bluuebunny/crossref_metadata_2025 huggingface dataset:
Considerations in the Surgical Management of Ventricular Septal Defect and Aortic Insufficiency
Authors: Sanfelippo Peter M. , Hector David A.
Published: July 2008

A 23-year-old man presented with progressive exercise-related dyspnea and easy fatiga bility. He gave a history of a murmur of aortic insufficiency since childhood. Cardiac catheterization demonstrated severe aortic insufficiency. At surgery the patient was found to have prolapse of the right coronary cusp into a significant supracristal ventricular septal defect. Repair was carried out with a Dacron patch closure of the septal defect and replacement of the valve with a 29-mm St. Jude valve. The patient recovered uneventfully and is fully active and employed 5 years later. Review of the literature documents that this is an uncommon lesion. The approaches to preoperative diagnosis include transesophageal echo. The management techniques have included ventricular septal defect closure, alone and with valvuloplasty, and septal defect closure with aortic valve replacement. The anatomic and patient characteristics guide selection of the most suitable management of these patients.
Perspectives in the Treatment of Dyslipidemias in the Prevention of Coronary Heart Disease
Authors: Borgia Maria C. , Medici Francesco
Published: July 2008

In this review the indications for the available treatments for dyslipidemias in the preven tion of coronary heart disease (CHD) are considered, and their efficacy according to the latest studies is analyzed. As data sources the authors used the main multicenter studies performed in the last twenty years to evaluate primary and secondary prevention of CHD by correcting dyslipidemias as well as the results of meta-analyses of these studies. All treatments considered were found effective in preventing CHD morbidity and mortality to some extent. In particular, the combination of diet with niacin or hydroxymethylglu taryl coenzyme A (HMG CoA) reductase inhibitors seems to give the best results. These drugs induce a marked reduction of total and low-density lipoprotein (LDL) cholesterol and an increase of high-density lipoprotein (HDL) cholesterol concentrations. The use of diet, niacin, and HMG CoA reductase inhibitors reduces total as well as specific mortality. Treatment of dyslipidemia to prevent CHD depends on the pattern and severity of dyslipi demia, the presence of overt CHD, and the patient's response to diet. Pharmacologic treatment should be started only after dietary modifications have been tried and must be combined with diet. Drug side effects must also be considered, for they may affect patient compliance.

High levels of total and LDL and low levels of HDL cholesterol are major risk factors for coronary atherosclerosis. Correcting lipid abnormalities can reduce the risk of devel opment or progression of CHD. Diet and drugs are the main instruments available to normalize lipid levels. The choice of drug to combine with diet must be based on its specific effects on lipid metabolism, side effects, and efficacy in reducing CHD.
Buerger's Disease in Two Brothers: Iliac Artery Occlusion by Thromboangiitis Obliterans
Authors: Wysokinski Waldemar E. , Kwiatkowska Wieslawa , Maslowski Leszek , Witkiewicz Wojciech , Kowal-Gierczak Barbara
Published: July 2008

Several characteristics of thromboangiitis obliterans are unique and confirm the existence of the disease as a distinct pathological entity. Its predilection for young smoking males, peripheral type of vascular involvement, recurrences of superficial thrombophlebites, and typical histolopathology form the principals of the disease although the etiology remains unknown. The authors report the unusual finding of Buerger's disease occurring in two brothers, one of whom had occlusion of the left external iliac and femoral arteries. All other clinical characteristics of these two cases were typical for thromboangiitis oblit erans. Presentation of some peculiarities of the disease, particularly the lack of familial association, may help to unravel the pathogenesis of thromboangiitis obliterans.
Nailfold Capillaroscopy in Hypothyroidism and Hyperthyroidism: Blood Flow Velocity During Rest and Postocclusive Reactive Hyperemia
Authors: Pazos-Moura Carmen C. , Moura Egberto G. , Breitenbach Marisa M. D. , Bouskela Eliete
Published: July 2008

Direct intravital microscopic examinations of nailfold capillaries were made in three groups of subjects: 15 healthy volunteers (C) and 11 patients, six with hypothyroidism (h) and five with hyperthyroidism (H). The groups h and H were examined twice, before the onset of treatment and when they returned to euthyroidism. Capillary blood flow velocity (CBFV) was measured during rest and after release of 60-second arterial occlusion. To assess autoregulatory capacity the authors determined peak CBFV postoc clusion and time to reach it in single capillaries. In patients with hypothyroidism, before the onset of the treatment, the mean resting and the mean peak CBFV were significantly lower (resting CBFV—group C: 0.93 ±0.11 mm/s (mean ±SE); group h: 0.33 ±0.09 mm/s; and mean peak CBFV—group C: 1.49 ±0.14 mm/s; group h: 0.79 ±0.19 mm/s). The time to reach mean peak CBFV postocclusion was significantly prolonged (group C: 8.9 ±0.65 s and group h: 19.2 ±2.0 s) compared with the group of healthy volunteers. When these patients achieved euthyroidism, all the studied parameters returned to control levels. In patients with hyperthyroidism only minor changes in CBFV could be detected. In patients with hypothyroidism, the skin microvascular autoregulatory mech anisms are disturbed. The impairments of the reactive hyperemia response could be corre lated with the control of the disease (thyroid state).
Successful Treatment of Ergotism with Iloprost
Authors: Piquemal R. , Emmerich J. , Guilmot J.L. , Fiessinger J.N.
Published: July 2008

