Objective: Chronic venous insufficiency (CVI) is the most common vascular disorder in the United States and disproportionately affects women, especially postmenopausal women. The increased prevalence of CVI in this population is likely to be multifactorial, with attributable risk factors including older age, obesity, and multiple pregnancies. One of the known pathophysiologic mechanisms of CVI is superficial venous reflux (SVR), in which the degree of SVR is proportional to the severity of CVI-related symptoms. This study aimed to identify the difference of SVR severity in premenopausal and postmenopausal women.Methods: During the course of 18 months, we interviewed 480 consecutive female patients with an established diagnosis of CVI. The average age of the patient cohort was 61.9 years; 55 patients had C6 disease, 2 had C5 disease, 138 had C4 disease, 269 had C3 disease, and 16 had C2 disease. Reflux rates from each patient's initial duplex ultrasound examination were retrospectively documented in a single-center registry. All patients were queried on how lower extremity pain related to their menstrual cycle.Results: There were 363 patients, with an average age of 67.5 years, reported to be postmenopausal; 94 patients, with an average age of 42.4 years, reported regular menstrual cycles, of whom 36 (38%) reported worse lower extremity pain during menses. Nine patients reported lack of regular menstrual cycles: six because of prior total abdominal hysterectomy, one because of effects of chemotherapy, one who recently gave birth, and one with menorrhagia. Nine patients reported no pain in association with their CVI, and five declined to answer our questions. The difference in average reflux rates of premenopausal and postmenopausal women can be found in the Table . Conclusions: Great saphenous vein reflux was found to be significantly higher in premenopausal women. Decreased serum progesterone in postmenopausal women may play a role, and these findings warrant further investigation.
Profound dystrophic changes, which involved granulocytes and were associated with acute inflammatory reaction, were observed in rabbit liver at the initial stage of experimental hypercholesterolemia. It was suggested that "acute phase" is important for the formation of a modified lipoprotein with autoantigenic properties. Key Words: hypercholesterolemia; C-reactive protein; leukocyte decationization; clasmatosisIt was hypothesized that modified apoprotein Bcontaining lipoprotein (apoB-LP) with autoantigenic activity [ 1,7] is an important factor of atherosclerosis [5]. Proceeding from this hypothesis, one can regard atherogenesis as a local immune inflammation [2]. The vascular wall is a target organ in which the modifications occurring in the organism are realized. The liver is the major organ that synthesizes and catabolizes various LP which were isolated from aortic intilna [1]. Hepatocytes are the major cell type producing the acute inflammation proteins C-reactive protein (CRP) and serum amyloid P (SAP). These proteins play an important role in the imnmnoregulation and activation of granular and agranular leukocytes [4]. A relationship mediated by the phospholipid groups has been established between the acute-phase proteins and low-and very low-density LP [6]. As we are aware, morphological manifestations of structural and functional modifications occurring in hepatocytes during the development of hypercholesterolemia have not been investigated except fatty dystrophy of the liver. Our objective was to analyze the morphofnnctional changes in the liver at the initial stages of experimental hypercholesterolemia when modified apoB-LP emerge in peripheral blood and the concentration of CRP and SAP increase. MATERIALS AND METHODSExperiments were performed on 28 male rabbits weighing 2.8-3.0 kg. Hypercholesterolemia was induced by feeding the animals with cholesterol dissolved in sunflower oil (200 mg cholesterol/kg body weight) through a gastric tube 5 times a week. Sermn lipids were measured in a Technicon AA-II analyzer before and on days 2, 4, 7, and 14 of hypercholesterolemia. The CRP and SAP contents were determined by light absorbance changes after the precipitation reaction.Blood smears as well as liver prints and sections were stained for cationic proteins by the method of V. E. Pigarevskii. Liver sections were stained for lipids with oil red O and with hematoxylin and eosin, hmnunohistochemical investigations were performed with the use of anti-CRP and anti-SAP polyclonal antibodies. Proliferative activity of hepatocytes was determined after a single intravenous injection of the synthetic analog of thy-0007-4888/98/0010-01059520.00 9Kluwer Ac~tdem[c/PlemmJ Publisher.~
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