bluuebunny/crossref_metadata_2025 huggingface dataset:
Estimation of Aortic Wall Sclerosis in Hypertension by Use of Carotid Pulse Tracing and Cine Magnetic Resonance
Authors: Honda Toshio , Hamada Mareomi , Matsumoto Yuji , Matsuoka Hiroshi , Shigematsu Yuji , Hiwada Kunio
Published: July 2008

In order to evaluate aortic wall sclerosis in hypertension, the authors studied the following two parameters of carotid pulse tracing and ascending aortic wall distensibility by using cine magnetic resonance (MR) in 15 age- and sex-matched normal volunteers (NC) (mean age, fifty-four years old) and 15 hypertensive patients (HT) (mean age, fifty-four years old). As the parameters of carotid pulse tracing, they measured the interval from aortic second heart sound to dicrotic notch (A2-DN), and the height from dicrotic notch to top/total height of carotid pulse tracing (b/a ratio). Ascending aortic distensibility was calculated from the following formula:

(max area - min area) / (min area x pulse pressure)

A2-DN interval was lower in HT than in NC (18.4 ± 7.9 vs 31.5 ± 9.2 ms, P < 0.01). The b/a ratio was lower in HT than in NC (0.34 ± 0.07 vs 0.44 ±0.09, P < 0.01). Ascending aortic distensibility was lower in HT than in NC (2.08 ± 1.37 vs 7.26 ± 2.51 × 10-3 mmHg-1, P < 0.01).

In conclusion, ascending aortic wall sclerosis is advanced in hypertension. A2-DN interval and b/a ratio measured by carotid pulse tracing are useful indicators in evaluating the ascending aortic wall distensibility in hypertension.
Comparison of Lower Limb Arterial Assessments Using Color-Duplex Ultrasound and Ankle/Brachial Pressure Index Measurements
Authors: Allen John , Oates Crispian P. , Henderson Jonathan , Jago James , Whittingham T. Anthony , Chamberlain John , Jones Nigel A. G. , Murray Alan
Published: July 2008

The strength of agreement between two noninvasive methods of assessing lower limb arterial disease and their relationship to patient symptoms following exercise have been investigated. Color-duplex ultrasound (CDU) and ankle/brachial pressure index (ABPI) (before and after exercise) measurements were obtained from 200 consecutive patients referred to a vascular investigations laboratory. From these patients, 290 limbs were available for study, comprising limbs without previous vascular surgery, from patients without diabetes and who could attempt a walking exercise test. The overall level of agreement between CDU and resting ABPI measurements was 83% (Kappa 0.66). The ABPI technique identified the more serious disease; a resting ABPI of less than 0.6 gave 100% agreement with CDU. With higher resting ABPIs the level of agreement became poorer: 83% (0.6 ≤ ABPI < 0.9) and 76% (normal ABPI ≥ 0.9). The addition of postexercise ABPI measurements in determining significant arterial disease increased the (continued on next page) (Abstract continued) strength of relationship between the two techniques by only 2% (85%, Kappa 0.69). The exercise test was generally limited by the most symptomatic limb in each patient, and the agreement between CDU and postexercise ABPI measurements in these limbs was higher at 93% (Kappa 0.81). In comparison, agreement for the least symptomatic group of limbs was found to be poor (69%, Kappa 0.37). Compared with symptoms after exercise, overall agreements with CDU and ABPI were both 67% (Kappa 0.27). The agreement was better (91%) when the resting ABPI was less than 0.6. The ABPI is biased toward the detection of more severe disease and is more consistent with CDU when the most symptomatic limbs are compared. The relationship between either test and symptoms after exercise is strong only for limbs with major disease.
Plasma Viscosity Increase with Progression of Peripheral Arterial Atherosclerotic Disease
Authors: Poredoš Pavel , Žižek Bogomir
Published: July 2008

Increased blood and plasma viscosity has been described in patients with coronary and peripheral arterial disease. However, the relation of viscosity to the extent of arterial wall deterioration—the most important determinant of clinical manifestation and prognosis of the disease—is not well known. Therefore, the authors studied plasma viscosity as one of the major determinants of blood viscosity in patients with different stages of arterial disease of lower limbs (according to Fontaine) and its relation to the presence of some risk factors of atherosclerosis. The study encompassed four groups of subjects: 19 healthy volunteers (group A), 18 patients with intermittent claudication up to 200 m (stage II; group B), 15 patients with critical ischemia of lower limbs (stage III and IV; group C), and 16 patients with recanalization procedures on peripheral arteries.

Venous blood samples were collected from an antecubital vein without stasis for the determination of plasma viscosity (with a rotational capillary microviscometer, PAAR), fibrinogen, total cholesterol, alpha-2-macroglobulin, and glucose concentrations. In patients with recanalization procedure local plasma viscosity was also determined from blood samples taken from a vein on the dorsum of the foot. (continued on next page)

(Abstract continued)

Plasma viscosity was most significantly elevated in the patients with critical ischemia (1.78 mPa.sec) and was significantly higher than in the claudicants (1.68 mPa.sec), and the claudicants also had significantly higher viscosity than the controls (1.58 mPa.sec). In patients in whom a recanalization procedure was performed, no differences in systemic and local plasma viscosity were detected, neither before nor after recanalization of the diseased artery. In all groups plasma viscosity was correlated with fibrinogen concentration (r=0.70, P < 0.01) and total cholesterol concentration (r=0.24, P < 0.05), but in group C (critical ischemia) plasma viscosity was most closely linked to the concentration of alpha-2-macroglobulin (r=0.78, P < 0.01). These results indicate that in patients with peripheral arterial disease plasma viscosity increases with the progression of the atherosclerotic process and is correlated with the clinical stages of the disease.