A 34-year-old woman was hospitalized for severe acute arterial insufficiency of the limbs. Overuse of ergotamine derivative was acknowledged by the patient, who had a long history of migraine headaches. An arteriogram showed diffuse arterial spasm and occlusion of right leg distal arteries. Intravenous infusion of a stable prostacyclin analog (Iloprost) was administered. Rapid and complete improvement of arteriospasm was noted within a few hours, confirmed by a further arteriogram. This appears to be one of the rare case reports of successful limb salvage by use of Iloprost for ergotism.
Improved Hemodynamics Shown by Continuous Monitoring of Electrical Impedance During External Counterpulsation with the End-Diastolic Pneumatic Boot and Improved Ambulatory EKG Monitoring After 3 Weeks of Therapy
Authors: Dillon Richard S.
Published: July 2008

Six normal subjects and 12 patients with clinical angina and significant ST depressions during baseline ambulatory cardiac monitoring were given a single treatment with the end-diastolic pneumatic compression boot, the Circulator Boot™. With the use of contin uous electrical impedance measurements, multiple hemodynamic variables were followed in five situations: (1) baseline before pumping; during end-diastolic pumping (2) on both legs after every heartbeat, (3) on one leg after every heartbeat, and (4) on both legs on alternate beats; and (5) during pumping on both legs during every systole. Both an increase in venous return and a reduction in afterload likely contributed to significant increases in cardiac output (CO) (51.1 ± 33.6%), stroke volume (SV) (52.1 ± 35.6%), change in impedance over time (dZ/dT) (72.0 ± 68.1%), cardiac index (CI) (51.2 ± 33.8%), and acceleration index (50.7 ± 62.2%) during end-diastolic pumping on both legs after every heartbeat. A crucial role for afterload reduction was implied by opposite effects observed on CO, CI, dZ/dT, and SV during systolic pumping. Again, reductions (or a lack of an increase) in ventricular ejection time and/or the preejection period suggested a decrease in afterload during end-diastolic pumping. Pumping on one leg after every beat and on both legs on alternate beats was also effective but less so. After the initial study, the patients were given 14 additional end-diastolic treatments to both legs over 3 weeks. A clinical benefit for the patients was shown by symptomatic improvement in all patients along with a significant reduction in the amount and duration of the RST abnor malities in their ambulatory heart monitoring (p = 0.012).
Diagnosis of Deep Venous Thrombosis by Use of Soluble Necrosis Factor Receptor
Authors: Taheri S.A. , Lazar Facs L. , Haddad G. , Castaldo R. , Wilson M. , Mousa S.
Published: July 2008

The purpose of this clinical study was to find a relationship between soluble tumor necrosis factor (TNF) receptor, deep venous thrombosis (DVT), and pulmonary emboli (PE). Clinical diagnosis of deep venous thrombosis and pulmonary emboli is a major dilemma for the clinician. Most existing tests are technician dependent, are expensive, or require sophisticated equipment. Advances in molecular biology will permit investigation of the value of TNF receptor as a test for screening, diagnosis, and evolution of DVT and PE.

Forty patients with diagnosis of DVT, documented by real-time ultrasound imaging, were the subject of this clinical study. Five cc of plasma from each patient was studied by enzyme-linked immunosorbent assay (Elisa) for measurement of soluble TNF receptor. Significantly increased concentration of plasma-soluble TNF receptor was present in patients with DVT as opposed to normal individuals. There was a close relationship between plasma concentration of soluble TNF receptor and evaluation of the disease.

In this preliminary clinical study, it appears that plasma measurement of soluble TNF receptor could be used as a clinical test for diagnosis of DVT and PE.
Dual-Lumen Femoral Vein Catheterization as Vascular Access for Hemodialysis
Authors: Al-Wakeel Jamal Saleh , Milwalli Ahmad Hassan , Malik Ghulam Hassan , Huraib Sameer , Al-Mohaya Suleiman , Abu-Aisha Hassan , Memon Nawaz
Published: July 2008

Prospectively from January 1991 to January 1993, the efficacy and complications of 104 polyurethane, double-lumen femoral vein catheterizations (FVC) in 96 renal failure patients were studied. Ambulation was allowed in the hospital as well as at home while the catheter was in. There were 53 males and 43 females, with ages ranging from 13 to 87 (mean, 48.3 ±19.7) years. Forty-eight patients had chronic renal failure and 48 had acute renal failure. The catheters were used for 1 to 26 days (mean, 8 ±5 days). Fifty-two (50%) of the FVC were used for 2 weeks and 14 (13.5%) for 3 weeks or longer. The various complications encountered were infection (n=31), poor blood flow (n=8), displaced catheter (n=6), thrombosis of the catheter (n=4), hematoma (n=4), bleeding (n=3), exit site infection (n=3), ileofemoral vein thrombosis (n=2), and tear in the catheter wall (n=2). On removal, bacterial colonization was present in 34 out of 93 catheter tips (36.5%); Staphylococcus epidermidis (n=12) was the commonest organism grown. There was no significant difference of infection between diabetic and nondia betic chronic renal failure patients. The duration of catheterization was found to have no relation with either thrombosis or infection. Femoral vein catheters can be used for hemodialysis for 2 to 3 weeks and ambulation during cannulation may be allowed.
Coronary Arteriovenous Malformations in a Patient with Hereditary Hemorrhagic Telangiectasia
Authors: Gurevitch Yoseph , Hasin Yonathan , Gotsman Mervyn S. , Rozenman Yoseph
Published: July 2008

Hereditary hemorrhagic telangiectasia (Osler-Weber-Rendu) disease is characterized by cutaneous, mucosal, and visceral vascular anomalies. Two patients were previously described with coronary artery aneurysms (ectasia) associated with this disease. This report describes a patient with Osler-Weber-Rendu disease in whom multiple coronary arteriovenous malformations were identified during coronary angiography. The patient presented with anginal chest pain resulting from severe anemia. Upper gastrointestinal endoscopy revealed multiple angiodysplastic lesions throughout the esophagus and stomach.
Prediction of Peak Oxygen Consumption in Patients with Intermittent Claudication
Authors: Womack Christopher J. , Hyman Brian A. , Gardner Andrew W.
Published: July 2008

