La fraction d'éjection du ventricule droit (FEVD) est un marqueur de survie en cas d'hypertension pulmonaire (PH), mais sa mesure est compliquée et fastidieuse. Le TAPSE (Tricuspid Annular Plane Systolic Excursion) est un bon indice de la FEVD mais il ne mesure que la composante longitudinale de la contraction ventriculaire droite. La fraction de variation surfacique du ventricule droit RVFAC (Right Ventricular Fractional Area Change) semble être un meilleur indice de FEVD car il prend en compte le sens longitudinal et transversal des éléments de la contraction du ventricule droit. Le but de notre étude était d'évaluer la performance RVFAC fonction de la sévérité hémodynamique chez les deux groupes de patients atteints de PH:l'hypertension artérielle pulmonaire (HAP) et l'hypertension pulmonaire thromboembolique chronique (CTEPH).Methodes: Soixante-deux patients atteints d'HTAP et CTEPH ont bénéficié d’un cathétérisme cardiaque droit et d’une IRM cardiaque dans un délai de 72 heures. Les surfaces ventriculaires droite et gauche a la fin de la diastole (RVEDA, LVEDA), la surface du ventricule droit a la fin da la systole (RVESA) et TAPSE ont été mesurés dans la vue quatre cavités. Le RVFAC (RVFAC=RVEDA-RVESA/RVEDA) et le rapport RVEDA/LVEDA ont été calculés. Le diamètre entre la paroi libre et le septum (DF-S) et le diamètre entre les parois antérieure et postérieures du ventricule gauche (DA-P) ont été mesurés et l'indice d’excentricité LV (IE) a été calculé (= DA-P / DF-S). Le RVEF a été calculée à l'aide de coupes jointives de 6 mm en petit axe du ventricule droit.Résultats: La population avait un âge moyen de 58 ans avec une majorité des femmes, la plupart des patients étaient en classe fonctionnelle III, 23 avaient des HAP) et 39 des CTEPH. La RVEF était faiblement corrélée aux variables hémodynamiques de la post-charge et de la fonction VD. Le RVFAC était plus fortement corrélée à FEVD (R2 = 0,65, p <0,001) que TAPSE (R2 = 0,35, p <0,001). Une FEVD <35% était mieux prédite par un RVFAC bas que par une diminution de TAPSE (TAPSE: AUC 0,73 et RVFAC: AUC 0,93, p = 0,0065). Nous avons divisé la population par la médiane de la résistance artérielle pulmonaire (RAP) et nous avons observé que dans le groupe avec la pire sévérité hémodynamique, cette différence a augmenté: dans le groupe avec PVR < 8,5 UW (RVFAC: R2 = 0,66, p <0,001 et TAPSE: R2 = 0,30, p =0,002) et dans le groupe avec PVR > 8,5 UW (RVFAC: R2 = 0,51, p <0,001 et TAPSE: R2 = 0,14, p = 0,041). Le groupe avec PVR> 8,5 WU avait un rapport RVEDA/LVEDA augmenté et une augmentation de l`indice excentricité. Les relations RVEF-RVFAC n’étaient pas différentes entre les groupes de HAP et CETPH.Conclusion: La fraction de variation surfacique du ventricule droit RVFAC fournit un reflet simple et fiable de la FEVD peut-être parce que contrairement à TAPSE qui ne prend en compte que le raccourcissement longitudinal, RFVAC prend également en compte la composante transversale de la fonction ventriculaire droite. / The right ventricular ejection fraction (RVEF) is a surrogate marker in pulmonary hypertension (PH), but its measurement is complicated and time consuming. The TAPSE (Tricuspid Annular Plane Systolic Excursion) is a good index of RVEF, though it measures only the longitudinal component of right ventricular contraction. The RVFAC (Right Ventricular Fractional Area Change) seems to be a better index of RVEF because it takes into account the longitudinal and the transversal components of right ventricular contraction. The aim of our study was to evaluate the RVFAC performance according to hemodynamic severity in two groups of patients with PH: pulmonary arterial hypertension (PAH) and chronic thromboembolicpulmonary hypertension (CTEPH).Methos: Sixty-two patients with PAH and CTEPH underwent right heart catheterization and cardiac MR in a 72-hour delay. The right and left ventricle end diastolic areas (RVEDA, LVEDA), the right ventricle end systolic area (RVESA) and TAPSE were measured in the four chamber view. The RVFAC (RVFAC=RVEDA–RVESA/RVEDA) and the RVEDA/LVEDA relationship werecalculated. The diameter between the left ventricle (LV) free wall and the septum (dL-S) and the diameter between the anterior and posterior walls (dAP) were measured and the LV eccentricity index (EI) was calculated (EI=dAP/dL-S). The RVEF was calculated by using 6 mm RV short axis cines.Results: The population had mean age of 58 years with female majority, most of the patients were in functional class III, 23 had pulmonary arterial hypertension (PAH) and 39 had chronic thromboembolic pulmonary hypertension (CTEPH). The RVEF was weakly correlated to the hemodynamic variables of RV afterload and function. The RVFAC was morestrongly correlated to RVEF (R2=0.65, p<0.001) than TAPSE (R2=0.35, p<0.001). RVEF<35% was better predicted by RVFAC than TAPSE (TAPSE: AUC 0.73 and RVFAC: AUC 0.93, p=0.0065). We divided the population by the median of the pulmonary vascular resistance (PVR) and we observed that in the group with worse hemodynamic severity this difference increased: inthe group with PVR<8,5WU (RVFAC: R2=0.66, p<0.001 and TAPSE: R2=0.30, p=0.002) and in the group with PVR>8,5 WU (RVFAC: R2=0.51, p<0.001 and TAPSE: R2=0.14, p=0.041). The group with PVR>8,5WU had an increased RVEDA/LVEDA and an increased EI. There was no differences in the RVEF relationships between the groups of PAH and CETPH.Conclusion: The RVFAC was better correlated to RVEF than TAPSE in the groups with less severe and more severe hemodynamics. In patients with increased hemodynamic severity, with no difference in the performance in theHAP or CTEPH groups. RVFAC was a better index of RVEF possibly because it takes into account the transversal component of right ventricular function.