Pavel Poredoš, M.D., Ph.D. University Clinical Center Trnovo Hospital of Internal Medicine Riharjeva 24
Underestimation of the Severity of Pulmonary Outflow Tract Obstruction in the First Day of Life—Doppler Echocardiographic Study
Authors: Robida Andrej
Published: July 2008

To find out whether there is an underestimated severity of narrowing in obstructive lesions of the pulmonary outflow tract in the first day of life, Doppler measurement of the pulmonary outflow tract gradient and estimation of the pulmonary artery systolic pressure in 15 neonates with pulmonary outflow tract obstruction with a variety of associated lesions were studied in the first twenty-four hours of life (mean thirteen hours, range six to twenty-four) and repeated at the age of twenty-six to seventy-two hours (mean forty-nine). The maximal instantaneous gradient across the pulmonary outflow tract obstruction (22.4 ±9.0 mmHg) in the first day of life was significantly lower than at the repeated study (61.0 ±19.4 mmHg, (P < 0.001). In 12 patients with patent ductus arteriosus, transductal gradient increased significantly at the repeated examination (19.6 ±9.3 vs 48.2 ±6.1 mmHg, P < 0. 001). The pulmonary outflow tract gradient in these 12 patients was 22.3 ± 8.4 vs 62.9 ±21.1 mmHg, (P < 0.001). The severity of the pulmonary outflow tract obstruction was underestimated in the first twenty-four hours of life. Low gradient across pulmonary outflow tract and low transductal gradient in the first day of life mirrored high pulmonary arterial systolic pressure. At the repeated study the increase in transductal gradient and the increase in the pulmonary outflow tract gradient more accurately represented the severity of pulmonary outflow tract obstruction owing to the decline in the systolic pulmonary arterial pressure.
Jaundice Induced by Streptokinase
Authors: Gilutz Harel , Cohn Gisela , Battler Alexander
Published: July 2008

Streptokinase is the mainstream therapy for acute myocardial infarction. A fifty-seven-year-old man with acute MI was admitted to the intensive cardiac care unit and received streptokinase and heparin. At the time of admission, he was not receiving any drugs and denied any previous exposure to a hepatotoxic agent. Five hours later, he developed a dramatic hypersensitivity reaction including high fever, pulmonary edema, cyanosis, and convulsions. Within twelve hours, his clinical state was stabilized. After forty-eight hours, he developed jaundice and transaminasemia, which subsided by the eighth day. Only a few reports of overt jaundice are associated with streptokinase.
A Simple, Noninvasive Method to Investigate Vascular Characteristics in Children
Authors: Hsieh Kai-Sheng , Chen Pao-Lan , Fu Shi-En
Published: July 2008

Palpation of pulses is an ancient clinical technique. In modern medical terms, arterial pulse analysis permits the evaluation of vascular characteristics, the important parameters for study of the properties of vessels. However, the various parameters used to describe the vascular characteristics have been conventionally deriving from expensive, invasive, and complicated methods and involving complex computations. The authors designed, therefore, a simple, noninvasive system to evaluate vascular characteristics.

The system consisted of two units of pressure transducer for simultaneous recording of two peripheral arterial pulses, an analog signal processor, an A/D converter, and a personal computer. The vascular characteristics were analyzed by use of the Windkessel model and cross-correlation function. The analysis program was designed by members of this team. Through this system, systemic arterial compliance and pulse wave velocity can be obtained. Thirty-five children (11 normal children and 24 children with various stable, mild congenital heart diseases) were enrolled for data analysis.

For these 35 children without hypertension or other clinically apparent arterial disease, the pulse wave velocity in the upper limb was between 3.7 and 16.8 m × sec-1, with a mean ± standard deviation of 9.3 ± 3.3 m × sec-1. The arterial compliance among the 11 normal children was between 0.72 and 1.72 mL x mmHg -1 × m-2 with a mean of 1.15 mL x mmHg-1× m-2; both were consistent with the previously reported values obtained from complex methods.

This system provides data comparable with those obtained from invasive methods. In the past, the arterial characteristics could not be extensively studied owing to the invasive nature of the conventional methods. This new, simple, convenient noninvasive system will thus provide a convenient method for clinical use in evaluating the vascular characteristics of patients, especially of children.
Massive Cerebral Infarction: A Potential Fatal Complication of Plaque Fissuring of Lipid-Rich Atheromas of the Carotid Artery Case Reports
Authors: Chow Louis Tsun-Cheung , Chow Wing-Hing , Lee Joseph Chuen-Kwun
Published: July 2008

The authors report 2 patients who died of massive cerebral infarction secondary to plaque fissuring of and hemorrhage into their carotid atheromas, resulting in overlying thrombosis and total occlusion of the internal carotid arteries. In both cases, the atheromas caused more than 75% reduction in luminal size of the carotid artery. In addition, they were rich in lipid content, which accounted for more than 40% of the cross-sectional area of the atheromatous plaques. It is postulated that high-grade stenotic carotid atheromatous plaques with a high lipid content are at an increased risk of giving rise to subsequent neurologic complications, including massive cerebral infarction, as exemplified by the present 2 reported cases.
Outcome Predictors of Ultrafiltration in Patients with Refractory Congestive Heart Failure and Renal Failure
Authors: Ramos Roque , Salem Bakr I. , DePawlikowski Maria P. , Tariq Manzoor , Haikal Maged , Pohlman Thomas , Mennes Paul
Published: July 2008

This study is an attempt to identify predictors of outcome from the use of ultrafiltration (UF) in patients with refractory congestive heart failure (CHF) and renal failure.

