bluuebunny/crossref_metadata_2025 huggingface dataset:
The Small Right Coronary Artery: Angiographic Implications—Case Reports
Authors: Venkataraman Kalyanasundaram , Gaw Johnny , Gadgil Uday G. , Samant Dinesh R. , Matthews Nur P.
Published: November 2007

Two patients with small right coronary arteries are presented. Possible complications during coronary angiography and methods of preventing them are discussed. It is stressed that the time of occlusion of the artery by the catheter tip should be kept to a minimum. The use of newly available angiographic catheters with side holes is also illustrated.
A New Syndrome: Angiotensin-Converting Enzyme Dysfunction Syndrome: Differential Diagnosis and Pathogenesis—Case Reports
Authors: Umeki Shigenobu , Terao Akira , Sawayama Toshitami
Published: November 2007

The authors previously reported a new syndrome, angiotensin-converting enzyme dysfunction syndrome (ACEDS), which is clinically characterized by mild systemic hypertension, a hypokalemic alkalosis, and hyperreninism with a high concentration of angiotensin-I (ANG-I), a normal angiotensin-II (ANG-II) value, and a normal aldosterone level. In the present study, they investigated the diagnosis and differentiation of diseases concomitant with hyperreninism, such as ACEDS, Bartter's syndrome, familial periodic paralysis, and renovascular hypertension treated with captopril for two months, and discussed the pathogenesis of ACEDS.
High 2,3-DPG Blood Cardioplegia and Myocardial Preservation During Cardiopulmonary Bypass
Authors: Card Robert T. , Prasad Kailash , Bharadwaj Baikunth , Hnatuk Lorrence A. P. , MacFadyen Mark A.
Published: November 2007

Blood may provide superior cardioplegia compared with crystalloid cardio plegic solution. However, the results are controversial. This may be due to a leftward shift of the hemoglobin (Hb)-02 dissociation curve induced by hypo thermia, increasing the oxygen affinity for Hb. This effect may negate the po tential benefit of blood cardioplegia. The oxygen affinity for Hb can be decreased by increasing the red cell 2,3-diphosphoglycerate (2,3-DPG), and hence, more oxygen can be delivered to the myocardium. The present investiga tion was undertaken to study the effects of 2,3-DPG-enriched blood cardiople gia on the functional recovery of the myocardium and changes in the coronary sinus red blood cell (RBC) adenosine-triphosphate (ATP), lactate, and RBC DPG after one and a half hours of reperfusion following one hour of ischemic cardiac arrest in dogs. The dogs were divided into three groups: crystalloid (CR); stored blood (SB), and high 2,3-DPG blood (HDPG) cardioplegic groups. Incubation of canine RBC in phosphoenal pyruvate (PEP) led to a 36% increase in DPG and a rightward shift in the Hb-O2 dissociation curve. There was a 4 mm Hg shift in the P50. When compared with the CR group, there was a significant decrease in the cardiac index (CI) and left ventricular work index (LVWI) and a significant increase in the total systemic vascular resistance (TSVR) in the SB group. The CI and LVWI of the HDPG group were similar to those of the CR group, but the TSVR was significantly greater in the former group. The LVWI was significantly greater and the TSVR smaller in the HDPG group as com pared with those in the SB group. The coronary sinus, lactate, and RBC 2,3- DPG were never significantly different at any point among the three groups, although a trend toward a decrease in lactate with the HDPG group was ob served. There was no significant difference in the RBC ATP content from the three different groups except during initial period of ischemic arrest when RBC ATP content of HDPG group was greater than that in CR group. There was a decrease in the Hb content of the blood in all three groups. The decreases were similar in all the groups except during the postpump period, when the Hb con tent of the HDPG and SB groups was higher than that of the CR group. These results suggest that stored blood was inferior to crystalloid and HDPG cardioplegia in preserving the myocardial function and cardiac metabolism. However, HDPG cardioplegia was not better than CR cardioplegia in preserv ing the cardiac function. Better preservation of cardiac function with HDPG as compared with the SB group might be due to a rightward shift in the Hb-O2 dissociation curve.
Histochemical and Fluorescent Techniques for Detection of Early Myocardial Ischemia Following Experimental Coronary Artery Occlusion: A Comparative and Quantitative Study
Authors: Chopra Prem , Sabherwal Usha
Published: November 2007

Several workers have used histochemical, enzymatic, and fluorescent meth ods to diagnose early myocardial ischemia, but the problem of unequivocal de tection of early ischemia still remains an enigma to pathologists. In the present study, the left coronary artery was ligated in an animal model, rat, in order to produce myocardial ischemia at different time intervals, from five minutes to six hours. Fluorescent techniques and tetrazolium staining of myocardial suc cinic dehydrogenases have been used to detect onset of ischemia with the pur pose of identifying a sensitive technique for use in routine pathologic specimens.

Nitroso-blue tetrazolium and triphenyl tetrazolium chloride staining of myocardium showed loss of dehydrogenases within five to twenty minutes of ligation of the coronary artery. This loss was consistent and progressively in creased at longer time intervals, the mean ischemic area mapped being 25.74 mm2 and 66.87 mm2 at five to twenty minutes and six hours respectively. Such comparison of ischemic area of myocardium at different time intervals has not been reported earlier.

Autofluorescence in formalin-fixed, hematoxylin and eosin-stained sections showed positive fluorescence only after fifty to seventy-five minutes of ischemia and was patchy in distribution in the left ventricular wall even up to six hours of ligation.

Examination of myocardium under fluorescent light after acridine orange staining proved to be more sensitive than autofluorescence for detecting ische mia. At five to twenty minutes, the mean ischemic area was 18.67 mm2 and by six hours it increased to 27.48 mm2 .

