This research study consisted of three parts.  In the first part two surveys were conducted, one among General Practitioners (GPs) in Grampian Area of Scotland and the second among Consultant Vascular Surgeons throughout the United Kingdom and Ireland, which aimed to explore the attitudes towards management of secondary risk factors in patients with intermittent claudication.  Postal questionnaires were used to determine how GPs and Consultant vascular surgeons screened for and controlled the major risk factors - cigarette smoking, hypertension, diabetes and hyperlipidaemia, whether and what anti-platelet treatment was prescribed, and the availability of facilities such as smoking cessation clinics and supervised exercise programmes for patients with intermittent claudication.  The findings from the GP survey were compared with the responses to a questionnaire of patients with intermittent claudication referred to the Vascular Clinic, Aberdeen Royal Infirmary and to the results of blood investigations. The results of the two surveys showed that a significant proportion of both GPs and Consultant Vascular Surgeons do not abide by current recommendations on management of major secondary risk factors.  This may be partly due to the lack of national guidelines and the paucity of local guidelines specifically on the management of secondary risk factors in intermittent claudication.  The surveys have also identified serious deficiencies in the availability of supervised exercise and smoking cessation programmes for this group of patients.  Only a very small minority of consultant vascular surgeons have access to a vascular physician.  Furthermore a wide discrepancy was noted between the claims made by GPs.

Thesis (M Nursing (Advanced Practice))--University of South Australia, 1995

Thesis (doctoral)--Turku, 1979. / "English summary: Intermittent claudication: noninvasive functional evaluation in diagnosis and follow-up of physical training."

After looking in the vault copies, the Digitization Centre has determined that page vi is a missing page and may be a printing error. -Digitization Centre / This study aimed to improve understanding of walking exercise among individuals with intermittent claudication. Using a prospective design, Ajzen's (1985, 1991) theory of planned behaviour was applied to examine psychosocial determinants of walking exercise. In addition, measures of barrier self-efficacy were explored as determinants of behaviour and perceived pain intensity was examined as a moderator of the intention-behaviour relationship. Ninety-four participants (n = 33 female) completed baseline measures of attitudes, subjective norms, perceived behavioural control, and intentions to engage in walking exercise. Additional measures of pain-related barrier self-efficacy and barrier self-efficacy regarding walking exercise were obtained and the Borg CR1 0 Pain Scale (Borg, 1998) was used to assess perceived pain intensity during walking. Participants were contacted weekly by telephone over four consecutive weeks and asked to recall their walking exercise and associated perceived pain intensity for the preceding seven-day period. Attitudes, subjective norms and perceived behavioural control contributed significantly to a multiple regression model predicting 67% of the variance in walking intentions. Intentions and perceived behavioural control explained 34% of the variance in walking exercise; however, pain-related barrier self-efficacy and barrier self-efficacy did not explain additional variance in behaviour and perceived pain intensity failed to moderate the intention-behaviour relationship. Findings support the theory of planned behaviour for predicting walking intentions and exercise among individuals with intermittent claudication, and suggest that pain cognitions as measured in this study do not play a role in determining walking. / Thesis / Master of Science (MS)

