Changes in the mechanical properties, biochemical contents and wall structure of the human coronary arteries with age and sex

An experimental study of the mechanical properties, biochemical composition and structure was carried out on the proximal and distal parts of the right and the anterior descending branch of left human coronary arteries. The vessels were removed during an autopsy of 121 males and 84 females being 1 day to 80 years old. The material was divided into six age groups. Branchless segments of vessels 15-20 mm long were cut from proximal and distal parts. The mechanical properties of the coronary arteries were determined by passing fluid at pressures ranging from 0 to 240 mmHg. It was found that the part of the wall of the coronary artery adjacent to the myocardium is thicker in all cases than the other part of the arterial wall. With increasing age the mean thickness of the wall of both coronary arteries increases but the wall-thickening process is non-uniform in nature in both the proximal and distal parts and in the individual layers. The changes in the stretch ratio and tangential modulus in circumferential direction with age and sex were investigated. The greatest changes in the wall thickness and in the mechanical parameters were found for the left coronary artery wall in men over 40 years of age and for the right coronary artery wall in women over 50 years of age. The results of biochemical and densitometric investigations were compared.     

Age-related patterns in body composition for men aged 20-79 yr

Fat-free body mass has been reported to decline by 30% between the ages of 30 and 70 yr, whereas body weight increases until age 50 yr. This study examined the age-related patterns in body composition, specifically its two components, fat-free body mass and fat mass, in 157 men aged 20-79 yr. Total body composition was assessed by hydrodensitometry and subcutaneous fat was measured with skinfolds. Approximately 15 men were tested in each of the 12 5-yr age groups (20-24, 25-29, 30-34, ... 75-79 yr). Body density, as determined by underwater weighing, was lower successively from the youngest to oldest age groups; men below age 40 yr had significantly higher (P < 0.01) body densities than the older men. Although there was a gradual decline in fat-free body mass with increasing age, there was not a significant age group effect until age 70 yr. Fat mass gradually increased with increasing age; men above age 40 yr had significantly higher (P < 0.01) total body fat when compared to the younger men. Subcutaneous body fat was similar at the distal limb locations for each age group; however, the proximal trunk locations, especially the abdomen, demonstrated significantly (P < 0.01) higher skinfold thicknesses with increasing age. In conclusion, fat-free body mass was maintained to a later age than previously reported; thus, the age-related decline in body density could be attributed to an age-related increase in body fat.     

Saccular aneurysm associated with fenestration of the distal segment of basilar artery

A 32-year-old man who presented with subarachnoid hemorrhage was found to have a saccular aneurysm arising from the proximal end of the fenestration formed at the distal third of basilar artery. The aneurysm dome was directed anteriorly and measured 3mm in diameter. It was successfully clipped via subtemporal transtentorial approach and the patient returned to his previous job. Basilar artery fenestration is angiographically found in 0.23-0.6%. The fenestration is most frequently located in the proximal basilar trunk close to the vertebro-basilar junction. In this report a rare case with an aneurysm associated with fenestration in the distal part of the basilar artery will be presented.     