The authors studied 30 patients in NYHA functional class IV in whom UF was utilized in the management of refractory CHF. Patients were retrospectively divided into two groups according to their outcome. Group A included 12 patients who improved and survived hospital admission, and group B included 18 patients who did not respond and died shortly after UF. Clinical, hemodynamic, and laboratory data before UF were fairly comparable between both groups. Renal function and hemodynamic parameters were compared and analyzed within the same group and between both groups before and after UF.

The mean age in group A was sixty-three ±thirteen years while in group B it was seventy ±eleven years (P < 0.005). A mean of 9.6 liters of fluid were removed from group A and 3.2 liters from group B (P < 0.001). Group A showed greater reduction in the mean values of right atrial pressure (P < 0.005) and pulmonary capillary wedge pressure (P < 0.05) after UF. Additionally, group A showed a significant decrease in their blood urea nitrogen (P < 0.05) and serum creatinine values (P < 0.05), in contradistinction to group B patients who showed a major increase in those values after UF. There was no significant change in the mean values of cardiac index, systemic vascular resistance, and pulmonary vascular resistance after UF. (continued on next page)

These findings suggest that younger age groups, greater fluid removal, as well as significant decreases in blood urea nitrogen, serum creatinine, and right atrial and pulmonary wedge pressures after UF, are associated with favorable outcome. Conversely, older age groups, less fluid removal, and rising blood urea nitrogen and serum creatinine levels after UF were associated with poor outcome.
Noninvasive Evaluation Of Right Ventricle Systolic Pressure During Dynamic Exercise by Saline-Enhanced Doppler Echocardiography in Progressive Systemic Sclerosis
Authors: Mininni Simone , Diricatti Gaetano , Vono Maria Concetta , Giglioli Cristina , Margheri Massimo , Olivo Giuseppe , Gensini Gianfranco , Galanti Giorgio
Published: July 2008

Progressive systemic sclerosis (PSS) is characterized in its first phases by vascular damage. Lungs are involved in two thirds of patients with initial progressive destruction of the capillary bed and consequent reduction of the functional reserve, which may lead to hypertension of the pulmonary circulation. For these reasons it is of great interest to have early information about the pressure of the pulmonary circulation, both at rest and during exercise, to follow the progression and the evolution of the illness independently from subjective symptoms.

The aim of the study was to evaluate by a noninvasive method, saline-enhanced Doppler echocardiography, the behavior of the right ventricular systolic pressure in patients with PSS, at rest and during exercise, without clear instrumental or clinical signs of pulmonary involvement at rest.

Nine patients (7 women and 2 men) with PSS, aged 55.7 ±8.7 years, and 9 control subjects were evaluated. All patients had normal pulmonary pressure at rest and negative history for effort dyspnea. Subjects underwent Doppler echocardiographic examination at rest and during exercise. Right ventricular systolic pressure was evaluated by saline- enhanced Doppler technique, at rest and throughout exercise. (continued on next page)

At rest the right ventricular systolic pressure was normal in all patients and controls. At the end of exercise, in 4 patients, values were still normal (40.7 ±2.2 mmHg); in the others pathologic values were recorded (59.8 ±3.9 mmHg). In the control group values were always normal (35.6 ±4.6 mmHg).

In our study the saline-enhanced Doppler echocardiography has been demonstrated to be an important diagnostic tool for the noninvasive evaluation of right ventricular systolic pressure, both at rest and during exercise; it could be useful in monitoring the pulmonary vascular damage in patients with PSS.
Comparative Assessment of the Effects of Vasodilators on Peripheral Vascular Reactivity in Patients with Systemic Scleroderma and Raynaud's Phenomenon: Color Doppler Flow Imaging Study
Authors: Aikimbaev Kairgeldy S. , Oğguz Mahmut , Özbek Sülayman , Demirtas Mustafa , Birand Ahmet , Batyraliev Talantbek
Published: July 2008

The aim of the present study was assessment of peripheral vascular reactivity during cold test and effects of different types of vasodilators on vascular resistance in patients with progressive systemic sclerosis and Raynaud's phenomenon with use of color Doppler flow imaging of upper extremity.
Stenotic Origin of an Aberrant Left Subclavian Artery from a Right-Sided Aortic Arch
Authors: Drnovsek Valerie , Weber Eric D. , Snow Ruth D.
Published: July 2008

A patient with a right-sided aortic arch giving origin to an aberrant left subclavian artery with circumferential ostial stenosis is reported. This asymptomatic anomaly was discov ered serendipitously during cerebral arteriography for subarachnoid hemorrhage. The embryologic origin of this anatomic variant is discussed, as are some practical implica tions relating to the angiographic technique of selective catheterization of branches of the aortic arch.
Evaluation of the Coagulation and Fibrinolytic Systems in Men with Intermittent Claudication
Authors: Handa Koichi , Takao Makiko , Nomoto Junko , Oku Keiko , Shirai Kazuyuki , Saku Keijiro , Arakawa Kikuo
Published: July 2008

The authors evaluated elements of the coagulation and fibrinolytic systems in 18 male patients with intermittent claudication vs 19 men matched for risk factors who served as controls.

