bluuebunny/crossref_metadata_2025 huggingface dataset:
Endovascular Presence of Chlamydia pneumoniae in Patients with Hemodynamically Effective Carotid Artery Stenosis
Authors: Maass M. , Krause E. , Engel P.M. , Krüger S. , Maass Matthias
Published: July 2008

The bacterial pathogen Chlamydia pneumoniae has been associated with atherosclerosis. Recent studies have reported chlamydial antigen to be present in atherosclerotic coronary arteries, but this relation has not yet been widely accepted. In order to verify an endovas cular presence of potentially viable chlamydiae by detection of genomic DNA, the authors examined atherosclerotic carotid arteries by using a C. pneumoniae-specific nested poly merase chain reaction. Chlamydial DNA was detected in 9 of 61 (15%) arterial samples obtained from therapy of hemodynamically effective cervical vascular stenosis. Chlamydial presence was limited to advanced atherosclerotic lesions (P≤0.02) : tissues from the same arteries with early subendothelial lesions did not harbor the pathogen. Thus, an etiologic role of C. pneumoniae is more plausible for progression than for initi ation of atherosclerotic lesions. Histomorphologic discrimination of infected and nonin fected samples was not possible and serology was unrewarding in detecting the infected patients. Chlamydial occurrence in atheromatous plaques is apparently a general phenomenon of atherosclerosis not limited to coronary arteries. Endovascular presence of genomic DNA of a bacterial pathogen susceptible to antimicrobial agents encourages thought on a new approach to prevent progression of atherosclerosis in a substantial proportion of patients. However, an etiologic contribution of C. pneumoniae in the multi- factorial process of atherogenesis yet remains to be demonstrated.
Effect of Enalapril Maleate on Cerebral Blood Flow in Patients with Chronic Heart Failure
Authors: Kamishirado Hirotoshi , Inoue Teruo , Fujito Tsuneo , Kase Makoto , Shimizu Minoru , Sakai Yoshihiko , Takayanagi Kan , Morooka Shigenori , Natsui Satoshi , Kamishirado Hirotoshi
Published: July 2008

The effect of enalapril on cerebral blood flow (CBF) was studied in 11 patients with chronic heart failure (NYHA II or III, dilated cardiomyopathy in 6 and old myocardial infarction in 5). CBF was evaluated by analyzing the Patlak-Plot curve obtained from radionuclide angiography with technetium-99m hexamethylpropylene amine oxime (99mTc-HM-PAO). Cardiac index (CI) and stroke volume (SV) were simultaneously measured by impedance cardiography. These measurements were performed before and at four weeks after daily administration of 5 mg enalapril. The stroke volume, cardiac index, and heart rate were not significantly changed after four weeks of enalapril admin istration. However, CBF was increased by 6.5% from 36.72 ±4.66 to 39.13 ±5.65 mL/ 100g/min (P<0.05). These results suggest that enalapril increased cerebral blood flow, which was not related to increased cardiac output in congestive heart failure. Patlak-Plot analysis of radionuclide angiography using 99m Tc-HM-PAO may be available for quantitative assessment of brain perfusion.
New Report of Severe Coronary Artery Disease in an Eighteen-Year-Old Girl with Pseudoxanthoma Elasticum
Authors: Kévorkian Jean-Philippe , Masquet Christiane , Kural-Ménasché Suzanne , Le Dref Olivier , Beaufils Philippe , Kévorkian Jean-Philippe
Published: July 2008

An eighteen-year-old woman with pseudoxanthoma elasticum (PXE) suffered from mild angina pectoris over a ten-year period. Severe triple-vessel disease with mild left ventric ular dysfunction was demonstrated on angiography. No revascularization was feasible. Despite a reported high frequency of angina pectoris among patients with PXE, only 10 convincing reports have appeared in the literature. Careful coronary artery evaluation is required in young patients with PXE, even though asymptomatic, because coronary artery disease (CAD) seems to be frequent and because no precise feature can be distinguished between types with or without severe vascular disease. Through very rare reports, surgical revascularization appears feasible and beneficial in a less severe form of CAD in patients with PXE. The risk of premature and severe diffuse CAD in PXE does not seem to be explained only by the combination of increased Lp [a] (or any other risk factor) and PXE.
Sulodexide Versus Calcium Heparin in the Medium-Term Treatment of Deep Vein Thrombosis of the Lower Limbs
Authors: Pinto Antonio , Corrao Salvatore , Galati Domenico , Arnone Sabrina , Licata Anna , Parrinello Gaspare , Maniscalchi Tiziana , Licata Giuseppe , Pinto Antonio
Published: July 2008

Thirty adult patients with distal, monolateral deep vein thrombosis of the lower limbs were randomly treated for sixty days either with subcutaneous Ca-Heparin or with Sulodexide, administered IM for ten days and orally for fifty days. The thrombus accretion above the knee, the venous pressures of the affected leg, the clinical sympto matology, and some laboratory coagulative tests were monitored throughout the admin istration period. Local tolerability of the two treatments was also evaluated.

