bluuebunny/crossref_metadata_2025 huggingface dataset:
Recurrent Embolization During Intravenous Administration of Tissue Plasminogen Activator in Acute Cardioembolic Stroke
Authors: Yasaka Masahiro , Yamaguchi Takenori , Yonehara Toshiro , Moriyasu Hideki
Published: July 2008

Treatment with recombinant tissue plasminogen activator (rt-PA) has been applied in acute cardioembolic stroke to reopen the occluded vessel and improve the patient's neurologic deficit. However, the effect of this therapy on intracardiac thrombus has not been documented previously

A forty-five-year-old man with dilated cardiomyopathy developed acute cardioem bolic stroke with disturbance of consciousness, right hemianopia, right hemiplegia, and global aphasia. Cerebral angiography demonstrated occlusion of the left middle cerebral artery trunk. Intravenous administration of 30 megaunits (MU) of recombinant tissue plasminogen activator was commenced two hours after the ictus and completed within sixty minutes. Cerebral angiography was repeated just after this treatment and demon strated a new occlusion of the left intracranial internal carotid artery along with occlusion of a branch of the left external artery. The authors subsequently performed two-dimen sional echocardiography and found a mobile thrombus in the left ventricle.

In patients with intracardiac mobile thrombi, recombinant tissue plasminogen activator seems to accelerate breakup or detachment of the thrombi and subsequent recurrent embolization. Therefore, it seems better to pay attention to the presence of mobile intracardiac thrombus before commencing intravenous infusion of rt-PA.
Effect of Rate of Administration of Recombinant Tissue Plasminogen Activator on Efficacy of Coronary Thrombolysis
Authors: Prewitt Richard M. , Gu Shian , Schick Usha , Ducas John
Published: July 2008

The authors employed a canine model of coronary thrombosis, induced by injection of radioactive blood clot, via a catheter placed in the left anterior descending (LAD) coronary artery, to compare effects of different rates of administration of recombinant tissue plasminogen activator (rtPA) on efficacy of coronary thrombolysis. In one group of dogs 0.75 mg/kg of rtPA was administered via the catheter placed in the LAD coronary artery over fifteen minutes. In a second group of dogs the same dose of rtPA was admin istered over forty-five minutes. Compared with the group in which the drug was admin istered over forty-five minutes, by thirty and forty-five minutes after onset of treatment, the extent of coronary thrombolysis was significantly greater (P < 0.05) in the group who received the drug over fifteen minutes. These results demonstrate that the rate of intracoronary administration of rtPA may significantly affect thrombolytic efficacy
Dietary Treatment of Lymphedema by Restriction of Long-Chain Triglycerides
Authors: Soria P. , Cuesta A. , Romero H. , Martinez F.J. , Sastre A.
Published: July 2008

Two patients suffering from idiopathic unilateral lower limb lymphedema were treated with a diet in which long-chain triglycerides (LCT) were drastically restricted. From the beginning of the treatment, a distinct improvement was observed in both patients, with reduction of the affected limb perimeters, decrease of edema tension, and decrease of skin turgescence. Patient A underwent weight loss, and the reduction of the diameter of the affected limb was greater than that in the nonaffected limb. In patient B, whose weight remained stable during the study, the diameter of the affected limb underwent a remarkable diminution, while no changes were detected in the nonaffected limb.

To the authors' knowledge, this is the first report of dietary treatment of idiopathic lymphedema, these being preliminary results of an ongoing study in a group of patients suffering from lymphedema treated with a low LCT diet.
Splenic Artery Aneurysm and Upper Gastrointestinal Bleeding in a Nulliparous Woman
Authors: Huncharek Michael , Klassen Henry , Klassen Mary
Published: July 2008

An eighty-three-year-old nulliparous woman hospitalized for orthopedic surgery developed postoperative upper gastrointestinal bleeding and hypotension resulting in her death. Postmortem examination revealed a ruptured splenic artery aneurysm. This is the second reported case of gastrointestinal bleeding due to ruptured splenic artery aneurysm in a nulliparous woman and the first such case resulting in death. The incidence, pathophysiology, clinical presentation, and diagnosis of splenic artery aneurysm are discussed.
Acute Myocardial-Infarction-Like Findings with Myocarditis in Infancy
Authors: Folger Gordon M. , Eltohami Eltohami Ahmed , Hajar Hajar Ahmed
Published: July 2008

A four-and-a-half-month-old infant suffered sudden circulatory collapse early in the course of a brief febrile illness. The electrocardiogram initially appeared normal; an abrupt change indicative of extensive myocardial infarction occurred following stabi lization. Coronary arterial anatomy and flow by echocardiography and angiography were normal except for the finding of single origin of the entire coronary system from the left sinus of Valsalva. Gallium 67 myocardial imaging was positive for an inflammatory process, and the diagnosis of myocarditis was supported. This is the first case, to the authors' knowledge, of myocarditis simulating myocardial ischemia in an infant of an age in which anomalous origin of the left coronary artery from the pulmonary artery is a recognized cause for myocardial infarction.
Pharmacotherapy of Chronic Pulmonary Arterial Hypertension: Value and Limitations
Authors: Alpert Martin A. , Concannon Milton D. , Mukerji Basanti , Mukerji Vaskar
Published: July 2008

Part I of this review discussed pharmacotherapy of primary pulmonary hypertension (PHT). Part II describes the value and limitations of oxygen and vasodilator therapy of secondary PHT, focusing on patients with PHT associated with selected connective tissue disease and chronic nonthrombotic hypoxic lung disease.
Usefulness of the Pulmonary Vein Flow Velocity-Time Profile as an Estimate of Left Atrial Storage Fraction
Authors: Arakawa Michio , Miwa Hiroshi , Noda Toshiyuki , Ito Yoshimi , Kagawa Kensaku , Nishigaki Kazuhiko , Kambara Kenjiro , Tomita Masaaki , Hirakawa Senri
Published: July 2008

