bluuebunny/crossref_metadata_2025 huggingface dataset:
Abnormal Erythrocyte Rheology in Patients with Morbid Obesity
Authors: Levy Yishai , Elias Nizar , Cogan Uri , Yeshurun Daniel
Published: July 2008

The objectives of this study were to investigate the rheological properties of the erythrocyte in patients with morbid obesity and to follow them up after a short-term weight loss. A fluorescent polarization method was used to assess erythrocyte membrane biorheology and to measure its fluidity. Eighteen sub jects participated in the study: 8 healthy controls and 10 patients with morbid obesity.

The erythrocyte membrane fluidity was obtained in the healthy subjects and in the patients with morbid obesity prior to and after a ten-day zero-calorie diet. Fluidity was determined by steady-state fluorescence polarization after incorpo ration of the lipophilic probe 1,6-diphenyl-1,3,5 hexatriene (DPH). With this method, the anisotropy parameter at 37 ° C, which is inversely related to mem brane fluidity, was obtained.

The patients with morbid obesity revealed an abnormal erythrocyte rheol ogy. They exhibited an abnormally low erythrocyte membrane fluidity as com pared with normal subjects. The anisotropy parameter at 37°C was 1.417 ± 0.093 in these obese patients compared with 1.279 ± 0.043 in normal- weight controls (p < 0.01).

Upon a short-term significant weight loss from a body mass index (BMI) (weight/height2) of 39 ± 5 to 36 ± 5 kg/m2 (p < 0.05), the anisotropy parameter did not change (1.401 ±0.190).

Thus, fluidity measurements permit recognition of an abnormal erythrocyte rheology in patients with morbid obesity. This abnormality may partially ex plain the excess cardiovascular and thromboembolic morbidity in morbid obe sity.
Increased Plasma Endothelin Levels in Kawasaki Disease: A Possible Marker for Kawasaki Disease
Authors: Morise Toshio , Takeuchi Yoshihiro , Takeda Ryoyu , Karayalcin Umit , Yachie Akihiro , Miyawaki Toshio
Published: July 2008

Plasma immunoreactive endothelin (iET) levels were investigated in patients with Kawasaki disease (KD). The iET level was 2.49 ± 0.13 pg/mL in KD pa tients and 1.32±0.06 in age-matched control subjects, showing a significant increase with KD. The iET level was not increased in patients with febrile in flammatory diseases of bacterial origin without KD (non-KD group). Parame ters indicating an inflammatory reaction, such as C-reactive protein, platelet count, white blood cell count, and interleukin-6 level, were increased in the KD patients. However, they were similarly increased in the patients with febrile diseases of bacterial origin and showed no significant differences between the two groups. This study is the first to report that plasma iET levels are elevated in a disease mainly involving vasculitis. These results suggest that blood iET levels are increased in KD patients as a result of the associated vascular endo thelial damage and that iET can be a useful marker for the diagnosis of KD.
Fatal Bile Pulmonary Embolism following Percutaneous Transhepatic Cholangiodrainage: Case Report and Literature Review
Authors: Kihira Takayuki , Konishi Tokuji , Shiraishi Taizo , Yatani Ryuichi , Nakano Takeshi
Published: July 2008

Bile pulmonary emboli were present at autopsy in a seventy-year-old woman who had undergone percutaneous transhepatic cholangiodrainage for pancre atic carcinoma obstructing the common bile duct. The patient also developed hemobilia following the drainage. In spite of emergency surgery, she died on the third day after the operation. Microscopic findings of the lungs at autopsy dis closed numerous bile emboli in the smaller arteries, arterioles, and capillaries. Review of the literature showed 13 cases of bile pulmonary embolism, 10 of which had an obvious history of marked jaundice and trauma to the liver, like the present case. Bile enters the systemic circulation through a fistulous com munication made by trauma between the biliary tree and the hepatic vein.
Hyperparathyroidism Associated with Raynaud's Phenomenon—A Case History
Authors: Schwartz J. , Rosenfeld V. , Stelian J. , Wohl Y. , Schindler D. , Leibovitz A. , Rabinovitz H. , Zats Z.
Published: July 2008

The authors describe a patient with hyperparathyroidism and Raynaud's phenomenon. This association was hitherto undescribed.
Association of Congenital Afibrinogenemia and K-Dependent Protein C Deficiency—A Case Report
Authors: De Mattia Domenico , Regina Guido , Giordano Paola , Del Vecchio Giovanni Carlo , Altomare Maria , Schettini Francesco
Published: July 2008

The authors describe a rare case of congenital afibrinogenemia with concom itant K-dependent protein C deficit that was brought to our observation for ischemic lesions of the foot in association with fibrinogen concentrate infusions.

These lesions can be attributed to the association of various factors: fibrino gen infusion without heparin coverage, microtrauma, and protein C (PC) defi cit. In fact, thromboembolic complications during afibrinogenemia were previously reported usually in association with substitutive therapy, and it is also known that PC deficit predisposes to thrombotic complications.

