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Depression in ICD-10

CASE STUDY, PSYCHIATRY

       WHAT CAN BE THE DIAGNOSIS?

       At the age of 25, D.A.K., a postgraduate student in chemistry, found himself at the emergency department (ED) of the university hospital, where the campus police had brought him. He had been working late at the laboratory alone when the police came. He had been awake for the past 4 days working on an experiment that he believed would save the world.

       D.A.K.’s professors had voiced concerns as the often quiet and well-mannered student had recently begun to take over the class discussions and interrupt lectures. More remarkable than the behavior itself was the change it represented. In the preceding semester, D.A.K. had been uncharacteristically quiet and withdrawn. Many suspected that he was depressed, but they could find no apparent reason for his behavior. Then he isolated himself from friends and family and stopped seeing his girlfriend of 2 years.

       D.A.K. had a family history of depression on his mother’s side, with a grandmother who had received electroconvulsive therapy (ECT) years ago in a state hospital. On his father’s side, his uncle had received lithium and had been diagnosed with manic depression. A vague history of colorblindness was also noted. D.A.K. had a younger sister who was often described as moody.

    

       In the ED, D.A.K. was belligerent, talked rapidly but coherently, and demanded to return to the laboratory so that he could save his experiment and thus the world. He wanted a lawyer and denied being suicidal but threatened those who, he claimed, were standing in his way. He accused the faculty of being against him, threatened legal action against those incarcerating him, denied hallucinations but clearly saw himself in highly grandiose terms, was orientated times 3, had good recall, and was colorful and verbose in his response to proverbs.

       No history of drug or alcohol use was noted, except for a large consumption of coffee in the preceding several weeks. He had no obvious medical problems.

       D.A.K. kept demanding to leave and return to the laboratory to save everyone. He was a huge challenge to the emergency physicians, who could not wait for the psychiatric resident to arrive

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Ten Delicious Bodybuilding Foods That Increase 

Serotonin Levels!

By Ed Clements January 2009 Serotonin is a neurotransmitter (brain chemical) that is involved in many vital body functions and is very important in the regulation of mood and sleep.

Serotonin has come under a lot of attention recently because research has shown that low levels of this neurotransmitter can lead to increased incidences of aggressive behaviour and increased symptoms of anxiety and depression.

Even more worryingly is that scientists have found that ‘lower serotonin function and impulsive/aggressive traits are associated with suicidal acts, including completed suicide.’(1)
In terms of dieting, making sure you're not serotonin deficient is very important because serotonin is crucial in triggering satiety after eating. Depressed serotonin levels is the likely reason why the vast majority of people cannot stay on a very low carbohydrate diet for the long term without feeling an unavoidable need to binge.
Here are my top 10 everyday bodybuilding foods that increase serotonin levels. I explain why these particular bodybuilding foods are fantastic for raising your mood.

Whilst these are all foods that increase serotonin levels, I’ve included each food for a slightly different reason:
1) Free Range Turkey
2) Flaxseed/ Flaxseed oil
3) Buckwheat
4) Wild Fish and Sea food
5) Whey protein
6) Bananas
7) High quality Eggs
8) Sour Cherries
9) Free Range Beef
10) Dark Chocolate

---

 
1) Free Range Turkey:
Tryptophan is an essential amino acid that is present, in different amounts, in all protein foods. This amino acid is the building block for the neurotransmitter serotonin.
Eating a diet containing adequate amounts of dietary protein is crucial to maintaining a positive mental outlook because without enough tryptophan your brain serotonin levels will fall.
When you eat a protein source containing tryptophan, along with a small amount of carbohydrate, all of the amino acids except for tryptophan are cleared from the bloodstream leaving tryptophan free to cross the blood brain barrier and form serotonin.

Turkey is one of your best protein foods that increase serotonin levels. The fact that people often report feeling very relaxed and even sleepy after eating turkey is testament to how much tryptophan it contains. Turkey is also rich in essential fats, and these are supplied in a balanced ratio.
Having a Turkey and cranberry sauce sandwich on whole grain bread as your evening meal is a great way to get your serotonin levels up.
 