During ventricular systole, the left atrium (LA) stores a certain amount of ventricular stroke volume; this is defined as an LA storage volume. From cineangiocardiograms, an LA storage fraction is obtained as the ratio of the LA storage volume to left ventric ular stroke volume. From the pulmonary vein (PV) flow velocity-time profile, the LA storage fraction may be estimated as a ratio of the PV flow velocity-time integral during systole (Sa) to a sum of that during systole and diastole (Sa+Da), namely, Sa/(Sa+Da), provided that the PV cross-sectional area remains relatively unchanged during one cardiac cycle and that the PV flow velocity-time profile is similar in any of the PVs draining to the LA. To evaluate usefulness of Doppler echocardiographic method of estimating the LA storage fraction, the authors measured the LA storage fraction from the left upper PV flow velocity-time profile by transesophageal Doppler echocardiography and compared it with the LA storage fraction from conventional cineangiocardiographic volumes. (continued on next page)

Subjects were 23 patients with a variety of cardiac diseases in normal sinus rhythm, ranging from eighteen to seventy-four years of age. The LA storage fraction was 0.58 ±0.12 (mean ±SD) from cineangiocardiography and 0.64 ±0.08 from Doppler echocar diography. Although the LA storage fraction from Doppler echocardiography was signif icantly larger than that from cineangiocardiography (P < 0.01), the correlation was good ( r=0.643). The authors conclude that the left upper PV flow velocity-time profile appears to provide a better correlation with that by cineangiography and may be used as a reliable quantitative estimate of the LA storage fraction.
Catheter-Directed Urokinase Thrombolysis: An Adjunct To PTA/Surgery for Management of Lower Extremity Thromboembolic Disease
Authors: Schilling Jolyon D. , Pond Gerald D. , Mulcahy Maureen M. , McIntyre Kenneth E. , Hunter Glenn C. , Bernhard Victor M.
Published: July 2008

Catheter-directed thrombolysis was used either alone or as an adjunct to percutaneous transluminal angioplasty (PTA) or surgery for peripheral vascular occlusion on 112 occasions in 102 patients. Symptom duration ranged from < one to > twenty-eight days. Thrombolytic therapy using urokinase plasminogen activator thrombolysis (uPAT), including intrathrombic injection when possible, was successful (> 50% lysis) in 99 procedures (88%). Technical failure (<50% lysis) occurred in 13 procedures (12%). In 9 of the 13 failures, intrathrombic injection of urokinase was not possible, but the duration of occlusion was > twenty-eight days in all but 1. Two other failures were from embolic sources and 2 more occurred in patients with a hypercoagulable state.

The uPAT was adjunctive to PTA/surgery in 56 cases (50%). PTA following uPAT was required and successfully performed in 24 of 27 cases (88.9%). Surgery followed lytic therapy in another 32 (including the 3 failed PTAs). In the remaining 56 cases (50%), no additional intervention was required.

There were 20 complications (18%), minor in 16 of 20 (80%). Minor complications included small puncture site hematomas and distal embolization resolved by continued lytic therapy Four major complications occurred. One was retroperitoneal hemorrhage directly contributing to the only death in the series. The other 3 were hematuria (2) and femoral neuropathy (1).

The authors conclude that catheter-directed lytic therapy alone or as an adjunct to PTA/surgery is a valuable approach to peripheral vascular thromboembolic disease. It is less likely to succeed in chronic occlusion. The incidence of complications is moderate but acceptable.
Long-Term Follow-up After Peripheral and Coronary Angioplasty in Patients Undergoing Both Types of Procedure
Authors: Millaire A. , de Groote P. , Decoulx E. , Coullet J.M. , Marache P. , Brunet J.Y. , Bertrand M.E. , Ducloux G.
Published: July 2008

Restenosis rates after peripheral and coronary angioplasties have been assessed only in patients who had either peripheral angioplasty or coronary angioplasty but never in patients who had both types. Among the 6364 angioplasties performed in the authors' institution since 1980, they studied 38 patients (36 men, 2 women, mean age fifty-five years, range thirty-four to seventy-seven) who had both peripheral and coronary angio plasty. The peripheral angioplasties were most often performed on iliac artery stenoses. They were performed before coronary angioplasty in 22 patients (58%) and after coronary angioplasty in 16 patients (42%). The follow-up after peripheral angioplasty was based on clinical data; ultrasound investigation was performed when the result of the clinical follow-up was poor (maximal walking distance lower than 500 meters). Follow- up after coronary angioplasty was assessed by a systematic coronary angiography at six months and with long-term clinical follow-up. The mean durations of the follow-up after peripheral or coronary angioplasty were not significantly different (respectively fifty-six ±eleven and forty-two ±nine months [mean ±2 SEM]). No patient was lost to clinical follow-up; 17 (45%) ultrasound investigations, 12 (32%) peripheral angiographies, and 34 (89%) coronary angiographies were performed. The restenosis rate after peripheral angioplasty was 18% and that after coronary angioplasty was 34%. These rates are similar to the classic rates observed in the literature. In conclusion, as reported for either procedure alone, the restenosis rates after peripheral angioplasty and after coronary angioplasty are different when assessed in patients who undergo both types of angioplasty.
Glucose Intolerance in Chronic Respiratory Failure
Authors: Umeki Shigenobu
Published: July 2008