Uma função autonômica adequada é essencial para a manutenção da estabilidade hemodinâmica durante a hemorragia. Diversos estudos tem demonstrado que a análise da variabilidade da frequência cardíaca (VFC) é uma técnica não-invasiva promissora para avaliação da modulação autonômica no trauma, mostrando haver uma associação entre a VFC e desfecho clínico. O objetivo deste estudo foi avaliar a VFC durante o choque hemorrágico e reposição volêmica, comparando a variáveis hemodinâmicas e metabólicas tradicionais. Vinte porcos anestesiados e ventilados mecanicamente foram submetidos ao choque hemorrágico (60% da volemia estimada) e avaliados durante 60 minutos sem reposição volêmica. Os animais sobreviventes foram tratados com solução de Ringer lactato e avaliados por mais 180 minutos. Medidas de VFC (no domínio do tempo e da frequência) e variáveis hemodinâmicas e metabólicas foram comparados entre animais sobreviventes e não sobreviventes. Sete dos 20 animais morreram durante o choque hemorrágico e reposição volêmica inicial. Todos os animais apresentaram diminuição do intervalo RR e aumento das medidas de VFC no domínio do tempo durante a hemorragia, sendo restaurados os valores basais após reposição volêmica. Embora não significante estatisticamente, foram observados diminuição de LF e LF/HF durante os estágios iniciais de sangramento, recuperação dos valores basais durante a manutenção do choque hemorrágico e aumento após reposição volêmica. Os animais não sobreviventes apresentaram valores significativamente menores de pressão arterial média (43 ± 7 vs 57 ± 9) e índice cardíaco (1,7 ± 0,2 vs 2,6 ± 0,5) e valores maiores de lactato (7,2 ± 2,4 vs 3,7 ± 1,4), excesso de base (-6,8 ± 3,3 vs -2,3 ± 2,8) e potássio sérico (5,3 ± 0,6 vs 4,2 ± 0,3), trinta minutos após indução do choque hemorrágico. Concluímos que as medidas de VFC não foram capazes de discriminar sobreviventes e não-sobreviventes durante choque hemorrágico. As variáveis metabólicas e hemodinâmicas foram melhores em refletir a gravidade do choque hemorrágico do que as medidas de VFC / An adequate autonomic function is essential for maintaining the hemodynamic stability during hemorrhage. The analysis of heart rate variability (HRV) has been shown as a promising non-invasive technique for assessing the cardiac autonomic modulation in trauma, and several studies have demonstrated the association between HRV and clinical outcome. The aim of this study was to evaluate HRV during hemorrhagic shock and fluid resuscitation, comparing to traditional hemodynamic and metabolic parameters. Twenty anesthetized and mechanically ventilated pigs were submitted to hemorrhagic shock (60% of estimated blood volume) and evaluated for 60 minutes without fluid replacement. Surviving animals were treated with Ringer solution and evaluated for an additional period of 180 minutes. HRV metrics (time domain and frequency domain) as well as hemodynamic and metabolic parameters were evaluated in survivors and non-survivors animals. Seven of the 20 animals died during hemorrhage and initial fluid resuscitation. All animals presented an increase in time-domain HRV measures during haemorrhage and fluid resuscitation restored baseline values. Although not significantly, normalized low-frequency and LF/HF ratio decreased during early stages of haemorrhage, recovering baseline values later during hemorrhagic shock and increased after fluid resuscitation. Non-surviving animals presented significantly lower mean arterial pressure (43 ± 7 vs 57 ± 9) and cardiac index (1.7 ± 0.2 vs 2.6 ± 0.5) and higher levels of plasma lactate (7.2 ± 2.4 vs 3.7 ± 1.4), base excess (-6.8 ± 3.3 vs -2.3±2.8) and potassium (5.3 ± 0.6 vs 4.2 ± 0.3), 30 minutes after hemorrhagic shock compared to surviving animals. Conclusions: The HRV metrics were not able to discriminate survivors from non-survivors during hemorrhagic shock. Moreover, metabolic and hemodynamic variables were more reliable to reflect hemorrhagic shock severity than HRV metrics

A fase da vida adulta entre 35 e 60 anos, também denominada de meia idade, compreende o período em que os principais sistemas biológicos apresentam importantes declínios funcionais. Nas mulheres, especificamente, é a fase marcada pelo climatério que tem como principal evento a ocorrência da menopausa. Esse evento fisiológico de importância hormonal e reprodutiva está associado em muitas mulheres ao expressivo aumento da prevalência de doenças cardiovasculares, muitas vezes associadas e precedidas por prejuízos na função autonômica cardiovascular. Nesse sentido, a avaliação da funcionalidade autonômica cardíaca é muito importante como conduta para estratificação de risco cardiovascular. De fato, a análise da variabilidade da frequência cardíaca (VFC) é muito utilizada, entretanto a metodologia segue um protocolo padrão que não leva em consideração situações fisiológicas importantes, como é o caso da reorganização da modulação autonômica cardíaca após o estresse induzido pelo exercício. Adicionalmente, a literatura tem optado por ferramentas lineares em detrimento das não lineares na avaliação da VFC. Nesse caso, a proposta do presente estudo foi avaliar e comparar a função autonômica cardíaca em mulheres jovens (GJ: 21 a 30 anos) e de meia idade pósmenopausa (GMI: 45 a 60 anos) por meio da análise linear (análise espectral) e não linear (análise simbólica) da variabilidade da frequência cardíaca em três momentos distintos (em repouso na posição supina, durante o tilt teste e durante o período de recuperação pós teste cardiopulmonar submáximo). O GMI apresentou menores valores de VO2pico (24 ± 1.0 