Determination of peak oxygen consumption (VO2peak) is considered important for assessing a patient's functional capacity and for exercise prescription. However, the equipment necessary to obtain accurate determination of Vo2peak is not always available in clinical settings. The present study sought to develop an equation to estimate VO2peak in peripheral arterial occlusive disease (PAOD) patients with intermittent claudication and to determine independent predictors of VO2peak in this population. One hundred and fifty-seven patients with intermittent claudication were assigned to either a validation group (n = 105) or a cross-validation group (n = 52). Medical history, height, weight, body mass index (BMI), age, gender, smoking status, resting and postexercise ankle/brachial systolic pressure index (ABI), and time to maximal claudication pain and maximal heart rate from an incremental graded exercise test (GXT) were used as potential independent predictors of VO2peak. Time to onset of maximal claudication pain, maximal heart rate, and BMI were all independently associated with VO2peak. These variables were used to estimate VO2peak by the following equation:

VO2peak (mL/kg/min) = (0.00872 x maximal claudication pain time [sec] )

+ (0.02839 x maximal heart rate [b/min] ) - (0.12034 x BMI) + 10.11411

r = 0.71, r2 = 0.50, standard error of estimate = 2.02 mL/kg/min, p < 0.0001

There was no significant difference between the estimated and actual VO2peak in the cross-validation group, and the coefficient of variation between estimated and actual VO 2peak in this group was 18.3%. There was no significant difference between the corre lation coefficient for the relationship between estimated and actual VO2peak in the cross- validation group (r = 0.61) and the multiple correlation coefficient from the validation group (r = 0.71). Results of this study suggest that a multiple regression equation can be used to estimate VO2peak in patients with intermittent claudication by measuring time to maximal claudication pain and maximal heart rate from a GXT and by measuring BMI.
Patients with Coronary Collaterals and Normal Left Ventricular Systolic Function: Clinical, Hemodynamic, and Angiographic Characteristics
Authors: Carmel Sara , Gueron Moshe , Ilia Reuben
Published: July 2008

One hundred and twenty consecutive patients with significant coronary artery disease, normal left ventricular systolic function, and coronary collaterals were compared with 111 patients with the same characteristics but with no collaterals. No significant differ ences were found between the two groups in hypertension, diabetes mellitus, and smoking. The left ventricular end diastolic pressure was 16.4 ± 7 in the study group and 16.9 ±6.9 in the controls (NS). Significantly more diseased vessels were observed in the study group than in the control group (2.1 ±0.6 versus 1.7 ±0.6, p = < 0.001 ) . One hundred and one totally occluded vessels were found in the study group but only two in the control group.

The richest collateral supply was to the right coronary artery: 94 sources to 85 diseased vessels (111%) including 66 sources to 52 totally occluded arteries (127%); to the left anterior descending: 59 sources to 89 diseased vessels (66%) including 37 sources to 33 totally occluded arteries (112%). The poorest supply was to the left circumflex: 17 sources to 69 diseased vessels (25%), including nine sources to 16 totally occluded arteries (56%). No collaterals were observed in 14 totally occluded vessels in the study group and in two of the controls, while the systolic function at rest was still normal.

It is suggested that coronary collaterals are important in preserving left ventricular systolic and diastolic performance at least at rest. Not readily visible collaterals may also prevent systolic dysfunction.
Enhanced Insulin Response to Oral Glucose Load in Patients with Angina Pectoris Associated with ST Segment Elevation in the Absence of Epicardial Coronary Arterial Obstruction
Authors: Takata Shigeo , Shimakura Atsuhiro , Sakagami Satoru , Nakamura Yukio , Ohkuwa Hitoshi , Kobayashi Ken-ichi , Nagai Hideo
Published: July 2008

The authors treated 10 patients with microvascular angina (MVA) manifesting angina pectoris, ST segment elevation suggestive of transmural myocardial ischemia, and no epicardial arterial obstruction. Since such patients frequently showed abnormal responses to oral glucose loading, the authors investigated the glucose and insulin responses to glucose loading in 10 MVA patients, 25 patients with vasospastic angina (VAP), 25 patients with effort angina (EAP), and 25 control subjects. Insulinogenic index, periph eral insulin activity [=104/(peak glucose x insulin at glucose peak)], glucose area, and insulin area were calculated. The MVA group included two patients with impaired glucose tolerance and two newly diagnosed diabetic patients. These proportions were similar to those in the VAP and EAP groups. Glucose levels at 30 to 180 min and insulin levels at 90 to 120 min in the MVA group were higher than in the control group. Peak glucose, glucose area, peak insulin, and insulin area were higher in the MVA group than in the control group (p<0.01).Those in the VAP and EAP groups were also higher. Insulin/glucose ratio at 120 min was higher, peripheral insulin activity, lower, in the disease groups than in the control group (p<0.05).The MVA patients showed a hyper glycemic and hyperinsulinemic response to oral glucose loading, as did the patients with EAP and VAP. Enhanced insulin response to oral glucose loading may also contribute to the pathogenesis of MVA.
Decreased Prevalence of Symptomatic Atherosclerosis in Arthritis Patients on Long-Term Aspirin Therapy
Authors: Sloop Gregory D.
Published: July 2008