A 75-g oral glucose tolerance test (OGTT) was performed on 18 patients with chronic respiratory failure and without fasting hyperglycemia, positive urine glucose, or hepatic/pancreatic disorders. Underlying diseases in these patients were pulmonary emphysema (11 cases, 61%), pulmonary tuberculosis (5 cases, 28%), and chronic bronchial asthma (2 cases, 11%). The body mass index (mean ±SD, 17.6 ±2.2 kg/m2, P < 0.001) in these patients was significantly lower than that (23.8 ±3.1 kg/m2) in normal subjects. The OGTT results showed an impaired glucose tolerance pattern in 9 cases (50%) and a diabetes mellitus pattern in 6 cases (34%). The mean two-hour plasma glucose value in the patients was 9.8 mmol/L. However, insulin secretion responded well to glucose loading. These results suggest that a high proportion of chronic respiratory failure patients may have an intolerance for glucose loading but a normal insulin secretion pattern.
Effects of a Low-Dose Fish Oil Concentrate on Angina, Exercise Tolerance Time, Serum Triglycerides, and Platelet Function
Authors: Salachas Anastasios , Papadopoulos Constantinos , Sakadamis George , Styliadis John , Voudris Vasilis , Oakley David , Saynor Reginald
Published: July 2008

Fish oils have shown beneficial effects on various parameters in patients with coronary artery disease (CAD). The purpose of this study was to investigate whether the same effects can be demonstrated with a low dose of fish oil concentrate (FOC).

Thirty-nine patients were studied and divided into two groups. Twenty were given 10 g fish oil (group A) and 19 were given 10 g placebo Italian olive oil (group B).

Weekly anginal attacks (AA), weekly glyceryl trinitrate consumption (GTN), exercise tolerance time (ETT), serum triglycerides (ST), platelet aggregation ratio (PAR), and β- thromboglobulin were measured at eight and twelve weeks after start of treatment.

1. The number of anginal attacks recorded by both groups decreased by 41% in group A reaching statistical significance (P < 0.05). No change was observed in group B.

2. GTN consumption decreased in group A (P < 0.05) with no significant change in group B (P: ns).

3. ETT increased significantly in group A eight and twelve weeks after start of treatment (20.6% P < 0.01, 22.6% P < 0.01). A smaller but insignificant increase was observed in group B (P: ns).

4. ST decreased significantly in group A by 22% eight weeks after start of treatment (P < 0.01) and to a lesser degree (11%) twelve weeks after start of treatment (P: ns). In group B, ST slightly increased (P: ns). (continued on next page)

5. No statistically significant change was observed in either group in regard to PAR and β-thromboglobulin (P: ns).

These observations suggest that dietary supplementation with a low dose of FOC may have beneficial effects on the clinical status of patients with CAD. It also seems that this low dose has no impact on platelet function.
Temporal Arteritis Associated with Acute Q Fever
Authors: Odeh Majed , Oliven Arie
Published: July 2008

The authors describe the case of a sixty-four-year-old man who presented with clinical and histopathologic evidence of temporal arteritis associated with acute Q fever. This association, which has not been previously reported, supports the possible infectious etiology in temporal arteritis.
The Effect of a Cerebral Vasodilator, Vinpocetine, on Cerebral Vascular Resistance Evaluated by the Doppler Ultrasonic Technique in Patients with Cerebrovascular Diseases
Authors: Miyazaki Manabu
Published: July 2008

Changes in cerebral vascular resistance were examined in patients with cerebral circulatory diseases by the Doppler ultrasonic technique after administration of a cerebral vasodilator, vinpocetine, for two months.

Continuous index (CI) and pulsatility index (PI) of the blood flow pattern in the internal carotid artery were used as objective parameters for changes in cerebral vascular resistance.

1. The CI and PI changed significantly after administration of the drug; ie, the CI increased while the PI decreased.

2. An inverse correlation was noted between the rate of change of the CI (ΔCI) and that of the PI (ΔPI).

3. The results suggest that measurement of the CI and PI by the Doppler ultrasonic technique is useful in investigating the effect of drugs on the cerebral circulation.
Lipid Profile in the First-Degree Relatives of Patients with Precocious Coronary Heart Disease in Rohtak Area (Northern India)
Authors: Ahlawat Sushil , Gupta Sanjay , Siwach S.B. , Mohan S.
Published: July 2008

Twenty-five patients with precocious coronary heart disease (CHD) (aged forty years or less) and 82 first-degree relatives were studied for lipid profile. Eighty-eight age- and sex-matched controls were also studied. The mean serum cholesterol, triglycerides, low density lipoprotein cholesterol, very low density lipoprotein cholesterol, and total cholesterol/high density lipoprotein cholesterol of patients and their first-degree relatives were significantly higher as compared with normal controls. High density lipoprotein cholesterol values were found to be almost identical in the patient group, their first-degree relatives, and normal controls. Hyperlipidemia was found in 68% of patients with CAD, of their first-degree relatives, and 24% of controls. Almost all lipid fractions in relatives of hyperlipidemic patients paralleled those of the patients suffering from CHD. Of 25 families studied, 16 had hyperlipidemia. In conclusion, it can be stated that there is a statistically significant hyperlipidemia in young patients with CHD that has a significant familial clustering, thus delineating a group of high-risk individuals (first-degree relatives of young coronary patients) for possible primary prevention of CHD. This familial clustering could be due to genetic or environmental factors; however, the relative contribution of these two factors requires further investigation.
Seeding of Vascular Grafts with an Immortalized Human Dermal Microvascular Endothelial Cell Line
Authors: Robinson Keith A. , Candal Francisco J. , Scott Neal A. , Ades Edwin W.
Published: July 2008