vs 39 ± 1.3 ml.kg. min-1) frequência cardíaca basal (71 ± 2 vs 81 ± 2 bpm) e maiores valores da pressão arterial média (91 ± 2 vs 81 ± 1 mmHg) em relação ao GJ. Também apresentou maior modulação simpática e menor modulação vagal da FC na posição supina, entretanto somente evidenciado pela análise linear. Durante o tilt test as respostas do GMI foram menos proeminentes quando comparado com o GJ. Nesse caso, as avaliações linear e não linear apresentaram resultados semelhantes. Por fim, a análise da VFC durante o período de recuperação mostrou que o GMI apresentou recuperação da modulação autonômica vagal mais rápida evidenciada em ambas análises, linear e não linear. Em conclusão, a avaliação da modulação autonômica cardíaca mostrou que em repouso as mulheres jovens apresentam um predomínio do componente autonômico vagal, enquanto as mulheres de meia idade pós-menopausa apresentam um predomínio simpático. Por sua vez, o tilt test mostrou que a resposta autonômica das mulheres jovens é mais intensa, entretanto na reorganização após o exercício físico as mulheres de meia idade apresentaram maior velocidade no reestabelecimento da modulação vagal. As causas são incertas, porém podem ser decorrentes da redução dos hormônios ovarianos, bem como do processo de envelhecimento por estabelecimento de uma menor complexidade nos sistemas fisiológicos envolvidos. / The stage of adulthood between 35 and 60, also known as middle-aged, covers the period in which the main biological systems have important functional decline. In women, specifically, it is the stage marked by climacteric whose main event the occurrence of menopause. This physiological event of hormonal and reproductive importance is associated in many women to the significant increase in the prevalence of cardiovascular disease, often associated and preceded by losses in cardiovascular autonomic function. In this sense, the evaluation of cardiac autonomic functionality is very important as practice for cardiovascular risk stratification. In fact, the analysis of heart rate variability (HRV) is widely used, however the methodology follows a standard protocol that does not take into account important physiological situations, such as the reorganization of cardiac autonomic modulation after exercise-induced stress. Additionally, the literature has opted for linear tools instead of linear no evaluation of HRV. In this case, the purpose of this study was to evaluate and compare the cardiac autonomic function in young women (GJ: 21 to 30 years) and half postmenopausal age (GMI: 45-60 years) through the linear analysis (spectral analysis ) and non-linear (symbolic analysis) of heart rate variability at three different times (at rest in the supine position during the tilt test and during the recovery period after submaximal cardiopulmonary test). The GMI showed lower values of peak VO2 (24 ± 1.0 vs 39 ± 1.3 ml.kg. min-1) basal heart rate (71 ± 2 vs 81 ± 2 bpm) and higher mean arterial pressure (91 ± 2 vs 81 ± 1 mm Hg) compared to GJ. Also showed higher sympathetic modulation and lower vagal modulation of HF in the supine position, however only evidenced by linear analysis. During the tilt test responses GMI were less prominent compared to GJ. In this case, the linear and nonlinear tools showed similar results. Finally, the analysis of HRV after submaximal cardiopulmonary test showed that the GMI recovered faster autonomic modulation, shown in both analyzes, linear and non-linear. In conclusion, the evaluation of cardiac autonomic modulation showed that resting young women have a predominance of vagal autonomic component, while women half postmenopausal age present a sympathetic predominance. In turn, the tilt test showed that the autonomic response of young women is more intense, but the autonomic reorganization after exercise, the middle-aged women have faster the reestablishment of vagal modulation. The reasons are unknown, but may be due to the reduction in ovarian hormones, as well as the aging process by establishing less complex physiological mechanisms.

Introdução: A fração de ejeção do ventrículo direito (FEVD) é um importante fator prognóstico em pacientes com hipertensão pulmonar (HP), porém a sua medida é complicada e demorada devido à complexidade anatômica do ventrículo direito (VD). O TAPSE (Tricuspid Annular Plane Systolic Excursion) é um bom índice da FEVD, mas ele avalia apenas o componente longitudinal da contração ventricular direita. A RVFAC (Right Ventricular Fractional Area Change) parece ser um melhor índice da FEVD por incluir os componentes longitudinal e transversal da contração ventricular direita. O objetivo deste estudo foi avaliar a performance da RVFAC de acordo com a gravidade do acometimento hemodinâmico em dois grupos distintos de pacientes portadores de HP pré-capilar: hipertensão arterial pulmonar (HAP) e tromboembolismo pulmonar crônico hipertensivo (TEPCH). Métodos: 62 pacientes realizaram cateterismo cardíaco direito e ressonância magnética cardíaca em ±72h. As áreas sistóica e diastólica finais do ventrículo direito (ASFVD, ADFVD), a área diastólica final do ventrículo esquerdo (ADFVE) e o TAPSE foram medidos nas imagens de quatro cavidades. A RVFAC (ADFVD-ASFVD/ADFVD) e a relação entre as áreas diastólica finais ventriculares (ADFVD/ADFVE) foram calculadas. Os diâmetros entre as paredes livre e septal (dL-S) e antero-posterior (dA-P) do ventículo esquerdo (VE) foram medidos nas imagens em eixo curto e o índice de excentricidade do VE (IE) foi calculado (=dA-P/dL-S). A FEVD foi calculada a partir de imagens consecutivas de 6mm no eixo curto. . Resultados: A