To the authors' knowledge, the case described by them is the first in which PC deficit is associated with afibrinogenemia. This association cannot be ex plained by a common genetic mechanism because the genes for fibrinogen and for protein C are located on different chromosomes (chromosomes 4 and 2 re spectively) .
Vertebrobasilar Insufficiency: Correlation of Clinical and Radiologic Findings
Authors: Fujiwara Takuya , Tanohata Kazunori , Hagiwara Yoshihito , Inoue Kiyoharu , Fujino Hideyo
Published: July 2008

Radiological and clinical findings of 20 cases with angiographically proven stenosis or occlusion of the vertebrobasilar system and with clinical signs and symptoms attributable to posterior circulation disorder were studied. A simpli fied classification of vertebrobasilar arterial disease was presented; type I refers to stenosis of the vertebrobasilar system or subclavian artery, type II refers to vertebrobasilar occlusion, and type III refers to vertebrobasilar branch disease. Type I lesions were further subdivided into types Ia and Ib; type Ia cases showed no infarction in the posterior territory, whereas type Ib cases showed one or more infarctions on computed tomography or magnetic resonance imag ing. This angiographic classification is based on treatment options that can be adopted to specific types of lesion. In type I cases, lesions are usually amenable to surgical or angiographic intervention. In type II cases, short-term anticoagu lation is the treatment of choice. In type III cases, treatment is primarily aimed at prevention of complication and further stroke.
Endomyocardial Disease and Eosinophilia
Authors: Felice Philip V. , Sawicki Janusz , Anto Joseph
Published: July 2008

The authors discuss the hypereosinophilic syndrome: incidence, terminol ogy, cytotoxicity, clinical presentation and diagnosis, prognosis, and treatment, and they provide a literature review.
Changes of Soft-Tissue Water Examined With Magnetic Resonance and Electrical Impedance Tomography: An in Vivo Experiment
Authors: Sievers K.W. , Gauger J. , Bauermann T. , Löhr E.
Published: July 2008

The purpose of this study was the examination of short-term changes in soft- tissue water under in vivo conditions. In 12 healthy volunteers the water distri bution of a selected slice of the lower limb was examined after change of position and rapid infusion of 0.9% saline solution. Two methods were used for data acquisition: magnetic resonance imaging (MRI) (Repetition Time (TR) = 1600 msec, Inverstion Time (TI) = 300 msec, Echo Time (TE) = 22 msec) and electrical impedance tomography (EIT). In orthostatic equilibrium all 12 volunteers dem onstrated changes of MR signal intensity and resistivity in the range of 12% and 7%, respectively. After infusion, mean changes of signal intensity and resistivity were 7% and 4%, respectively. The overall correlation of MRI and EIT was —0.96 (p < 0.001). Results indicate that inversion recovery sequences are a sen sitive method of detecting in vivo changes of water distribution in selected areas of the body.
Clinically Isolated Left Coronary Ostial Stenosis: A Manifestation of Cardiovascular Syphilis — Case History
Authors: Shah Dipen C. , Subramanyan K.
Published: July 2008

The authors report a case of clinically isolated left coronary ostial stenosis in a thirty-seven-year-old man as a manifestation of cardiovascular syphilis. Nota bly he was free of the usual risk factors for coronary artery disease, and the rest of the coronary tree was angiographically normal.
Recurrence of a Left Ventricular Thrombus After Surgical Excision in a Young Patient With Normal Left Ventricular Systolic Function—A Case Report
Authors: Bose Reddy S. Chandra , Ziady Galal M. , Zerbe Tony , Matesic Connie , Griffith Bartley
Published: July 2008

The case report of a young patient with recurrence of intraventricular thrombus represents an unusual presentation with no apparent clinical explana tion despite echocardiographic, surgical, and pathologic confirmation. The other unusual feature of this case is the absence of predisposing factors for intraventricular thrombus. The patient developed the second left ventricular thrombus after he stopped taking anticoagulants. The authors' recommenda tion for such a patient is that he continue to receive anticoagulants for life.
Total Occlusion of Left Main Coronary Artery in Orientals: Profile of 4 Cases
Authors: Soo Chee-Siong , Ling Lieng-Hsi , Yeoh Joon-Kuan , Choo M. , Kannan P.
Published: July 2008

The authors report 4 Oriental cases of total occlusion of the left core nary artery (LMCA) with differing presentations. The first patient had a twelve-year history of stable angina pectoris. The second patient had angina for a year, which became unstable two months prior to diagnosis. The third patient had myocardial infarction seven years ago and presented with a one-month history of rest angina. The fourth patient had stable effort angina for six years but presented with accelerated angina three months prior to diagnosis.

The incidence of total occlusion of the LMCA is rare and survival depends on the existence of collateral circulation. In LMCA disease, is usually disease in other parts of the coronary arterial tree, and the for urgent coronary bypass surgery.
Effects of Glyceryl Trinitrate on Blood Pressure and Arterial Compliance
Authors: Sumimoto Takumi , Hamada Mareomi , Kawakami Hideo , Suzuki Makoto , Abe Mitsunori , Matsuoka Hiroshi , Shigematsu Yuji , Hiwada Kunio
Published: July 2008

Glyceryl trinitrate (GTN) mainly reduces systolic blood pressure (SBP) rather than diastolic blood pressure (DBP) in acute conditions. To examine the efficacy of GTN as an antihypertensive agent in patients with isolated systolic hypertension (ISH), the authors examined the effects of GTN on BP and arterial compliance (AC) in patients who underwent cardiac catheterization. Seventy patients (with old myocardial infarction, 36; angina pectoris, 25; chest pain syndrome, 9) who underwent cardiac catheterization because of chest pain were included in this study. They were aged between thirty-seven and seventy-four (mean sixty-one) years. According to the levels of BP at cardiac catheterization, the authors selected two subgroups: the normotensive group (NT group, n = 18) and the isolated systolic hypertensive group (ISH group, n = 20) from all sub jects. The authors measured BP before and after (three minutes) sublingual administration of GTN (0.3 mg) at the cardiac catheterization. AC was assessed by means of diastolic pressure decay. The change of BP was estimated by the differences between values before and at three minutes after GTN. After ad ministration of GTN, SBP was decreased significantly from 157 ± 25 to 142 ± 23 mmHg (P < 0.01), while DBP did not change (83 ± 13 vs 84 ± 15 mmHg). The change in SBP was positively correlated with the pretreatment SBP and nega tively correlated with AC (r = 0.51, P < 0.001; r = 0.39, P < 0.001, respectively). AC was significantly lower in the ISH group than in the NT group (P < 0.01). The change in SBP after GTN was greater in the ISH group than in the NT group (P < 0.01). The change in DBP was not correlated with the pretreatment DBP and AC. These results suggest that GTN is effective in patients with a high SBP and a low AC, indicating that GTN provides a desirable antihypertensive agent for ISH in the elderly.
The Left Ventricular End-Systolic Pressure and Pressure-Volume Index. Comparison Between Invasive and Auscultatory Arm Pressure Measurements
Authors: Hædersdal C. , Madsen J. Kyst , Saunamäki K.
Published: July 2008