Friedman two-way analysis of variance, applied for comparative evaluation of techniques, showed that tetrazolium salts were more sensitive and the mean ischemic area was significantly greater than the zone outlined by acridine or ange (p < .05 at five to twenty minutes; p < .01 at fifty to seventy-five minutes; p < .001 at one and one half to two hours and p < .025 at two and one fourth to three hours).

Autofluorescence was significantly less than acridine orange fluorescence (p < .05 at five to twenty minutes and < .01 at six hours). Such statistical evalu ation has been done for the first time in the present study and has highlighted the value of acridine orange and tetrazolium salts in detection of early ischemia.
Combined Thrombolytic Therapy and Percutaneous Transluminal Angioplasty for Treatment of Complex Arterial Graft Thrombosis—A Case Report
Authors: Rubin Jeffrey R. , Pond Gerald D. , Bernhard Victor M.
Published: November 2007

Combined catheter-directed thrombolytic therapy followed by percutaneous transluminal angioplasty (PTA) was successfully performed for the treatment of a thrombosed complex mesenteric artery bypass graft resulting from an anasto motic stenosis. Restenosis of the graft due to neointimal hyperplasia was subse quently treated by PTA, with resultant long-term patency. This approach is an attractive alternative to surgical thrombectomy and graft revision, especially in patients who are poor surgical risks owing to concurrent medical problems.
Determinants of Left Ventricular Ejection Fraction by Ultrafast Computed Tomography
Authors: MacMillan Robert M. , Rees Michael R.
Published: November 2007

Twenty-seven patients had left ventricular ejection fraction (LVEF) mea sured by catheterization, single-plane angiography, and ultrafast computed to mography (cine CT). Twelve patients (mean age sixty-two years) had LVEF measured by use of the cine CT long-axis view LAV), and 15 patients (mean age fifty-eight years) had LVEF measured by use of the cine CT transaxial view (TAV). Cine CT LVEF was measured by means of two methods of edge detection (M1 and M2). A significant correlation was found between single-plane angiogra phy and cine CT LAV LVEF (M1, r=.96; M2, r=.93). A lesser correlation was found for catheterization vs TAV cine CT LVEF (M1, r=.77; M2, r=.81). There was no significant difference between the two methods of edge detection for determining LVEF (M1 vs M2: LAV, r=.98; TAV, r=.94); however, there was significant variability in cavity volumes. Therefore, the LAV is superior to the TAV for measurement of LVEF by cine CT; however, different methods of edge detection, though affecting volumes, may not affect LVEF.
Age- and Sex-Related Changes in the Ratio Between Ankle and Brachial Systolic Pressure in Normal Subjects
Authors: Hugues Ch. J. , Asmar R.G. , London G.M. , Safar M.E.
Published: November 2007

The ratio between ankle (ASP) and brachial (BSP) systolic pressure was studied by using Doppler ultrasound in 198 normal subjects aged between twenty and ninety years: 97 males and 101 females. The ASP/BSP ratio de creased significantly with age both in males (r = - 0.64; p < 0.001) and in females (r = -0.72; p < 0.001). In males, the decrease in the ratio with age was due to a significant decrease in ASP with age (r = - 0.52; p < 0.001), whereas BSP did not increase significantly with age. In females, a different result was observed, since only BSP (and not ASP) was significantly (and positively) cor related with age. In both sexes, the diameter of the terminal abdominal aorta measured by echocardiography was significantly increased with age, and full examination with Doppler ultrasound excluded any significant arterial stenosis of the lower limbs. The study provided evidence that age- and sex-related changes in arterial wave transmission do exist in normal subjects.
Effects of Naftidrofuryl in Patients With Intermittent Claudication
Authors: Karnik Ronald , Valentin Andreas , Stöllberger Claudia , Slany Jöry
Published: November 2007

In a randomized, double-blind, placebo-controlled study in patients with peripheral arterial occlusive dis ease stage IIb of Fontaine's classifica tion, the efficacy of naftidrofuryl, a vasoactive substance, was investi gated. Forty patients — 31 men and 9 women with an average age of 62.98 ± 10.65 years — were admitted to the study. All had a history of claudica tion for at least six months. The du ration of the trial was eighteen weeks. After a washout period of two weeks the patients received either two times 400 mg naftidrofuryl or two identical placebo tablets daily for eight weeks. Subsequently a cross over from verum to placebo and vice versa was carried out and the alter native medication was administered for another eight weeks.

Clinical results were evaluated by measuring painfree and maximal walking distance by treadmill test at a speed of 3.2 km/h and an inclina tion of 12°. Systolic ankle pressure and brachial pressure were measured by Doppler ultrasound, and ankle/ arm pressure ratio was calculated. Treadmill test, Doppler ultrasound examination, and laboratory data analysis were performed at the begin ning of every study period, every four weeks during and at the end of the study.

Results. The patients in both groups showed an initial homogeneity of age, risk factors, concomitant dis eases, walking distance, and Doppler indices. After eight weeks naftidro furyl resulted in a statistically signifi cant increase in painfree (p < 0.02) and maximal walking distance (p < 0.05). The placebo-treated group showed only a slight, statistically nonsignificant increase in both pain free and maximal walking distance. After crossover the administration of naftidrofuryl produced a further in crease in painfree walking distance (p < 0.05), whereas in the group crossed over to placebo, both pain free and maximal walking distance remained unchanged. Systolic ankle blood pressure and ankle/arm pres sure ratio showed no significant al terations in both groups within the study period. The authors conclude that naftidrofuryl is an efficient va soactive drug, which significantly im proves walking distance in patients with peripheral arterial occlusive dis ease stage IIb.
A Physical Model for the Cardiovascular and the Respiratory Systems
Authors: Nichelatti Michele , Pallotti Giovanni , Pettazzoni Paolo
Published: November 2007

We propose a two degrees of free dom oscillating system to simulate the working of both respiratory and car diovascular apparatus and to investi gate the physico-mathematical char acteristics of a possible decoupling between the physiological systems.