população tinha 58 anos em média, a maioria era do sexo feminino e estava em classe funcional III, 23 tinham HAP e 39 TEPCH. A FEVD apresentou correlações fracas com as medidas hemodinâmicas de sobrecarga e de função do VD. A RVFAC apresentou melhor correlação (R2=0,65, p < 0,001) do que o TAPSE (R2=0,35, p<0,001) com a FEVD e melhor capacidade para estimar FEVD<35% do que o TAPSE (TAPSE: AUC 0,73 e RVFAC: AUC 0,93, p=0,0065). Dividimos a população pela mediana da resistência vascular pulmonar (RVP) e observamos que no grupo com maior gravidade hemodinâmica essa diferença se acentuou: no grupo com RVP<8,5UW (RVFAC: R2=0,66, p<0,001 e TAPSE: R2=0,30, e p=0,002) e no grupo com RVP>8,5UW (RVFAC: R2=0,51, p<0,001 e TAPSE: R2=0,14, e p=0,041). O grupo com RVP>8,5UW apresentou maior ADFVD/ADFVE e maior IE. As correlações da RVFAC e TAPSE com FEVD foram semelhantes entre os grupos HAP e TEPCH. Conclusão: A RVFAC se correlacionou melhor com a FEVD do que o TAPSE tanto no grupo com menor como no grupo com maior gravidade hemodinâmica. No grupo com maior gravidade as correlações da RVFAC com a FEVD foram ainda mais significativas, não havendo diferenças na performance da RVFAC entre os pacientes com HAP e TEPCH. A RVFAC foi um melhor índice da FEVD talvez por incluir o movimento transversal da contração ventricular / Introduction: The right ventricular ejection fraction (RVEF) is a surrogate marker in pulmonary hypertension (PH), but its measurement is complicated and time consuming. The TAPSE (Tricuspid Annular Plane Systolic Excursion) is a good index of RVEF, though it measures only the longitudinal component of right ventricular contraction. The RVFAC (Right Ventricular Fractional Area Change) seems to be a better index of RVEF because it takes into account the longitudinal and the transversal components of right ventricular contraction. The aim of our study was to evaluate the RVFAC performance according to hemodynamic severity in two groups of patients with PH: pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH). Methos: Sixty-two patients with PAH and CTEPH underwent right heart catheterization and cardiac MR in a 72-hour delay. The right and left ventricle end diastolic areas (RVEDA, LVEDA), the right ventricle end systolic area (RVESA) and TAPSE were measured in the four chamber view. The RVFAC (=RVEDARVESA/RVEDA) and the RVEDA/LVEDA relationship were calculated. The diameter between the left ventricle (LV) free wall and the septum (dF-S) and the diameter between the LV anterior and posterior walls (dA-P) were measured and the LV eccentricity index (EI) was calculated (=dA-P/dF-S). The RVEF was calculated by using 6 mm RV short axis cines. Results: The population had mean age of 58 years with female majority, most of the patients were in functional class III, 23 had PAH and 39 CTEPH. The RVEF was weakly correlated to the hemodynamic variables of RV afterload and function. The RVFAC was more strongly correlated to RVEF (R2=0.65, p<0.001) than TAPSE (R2=0.35, p<0.001). RVEF<35% was better predicted by RVFAC than TAPSE (TAPSE: AUC 0.73 and RVFAC: AUC 0.93, p=0.0065). We divided the population by the median of the pulmonary vascular resistance (PVR) and we observed that in the group with worse hemodynamic severity this difference increased: in the group with PVR<8,5WU (RVFAC: R2=0.66, p<0.001 and TAPSE: R2=0.30, p=0.002) and in the group with PVR>8,5 WU (RVFAC: R2=0.51, p<0.001 and TAPSE: R2=0.14, p=0.041). The group with PVR>8,5WU had an increased RVEDA/LVEDA and an increased EI. There was no differences in the RVEF relationships between the groups of PAH and CETPH. Conclusion: The RVFAC was better correlated to RVEF than TAPSE in the groups with less severe and more severe hemodynamics. In patients with increased hemodynamic severity RVFAC perfomed even better, there was no difference in the performance of RVFAC in PAH or CTEPH. RVFAC was a better index of RVEF possibly because it takes into account the transversal component of right ventricular function

Atherosclerosis is a term coined to describe a state in which arterial wall thickens due to the accumulation of fatty materials like cholesterol. Though not completely understood, it is believed to occur due to the accumulation of macrophage white blood cells and promoted by low density lipoprotein. Increase in accumulation of plaque leads to enlargement of arteries as arterial wall tries to remodel itself. But eventually the plaque ruptures, letting out its inner content to blood stream. The ruptured plaque clots and heals and shrinks down as well but leaves behind stenosis - narrowing of cross section. Depending on the degree of stenosis blood supply from the artery to its respective organ could decrease and even get blocked completely. Frequently, as the vulnerable plaques rupture, thrombus formed as such could flow through bloodstream towards smaller vessels and block them, leading to a sudden death of tissues fed by that vessel. If the plaques do not rupture and artery gets enlarged to a great extent then it results in an aneurysm. Such blockage of coronary arteries in heart can lead to myocardial infarction - heart attack, in carotid arteries in brain can lead to what is called a stroke, in peripheral arteries in legs can lead to ulcers, gangrene (death of tissue) and hence loss of leg, in renal arteries can lead to kidney malfunction. The most disturbing fact about atherosclerosis is the inability to detect the disease in preliminary stages. As stated by Miller (2001), most of the times coronary artery disease (CAD) gets diagnosed only after 50-75 percent occlusion of arteries.

