What is the relationship of varicose vein pathogenesis with collagen fibers?

Aims and Background: In this study, the densities of collagen 1 and collagen 4, which are an effective vascular component in the remodelling of varicose veins, were investigated. Materials and Methods: The study included primary varicose vein samples of 20 patients and vein samples of 20 healthy controls. Immunohistochemical staining was performed using collagen 1 and collagen 4 antibodies. Histochemical staining was performed using Masson Trichrome. Results: In the immunohistochemical analysis of varicose samples, collagen 1 immunostaining was negative in 17 cases (85%) and positive in 3 cases (15%). In healthy venous tissue samples, collagen 1 immunostaining was negative in 12 cases (60%) and positive in 8 cases (40%). There was no statistically significant difference between both groups concerning collagen 1 immunostaining (p > 0.05). In varicose samples, collagen 4 immunostaining was negative in 4 cases (20%) and positive in 16 cases (80%). In healthy venous tissue samples, collagen 4 immunostaining was negative in 13 cases (65%) and positive in 7 cases (35%). Statistical comparison of healthy veins and varicose veins concerning collagen 4 immunostaining showed a significant difference (p = 0.03). In the histochemical analysis of varicose samples, Masson Trichrome staining was negative in 4 cases (20%) and positive in 16 cases (80%). In healthy venous tissue samples, Masson Trichrome staining was negative in 18 cases (90%) and positive in 2 cases (10%). Statistical comparison of healthy veins and varicose veins concerning collagen 4 immunostaining showed a significant difference (p = 0.01). Conclusion: The change in the density of collagen types plays an important role in vein wall remodeling.

The levels of cytokines in rats following the use of prophylactic agents in vascular graft infection.

OBJECTIVES: The aim of this study was to investigate the circulating levels of IL-1, IL-6, IL-10 and TNF-? in serum following the use of topical and intra-peritoneal vancomycin and teicoplanin, as well as topical fusidic acid to prevent MRSA vascular graft infection in a rat model. METHODS: Graft infections were established in the subcutaneous tissue of rats by implantation of Dacron prostheses. Circulating levels of IL-1, IL-6, IL-10 and TNF-alpha were measured in serum samples of all rats obtained by ELISA at sacrifice. RESULTS: The mean serum levels of IL-1, IL-6 and IL-10 were found indifferent in all groups. The mean serum levels of TNF-alpha were as follows: 32.9 +/- 9.9 pg/ml in uncontaminated control group, 59.9 +/- 7.1 pg/ml in untreated contaminated group, 41.4 +/- 11.5 pg/ml in intraperitoneal vancomycin group, 39.6 +/- 10.1 pg/ml in intraperitoneal teicoplanin group, 35.6 +/- 8.2 pg/ml in topical vancomycin group, 37.3 +/- 19.5 pg/ml in topical teicoplanin group, 35.5 +/- 16.7 pg/ml in topical 10% fusidic acid group, 36.4 +/- 6.9 pg/ml in topical 40% fusidic acid group. The level of TNF-alpha in untreated contaminated group was significantly higher than in all of the other groups (p < 0.01, p < 0.05, p < 0.02, p < 0.01, p < 0.01, p < 0.01, p < 0.01, respectively). CONCLUSION: TNF-alpha was determined to be a more accurate cytokine than IL-1, IL-6 and IL-10 in a rat model in which intra-peritoneal and topical glycopeptides as well as fusidic acid were administered for the prevention of vascular graft infection (Tab. 3, Fig. 2, Ref. 20).

Successful surgical treatment of giant main coronary artery fistula connecting to right atrium.

Coronary artery fistulas are rare; they are defined as congenital or acquired coronary artery abnormalities in which blood is shunted into a cardiac chamber, great vessel, or other structure, bypassing the myocardial capillary network. We report here on a case of successful surgical treatment of a giant left main coronary artery fistula in a 29-year-old man who presented to our institution with exertional dyspnea. In this report, the different methods of management are also discussed and the indications for the surgical technique are briefly outlined.

Serum concentration of procoagulant, endothelial and oxidative stress markers in early primary varicose veins.

OBJECTIVE: Endothelial disorders of the veins are considered to play a role in the pathogenesis of primary varicose veins and oxidative stress is implicated in these disorders. With this aim, we investigated vascular endothelial marker levels and the effect of endothelial damage on coagulation parameters and vasodilator substances to determine metabolic markers of oxidative stress in patients with varicose veins and vascular endothelial damage caused by oxidative stress. METHODS: We investigated the levels of malondialdehyde (MDA), protein C, protein S, fibrinogen, von Willebrand factor (vWf), tissue plasminogen activator (tPA), vascular endothelial growth factor (VEGF), interleukin-6 (IL-6), interleukin-12 (IL-12) and nitric oxide (NO) in the blood taken from the brachial vein of 25 patients with primary varicose veins (study group) and compared the results with 25 healthy volunteers (control group). We also investigated the urinary levels of prostaglandin I2 (PGI2) in the study group and compared the results with the control group. RESULTS: There was no statistically significant difference between the study group and the control group with respect to the plasma levels of MDA, protein C, fibrinogen, tPA, IL-6, NO and urinary levels of PGI2. But plasma levels of protein S, vWf, VEGF and IL-12 were found to be statistically significantly higher in the study group than in the control group. CONCLUSIONS: Although the systemically measured levels of protein S, vWf, VEGF and IL-12 were found to be higher in patients of primary varicose veins, levels of protein C, fibrinogen, homocysteine and PGI2 were not found to be statistically significant. No systemic increased oxidative stress seems to be related to the early stages of chronic venous insufficiency. Further studies are warranted for understanding the role of molecules such as NO, oxidative stress parameters and cytokines.

