bluuebunny/crossref_metadata_2025 huggingface dataset:
Cardiac Tamponade in Patients with Human Immunodeficiency Virus Disease
Authors: Gowda Ramesh M. , Khan Ijaz A. , Mehta Nirav J. , Gowda Mamatha R. , Sacchi Terrence J. , Vasavada Balendu C.
Published: July 2008

The characteristics of cardiac tamponade in patients with human immunodeficiency virus (HIV) disease were examined by evaluating the cases, case series, and related articles, including autopsy series, identified through a comprehensive literature search. One-hundred eighty-five cases of cardiac tamponade have been reported in patients with HIV disease. Sex data were available in 176 patients, of whom 154 (87%) were males. The mean age was 34.7 ±10.4 years (range, 11 months to 61 years). Mean CD4 cell count was 98 ±95 cells/mm3 (range, 3 to 430 cells/mm3). The most common etiology of pericardial tamponade was mycobacterial infection (78 patients), including Mycobacterium tuberculosis, Mycobacterium avium-intracellulare, and Mycobacterium kansasii. A bacterial cause was found in 20 patients (11%). Staphylococcus aureus was the predominant bacteria, followed by streptococci, Pseudomonas aeruginosa, Listeria monocytogenes, Klebsiella pneumoniae, and Rhodococcus equi. Lymphoma was found in 15 (8%) patients and Kaposi sarcoma in 13 (7%) patients. Numerous unusual organisms, including Cryptococcus neoformans, Nocardia asteroides, Aspergillus species, cytomegalo virus, and herpes simplex were also associated with cardiac tamponade in HIV patients. Occasionally, HIV itself was involved in the pathogenesis. In 48 patients (26%), no cause was found or reported. The most common clinical presentation was dyspnea, followed by fever, cough, chest pain, and cardiac arrest. The predominant pericardial fluid color composition was serosanguineous. The majority of patients died during hospitalization or in the immediate follow-up period. Vigilance for cardiac tamponade in patients with HIV disease, especially in those with opportunistic infections and/or malignancies, and cardiac symptoms, may result in early and proper management of cardiac tamponade in these patients.
Prevention of Venous Thrombosis in Long-Haul Flights with Flite Tabs: The LONFLIT-FLITE Randomized, Controlled Trial
Authors: Cesarone M.R. , Belcaro G. , Nicolaides A.N. , Ricci A. , Geroulakos G. , Ippolito E. , Brandolini R. , Vinciguerra G. , Dugall M. , Griffin M. , Ruffini I. , Acerbi G. , Corsi M. , Riordan N.H. , Stuard S. , Bavera P. , Di Renzo A. , Kenyon J. , Errichi B.M.
Published: July 2008

The aim of this study was to evaluate the development of edema, and superficial and deep vein thrombosis (DVT) prophylaxis with an oral profibrinolytic agent (Flite Tabs, 150 mg pinokinase, Aidan, Tempe, AZ, USA) in long-haul flights (7-8 hours), in high-risk subjects. A group of 300 subjects was included; 76 were excluded for several problems including concomitant treat ments ; 204 were randomized into 2 groups (active treatment or placebo) to evaluate the effects of prophylaxis with Flite Tabs. An exercise program was used in both groups. The femoral, popliteal, tibial, and superficial veins were scanned with ultrasound before and within 90 minutes after flights. Of the included subjects, 92 of 103 controls and 94 of 101 treated subjects completed the study. Dropouts were due to connection problems. Age, gender, and risk distribution were comparable in the groups. In the treatment group, no DVT was observed. In the control group, 5 subjects (5.4%) had a DVT and there were 2 superficial thromboses (7 events in 92 subjects; 7.6%). At inclusion, edema was comparable in the 2 groups. After flights there was an increase in score in controls (+12%) in comparison with a decrease (-15%) in the Flite Tabs group (the difference in variation was statistically significant). Intention-to-treat analysis for thrombotic events shows 18 failures in controls (11 lost to follow-up + 7 throm botic events) of 92 subjects (19.6%) in comparison with 7 failures (of 94 subjects, equivalent to 7.4%) in the treatment group (p<0.05). Events were asymptomatic. In conclusion, Flite Tabs were effective in reducing thrombotic events and in controlling edema in high-risk subjects in long flights.
Protein S Deficiency Presenting as Deep Vein Thrombosis
Authors: Khandekar Ashwinikumar A. , Kumbhalkar Sunita D. , Salkar Harsha R. , Parakkadavathu Rakesh T. , Salkar Ramesh G.
Published: July 2008

A rare case of spontaneous bilateral internal jugular vein (IJV) thrombosis is presented in absence of oral infection, malignancy, or intervention. Swelling of face, neck, and both upper limbs developed in a 30-year-old man 1 month before admission and after 4 weeks of use of nonpadded crutches. Computed tomography of the neck showed thrombus occluding both internal jugular veins extending to the opening of the superior vena cava. Protein S activity was found to be 30.3%, less than half of the lower limit of normal. Fibrinogen was 450 mg%, higher than normal. Protein C and antithrombin III were normal. The patient was treated conserva tively, and discharged on aspirin 150 mg/day. Follow-up after 3 months showed no complica tions. It was concluded that the outcome in IJV thrombosis, caused by protein S deficiency, is usually good. The advantage of being aware of diagnosis is that physician can be more vigilant for potential complications and treat them earlier.
Pneumomediastinum and Cervical Emphysema Associated with Unusual Clinical and Electrocardiographic Manifestations
Authors: Kounis Nicholas G. , Zavras George M. , Papadaki Paraskevi J. , Kouni Sophia N. , Batsolaki Maria , Gouvelou-Deligianni Georgia V. , Koutsojannis Constantinos C.
Published: July 2008