The two applied treatments evidenced a net antithrombotic activity, preventing thrombus accretion above the knee, improving with the same efficacy the venous pressures in the affected legs, and similarly reducing clinical symptoms, with a quick and statistically significant trend toward normalization. Blood fibrinogen was significantly lowered by both drugs, while only Ca-heparin yielded a prolongation of activated partial thromboplastin time. Local tolerability of treatments was better for the mainly oral Sulodexide administrations, while subcutaneous Ca-heparin often induced small, though transient, hematomas.
Pulmonary Sequestration Receiving Arterial Supply from the Right Coronary Artery
Authors: Matsunaka Tsuyoshi , Hara Yuji , Okayama Hideki , Kodama Koji , Shigematsu Yuji , Kohara Katsuhiko , Hamada Mareomi , Hiwada Kunio , Hara Yuji
Published: July 2008

Pulmonary sequestration is a relatively rare anomaly. The arterial supply usually is derived from the aorta or its major branches. We present a 65-year-old female patient with pulmonary sequestration receiving arterial supply from the right coronary artery, complicated with sick sinus syndrome.
Acute Type A Aortic Dissection Following Intramural Hematoma of the Aorta
Authors: Moriyama Yukinori , Shiota Kazuhito , Hisatomi Kouichi , Watanabe Shunichi , Saigenji Hideaki , Shimokawa Shinji , Toyohira Hitoshi , Taira Akira , Moriyama Yukinori
Published: July 2008

A seventy-three-year-old woman had symptoms of aortic dissection. Initial computed tomographic (CT) scan and angiography showed an extensive intramural hematoma (IMH) of the aortic segment from the ascending aorta to the bulk of the descending aorta without intimal tear or false lumen. Two weeks later the patient's symptoms recurred. A repeat CT demonstrated a classic type A aortic dissection with a false lumen and an intimal defect. The patient underwent a successful hemiarch repair with use of selective cerebral perfusion under profound hypothermic circulatory arrest. This case suggests extensive IMH as an important underlying pathology of the aortic dissection.
Quantitative Angiographic Analysis of PTCA-Induced Coronary Vasoconstriction in Single-Vessel Coronary Artery Disease
Authors: Altstidl Robert , Goth Claus , Lehmkuhl Hans , Bachmann Kurt , Altstidl Robert
Published: July 2008

Quantitative coronary angiography was applied to investigate the degree and extent of coronary vasoconstriction following percutaneous transluminal coronary angioplasty (PTCA) in single-vessel disease of segments distal to the PTCA site (n=46) and of control segments in nonmanipulated vessels (n=33) before PTCA, 15 minutes after PTCA, and again 10 minutes after 10 mg sublingual isosonbide dinitrate (ISDN) in 46 patients receiving neither nitrates nor calcium channel blockers prior to PTCA. Furthermore, the degree of coronary vasoconstriction was compared with ergonovine-induced vasocon striction (n=8) as well as in patients with and without restenosis during follow-up angiography 4 months later.

PTCA induced a moderate, but significant, vasoconstriction in both distal and control segments, with a reduction in coronary diameter from 2.34 ±0.58 to 2.26 ±0.55 mm (P=0.011) and from 2.70 ±0.62 to 2.60 ±0.65 mm (P=0.004), respectively. No corre lation between the degree of vasoconstriction on the one side and lesion severity and PTCA-induced mechanical stretch, judged by the sum of the products of inflation pressure and time, on the other side was found. Vasoconstriction was within the limits achiev able with the potent vasocontrictor ergonovine and did not differ in patients with or without restenosis. ISDN led to a significant vasodilatation in all segments.