The slope of the left ventricular (LV) end-systolic pressure-volume relation (ESPVR) has been established as a valuable clinical method to assess LV con tractile function independent of LV loading factors. The purpose of the present study was to evaluate whether the ESPVR could be reliably determined from auscultatory blood pressure (BP) measurements and from LV volume measure ment by contrast ventriculography (CVG).

Twenty-four patients with suspected or known ischemic heart disease were studied by cardiac catheterization with simultaneous, blinded, intravascular and auscultatory pressure measurements. LV volume was determined by CVG. The auscultatory mean arterial blood pressure (MAP) derived from: was found to be a useful measure of the LV end-systolic pressure in this connec tion. The correlation between invasively measured LV end-systolic pressure (ESP) and MAP was highly significant (r=0.82; SEE = 6.9 mmHg; p = 0.001). The correlation between invasively and semi-invasively measured ESPVR fell close to the line of identity ( r = 0.99; SEE = 0.23 mmHg mL-1; p < 0.001).

The replacement of ESP by MAP induced only a minimal error in the assess ment of the ESPVR. A complete noninvasive determination of the ESPVR and LV contractility therefore seems possible by using the MAP and by measuring the end-systolic volume by radionuclide ventriculography or by echocardiog raphy.
Intravascular Ultrasound Evaluation for Assessment and Therapeutic Decisions in Aortic Diseases
Authors: Feltrin Gian Pietro , Chiesura-Corona Matteo , Miotto Diego , Savastano Sergio , Castellan Lucio , Torraco Antonio
Published: July 2008

Intravascular sonography (IVS) was employed in several aortic pathologies. Acute dissecting aneurysm, chronic or recurrent dissection in previously re paired aneurysm, iatrogenic (postcatheterism) dissection, noncommunicating dissection (mural hematoma), chronic and acute partial thrombosis, and mural fibrosis following aspecific aortitis were studied. The stationary and dynamic observations combined with angiographic findings provided useful information for characterization of the lesions and for therapeutic decisions. In all 14 pa tients studied, supplemental data achieved from IVS suggest that a combination of angiography and IVS is the most nearly complete examination for concomi tant and fast diagnostic workup.
Platelet-Activating-Factor-Induced Changes in Cardiovascular Function and Oxyradical Status of Myocardium in Presence of the PAF Antagonist CV-6209
Authors: Gupta Jang B. , Prasad Marion , Kalra Jawahar , Prasad Kailash
Published: July 2008

The effects of platelet-activating factor (PAF) on cardiac function and con tractility and its mechanism of action are not fully understood. The authors investigated the effects of PAF in the absence or presence of a potent PAF antag onist CV-6209 on the cardiac function and contractility; lipid peroxidation prod uct malondialdehyde (MDA), an indirect measure of oxygen free radicals; serum creatine kinase (CK); blood lactate; and pH in anesthetized dogs. CV- 6209 (1 mg/kg, IV) did not produce significant changes in the various parame ters studied. PAF (1 μg/kg, IV) produced decreases in the cardiac function (cardiac index, left ventricular work index) and indices of cardiac contractility [(+) and (-) dp/dt, dp/dt at CPIP, (dp/dt)/IP, dp/dt at CPIP/IP, Vmax] and in creases in the systemic and pulmonary vascular resistance. It also produced increases in cardiac MDA, serum CK, blood lactate, and H+ and decreases in blood pH and HCO3- . CV-6209 completely prevented the PAF-induced changes in the hemodynamic and biochemical parameters.

These results suggest that PAF-induced cardiac depression may be due to PAF-induced release of oxyradicals from neutrophils and that PAF antagonist may be useful in counteracting the deleterious effects of PAF on the cardiovas cular system.
Nailfold Capillaroscopy in the Screening and Diagnosis of Raynaud's Phenomenon
Authors: Mannarino Elmo , Pasqualini Leonella , Fedeli Federico , Scricciolo Vito , Innocente Salvatore
Published: July 2008

Raynaud's phenomenon is in most cases idiopathic, but it may appear as secondary to other diseases. Since clinical evaluation is often inadequate to dis tinguish between these two forms, simple noninvasive methods are needed for an early diagnosis of the secondary form. The authors used nailfold capillaros copy to study 58 patients with Raynaud's phenomenon—44 apparently idio pathic and 14 secondary to connective tissue diseases. In all patients affected by secondary Raynaud's phenomenon nailfold capillaroscopy confirmed the pres ence of an abnormal pattern with typical systemic sclerosis alterations in 5 cases. Twenty-one (48%) of the other 44 patients presented a normal capillaro scopic pattern, 15 (34%) had alterations compatible with long-term idiopathic Raynaud's phenomenon, and 8 (18%) showed abnormal capillaroscopic pat terns, 2 of which were identified as the sclerodermic pattern.