Age and experimental obstructive emphysema. A morphometrical study on the rat

Age, as a risk factor in the development of experimental obstructive emphysema, is proposed as the hypothesis of this study. Ninety-two Wistar rats were organized into two age groups: adult (16 weeks) and middle-aged (56 weeks). Each age group was subdivided into three groups: a control group, consisting of unmanipulated animals; a "cannula" group consisting of animals into whose trachea a cannula was implanted; and a "valve" group, consisting of animals into whose trachea a valve had been implanted. The survival was one month. A histomorphometric study was performed on the lungs and the results were compared statistically. Throughout the experiment the amount of food consumed by each animal and the variations in weight were monitored. After sacrifice, the lungs were processed for light microscopy. Thirteen histomorphometric variables were quantified and subsequently systematized into three groups: those which quantified the size of the distal airspace ("area of the alveolar section", "alveolar chord" and "mean linear intercept"): those which quantified the tissue ("wall thickness", "tissue density", "internal perimeter of each alveolar section", "internal alveolar perimeter per field" and "alveolar section/section perimeter"); and those which quantified the elastic fibre ("elastic fibre area", "elastic fibre perimeter", "elastic fibre area/elastic fibre perimeter", "elastic fibre density" and "elastic fibre density per tissue density"). The results were compared statistically and the sensitivity, specificity and misclassification indices were calculated, as well as the attributable and relative risk. From the results, it was observed that, in general, the animals of the valve and cannula groups in both age groups displayed a decrease in food intake and a body weight loss. The middle-aged animals were the only group which displayed significant differences in all the morphometric variables except wall thickness, when the cannula and valve groups were compared with the control group. In both the cannula and valve groups, the values of the variables which quantified the distal airspace increased, while the values of the variables which quantified the lung tissue and the elastic fibre decreased. In the manipulated middle-aged group, the attributable risk of developing emphysema was 56.66% and the relative risk 5.55; in the group of manipulated adult animals, the attributable risk was 23.55% and the relative risk 1.66. The results of this study lead us to propose that the middle-aged rats with experimental airflow obstruction displayed a greater risk of developing emphysema than the adult rats which were subjected to the same procedure.     

One-stage open cancellous bone grafting of infected fracture and nonunion

BACKGROUND: A quantitative study of dermal and arterial elastic fibers as a function of age was carried out by computerized image analysis. OBJECTIVE: We investigated whether any parallelism can be established between the morphometric parameters of elastic fibers from the skin and the temporal artery in elderly subjects. METHODS: we quantitated the skin elastic fibers of the reticular dermis and the elastic fibers of the temporal artery using a specific staining procedure followed by automated image analysis in 16 subjects of age range 63-87 years. RESULTS: There was a good correlation between the area fraction occupied by the elastic fibers in the unexposed skin (inner part of the upper arm) and aging (r = 0.669, p < 0.01). The area fraction occupied by elastic fibers in unexposed skin was correlated with the area fraction occupied by elastic fibers in the deep part of the temporal artery (r = 0.498, p < 0.05). Actinic elastosis affected both tissues, but there was no correlation between the amount of elastotic material in the exposed skin and the area fraction of elastic fibers in the superficial part of the temporal artery. CONCLUSION: We provided evidence that in sun-protected tissues the area fraction occupied by elastic fibers in dermis and deep part of the temporal artery showed a significant correlation. We proposed that skin biopsies were a valuable diagnostic tool for predicting arterial wall abnormalities of elastic fibers.     

Atherosclerosis of the inferior epigastric and internal mammary arteries

Atherosclerosis of the inferior epigastric artery (IEA) and the internal mammary artery (IMA) was evaluated in 21 patients with coronary heart disease. Both arteries were used simultaneously in coronary artery bypass grafting. Histologic samples were obtained from the proximal and distal segments of IEA and from the distal segment of IMA. Morphologic findings in regard to atherosclerosis were classified semiquantitatively as normal (0), or luminal narrowing <25% (1), 25-50% (2) or >50% (3), or as overt atherosclerosis and calcification (4). Atherosclerosis was absent or minimal (1) in distal samples from both arteries. Only one IMA showed moderate (2) luminal atherosclerotic obstruction. Two samples from proximal IEA showed moderate (2) or severe (4) atherosclerotic changes which limited their use as free grafts. These finding suggest that atherosclerosis is minimal and comparable in distal IEA and IMA in their natural environments even in patients with coronary heart disease. The long-term effect of aortic pressure on free IEA graft is still unclear.     

Early adaptations in collateral and microvascular resistances after ligation of the rat femoral artery

Collateral and microvascular (including feed artery) resistances in the rat hindlimb were determined immediately or 1 wk after ligation of the femoral artery. Collateral-to-microvascular resistance ratios were determined from in vivo pressure measurements proximal and distal to the ligation. Microvascular resistance was 32 +/- 2.5 and 41 +/- 1.5% of the total collateral-dependent vasculature in acutely and chronically ligated limbs, respectively, and decreased 20% in both groups during reactive hyperemia. Minimum resistances of collateral vessels and the microcirculation arising from arterial branches proximal and distal to the ligation were determined by using a modification of the standard hindquarter perfusion technique for determining maximum vascular conductance. One week postligation, minimum total hindquarter resistance was decreased by a reduction in the resistance of the collaterals (approximately 50%) and microcirculation (approximately 33%) proximal to the ligation. The results suggest that the microvasculature distal to the occlusion is able to increase flow by dilation both initially and at 1 wk postligation but that collateral adaptations are primarily responsible for decreases in the minimum total resistance of the collateral-dependent region.     