This is the first case reported of combined cervical emphysema and pneumomediastinum asso ciated with unusual electrocardiographic and local neurologic findings. These may be the result of an increase in intracervical and intrathoracic pressure induced by the dissecting air.
Angioplasty of Bilateral Renal Artery Occlusion- A Case Report
Authors: Freiman David B. , Helinek Thomas G.
Published: July 2008

Percutaneous transluminal angioplasty of the renal arteries is a commonly performed procedure. The authors report a case of bilateral recanalization and dilation of occluded renal arteries in a young female. In this case, the procedure allowed for conservative management rather than emergency surgery, which would have been exceedingly hazardous to the patient's renal function and life.
Mitral Leaflet Billowing and Prolapse: Its Prevalence Around the World
Authors: Cheng Tsung O. , Barlow John B.
Published: July 2008

Primary mitral leaflet billowing, or so-called mitral valve prolapse, has become the most common valve anomaly in the United States and is also frequently found throughout the world. Its prevalence varies from less than 1% to 38%, differing not only between countries but also within the same country. The prevalence de pends on whether the study is clinical or echocardiographic, based on au topsy or surgical material, or of hos pital or non-care-seeking population. Other explanations for the varying prevalence are the age, sex and weight differences of the study popu lation, imprecise terminology, the care with which auscultation and/or echocardiography are carried out and interpreted, and some selection biases.

Although prevalent throughout the world, the condition is generally benign and can often be regarded as a normal variant. Among the compli cations of mitral valve prolapse, pro gressive mitral regurgitation and in fective endocarditis are particularly noteworthy. Primary mitral valve prolapse is currently a leading cause of mitral regurgitation and also of in fective endocarditis.
Effects of Glycosaminoglycans and Protamine Chloridrate on Platelet Aggregation Induced by Collagen and Thrombin
Authors: Luzzatto Guido , Paolini Rossella , Stevanato Francesco , Simioni Paolo , Cella Giuseppe
Published: July 2008

The effects of heparin (HE), dermatan sulfate (DS), heparan sulfate (HS) and protamine chloridrate (PC) on platelet aggregation were studied. Both PC and the three glycosaminoglycans (GAGs) did not influence collagen-induced platelet aggregation. In contrast, all the tested GAGs blocked thrombin-induced platelet aggregation. HE and HS were equivalent and very effective, while DS was also but to a lesser extent. This could be because HE and HS act via both antithrombin III and heparin-cofactor II, whereas DS exerts its action on the latter only. PC, too, inhibited, in a dose-dependent fashion, thrombin-induced platelet aggregation, probably by competing with the thrombin affinity binding sites on the platelet surface. When the GAGs were tested together with PC, HE was shown to be the most effective: on a weight-for-weight basis, an identical amount of PC was unable to counteract the inhibitory effect of HE, while it partially reversed those of DS and HS. A full reversal of the inhibitory effect of DS and HS was never observed, in spite of adding increasing amounts of PC. It seems likely that plasma components may preserve the bindings of such GAGs with their cofactors.
Abdominal Aortic Aneurysm with Inferior Vena Cava Obstruction: Case Report
Authors: Demircioglu Fatma Ferkan , Böke Erkmen , Demircin Metin , Dagsali Sabri , Küçükali Türkan
Published: July 2008

Behçet's syndrome, a multisystem disorder, is characterized by recurrent oral and genital aphthous ulcerations, eye lesions, and skin changes. Other manifestations, although rare, may affect the nervous, gastrointestinal, or loco- motor system, as well as veins and arteries. Vascular lesions occur in approxi mately 30% of reported cases. Although thrombosis in the larger veins is frequent, arterial thrombosis is somewhat less likely to occur. Only a few cases of arterial aneurysm have been documented in the literature.

This report describes a patient who had suffered from Behçet's syndrome for fifteen years and in whom a complete obstruction of the inferior vena cava was demonstrated. An aortailiac bypass was performed successfully, and the patient had had a good clinical recovery at long-term follow-up.
Comparison of the Efficacy and Safety of Quinapril vs. Captopril in Treatment of Moderate to Severe Hypertension
Authors: Schnaper Harold W
Published: July 2008

The results of this multicenter double-blind comparative study in 172 patients with moderate to severe hypertension indicate that twice daily quinapril (20-80 mg/day) is signifi cantly more effective than captopril (50-200 mg/day) at reducing blood pressure. Following a minimum of four weeks of treatment, the results in evaluable patients showed a signif icantly greater reduction of diastolic blood pressure (DBP) in the quinapril group than in the captopril group (18.6 vs 15.3 mm Hg, respectively, p < 0.05). An intent-to-treat analysis using blood pressure data from all patients having values within an eight-to-sixteen-hour postdose treat ment window showed quinapril to produce a significantly greater re duction in DBP than captopril (18.2 vs 14.8 mm Hg, respectively, p = < 0.05). Throughout the course of the six-week study, quinapril consist ently showed efficacy superior to cap topril despite a faster captopril dose titration.
Overall Tolerance and Safety of Quinapril in Clinical Trials
Authors: Frank G.J. , Knapp L.E. , McLain R.W. , Frank Graham J.
Published: July 2008

A comprehensive analysis of the reporting of adverse events, with drawals due to adverse events, and serious adverse events has been con ducted on 2,010 patients treated with quinapril hydrochloride. An analysis of all events (from both double-blind and open label studies combined) showed no increase in the incidence of events reported in congestive heart failure (CHF) patients compared to hypertensive patients.

