Abnormalities in physical properties of the cell membranes may strongly be linked to hypertension and other cardiovascular diseases. The purpose of the present review is to elucidate the possible relationships among atherosclerosis, endothelial function, and membrane fluidity (a reciprocal value of membrane microviscosity) of red blood cells (RBCs) in hypertensive and normotensive subjects using an electron spin resonance (ESR) and spin-labeling method. The ESR study showed that membrane fluidity was significantly decreased in hypertensive subjects compared with normotensive subjects. The reduced membrane fluidity of RBCs was associated with decreased levels of plasma nitric oxide (NO)-metabolites and increased levels of plasma asymmetric dimethylarginine (ADMA: an endogenous NO synthase inhibitor), indicating that endothelial function could be a determinant of membrane fluidity of RBCs. Higher levels of plasma adiponectin were linked to increased membrane fluidity of RBCs. In contrast, elevated levels of plasma homocysteine, oxidative stress, and inflammation were associated with decreased membrane fluidity of RBCs. Intervention with non-pharmacologic therapy (low-salt diet and aerobic physical exercise) and pharmacologic therapy (administration of the Ca channel blocker, benidipine) significantly improved membrane f luidity of RBCs in hypertensive subjects. In this context, it is strongly suggested that atherosclerotic changes might have a close correlation with impaired rheologic behavior of RBCs and microcirculatory dysfunction in hypertension, at least in part, via the NO-dependent mechanism.
Carnitine is essential for skeletal muscle oxidative metabolism (mitochondrial oxidation of long chain fatty acids), and it was pointed that graded treadmill performance was improved with the administration of carnitine. The aim of the present study was to investigate the effects of L-carnitine (900 mg/day for 3 months) on symptom, exercise performance, and quality of life (QOL) in patients with arteriosclerosis obliterans. In 33 patients, the activity domain measures of Vascular Quality of Life (VascuQOL, Japanese version), which are disease-specific questionnaire, were significantly improved between baseline and 3 months (p<0.05). The other measures did not show significant results, but demonstrated improved tendency in Brachial Artery Pulse Wave Velocity (baPWV), Augmentation Index (AI), 6 minutes maximum walking distance (6MD), and Walking Impairment Questionnaire (WIQ). Results indicated that carnitine affects impairment of skeletal muscle, suggesting possible beneficial effects on improvement of atherosclerosis.
It is uncertain whether exercise-induced zero toe brachial index sign (e-ZETS) is beneficial to prevent advanced perfusion disturbance in maintenance hemodialysis (HD) patients. In HD patients, we compared the clinical findings and prognoses among 22 toes in a resting zero toe brachial index sign (r-ZETS) group, 22 toes in an e-ZETS group, and 63 toes in a non-e-ZETS group. The hemodynamics of the lower extremities in the e-ZETS group is intermediate between the r-ZETS and non-e-ZETS groups. As the result of a 36-month follow-up observation, the r-ZETS avoidance rate was significantly lower in the e-ZETS group (63.6%; P<0.001) than the non-e-ZETS group (98.4%), showing that it was difficult to avoid advanced perfusion disturbance. The e-ZETS in HD patients may appear before r-ZETS, being beneficial as a predictor for advanced perfusion disturbance.
Changes of local thrombi and alterations of right heart load by the anticoagulant therapy were investigated in the patients with soleal vein thrombosis (SVT) and crural vein thrombosis (CVT). The subjects were 24 in the SVT and 21 in the CVT. In the changes of local thrombi, the effective rate of disappearance and decrease in size was 63% and was not significant between the SVT and the CVT. In the alterations of right heart load, the right heart systolic pressure decreased significantly. The rates of the patients with pulmonary hypertension more than 40 mmHg were significantly reduced in both SVT and CVT, and the rate of the patients with right ventricle load more than 30 mmHg was significantly reduced in the SVT. Anticoagulant therapy could give more extensive reduction of the right heart load to the patients with SVT than those with CVT.
The most effective treatment for Buerger disease is the cessation of smoking. Several treatments, including conservative medical treatments, lumbar sympathectomy, surgical revascularization, and endovascular treatment have been developed to treat the ischemic conditions associated with Buerger disease; however, it was not possible to manage some patients, who might require limb amputation, along with these treatments. We herein report a case in which spinal cord stimulation (SCS) effectively improved the ischemic symptoms of Buerger disease. In Buerger disease patients where conventional treatments were not sufficient to relieve ischemic symptoms, SCS should be considered as an alternative treatment modality.
We report a case of a 74-year-old man, who was emergently transported to our institution because of chest and abdominal pain. The computed tomography showed acute type B aortic dissection with superior mesenteric artery (SMA) malperfusion. Thoracic endovascular aortic repair (TEVAR) was performed to seal the primary entry, and the false lumen was sufficiently depressurized. However, SMA was still statically obstructed, thus retrograde SMA stent was successfully implanted through the small laparotomy. His postoperative course was uneventful, and he was discharged on the 20th postoperative day.