Epidermal nerve fiber density: normative reference range and diagnostic efficiency

BACKGROUND: The sensitivity of neuron-specific antibodies permit the identification of the small unmyelinated nerve fibers within the skin. OBJECTIVES: To develop a reference range of epidermal nerve fiber density in humans, and to evaluate their diagnostic efficiency for sensory neuropathies. METHODS: Ninety-eight normal controls (age range, 13-82 years) were examined with both directed neurologic examinations and quantitative sensory testing. The diagnostic utility was examined in 20 patients with sensory neuropathies. Each subject had 2 punch biopsies performed at each site in the thigh and distal part of the leg (total of 392 biopsies). After formalin fixation, 50-microm-thick free-floating sections were stained with a polyclonal antibody to neuron-specific ubiquitin hydrolase, anti-protein gene product 9.5. We enumerated intraepidermal nerve fibers per millimeter to derive a "linear density." The linear density technique was validated against a stereological technique that used the fractionator to measure the total length of intraepidermal nerve fibers per 3-mm punch. RESULTS: The biopsy technique was well tolerated, with no notable complications. The linear density quantitation was rapid and had high intraobserver and interobserver reliability. We determined that the density of intraepidermal fibers in normal controls was 21.1+/-10.4 per millimeter (mean +/- SD) in the thigh (fifth percentile, 5.2 per millimeter), and was 13.8+/-6.7 per millimeter at the distal part of the leg (fifth percentile, 3.8 per millimeter). Significantly higher intraepidermal fiber densities were seen in the youngest group (P = .004), and we observed no significant effect of race, sex, height, or weight. The density at the thigh was significantly correlated with that at the distal part of the leg (P = .01) and was consistently higher by about 60%, a reflection of the normal proximal-distal gradient. The results obtained with stereology and the linear density correlated significantly (P=.001), providing internal validation for the technique. Epidermal nerve fiber density was significantly reduced (P = .001) in patients with sensory neuropathies. With a cutoff derived from the fifth percentile of the normative range for the distal part of the leg, the technique had a positive predictive value of 75%, a negative predictive value of 90%, and a diagnostic efficiency of 88%. CONCLUSIONS: We have established a reference range for intraepidermal nerve fiber density in normal humans by means of a simple quantitation method based on enumeration of individual intraepidermal nerve fibers on vertical sections of punch skin biopsy specimens stained with the sensitive panaxonal marker anti-protein gene product 9.5. The utility of the density measurement was confirmed for sensory neuropathy with a diagnostic efficiency of 88%. Skin biopsies may be useful to assess the spatial distribution of involvement in peripheral nerve disease and the response to neurotrophic and other restorative therapies.     

Coronary artery restenosis after balloon angioplasty in humans is associated with circumferential coronary constriction

