bluuebunny/crossref_metadata_2025 huggingface dataset:
Percutaneous Subclavian Vein Catheterization for Hemodialysis: A Report of 57 Insertions
Authors: Al-Mohaya Sulieman , Sadat-Ali Mir , Al-Muhanna Fahd , Ibrahim-Saeed Abdulrahman
Published: July 2008

The authors report an analysis of 57 subclavian vein catheterizations for hemodialysis. A total of 51 pa tients (34 men, 17 women) kept the Cobe single- and double-lumen cathe ters for 1,726 days. The youngest pa tient was eighteen and the oldest sev enty-two years of age. There were no catheter-related deaths. Complica tions were encountered in 9 patients. The only life-threatening complica tion was cardiac arrest, which oc curred during flushing of the catheter. The patient was successfully revived. The other complications were pneumothorax and hydrothorax in 1 patient, catheter site infection in 5 patients, and arrhythmias in 2 pa tients, which stopped after readjust ment of the catheter tips.

Their experience indicates that percutaneous subclavian vein cathe terization is safe and provides quick access for hemodialysis with no mor bidity and mortality if done correctly, patiently, and meticulously. The au thors believe that this should be the first choice in patients with reversible renal failure and in patients with chronic renal failure, who are usually elderly and medically compromised, till a permanent vascular access is ready for use.
Immunoscintigraphic Detection of Venous Thrombosis of the Lower Extremities by Means of Human Antifibrin Monoclonal Antibodies Labeled with 111In
Authors: Lusiani Luigi , Zanco Pierluigi , Visonà Adriana , Breggion Giovanni , Pagnan Antonio , Ferlin Giorgio
Published: July 2008

A new monoclonal antibody spe cific for the beta-chain of human fi brin (C22A) and labeled with 111In has been obtained and successfully used in rabbits and dogs for the in vivo de tection of venous thrombosis. Studies in humans are currently ongoing. In order to assess the diagnostic value of 111In-antifibrin for the detection of ve nous thrombosis of the lower extrem ities, the authors investigated 25 consecutive patients. Ten patients had clinical and instrumental (con trast phlebography and duplex scan ning) evidence of acute deep venous thrombosis (DVT), 3 had a long standing DVT with relapsing epi sodes of swelling and pain, 5 had superficial venous thrombosis, and the remaining 7 had no signs of thrombosis at all. Twenty patients were being treated with heparin. All patients received 111In-antifibrin at the dose of 74 MBq IV and were scanned with a large field of view gamma camera coupled with a high- energy, parallel-hole collimator at 30 minutes and three, six, and twenty- four hours postinjection. Only the persistence of an abnormal uptake at twenty-four hours confirmed by two observers at visual inspection was considered as positive.

A positive result was obtained in 9 of 10 DVT patients (90% sensitivity) and in all SVT patients. The single DVT patient with a negative 111 In- antifibrin test had the longest inter val between scintigraphy and onset of symptoms (fifty-five days). Thus, the age of thrombi represented a sub stantial limitation for the test. A false-positive result was obtained in a single SVT patient, in whom also a deep involvement, unconfirmed by phlebography, was suspected (91.6% specificity).

The authors conclude that 111In- antifibrin is a new diagnostic tool for studying deep venous thrombosis, which allows direct imaging of thrombi during their relatively early phase, with a high degree of sensitiv ity and specificity.
A SPECT Study in Internal Carotid Artery Occlusion: Discrepancies Between Flow Image and Neurologic Deficits
Authors: Moriwaki Hiroshi , Hougaku Hidetaka , Matsuda Isato , Kusunoki Masahito , Shirai Jun
Published: July 2008

A SPECT (single photon emission computed tomography) study in internal carotid artery (ICA) occlusion was performed in 6 patients. The validity of iodoamphetamine (IMP) SPECT study in the evaluation of cerebral blood flow (CBF) or neurologic function is still controversial. In this study, the authors showed several cases in whom SPECT images of brain were not compatible with their neurologic deficits.

In 2 typical cases, a large low-density area was observed in the non-dominant hemisphere in computed tomography (CT) scan, but no apparent motor-sensory deficits in left limbs were present. In these patients, SPECT study also revealed flow reduction in the affected side of the brain. So there was a possibility that an IMP brain image could not always reflect CBF, which maintains neurologic function of the brain.
Pulmonary Hypertension in the CREST Syndrome: Variant of Systemic Sclerosis (Scleroderma) — A Case Report
Authors: Lie J.T.
Published: July 2008

The CREST syndrome (calcinosis, Raynaud's phenomenon, esophageal dysmotility, sclerodactyly, telangiectasia) is a variant but not a benign form of scleroderma. Pulmonary hypertension without pulmonary fibrosis appears to be more prevalent in the CREST than in scleroderma patients. Moreover, pulmonary hypertension in CREST may be rapidly progressive and a cause of sudden death from severe cor pulmonale.
Effects of Sublingual Administration of Nifedipine on Arterial Pressure, Plasma Renin Activity, and Glomerular Filtration Rate in Essential Hypertension
Authors: Yurtkuran Mustafa , Dilek Kamil , Güllülü Mustafa , Yavuz Mahmut , Müftüoglu Ayça
Published: July 2008

Effects of sublingual administration of nifedipine on systemic arterial pres sure (BP), plasma renin activity (PRA), aldosteron level (AL), and serum so dium (Na) and potassium (K) levels, have been determined. A significant decrease was observed in systolic and diastolic blood pressure five minutes after the sublingual administration of nifedipine in 21 patients with mild or moderate essential hypertension. Furthermore, in an observation period of six hours, it was also established that the effect of nifedipine on systolic and diastolic blood pressure continued. An increase was observed in glomerular filtration rate, whereas there were no changes in PRA, AL, or serum Na and K levels.
The Role of Lasers in the Management of Peripheral Vascular Disease
Authors: Sanfelippo Peter M.
Published: July 2008

Although it has been almost twenty-five years since the first studies of McGuff et al, who employed the laser for atheroablation, problems still require resolution.

