Introdução: O transplante autólogo de células progenitoras hematopoéticas é indicado para tratamento de várias doenças neoplásicas e não-neoplásicas, tais como linfoma, mieloma múltiplo e doenças autoimunes. Para isso, é imprescindível coletar as células progenitoras hematopoéticas (CPHs), em geral mobilizadas para o sangue periférico, por meio de equipamentos de aférese e acesso venoso adequado, seja de veia periférica seja de veia central quando a primeira não for adequada. Usualmente, o acesso periférico se dá por veia da fossa cubital. Entretanto, a veia jugular externa também poderia ser uma opção em pacientes em que a veia cubital não proporcionar fluxo sanguíneo adequado, uma possibilidade ainda muito pouco explorada nesse contexto. Objetivos: Avaliar a viabilidade de coletar CPHs pela veia jugular externa em pacientes que não tem acesso por meio da veia da fossa cubital.Métodos: Trata-se de estudo observacional do tipo transversal, com coleta retrospectiva dos dados por meio da análise das fichas médicas arquivadas no Hemonúcleo do Hospital de Câncer de Barretos. A amostra foi composta de 26 indivíduos, sendo que 13 (50%) dos participantes tiveram a punção da veia jugular externa e os outros 13 (50%) foram extraídos aleatoriamente do conjunto de 913 pacientes que tiveram a punção da veia da fossa cubital para equilíbrio numérico das amostras, no período de 2007 a 2014. Resultados: Dos 26 participantes do estudo, 19 (76,9%) foram do sexo masculino e 7 (23,1%) do sexo feminino. Entre as doenças, o mieloma foi a mais prevalente, não houve diferença quanto ao diagnóstico entre os dois grupos fossa cubital e jugular. As médias de células CD34+ coletadas no grupo fossa cubital e no grupo jugular foram de 10,0 x 106/kg e 5,1 x 106/kg, respectivamente (p=0,20). As volemias processadas foram de 4,2 e 4,4 para os grupos fossa cubital de jugular (p=0,12). O fluxo médio de aspiração do sangue foi de 69±17 mL/minuto e 62±17 mL/minuto (p=0,29). Conclusão: Há viabilidade da coleta de CPH por via jugular externa / Introduction: Autologous hematopoietic progenitor cell transplantation is indicated for the treatment of various neoplastic and non-neoplastic diseases, such as lymphoma, multiple myeloma, and autoimmune diseases. For this, it is essential to collect the hematopoietic progenitor cells (CPHs), usually mobilized into the peripheral blood, by means of apheresis devices and adequate venous access, either peripheral vein or central vein when the former is not adequate. Usually, the peripheral access is by the ulnar fossavein. However, the external jugular vein could also be an option in patients where the ulnar vein does not provide adequate blood flow, a possibility still very little explored in this context. Objectives: To evaluate the feasibility of collecting CPHs through the external jugular vein in patients who do not have access through the ulnar fossa vein. Methods: It is an observational cross-sectional study, with retrospective data collection through the analysis of the medical records filed at the Barretos Cancer Hospital. The sample consisted of 26 individuals; 13 (50%) of the participants had external jugular vein puncture and the other 13 (50%) were randomly extracted from a set of 913 patients who had ulnar fossa vein puncture to numerical equilibrium of the samples from 2007 to 2014. Results: Of the 26 participants in the study, 19 (76.9%) were male and 7 (23.1%) were female. Among the diseases, myeloma was the most prevalent; there was no difference in diagnosis between the two groups of ulnar and jugular fossa. The mean CD34 + cells collected in the cubital fossa group and in the jugular group were 10.0 x 106/kg and 5.1 x 106/kg, respectively (p=0.20). The blood volumes processed were 4.2 and 4.4 for the jugular fossa group (p=0.12). The mean blood aspiration flow was 69 ± 17 mL/min and 62 ± 17 mL/min (p=0.29). Conclusion: there is viability of the collection of CPHs by external jugular vein

