bluuebunny/crossref_metadata_2025 huggingface dataset:
Relationship Between Free-Living Daily Physical Activity and Peripheral Circulation in Patients with Intermittent Claudication
Authors: Gardner Andrew W. , Killewich Lois A. , Katzel Leslie I. , Womack Christopher J. , Montgomery Polly S. , Otis Rosemary B. , Fonong Tekum , Gardner Andrew W.
Published: July 2008

The purpose of this study was to determine the relationship between free-living daily physical activity and peripheral circulation under resting, reactive hyperemia, and maximal exercise conditions in peripheral arterial occlusive disease (PAOD) patients with intermittent claudication. Sixty-one PAOD patients (age=70 ±6 years, ankle/brachial index [ABI] =0.57 ±0.24) were recruited from the Vascular Clinic at the Baltimore Veterans Affairs Medical Center and from radio and newspaper advertise ments. Free-living daily physical activity was measured as the energy expenditure of physical activity (EEPA), determined from doubly labeled water and indirect calorimetry. Patients also were characterized on ankle/brachial index, calf blood flow, calf transcutaneous oxygen tension (TcPO2), and calf transcutaneous heating power (TcHP). ABI and calf blood flow served as markers of the macrocirculation of the lower extremity, while TcPO2and TcHP served as markers of the microcirculation. The clau dication patients were sedentary, reflected by a mean EEPA value of 486 ±274 kcal/day. EEPA was related to calf TcHP at rest (282 ±24 mW; r=-0.413, p=0.002), after postoc clusion reactive hyperemia (275 ±22 mW; r=-0.381, p=0.004), and after maximal exercise (276 ±20 mW; r=-0.461, p<0.001). ABI, calf blood flow, and calf TcPO2were not related to EEPA under any condition. In conclusion, higher levels of free-living daily physical activity were associated with better microcirculation of the calf musculature in older PAOD patients with intermittent claudication.
Prolongation of Left Atrial Augmentation After Handgrip Stress in Coronary Artery Disease: Observation Using Pulsed Doppler Flowmetry
Authors: Tanaka Tetsuya , Mizushige Katsufumi , Masugata Hisashi , Matsuo Hirohide , Mizushige Katsufumi
Published: July 2008

Although alterations in left ventricular diastolic filling dynamics have been observed during myocardial ischemia, few data exist regarding temporal changes in left ventricular filling during recovery. Therefore, the authors evaluated transmitral inflow pattern during and after handgrip exertion in coronary artery disease (CAD) by using Doppler echocar diography. The study population consisted of 18 normal (N) subjects and 47 patients with CAD. Of the CAD patients, 17 had coronary lesions associated with a limited area of underperfused myocardium (seven with good collateral circulation and 10 with distal lesions) (MILD), 15 patients exhibited a proximal lesion in a single vessel (SVD), and 15 patients had significant multivessel disease (MVD). Transmitral inflow velocities were continuously recorded at baseline, during handgrip exercise (50% of maximal for 1 minute), and for 5 minutes of recovery. Mean blood pressure, heart rate, early diastolic (E) and late atrial (A) inflow velocities, A/E ratio, and percent changes in E, A, and A/E from baseline were measured.

In N and MILD, respectively, left ventricular inflow pattern returned to baseline at 3 minutes after handgrip (%E: 0.7 ± 7.6%, 6.4 ± 13.7%; %A: -0.2 ± 7.9%, 3.1 ±6.5%; %A/E: -0.1 ±9.7%, -1.7 ±12.9%). In SVD and MVD, respectively, change in left ventric ular inflow pattern was continued at 3 minutes after handgrip (%E: 7.2 ±9.4%, -4.3 ± 17.2%, %A: 15.4 ± 11.7%, 20.4 ± 14.6%, %A/E: 7.9 ± 10.0%, 29.2 ±25.6%). Increases in A and A/E in SVD and MVD were significantly higher than in N and MILD.

Impaired left ventricular inflow pattern was observed at 3 minutes after handgrip in CAD, which may be reflected from prolonged impairment of diastolic function produced by ischemia. Therefore, temporal observation of left ventricular inflow pattern using the handgrip stress Doppler method may be useful for detection or follow-up of CAD.
Effect of Disopyramide on Left Ventricular Pressure Gradient in Hypertrophic Obstructive Cardiomyopathy in Comparison with Propranolol
Authors: Tokudome Takeshi , Mizushige Katsufumi , Ueda Takashi , Sakamoto Seiji , Matsuo Hirohide , Mizushige Katsufumi
Published: July 2008

The effect of intravenous administration of disopyramide (total dose 100 mg, bolus 20 mg every 5 minutes) was compared with that of propranolol (total dose 10 mg, bolus 2 mg every 5 minutes) in a patient with hypertrophic obstructive cardiomyopathy. Left ventric ular pressure gradient (LVPG) was assessed by continuous wave Doppler flowmetry. LVPG markedly decreased (97 to 16 mmHg), and preejection period (PEP) increased with an increase in heart rate (HR) during disopyramide injection. No changes were observed in LVPG and PEP, and a decrease occurred in HR during propranolol adminis tration. These results indicate that disopyramide produced greater effects on the reduction of LVPG than propranolol, a negative inotropic agent, did.
Left Mediastinal Central Line Malposition
Authors: Moskal Thomas L. , Ray Charles E. , Moskal Thomas L.
Published: July 2008