The various laser wavelengths from ultraviolet through visible to in frared have been employed for athero ablation. The laser's greatest appeal and the most spectacular results have been in reopening channels in totally occluded vessels. The laser's greatest problem has been damage of the arte rial wall and even perforation.

The purpose of this presentation is to clarify the present status of avail able lasers for the treatment of pe ripheral vascular disease of the lower extremities. To this end, the initial experience with angioscopically guided laser-assisted angioplasty with a new hybrid laser probe is reported.
Ketanserin in the Treatment of Systemic Hypertension During and Following Coronary Artery Bypass Surgery
Authors: van der Starre Peter J. A. , Reneman Robert S. , Scheijgrond Henk W.
Published: July 2008

One of the most important prob lems during cardiac surgery is the prevention and treatment of hyper tension, occurring in 40-60% of the patients following coronary artery bypass surgery (CABS). Hyperten sion should be avoided to prevent myocardial damage, neurologic com plications, increased blood loss, and premature graft closure due to inti mal damage. During and following cardiac surgery hypertension is rou tinely treated with vasodilating agents, which generally induce reflex tachycardia and increased intrapul monary shunting.

The results obtained with ketan serin, a specific S 2-serotonergic re ceptor blocker with alpha1-adrener gic receptor blocking properties, in the prevention and treatment of hy pertension in patients undergoing cardiac surgery, are presented. Ke tanserin effectively lowers blood pressure by decreasing systemic vas cular resistance but does not com pletely prevent perioperative and postoperative hypertension when ad ministered as a continuous infusion from the start of anesthesia. In con trast to sodium nitroprusside, ketan serin does not induce reflex tachycar dia in the treatment of postoperative systemic hypertension following CABS. The compound improves di uresis and perfusion of the skin pe rioperatively. Ketanserin is devoid of rebound phenomena after its admin istration is stopped. It is postulated that the antihypertensive effect of ke tanserin can be explained by its prop erty of simultaneously blocking al pha 1-adrenergic and S2-serotonergic receptors.
Ephedrine Improves Microcirculation in the Diabetic Neuropathic Foot
Authors: Wollersheim H. , Netten P.M. , Lutterman J.A. , Lenders J.W.M.
Published: July 2008

A diabetic patient is described who developed one-sided neuropathic ulcera tion. Noninvasive microvascular measurements during distant cooling and in spiratory gasp revealed signs of sympathetic denervation. The initially elevated total skin blood flow measured by laser Doppler equipment and decreased capil lary perfusion as determined by transcutaneous oxygen tension measurements were both partially restored after treatment with the α1-sympathicomimetic ephedrine. The improvement occurred once more after rechallenge.

In conclusion this study further supports the hypothesis of a capillary steal phenomenon caused by extreme vasodilation within sympathetically denervated arteriovenous shunt vessels.
Capillary Filtration and Ankle Edema in Patients with Venous Hypertension: Effects of Daflon
Authors: Cesarone Maria Rosaria , Laurora Giuseppe , De Sanctis Maria Teresa , Belcaro Giovanni
Published: July 2008

Capillary filtration (CF) was assessed in 43 patients with venous hypertension and in 10 normal subjects by means of strain gauge plethysmography. The patients were then divided into two treatment groups; 22 were treated with Daflon, 500 mg tid, and 21 with Daflon, 500 mg bid. The normal subjects were also treated (500 mg tid).

After four weeks CF was significantly decreased in all subjects, the decrease being higher in the high-dose groups. CF did not significantly change in normal subjects. In conclusion Daflon decreases CF in subjects with venous hypertension and the CF decrease is dose related.
New Prospects for the Treatment of Raynaud's Phenomenon Using A Serotoninergic S2 Receptor Antagonist (Ketanserin) and Stable Derivatives of Prostacyclin
Authors: Pola Paolo , Tondi Paolo , Serricchio Michele , Favuzzi Angela , Gerardino Laura
Published: July 2008

The authors propose a promising new therapy for the treatment of Raynaud's phenomenon, with parenteral prostacyclin (carbaprostacycline) and a serotonergic S2-receptor antagonist (ketanserin) given orally. They studied 31 patients, 22 treated with ketanserin and carbaprostacycline, 9 with carbaprostacycline alone. Both groups demonstrated successful results and a significant improvement in measurements performed by photoplethysmography and transcutaneous pulse oxymetry.
Interaction in Cardiovascular Crossover Studies: The Standard and the Clinical Analysis
Authors: Cleophas T.J.M.
Published: July 2008

The crossover trial, which is considered the most powerful means of deter mining the efficacy of cardiovascular drugs, is frequently biased by treatment- by-period interactions. A second problem is that the standard analysis (Hills-Armitage analysis) for these biases is unreliable because of a low sensitiv ity. The author recently introduced an alternative method for the detection of interaction bias entitled the clinical analysis, because it looks at the clinical performance of the separate treatment groups in a trial and not, as in the stand ard analysis, at the means of the groups. In a mathematical model this analysis was capable of detecting interaction at a 30% lower level than the standard analysis. The present study was undertaken to show not only that the clinical analysis performs better than the standard but also that it enables the investiga tor to differentiate among different types of interactions, eg, physical carryover effect, rebound phenomenon, and psychological carryover effect.
Echocardiographic Doppler Evaluation of Left Ventricular Diastolic Function in Athletes' Hypertrophied Hearts
Authors: Galanti Giorgio , Comeglio Marco , Vinci Marco , Cappelli Brunello , Vono Maria Concetta , Bamoshmoosh Mohamed , Galanti Giorgio
Published: July 2008

It is well known that one of the most evident effects of prolonged and intense physical training is an increase of left ventricular mass. This increase could have a great influence on the diastolic properties of the heart, which can now be accurately evaluated by use of pulsed- and continuous-wave of Doppler echocardiography.