When the data for all studies were combined, an age analysis showed no increase in the total reporting of ad verse events in the 379 elderly pa tients studied. The incidence of events was lower in those patients who did not take concomitant di uretic therapy.

A comparison of the double-blind phases showed quinapril to have a lower incidence of adverse events than captopril, enalapril, or chlor thalidone. An analysis of the onset of events, or withrawals, did not show an increase with time on quinapril therapy, and no dose-relationship. A review of serious adverse events did not reveal an unexpected occurrence or a high incidence of serious events considered to be related to quinapril therapy. The proportion of patients who experienced "first-dose" hypo tension, or symptomatic hypotension was similar to captopril or enalapril. Quinapril, a nonsulfhydryl ACE inhibitor, has been extensively stud ied and is equally well tolerated in the young and elderly for the treatment of hypertension and CHF.
Mapping the Cerebral Blood Vessels With High-Field MRI: Technical and Anatomic Review
Authors: Gomez Camilo R.
Published: July 2008

The technical background and quality of images obtained upon studying the cerebral circulation with high-field MRI are reviewed. Fifty studies were se lected as representative of normal cerebral blood vessels to illustrate the ana tomic information derived from the review. MRI appears to be a safe, easy, and reliable method of imaging the cerebral circulation noninvasively.
Hemodynamic Benefits of Atrial Ventricular Sequential Pacing in Complete Heart Block and Left Ventricular Failure: Case Study
Authors: Sacher Howard L. , Sacher Michael L.
Published: July 2008

The authors describe 2 cases of insertion of atrial ventricular (AV) sequential pacemakers and their hemodynamic benefits.
Phlegmasia Cerulea Dolens and Its Association with Hypercoagulable States: Case Reports
Authors: Cohen David J. , Briggs Richard , Head Harold D. , Acher Charles W.
Published: July 2008

Six patients who developed phlegmasia cerulea dolens are described. All pa tients had associated hypercoagulable states: heparin-induced thrombocytope nia (2 patients), congenital deficiency of protein C (1 patient), and antithrombin III deficiency (3 patients). Their clinical course and management are discussed. Previous reports have failed to show a definite correlation between phlegmasia cerulea dolens and hypercoagulable states because of an unavailability of appro priate diagnostic techniques. Phlegmasia cerulea dolens is a life- and limb- threatening complication. An appreciation of underlying hypercoagulable states is essential to proper management, prophylaxis, and treatment of this disorder.
Blackfoot Disease in Taiwan: A 30-Year Follow-up Study
Authors: Tseng Wen-Ping
Published: July 2008

Blackfoot disease is an endemic peripheral vascular disease found among the inhabitants of a limited area on the southwest coast of Tai wan, where artesian well water with a high concentration of arsenic has been used for more than eighty years. The natural history of blackfoot dis ease, based on a prospective study of 1,300 patients, is presented. The overall male/female ratio was 1.5:1. Although the clinical onset was usu ally insidious, it may be quite sudden and almost always begins with numb ness or coldness in one or more ex tremities, usually the feet. Ultimately, rest pain develops and progresses to gangrene.

In this series, 68% of the patients underwent spontaneous or operative amputation, and the reamputation rate was 23.3%. Lower extremity in volvement in blackfoot disease was observed in 97.7% of the cases. The average annual rate for major ampu tation was 3.81 per 100 patient-years. The factors influencing the progno sis, such as amputation in relation to age and disease onset, are analyzed.

The case fatality rate was 66.5% during thirty years; 44% of these were cardiovascular deaths. The an nual death rate was 4.84 per 100 pa tient-years. Other reported case fatality rates for vascular insuffi ciency are reviewed. A dose-response relationship between blackfoot dis ease and the duration of water intake was also noted. The survival rates af ter the onset of blackfoot disease were: five years, 76.0%; ten years, 59.5%; twenty years, 38.2%; thirty years, 28.6%. The 50% survival point was 13.5 years after onset of the dis ease.
Stress Testing in Patients One Year After Orthotopic Cardiac Transplantation
Authors: Hidalgo R. , Alegriá E. , Castelló R. , Aparicí M. , Peteiró J. , Sáenz de Burugaga J. , Martínez-Caro D.
Published: July 2008

To evaluate the circulatory re sponse of the denervated heart to ex ercise, the authors studied 15 patients with an orthotopic transplanted heart (TH). Mean age was 48±10 (range twenty-five to sixty-two) years. All patients underwent a symptom-lim ited bicycle stress testing following a continuous protocol increasing the work load by 30 watts every three minutes. Exercise test was performed 16±9 months after operation. Fifteen healthy subjects matched for age were used as the control group.

There were significant differences (p < 0.01) in heart rate, at rest, peak exercise, and at five minutes of the recovery period, in maximal oxygen consumption (VO2 max) and in dura tion of exercise between TH patients and controls.

Synchronization between recipi ent and donor sinoatrial nodes was observed in 10 of 15 patients. A case of silent myocardial ischemia was also observed in a patient with vascu litis and acute rejection.

