were found. The proportion of patients at risk for malnutrition or currently malnourished was significantly higher in the venous ulcer (24 out of 37) than in the control group (13 of 40, chi2 = 15.51, P <0.05). Statistically significant differences were found between the control and venous ulcer group for all anthropometrical assessment variables (BMI, arm circumference, calf circumference, and weight loss in past 3 months), use of more than three prescription drugs, dietary history/assessment (appetite, fluid consumption, independent feeding), and patient self-rated health. The results of this study confirm that a complete patient assessment must include evaluating patient nutritional status and that nutritional disorders are a serious problem among the elderly, especially those with venous ulcers. Additional studies to help optimize the nutritional assessment and management of older adults with venous ulcers are needed.

Morphometric study of the aortic and great pulmonary arterial pathways in human foetuses.

In prenatal and pediatric cardiovascular surgery knowledge of luminal diameters of the aortic and great pulmonary pathways is essential. The internal diameters of the aortic and great pulmonary pathways in 131 human foetuses (65 male, 66 female) were studied by means of anatomical, digital and statistical methods. During foetal development the absolute diameters revealed a linear increase. Correlation coefficients between these diameters and foetal age were statistically significant (P< or =0.05) for each age group and reached following values: r1 = 0.70 for the aortic bulb, r2 = 0.79 for the ascending aorta, r3 = 0.77 for the aortic isthmus, r4 = 0.79 for the descending aorta, r5 = 0.63 for the pulmonary trunk, r6 = 0.36 for the arterial duct, r7 = 0.46 for the right pulmonary artery and r8 = 0.49 for the left one. Diameters of the aorta and the pulmonary trunk indicated the relative increase in the values. A different tendency was observed for the internal diameters of the arterial duct and both pulmonary arteries, which were relatively decreased with increased foetal age. The largest diameter was observed in the arterial duct, the intermediate--in the right pulmonary artery and the smallest--in the left pulmonary artery. The cross-sectional area of the descending aorta was equal to the sums of the sectional areas of the aortic isthmus and the arterial duct (r9 = 0.97). The cross-sectional area of the pulmonary trunk was equal to the sums of the sectional areas of the both pulmonary arteries and the arterial duct (r10 = 0.91).

Skeletopic analysis of the gonadal veins in human foetuses.

During ontogenesis an imbalance is observable in the development of the skeletal and vascular systems. By means of anatomical and radiological methods the gonadal veins were studied in relation to the vertebral column in 60 human foetuses of both sexes aged from 4 to 6 months of prenatal life. In male foetuses aged 4--5 months the origin of the gonadal veins projected onto the sacral apex (r(1)=0.95, r(3)=0.85), and in 6(th) month they extended below the vertebral column (r(1')=0.80, r(3')=0.90). In female foetuses the origin of the gonadal veins in the 4(th) month projected symmetrically onto S(1) (r(5)=0.70, r(7)=0.70). In the 5(th) month of intrauterine life the origin of the left ovarian vein was found at S2 (r(7')=0.80) and the origin of the right one at S1-S2 (r(5')=0.80). In the 6th month the origin of the left ovarian vein was located at S(3) (r(7')=0.80) and the right one at S(2)-S(3) (r(5'')=0.90). The skeletopic analysis of the origin of the gonadal veins demonstrated gender (the origin was higher in females) and syntopic (the origin was higher on the right side) differences (p0.05). On the right side the termination of the gonadal (testicular and ovarian) veins projected constantly onto L(2). On the left side the termination of the left gonadal (testicular and ovarian) veins apparently descended by one vertebra (pseudodescensus).