Age-dependence of risk factors for carotid stenosis: an observational study among candidates for coronary arteriography.

In order to identify subjects at higher risk for carotid stenosis and to provide insights into mechanisms of disease development at different age-intervals, a color duplex ultrasound of extracranial arteries was performed in 624 consecutive patients (mean age 62.9+/-10.7, 483 males) undergoing coronary angiography. Significant carotid atherosclerosis (> or =50% stenosis) was documented in 87 patients (14%): the disease was moderate (50/69% stenosis) in 51 patients (8%), severe (> or =70% stenosis) in 36 patients (6%). Age (P<0.0001), smoking (P<0.0001), diabetes (P=0.0002), renal dysfunction (P=0.0119) and hypertension (P=0.0202) were independent predictors of significant carotid atherosclerosis; age (P=0.0001), smoking (P=0.0009) and diabetes (P=0.0201) were independent predictors of severe disease. Among 262 candidates for cardiac surgery, significant carotid artery disease was identified in 57 cases (2.63 Relative Risk, 95% Confidence Intervals: 1.32/5.24). Correlation and regression tree analysis demonstrated that diabetes was associated with greater severity of carotid stenosis in younger patients and hypertension in older ones. In conclusion age is the primary determinant of carotid artery disease; diabetes and smoking accelerate progression of atherosclerosis in younger patients, hypertension and smoking in older ones. Among patients undergoing coronary angiography, carotid ultrasonography should be recommended in high risk subgroups of patients.

[Carotid atherosclerosis in patients with suspected coronaropathy: the relationship to traditional risk factors in the 2 vascular areas]. / Aterosclerosi carotidea in pazienti con sospetta coronaropatia: relazione con i fattori di rischio tradizionali nei due distretti vascolari.

UNLABELLED: In order to evaluate the prevalence of carotid atherosclerosis (CA) in patients with coronary artery disease (CAD) and to identify the differential role of traditional risk factors, we analyzed data concerning 290 patients aged 61.9 +/- 10.8 years who underwent color duplex ultrasound of extracranial arteries before coronary angiography. Significant CA (stenosis > or = 50% in at least one extracranial artery) was disclosed in 44 patients (15%); significant CAD (stenosis > or = 70% at least in a major epicardial vessel) was documented in 238 patients (82%). Age and smoking were significantly associated with both CAD (respectively, p = 0.034 and p = 0.050) and CA (respectively, p = 0.000 and p = 0.000), but a stronger correlation was documented with CA (r = 0.325 vs r = 0.125 for age; r = 0.218 vs r = 0.114 for smoking). Diabetes (p = 0.031) and male gender (p = 0.016) were significantly associated with CAD, and hypertension (p = 0.029) with CA. CONCLUSIONS: Traditional risk factors play different roles in the pathogenesis of atherosclerotic disease of carotid and coronary circulation. Color duplex evaluation of the carotid arteries can be useful in high-risk patients, particularly if candidates for coronary surgery.

Color duplex scanning for the identification of extracranial atherosclerosis in patients with suspected coronary artery disease.

BACKGROUND: The presence of extracranial artery disease has been used as a predictor of coronary artery disease (CAD). The present study was conducted to test the prevalence of extracranial artery disease among patients with suspected CAD. METHODS: Among candidates for coronary arteriography, 400 consecutive patients (mean age 63 +/- 11 years, 78% males, 22% females) underwent color duplex ultrasound of carotid arteries. RESULTS: Extracranial artery disease was documented in 60 patients (15%), CAD in 309 patients (77%). Patients with extracranial artery disease were significantly older (p < 0.001), smoked a higher amount of pack-years (p < 0.001), showed a higher incidence of diabetes (p < 0.01), hypertension (p < 0.05) and CAD (p < 0.05) when compared to extracranial artery disease-free subjects. Plotting age against extracranial artery disease and CAD distribution, extracranial artery disease occurred later in life than CAD (p < 0.001). The best cut-off point of age for predicting extracranial artery disease was 68 years. Carotid angiography was performed in 114 patients after cardiac catheterization (k = 0.8044 with color duplex scanning). CONCLUSIONS: Extracranial artery disease is frequent among patients undergoing coronary arteriography. Carotid ultrasound screening is useful in older patients.

Free radicals: important cause of pathologies refer to ageing.