In conclusion, coronary vasoconstriction following PTCA is present in the coronary tree in a rather diffuse way. It is not associated with stenosis severity or PTCA-induced mechanical stretch, suggesting a complex underlying mechanism. ISDN-reversible vaso constriction was within the limits achievable with ergonovine and did not differ with regard to restenosis.
Prethrombotic State Due to Hypercoagulability in Patients with Permanent Transvenous Pacemakers
Authors: Ito Tatsuo , Tanouchi Jun , Kato Junji , Nishino Masami , Iwai Kunimitsu , Tanahashi Hideo , Hori Masatsugu , Yamada Yoshio , Kamada Takenobu , Ito Tatsuo
Published: July 2008

Venous thrombosis is a relatively usual but serious complication of permanent transve nous pacing. However, the pathogenesis has not been defined. To clarify underlying abnormalities in the coagulation-fibrinolysis system in patients with permanent trans venous pacemakers, we measured serum levels of fibrinopeptide A (FPA), thrombin-antithrombin III complexes (TATs), plasmin-α2 plasmin inhibitor complexes (PICs), D-dimer (D-D), β-thromboglobulin (β-TG), and platelet factor 4 (PF4) in 53 patients with permanent transvenous pacemakers and 10 control subjects. The patients were divided into two groups, as follows, according to the presence of mural thrombus documented along the pacing lead(s) by digital subtraction angiography and trans esophageal echocardiography: Group Th (-), patients without venous route thrombus; and Group Th (+), patients with venous route thrombus. FPA and TAT levels increased significantly even in Group Th (-), and further increased in Group Th (+) compared with control subjects (FPA: 7.5 ±4.9, 15.3 ±8.8 vs 3.0 ±1.4 ng/mL, respectively, P<0.05; TAT: 2.9 ±1.3, 4.8 ± 2.3 vs 1.7 ±0.6 ng/mL, respectively, P<0.05). There were no differences in levels of D-D, PIC, β-TG, and PF4 among control subjects, Group Th (-), and Group Th (+). These findings suggest that the hypercoagulable state appears in patients with permanent transvenous pacemakers, even without apparent venous throm bosis. The patients with permanent transvenous pacemakers are thought to be in the prethrombotic state even if they have no venous route thrombosis.
Pitfalls in the Echocardiographic Diagnosis of Aortic Dissection
Authors: Patel Sarine , Alam Mohsin , Rosman Howard , Alam Mohsin
Published: July 2008

The authors studied 25 patients with transthoracic echocardiography (TTE) and/or trans esophageal echocardiography (TEE) for suspected aortic dissection. Of these, aortic dissection was diagnosed correctly in 19 patients, but in 6 the echocardiographic findings for dissection were atypical or false-positive. In patient 1, the TEE revealed a dilatated proximal aortic root. TEE showed a possible flap but was nondiagnostic. The diagnosis was made by computed tomography (CT) and confirmed at surgery to be type 1 dissec tion. In patient 2, the TTE depicted flail aortic cusps, questionable vegetations, and dilatated aortic root. In patient 3, TTE demonstrated moderate pericardial effusion with hematoma but no dissection. Type 1 dissection was subsequently confirmed at autopsy in both. Patient 4 had TEE diagnosis of type 3 dissection. However, reevaluation of the study by a senior sonographer just prior to surgery led to the correct diagnosis of type 1 dissection. Patients 5 and 6 had dilatated ascending aortas with linear echoes within the lumen on TEE and were reported as having type 1 dissections. CT and/or angiography did not reveal dissection in either patient. In conclusion, TTE and TEE are vaulable tests in diagnosing aortic dissection. However, atypical features, misdiagnosis of the site of dissection, or false-positive studies can occur.
The Use of Multisite High Resolution Arterial Imaging to Assess Arteriosclerosis
Authors: Vagnini Frederic J. , Hill Susan , Puvogel John , Puvogel John
Published: July 2008

This article presents a model for the use of multisite, sonographic imaging to assess arte riosclerosis. The arteries of 100 randomly selected patients were scanned in three anatomical areas (carotid, femoral-popliteal, aorta-iliac) in conjunction with measure ment of selected risk factors (smoking, cholesterol, triglycerides, high density lipopro teins, antioxidant levels). Arteries were interrogated for intimal wall hyperplasia, plaque, and ulceration. Multisite scanning (24 sites) detected the presence of pathology in all sites surveyed. The model was developed at The Cardiovascular Wellness Center in Westbury, NY.
Stress/Rest Myocardial Perfusion SPET in Evaluation of the Hemodynamic Significance of a Fistula Between the Anterior Descending Branch of the Left Coronary and the Left Pulmonary Arteries
Authors: Rubini Giuseppe , Bovenzi Francesco , DiGiovine Giuseppe , D'Agostino Carlo
Published: July 2008