Nailfold capillaroscopy distinguishes between primary and secondary Ray naud's phenomenon and may be used to identify patients presenting no evidence of underlying disease who could be at risk of developing connective tissue dis ease.
Prevalence, Clinical Features, and Acute Course of Atypical Myocardial Infarction
Authors: Lusiani Luigi , Perrone Antonio , Pesavento Raffaele , Conte Giacomo
Published: July 2008

Ninety-four consecutive patients (60 men and 34 women; mean age 68.5 ± 11.5 years) with acute myocardial infarction (MI) were investigated ret rospectively, in order to evaluate the prevalence, clinical features, and short- term course of the atypical forms (symptoms other than chest pain). An atypical MI was found in 30 patients, with a prevalence of 32% (95% confidence limits 27-36%). It was most prevalent in women above sixty-five years old (P < 0.05). Abdominal pain, paroxysmal dyspnea, and pulmonary edema were the most frequent symptoms (33%, 17%, 13%, respectively). No differences were ob served between typical and atypical MI in regard to risk factors (hypercholes terolemia, arterial hypertension, diabetes mellitus, cigarette smoking) and history of MI, cerebrovascular disease, peripheral vascular disease, or chronic lung disease. Significantly fewer patients with atypical MI had a history of an gina pectoris (P < 0.05). No differences were observed in regard to previous medication, except for antiarrhythmic drugs, more often used by atypical pa tients (P < 0.05). Location and severity of MI (as judged by ECG and peak levels of creatine kinase in the serum) were similar in both subgroups, as were the complications (34% typical and 50% atypical) and death rate (12.5% and 16.7%, respectively).

In conclusion, atypical MI is not less severe than typical. This emphasizes the need for a high suspicion index in many different clinical settings, but particu larly (although not exclusively) in elderly females, in the presence of abdominal pain or otherwise unexplained paroxysmal dyspnea.
Anomalous Left Coronary Artery Originating in the Right Aortic Sinus with Retroaortic Course: A Postmortem Study
Authors: Reig J. , Jornet A. , Petit M.
Published: July 2008

Post-mortem study of a heart specimen from a forty-two-year-old man showed an anomalous origin of the left main coronary artery from the right aortic sinus and its course posterior to the aorta. In this case the branches of the left main artery were smaller than usual, being partly supplied by the right coronary artery, which originated in a common point with a right preventricu lar artery. In the case reported myocardial ischemic signs were not noted.
Pain Relief and Clinical Improvement Temporally Related to the Use of Pentoxifylline in a Patient with Documented Cholesterol Emboli—A Case Report
Authors: Carr Marcus E. , Sanders Karen , Todd William M.
Published: July 2008

A sixty-six-year-old man with known severe atherosclerosis was admitted with painful feet and nonblanching purpuric lesions of his toes. He had under gone cardiac catheterization and coronary artery bypass five and three months, respectively, prior to admission. Initial treatment included: stopping the pa tient's lisinopril, increasing his nifedipine dose, and adding pentoxifylline 400 mg po tid. Within twenty-four hours pain was markedly decreased. Skin biopsy confirmed a diagnosis of cholesterol embolism. Pentoxifylline was stopped and intravenous heparin therapy was initiated. Within twenty-four hours, pain re turned. Nitrol paste applied to the top of each foot had no effect. After forty- eight hours, pentoxifylline was restarted. Once again, pain relief was noted within twenty-four hours, and after forty-eight hours both feet were visibly improved. Heparin and analgesics were discontinued. On the ninth hospital day, the patient was able to walk and was discharged to home. The innocuous nature of the intervention combined with the prompt nature of the therapeutic response support a short trial of pentoxifylline in patients with cholesterol em boli who are not responding to other therapy.
Headache, Thrombolytic Therapy, and Chronic Subdural Hemorrhage—A Case Report
Authors: Nathan Paul E. , Sonenblick Debbie , Chakote Vaijinath , Wolf Robert , Sacchi Terrence J.
Published: July 2008

Subdural hematomas are well known but infrequent complications of throm bolytic therapy. Although these are usually associated with head trauma, the authors describe a case of a patient who received a particularly aggressive thrombolytic regimen and presented six months later with complaints of noth ing more than a headache resistant to medical therapy, without associated neu rologic manifestations, which was finally diagnosed as a chronic subdural hematoma by computerized tomography. In the era of thrombolysis, physicians should maintain a heightened index of suspicion for subdural hematoma in pa tients complaining of headache.
Double-Chambered Right Ventricle and Down's Syndrome: A Proposed New Association
Authors: Eltohami Eltohami Ahmed , Hajar Hajar Ahmed , Folger Gordon M.
Published: July 2008

Twenty-two cases of double-chambered right ventricle studied in detail from two different centers comprise the study population. Of these, 5 have trisomy- 21 Down's syndrome; these five cases, comprising nearly 25% of the entire study group, were essentially evenly divided between the two centers. This un expectedly high percentage of Down's syndrome associated with such an unu sual cardiovascular malformation, albeit among a small population, is likened to the currently recognized and similar association of Down's syndrome and atrioventricular cushion deformities.
Evaluation of Pulmonary Arterial Pressure in Acute Pulmonary Embolism
Authors: Shimizu Hiroyuki , Tanaka Junko , Yamada Norikazu , Ohnishi Takahiro , Nakamura Mashio , Shibata Munehiro , Hiraoka Naoto , Tanaka Hideki , Fujioka Hirofumi , Konishi Tokuji , Nakano Takeshi
Published: July 2008

Twenty-six patients with acute pulmonary embolism underwent hemody namic examination. Twenty-three of the patients were free of prior cardiopul monary diseases. The other 3 patients had prior history of cardiac disease. In the 23 patients, the mean pulmonary arterial pressure (PAm) ranged from nor mal range to 35 mmHg at the time of the embolic event and generally declined within ten days after the embolic event. However, in the 3 patients with a history of disease, reelevation of PAm was observed during the pressure monitoring. PAm was positively correlated with the extent of pulmonary vascular obstruc tion (r=0.863, p < 0.01) and also with mean right atrial pressure (RAm, r=0.830, p < 0.01). In the presence of prior cardiac disease, PAm in patients with normal preembolic PAm increased proportionally to the extent of obstruc tion.