Central venous line malpositioning in the left mediastinum is a rare event. A case of left superior intercostal vein central venous line placement is reported. Chest radiographs, especially lateral views and contrast studies, are useful for position evaluation. Catheter removal is prudent although the purpose of the catheter and the symptomotology can dictate further management of the malpositioned catheter.
Acute Reduction in Ankle/Brachial Index Following Smoking in Chronic Smokers with Peripheral Arterial Occlusive Disease
Authors: Yataco Alberto R. , Gardner Andrew W. , Gardner Andrew W.
Published: July 2008

The ankle-brachial systolic pressure index (ABI), a noninvasive measure of peripheral arterial occlusive disease (PAOD) severity, is considered a marker of atherosclerosis and an independent predictor of mortality. However, it is not known whether factors other than PAOD severity, such as cigarette smoking, have an effect on ABI measurement. Therefore, the authors examined the acute effects of cigarette smoking on ABI and the peripheral circulation in 10 older (63 ±10 years) chronic smokers (39 ±37 pack-years) with PAOD (ABI=0.64 ±0.14). The patients were instructed to refrain from smoking and from consuming caffeine-containing beverages for at least 12 hours before the tests. The patients were randomly assigned to 2 days of testing consisting of a nonsmoking and a smoking day. Resting heart rate, blood pressure, ABI, and calf blood flow by plethysmography were obtained on both testing days. The smoking day consisted of smoking two filter cigarettes over a period of 10 minutes before the measurement of ABI and calf blood flow. The ABI on the smoking day (0.55 ±0.11) was lower (p=0.008) than on the nonsmoking day (0.64 ±0.14) owing to a lower (p = 0.020) ankle systolic blood pressure (81 ±28 vs 93 ±28 mmHg). Brachial systolic blood pressures, heart rate, and calf blood flow were not altered by smoking (p>0.05). These results demonstrate that the acute effect of cigarette smoking lowers the ABI in chronic smokers with intermittent claudication, thereby yielding evidence of a transient deleterious effect of cigarette smoking on the peripheral circulation in chronic smokers.
Relation of Occupation to Presence or Absence of Coronary Artery Disease: An Angiographic Study
Authors: Mukerji Vaskar , Alpert Martin A. , Mukerji Rita , Mulekar Madhuri , Mukerji Vaskar
Published: July 2008

To determine the relation of occupation to the presence or absence of coronary artery disease (CAD) and cardiovascular risk factors, the authors compared the occupations of a series of 116 consecutive patients who underwent coronary angiography and were found to have normal or near-normal coronary arteries (<30% stenosis of all major coronary arteries) with those of a series of 116 patients with moderate to severe CAD (≥ 60% stenosis of one or more major coronary artery). The usual lifetime occupational status of each study participant was classified as sedentary, intermediate, or strenuous. The presence of the usual cardiovascular risk factors in the patients was also recorded. There was no significant difference in the frequency of the three occupational categories between the two groups (those with or without CAD) when subjects of all ages were considered or when subjects less than 40 years or more than 60 years old were consid ered. However, the results indicate that among 40-60-year-old individuals CAD occurred significantly more frequently in those engaged in strenuous occupations than in those engaged in sedentary occupations. Cardiovascular risk factors occurred significantly more frequently in patients with CAD than in those with normal coronary arteries and in those engaged in strenuous occupations compared with those in sedentary occupations.
Basic Fibroblast Growth Factor Increases Regional Myocardial Blood Flow and Salvages Myocardium in the Infarct Border Zone in a Rabbit Model of Acute Myocardial Infarction
Authors: Hasegawa Takaya , Kimura Akio , Miyataka Masaru , Inagaki Masahiko , Ishikawa Kinji
Published: July 2008

Basic fibroblast growth factor (bFGF) has been shown by some to promote angiogenesis and myocardial salvage in experimentally induced acute myocardial infarction. Although these findings have spurred much clinical interest, they are not universally observed, and the true efficacy of bFGF remains unclear. The authors used a rabbit model of acute myocardial infarction to further elucidate the effects of bFGF on acutely infarcted myocardium containing few collaterals. Myocardial infarction was evoked by ligation of the left coronary artery. Prior to ligation, either 100 μg of bFGF (bFGF group; n = 15) or physiological saline (control group; n = 22) was injected into the myocardium supplied by the ligated artery. With use of nonradioactive colored microspheres, regional blood flow (Qm) was measured before, immediately after, and 4 weeks after coronary artery ligation. Infarct and border zone sizes were measured in cross-sectional slices of the resected hearts, and the amount of viable myocardium (myocardium score) and the extent of fibrosis were histologically determined in each area. Four weeks after ligation, Qm values in the infarcted area did not significantly differ between the bFGF and control groups (0.54 ± 0.36 vs 0.48 ± 0.30 mL/min/g); in the border zone, Qm tended to be higher in the bFGF group (3.39 ± 2.68 vs 1.47 ± 0.80 mL/min/g), but the difference was not significant; finally in the noninfarcted area, Qm was significantly (p < 0.05) higher in the bFGF group (6.06 ± 3.85 vs 2.09 ± 0.82 mL/min/g). There was no significant differ ence in the amount of viable myocardium or the extent of fibrosis in the infarcted areas of the two groups. In the border zone, however, the amount of viable myocardium was significantly (p < 0.005) larger in the bFGF group (61.8 ±8.5% vs 35.8 ±20.3% of the visual field). Likewise, as graded on a scale from 0 to 5, the extent of fibrosis was signif icantly (p < 0.005) less in the bFGF group (2.1 ±0.5 vs 3.3 ±0.8). In conclusion, injection of bFGF into acutely infarcted myocardium increased blood flow to the noninfarcted area and salvaged the myocardium in the border zone.
Coronary Artery Aneurysms, Aortic Dissection, and Hypertension Secondary to Primary Aldosteronism: A Rare Triad
Authors: Safi Arshad M. , Kwan Tak , Afflu Ernest , Alam Mahmood , Anderson John E. , Clark Luther T.
Published: July 2008