Prothrombin time and activated partial thromboplastin time did not significantly differ in the patients and the controls. The plasminogen level in the two groups was not significantly different. The level of lipoprotein(a) was significantly higher in the patients than in the controls. The levels of antigen and the activity of protein C did not differ significantly between the two groups. The thrombomodulin level was significantly higher in the patients than in the controls. There were no significant differences between the two groups in the levels of α2-macroglobulin, C1-inactivator, or antithrombin III. The levels of fibrinogen and α-antitrypsin were significantly higher in the patients vs the controls. Significantly lower levels of α2-plasmin inhibitor and higher levels of α2-plasmin inhibitor/plasmin complex and thrombin/antithrombin III complex were found in the patients vs the controls.

These findings suggest that the levels of thrombin/antithrombin III complex, α2- plasmin inhibitor/plasmin complex, and thrombomodulin may perhaps serve as indica tors for injury to the peripheral endothelium and that the coagulation and fibrinolytic systems may be activated in patients with intermittent claudication.
Serial Changes in Blood Pressure and Neurohormone Levels After the Onset of Lacunar Stroke
Authors: Fujishima Shinichiro , Abe Isao , Okada Yasushi , Saku Yoshisuke , Sadoshima Seizo , Fujishima Masatoshi
Published: July 2008

To assess serial changes in blood pressure and its circadian variation following a lacunar stroke, the authors studied 7 patients who developed a single lacunar infarction in either the internal capsule or the corona radiata. Blood pressure and pulse rate were monitored noninvasively for twenty-four hours by an ambulatory blood pressure monitoring device in the acute, subacute, and chronic phases of the strokes. In the acute and chronic phases, the authors also measured urinary excretion of catecholamines every 6 hr, and serum cortisol concentration at 9:00, 17:00, and 21:00 hr. The patients were free from antihy pertensive agents during the study. The twenty-four-hour averages of both systolic and diastolic blood pressure in the chronic phase were lower than those in the acute phase (P < 0.05). A nighttime fall in blood pressure was observed in the subacute and chronic phases (P < 0.05), but not in the acute phase. Urinary excretion of epinephrine at night in the acute phase was significantly higher than that in the chronic phase (P < 0.05). Serum levels of cortisol at 17:00 and 21:00 hr in the acute phase also exceeded those in the chronic phase (P < 0.05 and P < 0.01, respectively). The authors conclude that an increased secretion of epinephrine and cortisol might, at least in part, contribute to a high blood pressure and a lack of circadian variation in blood pressure in the acute phase of lacunar stroke.
Acute Exacerbation of Masked Hyperthyroidism After Iodine Restriction Followed by Thyrotoxic Atrial Fibrillation and Cerebral Embolism
Authors: Kuroda Takeo , Okamura Ken , Sato Kaori , Inokuchi Kaeko , Mizokami Tetsuya , Fujishima Masatoshi
Published: July 2008

The authors present a seventy-two-year-old woman complaining of diffuse and firm goiter. At the first visit, she looked almost euthyroid with regular pulse rate of 78 per minute. After iodine restriction, however, she became severely thyrotoxic and developed cerebral embolism associated with atrial fibrillation due to Graves' hyperthyroidism. In conclusion, sudden withdrawal of dietary iodine might lead to exacerbation of Graves' hyperthyroidism resulting in serious cardiovascular or cerebrovascular complications, especially in elderly patients.
Prolonged Luminal Narrowing of Internal Mammary Artery Graft After Percutaneous Transluminal Angioplasty A Case Report
Authors: Ishizaka Nobukazu , Ishizaka Yuko , Ikari Yuji , Tamura Tsutomu , Suma Hisayoshi , Yamaguchi Tetsu
Published: July 2008

The authors describe a case with an internal mammary artery (IMA) graft that demon strated prolonged, but reversible, luminal narrowing persisting > twenty-four hours following percutaneous transluminal angioplasty. Luminal narrowing disappeared spon taneously, however, at the time of follow-up angiography one week after the angioplasty. Since haziness at the dilation site had been shown on preprocedural angiogram, sugges tive of intraluminal thrombus, this phenomenon may be attributed to either prolonged vasospasm or distal embolization of the IMA graft.
Leukocyte Flow Properties, Polymorphonuclear Membrane Fluidity, and Cytosolic Ca 2+ Content in Subjects with Vascular Atherosclerotic Disease with and Without Noninsulin-Dependent Diabetes Mellitus
Authors: Caimi Gregorio , Canino Baldassare , Ferrara Filippo , Montana Maria , Meli Francesco , Catania Anna , Lo Presti Rosalia
Published: July 2008

The aim of this research was the evaluation of white blood cell (WBC) filtration, reflecting WBC flow properties, polymorphonuclear cell membrane fluidity, and cytosolic Ca 2+ content in subjects with vascular atherosclerotic disease (VAD) and in VAD subjects with noninsulin-dependent diabetes mellitus (NIDDM), in good hemodynamic balance. The authors examined WBC filtration (unfractionated, mononuclear [MN], polymorphonu clear [PMN] cells), using the St. George Filtrometer and considering, respectively, the initial relative flow rate (IRFR) and the clogging rate (CR); the PMN membrane fluidity, employing the fluorescent probe TMA-DPH and calculating the fluorescence polarization degree; and the PMN cytosolic Ca2+ content, adopting the fluorescent probe Fura 2-AM and considering the ratio between the Fura 2-Ca2+ complex and the unchelated Fura 2 fluorescence intensity.