2) Flaxseeds/ Flax oil:
As well as being great for fat loss, flaxseeds are great foods that raise serotonin levels because they contain both tryptophan and high levels of omega 3 fatty acids. 60 percent of the brain is made of structural fats, and omega 3 fatty acids make up a large proportion of brain nerve cells.
Bearing this in mind, it's not that surprising that omega 3 fatty acids have been used to treat depression, post partum depression, violent behaviour and other psychological problems.
Despite there being no absolute requirement for the polyunsaturated fat alpha linolenic acid, many people find that taking 1 to 4 tablespoons of flaxseeds or 1 or 2 tablespoons of flax seed oil a day dramatically improves their mood.

Tip: Mix your cold processed flax oil into ‘American’ (high sulphur) cottage cheese, a high tryptophan food, to make the flax oil water soluble – this enhances absorption and allows the life giving omega 3 fatty acids to reach all of your cells. (For more information Google ‘The Budwig Diet’)

3) Buckwheat:
This natural starch food is particularly rich in many b vitamins and contains much more tryptophan than most starchy carbs. The B vitamins have been recommended for a while now as a means of improving energy levels and mood and of banishing depression.
Recent research has shown that certain b vitamins, particularly vitamin b6, are involved in proper serotonin synthesis in the brain.(2)

Most people need to include at least some starchy carb foods that increase serotonin in their diets to feel their best. Natural starch foods create a small insulin spike when ingested that is necessary for the clearance of other amino acids from the bloodstream, leaving tryptophan able to cross the blood-brain barrier where it is converted into serotonin.
Remember these starch foods stimulate the production of serotonin but you need tryptophan from protein foods as fuel for the creation of serotonin. Use starchy carbs wisely, if you eat too many carbs at once you will unbalance your blood sugar levels and cause serotonin levels to drop. Consider eating slightly more of your carbs later in the day, along with other foods that increase serotonin, to facilitate a deeper, more restful sleep.

It is very important to maintain stable blood sugar levels if you want to remain emotionally even and to sleep well. Out of all foods that increase serotonin, buckwheat is an excellent carb choice because it contains high levels of anti diabetic nutrient d-chiro-inositol that has been shown to effectively lower blood glucose and insulin levels (3). In a recent animal trial comparing buckwheat protein to casein (milk protein), the rodents fed buckwheat gained significantly more muscle and lost more fat… impressive!(4)  

4) wild fish and seafood:
Fatty fish like wild salmon, sardines and herring are rich in oils containing the essential fats EPA and DHA. Both of these long chain fats have been shown in trials both to smooth the mood swings of bipolar disorder and to ease regular depression.

Although some trials have shown high doses (around 10 grams of EPA and DHA) to be better, most trials show that maximal benefits are gained from as little as 1 gram of EPA and DHA a day (5). If you eat fatty fish a few times a week you will be getting fish oil that provides ample EPA and DHA to raise your mood and these fish are rich in tryptophan which we know is the amino acid needed to build serotonin.
If you don’t like high omega 3 foods that increase serotonin like wild salmon, sardines or mackerel or are avoiding them due to potential heavy metal problems it would be a good idea to supplement.

A gram or so of EPA and DHA each day has also been shown to improve fat burning in well controlled trials.(6) Supplementing with high quality fish oil whilst dieting, along with eating foods that increse serotonin, could help keep your mood up when the hunger kicks in.

5) Whey Protein:Whey protein has gained a greater and greater reputation as a super-food over recent years. Whey has been shown to regulate appetite, improve insulin sensitivity and blood sugar levels, bolster the immune system and has been shown to be the ideal protein source to use around workout time.
Aside from these benefits, one interesting study found that whey might actually be one of the best protein foods that increase serotonin levels:
In a double blind study researchers looked at whether a whey rich diet would increase plasma Trp-LNAA, an indicator of brain serotonin function, to a greater degree than sodium caseinate (standard milk protein) – whey did much better!