The aim of this study was to evaluate the diastolic function of a group of auperendurance athletes (professional. bicyclists, exercising more than forty hours a week). Sixteen athletes (A), aged between twenty and thirty-one years, during the period of maximal training, and 16 age-matched controls (C) were studied. All subjects were evaluated at rest with mono-dimensional, two-dimensional, and Doppler echocardiography.

Diastolic (DD) and systolic. (SD) diameter, posterior wall (PW), and interventricular septum (IVS) thickness were also measured. The ventricular mass (LVM) was calculated. Diastolic function was evaluated by calculating isovolumetric relaxation time (IVR) with continuous-wave Doppler, and deceleration time (DT), rapid filling flow peak (Ep), and atrial filling (Ap) were evaluated with pulsed Doppler echocardiography.

The LVM (A: 354±47 g vs C: 170.6±33.4, p<0.05), DD (A:57.7±3.9 mm C: 50.5±2.7, p < 0.01), PW thickness (A: 11:9±0:7 mm vs C: 8.4±0.6, p<0.05), and IVS thickness (A: 12.3±1 mm vs C: 8.2±0.9, p<0.05) were significantly greater in the athletes than in the controls.

The IVR (A: 69±12 msec vs C: 76±11, p<0.05) and DT (A: 171±52 msec vs C: 203±31, p<0.01) were significantly shorter in the athletes than in the controls; the Ep velocity was similar in the two groups (A: 84.3±12 cm/sec vs C: 85.1±19, p=NS), while the Ap velocity was lower in the athletes' group (A: 41.5±8 cm/sec vs C: 56±15, p<0.01).

It may be concluded that prolonged and intense physical training, while causing an increase of left ventricular mass, is able to induce favorable modifications of the diastolic properties of the left ventricle.
Transesophageal Echocardiography for Detecting Intracardiac Thrombi in Embolic Stroke
Authors: Toyoda Kazunori , Yasaka Masahiro , Nagata Seiki , Yamashita Nobushige , Imakita Satoshi , Yamaguchi Takenori
Published: July 2008

The authors studied 56 patients with cardioembolic stroke to search for intracardiac thrombi by use of transesophageal and transthoracic echocardiography. Forty consecutive patients were examined within four weeks of stroke onset and the remaining 16 in the chronic stage. They also performed ultrafast computed tomography in 9 of them. Underlying heart disease was present in all subjects. Anticoagulant therapy had already been started in 29 at the time of examinations. Using their own criteria for echocardiography, they diagnosed intracardiac thrombus in 7 cases and valvular vegetation in 1. Six thrombi were located in the left atrial appendage, 4 of which were smaller than 10 mm in diameter. These small thrombi were not found by either transthoracic echocardiography or computed tomography. Transesophageal echocardiography appears to be superior to the other two methods, especially for detecting small intracardiac thrombi in the left atrial appendage.
Plasma, Serum and Whole-Blood Viscosity Variations with Age, Sex, and Smoking Habits
Authors: Gudmundsson Magnus , Bjelle Anders
Published: July 2008

To study the influence of age, sex, and smoking habits on rheology, the authors measured plasma (PV), serum (SV), native (NBV), and corrected (CBV) blood viscosity with a computerized rotational viscometer in 152 blood donors (86 men and 66 women) and in 20 healthy persons (4 men and 16 women) attending smoke aversion treatment. None of the viscosity measures or erythrocyte sedimentation rate changed significantly with age, whereas hematocrit (HC) and fibrinogen concentration (FC) both increased with ageing (p < 0.05 and p < 0.001, respectively). Higher (p < 0.001) values of NBV and HC were found in men than in women, whereas higher values were found in women than in men for FC (p < 0.01) and ESR (p < 0.001). In blood donors, moderate smoking (mean twelve cigarettes/day) significantly influenced only ESR, which was higher (p < 0.001) in smokers than in nonsmokers. In heavy smokers (mean twenty-one cigarettes/day), however, higher (p < 0.001) PV, SV, and NBV were found, as well as higher (p < 0.01) FC and HC as compared with nonsmoking blood donors.
Renovascular Hypertension Caused by Lymph Node Metastasis in a Patient with Uterine Cervical Cancer: Case Report
Authors: Fujimoto Mika , Ohya Yusuke , Abe Isao , Kobayashi Kazuo , Hasuo Kanehiro , Fujishima Masatoshi
Published: July 2008

Renovascular hypertension was found in a fifty-four-year-old woman who had been diagnosed as having uterine cervical cancer, stage Ib, six months before admission. Renal arteriography showed a stenosis of the right renal artery with a significant increase in renal vein renin level from the ipsilateral kidney. Abdominal computed tomographic scanning showed enlarged lymph nodes in the para-aortic region at the level of the right renal artery, which suggested metastasis of the carcinoma. Metastatic lymph node swellings probably caused compression of the right renal artery.
A Case Report of Siblings with Hypertrophic Cardiomyopathy that Progressed to Dilated Cardiomyopathy-Case Reports
Authors: Okamoto Shinya , Ozaki Morihiro , Konishi Tokuji , Nakano Takeshi
Published: July 2008

The authors encountered 2 brothers with hypertrophic cardiomyopathy (HCM), both of whom were later found to have progressed to dilated cardiomyopathy (DCM).