Primary aldosteronism is a relatively uncommon etiology of hypertension. Plasma renin activity is suppressed in the majority of the cases but not always. Plasma renin activity has been associated with increased vascular injury. The occurrence of vascular complications has rarely been reported with low plasma renin activity. The authors report a case of long-standing secondary hypertension due to primary aldosteronism with coronary artery aneurysms and aortic dissection. Diagnosing is important, for therapeutic intervention can be curative.
Multivessel Spontaneous Coronary Artery Dissection in a Patient with Severe Systolic Hypertension: A Possible Association
Authors: Greenblatt Jeff M. , Kochar Gupreet S. , Albornoz M. Anthony
Published: July 2008

Spontaneous coronary artery dissection (SCAD) is an uncommon cause of myocardial ischemia and infarction. Hypertension has not been associated with SCAD. The authors report multivessel SCAD in an elderly woman with severe systolic hypertension. They postulate that hypertension of this degree may play a pathophysiologic role in the causation of SCAD.
The Effect of Cigarette Smoking Status on Six-Minute Walk Distance in Patients with Intermittent Claudication
Authors: Cahan Mitchell A. , Montgomery Polly , Otis Rosemary B. , Clancy Ryan , Flinn William , Gardner Andrew , Gardner Andrew W.
Published: July 2008

The purposes of the study were threefold: (1) to compare 6-minute walk performance as a measure of exercise tolerance among three different groups of peripheral arterial occlusive disease (PAOD) patients with intermittent claudication—current smokers, former smokers, and patients who have never smoked; (2) to identify important covari ates that might affect the relationship between smoking and exercise in the PAOD popu lation ; (3) to determine whether differences among the three groups in 6-minute walk performance persist after statistically controlling for the significant covariates. Recruited into the study were 415 PAOD patients with intermittent claudication between the ages of 42 and 88 years. The self-reported smoking status consisted of 182 current smokers, 196 former smokers, and 37 patients who had never smoked. The authors recorded 6- minute walk distance, a reliable measurement of exercise tolerance in PAOD patients, as well as age, body composition, self-reported ambulatory function, self-reported physical activity, and standard peripheral hemodynamics. Nonsmokers walked significantly farther (413 ± 14 m; mean ±standard error) and took more steps (665 ± 14 steps) than either current (352 ±7 m; 563 ±9 steps) or former smokers 370 ±7 m; 600 ±8 steps) (p<0.05). The nonsmokers had a higher ankle-brachial index (ABI) value (0.70 ±0.03) than patients who actively smoked 0.62 ± 0.01 (p<0.03); the authors observed an inverse relationship between smoking history and self-reported physical activity (WIQ Distance Score: nonsmokers 51 ±6%, former smokers 38 ±3%, and smokers 32 ±2%) (p<0.01). From a multivariate perspective, ABI, physical activity, and perceived walking ability were the only independent predictors of 6-minute walk distance. Differences in the adjusted 6-minute walk distance among the nonsmokers (388 ± 13 m), current smokers (359 ±6 m), and former smokers (368 ±6 m) no longer remained after controlling statis tically for these covariates. The findings suggest that 6-minute walk distance is a sensitive measure to detect differences in submaximal exercise performance between smoking and nonsmoking PAOD patients with intermittent claudication. Moreover, the group differ ence in the 6-minute walk distance is explained by group differences in walking percep tion, PAOD severity, and physical activity level.
Scintigraphy and Immunohistology of Antimyosin-Fab During Graft Rejection
Authors: Breuer M. , Schütz A. , Engelhardt M. , Hammer C. , Kemkes B.M. , Breuer M.
Published: July 2008

Up to now, the cellular localization pattern of monoclonal antimyosin antibodies (AMA) during acute rejection has not been described. Focused on this the authors made immunohistochemical and scintigraphic studies (AMS) with AMA in an animal trans plantation model. Heterotopic cervical heart transplantation was performed in 12 mongrel dogs. Immunosuppression consisted of triple drug therapy. As standard the grafts were examined by daily transmural biopsies and routine histology. Dependent on the daily biopsy results, 0.5 mg of indium 111 (111In)-labeled AMA-Fab was injected. Subsequently every 2 hours transmural biopsy cylinders were taken out of the right ventricle and examined in indirect peroxidase staining technique. Forty-eight hours after AMA injection, scintigraphy in single photon emission computed tomography (SPECT) technique (AMS) was carried out and the heart-to-lung ratio (H/L-ratio) was calculated. The immunohistochemical maximum of AMA accumulation could be found 20 to 72 hours after AMA injection. This means that a scintigraphic examination should be done earlier than 20 hours and later than 3 days after injection. Dependent on the grades of bioptic rejection diagnosis a specific morphologic AMA localization was seen (grade I+II intercellular and slightly intracellular detection of AMA, grade III strongly intracellular and in particular perinuclear accumulation of the antibody, p<0.01). Moreover, the authors found a good correlation between scintigraphic H/L-ratio results and the corre sponding histologic findings (grade I: H/L = 2.1 ± 0.2; grade II: H/L = 3.1 ± 0.2; grade III: H/L = 3.5 ± 0.3; n = 19; p < 0.02). The recently described positive AMS scans even in cases of mild rejection seem to be subject to an intercellular AMA localization. This typical AMA morphology during mild rejection favors the theory of the pore-forming protein allowing the efflux of myosin fragments as effector mechanism of cytotoxic lymphocytes in the early phase of acute rejection. The immunohistochemical AMA examination could explain the present discrepancy between positive AMS results of an intracellular protein in cases of mild or moderate acute rejection when visible cellular damage in the corre sponding routine histology is absent.
Influence of Thrombolytic Therapy on Inferior Acute Myocardial Infarction with Concomitant Anterior ST Segment Depression
Authors: Borgia Maria Clotilde , Gori Francesco , Pellicelli Adriano , Curcio Donatella , Lionetti Marco , Buccarella Paola Assunta , Lucidi Mara
Published: July 2008

