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Compensating crural anastomoses develop in patients with multi-level occlusion of the calf arteries in the course of atherosclerosis, arteriitis, diabetes, and in vascular malformations of the limbs. The peroneal artery is frequently the only patent calf vessel, especially in diabetic patients who have advanced tibial occlusive disease. The purpose of this study was to identify different types of compensating crural anastomoses in chronic critical limb ischaemia. Using combined anatomical-radiographic and statistical methods, 86 compensating crural anastomoses were studied in 59 specimens of lower limbs (amputated at the thigh) in the course of chronic critical ischaemia. Three types of compensating crural anastomosis and their components were identified. The most common type (55.8%) was the posterior tibioperoneal anastomosis. Less common (23.3%) was the intertibial anastomosis and least common (20.9%) the anterior tibioperoneal anastomosis. The posterior tibioperoneal anastomosis was concurrent with anterior tibioperoneal anastomosis in 26.3% of cases and with the intertibial anastomosis in 15.3% of cases. The great importance of the peroneal artery in the formation of natural crural collateral circulation should encourage vascular surgeons to consider peroneal bypasses.
Nitric oxide (NO) is a mediator of a diverse array of inter- and intracellular signal transduction processes. The aim of the present study was to analyze its possible role as a second messenger in the process of neuronal differentiation of PC12 pheochromocytoma cells. Upon NGF treatment wildtype PC12 cells stop dividing and develop neurites. In contrast, a PC12 subclone (designated M-M17-26) expressing a dominant-negative mutant Ras protein keeps proliferating and fails to grow neurites after NGF treatment. Sodium nitroprusside (SNP), an NO donor, was found to induce the p53 protein and to inhibit proliferation of both PC12 and M-M17-26 cells, but failed to induce neuronal differentiation in these cell lines. Key signaling pathways (the ERK and Akt pathways) were also not affected by SNP treatment, and the phosphorylation of CREB transcription factor was only slightly stimulated. It is thus concluded from the results presented in this paper that NO is unable to activate signaling proteins acting downstream or independent of Ras that are required for neuronal differentiation.
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