Effect of parental smoking on children?

CIMT measurement

Parental Smoking Causes Vascular Damage In Young Children - Surrogate markers of vascular disease are hsCRP, carotid artery intima media thickness. Carotid artery intima media thickness measurement is painless and repeatable. So, in one study specifically, they looked at the children's carotid artery intima-media thickness (CIMT) and arterial wall distensibility, using ultrasonography to take the measurements. The evidence was fairly conclusive and showed that children whose mothers smoked during pregnancy had on average carotid arteries showing 15% more stiffness, as well as arterial thickening of 19 microns, (which is about the thickness of a cassette tape) compared with their smoke free peers. Where both mother and father smoked during the pregnancy the stiffness rose to 21% and thickening to 28 microns. So, we should encourage parents to avoid smoking which is not only harmful to them but also to their children. Increased CIMT is also associated with increased coronary artery disease related events. This parameter has been used in the past and it correlated with the postprandial blood sugar levels.

 

Lipodermatosclerosis and chronic venous disease

Patients with chronic venous disease (venous insufficiency) develop changes in the foot, ankle and leg. They develop varying degrees of varicose veins, skin pigmentation, thickening of the skin and subcutaneous tissues and ulceration in the ankle region.  Skin thickening and nodular formation mimics cellulitis in many patients and there is a possibility that many of them may receive antibiotics for control infection and cellulitis. The thickening of the skin and subcutaneous tissues in chronic venous disease usually occurs on the medial side of the leg. Skin pigmentation is common and it is rare to see the induration and thickening on the medial side without skin pigmentation.   It is still not clear which factors will determine the development of the thickness of the tissues ( Lipodermatosclerosis) and the speed at which they develop in a given patient. We have seen this symptom Lipodermatosclerosis in people who are obese and non-obese, who are tall and short. It may not be uncommon to see a obese man with inverted champagne bottle like legs in vascular surgery clinics. The indurated, sclerotic plaques with a “bound-down” appearance (ie, they appear as if tethered—or bound—to the subcutaneous tissue) affecting the skin from below the knee to the ankle is common in our clinics in patients who had chronic venous disease for more than 10 years with or without history of DVT. Usually there is a sharp demarcation between affected and unaffected skin.  It is proposed that venous reflux leads to increased venous pressures which can result in extravasation of interstitial fluid and red blood cells, decreased diffusion of oxygen to the tissues, and eventual tissue and endothelial damage. As the endothelium is damaged, microthrombi formation and infarction ensue, stimulating fibroblasts to form granulation tissue.  Fibroblast might be playing a major role in progression of the fibrotic reaction in the ankle and leg region. The dilated veins are palpable in this scar like tissues and sometimes they may be source of profuse bleed from the ankle region.  When such a bleed occurs one would be concerned about further bleeds from the leg. Sclerotherapy may help to stop the bleed and heal ulcers. But patients would certainly like to get it excised completely and get skin grafting if possible.