The obtained data showed that only the filtration parameters (IRFR, CR) of unfrac tionated WBCs discriminated normal subjects from VAD groups, whereas the filtration parameters of MN and PMN cells did not demonstrate any distinction. PMN membrane fluidity did not distinguish normal subjects from VAD groups, whereas PMN cytosolic Ca2+ content was significantly increased in VAD groups in comparison with normal subjects. No relationship was evident between WBC filtration and plasma metabolic para meters ; the correlations obtained between PMN filtration and other PMN parameters need further investigation.
Compensatory Enlargement of Angiographically Normal Coronary Segments in Patients with Coronary Artery Disease
Authors: Nakamura Yukio , Takemori Hitoshi , Shiraishi Kouichi , Inoki Isao , Sakagami Manabu , Shimakura Atsuhiro , Usuda Kazuo , Kubota Kouji , Takata Shigeo , Kobayashi Ken-ichi
Published: July 2008

Intravascular ultrasound (IVUS) frequently reveals plaque formation at sites with a normal angiographic appearance. However, whether angiographically normal coronary arteries undergo adaptive expansion in vivo remains uncertain. The authors studied 12 patients (11 men, 1 woman; mean age fifty-three ± ten years [mean ± SD]) with focal coronary stenosis. Sixty IVUS images from angiographically normal coronary segments were analyzed (14 left main, 44 left anterior descending, and 2 left circumflex coronary arteries). The mean percent area stenosis was 36 ± 5% and the circular shape factor of the lumen cross section averaged 0.97 ± 0.02. Both total arterial area and internal elastic lamina area increased as the plaque area expanded (y = 2.13x + 8.07, r = 0.87, P = 0.0001; y = 2.06x + 4.57, r = 0.87, P = 0.0001, respectively), suggesting that for every 1 mm2 increase in plaque area, the total arterial area increased by approximately 2.13 mm2 and the internal elastic lamina area increased by approximately 2.06 mm2. The lumen area also increased as the plaque area expanded ( y = 1.06x + 4.57, r = 0.68, P = 0.0001), suggesting that for every 1 mm2 increase in plaque area, the lumen area increased by approximately 1.06 mm2. The medial area did not correlate with the plaque area ( r = 0.15, P = 0.26). Thus, compensatory enlargement precedes development of angiographically detectable coronary atherosclerosis. Furthermore, in early stages of atherosclerosis, arterial enlargement may overcompensate for plaque area. The reduction of the total medial mass does not appear to contribute to the mechanism of compen satory enlargement.
Cortical Blindness Following Coronary Arteriography: A Rare But Self-Cured Complication
Authors: Antonellis John , Kostopoulos Konstandinos , Rambaouni Athina , Margaris Nikolaos , Kranidis Athanasios , Salahas Anastasios , Ifantis George , Koroxenidis Gabriel
Published: July 2008

The rare and self-cured complication of cortical blindness following coronary arteriog raphy is presented in 2 patients who underwent cardiac catheterization. Both patients were submitted to an aortocoronary bypass grafting procedure a few years before and were under clinical investigation for a new onset of unstable angina pectoris.
Myocardial Infarction in Myxoma Patients with Normal Coronary Arteries
Authors: Isobe Naoki , Kanda Tsugiyasu , Sakamoto Hironosuke , Morishita Yasuo , Suzuki Tadashi , Kobayashi Isao
Published: July 2008

Three cases of patients with cardiac myxoma who had attacks of acute myocardial infarc tion are presented. Cineangiographic study showed normal coronary arteries. Immunohistochemical and serologic examination revealed that both interleukin-6 and interleukin-8 were secreted in cardiac myxoma. The authors discuss the relation between these cytokines and myocardial infarction with normal coronary arteries.
Significance of Dual Left Anterior Descending Coronary Artery in Interventional Cardiology
Authors: Oral Derviş , Berkalp Berkten , Pamir Gülgün , Ömürlü Kenan , Erol Çetin
Published: July 2008

The variants of the left anterior descending (LAD) coronary artery are important in inter pretation of coronary angiograms and in interventional procedures. The authors present a patient who had percutaneous transluminal coronary angioplasty and stent implanta tion to a presumed proximal LAD without the realization that dual LAD was present because of the total occlusion of the long LAD.
Sarcoid Heart Disease: A Rare Cause of Chest Pain and Malignant Cardiac Arrhythmia in a Young Asian Man
Authors: Lip Gregory Y. H. , Gupta Jayant , Gill Jaswinder S. , Singh Shyam P.
Published: July 2008

Cardiac sarcoidosis is a disease of young adults. In most cases, it presents with sudden death, arrhythmia, conduction disorders, heart failure, or cardiomyopathy. The authors describe a young Indo-Asian man with cardiac sarcoidosis who presented acutely with chest pain and malignant cardiac arrhythmias. The diagnosis of cardiac sarcoidosis should be considered in all young patients with unexplained arrhythmias or heart failure or in cases of sudden death.
Effects of Right Ventricular Pacing on Ventriculoatrial Conduction and Systemic Venous Responses in Sick Sinus Patients
Authors: Chi Woon Kong  , Wen Lieng Lee  , Hsu Tsui-Lieh , Wan Leong Chan  , Jiann Jong Wang  , Liou Jer-Young , Wang Shih-Pu , Chang Mau-Song
Published: July 2008

This study was designed to assess the ventriculoatrial (VA) conduction and systemic venous responses to right ventricular pacing at different pacing rates and the feasibility of identifying patients prone to pacemaker syndrome by means of a Doppler and two- dimensional echocardiographic technique.

Twenty-two sick sinus patients who received ventricular-demand permanent pace makers constituted the study group. The proximal inferior vena cava (IVC) diameters were measured by two-dimensional echocardiography. Fourteen patients had VA conduc tion by preimplant electrophysiologic study or paced electrocardiogram (Group II), while the other 8 patients presented no VA conduction (Group I).

