Search

The study aims at providing a better understanding of the main factors leading to environmentally-friendly practices by investigating the relationships among perceived values, felt responsibility, and pro-environmental behaviours. The analysis is performed with reference to four developed European countries – France, Germany, Italy, and the United Kingdom. Based on Eurobarometer data (2017) on the attitudes of Europeans towards the environment, a structural equation modelling approach reveals positive and significant relationships among the three constructs, with interesting cross-country differences. In Italy and the United Kingdom, perceived values are directly associated with pro-environmental behaviour, while in Germany and France, where the cultural European identity appears to be more salient, values provide less guidance for behaviour. These findings may assist policymakers in developing a set of well-designed strategies for strengthening citizens’ pro-environmental habits through the reinforcement of values and feeling of responsibility.

The oxidation of low density lipoprotein (LDL) is a key event in the development and progression of atherosclerosis because it generates molecular epitopes that are more atherogenic than parent LDL. We found previously that patients with carotid atherosclerosis have a significantly higher titer of autoantibodies against oxidatively modified LDL than normal subjects. The aim of this study is to correlate biological markers of in vivo LDL oxidation with the degree of carotid stenosis and of plaque ulceration (PU) in a series of patients undergoing carotid endoarteriectomy (CEA). Ninety-four consecutive patients (68M and 26F, aged 67.3 +/- 8.2 years) who underwent CEA at our institution between June 1993 and January 1994 were included in the study. The degree of carotid stenosis and the presence and extent of PU were correlated with the level of autoantibodies (IgG) against oxidatively modified LDL (Cu++-oxidized [oxLDL] or malondialdehyde derivatized LDL [MDA-LDL]), that consistently mirrors the occurrence of oxidative modifications in vivo. A statistically significant correlation (r = 0.23, p = 0.039) was found between the degree of carotid stenosis and antiMDA-LDL specific ratio (a parameter that describes the specificity of LDL towards other proteins as target for oxidative modification). A statistically significant correlation was also found between the PU score and antioxLDL IgG (r = 0.32, p = 0.011), antiMDA-LDL IgG (r = 0.25, p = 0.045) and antiMDA-LDL IgG specific ratio (r = 0.38, p = 0.002). None of the classical biochemical parameters (total, LDL and HDL cholesterol and triglycerides) correlated with the above-mentioned plaque characteristics. The results shown, support the use of biological markers of in vivo LDL oxidation (antioxidatively modified LDL autoantibody titers) to evaluate the clinical setting of high-risk carotid atherosclerosis both in screening and in follow-up studies.

A significant percentage of patients undergoing myocardial revascularization suffer from extracranial cerebrovascular disease; recognition of such combined lesions identifies patients at risk for cerebrovascular accidents during the cardiac procedure. Simultaneous or staged coronary artery bypass graft (CABG) and carotid endarterectomy operations have been performed for the last 20 years, however, the clinical indications and the timing of the procedures remain controversial issues. Between November 1988 and January 1994, 1122 patients underwent myocardial revascularization at our Institute and in 35 cases (3.7%) carotid endarterectomy was simultaneously performed; 502 isolated carotid endarterectomies were performed in the same period. Trivascular coronary artery disease was found in 27 cases and low ejection fraction in six. Each patient received an average of 3.7 coronary grafts. Hospital mortality was 5.7% and major neurologic morbidity 2.8%. We believe that a simultaneous approach is recommended in patients with unstable angina and symptomatic carotid artery disease; in patients with a critical but asymptomatic carotid artery stenosis the indication for operation is subject to individual clinical judgment.

A hypertensive 67-year-old woman was admitted with a large, non-tender abdominal mass that caused a gross bulging of the abdominal wall. The patient was symptom-free except for occasional low back pain. She had been aware of the mass for over 5 years, but had not sought medical attention. Her family history was negative for significant vascular pathology. She had no history of trauma or instrumentation. Renal function was normal. Computed tomography scan (Cover) showed a giant aneurysm of the left renal artery (diameter 25 cm). The wall was calcified; thrombosis was extensive, but incomplete and dyshomogenous. The abdominal organs were dislodged to the right. No other aneurysmal locations were disclosed. Magnetic resonance angiography (A) showed the origin of the lumen of the aneurysm to be in the mid-left renal artery. Surgery was performed through a transverse laparotomy. The gastrocolic ligament was incised and the anterior wall of the aneurysm exposed and incised (B). The thrombus was removed from the sac and the origin of the aneurysm from the left renal artery exposed (C, arrow). A breach in the arterial wall was visible. The unclamped artery was digitally compressed for hemostasis while the artery was closed primarily. Pathologic examination confirmed a true atherosclerotic aneurysm. The patient is alive and well 6 months after the operation, with normal renal function. Aneurysms of the renal artery may occasionally reach large dimensions, but this case must be considered exceptional. It is actually extremely uncommon for aneurysms in any location to reach this size without rupturing. Giant renal artery aneurysms ( 5 cm. diameter) have been reported in fewer than 20 cases in the English literature. They may be pseudoaneurysms, usually secondary to invasive procedures such as percutaneous transluminal angioplasty or pyelolithotomy, or true aneurysms, often with parietal calcifications. The principal justifications for surgical treatment are ureteral obstruction, hypertension, pain, and elimination of the risk for rupture. Repair may require arterial reconstruction or even nephrectomy, but may also require only simple closure of the artery defect, as was possible here.