To determine the effect of long-term aspirin therapy on the prevalence of symptomatic atherosclerosis, autopsy results from 44 arthritis patients taking aspirin were compared with a cohort from the general autopsy population. No decrease in the prevalence of symptomatic atherosclerosis was noted in patients with less than 8 years of arthritis, compared with controls. In contrast, the prevalence of symptomatic atherosclerosis was significantly decreased in arthritis patients with 8 or more years of arthritis and aspirin use. In these subjects, the prevalence of symptomatic atherosclerosis was inversely related to duration of arthritis. The inverse relationship between prevalence of symptomatic atherosclerosis and duration of aspirin therapy, as well as the decrease in all forms of symptomatic atherosclerosis, raise the possibility that this decrease is due to primary prevention of atherosclerosis.
Implantation of a Mechanical Valve Within the Orifice of a Mitral Bioprosthesis in a Case with Severely Calcified Left Atrium
Authors: Moriki Naoya , Doi Toshiki , Unno Hideya , Matsuzaki Kanji , Mitsui Toshio , Sakakibara Yuzuru
Published: July 2008

The case of a 61-year-old woman with deterioration of mitral bioprosthesis and severe left atrial calcification is presented. Although the implantation of a mechanical valve within the orifice of a mitral bioprosthesis was tried, we found a major pitfall in this method was exact orifice matching.
Comparison of Three Blood Pressure Methods Used for Determining Ankle/Brachial Index in Patients with Intermittent Claudication
Authors: Montgomery Polly S. , Gardner Andrew W.
Published: July 2008

The standard noninvasive test to assess the severity of peripheral arterial occlusive disease (PAOD) is the ankle/brachial systolic blood pressure index (ABI). While ankle systolic blood pressure is obtained by the Doppler ultrasound technique, brachial systolic blood pressure can be obtained by the Doppler, auscultatory, or oscillometric (Dinamap 1846 SX) methods. The purpose was to determine whether the three methods yielded similar brachial systolic blood pressure values, and consequently similar ABI values, in PAOD patients with intermittent claudication. Fifty patients who had a history of inter mittent claudication of 2.3 ±2.0 blocks for a duration of 5.7 ±5.8 years were recruited. Following 10 minutes of supine rest, brachial systolic blood pressure was measured in the right arm by the three techniques in a randomized order, and ankle systolic blood pressure (87.3 ±28.9 mmHg) was measured in the more symptomatic leg with the Doppler technique. Brachial systolic blood pressure was not significantly different (p=0.954) among the Doppler (128.5 ±18.4 mmHg), auscultatory (128.4 ±17.4 mmHg), and oscillometric (128.2 ± 17.1 mmHg) methods. Corresponding ABI values also were similar (p=0.922) among the three respective methods (0.68 ±0.22, 0.68 ±0.22, and 0.68 ±0.21), indicating that ABI did not vary according to the technique used to obtain brachial systolic blood pressure. It is concluded that the accuracy of deter mining ABI in PAOD patients with intermittent claudication was minimally affected by the method chosen to obtain brachial systolic blood pressure.
Doppler-Based Diagnosis of Restenosis After Femoropopliteal Percutaneous Transluminal Angioplasty: Sensitivity and Specificity of the Ankle/Brachial Pressure Index Versus Changes in Absolute Pressure Values
Authors: Radak Djordje , Labs Karl-Heinz , Jäger Kurt A. , Bojić Milovan , Popović Aleksandar D. , Radak Djordje
Published: July 2008

The aim of this study was to investigate the sensitivity and specificity of changes of the ankle/brachial pressure index (ABI) and changes in absolute ankle pressure values to detect restenosis in patients who underwent femoropopliteal percutaneous transluminal angioplasty (PTA).

In total, 171 patients were followed up prospectively for 12 months; sensitivity and specificity of Doppler-based diagnosis were calculated with duplex scanning as the gold standard. The criteria for restenosis were: (1) a loss of 50% of the ABI increase or (2) loss of 50% of the absolute ankle systolic pressure, gained by PTA. For both criteria, different cut-off points (minimum increase of ABI or ankle pressure gained by PTA) were evaluated.

The overall sensitivity and specificity of the ABI criterion was 67% and 80%, respec tively. The introduction of cut-off points (the minimum ABI increase gained by PTA), ranging between ≥ 0.13 and ≥ 0.35, did not markedly improve the results. The overall sensitivity and specificity of the absolute ankle pressure criterion again was poor (59% and 81 %). With the introduction of cut-off points (the minimum increase of absolute ankle pressure gained by PTA) ranging between ≥ 15 mm Hg and ≥ 20 mm Hg, the sensitivity and specificity of the criterion improved to acceptable 92% and 96%, respectively.

It is concluded, that in the long-term follow-up of PTA patients, the "loss of 50% ankle pressure" criterion will detect restenosis with reasonable accuracy in those patients, in whom an increase in systolic ankle pressure ≥20 mm Hg is warranted.
Lupus Carditis: Evaluation with Technetium-99m MIBI Myocardial SPECT and Heart Rate Variability
Authors: Laganà Bruno , Schillaci Orazio , Tubani Luigi , Gentile Raffaele , Danieli Roberta , Coviello Rossella , Baratta Luigi , Scopinaro Francesco , Laganà Bruno
Published: July 2008