In conclusion, the lack of neural control in TH patients allows them to maintain a normal resting cardiac output but precludes attaining a nor mal maximum oxygen uptake, de spite a normal contractile state. The high resting heart rate due to para sympathetic denervation constitutes an important limiting factor for an adequate chronotropic reserve. Functional capacity of transplanted patients is slightly impaired, but it does not preclude a good quality of life.
Progress of Coronary Artery Disease: Compliance to Therapy
Authors: Pistevos A. , Georgiou J. , Darsinos I.
Published: July 2008

From a sample of 1,824 patients with coronary artery disease (CAD) at the time of their interview, 827 males (M) and 251 females (F), had at least one distinct recurrence of their disease—some type of angina (A) or myocardial infarction (MI). In these patients, the age and type of CAD at the first and second manifes tations (MSs) were noted, together with the patient's compliance to pre scribed therapy. The first MF of CAD in Ms was A in 61% at the age of 59.4±10.15 years and MI in 39% at a significantly younger age (54.4±10.54 years, p < 0.001). In Ms with A, the second MF was again A in 39% at the age of 61.4±10.14 years and MI in 61% at 62.1±10.2 years. In Ms with MI, the second MF was A in 85% at 56.5±10.52 years and MI in 15% at 59.2±12.0 years. No statis tical difference was found between patients with good or poor compli ance to therapy in connection with the time of the second MF as A or MI. A significantly lower percentage of MI after A, as the first MF, was found in patients with good compli ance (55%) than in patients with poor compliance (69%, p < 0.01). In Fs the first MF was A in 88% at 61.6±9.82 years and MI in 12% at 58.1±9.1 years (p < 0.05). The second MF for all F patients was MI in 48% at 65.4±10.02 years, compared with A in 52% at the age of 64.5±9.78 years. Conclusions: In Ms a rather quick (≅2.5 years) progression of CAD is expected after its initial MF mainly as A (≅ 61 %), and in these, MI as the second MF is more common in pa tients with poor compliance to ther apy. In Fs there is a delayed first MF mainly as A (≅90%) and a delayed second MF as A and MI in equal pro portion.
Microvascular Evaluation of the Effects of Nifedipine in Vascular Patients by Laser-Doppler Flowmetry
Authors: Belcaro Giovanni , Nicholaides Andrew N.
Published: July 2008

Skin blood flow in the microcirculation of the distal foot was evaluated in patients with vascular disease and diabetes and compared with that in normal volunteers by use of laser-Doppler flowmetry.

Resting flow (RF) and the flow on standing (SF) were measured in a room at constant temperature (20-22°C). RF was significantly different in the five groups, being increased in patients with diabetes (in comparison with normal volunteers) and decreased in patients with intermittent claudication, rest pain, and ischemic limbs. The venoarteriolar reflex (in response to standing) was also decreased or abolished in diabetic and in all vascular patients.

After treatment of all vascular patients with nifedipine (10 mg tid) for one week, there was a significant increase in RF in all patients. The venoarteriolar reflex was improved but still remained below the normal limit.

In conclusion laser-Doppler flowmetry is useful both for differentiating classes of different vascular patients and for evaluating the microcirculatory changes induced by nifedepine.
Increased Arterial Pulse Wave Reflections and Pulsatile Energy Loss in Acute Hypertension
Authors: Li John K.-J.
Published: July 2008

Increased afterload is normally associated with hypertension.

The work of the heart increases to overcome this load, but whether this is beneficial for pulse transmission has not been examined.

Experimental measurements were obtained in induced acute hypertension in dogs.

Results show that increased pulse wave reflections compound the increase in arterial blood pressure, and the increased work output by the left ventricle is compromised by the reduced efficiency of pulsatile energy transmission to organ vascular beds.
Free Calcium in Rat Papillary Muscle at Contraction Assessed with Ca-Selective Microelectrodes
Authors: Gasser R. , Frey M. , Fleckenstein-Grün G.
Published: July 2008

Direct measurements of free intracellular calcium (Ca)i are needed for an understanding of the regulation of contractility. An on-line measurement of (Ca)i with Ca-selective microelectrodes in intact muscle strips provides a suitable means of investigating this problem, although considerable methodologic difficulties exist. Measurements of (Ca)i concentrations during muscle contraction have been carried out by different methods such as Ca-binding techniques and aequorin luminescence, but remain unsatisfying, since they were not performed on intact muscle strips. The authors' measurements were carried out with Ca-selective microelectrodes on rat papillary muscles (stretched to optimal length in a perfusion bath of 1.54 mL at 30°C). The impalement of electrodes was considered adequate when the heights of Ca-electrode potential and membrane potential remained constant for more than twenty minutes. For provoking contractile responses, the authors replaced the normal Tyrode solution by a caffeine-containing contracture solution (content in mM: 0 NaCl [choline], 4 CaCl2, 30 KCI, 25 caffeine, 1.05 MgCl2). Ca-se-

lective microelectrodes were calibrated before and after each measurement and only those impalements were taken as adequate that showed identical calibration curves before and after the experiment.

They measured the (Ca)i at 20%, 50%, and 80% of maximal contractile force and obtained (Ca)i concentrations of 1.1 ± 0.3 μM (at 20%), 3.6 ± 1.2 μM (at 50%), and 11.8 ± 0.27 μM (at 80%) (n=6, ±SEM).

These results represent the first on-line measurements of the myocardial (Ca)i concentrations with Ca++selective microelectrodes in intact muscle strips during various degrees of contraction. It can be seen that contractile response does not occur below a (Ca)i concentration of 1 μM. Maximal contractile response is reached at (Ca)i concentrations beyond 10 μM.
Efficacy and Safety of Pentoxifylline in Geriatric Patients with Intermittent Claudication
Authors: Crowder John E. , Cohn Jay B. , Savitsky J. Philip , Morgan DeAnn L. , Slywka M.S. Joseph , Cobert Barton L. , Hryniewicki Stephen W. , Piccirillo Ronald T. , Wilcox Charles S.
Published: July 2008