Patients with Peripheral Arterial Disease have a reduced capacity for exercise, the exact causes of which are poorly understood. This thesis investigated alternative testing procedures that aim to provide a more complete and precise description of the exercise capacities of these patients. Furthermore, the potential roles of gastrocnemius muscle fibre morphometry, capillary supply and glycogen stores in the exercise tolerance of PAD patients were studied. Study one aimed to determine the effect of test repetition on maximal exercise performance and test-to-test variability in PAD patients using an incremental treadmill walking test (T) (n=5), an incremental cycle test (C) (n=5), and incremental endurance (PF-endurance) and maximal strength (PF-strength) plantar flexion tests (n=5). Tests were conducted once per week for eight weeks. Performance was stable on the T (~530 s) and C (~500 s) tests across the eight weeks. Test-to-test variance on T decreased from 16%CV (CV: coefficient of variation) to 6%CV (p=.21,NS), and from ~8%CV to 2%CV on C (p<.05) over the eight week period. Variance of peak gas exchange variables tended to decrease with performance variance on both tests; however, other physiological variables, and the associated variance levels, were stable throughout the study. PF strength (635-712N) gradually increased over the initial 2-3 weeks (p<.05) which was accompanied by a reduction in variance from ~8%CV to ~3%CV (p<.05). Similarly, PF endurance increased over the first two weeks (~32,000 to 41500 N.s-1) while variance of this measure fell from ~21%CV to ~10%CV (p<.05) over the study duration. It is concluded that the implementation of familiarisation sessions leads to a reduction in whole body and local calf muscular performance variance in patients with PAD. Using a randomised crossover design, study two aimed to compare performance and the physiological and symptomatic responses between a T test and a C test in 16 patients with PAD. Peak exercise time on C (690 s) was greater than that on T (495 s); however the two were significantly correlated (n=16, r=.69, p<.05). Peak HR (120 bpm), VO2 (~1.22 l.min-1) and rate pressure product (~20') did not differ between the two tests, nor did the post exercise ankle pressure (T: 56; C: 61 mmHg). In two subjects with lower back pain during C, the ankle pressure of their "worst" limbs failed to fall by >10mmHg. Performance on both the T and C tests was closely related to the onset of leg symptoms; however the site of pain during C was much more variable than during T. Incremental cycle testing would overcome some of the limitations of treadmill testing (e.g. measurement of mechanical work), and it appears to be an acceptable alternative for measuring the exercise capacity and physiological exercise responses in known claudicants. Use of cycle ergometry for the diagnosis of PAD requires testing in the general population. Study three aimed to compare whole body (T test and C test) and local calf muscular (PF strength and endurance) exercise performance between 16 PAD patients (age: 63 ± 2; BMI: 25.9 ± 1.1) and 13 healthy, sedentary control (CON) subjects (age: 62 ± 1; BMI: 25.9 ± 0.4), and to describe relationships between the whole body and local calf muscular exercise capacities within the two groups. Furthermore, this study aimed to compare several histochemical characteristics of the medial gastrocnemius muscle fibres between PAD and CON, and to establish whether these factors were related to the exercise capacities of both groups. Maximal performance on T was 59% lower in the PAD group compared with the CON group, as was performance on C (50%), PF strength (25%), and PF endurance (58%). Compared with CON, PAD patients had a lower estimated calf muscle mass and a slight reduction (10%) in muscle fibre size (p=.14, NS). They also had a lower proportion of type I fibres (PAD: 49%; CON: 62%) that was offset by a greater proportion of type IIA fibres (PAD: 27%; CON: 16%), and a reduction in the capillary contacts per muscle fibre (PAD: 1.63; CON: 2.12) compared with CON. When expressed relative to fibre area there were no differences in capillarisation between PAD and CON; however this index was significantly related to resting and post exercise ABI in the PAD patients. There were no differences in the mixed muscle [glycogen], nor the optical density of glycogen in the individual fibres, between the two groups. PF endurance was poorly predictive of walking performance, and did not correlate with any of the morphological variables in both groups. Calf muscle mass correlated with PF strength (r=.59 - .62), and strength was correlated with T performance (r= .61 - .63) in both groups. In the PAD patients, T performance was correlated with the cross sectional area (n=12, r=.72, p<.05), capillary contacts (n=10, r=.81, p<.05) and glycogen density (n=9, r=.81, p<.05) of type I fibres. This study confirms that a reduction in calf strength, which appears to be mediated through muscle atrophy, plays some role in the reduced exercise capacity of claudicants. While both fibre area and capillary supply seem to be of relevance to the exercise capacity of PAD patients, these two factors are closely linked and further research is required to establish the determinants, and relative importance of both. An important, and possibly limiting role of carbohydrate oxidisation in PAD patients is supported by the strong relationship between type I glycogen stores and whole body exercise capacity.

Diss. (sammanfattning) Linköping : Linköpings universitet, 2005. / Härtill 6 uppsatser.