The objective of this paper was to investigate the incidence of myocardial perfusion defects in patients with systemic lupus erythematosus (SLE) associated with dysauto nomic alterations. Twenty patients without any sign or symptoms of heart disease, selected from a larger population of patients with SLE, underwent technetium-99m sestamibi (Tc-99m MIBI) single photon emission computed tomography (SPECT), at rest and after dipyridamole infusion; they also underwent heart rate variability (HRV) exam ination by a 24 hour ambulatory electrocardiography, analyzing in the time domain the standard deviation of the R-R intervals average (SDNN) and the percentage of R-R adjacent intervals differing from each other more than 50 msec (pNN50); in the frequency domain the low (LF) and high frequencies (HF) were analyzed. Twenty healthy volunteers served as control group for heart rate variability. At MIBI-SPECT examina- tion, the scan was found abnormal in 15 patients and normal in five: three patients demonstrated reversible defects in the anteroseptal region, four had irreversible defects in a region (two in the anteroseptal region and two in the lateral region), two had rest defects in two different regions (lateral and inferior, lateral and anteroseptal) that improved during dipyridamole scan, and six had both reversible and irreversible defects: four in a single segment (three anteroseptal and one lateral, and two in two different regions, particularly anteroseptal and lateral, lateral and inferior). All 20 patients showed significantly lower HRV parameters in comparison with the control group, except for pNN50, which indicates decreased physiologic periodic fluctuations of the autonomic nervous system. In six patients who underwent coronary angiography, the epicardial vessels were found completely normal. In view of the high incidence of myocardial hypoperfusion in patients with HRV alterations, the authors hypothesize that autonomic dysfunction may be associated with microvascular disease or metabolic alteration. They also believe that MIBI scintigraphy is a suitable technique in detecting myocardial damage in SLE patients free of clinical manifestation.
Developing Venous Gangrene in Deep Vein Thrombosis: Intraarterial Low-Dose Burst Therapy with Urokinase
Authors: Garg Sanjeeve K. , Yadav Karan S. , Garg Sanjeeve K.
Published: July 2008

Two patients with developing venous gangrene of the lower extremity and contraindi cations to systemic thrombolytic therapy are presented. Low-dose intraarterial burst therapy with urokinase provided rapid amelioration of symptoms and avoided amputa tion without any serious bleeding complications in both patients.
Anomalous Left Coronary Artery Arising from Right Sinus of Valsalva Could Be a Minor Congenital Anomaly
Authors: Abouzied Amr Mousa , Amaram Sudhir , Neerukonda Shanti K. , Neerukonda Shanti
Published: July 2008

Left coronary artery arising from the right sinus of Valsalva is a rare congenital coronary anomaly. This anomaly is either benign or serious, depending on the relation of the anomalous left coronary artery to the aorta and pulmonary artery. Potentially serious anomaly is associated with sudden cardiac death and warrants prophylactic coronary bypass surgery. A rare case of anomalous left coronary artery arising from the right sinus of Valsalva is reported, documented by coronary angiography; however, it took a safer course between the aorta and pulmonary artery. Prophylactic surgery was not performed, for this benign anomaly may not carry the same risk of sudden cardiac death.
A New Scoring System for the Detailed Description of the Distribution and Thrombotic Burden in Deep Leg Vein Thrombosis
Authors: Björgell Ola , Nilsson Paul E. , Svensson Peter J. , Bergqvist David , Björgell Ola
Published: July 2008

The scoring system most commonly used to date to describe the thrombotic burden of deep vein thrombosis (DVT) excludes several deep vein segments and is thereby of limited use in research. The aim of this prospective, comparative study was to develop a new scoring and distribution system that would include all major deep veins of the leg and pelvis. In total, 247 consecutive patients were included, of whom 105 had a positive phlebography. The positive phlebographies were registered in the new system and the result was compared with that obtained by the Marder system.

In 72% (76/105) of the patients the DVT distribution was not completely described and the thrombotic burden was significantly underestimated by the Marder system. Of these, 12% (13/105) were not scored at all, thus representing false-negative investiga tions. It was possible to score all DVTs and important vein segments of these patients with the new system. The scoring system previously used excludes several deep vein segments. A description of the important vein segments, where DVT is shown to originate and propagate, is mandatory in a scoring system designed for the purpose of research of DVT and later detected deep vein insufficiency. The new system meets this demand.
A Universally Applicable Clinical Classification of Lymphedema
Authors: Miller Albert J. , Bruna Josef , Beninson Joseph , Miller Albert J.
Published: July 2008

A simple classification of lymphedema is presented that is based solely on clinical obser vation. It is suggested that the universal use of such a classification would facilitate the collection of meaningful epidemiologic data and would make possible understandable comparisons of the effectiveness of various treatment modalities.
Clinical, Echocardiographic, and Angiographic Profile of Patients with Double-Chambered Right Ventricle: Experience with 48 Cases
Authors: Singh Mandeep , Agarwala Manoj K. , Grover Anil , Pathak Vijay , Varma Jagmohan S. , Grover Anil
Published: July 2008

Forty-eight patients with double-chambered right ventricle (DCRV) were prospectively studied over a 3-year period. Clinical, echocardiographic, hemodynamic, and angio graphic studies were done in all. Three patients were studied postoperatively also. Fifteen patients underwent surgery confirming the diagnosis. Echocardiography detected anomalous muscle bundles (AMBs) in 39/41 patients in whom this study was carried out. Angiographically AMBs were best demonstrated in anteroposterior views in a systolic frame. Common associated anomalies found with DCRV were ventricular septal defects (69%), pulmonary valve stenosis (38%), and double-outlet right ventricle (10%).
Myocardial Infarction in Patients with Systemic Lupus Erythematosus with Normal Findings from Coronary Arteriography and Without Coronary Vasculitis
Authors: Rangel Alberto , Lavalle Carlos , Chávez Eduardo , Jiménez Marcelo , Acosta José Luis , Baduí Elías , Albarrán Héctor , Rangel Alberto
Published: July 2008