Continuous hemodynamic monitoring is valuable for estimating the degree of embolic obstruction and the speed of embolus resolution and for detecting new embolic episodes in some cases.
Prospective Studies of Cerebral Perfusion and Cognitive Testing Among Elderly Normal Volunteers and Patients with Ischemic Vascular Dementia and Alzheimer's Disease
Authors: Mortel Karl F. , Pavol Marykay A. , Wood Stacey , Meyer John S. , Terayama Yasuo , Rexer Jennie L. , Herod Brian
Published: July 2008

To compare longitudinal changes of cerebral perfusion (CBF) and cognitive status in two common forms of dementia in the elderly, 42 patients with ischemic vascular dementia (IVD), 44 patients with dementia of the Alzheimer type (DAT), and 120 elderly normal volunteers were evaluated prospectively over a mean interval of 3.35 years. Subjects were at least age sixty, (mean age 71.1). Mean bihemispheric cerebral blood flow and cognitive test scores of control subjects were significantly higher than those of both demented groups at entry and remained so. After adjustment for initial CBF, course over time was similar for all groups. Group variability was similar for CBF but not for cognition. Both IVD and DAT patients were more variable than controls but similar to each other. Throughout, DAT patients showed greater cognitive impairments than IVD patients. Cognitive impairments stabilized among IVD patients treated by control of risk factors, antiplatelet or anticoagulant therapy but declined progressively among DAT patients.
Respiratory Variation in Mitral Flow Velocity in Pericardial Effusion and Cardiac Tamponade
Authors: Simeonidou Eftihia , Hamouratidis Nikolaos , Tzimas Konstantinos , Tsounos John , Roussis Stefanos
Published: July 2008

It has been suggested that the presence of increased respiratory variation in mitral flow velocity (RVIMFV) in patients with pericardial effusion (PE) represents significant hemo dynamic compromise regardless of the amount of PE or 2D-echo findings. Recent exper imental data do not, however, support this aspect.

The aim of this study was to evaluate the relation of RVIMFV to clinical, hemody namic, and 2D-echo findings in patients with PE and cardiac tamponade (CT). Therefore, 11 patients with PE and CT were studied with right-heart, pericardial, and arterial pressure measurements in conjunction with 2D and Doppler echocardiography during three stages of gradually decreasing PE, ie, (1) before any PE drainage, (2) after partial PE drainage, and (3) after full drainage.

A significant RVIMFV was noted during all three stages of our study It was maximal at the early stage [respiratory difference in mitral flow velocity (ΔMFV): 16.8 ±6.3 cm/sec, 24.1%, P = 0.0000026] coinciding with pulsus paradoxus, high pericardial pressure, and diastolic right heart collapse, and it decreased slightly after partial drainage when all signs of CT receded (ΔMFV:13.7 ±9.7 cm/sec, 18%, P = 0.00043). However, there was still some RVIMFV (ΔMFV:8.7 ±7.6 cm/sec, 13.9%, P = 0.0017) after full peri cardial drainage.

It is concluded that the presence and the magnitude of RVIMFV is not predictive of hemodynamic compromise in patients with PE.
Erythropoietin Treatment Does Not Compromise Cardiovascular Function in Chronic Renal Failure
Authors: Hædersdal C. , Mehlsen J. , Stenver D. , Nielsen B. , Jeppesen L. , Winther K.
Published: July 2008

The anemia in patients with chronic renal failure can be corrected through treatment with recombinant human erythropoietin treatment. This correction is associated with changes in the rheologic variables, which could explain the changes in hemodynamics found by many investigators.

The authors have followed up 11 patients with chronic renal failure on hemodialysis before and during six months of therapy with erythropoietin. The measurements were made before treatment, after four months of therapy, and after six months of therapy The measurements included hematocrit, osmotic resistance of the red blood cells, red blood cell volume, plasma volume, heart rate, arterial blood pressure, and cardiac output measured by the indicator dilution method.

They found a significant increase in hematocrit hemoglobin, and red blood cell volume and a decrease in osmotic resistance while the hemodynamic variables were unchanged. They conclude that, in spite of changes in rheologic variables, increasing viscosity of the blood and thus possibly increasing the peripheral resistance, these had no effect on the cardiovascular state. Erythropoietin treatment improves the subjective well-being in patients on chronic hemodialysis without compromising their cardiovascular function.
Bronchopulmonary Sequestration with MR Angiographic Evaluation
Authors: Donovan Charles B. , Edelman Robert R. , Vrachliotis Thomas G. , Frank Howard A. , Kim Ducksoo
Published: July 2008

Definitive diagnosis of pulmonary sequestration requires angiographic visualization of the anomalous feeding and draining vessels. The authors report a young woman who presented with persistent cough of two months' duration. Diagnosis of pulmonary seques tration was established with magnetic resonance (MR) angiography, which demonstrated abnormal feeding arteries to the sequestrum from the thoracic aorta with draining pulmonary veins.
Salmonella Prosthetic Valve Endocarditis
Authors: Lee Yi-Heng , Lai Ling-Ping , Shyu Kou-Gi , Peiliang Kuan  , Lien Wen-Pin
Published: July 2008

A patient with Björk-Shiley mechanical mitral valve was noted to have Salmonella pros thetic valve endocarditis, which was confirmed by positive blood cultures and vegetation found by transesophageal echocardiography