We suppose a double mathemati cal pendulum with forced and damped oscillations, with the first frequency equal to four times the sec ond one; not only, does the system not give resonance or beatings, but it also simulates with reasonable approxi mation the ratio between natural rel ative frequencies.

The two Langragian equations, that have form: with

cannot be solved in an analytical way, even if we suppose an approxi mation for little oscillations.

Now we are studying another two d-o-f mechanical system, with only one suspension point; we are also studying both the electrical equiva lent circuits.
Adrenaline-Induced Changes in Serum Electrolytes, ECG, and Blood Pressure, with Ca-Blockade Pretreatment
Authors: Johansson Bengt W. , Hansen Ole , Juul-Möller Steen , Svensson Ola
Published: November 2007

Adrenaline infusions (AI) (0.5 μg adrenaline per 10 kg body weight per minute over 120 minutes) were given weekly for three weeks to 20 healthy male volunteers aged twenty-one to thirty-eight years. The AI was given after three days' treatment with diltiazem (D), verapamil (V), or placebo (Pl) in a single-blind fashion. After pretreatment with PI, serum potassium (s-K) decreased from 3.93 ± 0.30 mmol/L (M ± SD) to 3.33 ± 0.31 (P < 0.001) with the greatest change 69.75 ± 46.24 minutes after the start of the AI. Corresponding values for s-Mg were 0.84 ± 0.06 to 0.78 ± 0.05 (P < 0.01) and 106.50 ± 36.71 minutes, for s-Ca 2.40 ± 0.07 to 2.30 ± 0.08 (P < 0.01) and 103.50 ± 36.06 minutes, for s-P 1.05 ± 0.17 to 0.91 ± 0.17 (P < 0.02) and 80.25 ± 47.25 minutes, and for s-urate 344.79 ± 50.55 to 329.26 ± 47.80 (P > 0.05) and 63.95 ± 46.05 minutes. After pretreatment with D, AI produced similar electrolyte changes as after PI, but the rise in blood glucose was slightly more pronounced and the drop in s-urate less pronounced. The heart rate (HR) before AI after pretreatment with D was lower than after PI, but the increase during the AI was of the same magnitude. The AI-induced changes in systolic (SBP) and diastolic (DBP) blood pressure after D did not differ significantly from those seen after PI, and neither did QT and QTc, whereas the PR duration was prolonged (0.18 ± 0.03 second) when compared with PI (0.16 ± 0.02) (P < 0.05). Although the magnitude of the change in DBP was not influenced, V prolonged the time till the lowest DBP (48.95 ± 26.38 minutes) when compared with PI (31.50 ± 29.16 minutes) (P > 0.05). The other variables followed the same pattern as for D.

In conclusion AI in healthy volunteers produced a drop in s-K but in addition a drop in s-Mg and s-Ca, the latter appearing later than the drop in s-K. Pretreatment with diltiazem and verapamil did not influence the magnitude of these changes but reduced the drop in s-urate.
Delayed Hypersensitivity and Differences of Histologic Pattern in Allergic Cutaneous Vasculitis
Authors: Tosca A. , Hatzis J. , Kyriakis K. , Stavropoulos P. , Varelzidis A. , Stratigos J.
Published: November 2007

Fourteen patients with allergic cutaneous vasculitis of either the polymorphonuclear (PMN)- or the mononuclear (MN)-predominant type were studied as regards the following parameters: the disease duration, histology, monoclonal antibody typing of the mononuclear cell infiltrate from recent lesions, and the delayed hypersensitivity (DH) response, assessed both by recall antigens (tuberculin type) and the dinitrochlorobenzene skin test. From the results, it was shown that in PMN-predominant vasculitis, DH reactions were well elicited, whereas in MN-predominant vasculitis, DH skin reactions were somehow impaired. In MN-predominant cases, many OKT3 +, OKT4+, OKT8+, and OKM1+ cells were usually seen to surround the skin vessels, whereas in PMN-predominant cases, rare OKT8+, OKT4+, or OKM1+ cells were seen in the dermis. The epidermal dendritic cell system, as revealed by the Na 134 monoclonal antibody, was unaffected in both types of allergic cutaneous vasculitis.
Continuous-Wave Doppler of Vertebral Arteries in Noninvasive Diagnosis and Management of Vertebro-Basilar TIAs
Authors: Amadori Andrea , Arnetoli Graziano , Nuzzaci Giuseppe , Stefani Paolo
Published: November 2007

Continuous-wave Doppler and angiography of the vertebro-basilar system were used in 38 patients with vertebro-basilar transient ischemic attacks. 63 vertebral arteries were studied. Among 47 normal Doppler parameters, 46 were confirmed by angiography. The sonographic diagnostic procedure showed a very high negative predictive value (97.87%), while the positive predictive value was relatively low (56.25%). Data from literature were reviewed. The authors suggest that when Doppler of vertebral arteries is negative, there is a very low probability that a follow-up angiography will reveal pathologic conditions calling for a surgical approach.
Long-Term Beneficial Effects of PTCA on Segmental Early Relaxation in Disease of the Left Anterior Descending Coronary Artery
Authors: Colle Jean-Pierre , Le Goff Germain , Carfora Antonietta , Delarche Nicolas , Kilpatrick David D. , Besse Pierre
Published: November 2007

The relationship between regional left ventricular (LV) motion and global pressure relaxation of the left ventricle remains unclear.