Free radical are highly reactive chemical species with an unpaired electron in an atomic or molecular orbital. In biological systems, the most important free radicals are superoxide anion and hydrogen peroxide; in the presence of transition metals such as iron, copper and manganese both these free radicals produce hydroxyl radicals. Free radicals attack proteins, nuclei acids and membranes containing large quantities of polyunsaturated fatty acids. Because of their toxicity, the organism has developed ways to deactivate them. The superoxide dismutase enzyme (SOD) catalyzes dismutation of the superoxide radical into hydrogen peroxide and oxygen hydrogen peroxide is in turn reduced to water and oxygen by peroxidase glutathione and catalase enzymes. The production of radicals in the brain is due to catecholamine metabolism such as dopamine and norepinephrine and is increased by the presence of transition metals and by a deficiency of antioxidant agents such as vitamin E. Two main groups of dementia exist in older age: the multi-infarctual dementias, caused by cerebrovascular disorders and the primary degenerative disorders such as Alzheimer, where no vascular disease is evident. Free radicals play an important role in Parkinson's disease, in Alzheimer's disease and in stroke. The value of SOD and CAT activity following the above mentioned degenerative diseases differ among the various studies carried out. In Alzheimer's disease, the value of SOD activity probably increases in the neuropathologically involved areas. In stroke, the SOD value does not vary either in the ischemic area or in the peri-infarctual one during the first 24 hrs after lesion, while the CAT value decreases.

Human aging brain disorders: role of antioxidant enzymes.

In order to investigate the role of two free radical detoxificant enzymes in patients with aging brain disorders, superoxide dismutase (SOD) and catalase (CAT) activities have been measured in blood from male and female human patients of different ages with several types of aging brain disorders. When compared with activities in the normal population, we have detected: 1) SOD and CAT activities are decreased in patients with Parkinson disease. 2) SOD activity seems to be normal and CAT activity is decreased in patients with dementia. 3) In the patients with stroke, SOD activity is normal, while CAT activity is decreased. SOD activity was measured in red blood cells using the Minami and Yoshikawa method. CAT activity was measured in hemolysates by the method of Aebi. We can conclude that SOD and CAT activities in patients with Parkinson disease are decreased.

[Atheroma plaque and Apo E alleles]. / Placca ateromasica ed alleli delle Apo E.

The authors report their experience regarding the identification of Apo-E alleles on atheroma carotid plaques in 20 patients of both sexes diagnosed as suffering from severe carotid stenosis using Doppler tests. A DNA hybridization and amplification method was used to identify Apo E-2, Apo E-3 and Apo E-4 alleles and their various phenotypical combinations. The following results were obtained in the 20 plaques examined: Apo E-3/E-4 in 114 patients (70%), 2 diabetic patients Apo E-4/E-3, one vascular demented patient Apo E-2/E-3, and 3 plaques defined as severely calcified Apo E-2/E-2. It can therefore be seen that the majority of plaques (70%), considered a risk for future stroke due to altered carotid Doppler tests, does not differ greatly by the homozygote allele Apo E-3/E-3 commonly found in the blood of the so-called "normal" population. It is difficult to draw any conclusions from the alleles found in the other 5 patients due to their scarce statistical value and the limited number of carotid plaques examined, but there appears to be some sort of correlation between calcified plaque, hyperlipidemia and the allele Apo E-2/E-2, with an interchange of position between cysteine arginine amino acids in the Apo E sequences.

Searching for a marker for Alzheimer's disease-Apo-E.

The authors present their study of 10 patients affected by Alzheimer's disease and 10 patients with multinfarctual dementia, who are already part of a CNR study, senile dementia project, longitudinal study. The method adopted was that of DNA crossbreeding and amplification, so as to have a precise individualisation of alleles APo-E, Apo E-3, Apo E-4 and of their various phenotype combinations. These isoforms are evaluated and compared with the disease studied, in order to help to identify a timely-marker for senile dementia. On the results obtained we hypothesised an association between Apo E-4 and the disease of about 40% for Alzheimer's disease, which leads us to increase our number of cases, regarding associations between demential diseases either Alzheimer or vascular and the presence of Apo E-4.

Evaluation of certain immunity parameters in rheumatoid arthritis, treated with cortisone.