Small-caliber vascular grafts (< 6 mm) for arterial bypass frequently fail owing either to acute thrombosis or long-term fibrosis. One strategy to enhance patency is the coverage ("seeding") of luminal polymeric graft surfaces with endothelial cells (EC), which may in themselves be thromboresistant and antiproliferative, or which could be transfected with genes whose products are thrombolytic or growth-inhibitory. Advances in understanding of EC-biomaterial interaction have led to improvements in cell coverage and retention, but the sources of EC for such procedures have been limited to large vessels (autologous veins) and microvascular endothelium isolated from autologous adipose tissue. Before the practice of graft seeding can gain widespread clinical acceptance, the practical constraints of EC harvest, EC culture, and quick access to the seeded prosthesis for the surgical procedure must be overcome. Ideally, an EC line with a high proliferative capacity could be preestablished on the grafts, which could then be cryopreserved and made available as needed. The authors have seeded Dacron graft material with an immortalized human dermal microvascular EC line, HMEC-1. These cells were initially transfected with simian virus 40A large T antigen and have been passaged more than 100 times without signs of senescence. They also express von Willebrand factor, take up acetylated low density lipoproteins, and rapidly form tubes when cultured on matrigel. Confluent coverage of Dacron graft segments, either untreated or coated with gelatin, was achieved in two weeks. The cells formed a monolayer over topographically elevated regions or appeared to be > one layer thick in other areas. Cells were also shown to remain viable after freezing. These results suggest a potential practical method for enhancement of small- caliber vascular graft biocompatibility in humans.
Transesophageal Echocardiography in Evaluation of Atrial Masses
Authors: Alam Mohsin , Rosman Howard S. , Grullon Carlos
Published: July 2008

Clinical and transthoracic echocardiographic findings in 92 patients who had atrial mass lesions identified by transesophageal echocardiography were retrospectively analyzed. Transthoracic echocardiography failed to diagnose or misdiagnosed 16 patients with small (< 3 cm) atrial thrombi, patients with thrombi localized to the appendage, or patients with technically difficult studies. The 3 patients with atrial myxoma who were not detected or were misdiagnosed by transthoracic echocardiography had small tumors (< 3 cm) or origin from the free wall of the atrium away from the atrial septum. Transthoracic study also failed to diagnose or misdiagnosed normal anatomic variants in 17 of 32 patients. In conclusion, transesophageal echocardiography is superior to the transthoracic study in evaluating the etiology and significance of atrial mass lesions.
Celiprolol vs Propranolol in Unstable Angina Pectoris: A Double-Blind, Randomized, Parallel-Group Study
Authors: Cleophas Ton J. , van't Leven Marjolein , Kauw Frans H. , Remmert Hendrik P. , Kuijper Aaf , Zwinderman Koos , Math D.
Published: July 2008

Celiprolol, a novel beta blocker, may be more effective than propranolol in unstable angina pectoris because of both its beta-1-receptor selectivity and its vasodilator property In the present report 53 patients with angiographic coronary artery disease but uncom promised left ventricular function and with electrocardiographically documented recurrent angina pectoris in spite of bed rest, aspirin, and repeated sublingual adminis tration of nitroglycerin were studied. They were randomized for treatment with equipo tent doses of either the nonselective beta blocker propranolol (80 mg/day) or the selective beta blocker with beta-2-agonistic property, celiprolol (200 mg/day) during one week. Angina frequency was higher in the propranolol group (P < 0.01), whereas myocardial oxygen demand as estimated by the double product (DP = SBP x HR, systolic blood pressure x heart rate) was equally reduced by the two beta blockers. Forearm blood flow was essentially higher in the celiprolol group (P < 0.001). A stepwise logistic regres sion analysis showed that the beneficial effects of the beta blockers were largely dependent on their effect on peripheral flow, in addition to reduction of the double product.

The authors conclude that (1) Both celiprolol and propranolol largely reduce angina pectoris frequency in unstable angina pectoris. (2) Celiprolol contributes to nearly complete relief in three times as many patients as propranolol; after adjustment for double product or for systolic blood pressure plus heart rate it performs even eight times better. (3) The similar effects of the two compounds on the double product and the essen tially different effects on peripheral flow support the conclusion that celiprolol exerts its beneficial effect to a large extent through its vasodilator property
Plasma Catecholamines, Thrombocyte Alpha 2- and Lymphocyte Beta 2-Adrenoceptor Densities in Hypertensive Patients with Low or Normal Plasma Renin Concentrations
Authors: Müller Ralf , Steffen Hans Michael , Juretzko Petra , Bönner Gerd , Krone Wilhelm
Published: July 2008

The sympathetic nervous system is unique in the regulation of plasma renin, for it can stimulate or suppress renin release by activation of either renal beta- or alpha2-adreno ceptors. The authors studied plasma renin concentration (PRC), noradrenalin and adrenalin levels in plasma, and the densities of lymphocyte beta2-adrenoceptors and thrombocyte alpha2-adrenoceptors in 25 hypertensive patients with either normal (11-40 mU/L; n=9) or low PRC (0-10 mU/L; n=14). There were no differences in plasma cate cholamine levels and adrenoceptor densities between the two patient groups. A positive correlation (r=0.66; P < 0.005) between beta2-adrenoceptor density and PRC in the patient group with low PRC, and a negative correlation ( r=-0.72; P < 0.01) between alpha2-adrenoceptor density and plasma renin in patients with normal PRC were found. They conclude that adrenoceptor densities on blood elements and plasma catecholamines do not differ in low and normal renin hypertension. The significant correlations between adrenoceptor densities and PRCs may indicate that adrenoceptors on blood elements mirror adrenoceptor densities in the kidney and that tonic suppression of renin release through alpha2-adrenoceptors is preserved in hypertensive patients with normal plasma renin levels.
Do Hydrophilic Guidewires Affect the Technical Success Rates of Percutaneous Angioplasty?
Authors: Hartnell George G. , Jones Ann M. , Murphy Paula
Published: July 2008

To determine whether the use of hydrophilic guidewires has influenced the success of peripheral percutaneous transluminal angioplasty (PTA), the results of PTA performed before and after the introduction of such guidewires (end of 1989) were analyzed.