‘A significantly greater increase in the plasma Trp-LNAA ratio after consumption of the alpha-lactalbumin diet than after the control diet (P = 0.0001) was observed; memory scanning improved significantly only in the high stress-vulnerable subjects (P = 0.019)’

The researchers made the following conclusions:
‘Because an increase in the plasma Trp-LNAA ratio is considered to be an indirect indication of increased brain serotonin function, the results suggest that dietary protein rich in alpha-lactalbumin improves cognitive performance in stress-vulnerable subjects via increased brain tryptophan and serotonin activities.’

I’ve always found that whey puts me in a good mood and these results seem to explain why.
My personal hunch as to why whey’s one of the best foods that increase serotonin levels is to do with whey’s high ranking in the insulinogenic index. Whey creates an insulin spike when you eat it, much like starches do, and I believe this allows more tryptophan to reach the brain than with other protein sources – just my speculation though!

6) Bananas:
Bananas are actually surprisingly high in tryptophan whilst also containing carbohydrates, making them one of my favourite foods that increase serotonin levels.

Your probably thinking that the G.I. and sugar content of a banana is bit too high to be eaten every day – I agree. But this doesn’t mean you can’t ever enjoy a banana!

Consider using a couple of bananas, combined in a shake with whey protein (and maybe some healthy fats), for a post workout meal that will restore electrolytes lost during exercise and will raise serotonin levels.

As well as this, half a banana simmered in coconut milk makes for a delicious Thai-style after dinner desert that will relax you and get you ready for sleep by increasing brain serotonin levels.

7) High Quality Eggs:
High quality eggs rank highly among foods that increase serotonin levels because they're a great source of omega 3 fatty acids, including the essential long chain fats E.P.A. and D.H.A. We’ve already seen that these fats can help to improve your mood and that some research shows that this is because they increase serotonin levels in the brain.

As well as this, eggs are a great source of natural cholesterol. A diet that includes cholesterol rich foods raises testosterone levels which improves mood and also raises serotonin levels! Healthy testosterone levels also support improved muscle gain and fat loss.

Despite the bad things you may have heard about cholesterol, numerous studies have shown that depressed people have lower levels of blood cholesterol. A recent meta analysis, using 30 results from 30 different investigations, concluded that ‘TC (total cholesterol) and depression were inversely related’(7).

8) Tart/ Sour Cherries:
When darkness hits our eyes at night, we begin to produce the hormone melatonin. This hormone is crucial as it tells your adrenal glands to produce DHEA, one of the master hormones of the body. Melatonin is crucial to sleeping well at night – a lack of melatonin is why you can’t sleep deeply when your bedroom light is on. Melatonin supplements are sold as sleep aids to insomniacs and are very safe.

Everyone knows that a rough night’s sleep ruins your mood the next day – part of the reason for this is that feel good neurotransmitters like serotonin are replenished during restful sleep, and if you miss out your brain serotonin levels will be depressed the next day. You should do everything possible to get a good night’s sleep if you want to get your serotonin levels, and your mood, up.

Sour cherries actually contain melatonin! Mark Konlee, author of The Immune Restoration Handbook, writes, ‘Drinking a glass of sour cherry juice, or eating about 20 red tart cherries before retiring at night, may assist in inducing a deeper state of sleep and supporting adrenal glandular function’(8).

Mark writes: ‘You can help yourself to a night of deep restful sleep by taking 10 grams of a cold processed whey protein, like ImmunePro, before bedtime, or eating ½ cup of cottage or ricotta cheese on rye bread, as a source of Glutamine and calcium lactate, and, when used with the cherries, may induce a deep sleep’.
This bedtime meal for insomniacs, combining two foods that increase serotonin levels, is actually very similar to the kind of meal top bodybuilding nutritionist John Berardi recommends for preventing night time muscle catabolism in his article ‘Bedtime Story’. By eating this delicious late night snack you should wake up in a better mood and having gained some lean muscle!