The authors present their study on interleukin-2 receptors (IL-2R), transferrin receptors (R-Tr), CD-4/CD-8 ratio, T-lymphocytes after therapy with a corticosteroid (125 mg/die), in 7 female geriatric patients suffering from rheumatoid arthritis. The study was performed with conjugated monoclonal antibody marking the lymphocytes with fluorescein (FITC) and phycoerythrin (PE). Using the considered parameters a depressant effect was presumed on T-lymphocytes and on the immune defences in the first 6 hours after starting therapeutic cortisone infusion. The proliferative effect on T-lymphocytes, CD4 and on the receptor state of the membrane, for IL-2R and Tr-R, was already evident in the 11-12th hour with a peak at 24 hours. It is therefore useful to follow the evolution of the immune state, even using the above parameters, in order to evaluate the correct therapeutic course.

Consideration on diminished immunologic defences in the elderly neoplastic subject.

We evaluated some useful parameters which identify immuno-depressive states in the elderly neoplastic patient, who is subject to possible associated infective diseases. Out of 27 patients followed-up over four months of chemotherapy in concomitance with an immunomodulator, it was seen that in 42.3% there was an increase in their immune defences, assessed by an increase in total lymphocytes with a lymphocyte ratio of T4/T8 and NK cells, and by checking the urinoculture for urinary infections which showed an improved performance status.

Evaluation of chemical parameters in breast cyst.

During our studies on breast diseases, the following biochemical values were measured: chlorine, sodium, potassium and albumin. We examined 153 syringe biopsies from women aged between 34 and 55 years, and an analysis of the above mentioned parameters enabled us to classify the breast cyst fluid into 2 groups: group I was definitely benign, while group II was calculated as having a risk factor two to four times greater than the control group in developing breast cancer.

[The atheromatous-fibrous plaque studied by cytofluorimetry]. / La placca ateromasica-fibrosa studiata mediante citoflorimetria.

Atherosclerosis is the most frequent disease in the majority of cardiovascular arteries. It is a complex disease with peculiar characteristics, including its principal localisation in the inner stratum of the artery (the intima). The paper examines 36 atherosclerotic lesions in elderly patients in which the presence of stenosing atherosclerotic plaque had been diagnosed. The presence of replicating DNA was demonstrated using flow cytometry together with a proliferative phenomenon within the fibrous-atherosclerotic plaque due to an hypothesised migration of smooth muscle cells inside the intima, leading to the final result, a gradual restriction of the arterial gauge and consequent alteration to blood flow. The plaques examined were localised at the bifurcation of the carotid artery, an area in which it is easier to find the physical and biochemical factors facilitating platelet adhesion, which together with other cells produce mitogenic activity since they release growth factors and create the conditions for the proliferation of fibrous tissue.

Neoplastic phlebothrombosis from renal vein to right atrium: a case report.

The authors present an atypical case of neoplastic thrombosis of the great abdominal veins, evaluated with echo-Doppler duplex scanner and computed tomographic scan with contrast enhancement. In this report the authors stress again the diagnostic accuracy of echo-Doppler methods in the study of such a phlebopathy. They describe its sonographic differential diagnosis from acute or chronic idiopathic phlebothrombosis.

[Role of non-invasive vascular diagnosis in the study of "diabetic foot"]. / Ruolo della diagnostica vascolare non invasiva nello studio del "piede diabetico".

The Authors examine the possibilities of instrumental diagnosis in patients with the "diabetic foot" syndrome. The lack of clinical relevance of the so called "microangiopathy" is stressed, because. Indeed, either the "macroangiopathy" or the diabetic neuropathy are responsible for almost all the symptoms of this syndrome. In the differential diagnosis between these two major sequelae of diabetes, with consequently wide differences in the therapeutic choices, the Doppler ultrasound examination has been of paramount usefulness, because it is very sensitive and specific in detecting and localizing any lesion suggestive of macroangiopathy.

Thrombosis of congenital double popliteal vein: case report.

The authors present the case of a patient with phlebothrombosis of the left lower limb, not diagnosed with traditional ultrasonographic methods (Doppler c w) but recognized by the echo Doppler (duplex scanner) method. The diagnosis was made difficult by the presence of a congenital double left popliteal vein, with hypoechogenic thrombosis of only one of the two twin veins. The authors stress the diagnostic importance of the duplex scanner method in the study of the phlebobstructive pathologies of the lower limbs.