To clarify the recent concept of segmental early relaxation in coro nary artery disease, the authors in vestigated two groups of patients. In group I, all 12 patients (mean age 47±7 years) exhibited evidence of a normal heart after an extensive in vestigation. In group II, 25 patients (55±7 years) presented an isolated stenosis of the left anterior descend ing coronary artery, and they under went a hemodynamic investigation before and after (six to nine months) a durable successful percutaneous transluminal coronary angioplasty (PTCA).

After all conventional hemody namic measurements had been done, a quantitative frame-by-frame analy sis of left ventricular wall motion was conducted. The authors' method is derived from that of Ingels, applying to LV cineangiograms filmed in 30° right anterior oblique view at a 50 frames/second rate. Thus segmental wall motion is analyzed in terms of amplitudes (%), velocities of shorten ing and lengthening in circumfer ences/second (circ/sec), and times of events (%). Statistical results took into account the reproducibility of the method.

Main results regarding the control state of group II consisted of an asy nergic motion of the anterior region taking place from end systole to early diastole:

1. Early end of contraction in an terior segments (% of systolic time in terval : 88±14% vs 96±6% in group I, p < 0.001)

2. Asynchronism at end systole (maximal velocity of shortening — 0.4±2.3 circ/sec in anterior segments vs 0.05±1.9 in inferior segments, p < 0.02)

3. An early but poor outward an terior wall motion (anterior lengthen ing at 0.04 sec after the end of ejec tion 2.9±10% in group II versus 5.4±7.2% in group I, p < 0.05)

These abnormalities are strongly correlated with a significant impair ment of peak negative diastolic pres sure/diastolic time (dP/dt) (1500 ±400 mmHg. sec-1 vs 1850±410 in group I, p < 0.02).

Long-term beneficial effects of PTCA in group II were characterized by an almost complete normalization, both asynergy and relaxation taking place back within the normal range.

The authors conclude that in this kind of patient, peak negative dP/dt could be an index of an asynergic seg mental motion, this one being cor rectly analyzed and quantified on LV cineangiograms with our method.
Effects of Splenectomy on Serum Lipids and Experimental Atherosclerosis
Authors: Asai Kanichi , Kuzuya Masafumi , Naito Michitaka , Funaki Chiaki , Kuzuya Fumio
Published: November 2007

The authors examined the effects of splenectomy on serum lipids in patients with hematologic disease, in rabbits, and also in cholesterol-fed rabbits with experimental atherosclerosis.

Serum cholesterol was determined in patients with hypersplenism before and after splenectomy. Meanwhile serum lipids were determined in two groups of rabbits: splenectomy group (Spx group, n = 19), and sham operation group (Sham group, n = 14) before and after the operation. Then the rabbits were divided into four subgroups: cholesterol-fed groups-Spx-C (n = 12) and Sham- C (n=9), and normal-chow-fed groups-Spx-N (n=7) and Sham-N (n=5). The Spx-C and the Sham-C rabbits were fed 1% cholesterol diet and the Spx-N and the Sham-N rabbits were fed normal chow for twelve weeks. In patients preop erative serum cholesterol levels were low, and significant increase in serum cho lesterol was observed following splenectomy. In rabbits, the Spx-C group showed significantly higher levels of serum cholesterol, triglycerides, and phos pholipids in contrast to lower levels of high density lipoprotein cholesterol, as compared with the Sham-C group. The percentage of aortic plaque area in the Spx-C group tended to be higher than that in the Sham-C group. On the other hand, the Spx-N and the Sham-N group showed no difference in serum lipids during twelve weeks. The worsening of atherosclerosis in the Spx-C group was considered to be mainly due to an enhanced hyperlipidemia.

Their results suggest a possible role of the spleen in lipid metabolism, in particular the existence of a splenic factor that can cause hypocholesterolemia in hyperplenism and can suppress hyperlipidemia.
Cardiac Alterations in Ankylosing Spondylitis
Authors: Alves Mario G. , Espirito-Santo Jorge , Queiroz Mario V. , Madeira Hugo , Macieira-Coelho Eduardo
Published: November 2007

Forty patients, 30 men and 10 women with an average age of 38.47 ± 11.07 years, suffering from ankylosing spondylitis and attending a Rheumatology Outpatient Clinic, were evaluated for cardiovascular involvement. The evaluation was based on patients' clinical observation, electrocardiography, echocardiography, and chest x-ray. More than a simple review, this study was undertaken with the aim of arriving at a better clinical definition of the cardiovascular manifestations found in ankylosing spondylitis. In fact, of the 40 patients, 8 (20%) had systemic hypertension for which an explanation could not be found, 4 of whom were less than forty-five years old; the echocardiogram showed mitral valve prolapse in 4 patients (10%), 2 of them with a systolic murmur and other 2 with a protosystolic click on auscultation. More significant than the changes in conduction was the finding of a sinus bradycardia in 9 patients (22.5%), and a PR interval below 120 msec in 3 patients (7.5%). The authors conclude that the extension of cardiovascular changes in ankylosing spondylitis is more vast than usually acknowledged.
Traumatic Aneurysms of Cerebral Vessels: A Case Study and Review of the Literature
Authors: Soria Emilio D. , Paroski Margaret W. , Schamann Mary E.
Published: November 2007

Traumatic cerebral aneurysms (TCAs) are rare: few more than 100 cases are recorded in the world literature. TCAs are located predominantly in the supratentorial compartment and are classified as either "true" or "false." A true aneurysm is a dilation resulting from partial disruption of the arterial wall. A false aneurysm results from a full-thickness tear, with the scar from the brain tissue or an organized hematoma acting as the aneurysmal wall. The authors present a case of a false traumatic aneurysm of the pericallosal artery, which was discovered in a young patient fourteen months after a self-inflicted gunshot wound to his head. The aneurysm was an incidental finding on a CT scan performed for the investigation of his late posttraumatic seizures. Its presence was confirmed by angiography. The interval between the traumatic episode and the diagnosis of a TCA usually ranges from a few hours

to a few weeks, for most are discovered by angiography performed in the acute or subacute stage of a head injury. The long interval between the injury and the diagnosis in our case is exceptional.