The effects of pentoxifylline on intermittent claudication were evaluated at a dose of 1200 mg/day in an open-label twelve-week study on geriatric patients with chronic occlusive arterial disease (COAD). Standardized treadmill testing and clinical signs and symptoms of COAD were followed up before and during drug administration. Twenty-four subjects with a mean age of 73.5 years, capa ble of walking between 20 and 200 meters on the treadmill, were entered into the trial; 22 participated for eight weeks and 19 completed the study in terms of treadmill walking distance measurements at 12 weeks. The mean walking dis tance for all patients was increased 111% over baseline at week 12. Thirteen subjects were considered drug responders ( ≥ 50% increase in treadmill walking distance) and 9 were considered nonresponders (<50% increase). Improve ments in clinical signs and symptoms of COAD were noted. Decreases in ele vated systemic systolic pressures (but not diastolic) were unexpectedly observed in many drug responders. Seven of 19 males reported sexual function improve ments while receiving pentoxifylline. Fourteen (58%) of the 24 subjects reported mild side effects of dyspepsia, nausea, vomiting, dizziness, headache, or insom nia; no subjects were withdrawn from the study because of side effects. In sum mary, pentoxifylline improved function and symptoms in 13 of 22 geriatric patients with intermittent claudication; the drug was safe and well tolerated at the usual dosage in this geriatric patient population.
Urinary Excretion of Connective Tissue Protein Markers in Arterial Disease
Authors: McIntosh C. Joy , Davis Paul F. , Ryan Patricia A. , Stehbens William E.
Published: July 2008

In diseases of major arteries there is an increased turnover of connective tissue components. This implies a greater excretion of fragments of collagen and elastin. The changes for each of these may be useful in further delineating the nature of the disease. In a preliminary study, the urine of 10 Marfan's syndrome patients was analyzed. The hydroxyproline (collagen) concentration was up to eight times higher than that of control subjects. The desmosine (elastin) crosslink concentration was either normal or slightly reduced in these patients. The mean of the ratio of hydroxyproline to desmosine was nearly seven times higher in the patients.
Rate-Dependent ST Segment Depression—A Case Report
Authors: Akgün Güneş , Diker Erdem , Kaymakalan Sabahat , Kervancioglu Celal
Published: July 2008

A patient with resting heart rate over 100 beats per minute (bpm) displayed 1.5-2 mm ST segment depression in her ECG during daily activities. She had unprovoked further increase in her heart rate up to 145 bpm, and during these episodes, her ECG displayed further ST segment depression up to 3 mm and of 0.12 second duration.

An organic cause could not be found to explain her sinus tachycardia. Results of all laboratory investigations, including coronary angiography, were normal.

It was observed that during an episode of reflex vagotonia, when her heart rate was below 95 bpm, her previously depressed ST segments became isoelec tric. With the thought that this patient's ST segment depression was rate depen dent, carotid sinus massage was performed, and when the heart rate slowed to 95 bpm her depressed ST segments became isoelectric. The same response was accomplished with beta blockers.

Sympathetic hyperactivity was thought to be the most likely mechanism of ST segment depression in this patient. A critical increase in heart rate caused these ECG abnormalities.
Clinical Efficacy of Picotamide in Long-Term Treatment of Intermittent Claudication
Authors: Coto Vincenzo , Cocozza Manlio , Oliviero Ugo , Lucariello Antonio , Picano Tommaso , Coto Francesco , Cacciatore Luigi
Published: July 2008

The clinical efficacy of picotamide was investigated in a randomized, double- blind, placebo-controlled study in patients with peripheral occlusive arterial disease of the lower limbs at functional stage II of the Fontaine classification. Forty patients with a history of claudication for at least six months were admit ted to the study and were given either 3 x 300 mg tablets of picotamide (20 subjects) or three identical placebo tablets (20 subjects) for six months. The two groups of patients were similar in regard to clinical features and potential risk factors.

At the end of treatment painfree walking distance and systolic ankle-arm pressure ratio improved more in the picotamide than in the placebo group (p=0.05). Systolic ankle pressure curves, determined before and after the six- month treatment, showed a positive trend to a higher postexercise ankle pres sure and a faster return to the preexercise levels in the picotamide group; however, the difference was not statistically significant. Laboratory monitoring revealed a slight prolongation of bleeding time, a significant decrease in arachi donic acid-induced platelet aggregation, and an enhanced fibrinolysis with ab sence of interference with hemostasis in the picotamide group. One patient in the placebo group developed a major cardiovascular event (angina pectoris) during the study.

These results indicate that picotamide is an effective drug that may modify the natural course of intermittent claudication and associated vascular prob lems.
Lumbar Chemical Sympathectomy in End Stage of Arterial Disease: Early and Late Results
Authors: Vulpio C. , Borzone A. , Iannace C. , Agnes S. , Mascaro A. , De Santis M. , Mingrone G. , Flore R. , Pola P. , Castagneto M. , Salgarello G.
Published: July 2008

Hemodynamic variables were used to evaluate the effectiveness of lumbar chemical sympathectomy in 20 patients with ischemic foot lesions. Early clinical improvement was obtained in 68% of the cases. The two-year cumulative limb salvage rate was 52%. Results indicate that lumbar chemical sympathectomy offers the same benefits as surgical sympathectomy and represents a useful al ternative in patients with advanced ischemic disease of the lower limb, decreas ing the rate and the level of amputations.
Survival in Patients With Heart Failure and Normal Basal Systolic Wall Motion
Authors: Kinney Evlin L. , Wright Robert J.
Published: July 2008