Therapies that inhibit intimal hyperplasia do not prevent restenosis after coronary artery balloon angioplasty, suggesting that additional mechanisms may be responsible for restenosis in humans. Using an intravascular ultrasound (Hewlett-Packard Sonos Intravascular Imaging System). 3.5F, 30-MHz (Boston Scientific) monorail imaging catheter, we studied 17 patients with clinical and angiographic restenosis at an average (mean +/- SD) of 7 +/- 6 months after balloon angioplasty (13 men age, 71 +/- 10 years; 12 left anterior descending coronary arteries, 4 right coronary arteries, and 1 left circumflex coronary artery) The lumen area (L.A), vessel wall area (VWA), and total cross-sectional area (CSA) within the external elastic lamina were measured at the restenosis site and at proximal and distal reference sites, which were defined as adjacent segments with the least amount of plaque. Consistent with coronary angiography findings, decreased LA at the restenotic site was detected in all 17 patients. The unique finding was that total CSA at the restenotic site was significantly decreased compared with both proximal and distal reference sites (10.1 +/- 2.4 versus 14.8 +/- 3.2 mm2 and 10.1 +/- 2.4 versus 13.8 +/- 3.1 mm2, respectively, P < .001), whereas VWA (intima plus media) was slightly increased at the angioplasty site compared with both proximal and distal reference sites (8.0 +/- 2.3 versus 7.6 +/- 2.3 mm2 and 8.0 +/- 2.3 versus 6.7 +/- 2.3 mm2, respectively, P = NS). Eighty-three percent of the loss in LA at the restenotic site was due to constriction of the total CSA, while the increase in VWA at the restenotic site accounted for only a 17% loss in LA. We then compared these results with the morphology of coronary artery segments in 14 patients without restenosis. These coronary artery segments had been previously treated with balloon angioplasty (7 +/- 5 months). Unlike that in restenotic lesions, the total CSA within the external elastic lamina at the sites of previous angioplasty was similar to that in distal and proximal reference sites (P = NS). Significant and consistent reduction in arterial CSA, with a minor increase in VWA, characterizes human coronary lesions that cause angiographic restenosis. These data suggest that in humans, "recoil" and/or vascular contraction with healing in response to balloon injury is a major contributor to restenosis after balloon angioplasty.     

Regional differences in the nitrergic innervation between the proximal and the distal colon in rats

BACKGROUND & AIMS: Functional differences in the inhibitory neural pathway between the proximal and the distal colon are unknown. METHODS: We investigated the nonadrenergic, noncholinergic (NANC) relaxation, nitric oxide synthase (NOS) synthesis, and NOS messenger RNA (mRNA) expression of the myenteric plexus in the proximal and the distal colon in rats. RESULTS: Transmural nerve stimulation of the neuromuscular preparations from the proximal colon showed greater NANC relaxations than those from the distal colon. NANC relaxations were abolished by the NO biosynthesis inhibitor (NG-nitro-L-arginine methyl ester) in the proximal and the distal colon, suggesting mediation by NO released from the myenteric plexus. The average number of NOS-immunoreactive cells was significantly higher in the tissue from the proximal colon than in the tissue from the distal colon. Western and Northern blot analyses showed a higher density of the immunoreactive NOS band and the NOS mRNA band in the tissue from the proximal colon than in that from the distal colon. CONCLUSIONS: These observations indicate that the number of NOS-containing neurons and the NOS activity are increased in the myenteric plexus of the proximal colon compared with the distal colon, resulting in greater NANC relaxation in the proximal colon. These findings may explain the physiological role of the proximal colon as an organ for fecal storage and absorption of excess fluid.     

Right ventricular blood flow during left ventricular support in an experimental porcine model

BACKGROUND: Right ventricular blood flow may be adversely affected during left ventricular assist device (LVAD) use leading to right ventricular (RV) ischemia and RV dysfunction. This study characterized normal RV blood flow responses to LVAD operation. METHODS: Seven Yorkshire pigs weighing 74.4 +/- 3.4 kg underwent right coronary artery blood flow measurements with an ultrasonic flow probe and injection of radiolabeled microspheres. A Thoratec LVAD was used in either synchronous or asynchronous modes and RV loading was increased using a pulmonary artery snare. RESULTS: The RV blood flow was compared between three regions that differed in proximity to the right coronary artery: proximal segment, mid-RV, and distal. The right ventricular distal flow was 0.93 +/- 0.07 mL x min-1 x g-1 compared with 0.74 +/- 0.06 mL x min-1 x g-1 at right ventricular proximal flow during control measurements (p = 0.0001). This difference was maintained during LVAD operation in either synchronous or asynchronous modes and also during pulmonary artery constriction. CONCLUSIONS: Global RV flow is not adversely affected by LVAD use. A flow gradient occurs along the right coronary artery with the distal vascular bed having relatively less reserve, which may be more susceptible to ischemia in patients with preexisting coronary disease or RV distention during LVAD use.     