The purposes of this study were to analyze the prognostic significance of precordial ST segment depression and to determine whether thrombolytic therapy is effective for all patients with inferior acute myocardial infarction (AMI) or whether there is a different effectiveness for patients with concomitant anterior ST segment depression persisting for 24 hours or longer. Medical charts of 176 patients were studied. On the basis of ECG the patients were subclassified into three groups according to the presence, persistence, or absence of significant ST segment depression: Group 1: anterior ST segment depres sion persisting for less than 24 hours (45.4%); Group 2: anterior ST segment depression persisting for more than 24 hours (17.6%); Group 3: no anterior ST segment depression (37%). Age, Killip class, peak creatine kinase, hospital deaths, left ventricular ejection fraction, regional wall motion score, postinfarction angina, and ventricular/supra ventricular arrhythmia of all patients were studied. Parameters of the three groups were compared: worse results were found in group 1 and the worst in group 2. This result is (continued on next page) (Abstract continued) independent of thrombolytic therapy. Finally, the same parameters of thrombolyzed and nonthrombolyzed groups were compared: no statistically significant difference was observed. Among thrombolyzed patients the number of those with ST depression lasting more than 24 hours is lower than in nonthrombolyzed patients. It can be assumed that thrombolytic therapy in inferior AMI determines a shifting of patients from a worse prognosis group (ST segment depression persisting for more than 24 hours) to a better prognosis group (ST segment depression persisting for less than 24 hours).
Prediction of Coronary Artery Lesions in Unstable Angina by Iodine 123 Beta-Methyl Iodophenyl Pentadecanoic Acid (BMIPP), a Fatty Acid Analogue, Single Photon Emission Computed Tomography at Rest
Authors: Morimoto Koji , Tomoda Haruo , Yoshitake Motoyuki , Aoki Naoto , Handa Shunnosuke , Suzuki Yutaka
Published: July 2008

Iodine 123 beta-methyl iodophenyl pentadecanoic acid (123I-BMIPP), a beta-methyl- branched fatty acid analogue, has been proven by experimental studies to reveal abnor malities in fatty-acid-related metabolism. This study was undertaken to validate the accuracy and limitations of 123I-BMIPP imaging at rest in detecting myocardial metabolic abnormalities and predicting coronary lesions in unstable angina (UA). One hundred UA patients without prior myocardial infarction were studied. 123I-BMIPP and thallium 201 chloride (201TlCl) imaging with single photon emission computed tomography (SPECT) and coronary and left ventricular cineangiography (LVC) were performed 1 week after the last episode of angina. There was reduced uptake of 123I-BMIPP imaging in 70 patients, reduced uptake of 201TICI in 41, and abnormal LVC contraction in 49 patients. There were significant increases in severity scores of 123I-BMIPP imaging along with increases in the number of stenosed coronary arteries and the severity of stenosis in indi vidual coronary arteries. There was a significant reduction in 123I-BMIPP severity scores 1 month after percutaneous transluminal coronary angioplasty (p<0.01) and a significant correlation between the severity scores of 123I-BMIPP and LVC ( r=0. 579, p<0.001). Overall rates of sensitivity and specificity in detecting significant coronary stenosis by 123I-BMIPP imaging were 74% and 86%, respectively, whereas rates of sensitivity and specificity in detecting significant coronary stenosis by 201TlCl were 31% and 91%, respec tively. 123I-BMIPP sensitivity increases to 86% if only advanced coronary stenosis of >90% is included. In conclusion, 123I-BMIPP myocardial imaging is an effective method of predicting coronary artery lesions of UA patients without provocative test.
Atherosclerotic Lesions Are More Frequent in Femoral Arteries than in Carotid Arteries Independent of Increasing Number of Risk Factors
Authors: Kröger K. , Kucharczik A. , Hirche H. , Rudofsky G.
Published: July 2008

The authors investigated the prevalence of atherosclerotic lesions in carotid and femoral arteries in people with varying risk factors. They searched for differences in the region of manifestation of atherosclerosis due to different risk factors. Over 5 years they investi gated 4,200 people (2,600 men, 1,600 women aged 20 to 70 years) who reported feeling healthy. They did a B-mode sonography of the internal, external, and common carotid artery; and the common, the proximal superficial, and profundal femoral artery. They questioned the people regarding hypertension, hypercholesterolemia, diabetes mellitus, and smoking habits.