L’évaluation de la Distance de Marche Maximale (DMM) des artériopathes claudicants représente un enjeu primordial puisqu'une DMM inférieure à 300 mètres est en faveur d'une prise charge chirurgicale. En routine clinique, la DMM est évaluée par questionnaires, méthode d'évaluation très subjective, ou par tests de marche sur tapis roulant qui sont protocole-dépendants et reproduisent mal la douleur habituelle. Aussi, l'objet de cette thèse est de tester la validité de méthodologies innovantes utilisant le GPS et la mesure transcutanée de la pression en dioxygène (TcPO2) lors d’un test de marche sur tapis roulant à l’égard de l’évaluation de la gêne fonctionnelle à la marche de patients artériopathes claudicants. La première étude montre que les scores au questionnaire EACHQ et la DMM déclarée par les patients sont plus corrélés à la DMM mesurée avec un GPS (reflet du patron de marche spontané) qu'aux scores du questionnaire WIQ, au test de marche de 6 minutes et au test sur tapis roulant. La seconde étude montre l'intérêt de la TcPO2 d'effort dans la détection des ischémies à l’exercice chez des patients présentant des Index de Pression Systolique de Cheville normaux. Les troisième et quatrième études montrent la fiabilité du GPS ainsi que son applicabilité dans l'évolution des paramètres de marche avant et après une revascularisation. Enfin, la cinquième étude suggère que le couplage GPS-accéléromètre permet l’estimation indirecte de la dépense énergétique chez le patient artériopathe. En conclusion, l'actimétrie (e.g., GPS, accéléromètre) et laTcPO2 d’effort constituent des méthodes valides et fidèles pour évaluer la marche de patients artériopathes claudicants. / Peripheral Arterial Diseased (PAD) is a major concern regarding their clinical care since a revascularization intervention is indicated below the cut-off point of 300 m. In clinical routine, MWD is usually assessed with clinical questionnaires, a highly subjective method, and with walking treadmill tests that are design-dependent and that hardly reproduce the usual pain of the patients during the walk. Therefore, the aim of this doctoral work is to test the validity of innovative methodologies based on GPS and Transcutaneous Pressure in Oxygen (TcPO2) during a treadmill test with respect to the assessment of the functional limitation in PAD patients. The first study shows that scores of the Estimation of Ambulatory Capacity by History-Questionnaire and MWD that is declared by the patients are more related to the GPS-measured MWD (that reflects the spontaneous walking pattern) than to the scores of the Walking Impairment Questionnaire, the 6-min walking test, and the walking treadmill test. The second study evidences the relevance of the use of TcPO2 during a walking treadmill test in detecting ischemia during exercise among patients with normal Ankle to brachial Index. The third and fourth studies show the reliability of the GPS as well as its applicability to the evolvement of the walking parameters following revascularization. Finally, the fifth study suggests that the GPS-accelerometer coupling is able to estimate the energy expenditure of PAD patients. To conclude, actimetry (e.g., GPS, accelerometer) and exercise TcPO2 are valid and reliable methods to evaluate the walk of PAD patients.

Made available in DSpace on 2017-07-21T14:13:03Z (GMT). No. of bitstreams: 1 Mona Lisa S Gomes.pdf: 2596723 bytes, checksum: cad81f365e93a147f44fe76b57ed4640 (MD5) Previous issue date: 2015-02-24 / Cilostazol is a selective inhibitor of phosphodiesterase III. It acts as a vasodilator and antiplatelet agent. It is the main drug for the treatment of intermittent claudication related to peripheral arterial occlusive disease. This drug belongs to the class II of the Biopharmaceutical Classification System (BCS) and shows low solubility and high permeability in gastrointestinal tract. The usual oral dose is 100 mg twice a day, which represents a disadvantage in treatment compliance. Cilostazol is a lipophilic drug and the development of controlled drug delivery systems can improve its bioavailability. The aim this study was to obtain and characterize nanocapsules suspensions prepared from poly(caprolactone) (PCL), poly(D,L-lactic-co-glycolic acid) (PLGA) and blends using polyethylene glycol (PEG), PCL/PEG and PLGA/PEG containing 0 to 3.0 mg.mL-1cilostazol. The analytical method was developed and validated for the quantification of cilostazol into the nanocápsulas by high performance liquid chromatography. All formulations had suitable encapsulation efficiencies (≥99.6%). Nanocapsules showed pH values between 6.0 and 6.4, average size lower than 137 nm, polydispersity index lower than 0.22 and average negative zeta potential of -35.34 mV. The images observed by electron transmission microscopy and scanning electron microscopy, revealed spherical shape with smooth surface. The results achieved by X-ray diffraction demonstrated no crystallinity which indicated the drug amorphization compared to the raw materials. Analyses performed by Fourier transform infrared spectroscopy showed no chemical reactions between drug and polymers. The formulations prepared from blends of PCL/PEG showed the best stability parameters after 60 days of storage. The use of nanoparticles can be a promising strategy for increasing the apparent solubility of cilostazol leading to better dissolution profiles and therapeutical effect. / O cilostazol é um inibidor seletivo da fosfodiesterase III, atuando como antiagregante plaquetário e vasodilatador. É o medicamento de primeira escolha para o tratamento clínico da claudicação intermitente por doença arterial obstrutiva periférica. O fármaco pertence à classe II do Sistema de Classificação Biofarmacêutica, apresentando baixa solubilidade e alta permeabilidade no trato gastrointestinal. A dose usual é de 100 mg, via oral, duas vezes ao dia, o que representa uma desvantagem à adesão ao tratamento. O cilostazol tem característica lipofílica, podendo ser utilizado no desenvolvimento de sistemas de liberação modificada de fármaco, com a finalidade de melhorar sua biodisponibilidade. Assim, com o propósito de se elaborar sistemas de liberação modificada, o objetivo deste trabalho foi obter e caracterizar suspensões de nanocápsulas, a partir do uso dos polímeros poli(caprolactona) (PCL), poli(D,L-ácido lático-co-ácido glicólico) (PLGA) e de blendas com polietilenoglicol (PEG), PCL/PEG e PLGA/PEG, contendo concentrações de 0 a 3,0 mg.mL-1 de cilostazol. O método analítico por cromatografia líquida de alta eficiência foi desenvolvido e validado para a quantificação do cilostazol presente nas nanocápsulas. Todas as formulações apresentaram valores de eficiência de encapsulação adequados (≥99,6%). As nanocápsulas obtidas apresentaram valores de pH entre 6,0 e 6,4, com tamanho médio de partículas inferior a 137 nm, índice de polidispersão menor que 0,22 e potencial zeta negativo de -35,34 mV, devido aos polímeros aniônicos empregados. As imagens obtidas por microscopia eletrônica de transmissão e microscopia eletrônica de varredura revelaram formato esférico com superfície lisa e homogeneidade das nanocápsulas. Os resultados obtidos por difração de raios X revelaram a ausência de cristalinidade das nanocápsulas, evidenciando sua característica amorfa, em comparação aos polímeros e ao fármaco. As análises efetuadas por espectroscopia na região do infravermelho com transformada de Fourier demonstraram que não ocorreram reações químicas entre o fármaco e os polímeros. Em geral, as formulações de cilostazol obtidas a partir de blendas PCL/PEG foram as que apresentaram os melhores parâmetros de estabilidade após 60 dias de armazenamento. O uso de nanopartículas pode ser uma estratégia promissora na promoção do aumento da solubilização aparente do cilostazol melhorando seu perfil de dissolução e, consequentemente, sua ação farmacológica.