<p>Uvod-Kardiovaskularne bolesti su vodeći uzrok smrti i radne nesposobnosti u Evropi, predstavljaju<br />veliko socijalno i ekonomsko opterećenje. Bolesti periferne arterijske cirkulacije se mogu podeliti u<br />dve celine i to na okluzivne i neokluzivne bolesti, odnosno funkcionalne smetnje. Učestalost<br />arterijske bolesti donjih ekstremiteta snažno je povezana sa godinama starosti. Faktori rizika za<br />perifernu arterijsku bolest su slični onima koji su važni u etiologiji koronarne arterijske bolesti:<br />gojaznost, pu&scaron;enje, dislipidemija, &scaron;ećerna bolest, hipertenzija. Najtipičnija prezentacija periferne<br />arterijske bolesti je intermitentna klaudikacija koja se karakteri&scaron;e bolom u listovima koji se<br />pojačava pri hodanju; bol obično nestaje u miru. Svi gojazni pacijenti sa perifernom arterijskom<br />bole&scaron;ću donjih ekstremiteta imaju povećan rizik od budućih kardiovaskularnih događaja, te je kod<br />njih obavezna op&scaron;ta sekundarna prevencija u cilju pobolj&scaron;anja prognoze. Fizičko vežbanje<br />predstavlja metodu izbora kod obolelih od periferne arterijske bolesti donjih ekstremiteta.<br />Cilj istraživanja: Uporediti efekte programirane fizičke aktivnosti i medikamentozne terapije na<br />hemodinamiku i riziko faktore za kardiovaskularna obolenja kod gojaznih osoba obolelih od<br />periferne arterijske bolesti donjih ekstremiteta.<br />Ispitanici i metode istraživanja: Obavila se retrospektivna-prospektivna, klinički deskriptivna,<br />kontrolisana studija, na ispitanicima Javne Ustanove Domovi Zdravlja Kantona Sarajevo -<br />Specijalističko konsultativna delatnost. OJ Specijalističko konsultativna delatnost predstavlja<br />sekundarni vanbolnički nivo zdravstvene za&scaron;tite. Ovom studijom se evaluirao period od 20 nedelja<br />(140 dana). U studiju je uključeno 75 ispitanika. Na početku istraživanja, na osnovu nalaza kolor<br />Doppler sonografije pedalnih arterija, nalaza ejekcione frakcije leve komore, spirometrijskog<br />nalaza, vrednosti pulsnog aortalnog pritiska te utvrđivanja preterane uhranjosti &ndash; gojaznosti<br />ispitanici su uključeni u istraživanje. Osim ultrazvučnog nalaza i nalaza spirometrije, pacijenti su<br />dali i iscrpnu anamnezu o prethodnim obolenjima. Uradilo se merenje indeksa telesne težine, obim<br />struka i klaudikacione distance. Lipidogram kao i jutarnji &scaron;ećer su bili urađeni za svakog pacijenta.<br />Pacijentima je prepisana ili produžena medikamentozna terapija, te data detaljna upustva za<br />svakodnevni program vazoaktivne &scaron;etnje.<br />Rezultati istraživanja: Na početku istraživanja prosečna vrednost obima struka ispitanika je<br />iznosila 87,94&plusmn;3,07cm, nakon dve sedmice prosečan obim struka je iznosio 87,10&plusmn;2,0 cm, a na<br />kraju istraživanja 84,96&plusmn;1,98cm. Na početku istraživanja ispitanici ispitivane grupe su imali indeks<br />telesne mase od 28,93&plusmn;2,10 kg/m2. Nakon dve sedmice istraživanja i provedene terapije indeks<br />telesne mase se smanjio i iznosio 28,36&plusmn;1,99 kg/m2, da bi na kraju istraživanja prosečna vrednost<br />indeksa telesne mase u ispitivanoj grupi iznosio 27,26&plusmn;1,87 kg/m2. Prosečna vrednost glukoze u<br />krvi na početku istraživanja je iznosila 5,77&plusmn;0,96 mmol/L, tokom istraživanja ta vrednost je bila<br />5,42&plusmn;0,88 mmol/L, a na kraju istraživanja 5,30&plusmn;0,92 mmol/L. Postprandijalna vrednost glukoze u<br />krvi je na početku istraživanja iznosila7,48&plusmn;0,85 mmol/L, tokom istraživanja ta vrednost je bila<br />6,82&plusmn;0,62 mmol/L, a na kraju istraživanja 6,44&plusmn;0,64 mmol/L. Na početku istraživanja vrednost<br />HbA1c je iznosila 5,52&plusmn;0,91%, tokom istraživanja 5,32&plusmn;0,97%, a na kraju istraživanja<br />5,09&plusmn;0,73%.Prosečna vrednost CRP-a na početku istraživanja je iznosila 3,77&plusmn;1,12mg/L, tokom<br />istraživanja vrednost je iznosila 3,66&plusmn;1,36mg/L, da bi na kraju istraživanja ta vrednost iznosila<br />3,61&plusmn;1,21mg/L. Uparenim t-testom nije ustanovljeno statistički značajno smanjenje ili povečanje<br />CRP-a tokom istraživanja. Prosečna vrednost holestarola u krvi ispitanika na početku istraživanja<br />je bila iznad referentnih vrednosti i iznosila 6,58&plusmn;0,90 mmol/L. Nakon dve sedmice istraživanja i<br />provedene terapije vrednost je iznosila 4,96&plusmn;0,46 mmol/L, da bi na kraju istraživanja vrednost<br />iznosila 4,15&plusmn;0,54 mmol/L. Prosečne vrednosti triglicerida na početku i tokom istraživanja su bile<br />povi&scaron;ene, da bi na kraju istraživanja bile u okvirima referentnih vrednosti. Razlika između<br />VI<br />vrednosti leptina kod mu&scaron;karaca na početku i kraju istraživanja je iznosila 2,66&plusmn;1,52 ng/ml<br />(t=3,024; p=0,094) dok kod ispitanica ženskog pola nije do&scaron;lo do statistički značajne razlike.<br />Prosečne vrednosti viskoznosti plazme su na početku i tokom istraživanja bile iznad referentnih<br />vrednosti da bi na kraju istraživanja ta vrednost bila u granicama fiziolo&scaron;kih vrednosti. Prosečne<br />vrednosti PSV na početku i tokom istraživanja su bile u granicama patolo&scaron;kih vrednosti da bi na<br />kraju istraživanja vrednost bila u granicma fiziolo&scaron;kih vrednosti. Na početku istraživanja prosečna<br />vrednost PSV-a je bila 25,64&plusmn;5,38 cm/s, tokom istraživanja 26,94&plusmn;5,31 cm/s, da bi na kraju<br />istraživanja iznosila 35,84&plusmn;5,73 cm/s. Tokom sva tri merenja do&scaron;lo je do statistički značajnog<br />pobolj&scaron;anja. Na početku i tokom istraživanja ispitanici ispitivane grupe su imali patolo&scaron;ke<br />vrednosti klaudikacione distance, da bi na kraju istraživanja ta vrednost bila u fiziolo&scaron;kim<br />granicama. Ustanovljeno je statistički značajno smanjenje pulsa tokom istraživanja i to u<br />fiziolo&scaron;kim okvirima. Iako je do&scaron;lo do statistički značajnog pobolj&scaron;anja EFLV ipak su vrednosti na<br />kraju istraživanja bile na donjim granicama fiziolo&scaron;kih vrednosti. U toku istraživanja dobilo se i<br />statistički značajno pobolj&scaron;anje vrednosti pulsnog aortalnog pritiska. Iako je do&scaron;lo do statistički<br />značajnog pobolj&scaron;anja FEV1 ipak su vrednosti na kraju istraživanja bile na donjim granicama<br />fiziolo&scaron;kih vrednosti.