Case No. 1 (younger brother): A diagnosis of HCM without left ventricular (LV) dilatation was made at age two by cardiac catheterization and echocardiogram. However, he had been well until age thirteen when dyspnea developed. Echocardiograms showed LV wall thickening (septum 20 mm, and posterior 18 mm) and LV dilatation (left ventricular diastolic diameter [LVDd] 60 mm) accompanied by LV dysfunction (ejection fraction [EF] 18%). At autopsy, the heart weighed 875 g and showed LV dilatation with thickened walls.

Case No. 2 (elder brother): At age twelve, he was found to have an increased heart size on x-ray when his family was evaluated owing to his brother's condition. Cardiac catheterization and echocardiogram showed HCM without LV dilatation. He remained asymptomatic until age twenty when dyspnea developed, at which echocardiography showed a dilatated LV.

The authors speculate that the HCM with progression to DCM is an atypical type of familial HCM and that progression to DCM is genetically determined.
Nitric Oxide Mediates Vasoactive Effects of Endothelin-3 on Rat Mesenteric Microvascular Beds in Vivo
Authors: Kurose Iwao , Fukumura Dai , Miura Soichiro , Sekizuka Eiichi , Nagata Hiroshi , Suematsu Makoto , Tsuchiya Masaharu
Published: July 2008

In order to clarify whether the vasoactive effects of endothelin-3 (ET-3) on microvessels are associated with the endothelium-derived relaxing factor (EDRF) in vivo, the authors examined the effects of L-NG-monomethyl arginine (L-NMMA), an analog of L-arginine, on low-dose ET-3 induced hemodynamic changes in the mesenteric microcirculation of male Wistar rats. The intravital observation revealed that ET-3 100 pM induced a remarkable and periodic vasoconstriction in arterioles, and the constriction was sustained for approxi mately fifteen minutes. No remarkable change was observed in the microvessels after the superfusion of 1 pM ET-3. Superfusion of 1 pM ET-3 with 100 μM L-NMMA elicited the vasoconstriction in arterioles, and the arteriolar diameter recovered to the control level within ten minutes in spite of continuing the su perfusion. The vasoconstriction induced by low-dose ET-3 with L-NMMA was suppressed by the additional superfusion of 200 μM L-arginine. The present study suggests that the recovery of arteriolar diameter after the ET-3-induced constriction may be mediated by nitric oxide at least in the early phase.
Evaluation of Ifenprodil Efficacy on Exercise-Induced Tissue Ischemia in Stage II Arteriopathy by Measurement of Transcutaneous Oxygen Tension During a Standard Treadmill Test: Double-Blind Study of Injectable Ifenprodil Versus Placebo
Authors: Caillard P. , Mouren X. , Bailliart O. , Cloarec M.
Published: July 2008

Measurement of transcutaneous oxygen tension (TcPo2) is a noninvasive and easily reproducible method for objectifying and quantifying exercise ischemia in patients with stage II occlusive arterial disease. This technique is also used at rest to evaluate the therapeutic effect of vasoactive treatments.

To objectively assess the effectiveness of a vasoactive treatment on the condi tions of tissue perfusion, a randomized double-blind study of ifenprodil tartrate versus placebo was performed in 20 patients, whose TCPo2 was continuously measured while they walked on a treadmill.

Patients treated with ifenprodil improved significantly as compared with the placebo group, for both the half-hypoxia area, representing the overall evolu tion of the tissue ischemia (+34.9% and —16.0%, respectively, p=0.01), and the half-hypoxia recovery time, estimating the postexercise recovery time (+30.2% and —3.6%, respectively, p < 0.05).

This study confirms that the continuous measurement of TcPo2 during the recovery phase after exercise represents an objective method for the evaluation and follow-up of patients with stage II intermittent claudication. The results enabled the objective assessment of ifenprodil efficacy on the evolution of tissue hypoxia.
Hypoxia-Induced Activation of Endothelial Cells as a Possible Cause of Venous Diseases: Hypothesis
Authors: Michiels Carine , Arnould Thierry , Remacle José
Published: July 2008

Blood stasis in leg veins is a situation commonly linked to the development of venous diseases such as varicoses. Such a stasis will provoke an ischemia, thus decreasing oxygen availability to tissues. Owing to its localization between blood and tissue, endothelium is the first target of this insult. The authors develop here a hypothesis in which the effect of oxygen deprivation on the functional state of the endothelium is the starting point of a cascade of events leading to the disorganization of the vessel wall typical of these pathologies. When venous human endothelial cells obtained from umbilical cords (HUVEC) are exposed to hypoxic conditions they become activated without change in their viability. The synthesis of a proinflammatory molecule (PAF, platelet-activating factor) and the adhesion of human polymorphonuclear neutrophils (PMN) on HUVEC are markedly increased during hypoxia incubation. These two processes are related to a calcium-dependent activation of endothelial cells due to a decrease of aden osine triphosphate (ATP) availability during hypoxia. Adherence of neutrophils to endothelial cells is the first step of diapedesis, which leads to the infiltration of these cells in the media of the veins, where they affect the smooth muscle cells and the connective tissue, leading to tissue alterations typical of the venous pa thologies. The authors propose that this sequential process which originates from a reduction in oxygen availability and which involves different cell types as one main cause of the venous disorders, in addition to genetic, hormonal, and mechanical factors.
The Deltopectoral Triangle as a Landmark for Percutaneous Infraclavicular Cannulation of the Subclavian Vein
Authors: Moran Stephan G. , Peoples James B.
Published: July 2008