Isolated carotid artery atherosclerosis was found in 2.8% of the men and 1.6% of the women; 10.9% of the men and 4.4% of the women had isolated femoral artery lesions. A combination of atherosclerotic lesions in both arteries was present in 8.3% of the men and 4.0% of the women. When only one risk factor was present atherosclerotic lesions of the femoral arteries were predominant. Diffuse atherosclerosis dominated with increasing number of risk factors. The rate of people with isolated carotid atheroscle rosis was highest when no risk factor was present and decreased to a fixed rate of 12% to 17% independent of the number of risk factors. An increasing number of risk factors can be associated with a diffuse manifestation of atherosclerotic lesions. However, there are a certain number of people who demonstrate only carotid artery or femoral artery atherosclerosis independent of the number of risk factors.
An Unusual Case of Bilateral Coronary Artery Fistulas
Authors: Nseir George , Syed Qarab , Safi Arshad , Salciccioli Louis , Kwan Tak , Clark Luther T.
Published: July 2008

The authors report an unusual case with bilateral coronary artery fistulas at the origin of the coronary cusps. The diagnostic technique and management are discussed.
Paget-Schroetter Syndrome Associated with FV:Q506 and Prothrombin 20210A
Authors: Sayinalp Nilgün , Özcebe Osman Ilhami , Kirazli Şerafettin , Doğan Riza , Dündar Semra V. , Gürgey Aytemiz
Published: July 2008

Effort thrombosis of the axillary-subclavian vein (Paget-Schroetter syndrome) develops usually secondary to heavy arm exertion. An underlying chronic venous compressive anomaly at the thoracic outlet or intimal damage of the axillary vein following forceful hyperabduction, external rotation of the shoulder joint has been proposed to explain the pathophysiology of this thrombosis. This condition is usually not attributed to an under lying hypercoagulability such as deficiency of natural coagulation inhibitors. Here, the authors present a case with thrombosis of the axillary-subclavian vein following an effort, with factor V Leiden and prothrombin 20210A mutations. Both factor V Leiden and the genetic variant in the prothrombin gene have been shown to confer an increased risk for venous thrombosis. Although rare, effort thrombosis may develop in a patient with hereditary thrombophilia, so laboratory evaluation should include the common causes of thrombosis.
Cyclic Variation of Thickness in An Age-Related Thick Mitral Valve Observed by Transthoracic Echocardiography
Authors: Masugata Hisashi , Senda Shoichi , Manabe Kimiteru , Sakamoto Haruhiko , Kinoshita Aki , Sakamoto Seiji , Matsuo Hirohide , Mizushige Katsufumi
Published: July 2008

The cyclic variation of thickness during the cardiac cycle in age-related degenerative mitral valve (MV) has not been reported. Transthoracic echocardiography was used to evaluate the cyclic alteration in MV thickness in 40 patients with age-related MV thick ening (diastolic MV thickness ≥4 mm, age 70 ± 14 years), 10 with mitral valve prolapse (MVP, age 49 ±11 years), 10 with rheumatic mitral stenosis (MS, age 66 ±9 years), and 31 control subjects (diastolic MV thickness ≤ 3.6 mm, 53 ±17 years). After determination of the site of maximal thickness during diastole, the maximal and minimal thickness during systole of the anterior MV were measured. The percent change in MV thickness from diastole to systole (%ΔT) was calculated. The mitral regurgitation (MR) area was measured on color Doppler echocardiogram. The %ΔT (mean ± sd) in age-related thickened MV and MVP groups were similar and significantly greater than that in control (60 ±8%, 61 ±6% vs 32 ±9%, p < 0.001). MR area was significantly greater in the age- related thickened MV group than that in controls (160 ±205 mm2 vs 14 ±40 mm2, p < 0.05). The %ΔT in MS (10 ±6%) was smallest (p < 0.001). A large cyclic alteration in valvular thickness was observed in the age-related degeneration of the MV and may be the cause of large MR despite no leaflet prolapse. The echocardiographic assessment of cyclic variation of MV thickness is feasible for estimating the histologic damage in thick MV.
Independent Origins of the Internal and External Carotid Arteries
Authors: Kaurich J. David , Brown Frederick R. , Dahn Michael S.
Published: July 2008

A case illustrating a congenital anomaly in the development of the left carotid artery is presented. The common carotid artery was found to be absent, with both internal and external carotid arteries arising separately from the aortic arch. This is a rare occurrence that is described angiographically and embryologically.
Hyperhomocyst(e)inemia Is Associated with Carotid Atherosclerosis
Authors: Lupattelli Graziana , Rufini Stefano , Locati Emanuela H. , Lombardini Rita , Ciuffetti Giovanni , Siepi Donatella , Mannarino Elmo , Lupattelli Graziana
Published: July 2008

The atherogenicity of homocyst(e)ine—H(e) —emerged from many studies showing an association between moderately elevated levels and vascular occlusive disease. The aim of this study was to evaluate whether high homocyst(e)ine levels were associated with carotid atherosclerosis. Carotid atherosclerosis was defined as an intimal media thickness of internal and carotid bifurcation of at least 2 mm on the near and far walls as deter mined by B-mode ultrasonography. The study population included 91 patients: group 1 (61% males, mean age 64 ± 10 years, 57% with history of hypertension) with ultrasound evidence of carotid atherosclerosis and 100 with normal carotid walls—group 2 (36% males, mean age 52 ± 15 years, 27% with history of hypertension). Homocyst(e)ine levels (μmol/L) were determined by high-performance liquid chromatography with a fluorescent detector. Body mass index, dyslipidemia, smoking, diabetes, serum creatinine, plasma folic acid and vitamin B12 were not significantly different in the two groups. Homocyst(e)ine levels (μmol/L) were significantly higher in patients with carotid ather- osclerosis than in those with normal arteries (11.7 ± 6.5 μmol/L, 95% CI 10.4-13.1 vs 8.07 ±4.4 μmol/L, 95% CI 7.2-8.9, p < 0.0001). By multiple regression analysis H(e) levels were positively correlated with male gender (p < 0.02), age (p < 0.001), and nega tively with folic acid (p < 0.0001). By logistic regression the independent predictors of carotid atherosclerosis were male gender (OR 2.65), hypertension (OR 2.55), age (x 10 years, OR 2.15) and H(e) levels (x 1 μmol/L, OR 1.11).