The authors present the cases of two young patients, a man and a woman, who presented with myocardial infarction, in the absence of ischemic heart disease or stenosis of the coronary arteries. The woman was known to have systemic lupus erythematosus (SLE) for the past 3 years (the immunoglobulin M [IgM] anticardiolipins antibodies were positive), without a history of coronary risk factors. Suddenly she presented with acute chest pain on rest that lasted 4 hours and culminated in anterior wall myocardial infarction. She was admitted to the coronary care unit, where no thrombolysis was given. She did not have echocardiographic evidence of Libman-Sacks endocarditis, but myocardial infarction was evident at the electrocardiogram (ECG) . The young man had SLE (the IgM anticardi olipins were absent, but he was positive for lupus anticoagulant antibodies), he was hyperlipidemic, was a moderate smoker and moderately obese, and had no history of ischemic heart disease. He suddenly presented with an acute myocardial infarction docu mented by ECG, enzymes, and gammagraphy. In both patients, coronary angiography findings were normal and myocardial biopsy did not show evidence of arteritis. The relevance of these cases is the rare association of ischemic heart disease in SLE, with normal coronary arteries and without evidence of arteritis or verrucous endocarditis.
Single Coronary Artery with "High Take-off" Origin in a Patient with Rheumatic Mitral Stenosis
Authors: Tikiz Hakan , Atak Ramazan , Ileri Mehmet , Demir Ahmet Duran , Kütük Emine , Tikiz Hakan
Published: July 2008

In this case report, a patient with rheumatic mitral stenosis and R-1 subtype single coronary artery arising from the ascending aorta ("high take-off" origin) and coursing between the aorta and pulmonary artery is presented. The clinical significance and differ ential diagnosis are discussed. To the authors' knowledge, this is the first case reported in the literature with a single R-1 subtype coronary artery that shows "high take-off" origin.
Recurrent Pericardial Effusion Due to Gunshot Wound of the Heart in a Hemodynamically Stable Child
Authors: Atalay Semra , Uysalel Adnan , Özberrak Haldun , Koçak Gülendam , Ercan Tutar H.
Published: July 2008

A 12-year-old girl presented with recurrent pericardial effusion due to firearm pellet injury to the left ventricle. The pellet was localized by two-dimensional echocardiog raphy within the left ventricular apical wall. Since the patient was asymptomatic, left ventriculotomy was avoided to extract the pellet and only pericardial tube drainage was carried out. A slightly elevated blood lead level of the patient was alarming for potential subsequent lead poisoning due to retained pellets.
Circulating Cytokines and Complements in Chronic Heart Failure
Authors: Koşar Feridun , Varol Ercan , Ileri Mehmet , Ayaz Selime , Hisar Ismet , Kisacik Halil , Koşar Feridun
Published: July 2008

Elevated levels of cytokines and complements have been reported in patients with advanced heart failure, but the exact clinical significance remains unclear. Therefore, assessments correlated with hemodynamic and clinical variables may provide important insight into the actions of cytokines and complements in chronic heart failure.

The authors evaluated the clinical significance of cytokines and complements. The study included 60 subjects (50 men, 10 women); 34 had idiopathic dilated cardiomy opathy (DCM) and 26 had ischemic heart disease (IHD). Tumor necrosis factor alpha and interleukin-2 receptor concentrations in chronic heart failure were greater than in control subjects (20.0 ±0.4 vs 18.0 ±0.5 pg/mL, p<0.05 and 817.23 ±63.50 vs 642.75 ±27.31 pg/mL, p<0.05, respectively). There was no significant difference between DCM and IHD patients in circulating levels of the cytokines and the components complements (p=NS). Additionally, although functional classes III and IV heart failure patients showed a tendency to increase the levels of the cytokines and the component complements, these differences were not statistically significant (p=NS). Similarly, correlation analysis showed that the levels of the circulating cytokines and the component complements had independent value for mortality. These results suggest that humoral and cellular immunity abnormalities may play an important role in the pathogenesis of heart failure and dilated cardiomyopathy.
Nitric Oxide Impacts Endothelin-1 Gene Expression in Intrapulmonary Arteries of Chronically Hypoxic Rats
Authors: Junbao Du , Jianfeng Jia , Wanzhen Li , Bin Zhao , Heping Zeng
Published: July 2008

This study aimed to investigate whether nitric oxide (NO) could inhibit the elevated endothelin-1 (ET-1) gene expression by pulmonary artery endothelial cells or smooth muscle cells in chronically hypoxic rats by use of in situ hybridization. Male Wistar rats (n = 40) were randomly divided into 1-week hypoxia group, 1-week hypoxia with L-arginine (L-arg) group, 1-week hypoxia with Nω-nitro-L-arginine methyl ester (L-NAME) group, 2-week hypoxia group, 2-week hypoxia with L-arg group, and 2-week hypoxia with L-NAME group. All rats were put into a normobaric hypoxic chamber with an oxygen concentration of 10 ±0.5% for hypoxic challenge. The results showed that most pulmonary arteries had 1-50% of the endothelial cells showing positive signals for ET-1 expression in hypoxic rats, which was significantly suppressed by L-arg. L-NAME, however, significantly augmented ET-1 gene expression in pulmonary artery endothe lial cells and smooth muscle cells. The results suggest that endogenous NO markedly inhibits ET-1 mRNA expression in both pulmonary artery endothelial cells and smooth muscle cells in chronically hypoxic rats, which may be one of the mechanisms by which NO modulates hypoxic pulmonary circulation.
Acute Hand Ischemia Secondary to Intraarterial Buprenorphine Injection: Treatment with Iloprost and Dextran-40
Authors: Gouny Pierre , Gaitz Jean Pierre , Vayssairat Michel , Gouny P.
Published: July 2008

Intraarterial injection may result in acute ischemia and amputation. The authors describe the case of a 27-year-old man with an acute hand ischemia following intraarterial injection of a suspension of buprenorphine. Despite its initial severity, this case was successfully treated with iloprost, a stable prostacyclin analogue, and dextran-40, a low- molecular-weight dextran.
Sudden Death with Malignant Hemangioendothelioma Originating in the Pericardium
Authors: Yoshida Akihiro , Kanda Tsugiyasu , Sakamoto Hironosuke , Masuda Hiroaki , Iwasaki Tsutomu , Nakajima Takashi , Kobayashi Isao , Nagai Ryozo , Kanda Tsugiyasu
Published: July 2008