<br />Zaključak - Vrednosti indeksa telesne mase ispitanika na kraju istraživanja su se statistički<br />značajno smanjile. Prosečna vrednost holesterola i triglicerida, kao i prosečna vrednost PSV-a,<br />BMI, EFLV, FEV1, kao i svih ostali poređenih parametara značajno se smanjila nakon oba<br />tretmana. Na osnovu dobijenih rezultata ustanovljeno je da je klaudikaciona distanca statistički<br />značajno manja u odnosu na početne vrednosti. Poredeći efekte medikamentoznog tretmana sa<br />efektima kombinovanog terapijskog pristupa dolazi se do zaključka da su svi poređeni parametri,<br />izuzev C-reaktivnog proteina u krvi, statistički značajno pobolj&scaron;ani na kraju kombinovanog<br />tretmana u odnosu na vrednosti na kraju medikamentoznog tretmana.</p> / <p>they represent a large social and economic burden. Diseases of peripheral arterial circulation can be<br />divided into two groups - the occlusive and non-occlusive disease, or functional impairment.<br />Incidence of arterial disease of the lower extremities is strongly associated with age. Risk factors<br />for peripheral arterial disease are similar to those that are important in the etiology of coronary<br />artery disease: obesity, smoking, dyslipidaemia, diabetes and hypertension. The most typical<br />presentation of peripheral arterial disease is intermittent claudication, which is characterized with<br />pain in the leaves, which increases during walking; the pain usually goes away in peace. All obese<br />patients with peripheral arterial disease of the lower extremities have an increased risk of future<br />cardiovascular incidents, and they require general secondary prevention in order to improve their<br />health forecasts. Physical activity represents the method of choice in patients with peripheral<br />arterial disease of the lower extremities.<br />Aim of the research: Compare the effects of programmed physical activity and medical therapy on<br />hemodynamic and risk factors for cardiovascular diseases in patients with peripheral arterial<br />diseases of the lower extremities.<br />Subjects and methods of research: A retrospective-prospective, clinically descriptive, controlled<br />study was conducted on subjects of the Public Institution Health Care Centre of Sarajevo Canton&ndash;<br />Specialist-consultative unit. Specialist-consultative unit represents secondary outpatient level of<br />health care. This study evaluated a period of 20 weeks (140 days). The study involved 75 subjects.<br />At the beginning of the study, based on the findings of colour Doppler sonography of the pedal<br />arteries, the findings of ejection fraction of the left ventricle, spirometry findings, values of<br />pulmonary aortic pressure and the determination of overweight - obesity subjects were included in<br />the research. In addition to ultrasound findings and spirometry findings, patients provided an<br />exhaustive history of previous illnesses. Measurement of the body weight index, waist<br />circumference and claudication distance were performed. Lipid status and morning blood glucose<br />level were performed for each patient. Prescribed or prolonged medicinal therapy was performed<br />for patients, and detailed instructions for everyday vasoactive walking program were given.<br />Research resultsAt the beginning of the study, the average volume of the subjects&#39; waist<br />circumference was 87.94 &plusmn; 3.07cm, after two weeks the average volume of the waist was 87.10 &plusmn;<br />2.0 cm, and at the end of the study 84.96 &plusmn; 1.98cm. At the beginning of the study, subjects of the<br />tested group had a body mass index of 28.93 &plusmn; 2.10 kg / m2. After two weeks of research and<br />performed therapy, the body mass index decreased and amounted to 28.36 &plusmn; 1.99 kg / m2, so that at<br />the end of the study, the average body mass index in the tested group was 27.26 &plusmn; 1.87 kg / m2.<br />The mean blood glucose level at the beginning of the study was 5.77 &plusmn; 0.96 mmol / L, during the<br />study this value was 5.42 &plusmn; 0.88 mmol / L, and at the end of the study, 5.30 &plusmn; 0.92 mmol / L. The<br />postprandial blood glucose level at the beginning of the study was 7,48 &plusmn; 0,85 mmol / L, during the<br />study, this value was 6.82 &plusmn; 0.62 mmol / L, and at the end of the study, 6.44 &plusmn; 0.64 mmol / L. At<br />the beginning of the study, the HbA1c value was 5.52 &plusmn; 0.91%, during the study 5.32 &plusmn; 0.97%, and<br />at the end of the study, 5.09 &plusmn; 0.73%. The C-reactive protein (CRP) mean at the beginning of the<br />study was 3.77 &plusmn; 1.12mg / L, during the study, the value was 3.66 &plusmn; 1.36mg / L, and at the end of<br />the study, this value was 3.61 &plusmn; 1.21mg / L. Paired t-test did not show a statistically significant<br />reduction or an increase in CRP during the study. The average blood cholesterol of the subjects at<br />the beginning of the study was above the reference values and amounted to 6.58 &plusmn; 0.90 mmol / L.