To assess the prognostic effect of preserved systolic function in patients with congestive heart failure (CHF), the authors analyzed survival curves in 91 nonselected adult patients with CHF. Patients were assigned to one of two groups on the basis of fractional shortening. The first group consisted of 44 patients with a normal fractional shortening (greater than 0.17), and the second group, of 47 patients with a fractional shortening of 0.17 or less. The two groups were similar in respect to all historical and physical findings. Median survival was eleven months for patients with a decreased fractional shortening and twenty-six months for patients with a normal fractional shortening. Patients with a decreased fractional shortening had a significantly shorter survival (p = 0.01). The authors conclude that congestive heart failure with preserved systolic function is common and is associated with a better prognosis, and the literature suggests it may require nonstandard therapy. Their data also suggest, however, that CHF patients with preserved systolic function cannot be reliably distin guished at the bedside. Rather, echocardiography or other tests of systolic wall motion are needed to make the diagnosis.
Routine 18F-2-Deoxy-2-Fluoro-D-Glucose (18F-FDG) Myocardial Tomography Using a Normal Large Field of View Gamma-Camera
Authors: Höflin F. , Ledermann H. , Noelpp U. , Weinreich R. , Rösler H.
Published: July 2008

There is a recent need to study glucose metabolism of the heart in is chemic, as well as in "hibernating or stunned" myocardium, and compare it with that in perfusion studies. In non-positron emission tomography centers, positron imaging is possible with a standard Anger-type camera if proper collimation and adequate shielding of the camera crystal can be achieved. For the study with fast-de caying isotopes, seven-pinhole tomo graphy (7PHT), a limited-angle method designed for transaxial tomo graphy of the left ventricle using a nonrotating camera, is well suited, because projections are acquired si multaneously. Individual adjustment (patient supine) of the camera's view axis (CAx) with the left ventricular axis (LVAx) gives excellent results: sensitivity for CHD 82%, specificity 72% in a prospective 201TI study (48 patients, x-ray coronarography as reference). Good alignment of CAx with LVAx is also achieved with the patient prone in LAO in a hammock above the camera surface. In this set ting additional lead shielding of the camera is possible using a table rein forced with 5 cm of lead with a cen tral hole for the 7PH-collimator, which has a special lead inlay. This allows utilization of the 511 KeV emitter 18F-FDG, which with a half- life of 109 minutes, can be trans ported a reasonable distance from the production site. System sensitiv ity and resolution for 18F was found comparable to 201Tl, 99mTc, and 123 I us ing a phantom. First clinical exami nations after 201Tl stress/redistribu tion studies showed increased 18F- FDG uptake in ischemic heart segments, as well as in "hibernating" nonperfused or "stunned" myocar dium.
Comparison of Treadmill Walking and Stair Climbing Over a Range of Exercise Intensities in Peripheral Vascular Occlusive Disease
Authors: Gardner Andrew W. , Skinner James S. , Vaughan Natalie R. , Bryant Cedric X. , Smith L. Kent
Published: July 2008

Although claudication pain and hemodynamic responses to exercise are related to the degree of arterial narrowing in the lower extremities, the nature of these responses to different exercise tasks and intensities is less clear. Thus, the purpose of this study was to compare claudication and hemodynamic responses to graded walking, level walking, and stair climbing over a range of exercise intensities. Ten patients with peripheral vascular occlusive disease performed five tests within each of the three exercise tasks. Similar values of oxygen consumption were obtained among exercise tasks at each intensity (p = ns). Time to onset of claudication pain and to maximal pain were similar among exercise tasks (p = ns), and both demonstrated a curvilinear decrease as intensity increased (p < 0.05). Foot transcutaneous oxygen tension, ankle systolic blood pressure, and ankle/brachial systolic pressure index were also similar among the three exercise tasks (p = ns); however, each decreased linearly as exercise intensity increased (p < 0.05). Thus, in peripheral vascular occlusive disease, the imbalance between oxygen delivery to the exercising lower extremity musculature and the local metabolic demand is similar during different weight-bearing activities. Second, even though the peripheral circulation is progressively impaired with increased exercise intensity, anaerobic metabolism in the ischemic lower extremity musculature may prevent a continual decline in claudication times. The clinical implication is that a more thorough assessment of the functional limitations imposed by claudication pain is not obtained by using different types of weight-bearing exercise tests as opposed to using only one type.
Risk Factors for Varicose Disease Before and During Pregnancy
Authors: Dindelli Moreno , Parazzini Fabio , Basellini Aldo , Rabaiotti Emanuela , Corsi Giuseppe , Ferrari Augusto , Parazzini Fabio
Published: July 2008

Risk factors for varicose disease before and during pregnancy have been analyzed by use of data from a survey on venous disease in pregnancy conducted in 611 women (mean age thirty years, range fifteen to forty-seven) who consecutively delivered at the Obstetric-Gynecologic Clinic "L. Mangiagalli" of Milan between January and April, 1989. In total, 137 women (22%) reported varicose disease before the index pregnancy. The relative risk (RR) of varicose disease before the index pregnancy increased with age, being, as compared with women aged twenty-nine years or less, 1.6 in those aged thirty to thirty-four and 4.1 in those aged thirty-five years or more (χ21 trend 29.28, p < 0.001). Compared with nulliparae, women reporting a full-term pregnancy before the index pregnancy had an RR of venous disease of 1.2, and the risk increased to 3.8 in women reporting two or more births (χ21 trend 25.28, p < 0.001). A family history of varicose disease was associated with an RR of venous disease of 6.2 (95% confidence interval, CI, from 4.1 to 9.6). No relationship emerged between varicose disease and overweight. Of the 474 women who did not report venous disease before the index pregnancy, 132 (28%) developed venous disease during the index pregnancy. The risk of developing venous disease in pregnancy increased with age, being, as compared with women aged twenty-four years or less, 4.0 in those aged thirty-five years or more, and the trend in risk was statistically significant (χ2 1 trend 16.25, p < 0.001). To be secondiparae or more was associated with an increased risk of developing venous disease in pregnancy. Compared with primiparae, the estimated RR was 2.0 (95% CI 1.3 to 2.9) in women reported to have given birth to one child or more. Women who developed venous disease in pregnancy reported more frequently a family history of varicose disease than those who did not; the RR estimate was 5.8, (95% CI from 3.8 to 8.9).
Behçet's Disease in the Etiology of Budd-Chiari Disease
Authors: Saatci Isil , Ozmen Mustafa , Balkanci Ferhun , Akhan Okan , Senaati Sassan
Published: July 2008