Before hydrophilic guidewires became generally available, the technical success rates for iliac stenosis PTA were 96%, for femoral stenosis PTA 84%, and for femoral occlusion 78%. After the introduction of hydrophilic guidewires, technical success rates were 100% (NS), 97% (P=0.018), and 97% (P=0.011), respectively.

A prospective study of 33 patients randomly selected for PTA of femoropopliteal occlusion using either conventional or hydrophilic guidewires was performed. In this group, the technical success rate was 14/15 in the hydrophilic group, and 18/18 in the conventional group (NS). Since the introduction of hydrophilic guidewires, the technical success rates of PTA have improved and are now approaching 100%.
Multiple Aneurysms of the Cephalic Vein
Authors: Ekim Hasan , Gelen Tekinalp , Karpuzoglu Gülten
Published: July 2008

An uncommon case of multiple multiform venous aneurysms of the cephalic vein of a seventeen-year-old girl is presented. The case is discussed in the light of the related literature.
Beneficial Effects of Antioxidants in Hemorrhagic Shock
Authors: Kapoor Rakesh , Prasad Kailash
Published: July 2008

The present study was undertaken to investigate the role of endogenous hydrogen peroxide (H202) in cardiac depression and cytotoxicity during hemorrhagic shock and reinfusion. To achieve this objective, the changes in the cardiac function and contractility, plasma creatine kinase (CK) and CK-MB activity and lactate concentration, oxyradical producing activity of polymorphonuclear leukocytes (PMNL-CL), and cardiac malondi aldehyde (MDA) concentration in anesthetized dogs were determined before and during shock and reinfusion in the presence or absence of catalase (a metabolizer of H2O2). The dogs were divided into three groups randomly. Group I: sham, four hour duration; group II: two hours of shock followed by two hours of reinfusion; group III: same as group II but pretreated with catalase. Hemorrhagic shock was produced in the dogs by lowering the mean arterial pressure to 50 ±5 mm Hg by bleeding into standard blood bank bags containing 63 mL of citrate, phosphate, dextrose, and adenine (CPDA) anticoagulant for 450 mL of blood. The shock was maintained for two hours by bleeding or reinfusing the shed blood as needed.

Cardiac function and contractility were depressed while plasma CK, CK-MB, and lactate increased during shock. Reinfusion after two hours of shock tended to return hemodynamic parameters and plasma lactate levels toward control values. Plasma CK and CK-MB and PMNL-CL increased further. Cardiac MDA content also increased after shock and reinfusion, suggesting oxidative damage. Pretreatment with catalase attenu ated the deleterious effects of shock and reinfusion on the cardiovascular function and contractility, and the rise in plasma CK, CK-MB, and lactate, PMNL-CL, and cardiac MDA. However, the protection with catalase was not complete. These results suggest that hydrogen peroxide (H202) may partly be involved in the deterioration of cardiovascular function and cellular injury during hemorrhagic shock and reinfusion.
Experimental Prosthetic Vein Valve
Authors: Taheri Syde A. , Schultz Raymond O.
Published: July 2008

Chronic venous insufficiency is a disease that carries significant morbidity and repre sents a sizeable burden to the health care system. Current medical and surgical therapies are associated with a high incidence of failure. This has prompted the development of a synthetic vein valve for the treatment of chronic venous insufficiency. Nine dogs underwent the implantation of ten valves into the femoral veins. Initial studies showed the valves to be competent and patent. However, over a two-year period dense ingrowth of intimal hyperplasia rendered the valves functionless.
Quality Assurance of High-Dose IV Heparin Treatment Exemplified by Patients Implanted with Coronary Palmaz-Schatz Stents
Authors: Haushofer Alexander , Halbmayer Walter Michael , Prachar Herbert , Fischer Michael
Published: July 2008

The need to standardize treatment with high-dose IV standard heparin by using activated partial thromboplastin time (APTT) reagents tested for their heparin sensitivity and by establishing a standard treatment schedule led to the development of the "Lainz concept" of heparin management. The determination of heparin sensitivity of the 2 APTT reagents used (APTT Micronized Silica and APTT Actin FSL), their good agreement (r=.9977; P=.000), and their therapeutic APTT ratio of 1.5-2.5 fold of baseline APTT (therapeutic range, forty-five to seventy-five seconds) equivalent to 0.3-0.7 antifactor Xa units are presented.

The "Lainz concept" was tested in 29 patients receiving high-dose heparin after coronary artery stenting. A mean dose of 1,273 U of standard heparin/hour (15.7 U/kg body weight/hour) was shown to produce APTTs in the therapeutic range. From the introduction of the "Lainz concept" 81% of the APTTs were kept within the therapeutic range by using a defined heparin-monitoring schedule based on a guideline protocol for controlling heparin treatment. Only 19% of the APTTs were below the therapeutic range. Factors underlying subtherapeutic APTTs are discussed. The reduction in the rate of subtherapeutic APTTs to less than 3% seen after the introduction of the "Lainz concept" constitutes an important contribution toward quality assurance in high-dose heparin treatment.
Electrocardiographic Appearance of a Non-Q Wave Acute Myocardial Infarction in a Patient with Thyrotoxicosis
Authors: Alexopoulos Dimitrios , Lazarou Nikolaos , Vagenakis Apostolos G.
Published: July 2008