This study confirmed homocyst(e)ine is associated with carotid atherosclerosis. Consequently the authors recommend H(e) levels be screened in all patients at risk for atherosclerosis.
Tissue Characterization of Myocardial Cells by Use of High-Frequency Acoustic Microscopy: Differential Myocyte Sound Speed and Its Transmural Variation in Normal, Pressure-Overload Hypertrophic, and Amyloid Myocardium
Authors: Masugata Hisashi , Senda Shoichi , Kinoshita Aki , Xin Lu  , Sakamoto Haruhiko , Sakamoto Seiji , Matsuo Hirohide , Mizushige Katsufumi
Published: July 2008

The purpose of the present study was to evaluate the acoustic properties of myocytes in normal, pressure-overload hypertrophic, and amyloid myocardium. Myocardial tissue specimens at autopsy were obtained from 10 subjects without cardiovascular disease, six patients with left ventricular (LV) hypertrophy, and six patients with cardiac amyloi dosis. Sound speed of myocytes was measured at subendocardial and subepicardial regions in myocardium by use of a high-frequency (450 MHz) acoustic microscope. In normal myocardium, the sound speed of myocytes was significantly higher in subendo cardial region (1,728 ± 19 m/sec) than in subepicardial region (1,645 ±22 m/sec) (p < 0.0001). A significantly higher sound speed of myocytes was observed in the suben docardial region in LV hypertrophic myocardium (1,779 ± 19 m/sec) than that in normal myocardium (p < 0.001). In amyloid myocardium, a significantly lower sound speed of myocytes was observed in subendocardial (1,560 ± 8 m/sec) and subepicardial (1,594 ± 48 m/sec) regions than that in respective regions of the normal myocardium (p < 0.0001 and p < 0.05, respectively). Transmural variation in sound speed of myocytes measured by high-frequency acoustic microscopy existed in normal left ventricle. The differential myocyte sound speed and its transmural variation was observed in LV hyper trophic and amyloid myocardium as compared with normal myocardium. High-frequency acoustic microscopy can be a promising technique for myocardial tissue characterization at the myocyte level.
Magnetic Resonance Imaging in Internal Carotid Artery Agenesis with Computed Tomography and Angiographic Correlation
Authors: Graham Cole Blease , Capps Gerald W. , Wippold F.J.
Published: July 2008

The authors present two cases of agenesis of the internal carotid artery (ICA) discovered incidentally on magnetic resonance imaging and confirmed on computed tomography, magnetic resonance angiography, and conventional angiography. They also propose a clinical algorithm for the workup of patients with suspected absence of the ICA.
Giant Unruptured Aneurysm of the Thoracic Aorta
Authors: Kitami Yutaka , Takata Yasunori , Fukuoka Tomikazu , Arimitsu Junsuke , Hiwada Kunio , Okura Takafumi
Published: July 2008

An asymptomatic 88-year-old woman underwent a screening medical examination. The chest x-ray film showed a large mediastinal mass with calcification. Both chest computed tomography and nuclear magnetic resonance imaging revealed an unruptured aortic aneurysm, predominantly affecting the ascending aorta and the proximal part of the aortic arch. Its maximum diameter was 10.5 cm. An ascending aortic aneurysm more than 10 cm in diameter is very rare. She died of acute pulmonary embolism unrelated to the aneurysm, and autopsy indicated that the etiology of the aneurysm was atheroscle rotic degeneration. Retrospectively, the natural progression of the aneurysm was able to be followed on a series of chest x-ray films obtained over 18 years.
Changes in QT Dispersion Magnitude During Respiratory Phases: Role of Maximum Inspiration and Expiration
Authors: Yetkin Ertan , Yamk Ahmet , Kutlu Makbule , Ileri Mehmet , Çehreli Sengül
Published: July 2008

There is still controversy about the reliability and prognostic value of QT interval disper sion because of interobserver and intraobserver variability. The authors aimed to study the effect of respiratory phases on QT dispersion. Sixty healthy volunteers (38 men, 22 women, mean age 25 ±3 years) from the medical staff comprised the study group. Electrocardiograms were recorded by the same technician with a rate of 50 mm/s during mormal breathing, maximum inspiration and expiration. QT dispersion was defined as the difference between the maximal and minimal QT interval measurement occurring among any of the 12 leads. Corrected QT (QTc) interval was calculated according to Bazzet's formula. There were no significant differences between QTc max interval during maximum inspiration and expiration compared with those in normal breathing (409 ±20 ms vs 417 ±26 ms, p>0.05 and 412 ± 18 vs 417 ±26 ms, p>0.05 respectively). QTc dispersion during maximum inspiration and expiration was significantly lower than that of normal breathing (36 ± 8 ms vs 44 ± 9 ms, p<0.003 and 32 ±7 vs 44 ±9 ms, p< 0.003, respectively). And the QTc dispersion during maximum expiration was also lower than that during maximum inspiration (p<0.01). QT dispersion magnitude is affected by the respiratory phases in healthy subjects and decreases during both maximum inpiration and expiration as compared with normal respiration.
Histologic Comparison of Coronary and Iliac Atherectomy Tissue from Cases of In-Stent Restenosis
Authors: Ishibashi-Ueda Hatsue , Yutani Chikao , Imakita Masami , Kuribayashi Sachio , Takamiya Makoto , Uchida Hideo , Kichikawa Kimihiko , Suzuki Takahiko , Ishibashi-Ueda Hatsue
Published: July 2008

