Effect of cilostazol and pentoxifylline on gait biomechanics in rats with ischemic left hindlimb

Objective: The purpose of this study was to determine the impact of pharmacologic treatment with cilostazol and pentoxifylline on gait biomechanics of ischemic rat hindlimbs compared with nonischemic controls. Methods: An experimental study was designed using 30 Wistar rats divided into five groups (n = 6): control (C); ischemia (I) - animals submitted to left common iliac artery interruption without pharmacologic treatment; pentoxifylline (Pen) - rats submitted to procedure and treated with pentoxifylline 3 mg/kg twice a day for 6 weeks; cilostazol (Cil) - animals submitted to procedure and treated with cilostazol 30 mg/kg twice a day for 6 weeks; and sham (S) - animals submitted to procedure without artery interruption. Gait analysis was performed using a computed treadmill. Time, number, and duration of each hindlimb contact were obtained. The total number of contacts (TNC) and the total duration of contacts (TDC) were compared between left and right hindlimb and among groups. Left hindlimb ischemic incapacitation index (LHII) was defined by the formula: LHII = (1 - TNCleft x TDCleft/TNCright x TDCright) x 100 Results: Left hindlimb TNC values were twofold lower in I, Pen, and Cil groups than in C and S groups (P < .01). In I, Pen, and Cil groups, TNC values for the left hindlimb were half of the right hindlimb ones (P < .01). Left hindlimb TDC values were lower in I and Pen groups than the other groups (P < .01). Cil group presented twofold increased values, not different from C and S groups (P = 0.16). Right hindlimb TNC values were greater for I group (P < .01). LHII was around zero in C and S groups and 82 in both I and Pen groups (P < .01). Cil group presented a LHII of 42; higher than C and S groups, but lower than I and Pen groups (P < .01). Conclusions: Cilostazol at a dose of 30 mg/kg twice a day promoted improvement in gait performance in rats submitted to chronic hindlimb ischemia. Pentoxifylline at a dose of 3 mg/kg twice a day did not show this effect. (J Vasc Surg 2012;56:476-81.)

Síndrome ocular isquêmica simulando retinopatia diabética unilateral: relato de caso e revisão da literatura

A síndrome ocular isquêmica (SOI) ocorre devido à hipoperfusão ocular crônica secundária à obstrução da artéria carótida. O quadro clínico inclui, entre outros, retinopatia proliferativa similar a retinopatia diabética. A SOI deve ser considerada principalmente nas retinopatias proliferativas unilaterais ou muito assimétricas e nos casos refratários ao tratamento por fotocoagulação. A indicação da endarterectomia nos pacientes com SOI isolada não é bem definida. Este trabalho relata uma paciente com SOI simulando retinopatia diabética proliferativa unilateral e tratada por endarterectomia.

Correção endovascular de aneurisma de aorta abdominal e artéria ilíaca comum esquerda em paciente com hemofilia C grave

A deficiência do fator XI, também conhecida como hemofilia C, é uma doença hematológica hereditária rara, que se manifesta clinicamente com hemorragia persistente após cirurgias, traumas, menorragias e extrações dentárias. Neste artigo, relatou-se a correção endovascular de um paciente com aneurisma de aorta e de artéria ilíaca comum esquerda em um paciente portador de deficiência major do fator XI (atividade do fator XI inferior a 20%). O procedimento foi realizado com sucesso, com o manuseio do distúrbio da coagulação por meio da infusão de plasma fresco no pré-operatório imediato e no pós-operatório, e controle laboratorial da coagulação do paciente.

Obstructive sleep apnea is common among patients referred for coronary artery bypass grafting and can be diagnosed by portable monitoring

Background Obstructive sleep apnea (OSA) is common among patients with coronary artery disease. However, OSA remains largely under recognized. The lack of clinical suspicion and difficulties to access full polysomnography (PSG) are limiting factors. The aim of this study was to evaluate, among patients referred to coronary artery bypass grafting (CABG): (i) the prevalence of OSA, (ii) the association of OSA with clinical symptoms, (iii) the performance of overnight unattended portable monitoring (PM) as an alternative method for the diagnosis of OSA. Methods Consecutive patients referred for CABG were evaluated by standard physical evaluation and validated questionnaires (Berlin questionnaire and Epworth Sleepiness Scale) and underwent full PSG and PM (Stardust II). Results We studied 70 consecutive patients (76% men), age 58 +/- 7 years (mean +/- SD), BMI [median (interquartile range)] 27.6 kg/m(2) (25.8-31.1). The prevalence of OSA (full PSG) using an apnea-hypopnea index of at least 5 events/h was 87%. Commonly used clinical traits for the screening of OSA such as the Epworth Sleepiness Scale and neck circumference had low sensitivities to detect OSA. In contrast, the Berlin questionnaire showed a good sensitivity (72%) to detect OSA. PM showed good sensitivity (92%) and specificity (67%) for the diagnosis of OSA. Conclusion OSA is strikingly common among patients referred for CABG. The Berlin questionnaire, but not symptom of excessive daytime sleepiness is a useful tool to screen OSA. PM is useful for the diagnosis of OSA and therefore is an attractive tool for widespread use among patients with coronary artery disease. Coron Artery Dis 23:31-38 (C) 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins.