The authors report a rare case of a malignant hemangioendothelioma (MH) originating in the pericardium. In this case, a metastatic skin lesion was found first, and subsequently the existence of a primary cardiac lesion was confirmed. Generally, primary cardiac tumors grow slowly, and the prognosis of MH is relatively good. In this case, however, the patient died suddenly during the creation of a pericardial window for drainage. An autopsy showed that the MH originated from a pericardial lesion in the right atrium.
Decreased Baroreflex Sensitivity Assessed from Phase IV of Valsalva Maneuver in Mild Congestive Heart Failure
Authors: Rostagno Carlo , Felici Massimo , Caciolli Sabina , Olivo Giuseppe , Comeglio Marco , Galanti Giorgio , Serneri Gian Gastone Neri
Published: July 2008

Decreased sensitivity of cardiopulmonary and arterial baroreceptors has been hypothe sized to sustain sympathetic activation in patients with heart failure. In the present inves tigation the relationship between the impairment of baroreflex sensitivity and clinical severity of congestive heart failure was investigated. The authors studied 58 patients with heart failure (14 in NYHA class I, 22 in NYHA class II, and 22 in NYHA class III), 38 women and 20 men, age range 28-65 years. Thirty-two patients suffered from idiopathic dilated cardiomyopathy and 26 from coronary heart disease. As control group they examined 21 age-matched subjects. Baroreceptor sensitivity was studied by using the Valsalva maneuver as stimulus. Arterial pressure and heart rate were measured nonin vasively by Finapres instrument (Ohmeda) and signals were recorded and elaborated with a personal computer. A decrease of baroreflex sensitivity was already demonstrable in NYHA class I patients (4.72 ±3.31 vs 9.25 ±5.05 msec/mm Hg in control group) (p < 0.005). A further impairment of baroreceptor response was found in patients in NYHA class II (1.94 ±2.88 msec/mm Hg, p < 0.001) and class III (1.78 ±1.52 msec/mm Hg, p < 0.001). Baroreceptor response showed a significant correlation with functional NYHA class (r = 0.61, p < 0.001) and anaerobic threshold (r = 0.57, p < 0.001) while the correlation was less tight with left ventricular end-diastolic diameter, fractional short ening, left ventricular ejection fraction, pulmonary mean arterial blood pressure, cardiac index, distance at 6 minutes walk corridor test, and maximal oxygen consumption (VO 2max). These results suggest that baroreceptor function may be impaired early in the clinical course of heart failure and may contribute to sympathetic activation.
Double-Orifice Mitral Valve with Multiple Papillary Muscles
Authors: Mao Jing-Tao , Tang Juhong , Yuemei Li  , Peiyun Sun  , Mao Jing-Tao
Published: July 2008

Two patients with double-orifice mitral valve, in addition to ventricular septal defect in one patient and mitral insufficiency in the other, and multiplicity of left-ventricle papillary muscles are reported.
Comparison of Low-Molecular-Weight Heparin, Administered Primarily at Home, with Unfractionated Heparin, Administered in Hospital, and Subcutaneous Heparin, Administered at Home for Deep-Vein Thrombosis
Authors: Nicolaides A.N. , Cesarone M.R. , Laurora G. , De Sanctis M.T. , Incandela L. , Barsotti A. , Corsi M. , Vasdekis S. , Christopoulos D. , Lennox A. , Malouf M. , Belcaro G.
Published: July 2008

In this study, 294 patients with acute proximal DVT (deep venous thrombosis) were randomly assigned to receive intravenous standard heparin in the hospital (98 patients) or low-molecular-weight heparin (LMWH) (nadroparin 0.1 mL [equivalent to 100 AXa IU] per kg of body weight subcutaneously twice daily) administered primarily at home (outpatients) or alternatively in hospital (97 patients) or subcutaneous calcium heparin (SCHep) (99 patients, 0.5 mL bid) administered directly at home. The study design allowed outpatients taking LMWH heparin to go home immediately and hospitalized patients taking LMWH to be discharged early. Patients treated with standard heparin or LMWH received the oral anticoagulant starting on the second day, and heparin was discontinued when the therapeutic range (INR 2-3) had been reached. Anticoagulant treatment was maintained for 3 months. Patients treated with SCHep were injected twice daily for 3 months without oral anticoagulants. Patients were evaluated for inclusion and follow-up with color duplex scanning. Venography was not used. In case of suspected pulmonary embolism (PE) a ventilatory-perfusional lung scan was performed. Endpoints of the study were recurrent or extension of DVT, bleeding, the number of days spent in hospital, and costs of treatments. Of the 325 patients included, 294 completed the study. Dropouts totaled 31 (10.5%); six of the 325 included patients (1.8%) died from the related, neoplastic illness. Recurrence or extension of DVT was observed in 6.1% of patients in the LMWH group, in 6.2% in the standard heparin group, and in 7.1% in the SCHep group. Most recurrences (11/17) were in the first month in all groups. Bleedings were all minor, mostly during hospital stay. Hospital stay in patients treated with LMWH was 1.2 ± 1.4 days in comparison with 5.4 ± 1.2 in those treated with standard heparin. There was no hospital stay in the SCHep group. Average treatment costs in 3 months in the standard heparin group (US $2,760) were considered to be 100%; in comparison costs in the LMWH group was 28% of the standard heparin and 8% in the SCHep group. This study indicated that LMWH and SCHep can be used safely and effectively to treat patients with proximal DVT at home at a lower cost.
Ruling Out Acute Deep Vein Thrombosis by ELISA Plasma D-Dimer Assay Versus Ultrasound in Inpatients More Than 70 Years Old
Authors: Le Blanche Alain F. , Siguret Virginie , Settegrana Catherine , Bohus Sorina , Le Masne de Chermont Elisabeth , Andreux Jean-Paul , Gaussem Pascale
Published: July 2008