<br />After two weeks of research and therapy, the value was 4.96 &plusmn; 0.46 mmol / L, and at the end of the<br />study the value was 4.15 &plusmn; 0.54 mmol / L. The average triglyceride values at the beginning and<br />during the study were elevated so that at the end of the study they were within the reference values.<br />VIII<br />The difference between the values of leptin in male subjects at the beginning and at the end of the<br />study were 2.66 &plusmn; 1.52 ng / ml (t = 3.024; p = 0.094) while there was no statistically significant<br />difference in female subjects. The average values of plasma viscosity were initially and during the<br />study above the reference values, and at the end of the study this value was within the limits of<br />physiological values. The mean values of PSV at the beginning and during the study were within<br />the limits of pathological values, and at the end of the study the value was within the physiological<br />limits. At the beginning of the study, the mean PSV value was 25.64 &plusmn; 5.38 cm / s, during the study<br />26.94 &plusmn; 5.31 cm / s, and at the end of the study it was 35.84 &plusmn; 5.73 cm / s. During all three<br />measurements statistically significant improvement was observed. At the beginning and during the<br />study, the subjects of the tested group had pathological values of claudication distance, and at the<br />end of the study this value was within the physiological limits. A statistically significant reduction<br />in pulse was observed during the study, in physiological frameworks. Although there was<br />statistically significant improvement in EFLV, however, the values at the end of the study were at<br />the lower limits of physiological values. During the study, statistically significant improvement in<br />the value of pulmonary aortic pressure was obtained. Although there was statistically significant<br />improvement in FEV1, the values at the end of the study were at the lower limits of physiological<br />values.<br />Conclusion - The values of the body mass index of subjects involved at the end of the study were<br />statistically significantly reduced. The average value of cholesterol and triglycerides, as well as the<br />average value of PSV, BMI, EFLV, FEV1 as well as all other comparable parameters, decreased<br />significantly after both treatments. Based on the obtained results it was found that the claudication<br />distance was statistically significantly lower than the baseline values. Comparing the effects of<br />medicinal treatment with the effects of the combined therapeutic approach, it is concluded that all<br />the compared parameters, other than C-reactive protein in the blood, were statistically significantly<br />improved at the end of the combined treatment compared to the values at the end of the medicinal<br />treatment.</p>

<p>The laparoscopic way of performing general surgical procedures was introduced all over the Western world in a few years around 1990. No previous scientific studies of the safety of this new way of performing general surgery had been undertaken.</p><p>In an animal study, it was shown that carbon dioxide pneumoperitoneum (CO₂PP) causes an increase in inferior caval vein (ICV) pressure, although there were no effects on the ICV blood flow. There were gradual increases in systemic, pulmonary and ICV vascular resistance, which remained after exsufflation. These effects on vascular resistance could not be reproduced in a second animal study, presumably due to a different form of anesthesia. In this study, there was only indirect evidence of CO₂ PP decreasing urine output. No increase in vasopressin, which is commonly seen during CO₂ PP, was found, indicating that vasopressin may play a role in the decreased urine output during CO₂ PP but that there must be other contributing factors as well. Only brief effects on the renal arterial blood flow were seen.Renal venous pressure increased to that of the ICV.</p><p>A literature review indicated that thromboembolic complications do occur after laparoscopic cholecystectomy (LC). The relative frequencies indicated an underreporting of deep vein thrombosis (DVT) in relation to pulmonary embolism (PE).</p><p>In a clinical study, activation of the coagulation after LC was demonstrated. There were differences between the groups receiving dextran and low molecular weight heparin as prophylaxis. A further clinical study showed the incidence of DVT, as demonstrated by phlebography, to be 2.0 % (95 % confidence interval 0-6.0 %) 7-11 days after LC, even though thromboembolism prophylaxis was given in shorter courses than those scientifically proven to be effective against DVT. D-dimer values increased at the first postoperative day and even further at the time of phlebography, suggesting that the effects of LC on coagulation and/or fibrinolysis may be of longer duration than previously known.</p>

The complement fragments C3a and C5a were purified from zymosan-activated human serum by column chromatographic procedures after the bulk of the proteins had been removed by acidic polyethylene glycol precipitation. In the isolated in situ perfused rat liver C3a increased glucose and lactate output and reduced flow. Its effects were enhanced in the presence of the carboxypeptidase inhibitor DL-mercaptomethyl-3-guanidinoethylthio-propanoic acid (MERGETPA) and abolished by preincubation of the anaphylatoxin with carboxypeptidase B or with Fab fragments of an anti-C3a monoclonal antibody. The C3a effects were partially inhibited by the thromboxane antagonist BM13505. C5a had no effect. It is concluded that locally but not systemically produced C3a may play an important role in the regulation of local metabolism and hemodynamics during inflammatory processes in the liver.