Abnormal systolic retrograde flow in the hepatic vein following each paced beat could be demonstrated in those patients with VA conduction in the basal state. In the 8 patients without VA conduction, the IVC diameters were significantly increased during rapid right ventricular pacing in those with left ventricular dysfunction (n=4) as compared with those with normal left ventricular function (n=4) (% increment at 120 beats per minute [bpm] pacing rate, 9% ±6% vs 2% ±3%, P = 0.03). Seven of 14 patients with retrograde conduction showed a 1:1 or 2:1 ratio of paced beat to retrograde flow, at 120 bpm pace rate (Group IIA). Their IVC diameter significantly increased at higher pacing rates than those presenting a higher ratio (group IIB) (% increment at 120 bpm paced rate, 7% ±6% vs -4% ±5%, P < 0.005). Four of 7 patients in group IIA developed symptoms of pacemaker syndrome. However, there were no significant changes in the severity of tricuspid regurgitation at different pacing rates.

These data suggest that detection of abnormal systolic retrograde flow in the hepatic vein and measurement of percent changes in IVC diameters during high pacing rates could be helpful in identifying possible pacemaker syndrome in patients receiving ventric ular-demand pacemakers.
2-D Time-of-Flight (TOF) MRA of Thrombophlebitis of Upper Extremity and Subclavian Veins
Authors: Chang Yeun-Chung , Dai Min-Hong , Wang Teh-Chen , Su Cheng-Tau , Chiu Lee C.
Published: July 2008

In this report, the authors present a case of segmental thrombosis of left subclavian vein that was inaccessible to conventional venography and inconclusive in magnetic resonance techniques (spin echo, gradient echo) but was clearly demonstrated by two-dimensional time-of-flight magnetic resonance angiography (2D TOF MRA). This technique is very sensitive to detect slow flow or partial occlusion of the vessels and is of great help in solving the problem of axillary-subclavian venous obstruction or thrombophlebitis.
Coronary Back Flow Pressure is Elevated in Association with Increased Left Ventricular End-Diastolic Pressure in Humans
Authors: Doi Yasuji , Masuyama Tohru , Yamamoto Kazuhiro , Mano Toshiaki , Naito Johji , Nagano Reiko , Kondo Hiroya , Hori Masatsugu
Published: July 2008

To clarify the effect of left ventricular (LV) diastolic pressure on the coronary pressure- flow relation in humans, the instantaneous diastolic coronary pressure-Doppler flow velocity relation was analyzed at rest and during papaverine-induced maximal vasodila tion in 15 patients with angiographically normal coronary arteries. The values for slope (αPF) and zero-flow pressure intercept (Pzf index) of the instantaneous diastolic coronary pressure-flow velocity relation were obtained by a linear regression analysis. Although αPF did not correlate with LV end-diastolic pressure (EDP), the Pzf index correlated posi tively with LVEDP both at rest and during maximal vasodilation (r=0.64, P < 0.05 and r=0.58, P < 0.05, respectively). Thus, the back pressure to coronary inflow, as indicated by the Pzf index, may be elevated in patients with increased LVEDP, resulting in the rightward shift of the maximally dilated coronary pressure-flow relation and decreased maximal coronary flow and reserve at any given perfusion pressure.
Delineation of Premature P Waves on Four-Dimensional Electrocardiography, a New Display of Electrical Forces by Computer Techniques
Authors: Morikawa Junichiro , Habuchi Yoshizumi , Nishio Manabu , Yamamoto Taku , Tanaka Hideo , Kashima Kei
Published: July 2008

This study investigated the feasibility of four-dimensional electrocardiography (4-D ECG), a new display in which the vector loop was rotated and scanned along a timed axis to overcome the shortcomings of vectorcardiography (VCG). The subjects consisted of 38 patients with premature atrial complexes and 30 controls. The orthogonal Frank elec trocardiograms were rotated three-dimensionally according to the right-hand rectangular coordinate system and scanned along a timed axis. The P wave delineation score, signi fying good agreement with the intraobserver and interobserver variability, was signifi cantly higher in 4-D ECG than those in the orthogonal leads or those on the transverse and frontal projections (P < 0.001). The authors measured the premature P loop areas as viewed from 361 directions. P loop areas were best delineated when viewed from cranial directions of 42.6 ±34.0 degrees and from rightward directions of 11.3 ±30.7 degrees. Adequate cranial rotation followed by scanning along a timed axis will maximally delineate premature atrial signals and provide comprehensive visualization of electrical forces.
Microvascular Changes in Venous Disease: An Update
Authors: Bollinger A. , Leu A.J. , Hoffmann U. , Franzeck U.K.
Published: July 2008

In an overview the microvascular involvement in chronic venous insufficiency (CVI) is described. Microangiopathy in the lower leg areas is characterized by the presence of typical enlarged and ramified blood capillaries, reduced capillary number, microvascular thrombosis and obliterations, and/or increased permeability of microlymphatics. Transcutaneous oxygen tension (tcPO2) is decreased and directly correlated to the number of perfused capillaries, whereas laser Doppler flux is enhanced. This apparent paradox may be explained by hyperperfusion in the deeper skin layers (mainly shunt vessels) and hypoperfusion in the superficial nutritive vessels.

Microvascular changes are of patchy distribution. Trophic changes up to overt venous ulceration are mainly caused by microvascular ischemia and edema formation due to increased capillary permeability and deficient lymphatic drainage.
Therapy Approaches for Lymphedema
Authors: Mortimer P.S.
Published: July 2008

Lymphedema, regardless of etiology, is essentially incurable but different therapy approaches exist which serve to contain swelling. The objectives of treatment are to reduce swelling, restore shape, and prevent inflammatory episodes, eg, recurrent cellulitis. There are essentially three main approaches to lymphedema treatment: physical therapy, drug therapy, and surgery.