A total of 180 patients participated in the study, with 30 withdrawn due to various reasons. At 12 weeks, 76% patients treated with SSB, 78% patients treated with 4LB, and 31% patients treated with usual care alone had completed ulcer healing. The hazard ratios for healing for 4LB and SSB relative to the control group were 3.14 (95% CI = 1.74-5.67) and 2.72 (95% CI = 1.53-4.86), respectively. The key findings indicated the significant effects of compression bandaging resulted in a higher proportion of complete ulcer healing; reduction in ulcer size, pain severity, and pain interference; and improvement in quality of life and lifestyle activity. Across the 12-week study period, the present study also highlighted the significant improvement of the psychosocial composite outcome among the three study groups. Furthermore, the reduction in pain severity and pain interference accounted for the major contribution to the total effect of the psychosocial composite outcome. Therefore, effective pain control and minimizing the effect of pain on daily life is essential in promoting ulcer healing. It is evident that the application of compression bandaging with either 4LB or SSB is feasible and more effective than the current usual care with no compression. This study add new knowledge to the psychosocial benefit of compression bandaging for venous ulcer patients living in the community; and support incorporating compression bandaging in the routine venous ulcer care. Further studies are therefore suggested to focus on the assessment of the cost-effectiveness of and the satisfaction and experience of both patients and nurses with compression bandaging using different high compression bandage systems. / The study was a randomized controlled trial. Those patients who participated in the experimental groups received compression bandaging with either the 4LB or SSB along with a local usual care. In contrast, the control group participants received usual care. A 12-week study intervention was given individually to the study participants. The research outcome of this study was the proportion of complete ulcer healing, ulcer size, pain severity, pain interference, disease-specific and generic health-related quality of life measures, and lifestyle activity. The instruments used include VeV MD stereophotogrammetry, Brief pain Inventory, The SF-12 Health Survey, Charing Cross Venous Ulcer Questionnaire, and the Frenchay Activity Index. Data analysis involved the use of descriptive statistics and inferential statistics such as survival analysis, one way analysis of variance (ANOVA), multivariate analysis variance (MANOVA), doubly multivariate analysis of variance (Doubly MANOVA), and Roy-Bargman stepdown analysis were used. / Venous ulcer is the most serious clinical consequence of chronic venous insufficiency. It is a chronic health problem that afflicts older people as well as health care professions. Its chronicity, together with its high recurrent rate, creates not only a big challenge to nurses' workload and health cost, but it also has a direct impact on patients' physiological and psychosocial well-being. Compression bandaging has been identified as the mainstream form of treatment for venous ulcer in previous literature, although this is not very well known by the nurses in Hong Kong. Previous studies have confirmed that the proportion of complete ulcer healing is improved with high compression as compared to no compression. However, a definite conclusion on the effectiveness of different high compression systems, such as the four-layer compression system (4LB) and short-stretch compression system (SSB), was not found. Most importantly the treatment impacts on proportion of complete ulcer healing, ulcer size, pain severity and pain interference, health-related quality of life, and lifestyle activities are essential influences on patients' participation in venous ulcer care and treatment choice. These limited data leave a gap in today's knowledge on venous ulcer management in relation to both patients and health care providers. Therefore, the aim of this study is to examine the effect of two compression bandage systems, the 4LB and SSB, in promoting ulcer healing in terms of the proportion of complete ulcer healing and ulcer size, as well as the psychosocial well-being including pain, heath-related quality of life, and lifestyle activity for older people in the community. / Wong, Kit Yee Irene. / "December 2007." / Adviser: Diana T. F. Lee. / Source: Dissertation Abstracts International, Volume: 69-08, Section: B, page: 4672. / Thesis (Ph.D.)--Chinese University of Hong Kong, 2007. / Includes bibliographical references (p. 248-268). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Electronic reproduction. [Ann Arbor, MI] : ProQuest Information and Learning, [200-] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstract in English and Chinese. / School code: 1307.