Experimentally induced pulmonary arterial occlusion with detachable balloon in pigs: thin-section CT findings

RATIONALE AND OBJECTIVES: The authors evaluated changes of lung attenuation in pigs, with special attention to the mosaic pattern of low attenuation, at thin-section computed tomography (CT) after obstruction of the proximal pulmonary artery with a detachable balloon. MATERIALS AND METHODS: In seven pigs, nine sites of the descending pulmonary artery were obstructed with detachable balloons. This-section CT scans of the lungs were obtained immediately (n = 9) and at 1 week (n = 5), 2 weeks (n = 1), 3 weeks (n = 2), 4 weeks (n = 1), 6 weeks (n = 1), 8 weeks (n = 1), and 12 weeks (n = 1) after pulmonary artery obstruction. RESULTS: No statistically significant difference was found between the measured lung attenuation of the normal lung and that of the lung distal to the obstruction. Of the nine sites of pulmonary artery obstruction, five (56%) showed an irregular area of increased lung attenuation without lobular architecture. The diameter of the pulmonary artery after obstruction, compared with the diameter before obstruction, decreased by a range of 13%-57% (mean, 35%) and by 0-67% (mean, 44%) at levels 1 cm and 2 cm distal to the obstruction, respectively. CONCLUSION: This experimental study reveals that regional low-attenuation areas do not develop for up to 12 weeks after the obstruction of proximal pulmonary artery, despite a marked decrease in the diameter of the pulmonary artery distal to the obstruction.     

Morphologic changes in the elastic fibers of the temporomandibular joint after experimental disc perforation in the rabbit

PURPOSE: Elastic fibers in the attachment regions of the temporomandibular joint (TMJ) are considered important in the movements of the disc during jaw motion. This study was designed to determine whether there are change in the elastic fibers of the TMJ when the disc is perforated for a long period. MATERIALS AND METHODS: Each TMJ of five rabbits was surgically exposed, and a mediolateral perforation was made in the center of the articulating region of the disc with a scalpel. Five untreated and three sham-operated rabbits were used as controls. The TMJs were removed after 10 months and processed for histochemical demonstration of elastic fibers. RESULTS: Osteoarthritic changes and a significant decrease in number of the elastic fibers in the anterior-inferior attachment and posterior-inferior attachment of the TMJ disc were observed after disc perforation. Conversely, elastic fibers appeared in the fibrous tissue on the resorbed bone of the articular eminence. CONCLUSIONS: Experimental disc perforation changes the distribution and density of the elastic fiber in the TMJ as well as causes osteoarthritis. A knowledge of these facts may improve our understanding of perforation of the disc.     

Regional differences in the pineal gland of the cotton rat, Sigmodon hispidus: light microscopic, electron microscopic, and immunohistochemical observations

Light microscopic, electron microscopic and immunohistochemical observations of the various portions of the pineal gland of the cotton rat (Sigmodon hispidus) were made. The volume of the proximal half occupied about 30% of the whole organ, and pinealocytes were slightly smaller in size in the proximal portion than elsewhere. The distal and intermediate portions contained few interstitial cells and numerous astrocytes, but the proximal portion lacked interstitial cells and had more abundant astrocytes than elsewhere. Astrocytes, which were immunoreactive for glial fibrillary acidic protein, mainly lined the pericapillary spaces in the distal and intermediate portions, but in the proximal portion these cells often surrounded isolated or groups of pinealocytes. In the distal and intermediate portions, abundant sympathetic fibers and less numerous non-sympathetic, peptidergic fibers were mainly localized in the pericapillary spaces; these fibers were sparsely distributed in the parenchyma close to interstitial cells or astrocytes. In the proximal portion, non-sympathetic fibers were scarce and sympathetic fibers were distributed abundantly and almost exclusively in the parenchyma. Most of the sympathetic fibers were adjacent to astrocytes and, occasionally, made specialized contact with them. Fenestrae in the capillary endothelium were numerous in the distal portion but absent in the proximal portion. Thus, marked differences in structure existed between the distal and proximal portions of the pineal gland of the cotton rat suggesting that both portions are functionally dissimilar. In addition, the present study indicates that the proximal portion of the cotton rat was well developed and showed morphological features similar to the deeply situated pineal glands of other mammals.     