See John Berardi's website, Precision Nutrition, for high quality information on how to eat to build serious amounts of muscle whilst staying lean. John Berardi is an expert on post workout nutrition that I pay a lot of attention to.



9) Free Range Beef:
Beef, like eggs, is a good source of cholesterol and tryptophan which are both important for raising serotonin levels in the brain. It’s important to buy good quality beef if you don’t want to be ingesting a load of hormones and antibiotics with your meat (not so much of a problem in Europe).

Pork, veal, duck, chicken, lamb etc. are all good foods that increase serotonin as well. I’ve listed beef in particular because, in my opinion, it is the best muscle building food you can eat – if you substitute beef into your daily diet I guarantee you will gain muscle.

Just for the record, I’m not suggesting that the more red meat you eat the happier you will become! Very high protein diets, that drastically cut fat and carbohydrates, tend to worsen your mood, as anyone on Atkin’s diet induction will confirm! A little carbohydrate in your meals is important for optimal serotonin production, so don’t drop all carbs in favour of high protein foods.

10) Dark Chocolate:
Cocoa is well known to increase serotonin levels in the brain – the trick is not to eat so much that you crash a few hours later. Similarly most chocolate is clearly high in sugar and will spike blood sugar levels causing serotonin levels to plummet when your blood sugar crashes.

If you try to acquire a taste for 70% and higher cocoa chocolate you can have the benefits of chocolate without the downsides – I now find anything under 90% very sweet.
Small amounts of cocoa in the diet have been shown to improve insulin sensitivity (9) and cocoa is very rich in antioxidants and polyphenols – enjoy!

A few more foods that increase serotonin levels:
Other healthy and delicious foods that increase serotonin levels are asparagus, avocado, pecans, pineapple, eggplant, spinach, walnuts, oats, and coffee (if you use it sensibly).

If tryptophan rich foods aren’t quite enough to get your mood up consider trying a supplement called 5 HTP which is one step closer in the serotonin production chain than tryptophan. Many people find 5 HTP to be very effective as an anti-depressant and research suggests it will work faster than using foods that increase serotonin levels to improve your mood.

A great hot drink that will raise your serotonin levels is nettle tea – this refreshing hot drink is full of minerals, vitamin c, flavanoids and malic acid and is reported to improve the complexion.
A cup of nettle tea noticeably lifts the spirits and can be helpful if trying to reduce caffeine consumption. Nettle has also been shown to be a powerful anti-estrogen – anti-estrogens are important to athletes because they keep testosterone up allowing you to build more muscle and burn more fat.

Finally…
There are other factors than simply eating foods that increase serotonin involved in getting your mood up – exercising, getting natural sunlight each day, getting enough vitamin d, laughing, getting enough sleep etc. are all very important to raising your mood. Including these foods that increase serotonin levels in your diet will certainly help though!

If you’re feeling down give my personal serotonin boosting formula a go, it runs roughly as follows: Jog to the gym; do a great workout; walk back, have a whey, banana and coconut milk shake; relax – simple, but very effective!

Purify Our Mind

THE most important thing in our life should be "To Purify Our Mind". In this page I will donate my knowledge and time to work with those who are interested in this field. Any questions are welcome.

TO purify our mind, we need to first broaden ourselves with activities of compassion so as to gradually get rid of the self-centered habits.

TO broaden ourselves, we should FIRST FILL OUR MIND with BEAUTIFUL THOUGHTS:
WE should try to make our mind like land, because land has beautiful virtues: when animals shed their excrement on land, land never express anything angrily, because it is not swayed and is completely indifferent; when humans (the rich and famous, sages and saints, or perfect people) walk over land, land feels nothing, again because it is not swayed and is completely indifferent.

Land is not involved or affected by favorable or dangerous situations. Land always welcomes all kinds of situations. It will not take or give up anything, is never confused, is never swayed or attracted by anything, never starts an idea or gives up an idea, peacefully enjoys leisure and endures patiently, and is completely serene. These are some of the beautiful virtues of the land that we step on every day.