The prevalence of work-related muscle pain (WRMP) is large in the general population in the industrialized world. Despite significant advances over recent years in some research areas, the mechanisms of why WRMP occurs and the pathophysiological mechanisms behind the disorders are still unclear. One suggested explanation is that WRMP is caused initially by a limitation of the local muscle circulation and oxidative metabolism. There is a lack of objective methods to gauge the development and diagnosis of WRMP. Near infrared spectroscopy (NIRS) is a non-invasive technique that allows for determinations of oxygenation and blood flow. The purpose of this thesis was to evaluate NIRS (1) as a method for measuring muscle oxygenation and hemodynamics for the extensor carpi radialis (ECR) and trapezius descendens muscles (TD), and (2) to investigate whether variables measured by NIRS differed between patients diagnosed with WRMP and healthy subjects. Several variables of NIRS were produced and investigated. These included muscle oxygenation (StO2%), changes during contractions (ΔStO2%) and StO2% recovery (Rslope), total hemoglobin (HbT) as an indication of blood volume and its changes during contractions (ΔHbT). In addition, for the ECR, by applying an upper arm venous occlusion (VO) HbTslope increase as a surrogate of blood flow, and for both VO and arterial occlusion (AO) HHbslope increase (i.e. deoxyhemoglobin slope) as a surrogate of oxygen consumption were variables of interest. A first objective was to determine how StO2% and HbT responded to various contraction forces and how it related to muscle activation measured by electromyography (EMG). For both muscles isometric contractions of 10, 30, 50 and 70% of maximal voluntary contraction (MVC) were maintained for 20 s each by healthy males and females; additionally a 10% MVC contraction was sustained for 5 min. For the different contraction levels, predictable relationships were seen between ΔStO2% and force, and between ΔStO2% and EMG RMS amplitude. The general trend was a decrease in ΔStO2% with increasing force and increasing EMG. Females showed a tendency for a higher oxygen use (i.e., drop in StO2%) for the ECR over force levels than males and a higher RMS% MVC for the TD. For the 10% MVC contraction sustained for 5 min gender specific changes over time for HbT and RMS for the ECR, and for StO2% for the TD muscle were seen. A second objective was to determine the day-to-day reliability of NIRS variables for the ECR and TD muscles at group level (Pooled data) and at gender level (males and females). Measurements were performed on two occasions separated by 4-6 days and intraclass correlation coefficients (ICC) and limits of agreement (LOA) were determined as reliability and reproducibility indicators, respectively. Variables tested were ΔStO2% during submaximal isometric contractions of 10, 30, 50 and 70% MVC and StO2% recovery (Rslope) after contractions and after AO. For the ECR, HbTslope as an indication of blood flow (using VO) and HHbslope as a surrogate of oxygen consumption for both VO and AO were computed. For ΔStO2% for the ECR the highest ICC was at 30% MVC for both the pooled data and at gender level. For the TD ICCs were comparably high for 30, 50, 70 % MVC (for both muscles the ΔStO2% at 10% MVC showed the lowest ICC). Further, females showed a higher ICC than males for contraction levels of 50 and 70% MVC. For both muscles, LOA for ΔStO2% was lowest at 10% and highest at 50 and 70% MVC. For the ECR Rslope ICCs were high for all contraction levels, but was lower for AO; LOA was lowest at 70% MVC. For the TD, Rslope ICCs were also high for all contraction levels and LOA was lowest at 30 % MVC. ICC for HbTslope was the lowest of all variables tested. For HHbslope ICC was higher for AO than for VO, and LOA was lower for AO. A third objective was to determine if there were differences between healthy subjects and patients diagnosed with WRMP in ΔStO2% and ΔHbT responses during varying submaximal contractions (10, 30, 50 and 70% MVC), and StO2% recovery (Rslope) immediately after contractions and AO. Additional variables tested in the ECR at rest were HHbslope to indicate oxygen consumption (using AO) and HbTslope as an indication of blood flow. There were no differences between groups in ΔStO2% and ΔHbT variables during the contractions or Rslope in the recovery after contractions or AO. Furthermore, HbTslope was not different between groups However, oxygen consumption for the ECR and StO2% for the TD at rest were significantly greater for healthy subjects compared to patients. A fourth objective was to determine if there were differences in StO2% and HbT between healthy subjects and WRMP patients during a 12 min sustained contraction of 15 % MVC. In addition, the protocol included a recovery period of 30 min. Prior to contraction, as well as during the recovery period, HbTslope as a surrogate of blood flow was determined for the ECR. Neither the ECR nor the TD exhibited significant differences between groups for StO2% and HbT during the contraction. For the TD patients showed a lower StO2% value at rest and throughout the contraction than healthy subjects. For the ECR HbT during the sustained contraction the general trend was an initial decrease with gradual increase throughout the contraction for both groups. For HbTslope no differences were seen between patients and healthy subjects before the sustained contraction and during the recovery period for both muscles. NIRS is deemed a suitable technique for assessing physiological measurements of the upper extremity, including for day-to-day testing. NIRS was not able to distinguish between the patients with WRMP and controls. A concern in the thesis is the characteristics of the patient group in being equally active in recreational sports, actively working, and similar in muscle strength as controls. Thus, applying NIRS for studying a more severe patient group could yield different results.

The laparoscopic way of performing general surgical procedures was introduced all over the Western world in a few years around 1990. No previous scientific studies of the safety of this new way of performing general surgery had been undertaken. In an animal study, it was shown that carbon dioxide pneumoperitoneum (CO2PP) causes an increase in inferior caval vein (ICV) pressure, although there were no effects on the ICV blood flow. There were gradual increases in systemic, pulmonary and ICV vascular resistance, which remained after exsufflation. These effects on vascular resistance could not be reproduced in a second animal study, presumably due to a different form of anesthesia. In this study, there was only indirect evidence of CO2 PP decreasing urine output. No increase in vasopressin, which is commonly seen during CO2 PP, was found, indicating that vasopressin may play a role in the decreased urine output during CO2 PP but that there must be other contributing factors as well. Only brief effects on the renal arterial blood flow were seen.Renal venous pressure increased to that of the ICV. A literature review indicated that thromboembolic complications do occur after laparoscopic cholecystectomy (LC). The relative frequencies indicated an underreporting of deep vein thrombosis (DVT) in relation to pulmonary embolism (PE). In a clinical study, activation of the coagulation after LC was demonstrated. There were differences between the groups receiving dextran and low molecular weight heparin as prophylaxis. A further clinical study showed the incidence of DVT, as demonstrated by phlebography, to be 2.0 % (95 % confidence interval 0-6.0 %) 7-11 days after LC, even though thromboembolism prophylaxis was given in shorter courses than those scientifically proven to be effective against DVT. D-dimer values increased at the first postoperative day and even further at the time of phlebography, suggesting that the effects of LC on coagulation and/or fibrinolysis may be of longer duration than previously known.