Computerized morphometric quantitation of elastin and collagen in SMAS and facial skin and the possible role of fat cells in SMAS viscoelastic properties

Recently, the superficial musculoaponeurotic system (SMAS) was found to be a composite tissue comprising collagen, elastic fibers, and fat cells in an extracellular viscous matrix. Both SMAS and facial skin tissues exhibit viscoelastic properties, but SMAS tissue has delayed stress relaxation. As a consequence, SMAS is viewed as a firmer elastic foundation for the more viscous facial skin. In some patients, a slackening effect of SMAS tissue takes place over a period ranging from weeks to months after tightening. To determine the relative quantity of viscoelastic components and better understand their biomechanical behavior, a quantitative morphometric study of the elastic and collagen fibers in the SMAS and facial skin was conducted. Thirty-four SMAS preparations were taken from 17 patients during either primary face lift operations (12 women) or reoperative face lift procedures (4 women, 1 man), which were performed 4 to 9 months after the original surgery, to examine the elastin and collagen content. For comparison, preauricular skin was also gathered from these patients. The specimens were stained with Weigert's staining to identify elastin and collagen fibers. Using a computerized morphometric analysis, 100 fields of each SMAS and skin specimen were examined. According to our findings, the average percentage of elastin and collagen fibers in SMAS and facial skin was as follows: (1) the percentage of elastin fibers in the SMAS was 4.71 +/- 1.2 (standard error of mean +/- 0.0291); (2) the percentage of elastin fibers in the skin was 6.1 +/- 1.8 (standard error of mean +/- 0.0436); (3) The percentage of collagen fibers in the SMAS was 38.7 +/- 5.9 (standard error of mean +/- 0.1430); and (4) the percentage of collagen fibers in the skin was 48.47 +/- 6.96 (standard error of mean +/- 0.1688). A statistical significance of p < 0.0001 was demonstrated between the collagen and elastin groups. A different percentage of elastin and collagen fibers was found among the 17 patients and within each of them separately. Neither gender nor age differences were found regarding elastin and collagen fiber content. No statistical differences were demonstrated between specimen sources, i.e., whether the operations were primary or reoperative face lift procedures. Findings from previous studies indicate that the cheek has two viscoelastic layers, the skin and the SMAS. The proportional similarity in average percentages of elastin and collagen in SMAS and facial skin cannot explain the relatively delayed stress relaxation effect of the SMAS. Therefore, the fat cells that are found exclusively in the SMAS probably lend a certain degree of firmness to this layer and play a significant role in the long-term efficacy of SMAS surgery.     

Comparison of spontaneously released endothelium-derived relaxing factor in cerebral and extracerebral arteries in rabbits

To investigate regional differences in spontaneously released endothelium-derived relaxing factor (EDRF), a bioassay of spontaneously released EDRF was performed on rabbit basilar, ear, common carotid and thoracic arteries using an isometric tension measurement technique and a measurement of cyclic guanosine monophosphate (cGMP) content in the vascular smooth muscle. The amount of spontaneously released EDRF was higher in the basilar artery than in any other arteries examined (p < 0.01). The levels of cGMP were 57.3 +/- 4.4 (n = 7) in basilar, 26.5 +/- 4.3 (n = 6) in ear, 24.5 +/- 2.3 (n = 11) in common carotid, and 30.3 +/- 3.8 pmol/g tissue (n = 8) in thoracic artery with endothelium, while endothelium-denuded arteries showed 24.2 +/- 6.6 (n = 5), 17.5 +/- 5.1 (n = 6), 20.1 +/- 2.9 (n = 7) and 14.4 +/- 2.3 pmol/g tissue (n = 8) in the same order. Haemoglobin (10(-5) M, incubated with the artery for 5 min, significantly reduced the level of cGMP in all vessels with endothelium: 35.3 +/- 4.4 (basilar), 16.0 +/- 2.1 (ear), 14.0 +/- 1.9 (common carotid) and 8.7 +/- 1.2 pmol/g tissue (thoracic artery). Since endothelium-dependent relaxation is associated with a rise in the cGMP content of the smooth muscle cell, the data of cGMP measurement in addition to the bioassay of spontaneously released EDRF in tension measurement suggests that the spontaneous release of EDRF is much greater in the basilar artery than in extracerebral arteries. It is concluded that the intensity of the spontaneously released EDRF is relatively higher in the intracerebral artery than in the extracerebral artery.     