Yang, Chao. / Thesis (M.Phil.)--Chinese University of Hong Kong, 2011. / Includes bibliographical references (leaves 137-146). / Abstracts in English and Chinese. / Thesis Committee --- p.i / Acknowledgements --- p.ii / Contents --- p.iii / Declaration --- p.vii / Abstract --- p.viii / 摘要 --- p.xi / Abbreviations --- p.xiii / Chapter CHAPTER ONE: --- INTRODUCTION / Chapter 1.1 --- Occurrence and Structure of Phytosterols in Plants --- p.P.1 / Chapter 1.2 --- Biological Effects of Phytosterols / Chapter 1.2.1 --- Cholesterol-lowering Effect of Phytosterols --- p.P.3 / Chapter 1.2.2 --- Anti-cancer Effect of Phytosterols --- p.P.5 / Chapter 1.2.3 --- Anti-proliferative Effect of Phytosterols --- p.P.5 / Chapter 1.3 --- Intake and Absorption of Phytosterols in Human Beings --- p.P.6 / Chapter 1.4 --- Occurrence and Physiological Levels of Phytosterol Oxidation Products (POPs) / Chapter 1.4.1 --- Occurrence of POPs --- p.P.8 / Chapter 1.4.2 --- Physiological Levels of POPs --- p.P.8 / Chapter 1.5 --- Endothelium and the Vascular Tone / Chapter 1.5.1 --- Role of Endothelium in the Control of Vascular Tone --- p.P.11 / Chapter 1.5.2 --- "Endothelial Dysfunction, Cholesterol Oxidation Products (COPs) and Phytosterol Oxidation Products (POPs)" --- p.P.12 / Chapter 1.6 --- Calcium Homeostasis in the Vascular Smooth Muscle Cells (VSMCs) / Chapter 1.6.1 --- Modes of Ca2+ Entry in VSMCs --- p.P.15 / Chapter 1.6.2 --- Modes of Ca2+ Efflux in VSMCs --- p.P.18 / Chapter 1.7 --- Objectives of the Study --- p.P.19 / Chapter CHAPTER TWO: --- β-SITOSTEROL OXIDATION PRODUCTS ATTENUATE VASORELAXATION BY INCREASING REACTIVE OXYGEN SPECIES AND CYCLOOXYGENASE-2 / Chapter 2.1 --- Introduction --- p.P.21 / Chapter 2.2 --- Materials and Methods / Chapter 2.2.1 --- Preparation of SOPs --- p.P.24 / Chapter 2.2.2 --- Gas Chromatography -mass Spectrometry (GC-MS) Identification of SOPs --- p.P.24 / Chapter 2.2.3 --- Analysis of SOPs --- p.P.25 / Chapter 2.2.4 --- Vessel Preparation --- p.P.25 / Chapter 2.2.5 --- Isometric Force Measurement --- p.P.26 / Chapter 2.2.6 --- Western Blotting --- p.P.27 / Chapter 2.2.7 --- Primary Culture of Rat Aortic Endothelial Cell --- p.P.28 / Chapter 2.2.8 --- Measurement of SOPs-induced Intracellular Oxidative Stress --- p.P.29 / Chapter 2.2.9 --- Drugs --- p.P.30 / Chapter 2.2.10 --- Data Analysis --- p.P.30 / Chapter 2.3 --- Results / Chapter 2.3.1 --- GC-MS Identification of SOPs --- p.P.32 / Chapter 2.3.2 --- Analysis of SOPs --- p.P.34 / Chapter 2.3.3 --- SOPs But Not β-Sitosterol Impaired ACh- and A23187-induced relaxations --- p.P.36 / Chapter 2.3.4 --- Inhibition of COX Pathway Reversed SOPs-induced Impairment in Relaxation --- p.P.39 / Chapter 2.3.5 --- SOPs Elevated Endothelial COX-2 Expression --- p.P.42 / Chapter 2.3.6 --- SOPs Increased COX-2 Expression via An Oxidative Stress-sensitive Pathway --- p.P.45 / Chapter 2.4 --- Discussion --- p.P.52 / Chapter 2.5 --- Conclusion --- p.P.56 / Chapter CHAPTER THREE: --- β-SITOSTEROL OXIDATION PRODUCTS POSSESS POTENTIAL VOCC BLOCKING EFFECT IN VSMCs / Chapter 3.1 --- Introduction / Chapter 3.1.1 --- 2+ Modes of Ca Entry and Efflux in Vascular Smooth Muscle Cells (VSMCs) --- p.P.57 / Chapter 3.1.2 --- Effect of Cholesterol and COPs on VSMCs --- p.P.57 / Chapter 3.2 --- Methodology and Materials / Chapter 3.2.1 --- Vessel Preparation --- p.P.59 / Chapter 3.2.2 --- Isometric Force Measurement iv --- p.P.59 / Chapter 3.2.3 --- Drugs --- p.P.60 / Chapter 3.2.4 --- Data Analysis --- p.P.61 / Chapter 3.3 --- Results / Chapter 3.3.1 --- SOPs but not β-Sitosterol Induced Relaxation in 60 mM K+ -preconstricted Endothelium-denuded Aorta --- p.P.62 / Chapter 