An anatomic landmark is identified and described that simplifies the tech nique of central venous cannulation via the subclavian vein. The commonly used techniques are an approach to the subclavian at the junction of the medial and middle thirds of the clavicle or at the midclavicular line. A described ana tomic landmark, the deltopectoral triangle, is easily identified in virtually all patients and requires no measuring or extensive knowledge of anatomy for lo calization. Penetration of the skin at this landmark facilitates the procedure and produces less patient discomfort. Using this technique, the authors have suc cessfully cannulated the subclavian vein in 92.7% (51/55) of attempts with a 5.5% (3/55) complication rate. The only complications were arterial punctures, which were treated with pressure and were of no consequence to the patient.
Vasodilator Effects of Hydroxylamine in the Isolated Rodent Lung
Authors: Santoian Edward C. , Thomas George , Angerio Allan D. , Kot Peter A. , Ramwell Peter W.
Published: July 2008

Hydroxylamine is a natural product of cellular metabolism that possesses vasodilating properties similar to those of endothelium-derived relaxing factor (EDRF). In the rodent pulmonary circulation preconstricted with the endo peroxide analog U-46619, hydroxylamine relaxed the vasculature in a concen tration-dependent manner. Blockade of the hydroxylamine vasodilator response by methylene blue indicated that the mechanism of vasorelaxation is similar to that of EDRF. In this preparation, hydroxylamine is a more potent vasodilator than nitroglycerin.
Atrial Natriuretic Peptide and Left Atrial Systolic Function in Normal Subjects
Authors: Kawakami Hideo , Sumimoto Takumi , Matsuoka Hiroshi , Kobayashi Takamasa , Ohtani Takashi , Abe Mitsunori , Shigematsu Yuji , Hamada Mareomi , Hiwada Kunio
Published: July 2008

The purpose of this study is to elucidate factors determining the release of atrial natriuretic peptide (ANP) in normal volunteers at rest. Ten normal volun teers were included in this study. Ages ranged between twenty-seven and thirty- three years (mean twenty-seven). The authors measured plasma levels of ANP, and four cardiac chamber volumes, and their functions by cine magnetic reso nance imaging using the rephased gradient-echo method. Plasma levels of ANP in 10 normal subjects were 15.0-37.1 pg/mL (mean 23.6 pg/mL). No significant relationship was seen between ANP level and heart rate or blood pressure. The level of ANP was positively correlated with left atrial (LA) emptying fraction and negatively correlated with LA minimal volume (r=0.85, P < 0.01; r = 0.64, P < 0.05, respectively). No significant relationship was observed between plasma ANP level and left ventricular, right ventricular, or right atrial parame ters. These results suggest that LA systolic function is one of the major determi nants for ANP release in normal subjects at rest.
Coronary Flow Reserve Measurements With a New Judkins-Style Doppler Angiographic Catheter
Authors: Chauhan Anoop , Mullins Paul A. , Thuraisingham Suren , Taylor Gerard , Petch Michael C. , Schofield Peter M.
Published: July 2008

The authors assessed whether measurements obtained by Judkins-style Dop pler catheters are comparable to those achieved with the intracoronary Doppler technique in 42 patients with normal coronary arteries on angiography (19 syn drome X and 23 heart transplant patients). Resting coronary flow velocity and response to a hyperemic intracoronary dose of papaverine was measured with a Judkins-style, 8F Doppler-tipped catheter positioned in the left coronary ostium and a 3.6F intracoronary Doppler catheter positioned in the proximal left ante rior descending artery. Mean coronary flow velocity at rest was significantly higher with the Judkins Doppler (10.1 ± 4.6 vs 6.3 ± 4.5 cm/sec, p < 0.01). The mean coronary flow velocity at peak hyperemia was also significantly higher with the Judkins Doppler (33.7 ± 14.1 vs 19.7 ± 11.5 cm/sec, p < 0.01). Coro nary flow reserve was 3.57 ± 1.3 with the Judkins Doppler and 3.47 ± 1.2 with the intracoronary Doppler (r = 0.85) . A second study was performed in 14 heart transplant patients with the intracoronary Doppler positioned in the left main coronary artery. The resting and hyperemic flow velocities were again higher with the Judkins Doppler but the differences were not statistically significant. There was again a strong correlation between the Doppler catheters for coro nary flow reserve measurements. The Judkins-style Doppler technique appears to be a quick, safe, and accurate alternative to the intracoronary Doppler tech nique.
Lysis Block Treatment: A New Form of Local Thrombolysis
Authors: Martin Michael , Heimig Thomas , Othmar Fiebach B.J. , Magnus Lothar , Riedel Christa
Published: July 2008

Lysis block treatment (LBT) is a new form of fibrinolytic therapy for deep vein thrombosis and arterial occlusion in the distal parts of the limbs. Strictly local lysis was achieved by placing a cuff around the thigh or the upper arm, inflating the cuff to a pressure of 500 mmHg ("Bier's blockade"), and giving heparin and tissue plasminogen activator (rt-PA) by intravenous injection into the dorsal pedis or antecubital veins. Occlusion lasted for one hour. This new technique was demonstrated in 22 patients. Six patients presented with popliteal vein thromboses and 1 patient with a distal femoral vein thrombosis. In addi tion, 15 arterial occlusions were treated comprising 3 calf, 6 popliteal, 3 distal femoral, and 2 digital sites and 1 brachial site. Five of 7 venous and 9 of 15 arterial occlusions were partially or totally removed. The activated partial thromboplastin time remained nearly unchanged during LBT and only a limited and short-term lengthening was recorded after restoration of blood flow. This was of importance for patients with bleeding tendencies, which are normally a contraindication for systemic lysis. LBT may therefore be considered as a useful alternative to systemic fibrinolytic treatment.
PTCA in Chronic Total Occlusions: Clinical Results with a Wire System
Authors: Pektas Oral , Isik Ersoy , Dokumaci Barbaros , Uyan Cihangir
Published: July 2008