Any edema arises from an imbalance between capillary filtration and lymph drainage. The principle of physical therapy is to a) reduce excessive capillary filtration and b) improve drainage of interstitial fluid and macromolecules from congested regions to normally draining lymph node sites. This is achieved through a combination of compres sion, exercise, and if possible, massage. Control of recurrent inflammatory episodes can only be achieved through diabetic type skin care, a reduction in swelling, and if necessary, prophylactic antibiotics.

Drug therapy comprises diuretics or the coumarin/flavonoid group of drugs. The use of diuretics for pure lymphedema is physiologically unsound but may be of use in edema of mixed origin and in palliative (cancer) circumstances. Coumarin/flavonoids have been shown to reduce swelling in all types of lymphedema.

Surgery is indicated at an early stage for facial swelling, where vision is compro mised, or genital lymphedema, where genitourinary function is affected. Otherwise, reducing operations should only be performed when alternative therapy has failed. Microsurgery for certain forms of lymphedema continues to be evaluated.
Survival Following Cardiogenic Shock Caused by Acute Left Main Coronary Artery Total Occlusion
Authors: Itoh Tomonori , Fukami Ken'ichi , Oriso Seizou , Umemura Jun , Nakajima Jun , Obonai Hisato , Hiramori Katsuhiko , Fukami Ken'ichi
Published: July 2008

The authors describe a fifty-five-year-old Japanese man with an acute extensive anterior myocardial infarction associated with a total occlusion of the left main coronary artery. The patient suffered cardiogenic shock and was treated successfully with rescue percu taneous transluminal coronary angioplasty and an intraaortic balloon pump (IABP) after unsuccessful intracoronary thrombolysis. Ten days after admission, he was weaned from IABP, and recovery-phase coronary angiography revealed no significant coronary artery stenosis and an ejection fraction of 32% by left ventriculography. The patient was discharged from the hospital without any ischemic findings.
Cholestyramine Therapy for Quinidine-Induced Diarrhea
Authors: RuDusky Basil M. , RuDusky Basil M.
Published: July 2008

The effective use of quinidine as an antiarrhythmic agent is frequently curtailed by one of its most common side effects—relentless diarrhea. Seven patients are described in whom diarrhea was quickly and completely controlled by the use of cholestyramine resin. To date, this is the only therapy reported to be effective for this purpose. It has proven to be safe, well tolerated, and continuously effective in these cases.
Lipid Profile and Peripheral Vascular Disease in Arseniasis-Hyperendemic Villages in Taiwan
Authors: Tseng Chin-Hsiao , Chong Choon-Khim , Chen Chien-Jen , Tai Tong-Yuan
Published: July 2008

To examine whether lipid abnormalities contributed to the endemic peripheral vascular disease (PVD) in villages where arseniasis was hyperendemic in Taiwan, the authors studied 533 adults with Doppler ultrasound and lipid profiles including total cholesterol, triglyceride, high- and low-density lipoprotein cholesterol, apolipoprotein AI, and apolipoprotein B. Among them, 63 had PVD based on an ankle-brachial index < 0.90. Long-term arsenic exposure indices including cumulative arsenic exposure in mg/L-years, duration of drinking artesian well water in years, and duration of living in arseniasis- hyperendemic villages in years were calculated from detailed history obtained through standardized interviews based on a structured questionnaire and arsenic concentration in well water. Possible confounders including age, sex, body mass index, cigarette smoking, and disease status of diabetes mellitus and hypertension were considered in the analyses. None of the lipid profiles differed significantly between the presence and absence of PVD. The odds ratios for PVD did not differ among different quintiles of lipid profiles with the lowest quintile as the referent. However, a significant dose-response relation was found for the long-term arsenic exposure indices. The multivariate-adjusted odds ratios for cumulative arsenic exposure of 0.1∼19.9 and ≥ 20 mg/L-years were 2.77 and 4.68, respectively, compared with the unexposed. These results suggest that the PVD in arse niasis-hyperendemic villages is correlated with ingested inorganic arsenic and not with the lipid profiles.
Aortoiliac Occlusion Associated with the Lupus Anticoagulant
Authors: Setoguchi Motoko , Fujishima Yae , Abe Isao , Kobayashi Kazuo , Fujishima Masatoshi , Setoguchi Motoko
Published: July 2008

Aortoiliac occlusion due to atherosclerosis is known to occur in elderly people. Two unique cases are documented here in which aortoiliac occlusion was observed in young men. These patients had no identifiable risk factors for developing atherosclerotic throm bosis except for the lupus anticoagulant, an immunoglobulin associated with throm boembolic episodes. Although previously the lupus anticoagulant has been reported to cause thrombosis only in relatively small-sized arteries or veins, it may also be associated with aortoiliac atheromatous occlusion in young men.
A Case of Favorable Dilation of Protected Left Main Coronary Artery Lesion Achieved Through Performance of Adjunctive DCA on Residual Stenosis Following Use of Rotablator
Authors: Taniguchi Masayuki , Yabe Yoshimasa , Nakano Hajime , Wagatsuma Kenji , Kabano Toshio , Uchida Toshihiko , Taniguchi Masayuki
Published: July 2008