Coronary to Bronchial Artery Fistula: Are We Treating it Right?

Fistulas between coronary artery and bronchial artery may be present from birth, with few hemodynamic consequences, and may remain closed due to similarity of the filling pressures at these 2 sites.(1) They can also be secondary to pulmonary artery occlusive disease or chronic pulmonary inflammation.(2,3) These pulmonary changes may cause a dilation of the fistula and make it functional, causing angina pectoris by coronary steal syndrome, which is the most common symptom. The presentation may also be composed of episodes of hemoptysis, heart failure, and infective endocarditis. However, most patients remain asymptomatic. The ones that need treatment may not have a good response to the medical management, requiring an intervention. This can be done using embolization coils, stents grafts, and performing surgical ligation of the fistulas.(2-4) J INVASIVE CARDIOL 2012;24(11):E303-E304

A new NO donor failed to release NO and to induce relaxation in the rat basilar artery

Nitric oxide (NO)-donors are pharmacologically active substances that in vivo or in vitro release NO. Their most common side effect is headache caused by cerebral vasodilatation. We previously demonstrated that the new NO-donor Ru(terpy)(bdq)NO](3+) (Terpy), synthesized in our laboratory, induces relaxation of rat aorta. This study aimed to verify the effect of Terpy and sodium nitroprusside (SNP) in basilar artery. We conducted vascular reactivity experiments on endothelium-denuded basilar rings. The concentrations of iron (Fe) and ruthenium (Ru) complex were analyzed in basilar artery lysates after incubation with NO donors by mass spectrometry. We also evaluated the NO released from SNP and Terpy by using confocal microscopy. Interestingly, Terpy did not induce relaxation of the basilar artery. SNP induced relaxation in a concentration-dependent way. NO donors cross the membrane of vascular smooth muscle and entered the cell. In spite of its permeability, Terpy did not release NO in the basilar artery. Otherwise, SNP released NO in the basilar artery cells cytoplasm. Taken together, our results demonstrate that the new NO donor (Terpy) failed to release NO and to induce relaxation in the basilar artery. The NO donor SNP induces vascular relaxation due to NO release in the vascular smooth muscle cells. (C) 2011 Elsevier B.V. All rights reserved.

Doppler-guided hemorrhoidal artery ligation with rectal mucopexy technique: initial evaluation of 42 cases

The treatment of hemorrhoidal disease (HD) by conventional hemorrhoidectomy is associated with significant morbidity, mainly represented by the postoperative pain and the late return to daily activities. Doppler-guided hemorrhoid artery ligation (DGHAL) is a minimal-invasive surgical treatment for HD that has been used as an alternative method in order to reduce these inconveniences. OBJECTIVE: To analyze the initial results of the DGHAL technique associated with rectal mucopexy in the treatment of HD. METHODS:Forty-two patients with stage I, III and IV hemorrhoids who were submitted to DGHAL were analyzed from December 2010 to August 2011. Eleven patients (26%) were stage II; 21 (50%), stage III; and 10 (24%), stage IV HD. All patients were operated by the same surgeon under spinal anesthesia and using the same equipment and technique to perform the procedure. The 42 patients underwent ligation of six arterial branches followed by rectal mucopexia by uninterrupted suture. Nine patients needed concomitant removal of perianal skin tag. In the postoperative, the following parameters were evaluated: pain, tenesmus, bleeding, itching, prolapse, mucus discharge and recurrence. The mean postoperative follow-up lasted four months (one to nine months). RESULTS: Tenesmus was the most common postoperative complaint for 85.7% of patients followed by pain, in 28.6%, perianal burning, in 12.3%, mucus discharge and perianal hematoma in 4.7%. Two patients had severe postoperative bleeding and required surgical haemostasis, one of which needed blood transfusion. Ninety-five percent of the patients declared to be satisfied with the method. CONCLUSION: Even though DGHAL has complications similar to those of other surgical methods, its results present less postoperative pain, allowing faster recovery and return to work. Studies with more cases and a longer follow-up are still necessary to assess the late recurrence.