A patient with severe thyrotoxicosis developed the typical electrocardiographic (ECG) evolution of a non-q myocardial infarction. This occurred without evidence of myocardial necrosis and in the absence of coronary artery disease. Treatment with beta blockers resolved the ECG changes despite the persistence of the thyrotoxic state.
A Quantitative Analysis of the Structure of Right Ventricle-Pulmonary Artery Junction for Balloon Pulmonary Valvuloplasty in Children
Authors: Hwang Betau , Chen Li-Yun , Lu Jen-Her , Meng C. C. Laura
Published: July 2008

Percutaneous balloon valvuloplasty (PBVP) was performed in 55 children, aged from four days to twelve years and nine months, with different severity of congenital pulmonary stenosis (PS). To evaluate its efficacy, a quantitative analysis of the structure of right ventricle-pulmonary artery junction was conducted. Significant reductions of peak systolic right ventricular pressure, ratio of peak right-to-left ventricular pressure, and pressure gradients between the right ventricle and pulmonary artery were obtained in 48 children who scored 3 or less (Group I) and 7 children who scored over 3 (Group II) (P<0.05). After two to forty-six months (M ± SD = 17.1 ±15.5 months) of follow-up study, the residual gradients between right ventricle and pulmonary artery over 36 mmHg were higher in children who scored over 3 than in those who scored 3 or less (71.4% vs 20.8%) (P<0.01).

Repeated percutaneous balloon valvuloplasty was successfully performed in 4 children, 2 each in Group I and Group II. Surgical open pulmonary valvotomy was needed in 1 in Group II because of the dysplastic pulmonary valve and the need for repair of atrial septal defect and in 2 in Group I because of the failure to complete repeated PBVP in the catheterization laboratory or the need for repair of associated atrial septal defect.
Pulse Wave Velocity and Lipid Profile in Varicose Vein Patients
Authors: Reghunandanan Rajalaxmy , Sood Sushma , Reghunandanan Vallath , Nagpaul Ravi , Suresh P.S. , Singh Pardaman I. B.
Published: July 2008

In 20 varicose vein patients, aged twenty-five to forty-five years, and suffering the disease for more than two years, pulse wave velocity (PWV) of the femoral-dorsalis pedis artery of the lower limbs was measured and compared with that of 20 age-matched normal subjects. Blood pressure and fasting serum total cholesterol level, triglycerides, high density lipoprotein (HDL), low density lipoprotein (LDL), very low density lipoprotein (VLDL) were also estimated for these subjects. PWV showed a significant increase (P < 0.001) in varicose vein patients as compared with control subjects. There was no significant difference either in the blood pressure or lipid profile. It appears that neither hypertension nor atherosclerosis is responsible for the increase in PWV in varicosities. On the basis of the present study, it may be suggested that arteries are also involved in the pathogenesis of varicose veins. The involvement of the arterial tree in the pathogenesis of varicose veins, if given due consideration, may add a new dimension to the understanding of many ill-defined facets of this disease.
Percutaneous Balloon Valvuloplasty in Severe Pulmonary Valvular Stenosis
Authors: Jaing Tzong-Long , Hwang Betau , Lu Jen-Her , Hsieh Kai-Sheng , Meng C.C. Laura
Published: July 2008

Percutaneous balloon pulmonary valvuloplasty (PBPV) was achieved successfully in 20 of 22 patients with severe pulmonary valvular stenosis, aged two days to ten years (median four years and two months). The diameters of the balloon for PBPV were 88-125% (mean ±SD=109.5 ±10.0%) of the pulmonary valve annulus. PBPV failed in 2 patients because of the inability of the cardiac catheters to cross the stenotic valve. A significant reduction of right ventricle-pulmonary artery (RV-PA) pressure gradient occurred in all 20 patients (mean ±SD=72.1 ±10.3%). The mean RV-PA pressure gradient was reduced from 93.2 ±33.1 to 26.3 ± 15.6 mmHg (P < 0.0001) and the mean right ventricular peak systolic pressure fell from 117.2 ±32.4 to 51.6 ±17.3 mmHg (P < 0.0001). Five (25%) of 20 patients had an infundibular gradient before PBPV. Two (10%) developed a new infundibular stenosis immediately after PBPV. Four (20%) presented with cyanosis, which disappeared after the successful PBPV. Two patients (10%) who showed a residual RV- PA pressure gradient of more than 40 mmHg had a significant infundibular obstruction initially. Two patients underwent recatheterization fifteen months after PBPV owing to a significant residual RV-PA pressure gradient and had no reductions in right ventricular pressure and RV-PA pressure gradient, but resolution of infundibular obstruction was noted in both. Repeat PBPV was successfully performed on these 2 patients. No significant complications were noted in any patient. It is concluded that PBPV with a balloon diameter of 88-125% of the pulmonary valve annulus is the first choice to treat a patient with severe pulmonary valvular stenosis, even in early infancy.
Impaired Thermoregulation in Raynaud's Phenomenon
Authors: Greenstein D. , Gupta N.K. , Martin P. , Walker D.R. , Kester R.C.
Published: July 2008

In an attempt to examine the role of the thermoregulatory apparatus in the etiology of Raynaud's phenomenon (RP), the authors exposed 15 women with RP and 12 controls to central body cooling and central body warming. Subjects were placed in an environ mental chamber at 25°C. Their right hand was placed in an annex of the chamber, which was insulated from the main chamber and maintained at a constant temperature of 25°C throughout the experiment. Blood flow was measured in the digits of the right hand by venous occlusion strain gauge plethysmography and skin thermometry. Body temperature was measured with an oral thermometer. The temperature of the chamber was then increased to 35°C and then reduced to 13°C for twenty-five minutes with measurements repeated. Following this period patients were rewarmed in an ambient temperature of 35°C for twenty minutes.