Up to now, only 5 cases of Salmonella prosthetic valve endocarditis have been reported in the literature. Because of the malignant course of this rare infection, the authors suggest that early surgical intervention should be considered in Salmonella pros thetic valve endocarditis, especially when the patients have recurrent fever during medical treatment.
Rare Anomaly of the Aortic Arch Complex with Extreme Degenerative Changes
Authors: Akduman Ece Isin , Balkancl Ferhun , Ariyürek Orhan Macit
Published: July 2008

A forty-one-year-old woman with a rare anomaly of the aortic arch complex is described. The case closely resembles a combination of right cervical aortic arch and right aortic arch with aberrant left subclavian artery with additional tortuous right-sided aortic arch struc tures, absent left common carotid artery, and right common carotid artery originating from the left side of the aortic arch.
Three-Dimensional Volumetric Ultrasound Imaging of Arterial Pathology from Two-Dimensional Intravascular Ultrasound: An in Vitro Study
Authors: Chandrasekaran Krishnaswamy , Sehgal Chandra M. , Hsu Tsui-Lieh , Young Nancy A. , D'Adamo Arthur J. , Robb Richard A. , Pandian Natesa G.
Published: July 2008

The objectives of this study were to evaluate: (1) the feasibility of generating three- dimensional (3-D) ultrasound (US) volumetric images of arterial segments from intravascular (IV) US images by retaining full range of gray levels; (2) the feasibility of volumetric quantitation of various arterial wall pathology from the 3-D volume US images of arterial segments. IVUS provides morphologic details of arterial wall diseases. This is seen as variation in gray levels. However, when a 3-D US image is generated currently, the full range of gray levels is not utilized. This limits optimal assessment of arterial wall pathology

Sequential cross-sectional IVUS images from 11 arterial segments consisting of various pathology were obtained in vitro by calibrated withdrawal of an IVUS catheter. These images were digitized by an 8 bit digitizer to retain full 256 gray levels of bright ness. 3-D volume generation was carried out using "ANALYZE" software. After the IVUS imaging, arterial segments were sectioned transversely in a 0.3-0.4 mm cross section and stained with hematoxylin, eosin and elastin. Geometrical measurements and gross morphological changes of the arterial segments were noted and correlated with the corre sponding section of the image from the three-dimensional volume. Arterial wall (continued on next page) (Abstract continued) pathology, its extent and its effect on lumen geometry were easily appreciated in multiple tomographic sections of a 3-D volume image. Similarly, arterial wall pathology was easily quantitated from 3-D volume. The above assessments were only feasible by retaining full range of gray levels in the 3-D volume image. This study indicates that (1) it is feasible to generate a 3-D US volume image by retaining full range of gray levels from IVUS images, (2) retaining full range of gray levels allows optimal assessment of arterial wall pathology and its extent in 3-D volume, and (3) IVUS allows quantitation of arterial wall pathology, and thereby one can assess the effect of intervention.
The Concentration of Magnesium in Erythrocytes in Female Patients with Primary Raynaud's Phenomenon; Fluctuation with the Time of Year
Authors: Leppert J. , Åberg H. , Levin K. , Ringqvist I. , Jonason T.
Published: July 2008

The magnesium (Mg) concentration was measured in erythrocytes of 30 women with pronounced primary Raynaud's phenomenon (PRP) and of 33 age-matched healthy control women. The measurements were made at three different times, six months apart. The mean Mg concentration in the PRP group and the control group differed signifi cantly at each measurement. The values for the two groups were, respectively 1.64 ±0.21 and 2.02 ±0.21 mmol/L (P<0.001) in February, 1988; 2.16 ±0.21 and 1.85 ±0.21 mmol/L (P<0.001) in August, 1988; and 2.01 ±0.21 and 2.37 ±0.20 mmol/L (P<0.001) in January, 1989. The erythrocyte Mg level varied significantly with the time of year in both groups. In the PRP group the mean value was significantly higher in August than in the two winter months, but in the control group it was significantly lower in August. The authors conclude that women with PRP have a significantly lower magnesium concentration in erythrocytes during winter than the healthy controls and that this concentration varied with the season of the year in both groups.
Platelet-Derived Growth Factor (PDGF) in Patients with Different Degrees of Chronic Arterial Obstructive Disease
Authors: Cimminiello Claudio , Arpaia Guido , Aloisio Manuela , Uberti Tiziano , Rossi Florica , Pozzi Francesca , Bonfardeci Giuseppe
Published: July 2008

Platelet activation and platelet-derived growth factor (PDGF) play a pivotal role in the pathogenesis of atherosclerosis. Evidence has been accumulating that in the evolution of chronic arterial obstructive disease (CAOD) platelets are also crucially important. The aim of the present study was, therefore, to assess plasma levels of PDGF in patients with different degrees of CAOD according to Fontaine.

Twenty patients (17 men, 3 women, mean age sixty-eight ± seven years) with inter mittent claudication (Fontaine stage II) entered the study and their PDGF levels were assessed by radioimmunoassay. Ten additional patients (7 men, 3 women, mean age seventy-three ± seven years) with more severe CAOD (leg pain at rest/skin ulcers) were also studied. Ten healthy subjects (6 men, 4 women, mean age fifty-four ±six years) comprised the control group. Patients in stage II were reinvestigated after sixty days of a "training" procedure.