Hepatic venous outflow obstruction (Budd-Chiari syndrome—BCS) was diagnosed in 30 patients during the period from March, 1987, to May, 1991, in Hacettepe University Hospital, Turkey. Patients with Behçet's disease constituted the major group (12/30) in the etiologic distribution. Although the vascular manifestations of Behçet's disease, including venous and arterial occlusions, varices, and aneurysms, are well known, the hepatic vein involvement has been reported in only 22 cases in the literature so far.

The authors present 30 cases of BCS, of whom patients with Behçet's disease comprise the largest group (40%). The angiographic findings are not specific to Behçet's disease. It is noted, however, that inferior vena cava involvement is more common in these patients (83.3%) than it is in the rest of the group (61.1%).

It is suggested that Behçet's disease should be included among the diagnostic possibilities in a case of BCS, particularly in the countries in which it is prevalent.
Indium 111-Labeled Platelets Accumulation Over Abdominal Aortic Graft with Chronic Disseminated Intravascular Coagulation-A Case History
Authors: Kanda Tsugiyasu , Kaneko Katsumi , Yamauchi Yasuhiko , Kanazawa Norio , Sasaki Toyoshi , Takeuchi Hideo
Published: July 2008

The authors describe a seventy-six-year-old man with aortic graft, which became the focus of chronic disseminated intravascular coagulation (DIC). The patient had abdominal aortic aneurysm (AAA) and the size had increased up to 38 mm in diameter. The AAA was excised and replaced by Dacron graft. Ten months later, the DIC became chronic with renal dysfunction. Indium 111-labeled platelets scintigraphy showed increased accumulation of radioactivity over the graft. In the treatment of chronic DIC, low-dose subcutaneous heparin injection (5,000-10,000/day) was effective, and he was discharged. In this case there was also suspicion of lung cancer and recurrent aortic aneurysm, which were a more reasonable cause of chronic DIC. This case suggests that an aortic graft prosthesis may be a cause of localized chronic DIC and that indium 111-labeled platelets scintigraphy is useful for the detection of localized chronic DIC. Moreover, subcutaneous heparin administration may be effective for chronic DIC in patients with an abdominal aortic graft prosthesis.
Accelerated Idioventricular Rhythm in Pregnancy: A Case Report
Authors: Navarro Victor , Nathan Paul E. , Rosero Hugo , Sacchi Terrence J.
Published: July 2008

A seventeen-year-old primigravida, without structural heart disease or ab normalities of serum chemistry, presented with complaints of palpitations dur ing the twenty-fourth week of gestation. Holter monitoring revealed long episodes of accelerated idioventricular rhythm. The authors are not aware of similar reports, but this entity may be more common than realized because of the relative infrequency of rhythm monitoring in this particular group.
A Variant of Noonan's Syndrome: A Case History
Authors: Schwartz J. , Rabinovitz H. , Leibovitz A. , Rozenfeld V. , Schindler D. , Madjar J.
Published: July 2008

The authors describe a variant of Noonan's syndrome hitherto undescribed. The special findings in this case were anomalous origin of the aortic arch vessels and focal glomerulonephritis.
Invasive Development of Right Atrial Myxoma— A Case Report
Authors: Nakayama Masaru , Matsumura Kiyoshi , Abe Isao , Kaku Ryuichiro , Kobayashi Kazuo , Fujishima Masatoshi , Aso Hidetoshi , Tokunaga Koichi , Ishii Yutaka
Published: July 2008

A thirty-nine-year-old man was admitted to the authors' department com plaining of exertional dyspnea and high fever. An echocardiogram showed a mass in the right atrium, which was observed to move to the right atrium during the systolic phase and to the right ventricle during the diastolic phase. Magnetic resonance imaging showed that the mass developed from the right atrium to the superior vena cava. Intravenous digital subtraction angiography also showed a partial defect of the right atrium as well as obstructions of both the superior vena cava and the bilateral innominate veins. A pulmonary hemodynamic scin tigram showed multiple defects at the mid and inferior areas of each lung, sug gesting multiple pulmonary infarctions. The right atrial tumor was surgically removed. The superior vena cava and the innominate veins were found to be obstructed by organized thrombi, and the tumor had invasively grown into the right atrial wall. Histologic findings demonstrated that most of the tumor was composed of organized thrombi with scattered myxomatous tissue and was di agnosed as cardiac myxoma. These histologic findings suggest that the histogen esis of this right atrial myxoma might be thrombogenic.
Patent Ductus Arteriosus Involving Three Generations— A Case History
Authors: Schwartz J. , Rabinovitz H. , Leibovitz A. , Rosenfeld V. , Schindler D. , Stelian J. , Baumohl Y. , Habot B.
Published: July 2008