Prevalence of osteoporosis in the Czech Republic

BACKGROUND: The objective of this study was to evaluate the prevalence of osteoporosis and osteopenia in Czech women and men aged 50 to 75 years. METHODS AND RESULTS: Bone mineral density was assessed in an age-stratified random sample of 713 women and 429 men from two cities (Prague and Litom?rice) in the lumbar spine, proximal femur and total body by dual X-ray absorptiometry and in the distal forearm by single X-ray absorptiometry. The proportion of women and men in each age group with bone density below specified levels at any of these skeletal sites was projected to the population structure of the Czech Republic. With advancing age, in women at 55 years and in men at 65 years of age the population with normal bone mineral density becomes smaller, and a greater proportion has osteopenia or osteoporosis. Overall, an estimated 428,000 women and 195,000 men over age 50 have osteoporosis and another 680,000 women and 435,000 men have osteopenia. CONCLUSIONS: The results of this first population-based cross sectional study in the Czech Republic document a high prevalence of osteoporosis and osteopenia which is comparable with that published for the Netherlands and the United States. The results offer a basis for economical considerations in diagnosis, treatment and consequences of osteoporosis.     

Comparison of the morphologic and vascular reactivity of the proximal and distal radial artery

BACKGROUND: Variations in the morphology and vascular reactivity of the proximal and distal radial artery might influence its performance as a bypass conduit. METHODS: The morphologic and functional characteristics of the proximal and distal RAs were compared with those of the left and right internal mammary arteries by using histologic and in vitro organ bath techniques. RESULTS: Proximal RA had a significantly greater medial cross-sectional area compared with that of the distal RA (2.48+/-0.27 mm2 compared with 1.86+/-0.21 mm2, p< 0.05), which were both significantly greater than the left internal mammary artery (0.54+/-0.09 mm2) or the right internal mammary artery (0.67+/-0.03 mm2). Proximal RA had a significantly greater response to 90 mmol/L potassium chloride than that of distal RA (88.4+/-7.3 compared with 60.2+/-10.3 mN, p<0.05), and both contracted more than the left internal mammary artery (30.3+/-2.9 mN) and the right internal mammary artery (32.6+/-4.1 mN). There was no difference in the response to noradrenaline and adrenaline between proximal and distal RA, both of which contracted more than the left and right internal mammary arteries. CONCLUSIONS: When choosing a segment of RA for use as a bypass conduit, regional variations in biologic properties should be considered.     

Vascular distribution of paradoxical emboli by transcranial Doppler

BACKGROUND AND PURPOSE: Paradoxical embolism through a patent foramen ovale is a contributory mechanism to stroke and may be diagnosed by contrast echocardiography. The intracranial distribution of these emboli has not been previously reported. METHODS: We used transcranial Doppler combined with agitated saline contrast injection to determine whether there was a preferential distribution of the contrast into the anterior or posterior intracranial circulation of patients with an acute stroke or transient ischemic attack. RESULTS: Forty-nine patients were studied--27 men and 22 women, with a mean age of 62.7 +/- 13.3 years (range, 29 to 85 years). Microcavitations were detected in the proximal right middle cerebral artery in 12 of 49 patients (24%). A patent foramen ovale was confirmed in all cases by simultaneous transesophageal echocardiography. Of the 12 patients, microcavitations were also detected in the proximal basilar artery in nine (75%). CONCLUSIONS: While paradoxical embolism appears to occur more frequently in the anterior circulation, the high rate of detection of microcavitations in the basilar artery suggests that paradoxical embolism to the posterior intracranial circulation may be more frequent than generally believed.     

Giant fusiform basilar artery aneurysm: endovascular treatment by flow reversal in the basilar artery

We report a patient presenting with subarachnoid haemorrhage due to rupture of a giant fusiform aneurysm of the proximal basilar artery. The aneurysm was successfully treated by reversing blood flow in the basilar artery by balloon occlusions of both vertebral arteries proximal to the posterior inferior cerebellar artery origins. Substantial thrombosis and regression of the aneurysm was evident 4 months later.