Results: subjects with RP had significantly lower blood flow at all stages of the test; moreover, their digital rewarming response following central cooling was considerably prolonged when compared with controls. Body temperature was lower and dropped significantly more in the RP group following the cold challenge. The authors conclude that subjects with RP have an impaired thermoregulatory mechanism. This may partially explain cold sensitivity.
Transthoracic Visualization of Pulmonary Thrombus that Mimicked Left Atrial Thrombus
Authors: Iwase Masatsugu , Nagai Nobue , Takeda Kyoko , Matsuyama Hiroyuki , Hishida Hitoshi
Published: July 2008

A forty-five-year-old woman with an unusual case of primary pulmonary hypertension is presented. She showed a progressive dilatation of the pulmonary arteries and pulmonary thrombus over twenty-one years. Transthoracic echocardiography showed the presence of pulmonary arterial thrombus that mimicked left atrial thrombus. However, when the transducer was rotated clockwise to obtain the short-axis view, a thrombus was observed in the right pulmonary artery with spontaneous echo contrast. Although the visualization of pulmonary arterial thrombus by echocardiography has been quite limited, it would be worthwhile since patients with primary pulmonary hypertension may have enlarged pulmonary arteries, as observed in the present case.
Atrial Natriuretic Factor in High-Altitude Pulmonary Hypertension
Authors: Soodanbekova Gildyzkan K. , Batyraliev Talantbek A. , Niyazova Zarema A. , Kudaiberdieva Gulmira Z. , Birand Ahmet
Published: July 2008

Since the renin-angiotensin-aldosterone system and atrial natriuretic factor are directly involved in the regulation of hemodynamics and structural alterations in the circulatory system, the interest of investigators in the observed changes in this system during exogenous hypoxia and the resultant development of high-altitude pulmonary hyperten sion is quite understandable. The authors measured the plasma levels of hormones from the major vasoconstrictor neurohumoral system and from one vasodilatory system and correlated them with hemodynamic variables in native highlanders of Tien-Shan.
Familial Mediterranean Fever and Primary Antiphospholipid Syndrome, a Rare Association
Authors: Halabe-Cherem Jose , Nellen-Hummel Haiko , Flores-Padilla Guillermo , Mercado-Atri Moises , Pizutto-Chavez Javier
Published: July 2008

The authors present the case of a twenty-one-year-old woman with familial Mediter ranean fever who during her first pregnancy developed a primary antiphospholipid syn drome. This is an association not reported previously.
Endothelium-Derived Vasoactive Substances in Bartter's Syndrome
Authors: Calò Lorenzo , Cantaro Salvatore , Calabrò Alessio , Piarulli Francesco , Rizzolo Monica , Favaro Silvana , Antonello Augusto , Crepaldi Gaetano , Borsatti Arturo
Published: July 2008

An imbalance between endothelium-derived vasoactive substances such as endothelin and endothelium-derived nitric oxide (NO) might be viewed as a possible determinant of vascular hyporeactivity. To check this possibility the authors evaluated the role of endothelin and NO in the reduced vascular reactivity of Bartter's syndrome.

Plasma immunoreactive endothelin (22.07 ±7.06 vs 13.80 ±1.43 pmol/L, P < 0.011), urinary excretion of NO 2- (0.28 ±0.10 vs 0.15 ±0.02, μmol/μmol of urinary creatinine, P < 0.01) and NO3- (0.17 ±0.07 vs 0.09 ±0.02 μmol/μmol of urinary crea tinine, P < 0.011), and forearm resting blood flow (FRBF) (6.67 ±1.69 vs 4.30 ±0.38 mL/m'/100 mL, P < 0.005) were increased in patients with Bartter's syndrome in comparison with normal controls (C).

No difference in postischemic maximal FBF was found (34.14 ±4.67 vs 31.35 ±2.86 mL/minute/100 mL), while patients showed a slower recovery after peak flow (PF) (77.57 ±61.35 vs 9.42 ±3.69 seconds, P < 0.013). Higher plasma endothelin supports the defect in vascular reactivity of Bartter's syndrome already shown for angiotensin II and norepinephrine and is in keeping with the altered intracellular calcium signaling previously demonstrated by the authors in this syndrome. The increased excretion of NO2- and NO3- in this syndrome, together with the higher FRBF and the slower recovery of the FBF after PF, argues in favor of an increased NO synthesis in Bartter's syndrome and of assigning it a role in the vascular hyporeactivity of Bartter's syndrome.
Acute Myocardial Infarction in a Patient with Primary Coronary Dissection and Severe Coronary Vasospasm
Authors: Imamura Mitsuhide , Tsuchiya Yoshihiro , Tahara Hisashi , Nii Takanobu , Nakashima Yoshiyuki , Arakawa Kikuo , Kawaguchi Hiroshi
Published: July 2008

A case of myocardial infarction associated with coronary artery dissection in a thirty- five-year-old woman is reported. An emergent coronary angiogram revealed extensive dissection and thrombosis in the right coronary artery; in addition, severe vasospasm was observed in the left coronary artery on the next day. She was successfully treated with intracoronary thrombolysis and intra-aortic balloon pumping. The patient is alive and well two years after infarction.
Anomalous Origin of Left Circumflex Artery in a Scimitar Syndrome
Authors: Lee Tsung-Ming , Chen Wen-Jone , Chen Ming-Fong , Liau Chiau-Suong , Lee Yuan-Teh
Published: July 2008