Pathologically, restenotic lesions after stenting were investigated by use of atherec tomized tissues of seven coronary and seven iliac arteries. The mean interval of the stent deployment to restenosis was 9.1 months for the coronary artery and 33.7 months for the iliac artery, indicating a 3.7-fold longer interval for the latter. This study does not include cases of acute thrombotic occlusion. The atherectomized tissue from restenotic coronary arteries showed abundant neointima with α-actin-positive and ultrastructually synthetic- type smooth muscle cells in a rich myxomatous extracellular matrix. In the iliac arteries, the predominant component of restenosis consisted of organized thrombi. The neointima of the iliac arteries was mature, and only a small amount of spindle cells were observed in the hyalinized matrix. The tissue that developed restenosis after stenting was different in the coronary and iliac arteries included in this series. This study on the atherectomized tissue suggests that even in the chronic stage, a major cause of in-stent restenosis among the larger caliber vessels such as the iliac artery is not neointima but stent thrombosis.
Neurogenic Regulation of Basal Tone of Coronary Artery with Mild Atherosclerosis in Humans: Observation Using Two-Dimensional Intravascular Ultrasound
Authors: Tokudome Takeshi , Mizushige Katsufumi , Ohmori Koji , Watanabe Kazufumi , Takagi Yuichiro , Takano Yuzuru , Matsuo Hirohide , Mizushige Katsufumi
Published: July 2008

The purpose of this study was to assess the role of the autonomic nervous system in the regulation of basal coronary artery tone in normal and atherosclerotic plaque segments by using intravascular ultrasound in humans. In each of 21 patients, a short-axis image at one site of coronary artery was imaged by means of a 3.2F, 30-MHz intravascular ultrasound before and after intracoronary administration of 2 mg isosorbide dinitrate (ISDN). The authors identified the perimeters of the vessel wall segments with normal or atherosclerotic plaque on ultrasound images and evaluated the basal tone in each segment as a percent increase in each perimeter produced by ISDN. Using heart rate variability analysis for 512 seconds recorded immediately before ISDN administration, they evaluated cardiac sympathetic and vagal activities at rest as the integrated power of fast Fourier transform (FFT) spectrum for the low-frequency (LF: 0.04 to 0.15 Hz), and high-frequency (HF: 0.15 to 0.4 Hz) components, respectively. Of 29 segments examined by ultrasound, 16 were normal and 13 were atherosclerotic plaque. In all 29 segments, ISDN produced an increase in the perimeter of the vessel wall. At the normal 16 segments, the increase in perimeter by ISDN exhibited a significant correlation to the power of HF (r = 0.749, p = 0.0008) but no significant correlation to LF. At 13 plaque segments, however, no significant correlation between the response to ISDN and autonomic nerve activity was observed. In conclusion, the basal tone of normal coronary arterial wall segment is closely related to parasympathetic nerve, whereas the relation is impaired in mild atherosclerotic segments.
The Prevalence of Middle Ear Disease among Learning Impaired Children
Authors: Freeman Barry A. , Parkins Charles
Published: July 2008

The prevalence of middle ear disease among children who are educationally classified as learning disabled as compared to that found in normal children is discussed. A higher incidence of middle ear pathology was found among the learning impaired children. The potentially hazardous effects that middle ear disease can have upon academic and linguistic develop ment are emphasized.
Primary Meningococcal Conjunctivitis In An Infant
Authors: Zagorzycki Maria T. , Brook Itzhak
Published: July 2008

A case of primary meningococcal conjunctivitis in an infant was presented and its treatment is discussed. Because of the potential for systemic spread of the infection in the patient, local and systemic therapy was instituted. The current literature on meningococcal conjunctivitis with its potential complica tions is briefly reviewed.
Psychological Aspects of Atopic Dermatitis
Authors: Fritz Gregory K.
Published: July 2008

An overview of existing research on the psychological aspects of atopic dermatitis is presented. Conclusive evaluation of specificity hypotheses, relat ing to emotional conflicts or personality types, is lacking, yet these theories continue to exert their influence. A reactive-interactive model is elaborated whereby a number of psychological processes exacerbate and maintain the disorder. Management strategies and psychiatric involvement are discussed.
Opsomyoclonus and Neuroblastoma
Authors: Nickerson Bruce G. , Hutter John J.
Published: July 2008

Children with neuroblastoma whose opsomyoclonus recurs or persists after initial surgery should be carefully evaluated for tumor. If no tumor is detectable, therapy with ACTH should be considered in patients whose sympto matology is severe enough to compromise normal development.
Chronic Middle Ear Disease and Auditory Perceptual Deficits
Authors: Gottlieb Marvin I. , Zinkus Peter W. , Thompson Anne
Published: July 2008

Data are presented indicating a correlation between chronic recurrent otitis media of early childhood and an increased likelihood of subsequent auditory processing deficits in a group of children referred for evaluation of impaired learning. Helpful appendices are added for a better understanding of central auditory processing skills.
Are Constitutional Delay of Growth and Familial Short Stature Different Conditions?
Authors: Lanes Roberto , Lee Peter A. , Plotnick Leslie P. , Avinoam Kowarski A. , Migeon Claude J.
Published: July 2008

Children between 2 and 4 standard deviations below the mean height for age with no specific cause to account for their short stature are usually considered to represent either constitutional delay of growth (CDG) or familial short stat ure (FSS). This study was undertaken to determine whether 167 patients who were referred to our clinic for short stature could be divided into two distinct populations that fit the criteria of CDG and FSS. When the patients were arti ficially divided into 2 subgroups based on skeletal age greater or less than 2 standard deviations below the mean, no significant difference in growth rates or midparental heights could be found between them. Height ages were sig nificantly more delayed in the group with greater skeletal age delay. Mid parental height of our total population of short children was less than the mean midparental height of normal American children. It was concluded that our patients did not distribute into these two clear-cut entities. Whether they repre sented one continuum or two largely overlapping populations could not be decided on the basis of our data.
Chromosomal Abnormality in the Newborns of Hepatitis B Surface Antigen (HBsAg) Carrier Mothers
Authors: Jhaveri Ramesh C. , Verma Ram S. , Rosenfeld Warren , Salazar Delfor J. , Dosik Harvey , Evans Hugh E.
Published: July 2008