3.3.2 --- Both SOPs and β-Sitosterol did not Relax U46619-preconstricted Endothelium-denuded Aorta --- p.P.64 / Chapter 3.3.3 --- Both SOPs and β-Sitosterol did not Relax PDA -preconstricted Endothelium-denuded Aorta --- p.P.66 / Chapter 3.3.4 --- SOPs Attenuated 60 mM K+-induced Contraction --- p.P.68 / Chapter 3.3.5 --- SOPs Attenuated Phenylephrine-induced Contraction --- p.P.70 / Chapter 3.3.6 --- Effect of SOPs on Concentration-dependent Responses to U46619 --- p.P.72 / Chapter 3.3.7 --- Preincubation with Bay K 8644 Abolished SOPs-induced Relaxation in 60 mM K+ -preconstricted Rings --- p.P.74 / Chapter 3.3.8 --- Preincubation with Thapsigargin did not Affect SOPs-induced Relaxation in 60 mM K+ -preconstricted Rings --- p.P.76 / Chapter 3.3.9 --- Preincubation with Ouabain did not Affect SOPs-induced Relaxation in 60 mM K+ -preconstricted Rings --- p.P.78 / Chapter 3.3.10 --- Preincubation with Nickel Potentiated SOPs-induced Relaxation in 60 mM K+ -preconstricted Rings --- p.P.80 / Chapter 3.4 --- Discussion --- p.P.84 / Chapter 3.5 --- Conclusion and Future Work --- p.P.88 / Chapter CHAPTER FOUR: --- INVOLEMENT OF NITRIC OXIDE IN THE PROTECTIVE EFFECTS OF PHYTOSTEROLS AGAINST HOMOCYSTEINE-INDUCED IMPAIRMENT OF ENDOTHELIUM-DEPENDENT RELAXATIONS OF RAT AORTA / Chapter 4.1 --- Introduction --- p.P.89 / Chapter 4.2 --- Materials and Method / Chapter 4.2.1 --- Vessel Preparation --- p.P.93 / Chapter 4.2.2 --- Isometric Force Measurement --- p.P.93 / Chapter 4.2.3 --- Western Blotting --- p.P.94 / Chapter 4.2.4 --- "1,1 -diphenyl-2-picrylhydrazyl (DPPH) Radical Scavenging Capacity" --- p.P.96 / Chapter 4.2.5 --- Primary Culture of Rat Aortic Endothelial Cells V --- p.P.96 / Chapter 4.2.6 --- Measurement Intracellular Oxidative Stress --- p.P.97 / Chapter 4.2.7 --- Nitric Oxide (NO) Measurement --- p.P.97 / Chapter 4.2.8 --- Drugs --- p.P.98 / Chapter 4.2.9 --- Data Analysis --- p.P.99 / Chapter 4.3 --- Results / Chapter 4.3.1 --- Impairment of Endothelium-dependent Relaxation by HC was Reversed by ROS Scavenger --- p.P.100 / Chapter 4.3.2 --- Brassicasterol Reversed HC-induced Endothelial Dysfunction In a Dose-dependent Manner --- p.P.102 / Chapter 4.3.3 --- β-Sitosterol and Stigmasterol Reversed HC-induced Endothelial Dysfunction --- p.P.104 / Chapter 4.3.4 --- Effects of β-Sitosterol Oxidation Products (SOPs) on HC-induced Endothelial Dysfunction --- p.P.106 / Chapter 4.3.5 --- Effects of Brassicasterol and β-Sitosterol on H2O2-induced Impairment of Endothelium-dependent Relaxation --- p.P.108 / Chapter 4.3.6 --- Phytosterols did not Directly Scavenge Free Radicals --- p.P.110 / Chapter 4.3.7 --- "HC and Brassicasterol did not Affect the Expression of SOD-1, SOD-2, eNOS, COX-1 and COX-2 in Aorta" --- p.P.112 / Chapter 4.3.8 --- HC Increased ROS Production in Primary Rat Aortic Endotelial Cells --- p.P.116 / Chapter 4.3.9 --- Brassicasterol did not Reverse the ROS Production by HC treatment In the Endothelial Cells --- p.P.120 / Chapter 4.3.10 --- Effect of L-NAME on Reversing the Effect of Brassicasterol on ACh-induced Relaxation --- p.P.123 / Chapter 4.3.11 --- Brassicasterol Reversed the Inhibitory Effect of HC on ACh-induced NO Production in Endothelial Cells --- p.P.125 / Chapter 4.4 --- Discussion --- p.P.128 / Chapter 4.5 --- Conclusion and Future Work --- p.P.132 / Chapter CHAPTER FIVE: --- CONCLUSIONS AND FUTURE WORK --- p.P.134 / Chapter CHAPTER SIX: --- REFERENCES --- p.P.137

Thesis (M.S.)--Massachusetts Institute of Technology, Dept. of Mechanical Engineering, 1981. / MICROFICHE COPY AVAILABLE IN ARCHIVES AND ENGINEERING. / Bibliography: leaves 59-62. / by John Luigi Battaglioli. / M.S.