A previous CT scan done four months after the injury did not reveal the aneurysm, which strongly suggests a protracted growth of the aneurysmal sac long after the trauma.
Multicenter Double-Blind Study of Ticlopidine in the Treatment of Intermittent Claudication and the Prevention of its Complications
Authors: Arcan J.C. , Blanchard J. , Boissel J.P. , Destors J.M. , Panak E.
Published: November 2007

In this multicenter trial 169 patients with chronic intermittent claudication due to obstructive peripheral vascular disease were randomized in a double- blind fashion into two parallel groups receiving either 250 mg ticlopidine or placebo, twice daily. At entry, the two groups (83 ticlopidine, 86 placebo) were well matched for the major clinical features apart from an excess of women in the ticlopidine group. At six months, 167 patients were alive, 2 having died of malignant disease (1 from each group). At this stage, 39 patients from the ticlo pidine group and 29 from the placebo group (p = 0.04) had increased their walking distance by more than 50% of baseline values. For the groups as a whole pain-free and total walking distance were greater in the ticlopidine group than in the placebo group (194 vs 124 meters, p = 0.03 and 236 vs 170 meters, p = 0.04, respectively). Two patients from the ticlopidine group vs 9 patients from the placebo group (p = 0.03) developed significant cardiovascular events during the study. These results indicate that ticlopidine has a beneficial effect both in the treatment of the symptoms and the prevention of vascular complica tions in patients with intermittent claudication.
Pure Infundibular Pulmonary Stenosis Induced by Radiation Therapy — A Case Report
Authors: Katayama Tomoyuki , Irita Akiko , Honda Yukiharu
Published: November 2007

A sixty-one-year-old woman developed acquired infundibular pulmonary stenosis eleven years after radiation therapy to the mediastinum. On catheteri zation, there was a 48 mmHg gradient between the right ventricle and the pul monary artery. Postmortem examination revealed remarkable narrowing of infundibulum. Histologic examination strongly suggested that muscular hyper trophy of the right ventricular outflow tract had been induced by a high dose of radiation therapy.
A Double-Blind Trial of Calcium Dobesilate in Chronic Venous Insufficiency
Authors: Casley-Smith John Royle
Published: November 2007

Calcium dobesilate was studied in a double-blind trial in 30 normal subjects and in 30 patients with chronic venous insufficiency (CVI). There were no sig nificant alterations in the normal subjects. In patients with CVI the active drug gave significant improvements (p < 0.01) in the measured volume of the foot and lower limb, in clinical tenderness (p < 0.05), and in most of the symptoms (in cluding feelings of heaviness, swelling, tiredness, and aching in the lower ex tremities). Even though the chronic venous insufficiency had existed for an av erage of fifteen years, a relatively short course of the drug caused considerable, and significant, improvements in a number of signs and symptoms of the dis ease.
The Carpal Tunnel Syndrome — A Disease Underlying Raynaud's Phenomenon?
Authors: Loebe M. , Heidrieh H.
Published: November 2007

Forty patients with clinically and electromyographically proven carpal tun nel syndrome were examined for the frequency of concomitantly occurring Ray naud's phenomenon. The angiologic work-up was based on a detailed vascular history and examination, Doppler sonography to determine systolic digital ar tery pressures before and after exposure to the cold (10 ° C for one minute), and thermoplate tests for recording heat convection of the hands at normal room temperature and measuring rewarming time after standardized cold exposure. Only 10% of the patients were found to have manifest Raynaud's phenomenon. The incidence was thus the same as in the general population. In addition, Ray naud's phenomenon and the carpal tunnel syndrome were poorly correlated with respect to their preliminary symptom appearances.

Consequently, the carpal tunnel syndrome can no longer be regarded as a disease underlying Raynaud's phenomenon.
Coumarin Skin Necrosis in a Patient with Heparin-Induced Thrombocytopenia — A Case Report
Authors: Celoria Giovanni M. , Steingart Richard H. , Banson Bernabe , Friedmann Paul , Rhee Sang W. , Berman Joel A.
Published: November 2007

A patient with evidence of both heparin-related thrombocytopenia and coumarin-induced skin necrosis is presented. Etiology, diagnostic evaluation, histopathology, and therapeutic options are discussed.
Photoplethysmographic Documentation of Improved Microcirculation After Pentoxifylline Therapy
Authors: Roeren Thomas , LeVeen Robert F. , Nugent Loree
Published: November 2007

Pentoxifylline is the prototype of a new class of drugs that improve periph eral blood flow mainly by increasing red blood cell flexibility. Few studies have been performed to objectively evaluate the effect of the drug in a routine clinical setting.

In 11 patients with intermittent claudication, photoplethysmography was used to monitor the effect of pentoxifylline on the microcirculation in the lower extremities. Values obtained improved significantly (p < .0001) under therapy. Concomitant measurements of ankle-brachial indices showed no significant changes despite clinical improvement. Diabetic patients in this study seemed to benefit from treatment with pentoxifylline at least as much as nondiabetic pa tients.