The authors present a family with patent ductus arteriosus (PDA) involving three generations, in the absence of consanguinity.
Diffuse Arterial Aneurysms in a Case of Ehlers-Danlos Syndrome—A Case Report
Authors: Olguntürk F. Rana , Tunaoglu F. Sedef , Gümüs Halil , Beyazova Ufuk , Türkyilmaz Canan
Published: July 2008

A three-year-old boy with the diagnosis of Ehlers-Danlos syndrome (EDS) with persistent ductus arteriosus and multiple diffuse arterial aneurysms is pre sented. The case is classified as "EDS type unknown" because the clinical fea tures and the inheritance pattern differ from the types described previously. It is stressed that the diagnosis of the disease is important for genetic counseling and surgical intervention.
Left and Right Coronary Artery to Left Ventricular Fistula: Demonstration of Myocardial Ischemia by Treadmill Test and Holter Monitoring—A Case Report
Authors: Kwang Kon Koh  , Sang Kyoon Cho  , Sam Soo Kim
Published: July 2008

Fistulous communication from the coronary artery to the left ventricle is extremely rare. The authors report such a case in a sixty-year-old woman with chest pain. They demonstrated myocardial ischemia on treadmill test and Hol ter monitoring in this patient.
Hyperhidrosis—A Case History
Authors: Rosenblum Jay A. , Cohen Jeffrey M. , Lee Mathew
Published: July 2008

The authors present a case report on hyperhidrosis. The social and occupa tional consequences of this disease entity are discussed as well as the genetic implications of this disorder.

The medical and surgical treatments of hyperhidrosis are evaluated. The use of infrared imaging techniques as a cost-effective, rapid, noninvasive procedure to diagnose this disorder is described.
Changed Blood Rheology in Patients With Idiopathic Dilated Cardiomyopathy
Authors: Gustavsson Carl Gunnar , Persson Sylvi U. , Larsson Hans , Persson Stig
Published: July 2008

Rheologic properties of blood were studied in 8 patients with dilated car diomyopathy (DCM) and in 10 healthy subjects. Whole-blood viscosity was measured at four different shear rates, by means of a computer-controlled rota tional viscometer. The patients had significantly higher blood viscosity at all shear rates, both at their natural hematocrits and after an in vitro adjustment of sample hematocrits to 45%. Erythrocyte filterability (5 μm pore size) was significantly lower, fibrinogen concentration significantly higher, and HDL-cho lesterol concentration significantly lower in the patient group. No significant differences were found regarding hematocrit, mean corpuscular volume, hemo globin concentration, leukocyte count and filterability (8 μm pore size), plasma viscosity, and total cholesterol concentration.

The measured hemorheologic abnormalities may contribute to the previ ously reported reduction of coronary blood flow reserve in DCM patients and to myocardial microcirculatory disturbances, which have been suggested as a cause for DCM.
Hemodynamic, Hemorheologic, and Hemocoagulative Changes After Treatment With Picotamide in Patients Affected by Peripheral Arterial Disease (PAD) of the Lower Limbs
Authors: Neirotti Massimo , Molaschi Mario , Ponzetto Maria , Macchione Carmine , Poli Leone , Bonino Flavio , Fabris Fabrizio
Published: July 2008

Effects of picotamide on platelet activity and on some hemorheologic, coagu lative, and hemodynamic parameters were investigated in a randomized, dou ble-blind, placebo-controlled study for eighteen months. Twenty patients, average age 61.5±9.6 (SD) years, with peripheral arterial disease (PAD) at functional stage 2 of the Fontaine classification and with intermittent claudica tion for at least six months were studied.

Ten patients received tablets of picotamide, 300 mg three times a day, and 10 subjects received three identical placebo tablets each day. Similar atheroscler otic disease risk factors were present in both groups.

Picotamide induced a significant decrease of plasma viscosity, fibrinogen, and beta-thromboglobulin and an increase of amplitude of the photoplethysmo graphic wave.
Diagnostic Value of Captopril Test in Hypertensive Patients with Renal Artery Stenosis
Authors: Takata Masanobu , Yoshida Koshiro , Tomoda Fumihiro , Oh-hashi Shinya , Ueno Hitoshi , Yasumoto Kotaro , Iida Hiroyuki , Sasayama Shigetake
Published: July 2008

To examine the utility of the single-dose captopril test in detecting renovascular hyper tension (RVHT), the authors measured peripheral plasma renin activity (PRA), before and thirty and sixty minutes after an oral dose of captopril (25 mg), in 28 patients with RVHT and 22 patients with high-renin essential hypertension (EHT) without renal artery stenosis who were consuming 8 grams of sodium chloride per day There was consider able overlap of individual values in basal PRA between the two groups. Sixty minutes after captopril, PRA was higher in RVHT than in EHT patients (74.8 ±63.9 versus 15.1 ± 11.9 ng/mL/hr, P < 0.01). With the cutoff point set at 16 ng/mL/hr, RVHT was detected with a sensitivity of 96% and a specificity of 77%. The discriminating power was also superior to that based on blood pressure response to angiotensin II analogue under sodium depletion, rapid-sequence intravenous pyelography, or renography These results show that captopril-stimulated peripheral PRA is an adequate screening tool for detecting RVHT in a population with high-renin hypertension.
Bone and Leukocyte Scintigraphy of a Complicated Case of Ruptured Mycotic Aneurysm of the Aorta
Authors: Van der Wall Hans , Palmer Amanda , Thomas Martin , Chu John
Published: July 2008

While rare, mycotic aneurysms of the aorta have a high mortality rate from immediate rupture and late complications. The case of a patient with a ruptured mycotic aneurysm is presented, and the important role of scintigraphic studies in the early detection of complicating extensive soft-tissue infection and osteomyelitis is demonstrated.