Complication of hemodialysis graft: anastomotic pseudoaneurysm: a case report.

Pseudoaneurysm is a relatively rare complication of synthetic vascular prostheses in patients on hemodialysis treatment and comes from a needle puncture. Anastomotic pseudoaneurysm is also rare. We have reported a case in which an anastomotic pseudoaneurysm developed in the early period in a patient on hemodialysis treatment.

Gelatin-sealed dacron graft is not more susceptible to MRSA infection than PTFE graft.

OBJECTIVES: The purpose of this experimental study was to compare the susceptibility of gelatin-sealed Dacron and PTFE prostheses to infection by MRSA. DESIGN: Prospective, randomized, controlled animal study. MATERIALS AND METHODS: Graft infections were established in the subcutaneous tissues of 60 female Spraque-Dawley rats by the implantation of gelatin-sealed Dacron or PTFE prostheses followed by topical inoculation with methicillin-resistant Staphylococcus aureus. The study groups were as follows: (1A) uncontaminated gelatin-sealed Dacron group, (1B) untreated contaminated gelatin-sealed Dacron group, (1C) contaminated gelatin-sealed Dacron group with intraperitoneal teicoplanin treatment, (2A) uncontaminated PTFE group, (2B) untreated contaminated PTFE group, and (2C) contaminated PTFE group with intraperitoneal teicoplanin treatment. The grafts were removed after 7 days and evaluated for infection by counting the number of adherent bacteria on the graft material after rinsing and sonication. The perigraft tissue was harvested for histopathological study. To investigate the existence of any infection, blood samples were collected by cardiopuncture for a culture analysis. RESULTS: No significant difference in bacteria counts was observed between gelatin-sealed Dacron and PTFE grafts. In groups 1A and 2A, there was no infection detected. The bacterial counts for MRSA were 7.4 x 10(5) in group 1B and 8.6 x 10(5) in group 2B. There was also no infection in groups 1C and 2C. While the difference between group 1B and 2B was not significant (p>.05), bacterial counts in group 1B or 2B were significantly higher than those in other groups. Blood cultures were only positive in four rats in group 1B and in two rats in group 2B. The severities of the inflammation of the perigraft tissues was low in groups 1A and 2A, high in groups 1C and 2C, and between the range from low to moderate in groups 1B and 2B. CONCLUSION: The susceptibility of gelatin-sealed Dacron to bacterial infection was not higher than that of PTFE.

Efficacy of vancomycin, teicoplanin and fusidic acid as prophylactic agents in prevention of vascular graft infection: an experimental study in rat.

OBJECTIVES: To compare the efficacy of a single prophylactic dose of intra-peritoneal vancomycin and teicoplanin with anti-biotic treated Dacron grafts (vancomycin, teicoplanin, 10 or 40% fusidic acid-soaked grafts) in preventing vascular graft infections in a rat model. DESIGN: Prospective, randomized, controlled animal study. MATERIALS AND METHODS: The graft infections were established in the subcutaneous tissues of 80 female Sprague-Dawley rats by the implantation of Dacron prostheses followed by the topical inoculation with methicillin-resistant Staphylococcus aureus. The study groups were as follows: (1) uncontaminated control group, (2) untreated contaminated group, (3) contaminated group with intra-peritoneal vancomycin, (4) contaminated group with intra-peritoneal teicoplanin, (5) contaminated group received vancomycin-soaked Dacron graft, (6) contaminated group received teicoplanin-soaked Dacron graft, (7) contaminated group received 40% fusidic acid-soaked Dacron graft, and (8) contaminated group received 10% fusidic acid-soaked Dacron graft prophylaxis. The grafts were removed after 7 days and evaluated by a quantitative culture analysis. RESULTS: No infection was detected in controls. The untreated contaminated group had a high bacteria count (6.0 x 10(4) CFU/cm2 Dacron graft). Groups that received intra-peritoneal vancomycin or teicoplanin had less bacterial growth (4.8 x 10(3) and 3.9 x 10(3)CFU/cm2 Dacron graft, respectively). Similarly, the group that received 10% fusidic acid-soaked graft showed less bacterial growth (3.6 x 10(3) CFU/cm2 Dacron graft). The groups with vancomycin-, teicoplanin- and 40% fusidic acid-soaked grafts showed no evidence of infection. Statistical analyses demonstrated that intra-peritoneal prophylactic antibiotic treatment was less effective in inhibiting bacterial growth than high concentration antimicrobial-soaking of grafts. CONCLUSION: The use of vancomycin-, teicoplanin- and 40% fusidic acid-soaked grafts was effective in preventing primary prosthetic vascular graft infection.

Superficial brachial artery.

Anomalies of the ramification of arteries in the upper extremity are an important consideration due to the large number of invasive procedures, both diagnostic and therapeutic, performed particularly in the cubital region of the upper limb. It is important for health professionals to be aware of arterial variation to prevent complications during diagnostic and therapeutic procedures. Here, we describe a rare unilateral anomaly of the brachial artery which courses subcutaneously through the right arm to the cubital region in a 75 year-old female patient.