Submitted by Natalia Vieira (natalia.vieira@famerp.br) on 2016-05-20T17:54:02Z No. of bitstreams: 1 danielleliliadantastukamoto_dissert.pdf: 6750015 bytes, checksum: a409b5df80783b77a0948c423b3fbcb5 (MD5) / Made available in DSpace on 2016-05-20T17:54:02Z (GMT). No. of bitstreams: 1 danielleliliadantastukamoto_dissert.pdf: 6750015 bytes, checksum: a409b5df80783b77a0948c423b3fbcb5 (MD5) Previous issue date: 2015-06-12 / Introduction: The frequency of events of total anomalous pulmonary venous connection (TAPVC) varies in the different series from 5.9 to 7.1 / 100 000 live births, representing 1 to 5% of cases of congenital heart disease. Since the current care has developed; the need to approach possible late complications, such as arrhythmias, is important. Objective: To evaluate the distribution of arrhythmias and possible related variables in patients in the late postoperative TAPVC. Method: Medical record review and clinical and noninvasive arrhythmia evaluation were used for data analysis of 20 patients who underwent isolated TAPVC. Statistical analysis for the detection of related variables. Results: Clinical and echocardiographic evaluations showed no significant changes. Of the 20 patients, 13 (65%) showed some abnormalities for age according to the 12-led EGC. By Holter, six patients (30%) presented atrial and / or ventricular ectopy with higher frequency than mild. Junctional rhythm and 2: 1 atrioventricular occurred in one patient (5%). Analyzing the criteria for sinus node dysfunction, bradycardia was observed by Holter in 30% of the patients. There were no pauses longer than two seconds. By Ergometric test, 82% of children had chronotropic deficit. Follow-up more than 60 months and abnormal ECG were related to the presence of arrhythmias. Conclusion: The long term follow-up of patients undergoing anomalous pulmonary venous connection showed that regardless of the good clinical and echocardiographic results, the possibility of occurrence of atrial and / or ventricular arrhythmias highlight attention to the need for maintenance of regular clinical evaluations. / Introdução: A frequência de ocorrência da conexão anômala total de veias pulmonares (CATVP) varia nas diversas séries entre 5,9 a 7,1/100 mil nascidos vivos, representando 1 a 5 % dos casos de cardiopatia congênita. A evolução nos cuidados atuais leva à necessidade de abordagem de eventuais complicações tardias, como as arritmias. Objetivo: Avaliar a distribuição das arritmias e possíveis variáveis relacionadas em pacientes em pós operatório tardio de CATVP. Método: Análise dos dados de 20 pacientes operados de CATVP isolada, com revisão de prontuário e avaliação clínica e não invasiva de arritmias. Estudo estatístico para detecção de variáveis relacionadas. Resultados: As avaliações clínica e ecocardiográfica não evidenciaram alterações significativas. O eletrocardiograma (ECG) de 12 derivações apresentou anormalidades para a idade em 13 dos 20 pacientes estudados (65%). Ao Holter, 6 pacientes (30%) apresentaram ectopias atriais e/ou ventriculares de frequência maior que discreta. Ritmo juncional e bloqueio atrioventricular 2:1 aconteceram em um paciente (5%). Analisando-se os critérios para disfunção do nó sinusal, observou-se bradicardia ao holter em 30% dos pacientes. Não houve pausas maiores que 2 segundos. Ao teste ergométrico, 82% das crianças apresentaram déficit cronotrópico. Seguimento maior que 60 meses e ECG anormal relacionaram-se à presença de arritmias. Conclusão: O seguimento em longo prazo de pacientes operados de conexão anômala total de veias pulmonares mostrou que independentemente dos bons resultados clínicos e ecocardiográficos, existe a possibilidade de ocorrência de arritmias atriais e/ou ventriculares, chamando a atenção para a necessidade de manutenção de avaliações clinicas regulares.