The authors discuss the use of a wire system in chronic total occlusion, not ing the factors that affect primary success and the clinical results. Percutaneous transluminal coronary angioplasty was performed on 29 patients with single- vessel disease. The mean age of the patients was fifty-three ± three years. The authors used routine angioplastic techniques with the wire system. Fifteen of the lesions were functional and the others were in total anatomic occlusion. The primary success rate was 69%. Primary success was 88%, 48%, and 75%, in the left anterior descending, left circumflex, and right coronary artery, respec tively. In 4 cases the wire did not cross the occlusion. One patient required direct-current cardioversion for ventricular fibrillation during the procedure, and 1 patient sustained a non-Q wave myocardial infarction following the pro cedure. There were no deaths.
Multiple Brain Infarction and Hemorrhage by Nonbacterial Thrombotic Endocarditis in Occult Lung Cancer—
Authors: Fujishima Shinichiro , Okada Yasushi , Irie Katsumi , Kitazono Takanari , Saku Yoshisuke , Utsunomiya Hidetsuna , Sugihara Shigetaka , Sadoshima Seizo , Fujishima Masatoshi
Published: July 2008

A fifty-four-year-old woman died from multiple brain infarction and hemor rhage in the bilateral cerebrum, cerebellum, and brainstem, with renal infarc tion. She developed hematuria and transient blindness sixteen days before admission. Low-grade fever, heart murmur, and aortic valve vegetation on ul trasonic cardiography suggested infectious endocarditis. Autopsy study re vealed occult adenocarcinoma in the lung and nonbacterial thrombotic endocarditis, but infective endocarditis was not histologically confirmed. The patient was considered to be a rare case of nonbacterial thrombotic endocarditis who developed multiple small infarctions mainly in the brainstem and cerebel lum. Nonbacterial thrombotic endocarditis seems to be still an important dis ease as the embolic source, even if cryptic, of systemic thromboembolism.
The Effects of Orally Administered Atenolol on the Coronary Hemodynamics and Prostaglandin Metabolism in Angina Pectoris Patients
Authors: Kurita Akira , Takase Bonpei , Uehata Akimi , Nishioka Toshihiko , Satomura Kimio , Nagayoshi Hirokazu , Mizuno Kyoichi
Published: July 2008

The effects of oral atenolol on coronary hemodynamics and prostaglandin metabolism have been investigated in 8 chronic stable angina pectoris patients who underwent the supine bicycle ergometer.

At rest, atenolol taken orally reduced the pressure-rate product significantly (P < 0.05) but did not significantly affect the coronary sinus blood flow or the coronary sinus pressure. During exercise, atenolol also reduced the pressure-rate product signifi cantly (P < 0.05) but did not significantly affect the coronary sinus blood flow, the coronary sinus pressure, or the coronary vascular resistance. Atenolol also did not signif icantly affect the thromboxane B2/6-keto prostaglandin F1α ratio in the arterial blood before and after exercise but did reduce this ratio in the coronary sinus blood by 15% from 1.9 ±1.1 to 1.5 ±0.46 (P < 0.10) after exercise.

These results indicate that atenolol taken orally does not significantly depress the coronary hemodynamics. However, the effects of atenolol on the prostaglandin metabo lism could not be clearly determined.
Electrical Injury in the Femoral Artery of Rabbits as a Model for Arterial Thrombosis: A Pilot Study
Authors: Kornowski Ran , Glikson Michael , Ohad Dan , Varda-Bloom Nira , Battler Alexander
Published: July 2008

Electrical stimulation was delivered to the femoral artery of 20 rabbits to examine whether endothelial injury results in a consistent formation of arterial thrombosis. The arterial patency was monitored throughout the experiment by flowmeter and was visu alized by femoral angiography in 5/20 cases. The arterial segments remained totally occluded in 7/20 (35%), partially occluded in 9/20 (45%), and patent in 4/20 (20%) rabbits following stimulation with 200 μA anodal current for 180 minutes. The average time of electrical stimulation needed to achieve total occlusion (n = 7) was 110 ±49 minutes. Alternating occlusion and recanalization of the artery (cyclic flow variation) was observed in 12 rabbits, with total occlusion ensuing in 6/12 cases. Intravenous administration of recombinant tissue-type plasminogen activator (20 μg/kg/min for sixty minutes) resulted in femoral reflow and subsequent reocclusion in 2/5 cases. Histopathologic examination disclosed arterial thrombi composed of platelets, fibrin, and red blood cells.

Thus, according to these data this technique was found to induce arterial thrombosis following electrical stimulation of the rabbit femoral artery but was inconsistent regarding the arterial patency.
Pentoxifylline for Intermittent Claudication
Authors: Ernst E.
Published: July 2008

Pentoxifylline was first introduced in Germany twenty years ago. Today it is the best researched oral drug for intermittent claudication. A total of seventeen placebo- controlled trials could be retrieved from the world literature. The majority of these studies show that pentoxifylline will prolong the walking distance in a statistically significant way. Even though these trials are conducted with considerable scientific rigor, important flaws can be identified. Whether the symptomatic improvement is clin ically relevant is difficult to say and may depend on the patient's individual situation. These collective data show that pentoxifylline prolongs the walking distance in patients with intermittent claudication.
Pulmonary Arteriovenous Malformations
Authors: Grahmann Paul R. , Bonnet Reiner , Swoboda Lothar , Nöldge Gerd , Hasse Joachim
Published: July 2008

Pulmonary arteriovenous malformations (PAVM) represent an uncommon disease with only 500 reported cases. To emphasize the resectional surgical standard, 2 patients with PAVM and pulmonary right-to-left shunt are presented and the optional treatments discussed. One patient had suffered from a cerebrovascular accident. The other patient's diagnosis resulted from a coincidental finding in connection with an unrelated illness. Because of the risk of acutely developing complications, especially disabling or fatal cerebral ischemia, therapy is generally recommended even in asymptomatic patients. The 2 patients presented here were treated by resection. Surgical treatment with a very low risk and parenchyma-sparing technique remains the golden standard for large isolated malformations. In addition to the established and reliable operative therapy since 1978 catheter embolization is becoming the method of choice with an increasing range of indications in those centers experienced with this technique.
Left Circumflex Coronary Artery Arising as a Terminal Extension of Right Coronary Artery
Authors: Sagkan Olcay , Ornek Ender , Yeşildağ Osman
Published: July 2008

Many types of coronary artery anomalies have been detected, and most of them occur in the left circumflex artery.