IF you have no mind to all living things, then what's the harm of letting these things surround you? We really should learn the spiritual part of land and cultivate the broad and generous mind. This will help to purify our mind.

THE GOOD and THE BAD:

WHEN you face favorable situations or dangerous situations, you can still do everything without the least worry and feel comfortable and able to do anything of your own free will. When you meet somebody, perhaps the person you like the least in your life, a person who looks at you with dirty stares, do you still feel comfortable and free? As a matter of fact, in these kinds of moments, there is a fight between "The state of holiness and wisdom" and "The temptations or evil influence." If we use the worldly words it's like a fight between "The Good" and "The Bad." Becoming The Good or The Bad is all depended on our MIND.
BECAUSE The Good and The Bad are decided by our mind, maybe we can put it this way: The Good and The Bad share our mind. When The Good defeats The Bad, the whole of our mind is Good. When The Bad defeats The Good, the whole of our mind is Bad. From this angle you might have an idea that The Good and The Bad are all from our mind.
THE way our mind treats the situations we face creates the difference between "The state of holiness and wisdom"(The Good) and "The temptations or evil influence"(The Bad). If our mind is contaminated by situations, the mind becomes "The Bad." If our mind is not contaminated by situations, the mind becomes "The Good".

WHY BOTHER:

WHEN adverse circumstances come, just let them do what they like; when adverse circumstances go, just let them do what they like also. When fortunate circumstances come, just let them arise naturally without extra effort; when fortunate circumstances go, again just let them depart naturally without extra effort. Our mind should not be linked up with any circumstances, whether good circumstances or bad circumstances. This will help Purify Our Mind.

WHEN adverse circumstances come, do not feel delighted, when adverse circumstances leave, do not feel disappointed. If the mind feels delighted or disappointed, it shows that we can not control ourselves. In this moment, our mind will have all kinds of entanglements of love, hate, desire, and possession by force. After this step, all kinds of problems will follow and never end.

THE IDEA OF the word "IMPERMANENT":

IF we observe things around us, we will find out that "None is permanent". Things, whether material or non-material, change constantly. Some of the changes are evident, some of them are not. Ever since life began, natural phenomena have been like this. From this point of view, we should understand that things always arise depending on conditions. When the appropriate conditions come together, things arise; when those conditions disperse, things cease.

IF you could understand the point that Nothing is permanent, you will not keep thinking of something in your memory all the time, because it is impermanent and will eventually vanish, no matter how much you keep remembering it. In such a case, why don't we just leave it alone?

IN the Universe, everything that we can see, hear, and think of all arising depending on conditions, meaning that everything is impermanent. The people we love the most or the situations we like the most will all vanish. The people we hate the most or the situations we like the least will all vanish too. Do we still want to persist in our own opinions of things that happen one minute and vanish the next in this world?

THE THOUGHTS in OUR MIND:

THERE are all kinds of thoughts in our mind: evil thoughts, greedy thoughts, and kind thoughts. These thoughts are always confused, tangled, profuse, disordered, and most of the time, we can not control them. Actions, motions, works, and even mistakes all arise from thoughts in our mind. When we put an idea of going to a place in our mind, then action will lead our body to that place. When we start an idea of going to the church, then action will bring us to that church. We will spend our entire fortune doing something because of a little thought in our mind. We will begin to be deeply attached to one thing or act on momentary impulse because of a little thought in our mind. We will offend people by our words because of a little wrong thought in our mind. We might do something offensive or harmful to society's morals because of a little evil thought in our mind.

WE always maneuver for positions or benefits against rivals. We try to cause alienation between friends or relatives by spreading rumors or doing something. Does anybody know why? It is because "What one is thinking of at any given moment is often evil thoughts."

THE Good and The Bad all are from our MIND. We are the masters of the mind and also are the watershed of The Good and The Bad. Mind produces all kinds of thoughts; mind is the origin of events that follow from Good thoughts and Bad thoughts. From this point of view, we all should understand how important it is to purify our mind.