Atherosclerosis, the leading cause of mortality in Western societies, affects large elastic arteries, causing focal deposition of proliferative inflammatory and lipid-laden cells within the artery. Several risk factors have been causally implicated in the ???reaction to injury??? hypothesis first described by Ross in 1969. The ???injury??? sustained by endothelial cells may be either mechanical or chemical. Environmental factors have a role in the production of chemical agents that are injurious to the endothelium. Mechanical stresses such as wall tensile stress are proportional to systemic blood pressure and pulse pressure. Essentially, these systemic pressures are fairly evenly distributed throughout the circulation. However, atherosclerotic lesions characteristically occur at focal sites within the human vasculature; at or near bifurcations, within the ostia of branch arteries and at regions of marked or complex curvature, where local haemodynamic abnormalities occur. The most discussed haemodynamic factor seems to be low or highly oscillating wall shear stress which exists on the outer wall of bifurcations and on the inner aspect of curving vessels. The magnitude of these haemodynamic forces may not be great but the subtleties of their variable spatial distribution may help to explain the multifocal distribution of atherosclerotic plaques. With the altered haemodynamics there is endothelial injury and phenotypic changes in the endothelium result, which in turn lead to endothelial cell dysfunction. These haemodynamic variables are difficult to measure directly in vivo. In this work a novel model is developed utilising human autologous vein bypass grafts as a surrogate vessel for the observation of pathological structural changes in response to altered haemodynamics. The influence of haemodynamic factors (such as wall shear stress) in the remodeling of the vein graft wall and the pathogenesis of Myointimal Hyperplasia (MIH) and resultant wall thickening in femoral bypass grafts is analysed. The haemodynamic determinants of MIH (which have been established in many animal models) are similar to those implicated in atherosclerosis. The accelerated responses of the vein (Intimal hyperplasia develops much more rapidly than atherosclerotic lesions in native vessels) make it an ideal model to expediently examine the hypothesised relationships prospectively in an in vivo setting. Furthermore, the utilisation of in vivo data acquired from non-invasive diagnostic methods (such as Magnetic Resonance Angiography (MRA) and Duplex ultrasound) combined with the application of state-of-the-art Computational Fluid Dynamic (CFD) techniques makes the model essentially non-invasive. The following hypotheses are examined: 1) regions of Low shear and High tensile stress should develop disproportionately greater wall thickening, 2) regions of greater oscillatory blood flow should develop greater wall thickening, and 3) regions of lower wall shear should undergo inward (or negative) remodelling and result in a reduction in vessel calibre. The conclusions reached are that abnormal haemodynamic forces, namely low Time-averaged Wall Shear Stress, are associated with subsequent wall thickening. These positive findings have great relevance to the understanding of vein graft MIH and atherosclerosis. It was also evident that with non-invasive data and CFD techniques, some of the important haemodynamic factors are realistically quantifiable (albeit indirectly). The detection of parameters known to be causal in the development of graft intimal hyperplasia or other vascular pathology may improve ability to predict clinical problems. From a surgical perspective this might be employed to facilitate selection of at-risk grafts for more focused postoperative surveillance and reintervention. On a broader stage the utilisation of such analyses may be useful in predicting individuals at greater risk of developing atherosclerotic deposits, disease progression, and the likelihood of clinical events such as heart attack, stroke and threat of limb loss.

<p>Treatment for varicose veins (VV) is insufficiently evidence based and recurrence rates are high. The aim of this thesis was to study the long-term results after VV surgery, risk factors for recurrences and the effect of preoperative duplex scanning on recurrence rate, quality of life (QoL) and costs.</p><p>In a follow-up study 89 patients with 100 legs operated on for VV 6–10 years earlier were re-examined with duplex, in 13 cases also with varicography. 57% had incompetent vessels in the groin visible with duplex, equally well defined by varicography. Residual branches could not be differentiated from new vessel formation. The recurrence rate did not correlate to the surgeon’s level of experience or perioperative difficulties at primary surgery. </p><p>In a prospective randomized study 293 patients (343 legs) were operated on for primary VV with or without preoperative duplex. Duplex was done postoperatively, at 2 months and 2 years. QoL was measured with SF-36 preoperatively, at 1 month, 1 year and 2 years. </p><p>After 2 years the number of reoperations were 2 in the group with preoperative duplex and 14 in the group without (p=0.002). Incompetent veins were seen in the saphenofemoral or saphenopopliteal junction in 19 and 53 legs respectively (p<0.001).</p><p>Preoperative QoL was worse in the VV patients compared to a reference population, and was normalised 2 years postoperatively. The improved surgical result in the duplex group was not reflected in a significantly higher QoL. </p><p>The lower costs for redo surgery in the duplex group did not offset the costs for duplex, partly due to more extensive primary surgery. </p><p>A significant proportion of recurrences after 2 years was new vessel formation and progression of disease. Preoperative perforating vein incompetence did not influence recurrence rate, and was abolished without specific interruption in 60% at 2 years postoperatively.</p>