In this report a unique circumflex artery anomaly is presented. The left circumflex artery arose as a terminal extension of the right coronary artery. The main stem and obtuse marginal branches of the circumflex artery were normal and well developed.
Thrombus Detection on Central Venous Catheters in the Neonatal Intensive Care Unit
Authors: Tanke R.B. , van Megen R. , Daniëls O.
Published: July 2008

Between September, 1989, and September, 1992, 193 infants were investigated prospectively for development of central-venous-catheter-induced thrombosis. In 25 infants intracardiac or central-venous-catheter-induced thrombosis was demonstrated (13%). A slightly higher incidence of thrombosis was found in infants with umbilical catheters in comparison with infants with subclavian catheters, although no significant difference was demonstrated. The results make clear that central venous catheters in neonatal intensive care have considerable risk in developing central venous or intracardiac thrombosis, and echocardiography is an excellent technique for diagnosing these thromboses.
Intravascular Ultrasound: Value of Electronic and Mechanical Devices for Quantifying Mild to Moderate Atherosclerosis
Authors: Duda Stephan H. , Wehrmann Manfred , Erdtmann Bernd , Huppert Peter E. , Claussen Claus D.
Published: July 2008

To define the accuracy of electronic and mechanical ultrasound (US) devices for deter mining the thickness of intima and media, 32 fresh normal and atherosclerotic human femoral arteries were obtained at necropsy. The samples were imaged with a 64- element array and a mechanically rotating US transducer at 20 MHz. The mean thickness of the intimal and medial layer was measured with electronic calipers followed by histopathologic and micromorphometric analysis. Morphometric correla tion for intima showed r = 0.64 for the electronic and r = 0.58 for the mechanical US device. The correlation between ultrasonic and histologic measurement of medial thickness in normal and diseased specimens was r = 0.79 for the multielement and r = 0.76 for the mechanical transducer. In conclusion, multielement array transducers are equivalent to mechanically driven probes in the quantitative assessment of periph eral arterial wall layers. Both systems lack sufficient accuracy in the determination of mild to moderate intimal thickening.
Effect of Magnesium Sulfate Infusion on Circulating Levels of Noradrenaline and Neuropeptide-Y-Like Immunoreactivity in Patients with Primary Raynaud's Phenomenon
Authors: Leppert Jerzy , Myrdal Urban , Hedner Thomas , Edvinsson Lars , Tracz Zofia , Ringqvist Ivar
Published: July 2008

The effect of a short-term magnesium sulfate (MgSO4) infusion on venous plasma concen tration of noradrenaline (NA) and neuropeptide-Y-like immunoreactivity (NPY-LI) was investigated in 12 women with primary Raynaud's phenomenon (PRP) and in 12 healthy matched controls.

The Raynaud's patients did not demonstrate any significant changes in mean basal plasma NA concentration (0.29 ±0.15 vs 0.37 ±0.09 ng/mL, ns) after MgSO4 infusion. However, in the controls there was more than twice the amount of circulating nora drenaline (cNA) (0.21 ±0.14 vs 0.54 ±0.22 ng/mL, P < 0.001) after MgSO4 infusion, compared with the preinfusion value. Measurements during the cold pressor test prior to the MgSO4 infusion showed a significant increase of cNA in both the PRP group and the control group (from 0.29 ±0.15 to 0.33 ±0.16 ng/mL, P < 0.05, and from 0.21 ±0.14 to 0.29 ±0.16 ng/mL, P < 0.005, respectively). After MgSO4 infusion the levels of cNA during the cold pressor test increased significantly only in the PRP group (from 0.37 ±0.09 to 0.41 ±0.11 ng/mL, P < 0.05).

Circulating NPY-LI concentrations increased significantly during MgSO4 infusion in the Raynaud's patients as well as in the controls from 105 ±21 to 127 ±23 pmol/L, P<0.05, and from 107 ±17 to 132 ±27 pmol/L, P<0.01, respectively. There were no detectable changes during the cold pressor tests in either group. In healthy women short-term MgSO4 infusion induced a sympathetic response, shown by the increased concentration of cNA and NPY-LI, while in PRP patients there was only an increase in NPY-LI. The discrepancy between PRP patients and healthy controls supports the view of a so-called "local fault" in the sympathetic nerve terminal of arterial/arteriolar walls in Raynaud's patients.
Comparative Evaluation of Pentoxifylline, Buflomedil, and Nifedipine in the Treatment of Intermittent Claudication of the Lower Limbs
Authors: Chacón-Quevedo A. , Eguaras M.G. , Calleja F. , Garcia M.A. , Roman M. , Casares J. , Muñoz I. , Concha M.
Published: July 2008

In the light of the current controversy surrounding the use of hemorheologic and vasodilator drugs in the treatment of peripheral arteriosclerosis, a comparative study was designed in order to evaluate the efficacy of pentoxifylline, buflomedil, and nifedipine in 45 patients with peripheral arterial disease (Fontaine stage II).

