Objective-C-reactive protein (CRP) levels predict outcome in healthy individuals and patients with atherosclerosis.Arterial stiffness also independently predicts all-cause and cardiovascular mortality and may be involved in the process of atherosclerosis. The aim of this study was to investigate the relationship between stiffness and inflammation in a cohort of healthy individuals. Methods and Results-Pulse wave velocity (PWV) and blood pressure were assessed in 427 individuals. Subjects with cardiovascular disease, diabetes, hypercholesterolemia and those using medication were excluded. CRP correlated with age, mean arterial pressure (MAP), brachial and aortic PWV, and pulse pressures. In multiple regression models, aortic PWV correlated independently with age, CRP, male gender, and MAP (R 2 ϭ0.593; PϽ0.001). CRP was also independently associated with brachial PWV. Aortic augmentation index correlated with age, gender, MAP, and inversely with heart rate and height, but not with CRP (R 2 ϭ0.794; PϽ0.001). Aortic, carotid, and brachial pulse pressures were also independently associated with CRP levels. Conclusion-Aortic and brachial PWV, and pulse pressure, relate to levels of inflammation in healthy individuals, suggesting that inflammation may be involved in arterial stiffening. Anti-inflammatory strategies may, therefore, be of benefit in reducing arterial stiffness and thus cardiovascular risk, especially in patients with premature arterial stiffening. Key Words: C-reactive protein Ⅲ pulse wave analysis Ⅲ augmentation index Ⅲ pulse wave velocity Ⅲ inflammation T he pathogenesis of atherosclerosis remains incompletely understood, but inflammation is thought to play an important role. 1 Several studies have demonstrated that serum levels of the acute phase protein, C-reactive protein (CRP), independently predict outcome in patients with cardiovascular disease 2,3 and in apparently healthy individuals. 4,5 Levels of CRP also correlate with endothelial function, an independent predictor of cardiovascular risk, 6 in patients with coronary artery disease. 7 Moreover, CRP has direct proinflammatory effects on human endothelial cells in vitro 8 and can induce endothelial dysfunction. 9 Aortic pulse wave velocity (PWV), a measure of aortic distensibility, predicts mortality in patients with end-stage renal failure, hypertension, diabetes, and older otherwise healthy individuals, independently of known confounding factors. 10 -13 Interestingly, recent evidence suggests that brachial pulse pressure, a surrogate measure of arterial stiffness, is correlated with CRP and interleukin-6 (IL-6) levels in apparently healthy men. 14,15 Moreover, an association between CRP and aortic PWV has been reported in subjects with end-stage renal failure. 16 However, whether there is any relationship between inflammation and central pulse pressure or more direct indices of arterial stiffness such as aortic PWV in healthy individuals is unclear. We hypothesized that CRP levels would be correlated with aortic PWV and central pulse pressure...

We assessed the efficacy of local fibrinolytic therapy in 35 axillary-subclavian vein thromboses (SVT) that occurred in cancer patients with percutaneous central venous catheters (CVC). These catheters were indwelling for a median of 1 month (range, one day to 10 months) before thrombosis developed. Urokinase was administered at a dose of 500 to 2,000 U/kg/h. Complete lysis occurred in 25 of 30 thrombi that were directly infused, after a median of four days. Complete lysis occurred in one of 12 thrombi that could not be directly infused with urokinase and in two of six with associated phlebitis. Eighty-one percent of the thrombi that were symptomatic for less than 1 week before treatment resolved, compared with 56% present for longer than 1 week. Sixteen patients who had complete (12) or partial (four) thrombolysis did not have their CVCs removed. All four patients with partial thrombolysis had recurrent thrombosis at a median of eight days (range, one to 90). Only two patients who had complete thrombolysis had recurrent thrombosis, at 8 and 16 months. Only minor hemorrhagic toxicity was seen.

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The gastroduodenal arteries of 7 patients were occluded for treatment of duodenal bleeding in 4, hepatic devascularization in 2, and redistribution of blood flow for intra-arterial chemotherapy in one patient. In 6 patients, occlusion was performed with Gianturco coils, and with Gelfoam in one. No major complication was encountered. This approach was successful in the control of bleeding from peptic ulcers, arteriovenous malformation and invasion of duodenum by retroperitoneal metastatic lymph nodes from carcinoma of the testicle. Occlusion of the gastroduodenal artery was utilized for further dearterialization of hepatic neoplasms. Redistribution of hepatic blood flow was accomplished by the occlusion of the gastroduodenal and replaced right hepatic arteries allowing infusion of chemotherapeutic agents into the entire liver through the left hepatic artery.