Treatment for varicose veins (VV) is insufficiently evidence based and recurrence rates are high. The aim of this thesis was to study the long-term results after VV surgery, risk factors for recurrences and the effect of preoperative duplex scanning on recurrence rate, quality of life (QoL) and costs. In a follow-up study 89 patients with 100 legs operated on for VV 6–10 years earlier were re-examined with duplex, in 13 cases also with varicography. 57% had incompetent vessels in the groin visible with duplex, equally well defined by varicography. Residual branches could not be differentiated from new vessel formation. The recurrence rate did not correlate to the surgeon’s level of experience or perioperative difficulties at primary surgery. In a prospective randomized study 293 patients (343 legs) were operated on for primary VV with or without preoperative duplex. Duplex was done postoperatively, at 2 months and 2 years. QoL was measured with SF-36 preoperatively, at 1 month, 1 year and 2 years. After 2 years the number of reoperations were 2 in the group with preoperative duplex and 14 in the group without (p=0.002). Incompetent veins were seen in the saphenofemoral or saphenopopliteal junction in 19 and 53 legs respectively (p&lt;0.001). Preoperative QoL was worse in the VV patients compared to a reference population, and was normalised 2 years postoperatively. The improved surgical result in the duplex group was not reflected in a significantly higher QoL. The lower costs for redo surgery in the duplex group did not offset the costs for duplex, partly due to more extensive primary surgery. A significant proportion of recurrences after 2 years was new vessel formation and progression of disease. Preoperative perforating vein incompetence did not influence recurrence rate, and was abolished without specific interruption in 60% at 2 years postoperatively.

Το παρόν πρωτόκολλο σχεδιάστηκε προκειμένου να εκτιμήσει την ασφάλεια και την feasibility των μεταλλικών ενδοπροθέσεων που απελευθερώνουν φαρμακευτικές ουσίες (Drug-Eluting Stents, DES) έναντι των απλών μεταλλικών ενδοπροθέσεων (Bare-Metal Stents, BMS) στο φλεβικό μοντέλο κονίκλου, χρησιμοποιώντας Οπτική Συνεκτική Τομογραφία (Frequency Domain – Optical Coherence Tomography, FD-OCT). Μέθοδοι Δεκατρείς λευκοί κόνικλοι Νέας Ζηλανδίας υποβλήθηκαν σε τοποθέτηση μεταλλικών ενδοπροθέσεων που απελευθερώνουν Zotarolimus (Group DES) στη μία κοινή λαγόνιο φλέβα και απλών μεταλλικών ενδοπροθέσεων (Group BMS) στην απέναντι κοινή λαγόνιο. Τα πρωτογενή καταληκτικά σημεία περιελάμβαναν την τεχνική επιτυχία της τοποθέτησης των μεταλλικών ενδοπροθέσεων καθώς και την σύγκριση της νεοενδοθηλιακής υπερπλασίας ανάμεσα στα δύο υπό μελέτη σύνολα με την βοήθεια την οπτικής συνεκτικής τομογραφίας. Αποτελέσματα Η τεχνική επιτυχία της τοποθέτησης 13 μεταλλικών ενδοπροθέσεων που απελευθερώνουν φαρμακευτικές ουσίες και 13 απλών μεταλλικών ενδοπροθέσεων ήταν 100% (26/26 μεταλλικές ενδοπροθέσεις). Τρεις κόνικλοι πέθαναν (3/13, 23%) μέσα στις πρώτες 45 μέρες. Τα υπόλοιπα 10/13 ζώα (77%) θανατώθηκαν την 90η μέρα από την ημέρα τοποθέτησης των μεταλλικών ενδοπροθέσεων. Οι 20 μεταλλικές ενδοπροθέσεις (stents) αφαιρέθηκαν με επιτυχία. Επιτυχής FD-OCT πραγματοποιήθηκε σε όλα τα τμήματα των κοινών λαγόνιων φλεβών που αφαιρέθηκαν, 10 στο Group DES και 10 στο Group BMS. Δεν υπήρξε στατιστικά σημαντική διαφορά στην μέση νεοενδοθηλιακή υπερπλασία ανάμεσα στα δύο σύνολα (3.02±1.19mm2 στο Group DES, έναντι 2.76±1.17mm2 στο Group BMS). Συμπέρασμα Σε αυτό το πειραματικό πρωτόκολλο, η τοποθέτηση DES στο φλεβικό αγγειακό σύστημα ήταν δυνατή. Η νεοενδοθηλιακή υπερπλασία ήταν παρόμοια και στα δύο σύνολα μετά από περίοδο ελέγχου τριών μηνών. / This protocol was designed to evaluate the safety and feasibility of drug-eluting stents (DES) implantation, as well as to compare their long-term results vs. bare-metal stents (BMS) in a rabbit venous model, using Frequency-Domain Optical Coherence Tomography (FD-OCT). Methods Thirteen New Zealand white rabbits underwent implantation of a Zotarolimus-eluting stent in the iliac vein (Group DES) and a BMS in the contralateral iliac vein (Group BMS). Study’s primary endpoints included technical success and the comparison of in-stent neointimal hyperplasia in the two study groups using ex vivo FD-OCT, at 3 months. Results Thirteen DES and 13 BMS were successfully implanted. Technical success rate was 100% (26/26 stents). Three animals (3/13, 23.0%) died within the first 45 days. The remaining 10/13 animals (77%) were euthanized at the 90th day following stent implantation. The 20 stents were successfully removed. Successful ex vivo FD-OCT was performed in all stent-implanted iliac vein segments; 10 in group DES and 10 in group BMS. There was no statistically significant difference in the mean neointimal thickness (NIT) between the two groups (3.02±1.19mm² in group DES vs. 2.76±1.17mm² in group BMS; p=0.0501). Conclusions In this experimental protocol, DES application in the venous system was safe and feasible. Hyperplasia thickness was similar in both groups after 3 months follow-up.