The patients in this prospective randomized study were divided into three groups: 15 patients received pentoxifylline treatment (1,200 mg/day), 15 were treated with buflomedil (600 mg/day), and 15 with nifedipine (60 mg/day).

Response to treatment was assessed at the start of the study and after forty-five and ninety days, by clinical examination, Doppler test, strain test, and digital occlusion plethysmography using a strain gauge ring. Pentoxifylline was significantly more effective (P < 0.05) than buflomedil and nifedipine at ninety days in improving walking perfor mance, resting toe pressure, resting and postexercise ankle/brachial pressure ratio, and basal/postischemic toe-pulse ratio. Significant differences within groups were also noted for initial claudication, toe peak-flow time, pulse reappearance time (PRT/2), and maximum postischemic flow time, together with significant intergroup variables. In conclusion, pentoxifylline proved more effective than the other drugs tested in:

1. improving distal pressure and resting microcirculatory blood flow;

2. increasing postexercise distal flow, ratios, and pressures and enabling faster recuper ation of basal pulse rates;

3. increasing initial claudication distance in the strain test within the test group and achieving a greater absolute subjective claudication distance than that obtained using the other treatments.
Primary Raynaud's Phenomenon
Authors: Planchon Bernard , Pistorius Marc-Antoine , Beurrier Philippe , De Faucal Philippe
Published: July 2008

Many authors consider that late onset is a suspect criterion for differentiating primary Raynaud's phenomenon (Raynaud's disease, RD) from Raynaud's syndrome (RS). However, many cases of late-onset Raynaud's phenomenon in patients over forty years of age remain without etiologic diagnosis and therefore deserve the designation "late- onset RD." One hundred and ninety-four patients with RD (143 women, 51 men) were selected among 424 patients with Raynaud's phenomenon, according to Allen and Brown's criteria with negative serologic investigations and normal capillaroscopy. The purpose of the study was to consider the possible discriminant value of age of onset in distinguishing between RD and RS. The following epidemiologic features were studied: age of onset, sex, family history of Raynaud's phenomenon and migraine, and smoking and working habits. Microcirculation was assessed by capillaroscopy and strain-gauge plethysmography. Maximal digital flow at 45°C and reactivity to cold were determined for each patient.

Results were related to age of onset. The existence of true cases of late-onset RD in patients over forty years of age was confirmed (prevalence 27%), showing a correlation (continued on next page) with a family history of Raynaud's phenomenon inferior to that found in early-onset cases (p < 0.0001). Microcirculation studies generally indicated a strong correlation between reactivity to cold, familial RD, and early onset, whereas no correlation was found with migraine or smoking. Nor was there any clinical or plethysmographic evidence for arteritis as a possible pathogenetic factor in late-onset RD. These results indicate that late-onset RD is a valid designation and that its pathogenesis seems less dependent on genetic sensitivity to cold than that of early-onset cases. In the absence of underlying arteritis, neurovascular dysfunction or a hemorheologic mechanism may be suggested as plausible causes of late-onset RD.
Ace Inhibitors and Cough
Authors: Yesil Sena , Yesil Murat , Bayata Serdar , Postaci Nursen
Published: July 2008

Probably the most common and irritating side effect of angiotensin-converting enzyme (ACE) inhibitors is cough. In this retrospective study the incidence of cough was investigated in 1113 patients with arterial hypertension who were receiving ACE inhibitors alone or in combination with other antihypertensive agents. Patients were treated with one of the following ACE inhibitors: enalapril 10-20 mg/day (n:668), captopril 25-75 mg/day (n:234), perindopril 2-8 mg/day (n:90), or lisinopril 5-20 mg/day (n:121). Mean follow-up periods were twenty-six months with enalapril, twenty-nine months with captopril, eleven months with perindopril, and thirteen months with lisinopril. Spontaneously declared cough incidence in enalapril, captopril, perindopril, and lisinopril groups were 7%, 5.1%, 2.2%, and 1.6%, respectively Cough was not dose related. Treatment was stopped in all patients with cough. In 59% of patients the onset of cough occurred after the first month of treatment (thirty to one hundred eighty days). Cough decreased by 50% within three days of drug cessation and disappeared in ten days. Mean age of patients with cough was 58.7 years and 79% of them were women. In patients without cough, mean age was 57.8 years and 56% of them were women. There was no significant difference between the two groups regarding mean age, but the sex difference between groups was statistically significant (P < 0.05).

In conclusion, although cough may occur with all four types of ACE inhibitors, the incidence of this side effect was higher during enalapril and captopril treatment than during lisinopril and perindopril treatment. The incidence was also greater in women than in men.
Multiple Balloon Rupture During Coronary Angioplasty: A Case Report
Authors: Kwan Tak , Huber Michael S. , Jani Haresh , Feit Alan
Published: July 2008

The authors report a case of coronary angioplasty of the left anterior descending artery complicated by multiple balloon rupture. Various balloon types including polyethylene terephthalate and PE 600® (ACS) ruptured at low atmospheric pressure. During balloon rupture, a septal side branch was dissected with severe intimal staining. The authors postulate that a particular lesion morphology was responsible for balloon rupture. Approaches to such lesions using alternative coronary angioplasty techniques and newer technologies are discussed.
Dextrocardia with Single Coronary Artery Ostium in a Patient with Aortic Regurgitation and Supraventricular Tachycardia
Authors: Yip Alex S. B. , Chow W.H. , Cheung K.L.
Published: July 2008

A sixty-year-old man who presented with dyspnea and palpitations was investigated in this institution and was found to have dextrocardia, single aortic coronary ostium, severe aortic regurgitation, and atrioventricular nodal reentrant tachycardia. The association of single aortic coronary ostium and this combination of cardiac abnormalities has not been previously reported.