Photoplethysmography proved to be a very efficient and inexpensive method of studying the effects of pentoxifylline. Ankle-brachial indices are not a suit able method of detecting flow changes attributable to the mechanism of action of this drug.
Opening of Coronary Collaterals by Repeated Brief Coronary Occlusions in Conscious Dogs
Authors: Fujita Masatoshi , McKown Daniel P. , McKown Michael D. , Franklin Dean
Published: November 2007

The collateral blood flow and regional myocardial function during a one- minute coronary occlusion were compared before and after multiple one-minute coronary occlusions. After repeated coronary occlusions, the collateral blood flow velocity increased significantly from 0.7 ± 0.1 (SE) to 2.0 ± 0.2 cm/sec (p < 0.05), and the blood flow debt repayment decreased from 326±26% to 189 ± 12 % (p < 0.05). The systolic segment shortening in the collateral depend ent zone improved slightly. Thus, the native coronary collateral vessels open in response to a repeated ischemic stimulus.
Hemolymphangioma in a Neonate — A Therapeutic Problem — Case History
Authors: Beninson Joseph , Hurley Jeffrey P.
Published: November 2007

The authors present the case of a one and one-half-day-old child with a 4 x 5 cm hemolymphangioma of the left lower extremity.

The mass was a violaceous, protu berant, compressible tumor covered with distended peau d'orange skin. A pressure dressing was applied to the lesion, and it was made certain that the blood supply to the foot was not cut off. The lesion began to resolve within a week and over the next few months; however, pressure may need to be continued for her lifetime.

The patient had been wearing a pressure-gradient leotard as of six months of age, but this was discontin ued after two weeks because of the authors' inability to converse with the child to determine how much pressure could be safely employed.

This is one example of a to date successfully treated hemolymphan gioma in a neonate using a pressure dressing initially followed by com bined compression therapy. The pro posed mechanism of this therapy, as well as comparison with other types of therapy, is discussed.
Sinus Node Suppression in Acute Strokes—Case Reports
Authors: Bashour Tali T. , Cohen Michael S. , Ryan Colman , Antonini Charles
Published: November 2007

The authors report on 5 patients, 4 of them observed over a period of only two months in one community hospital, who developed profound sinus node suppression in the early phase following acute strokes. This complication re sulted in the death of 2; in the remaining 3, it was controlled by electrical car diac pacing or intravenous atropine. In 3 patients, the strokes were due to subarachnoid hemorrhage, and in 2, they were secondary to vascular occlusion. In at least 4 patients, the prognosis seemed favorable from a neurologic stand point. Vagally mediated sinus node arrest may, therefore, represent a poten tially fatal complication of strokes and may be more frequent than currently appreciated. Continuous monitoring in the early phase of acute strokes and pacemaker therapy may be lifesaving in some patients. This and the general phenomenon of functional failure of the sinus node due to a variety of causes are discussed.
Current Therapy of Peripheral Obstructive Arterial Disease. The Non-Surgical Approach
Authors: De Felice Maria , Gallo Pasquale , Masotti Giulio
Published: November 2007

In recent years double-blind trials have proved the effectiveness of nonsurgical therapy in the treatment of peripheral obstructive arterial disease (POAD). Among the non-pharmacologic measures taken, walking distance was increased by 40% in subjects who stopped smoking and by more than 100% in those who undertook physical exercise. Drug treatment reduces the atherosclerotic process and brings about an improvement in the symptoms of the disease. In subjects given hypolipidemic treatment the progression of the disease was reduced by two thirds. Two separate studies suggest that antiplatelet drugs, taken over a period of two to four years, significantly slow the progression of atherosclerosis in lower extremity arteries. In the treatment of claudication, two vasodilating drugs, naftidrofuryl and buflomedil, have shown a significant improvement in painfree walking distance and/or total walking distance, compared with treatment with placebo.

Another effective approach is in the treatment of blood rheology through drugs such as pentoxifylline or by hemodilution. Double-blind trials with pentoxifylline demonstrated an average increase of 66% in maximum walking distance as compared with 22% with placebo. The effectiveness of hemodilution was demonstrated by two controlled trials, during which the reduction of the hematocrit to values of 40-42 for periods of four to six weeks increased both walking distance and resting blood flow. When introduced intraarterially in low doses in the vicinity of the occluding thrombus, thrombolytic agents have been found to be helpful in the treatment of acute and chronic POAD. This therapy should, however, be regarded as a substitute for surgical treatment only in highrisk patients. Further, after having produced the lysis of thrombi, the treatment permits the underlying parietal lesions to be accurately identified; at this point the appropriate therapy can be decided upon, either an operative procedure or a balloon dilation.

In conclusion the many controlled clinical trials carried out over the past few years have clearly demonstrated that conservative treatment can alleviate clinical signs and symptoms in patients with claudication and pain at rest.
Calcium Antagonists: Pharmacologic Agents in Search of New Clinical Indications
Authors: Gasser Robert
Published: November 2007

The broad availability of new pharmacologic agents is usually followed by both the search for similar compounds with more specific and refined actions and the expansion of clinical applicability for these agents.

During the last twenty years extensive investigations have revealed that calcium (Ca) antagonists hold a multifaceted pharmacodynamic potential that includes not only the antiarrhythmic and antihypertensive effects of the drug but also the protection against excessive Ca entry into the cells of the cardiovascular system and subsequent cell damage.