The association of maternal hepatitis B surface antigen carriers (HBsAg) and chromosomal abnormalities in their newborns has been previously sug gested. This is a report on two female infants with abnormalities of chromosome 18 and trisomy 3q syndrome who were born to HBsAg carriers. These cases indicate that a possible relationship exists between the HBsAg carrier state in the mother and chromosome abnormalities in her offspring. It is suggested that the parents of all newborns with a structural chromosomal abnormality be tested for HBsAg.
Chlamydial Pneumonia of Infancy
Authors: San Joaquin Venusto H. , Herrin James R. , Hautala John M.
Published: July 2008

Two patients with chlamydial pneumonia of infancy are described. One recovered spontaneously without any specific antichlamydial treatment. The other, prior to a belated antimicrobial therapy, developed a persistent and pro tracted respiratory illness characterized by wheezing. Our observations suggest that: (1) untreated chlamydial pneumonia of infancy may spontaneously re solve, or may become a persistent and protracted disease, and (2) wheezing may be a very prominent manifestation of the disease and should be differentiated from wheezing due to bronchiolitis and bronchial asthma.
Kala-Azar as a Cause of Disseminated Intravascular Coagulation
Authors: Blount E.R. , Hartmann Robert , Nernoff John
Published: July 2008

With our present day highly mobile population, the diagnosis of kala-azar must be considered in any patient presenting with fever, enlarged liver and spleen, anemia and leukopenia who has visited a region where this disease is endemic, particularly since the incubation period may be as long as a year. We report a case in which disseminated intravascular coagulation was an un usual complication.
Cat-Scratch Disease with Encephalopathy
Authors: Miller Philip , Bell William E.
Published: July 2008

A case of encephalopathy complicating cat-scratch disease has been de scribed. Neurologic signs manifested by convulsions and stupor appeared ten days after epitrochlear lymphadenopathy. The clinical course gradually improved over the next few days and recovery was complete. The spinal fluid was normal. The skin test with CSD antigen was positive. In all cases of encephalopathy developing within six weeks following the appearance of un explained lymphadenopathy, the diagnosis of cat-scratch disease should be entertained. The importance of the cat-scratch disease antigen in diagnosis is emphasized.
The Child Accident Repeater
Authors: Jones Jerry G.
Published: July 2008

The child accident repeater is defined as one who has at least three accidents that come to medical attention within a year. The accident situation has features in common with those of the child who has a single accident through simple "bad luck", but other factors predispose him to repeated injury. In the child who has a susceptible personality, a tendency for accident repetition may be due to a breakdown in adjustment to a stressful environment. Prevention of repeat accidents should involve the usual measures considered appropriate for all children as well as an attempt to provide treatment of significant maladjustment and modification of a stressful environment.
Pyloric Stenosis and Direct Hyperbilirubinemia with Alpha-1-Antitrypsin Deficiency
Authors: Ghishan Fayez K. , LaBrecque Douglas R. , Mitros Frank A. , Younoszai Kabir
Published: July 2008

The occurrence of unconjugated hyperbilirubinemia in infants with pyloric stenosis is common. We report an infant who presented with projectile vomiting secondary to pyloric stenosis. In addition, he had conjugated hyperbilirubine mia which proved to be due to alpha-1-antitrypsin deficiency of PiZZ pheno type. This is the first case report of such an association. Infants with pyloric stenosis and conjugated hyperbilirubinemia should be investigated for under lying infectious, metabolic causes or anatomical defects of the biliary tree.
Deleterious Effects of Drugs Used for Hyperactivity on Patients with Gilles de la Tourette Syndrome
Authors: Sleator Esther K.
Published: July 2008

Two pediatricians failed to recognize Gilles de la Tourette syndrome in a child. The symptoms were exacerbated after the child took both pemoline and methylphenidate. All medications commonly used to treat hyperactivity may cause such exacerbation. Gilles de la Tourette syndrome is frequently asso ciated with symptoms characteristic of hyperactivity and often goes unrecog nized for long periods of time. The symptoms of the syndrome and the evidence that they are exacerbated by medication used to hyperactivity are briefly reviewed. Physicians should be aware of the possibility of Gilles de la Tourette syndrome in any hyperactive patient who manifests or has a history of a tic.
Selective Hearing Screening for Young Children
Authors: Palfrey Judith S. , Hanson Margaret A. , Pleszczynska Chantal , Norton Susan , Levine Melvin D.
Published: July 2008

A "selective" hearing screening program was instituted in an early education project. Three-year-old children were deemed "at risk" for mild-to-moderate hearing loss if they met one of the risk criteria established by the Joint Com mittee on Infant Hearing Screening, if they had recurrent ear infections, or if there was parent or staff concern about the child's hearing. Based on these criteria, 31 per cent of the 228 children in the project were eligible for full audiologic evaluation at a speech and hearing center. The parents of 45 chil dren took advantage of this special evaluation. Twenty-nine per cent of these selected children had some hearing loss documented. The highest yields of abnormal hearing were for children "at risk" because of recurrent ear infec tions (42%), and parent or educational staff concern (71%).