Patients with both intermittent claudication and more severe disease had higher levels of PDGF than controls (controls 165.9 ±119.1 pg/mL; Fontaine stage II 403.5 ±218.4; Fontaine stage III/IV 578.1 ±637.2: ANOVA P = 0.04) with no difference between the two groups of patients. After the training period, PDGF levels were signifi cantly higher than at baseline (863.7 ±819.6 pg/mL vs 403.5 ±218.4) but without signif icant improvement of physical performance. (continued on next page)

The elevation of PDGF levels in blood from CAOD patients could be the result of marked platelet activation due to interaction with a widely damaged peripheral vascula ture. The same was not true for coronary heart disease, in which normal values of PDGF in venous blood were found. Nevertheless, as in acute coronary syndromes, PDGF increases when the clinical picture improves, perhaps in relation to its reduced consump tion in vessel walls.
Angina Pectoris Associated with ST Segment Elevation in the Absence of Epicardial Coronary Arterial Obstruction
Authors: Nagai Hideo , Nakamura Yukio , Takata Shigeo , Kobayashi Ken-ichi
Published: July 2008

Two cases are presented in which angina pectoris associated with ST segment elevation occurred during either an ergonovine provocation test or coronary angioplasty, despite the absence of epicardial coronary artery obstruction. In both cases, no epicardial coronary spasm, thromboembolic occlusion, coronary air embolus, vessel dissection, or side-branch occlusion was observed. These findings suggest that transmural myocardial ischemia without epicardial coronary artery obstruction can occur owing to abnormalities of the coronary microcirculation. Microvascular vasoconstriction leading to transmural myocardial ischemia may be induced by ergonovine or by the release of potent vasocon strictors from disrupted coronary lesions during angioplasty.
Right Precordial Coved ST-T Segment Elevation in a Healthy Subject Evaluated by Isoproterenol Infusion Test
Authors: Kataoka Hajime
Published: July 2008

A sixty-seven-year-old woman was admitted with a complaint of atypical chest pain and with right precordial coved ST-T elevation, mimicking acute anterior myocardial infarc tion. Results of echocardiographic examination and a coronary angiographic study were normal. The etiology of her electrocardiographic pattern was evaluated by isoproterenol infusion test and was revealed to be an early repolarization.
Flavonoids
Authors: Struckmann Jan R. , Nicolaides Andrew N.
Published: July 2008

Daflon 500 mg consists of 450 mg diosmin and 50 mg flavonoid expressed as hesperidin. The authors describe its effects on the microcirculation in chronic venous insufficiency: improvement of venous tone, inhibition of prostaglandin synthesis, protection against free radicals, activation of the complement system, and increased lymphatic drainage. The authors summarize studies of its therapeutic efficacy in reducing venous capaci tance, distensibility, and emptying time; reducing capillary permeability; and increasing capillary resistance.
Effects of Pentoxifylline on Choroidal Blood Flow in Nonproliferative Diabetic Retinopathy
Authors: Sebag Jerry , Tang Mai , Brown Sharon , Sadun Alfredo A. , Charles M. Arthur
Published: July 2008

Objective: Diminished blood flow plays an important role in the progression of diabetic retinopathy. Since increased blood viscosity is a contributing factor to hypoper fusion, it was of interest to determine whether therapy intended to decrease blood viscosity and induce vasodilation could increase blood flow in patients with diabetic retinopathy

Methodology: Ten patients, 4 with nonproliferative diabetic retinopathy and 6 age- matched, nondiabetic controls, were studied by a noninvasive system to index choroidal blood flow. Pentoxifylline was administered daily at an oral dose of 400 mg tid in the diabetic patients for nine months.

Results: The control group had pulse amplitude=2.87 ± 0.67 mm Hg with pulsatile choroidal blood flow=714 ± 196 μL/minute. Reproducibility studies in the control group (6 patients measured on three separate occasions) demonstrated an intraclass correlation coefficient of reliability, r=0.83. In the diabetic patients, pulsatile flow=276 ± 68 μL/minute, 61% lower than the age-matched nondiabetic subjects (P=0.003). After nine months of pentoxifylline therapy the diabetic patients had an increase in pulsatile choroidal blood flow to 469 ± 152 μL/minute (P < 0.002).

Conclusions: Pentoxifylline therapy brought blood flow levels in the diabetic patients closer to those of the nondiabetic age-matched control population so that following therapy there was no statistically significant difference between the two groups although the former were still lower. The potential efficacy of pentoxifylline in improving ocular blood flow in patients with diabetic retinopathy should be tested in a large controlled clinical trial.
Circulatory and Plasma Catecholamine Responses to Mental Stress in Young Subjects with two Different Types of Hypertension
Authors: Kawabe Hiroshi , Saito Ikuo , Hasegawa Chika , Nagano Shiro , Saruta Takao
Published: July 2008

To determine whether any differences exist between young male subjects with elevated diastolic and systolic blood pressure (BP) and those with only an elevated systolic BP, the responses of BP and plasma catecholamines to a mental arithmetic test were studied in 11 young men (mean age of nineteen years) with BP of ≥ 140/90 mm Hg at a routine health check-up (group I-hypertension [HT]), 26 age-matched men with only elevated systolic BP (≥ 140 mm Hg) (group II-HT), and 12 age-matched normotensive (NT) men (< 140/90 mm Hg). During an arithmetic test, group I-HT showed a significantly higher increment of systolic BP (+14.5-18.0%) than group II-HT (+9.3-10.2%) and NT controls (+6.4-8.2%). However, no significant difference in BP response was seen between group II-HT and NT controls. Plasma norepinephrine in group I-HT showed a significant increase after the test, (171 ±23 → 202 ±27 pg/mL), whereas group II-HT and NT controls showed no change. No significant difference occurred in epinephrine response among the three groups. These results suggest that the young male subjects with screening BP above 140/90 mm Hg are hyperreactive to a mental stress as compared with subjects with only elevated systolic BP or NT controls.
Thrombocythemic Erythromelalgia, Primary Erythermalgia, and Secondary Erythermalgia: Three Distinct Clinicopathologic Entities
Authors: Drenth Joost P. H. , van Genderen Perry J. J. , Michiels Jan J.
Published: July 2008