The physiologic age-dependent Ca accumulation in the arterial wall, which inevitably appears after the second decade, reaches maximal values in the age group of eighty-one to ninety years when the aortic wall exhibits a total Ca content that is 100 times higher than in arteries of infants. In animals we also find age-dependent accumulation of Ca in the arterial wall that is severely aggravated by uncontrolled diabetes or hypertension. Fleckenstein has shown that this arterial calcinosis can be prevented by chronic administration of Ca antagonists. Furthermore, Fleckenstein has demonstrated that excessive Ca overload of myocardial tissue constitutes a basic pathologic process in the development of cardiac necroses—brought about by extreme beta-adrenergic drive (overdoses of catecholamines), high doses of vitamin D3, dihydrotachysterol, alimentary factors such as K or Mg deficiency, or genetic defects (hereditary cardiomyopathy). Even cardiac hypertrophy, either idiopathic or as a consequence of hypertension, can be prevented by the action of Ca antagonists. In addition, the uncontrolled Ca entry into the cell constitutes an important etiologic factor in microstructural impairment of the myocytes due to ischemia—hence Ca antagonists are successfully used as cardio-protective agents in cardioplegic solutions. More recently the tissue-protection action of Ca antagonists has also been proven to be effective in renal transplantation and inhibition of toxic liver injury.

It can be concluded that Ca antagonists have an antiatherosclerotic, anticalcinotic, and tissue-protective potential that opens a wide spectrum of applications both prophylactic and therapeutic, especially in the cardiovascular field.
Hyperbaric Oxygen Therapy in Chronic Vascular Wound Management
Authors: Wattel F. , Mathieu D. , Coget J.-M. , Billard V.
Published: November 2007

Many nonhealing tissues are hypoxic, with oxygen tensions frequently ranging from 5 to 15 mmHg. In such an environment, the normal wound healing sequence is disrupted or halted and phagocytic killing activity depressed. So the adjunctive use of hyperbaric oxygen (HBO), based on physiologic data and clinical observations, can provide the substrate necessary to initiate and sustain the healing process.

During a twelve-month period, 20 patients with a nonhealing wound were referred to the hyperbaric center : chronic arterial insufficiency ulcers in 9 cases, diabetic wounds (foot lesions) in 11 cases.

Adjunctive HBO therapy, initiated twice a day, consisted of pure oxygen, 2.5 ATA, 90 min. The average length of sessions was 46 (15-108). Complete healing was observed in 15 of 20 cases.

The wound management can be helped with the transcutaneous oxygen measurements under hyperbaric oxygen. The distal TCPO2 at 2.5 ATA pure oxygen is a reliable test to predict final outcome (healing or no change), when these values were not different in normal air and in normobaric oxygen:

Distal No TCPO2 Healing Change air 32 ± 31 NS 12 ± 4 1 ATA O2 75 ± 70 NS 18 ± 10 2 ATA O2 635 ± 388 p = 0.003 45 ± 20

In hyperbaric oxygen therapy, when the distal TCPO2 value was inferior to 100 mmHg, all patients showed either no improvement or aggravation, and when the value was higher than 100mmHg, wound healing was achieved with all patients.
Transcranial Doppler Monitoring During Percutaneous Transluminal Aortic Valvuloplasty
Authors: Karnik Ronald , Valentin Andreas , Bonner Gerhard , Ziegler Bert , Slany Jörg
Published: November 2007

Cerebral blood flow was studied in 12 elderly patients with severe calcific aortic stenosis by means of transcranial Doppler sonography (TCD) during percutaneous transluminal aortic valvuloplasty (PTAV).

In 8 of these 12 patients duplex sonography revealed a stenosis of the internal carotid artery (ICA) exceeding 50%. Frequency spectra of 10 patients showed a satisfactory quality and were analyzed. In 7 subjects balloon inflation was well tolerated and systolic blood pressure did not drop below 75 mmHg. In these patients, whether they had a stenosis of the ICA or not, blood flow velocity in the middle cerebral artery (MCA) did not decrease to a critical level. The authors defined "critical" as a reduction of mean blood flow velocity in the MCA exceeding 50% or a decrease below 35 cm/sec. Three patients showed a rapid decrease of systolic aortic pressure below 75 mmHg. In these subjects mean blood flow velocity in the MCA dropped to levels below 35 cm/sec. Deflation and retraction of the balloon resulted in a rapid increase of systemic blood pressure and flow velocity in the MCA. This report demonstrates TCD to be a useful monitoring method of determining residual perfusion in patients with aortic stenosis during PTAV.
Coronary Angioplasty of Bifurcational Stenoses: A New Approach Utilizing a Single-Guide, Double-Probe Technique: Case Reports
Authors: DiSciascio Germano , Goudreau Evelyne , Vetrovec George W.
Published: November 2007

The authors describe a new approach to percutaneous transluminal coronary angioplasty (PTCA) of bifurcational lesions with a single-guide, "kissing balloon" technique, utilizing two probe dilatation systems, inserted simultaneously into the guiding catheter and across both diseased branches. The versatility of the probe dilatation system in complex angioplasty is portrayed, both for simultaneous or alternate balloon inflations, and the low-profile characteristics of the system are highlighted, which allow a double-probe introduction into a single guiding catheter, good visualization still being retained by guide injections.
Usefulness of Echocardiographic Left Ventricular Hypertrophy and Silent Ischemia in Predicting New Cardiac Events in Elderly Patients With Systemic Hypertension or Coronary Artery Disease
Authors: Aronow Wilbert S. , Epstein Stanley , Koenigsberg Mordecai
Published: November 2007