<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>

L'apparence et la représentation sous toutes leurs formes ont constitué des aspects très importants dans la société gréco-romaine. La beauté des corps et la perfection dominaient toute une mentalité sociale. Cependant, les Anciens n'ont pas omis de représenter la laideur, elle aussi, sous plusieurs formes. C'est dans cet ordre d'idées que l'on peut observer des cas d'imperfection des membres inférieurs : la claudication et le monosandalisme. Ces deux phénomènes visibles dans la littérature et dans l'art iconographique ont chacun des significations particulières. La position instable des monosandales et des boiteux dévoile un symbolisme rattaché, souvent, à un phénomène social. L'objectif de ce mémoire est d'étudier le symbolisme qui peut émaner des cas de monosandalisme et de claudication. Pour ce faire, nous avons, dans un premier temps, observé le contexte dans lequel on retrouve des monosandaloi. Nous avons pu constater que leur pied déchaussé était en lien avec l'instabilité des initiés lors d'un rite de puberté et de passage. Cette position instable témoignerait d'un changement de statut social. Par ailleurs, nous avons observé que dans certains cas de monosandalisme, la position unichaussée serait aussi liée à un rituel magique ayant pour objectif soit d'éloigner les ennemis, soit d'invoquer les divinités chtoniennes. Nous avons, dans un deuxième temps, soupesé le cas d'Héphaïstos, divin boiteux. Son statut particulier dans l'Olympe reflèterait une mentalité sociale. Enfin, l'analyse des cas de monosandalisme a mené à la conclusion que la position unichaussée reflétait un moment instable vécu par les monosandales. Que ce soit des initiés à la veille ou lors d'une initiation, que ce soit un guerrier affrontant la mort ou un usurpé reprenant ce qui lui appartient de droit, la position des unichaussés témoigne de cet état d'instabilité dans laquelle ils se trouvent. Pour sa part, l'analyse du cas particulier d'Héphaïstos a démontré que sa claudication était possiblement liée à la vision négative que l'on se faisait des claudicants. Les circonstances de sa naissance illustrent bien cette malédiction que l'on associait aux enfants difformes. D'autre part, la boiterie, affectant la verticalité de l'homme et son autonomie, se voit comme la pire difformité. Les boiteux se retrouvaient ainsi en bas de l'échelle sociale. Cette analyse a aussi mené à la conclusion que la claudication d'Héphaïstos est probablement liée au fait qu'il est forgeron, métier artisanal que les Grecs méprisaient. Sa posture courbe et son apparence hideuse refléteraient l'idée que l'on se faisait du travail manuel. La position instable des monosandales ou des claudicants témoigne donc d'un symbolisme particulier. ______________________________________________________________________________ MOTS-CLÉS DE L’AUTEUR : monosandalisme, claudication, symbolisme, Antiquité, Héphaïstos