It is believed that directional coronary atherectomy (DCA) is more suitable than percu taneous transluminal coronary angioplasty for lesions such as severe eccentric lesions, ostial lesions, and branch lesions. However, it remains a fact that lesions that are also highly calcified are often suboptimal, since there may be difficulties such as in insertion of the housing and in sufficient cutting and removal. On the other hand, Rotablator is effective on calcified lesions, but afterward, dilation by balloon angioplasty for residual stenosis becomes necessary in many cases. This is a report of the authors' experience on an interesting case in which favorable dilation of a lesion in the protected left main coronary artery (LMCA) was achieved by using Rotablator after confirmation of a high degree of calcification by means of intravascular ultrasound (IVUS) echocardiograhy, followed by the performance of DCA on the residual stenosis.
Cholera and Myocarditis
Authors: Leon Francisco , Badui Elias , Campos Arturo , Enciso Roberto , Fakih Tarek , Guadarrama Maria , Valdespino Aquiles , Murillo Hector , Calleja Consuelo , Badui Elias
Published: July 2008

The authors describe the case of a fifty-nine-year-old white man, previously in good health, who initiated his present illness with acute episode of enterocolitis characterized by mild fever and, in the next eight hours, twenty-four episodes of watery diarrhea, nausea and vomiting, as well as generalized sweating and severe weakness secondary to hypovolemia and electrolyte disorder. These complications were corrected in seventy- two hours in the intensive care unit. Two days later, when the patient was stable hemo- dynamically, under cardiac monitoring and with normal laboratory studies including serum electrolytes, he developed electrocardiographic changes characterized by trifasci cular block (prolonged P-R interval, complete right bundle branch block [CRBBB] and left posterior hemiblock [LPH]) with a cardiac rate of thirty beats per minute, for which a temporary pacemaker was inserted. Endomyocardial biopsy showed histopathologic signs of myocarditis and the immunologic study of the cardiac tissue revealed positive poly merize chain reaction (PCR+) with the presence of antitoxine choleric antibodies (AcTCA). After three weeks, the same conduction disturbances remained, for which a permanent pacemaker was inserted. On top of intravenous fluid replacement and elec trolyte supplements, the patient was managed with tetracycline 2 g a day for one week and sulfamethoxazole-trimethoprim 800/160 mg a day for two weeks. The purpose of this study is to present a rare and very well-documented myocarditis by cholera in a patient with enteric disease, in whom several cardiac complications occurred.
Noninvasive Detection of Iliac Artery Disease and Prediction of Its Severity from Doppler Spectral Analysis in Common Femoral Artery
Authors: Makita Shinji , Ohira Atsushi , Murakami Hirofumi , Itoh Shigehiro , Hiramori Katsuhiko , Makita Shinji
Published: July 2008

The direct interrogation of iliac artery disease (IAD) with color-coded duplex scanning is limited by the presence of intestinal gas or obesity. The purposes of this study were to examine the diagnostic accuracy of duplex ultrasound (DUS) analysis of spectral waves in common femoral artery (CFA) for detection of IAD and to predict its severity.

DUS and arteriography were performed in 107 lower extremities in this study. The following were calculated from the CFA spectral waves obtained by DUS: peak systolic velocity (PSV), acceleration (PSV/pulse rise time), and deceleration (PSV/pulse decay time). In patients with isolated IAD, the treadmill exercise test was also performed to evaluate the ischemic severity expressed as recovery rate of ankle pressure index five minutes after exercise (RR-API). Forty-six lower extremities with IAD and 61 without IAD were diagnosed by arteriography. PSV was significantly reduced in lower extremities with IAD (109.5 ±32.7 vs 59.8 ±32.9 cm/s, P<0.05). The deceleration detected IAD with a greater specificity and sensitivity vs acceleration (100.0 vs 82.0% and 97.8 vs 82.6%, respectively). Moreover, the acceleration and deceleration significantly corre lated with the RR-API (r=0.589, P<0.05 and r=0.779, P < 0.01, n=14, respectively).

The present evaluation is a simple and accurate technique to augment other exami nations for detection of IAD and to assess its ischemic severity.
Leriche Syndrome
Authors: Sugimoto Takaki , Ogawa Kyoichi , Asada Tatsuro , Mukohara Nobuhiko , Higami Tetsuya , Obo Hidefumi , Gan Kunio , Kitano Ikuo , Izumi Yuko , Sugimoto Takaki
Published: July 2008

During the past thirteen years, 29 patients underwent surgical intervention for Leriche syndrome. Fifteen patients (aged forty-two to seventy-two years, average 60.7 years) underwent anatomical bypass, and 9 of them whose thrombus was confined to the infrarenal aorta received a routine graft insertion. In the other 6 whose thrombus extended to the level of the renal arteries, an open thrombectomy of the juxtarenal aorta was first performed through a transection of the infrarenal aorta under renal ischemia (4-14 minutes, average 7). Twelve elderly or high-risk patients (aged sixty-eight to eighty-four years, average 75.3 years) underwent an axillobifemoral bypass, and another (continued on next page) 2 (fifty-eight and sixty years old, respectively) who had been operated on at an earlier time received an ascending aortobifemoral bypass.

In cases of anatomical bypass, no graft has occluded and all patients but 1, who died of cerebral infarction, have an active life now. In cases of extraanatomical bypass, 5 of the 28 grafts occluded and only 6 patients have survived. The other 8 patients died of malignancy, atherosclerotic complications, or unknown causes. The 10-year survival rate was 92.9% and 29.5% in the anatomical bypass and extraanatomical bypass group, respectively.

In Leriche syndrome, anatomical bypass is preferred to extraanatomical bypass if conditions permit. In the juxtarenal type, an open thrombectomy under renal ischemia is mandatory for anatomical bypass, and a transection of the infrarenal aorta facilitates this procedure. Because the patients with Leriche syndrome are elderly and harbor arte riosclerotic lesions, a careful follow-up is mandatory.