TO DEAL with THOUGHTS:

IF we want to avoid disasters or calamities made by ourselves, we have to stop putting ideas in our head. The moment we stop an idea arising is called "True Awakening".

THERE are all kinds of garbage in our mind. If we want to purify our mind, getting rid of the garbage in our mind might be the first thing we have to do. What is the garbage of mind? Dirty and polluted thoughts, greedy thoughts, hateful thoughts, infatuated thoughts, worried thoughts, suffering thoughts, haughty thoughts, impudent thoughts, envious thoughts, indecent thoughts, heterodox thoughts, dreary thoughts, and hollow thoughts. These can all be called garbage of the mind.
Someone in history said once that one who can govern a battalion of a million soldiers is not a hero: the real hero is that person who can govern his mind. We should understand the meaning of these words.

IF an evil thought arises in our mind, then more evil thoughts like water will come in torrents; nothing can ward them off. These evil thoughts will forever lead us to thinking, speaking, and acting evil. Ever since life began, the habitual temperament of human beings makes us like this. It is doubly difficult to get rid of them.

WHEN we can govern our thoughts, our mind will not be affected by situations. From this, our mind can be free. This is a very hard level to reach, but the first step always is hard.

FOR those who have too many friendly feelings (such as being crazy about women), if they do not control their feelings well, they will follow their thoughts and will sink into the deep sea of feelings. For those who desire wealth and honor greatly, their minds are clouded by material desires, the covetous thoughts will lead them to fame and wealth, and they will be in the bondage of reputation and wealth forever.

ALWAYS keep a watch on thoughts in your mind. Try to realize or know what and where your thoughts are. As a matter of fact, according to the experienced people's idea, "Thoughts always vanish when you watch them." If we could practice like this all the time, the power of our thoughts will decrease over time. This is not a very easy level to reach, but at least we have an idea that there is a way to get rid of thoughts.

LIKE we mentioned, things arise always depending on conditions: when conditions come together or gather together, things arise; when conditions disperse or dispel, things cease. [This is a doubly important notion]. When we understand this notion, we will also understand that everything in the universe is impermanent; from this point of view, it should be easy to get rid of CLINGING, and always persisting in our opinion. Always remember and practice the notion of IMPERMANENCE. This will help to purify our mind a lot.

THE ORIGINAL NATURE OF HUMAN BEING:

WE should live in a world which belongs to our real inner self or original nature of human being. This world is bright and brilliant, where there no dispute, and we are not bothered by material concerns. It is pure and peaceful, enjoying leisure and not sorrowful; but we never try to act in response to this world, we never try to be a friend of our real inner self. The only thing we do day in and day out is to try and climb up socially. This is what the Chinese call "Attending to the superficials and neglecting the essentials".

WHEN our real inner self is led astray by human desires, we all know that desires are bottomless. We all will not be able to do anything of our own free will, and we become the slaves of human desires.

THE power of temptation of human desires is doubly brutal. Some people always try to attain their desires with nefarious tactics. The moment we have a thought like this, the moment we lose the chance to contact our real inner self, we are going to be gone far away from purifying our mind.

OUR mind will not stop producing thoughts because of human desires. Therefore, our real inner self will be clouded by material desires forevermore, and our original nature will be contaminated forevermore also.

WHY does our mind always produce thoughts? Before we talk about this subject, maybe we should understand some evil ingredients in our mind. According to the experienced people's idea, " Being greedy for everything, angry at everything, and not understanding the real truth are the most common evil ingredients in our mind."

THESE evil ingredients influence and poison our mind very strongly. That is the reason why our mind produces thoughts every minute of the day. And like we mentioned, "What one is thinking of at any given moment is often evil thoughts." From this, we should understand that fighting these evil thoughts is the most important thing we are going to do.