In geriatric care, deep-vein thrombosis (DVT) is mostly diagnosed by noninvasive tech niques. The objectives of this prospective study were: (1) to evaluate the power of ELISA plasma D-dimer assay versus ultrasound (US) in ruling out acute DVT of the lower limbs in symptomatic geriatric inpatients, and (2) to determine the most effective D-dimer cutoff value over the age of 70 years. Over a 10-month period, inpatients with suspected lower limb DVT simultaneously underwent US examination and ELISA plasma D-dimer assay. Noninclusion criteria were comorbid conditions able to modify the D-dimer level. Data were processed by receiver operating characteristic (ROC) curve analysis. In total, 150 patients (125 women, 25 men), average age 86.3 years (range 70-101) were included. A diagnosis of lower limb DVT was established in 53 patients (35.3%). With a 500 ng/mL D-dimer cutoff conventional value, DVT was ruled out in only five patients (3.3%), whereas a 750 ng/mL value ruled out DVT in 19 patients (12.7%) with a sensitivity of 98.1%, and a negative predictive value of 95.0%. The only false negative corresponded to a patient with a 15-mm thrombus in the distal calf. In inpatients above 70, an ELISA plasma D-dimer value smaller than 750 ng/mL is a rapid reliable noninvasive means to rule out lower limb DVT, if color flow Doppler ultrasound is not available on site.
Treatment of Venous Leg Ulcers with Sulodexide
Authors: Scondotto Gaetano , Aloisi Daniele , Ferrari Patrizio , Martini Luca
Published: July 2008

Venous ulcers are still today one of the main socioeconomic problems of medical interest in terms of prevalence, morbidity, and costs to the health service. In the past, various studies have been carried out to identify a systemic pharmacologic treatment able to accelerate venous ulcer healing times, but frequently the results have not been satisfac tory. The aim of this study was to evaluate the efficacy of sulodexide, a drug with profibrinolytic and antithrombotic activity, in accelerating venous ulcer's healing time. Ninety-four patients (32 men and 62 women), aged 72 years old on average, were randomly distributed between two groups. In the first group ("control group") a standard treatment was applied, which consisted of cleansing by washing with physiological solution and the application of elastic compression with short-extensibility, removable bandages. The second group ("sulodexide group") received the standard treatment plus sulodexide (600 lipoprotein lipase releasing units [LRU] by im route per day for 30 consecutive days, followed by 500 LRU by oral route per day for a further 30 days). After 2 months the venous ulcers were found healed in 15 patients (36%) in the control group and in 30 patients (58%) in the sulodexide group (p = 0.03). The life table showed that the healing times were shorter in the sulodexide group in the first 2 months of treatment. Total healing times amounted to 110 days in the control group and 72 days in the sulodexide group (p = 0.08) and the results were in proportion to the initial severity of the lesion. A significant correlation was noted between ulcer healing times and severity of the initial ulcerous lesion, the duration of the ulcer, and the group the patient belonged to. No correlation was found between age, gender of the patient and the etiology of the ulcer. In conclusion sulodexide was shown effective in the treatment of venous leg ulcers, yielding healing more quickly than the standard treatment.
Experimental Inhibition of Protamine Cardiotoxicity by Prostacyclin
Authors: Fehmi Katircioğlu S. , Ulus Tulga , Yamak Birol , Saritaş Zülfikar , Yildiz Ülkü
Published: July 2008

Twelve animals (26 ± 5 kg) were subjected to the study. In this experimental study, the authors used prostacyclin to inhibit the toxic metabolite release during protamine admin istration. Animals were divided into two equal groups. Six animals received prostacyclin (the prostacyclin group), and the other six animals did not receive any additional treatment (the control group).

All cardiac output and biochemical measurements were evaluated at baseline; before cardiopulmonary bypass; and at 5, 30, and 60 minutes after protamine administration. The measured cardiac index showed that the hearts treated with prostacyclin had satis factory preservation of left ventricular function.

Metabolic and biochemical data showed that the tumor necrosis factor level was raised significantly in the control group (20.75 ± 2.2 in the control group and 13.75 ± 2.5 pg/mL in the prostacyclin group). Also, E and P selectin levels were elevated in the control group, but this change was less marked in the prostacyclin group. In addition, the intracellular adhesion molecule-1 (ICAM-1) level was significantly higher in the control group than in the prostacyclin group (9.26 ±2.13 in the control group and 5.13 ± 1.66 ng/mL in the prostacyclin group).

The authors observed that prostacyclin inhibited the toxic mediator release during heparin reversal with protamine. This inhibition is one way of protecting the myocardium reserves from protamine cardiotoxicity.
Peripheral Arterial Involvement in Neurofibromatosis Type 1
Authors: Ilgit Erhan T. , Vural Metin , Oguz Aynur , Ozdogan Mehmet Emin
Published: July 2008

Neurofibromatosis is a dominantly inherited, progressive, generalized dysplasia of meso dermal and neuroectodermal tissues. Vascular lesions associated with neurofibromatosis type 1 (NF-1) are mainly characterized by stenosis, occlusion, aneurysm, pseudoaneurysm, and rupture or fistula formation of small, medium, and large-sized arteries. The authors hereby present a rare case of NF-1 with bilateral aneurysms and large pseudoaneurysms of the femoral and popliteal arteries and occlusion of the left superficial femoral artery.