Atherosclerosis, the leading cause of mortality in Western societies, affects large elastic arteries, causing focal deposition of proliferative inflammatory and lipid-laden cells within the artery. Several risk factors have been causally implicated in the ???reaction to injury??? hypothesis first described by Ross in 1969. The ???injury??? sustained by endothelial cells may be either mechanical or chemical. Environmental factors have a role in the production of chemical agents that are injurious to the endothelium. Mechanical stresses such as wall tensile stress are proportional to systemic blood pressure and pulse pressure. Essentially, these systemic pressures are fairly evenly distributed throughout the circulation. However, atherosclerotic lesions characteristically occur at focal sites within the human vasculature; at or near bifurcations, within the ostia of branch arteries and at regions of marked or complex curvature, where local haemodynamic abnormalities occur. The most discussed haemodynamic factor seems to be low or highly oscillating wall shear stress which exists on the outer wall of bifurcations and on the inner aspect of curving vessels. The magnitude of these haemodynamic forces may not be great but the subtleties of their variable spatial distribution may help to explain the multifocal distribution of atherosclerotic plaques. With the altered haemodynamics there is endothelial injury and phenotypic changes in the endothelium result, which in turn lead to endothelial cell dysfunction. These haemodynamic variables are difficult to measure directly in vivo. In this work a novel model is developed utilising human autologous vein bypass grafts as a surrogate vessel for the observation of pathological structural changes in response to altered haemodynamics. The influence of haemodynamic factors (such as wall shear stress) in the remodeling of the vein graft wall and the pathogenesis of Myointimal Hyperplasia (MIH) and resultant wall thickening in femoral bypass grafts is analysed. The haemodynamic determinants of MIH (which have been established in many animal models) are similar to those implicated in atherosclerosis. The accelerated responses of the vein (Intimal hyperplasia develops much more rapidly than atherosclerotic lesions in native vessels) make it an ideal model to expediently examine the hypothesised relationships prospectively in an in vivo setting. Furthermore, the utilisation of in vivo data acquired from non-invasive diagnostic methods (such as Magnetic Resonance Angiography (MRA) and Duplex ultrasound) combined with the application of state-of-the-art Computational Fluid Dynamic (CFD) techniques makes the model essentially non-invasive. The following hypotheses are examined: 1) regions of Low shear and High tensile stress should develop disproportionately greater wall thickening, 2) regions of greater oscillatory blood flow should develop greater wall thickening, and 3) regions of lower wall shear should undergo inward (or negative) remodelling and result in a reduction in vessel calibre. The conclusions reached are that abnormal haemodynamic forces, namely low Time-averaged Wall Shear Stress, are associated with subsequent wall thickening. These positive findings have great relevance to the understanding of vein graft MIH and atherosclerosis. It was also evident that with non-invasive data and CFD techniques, some of the important haemodynamic factors are realistically quantifiable (albeit indirectly). The detection of parameters known to be causal in the development of graft intimal hyperplasia or other vascular pathology may improve ability to predict clinical problems. From a surgical perspective this might be employed to facilitate selection of at-risk grafts for more focused postoperative surveillance and reintervention. On a broader stage the utilisation of such analyses may be useful in predicting individuals at greater risk of developing atherosclerotic deposits, disease progression, and the likelihood of clinical events such as heart attack, stroke and threat of limb loss.