TO REDUCE THE THOUGHTS IN OUR MIND:

BESIDES what we have already mentioned, there are other ways to reduce thoughts in our mind. Here we try to introduce some of them. Hopefully this will benefit everybody who is seriously interested in this field.

TRY our level best to understand that all living things in the universe are equal; otherwise, we will have a special mind which always looks at things from a dualistic perspective. For example, making a distinction between the good and the bad. And all the problems will be starting from right here, such as "Always persist our own ideas", "Always argue", "Always hate", "Always fight", …and never stop.

LIKE we mentioned in the beginning, we should try to make our mind like LAND, and be tolerant of other people's mistakes, or wrongdoing or weaknesses. Try to express solicitude for everybody (Friends, enemies, good, and bad) equally. Try not to dispute or discuss in minute detail gaining or losing. Try not to be moved by sad or delighted things. Try not to feel so pleased when people respect or praise us. Try not to hate or abhor when people slight us.

WHEN people show their beautiful virtues (like helping others), we should show our respect and join in their actions, and we should try not to be jealous of other people's beautiful virtues. When we see people facing troubles, we should not gloat over their disaster.

ACCORDING to the experienced people's idea, "The highest wisdom comes from a merciful heart", the merciful heart comes from "Solving people's problems without any conditions and helping people to get peace, calm, and sagacity without any conditions either".
IF we look at things or treat things unequally, from here, all the worry, trouble, and prejudice will be produced almost right away. Thus if we want to purify our mind, we have to learn to look at things or treat things with equality.

SOMEDAY when we realize that all the beings are equal and could be blend or mix together, and become "ONE" in some way, we will understand really what is the "Real Truth". 

ATHEROME- RESUME

• un accumulation focale de lipide, glucide comlexes, de sang et dépots calcaires + remaniement de la média!
• les facteurs de risques :
• les principaux facteurs
• tabagisme
• HTA
• les dyslipidemie
• facteurs prédiposants:
• obésité
• sédentarité
• Localisation --> zone de contrain mécanique & zone de bifurcation!
• A.Carotide 
• souclaviere 
• vertebrale 
• aort thoracique descendente
• aort abdominale
• atère des memebre inf.

 

• Le Mécanisme de la Maldie Atheromateuse
  ·         Cause mecanique :
  o   Hypertension arterielle
  ·         Cause biochimique
  o   Hypoxie
  o   Radicaux libre par le tabagisme
  o   Substance vaso active
  o   Diabète
  o   LDLc
  ·         Cause infectieuse
  o    CMV
  o   Chlamydia pneumonia
  
  
  ·      -->   L’endothelium lésé --> expression molécule VCAM & ICAM -->  favorise recruitement de monocytes
  ·         Les monocytes entrant  endothelium devient les macrophages
  o   Un part capte LDL à cellules spumeuse
  §  Sécrétion IL1 & GF & PDGF à migration cellulese musculaier lisse & sécretion matrice extra cellulaire
  o   d’autre part àsubstance protéase (mettalo protéase)à réaction inflamatoire
   --> peut rupturer des plaque prémature
  ·         quand les cellules spumeuse mort --> lipide extracellulaire accumuler --> noyau lipidique
  ·         on peut trouver aussi des augmentation de facteuse thrombogenes:
  o   Thromboxane A2
  o   Facteurs plaquettaire 4
  o   Beta thromboglobuline
    
  ANATOMOPATHOLOGIQUE
  
  
  ·         Stade precose --> strie lipidique
  ·         Stade de la plaque
  o   Noyou lipidique
  o   Charpent fibreuse
  
  
  EVOLUTION NATURELLE DE LA PLAQUE D’ATHEROME
  
  
  ·         Instabilite de la plaque
  o   Syndrome coronarienne
  o   AVC
  o   Ischemie des membre inf.
  ·         Vers le plaque complique
  o   Ulcération --> adhesion plaquettaire
  o   Fissuration ou rupturation --> coagualtion à thrombus
  o   Hémorragie intra plaque --> occlusion par embole cruorique