The authors performed a prospective study to correlate echocardiographic left ventricular hypertrophy (LVH) and silent ischemia (SI) detected by twenty-four-hour ambulatory electrocardiographic monitoring with new cardiac events in 355 patients, mean age eighty-two ± eight years, with systemic hypertension or coronary artery disease (CAD). Cardiac events included myocardial infarction, primary ventricular fibrillation, or sudden cardiac death. Mean follow-up was thirty-one ± seven months (range twelve to forty). Cardiac events occurred in 28 of 147 patients (19%) without LVH or SI (A), in 56 of 113 patients (50%) with LVH and no SI (B), in 16 of 29 patients (55%) with SI and no LVH (C), and in 52 of 66 patients (79%) with LVH and SI (D). Significant p values were p < 0.001 comparing D with A, D with B, C with A, and B with A; and p < 0.02 comparing D with C. These data indicate that echocardiographic LVH and SI detected by ambulatory electrocardiographic monitoring are independent risk factors for new cardiac events in elderly patients with systemic hypertension or CAD.
"Pseudo-Delta Sign" on Computed Tomography in an Extremely Acute Stage of Superior Sagittal Sinus Thrombosis—A Case Report
Authors: Shintani Shuzo , Murase Hiroshi , Ota Hidekazu , Tsukagoshi Hiroshi , Shiozawa Zenji
Published: November 2007

A case of superior sagittal sinus (SSS) thrombosis with a "pseudo-delta sign" on computed tomography (CT) is reported. The so-called "empty delta sign," which usually appears following contrast enhancement, is reliable in the CT diagnosis of SSS thrombosis but may not appear, it is said, in the extremely acute stage. In this patient, however, the "empty delta sign" appeared with precontrast CT scans and disappeared with postcontrast CT scans, "pseudo-delta sign," in the extremely acute stage of SSS thrombosis. On the precontrast CT, blood surrounding the sagittal sinus outlined it; when contrast was given, it became dense with blood.
HLA-D Region Genomic Polymorphism Associated with Takayasu's Arteritis
Authors: Takeuchi Yumiko , Matsuki Kazumasa , Saito Yoshimi , Sugimoto Tsuneaki , Juji Takeo
Published: November 2007

Takayasu's arteritis, with a strong predilection for women and particular geographic areas, has revealed significant association with human lymphocyte antigens (HLA) specificities. In the present study, the authors investigated for the first time the association of Takayasu's arteritis and HLA at the genomic level. By use of a restriction endonuclease Taq-I and a DQA cDNA probe, HLA-D region restriction fragment length polymorphism was examined in 32 Japanese patients. It was revealed that 65.6% of the patients shared a 6.6 kb fragment, although this fragment was found in 35.3% of the healthy Japanese (Chi square: 6.07, p < 0.02). This finding suggests that HLA-D region gene variations determine susceptibility to Takayasu's arteritis.
Effects of Acute Lower Limb Ischemia on Femoral Venous Efflux
Authors: Celoria Giovanni , Zarfos Kristen , Berman Joel
Published: November 2007

Revascularization of an acutely ischemic limb may lead to the development of a reperfusion syndrome, characterized by acidosis, hyperkalemia, myoglobinuria, and disseminated intravascular coagulation. The authors evaluated the components of the femoral venous efflux after reperfusion of an acutely ischemic limb in both an experimental model and in a small clinical series.
Effect of Ischemia on Ventricular Contractility in Patients with Coronary Artery Disease
Authors: Spaccavento Leo J. , Grassman Eric D. , Briesblatt Warren M. , Schwartz Robert S.
Published: November 2007

The constant of elastance (E-MAX) is determined by measuring continuous left ventricular pressure and volume changes during the cardiac cycle. To evaluate the effect of myocardial ischemia on contractility, E-MAX was measured from serial pressure volume loops at baseline, with atrial pacing-induced ischemia,and after the administration of intravenous nitroglycerin with repeat pacing. Ten patients undergoing cardiac catheterization for presumed coronary artery disease were evaluated by this method. The severity of the coronary artery disease was graded angiographically by using the Gensini coronary score. In 8 of the 10 patients there was a significant decrease in E-MAX during atrial pacing (P < .05). With the administration of nitroglycerin there was an attenuation of the ischemic effect previously noted with pacing. In 3 of the 10 patients administration of nitroglycerin produced a further decrease in E-MAX with ischemia. All 3 patients had a significantly lower Gensini coronary score with a well-developed, visible coronary collateral network. The authors' results indicate that continuous pressure volume loop analysis is possible using the nuclear stethoscope. Significant ischemic changes are seen with atrial pacing, which are relieved by the administration of nitroglcerin, except in the presence of coronary collaterals.
Placebo-Controlled, Double-Blind Study of the Effect of Verapamil in Intermittent Claudication
Authors: Kimose Hans-Henrik , Bagger Jens Peder , Aagaard Michael Trier , Paulsen Peter Kildeberg
Published: November 2007

The clinical effect of verapamil was tested in 24 patients with intermittent claudication in a randomized, placebo-controlled, double-blind, crossover study. Slow-release verapamil or placebo was given for two periods of three weeks. The walking distance, systemic blood pressure, and ankle-brachial blood pressure index were measured. Furthermore, a possible change in peripheral vascular tone was provoked by hyperventilation. The walking distance rose after both verapamil (40%) and placebo (31%) (p<0.01 for both) but tended to increase only after verapamil (7%) as compared with placebo. Blood pressure fell equally after both verapamil and placebo (p<0.05 for both). Verapamil did not influence the ankle-brachial blood pressure index. No signs of vasoactivity in the lower extremities were seen after hyperventilation. Although the greatest individual improvements in walking distance were seen after verapamil administration, it was not possible to predict positive responders among the patients.