This report concerns a twenty-seven-year-old woman with scimitar syndrome of abnormal origin of the left circumflex artery from the pulmonary artery. Operation was performed to redirect the abnormal venous return to the left atrium and abnormal origin of the left circumflex artery to the aorta. Unfortunately, pulmonary hypertension with hemoptysis occurred nineteen months after the operation. A second angiogram showed total occlusion of the graft to the left circumflex artery and impaired left ventricle function, rather than thrombosis of the anastomosis to the scimitar vein, as the cause of pulmonary hypertension.
Myocardial Scintigraphy with 99mTc-Sestamibi in Children with Kawasaki Disease
Authors: Schillaci Orazio , Banci Maria , Scopinaro Francesco , Tavolaro Rosanna , Villotti Giuseppe , De Vincentis Giuseppe , Ventriglia Flavia , Borgia Maria Clotilde , Centi Colella Antonio , Colloridi Vincenzo
Published: July 2008

Kawasaki disease (KD) is a systemic vasculitis syndrome of early childhood. It involves particularly the coronary arteries and may cause aneurysms and thrombotic occlusions. Echocardiography is the most useful method of detecting coronary aneurysms. Nevertheless, obstructive lesions are difficult to evaluate and often need invasive coronary angiography. An important feature of this disease is the possibility of finding coronary pathology several years after the onset. This characteristic makes KD an important cause of coronary artery disease (CAD) in young adults. Thus patients with KD and previously diseased coronary arteries should be kept under long-term control. However, coronary angiography is invasive and cannot be performed repeatedly, espe cially in young patients.

As an alternative, thallium 201 scintigraphy has been employed, but its low-energy photons are suboptimal for standard gamma-camera imaging, particularly in children aged less than three years.

To verify the usefulness of a noninvasive assessment of myocardial perfusion, the authors used rest and dipyridamole 99mTc-Sestamibi scan in 15 children (ranging from one to six years of age) with Kawasaki's cardiac involvement.

Coronary aneurysms have been demonstrated by echocardiography in 12 patients; 8 patients were also submitted to cardiac catheterization. The sensitivity of 99mTc-Sestamibi imaging for detection of overall coronary lesions was 88% and the specificity was 93%.

These data suggest that rest/dipyridamole 99mTc-Sestamibi scintigraphy is an accurate and noninvasive method for the detection and follow-up of Kawasaki's cardiac damage even in patients aged one year.
Angioplasty-Induced Pseudoaneurysm Successfully Treated with a Palmaz Stent
Authors: Castaneda Flavio , Wright Jamey D. , Méndez Alejandro
Published: July 2008

Pseudoaneurysm formation and vessel rupture are considered rare complications of percutaneous transluminal angioplasty (PTA), and few reported cases exist in the litera ture. The true incidence of pseudoaneurysm formation is unknown, for follow-up angiog raphy is not routinely performed unless symptoms recur or persist. Currently, the only intervention widely accepted for angioplasty-induced pseudoaneurysm involves surgical excision or repair. The authors describe a case of successfully treated pseudoaneurysm with a noncovered stent.
Hypertension and Peripheral Arterial Hemodynamics
Authors: Milio Glauco , Cospite Valentina , Cospite Michele
Published: July 2008

Sixty uncomplicated hypertensive patients (30 stable and 30 borderline) were studied, by strain gauge plethysmography, in comparison with 25 normotensive subjects, in order to evaluate the arterial hemodynamics of the lower limbs in essential hypertension and to verify the different pattern in borderline and in stable hypertensives.

Resting blood flow, even if slightly decreased in hypertensive groups, did not show significant differences in its mean values; peak flow, instead, was reduced proportionally to the severity of hypertension in all the hypertensive patients, but only in the stable hypertensives was it statistically significant. Minimal vascular resistance showed a similar behavior: it was significantly increased only in the stable hypertensives, whereas basal vascular resistance was raised in all hypertensive patients and also in the borderline group. Finally, the half-time and the total hyperemic response time, which indicate vascular reactivity, were significantly decreased in all the hypertensives.

These results suggest that the stable hypertensive patients develop principally arterial structural changes, while the borderline hypertensive patients have only functional modi fications, such as a reduced compliance and a hyperdynamic condition.
Zero Flow Pressure in Human Coronary Circulation
Authors: Nanto Shinsuke , Masuyama Tohru , Hori Masatsugu , Shimonagata Tsuyoshi , Ohara Tomoki , Kubori Syujiro
Published: July 2008

Coronary pressure-flow (P/F) relationship has been investigated mainly from the viewpoint of coronary resistance. However, recent experimental evidence suggests that the zero flow pressure intercept (Pzf) provides important characteristics of coronary circulation. Although Pzf is likely to provide meaningful information about characteristics of coronary circulation, no data are available about Pzf in humans. The authors attempted to determine Pzf in humans by analyzing P/F relationship during long cardiac pause. This relationship, provoked by intracoronary adenosine triphosphate (ATP) infusion, was analyzed in 9 patients (8 men, 1 woman) with coronary heart disease (ages: fifty-six ±six years). After the diagnostic cardiac catheterization, ATP, 0.6 mg/3 mL, was administrated by bolus intracoronary injection during measurements of coronary blood flow velocity. Coronary blood flow velocity in the left anterior descending artery was measured with a 0.018-inch Doppler angioplasty guide wire (FloWire, Cariometrics, Inc., Mountain View, Calif.). The dynamic P/F relationship was obtained by correlation of the instantaneous aortic pressure and flow velocity with each other at constant intervals. The least square linear regression analysis was applied to the P/F data to yield the extrapolated Pzf axis. Immediately after intracoronary injection of ATP, long pause (5320 ±1498 msec) appeared and coronary blood flow velocity decreased to 11 ±8 cm/sec. Pzf calculated with P/F relationship was 14 ± 7 mmHg.

Conclusions: Thus, the results clearly demonstrate that Pzf is higher than right atrial and left ventricular end-diastolic pressure in humans, indicating the complexity of the determinants of the Pzf.