On the basis of clinical, laboratory, and histopathologic studies, the authors discern three distinct types of red, congested, and burning extremities that need to be distinguished for effective treatment according to their etiology: erythromelalgia in thrombocythemia, primary erythermalgia, and secondary erythermalgia. Each entry is discussed in turn.
Effect of Prostaglandin E1 Analogue Administration on Peripheral Skin Temperature at High Altitude
Authors: Saito Shigeru , Shimada Hitoshi
Published: July 2008

The effect of prostaglandin E1 analogue on peripheral skin temperature was examined at high altitude, where local cold injuries are common owing to severe environmental condi tions. The peripheral skin temperature at rest was significantly lower at higher altitudes. Oral administration of the prostaglandin E1 analogue limaprost reversed this temperature decrease, probably by enhancement of peripheral circulation. The temperature recovery rate after a cold water challenge was also improved after the administration of limaprost. This oral type of prostaglandin E 1 analogue is strongly recommended as an effective prophylactic and therapeutic vasodilator for local cold injuries at high altitudes.
Arterial Thrombophilia in Primary Thrombocythemia
Authors: van Genderen Perry J. J. , Michiels Jan J.
Published: July 2008

The clinical course of a case of primary thrombocythemia is described, complicated by a variety of recurrent and sequential thrombotic manifestations, involving the peripheral as well as the cerebrovascular and coronary microvasculature, demonstrating that throm bocythemia should be considered as an important risk factor for thrombosis, already at platelet count states in excess of 400 x 109/L.
Concurrent Balloon Dilation in a Patient with Mitral Stenosis and Coronary Artery Disease
Authors: Chow Wing-Hing , Yip Alex S. B. , Chow Tsun-Cheung
Published: July 2008

A patient with coexistent mitral stenosis and coronary artery disease is described in whom a concurrent balloon dilation was performed successfully.
Analytical Evaluation and Comparison of Dupont aca® Lactate Dehydrogenase-1 (LD1) Isoenzyme Assay Diagnostic Efficiency for Acute Myocardial Infarction Detection with Other LD1 Methods and aca@ CK-MB
Authors: Painter Pennell C. , Van Meter Stuart , Dabbs Randal L. , Clement Gerald E.
Published: July 2008

The purpose of this study was to examine the analtyical characteristics of a rapid new assay for lactate dehydrogenase 1 (LD1) isoenzyme on the Dupont aca® analyzer and the diagnostic efficiency of LD1 for detection of acute myocardial infarction (AMI) when used alone and with creatine kinase MB (CKMB). Total aca LD1 assay precision, with percent coefficients of variation (%CVs) of less than 3.2% from 56 U/L to 469 U/L LD1, across fifty assay days was excellent. Linearity was confirmed from 0 to 332 U/L and no detectable calibration drift was noted from 5 to 489 U/L over a ninety-day period. The aca LD1 results compared well with Roche Isomune-LD1, Abbott Spectrum A-Gent, Helena electrophoresis, and Beckman electrophoresis LD1 methods, giving r's from 0.987 to 0.994, slopes from 0.94 to 1.65, and y-intercepts from -2.95 to 6.94 U/L.

Examination of 450 ambulatory subjects, about equally distributed by sex, yielded a 43 ±14 U/L aca LD1 patient reference interval. Serum samples from 159 consecutive patients at the University of Tennessee Memorial Hospital and 96 patients at Allentown Hospital, submitted for AMI detection assistance, were assayed in a single-blind study for LD1 and ion-exchange CKMB by Dupont aca methods, which provide automated results in ten minutes whenever needed. The aca LD1 assay yielded a clinical sensitivity of 89% and specificity of 95% for AMI with a decision threshold of 120 U/L. The diagnostic effi ciency of the aca LD1 assay was 94% at 120 U/L, which equaled or exceeded that of the three comparative LD1 methods. The predictive value of positive (PV+) and negative (PV-) results on the first sample collected were 80% and 85% for aca LD1, 65% and 90% for aca ion-exchange CKMB, and 83% and 90% when both tests were combined. Significantly, the PV+ and PV- results when two or more samples were assayed was improved to 88% and 95% for aca LD1, relatively constant at 65% and 97% for aca ion- exchange CKMB, and dramatically improved to 95% and 100% when both CKMB and LD1 tests were combined. The results from these two medical centers show that the aca LD1 assay provides useful clinical information for AMI diagnosis when employed alone or in combination with aca CKMB. These results also suggest that LD1 should be included in biochemical evaluations for AMI to attain optimal predictive values of results.
The Effect of Poststenotic Vessel Wall Compliance upon the Pulsus Tardus Phenomenon
Authors: Bude Ronald O. , Rubin Jonathan M. , Platt Joel F. , Adler Ronald S.
Published: July 2008

Recent studies have investigated the detection of significant arterial stenoses through identification of the "pulsus tardus" phenomenon in Doppler waveforms obtained distal to the stenosis. The etiology of this phenomenon, however, has not yet been determined. Using an in vitro model based upon an electrical circuit analogy, the authors had as their objective to determine whether the compliance of the vessel wall immediately distal to a stenosis, in conjunction with the stenosis, is the cause of pulsus tardus. For a constant stenosis, it was found that the degree of pulsus tardus, as quantitated by the acceleration index, increased as the compliance of the poststenotic segment increased. It is concluded that pulsus tardus distal to an arterial stenosis is likely due to the compliance of the normally distensible artery, in conjunction with the stenosis. Pathological conditions that alter the compliance of the poststenotic segment may affect the degree of pulsus tardus, perhaps limiting its usefulness for upstream stenosis detection.