This paper describes the use of Stress/Rest Tc-99m Sestamibi (MIBI) Single Photon Emission Tomography (SPET) to evaluate the hemodynamic significance of an unusual fistula between the descending anterior branch of the left coronary artery and the left pulmonary artery. Coronary arteriography in a patient with myocardial infarction of the inferior wall revealed subocclusive (greater than 90%) stenosis of the right coronary and an abnormal branch proceeding from the intermediate section of the left anterior descending (LAD) artery to the left pulmonary artery.

Treatment of the stenosis by percutaneous transluminal coronary angioplasty gave a good angiographic result but failed to resolve the angina. Myocardial Stress/Rest Tc-99m MIBI SPET disclosed an irreversible defect corresponding to the previous infarc tion. The anterior wall and apex were marked by a reversible defect due to a flow steal via the abnormal branch running from the intermediate section of the LAD artery to the left pulmonary artery. The examination was thus able to reveal perfusion defects in two different sites and of different size and gravity. Its findings and the coronary angiog raphy data showed that these defects were caused by different coronary disorders (ather osclerosis of the right coronary artery and a coronary arteriovenous fistula of the LAD artery). It also demonstrated the functional importance of the LAD to the left pulmonary artery coronary fistula.
Pre-PTCA Detection of Chronic But Reversible Postischemic Myocardial Dysfunction by Nicardipine
Authors: Pust Borut , Surlan Milos
Published: July 2008

The aim of the study was to find out whether in patients (n = 24) with one-vessel coronary artery disease, reversibility of related left ventricular (LV) wall motion abnor malities after successful percutaneous transluminal coronary angioplasty (PTCA) can be predicted by the immediate effect of calcium antagonist nicardipine.

Dynamic quantitative left cineventriculography performed four times successively (as the control, 30 minutes after oral nicardipine, 10 minutes after PTCA, and 6 months after PTCA) and hemiaxis method (mean relative hemiaxis shortening or Xδr %) were used for wall motion analysis of 48 poststenotic LV myocardial segments divided into three groups: hypokinetic noninfarcted (PNHS, n = 25), infarcted (PIS, n = 12), and normokinetic noninfarcted (PNNS, n =11) and of 24 normal LV myocardial segments (NS).

In PNHS and PIS close correlation (r = 0.75, P < 0.0001 and r = 0.71, P < 0.005) was demonstrated between postnicardipine improvement (21 ±4% to 37 ±9%, P < 0.0001, and 16 ±7% to 20 ±8%, P < 0.0005) and 6 months after PTCA improvement (21 ±4% to 33 ± 7%, P < 0.0001, and 16 ± 7% to 19 ± 9%, P < 0.0005) of wall motion. It was loose in PNNS and absent in all three groups immediately after PTCA. The sensitivity of the nicardipine test for 6 months after PTCA reversible LV segmental hypokinesia was high in PNHS (95%) and lower in PIS and PNNS (67% and 60%, respectively). The speci- ficity was 100% in PIS, lower in PNNS (67%), and absent in PNHS (owing to lack of true nonresponders). Immediately after PTCA, contraction significantly improved only in PNHS; the nicardipine test was 100% sensitive but nonspecific.

Significant improvement of contraction of all groups of poststenotic LV wall segments is expected 6 months after successful PTCA of related artery stenosis, being well predictable by the pre-PTCA effect of nicardipine, at least in PNHS and in PIS. Immediate ly after PTCA, only in PNHS can significant improvement of contraction be expected.
Pyoderma Gangrenosum and Extensive Caval Thrombosis Associated with the Antiphospholipid Syndrome
Authors: Chacek Samuel , MacGregor-Gooch Julian , Halabe-Cherem Jose , Nellen-Hummel Haiko , Quiñones-Galvan Alfredo
Published: July 2008

Pyoderma gangrenosum is a rare cutaneous disorder frequently associated with systemic diseases. The authors report the case of a 28-year-old man with pyoderma gangrenosum and inferior cava vein syndrome due to thrombosis. The search for pyoderma gangrenosum-associated conditions (gastrointestinal, rheumatic, neoplasic, and infec tious diseases) was negative. A prolonged partial thromboplastin time and a positive test for circulating anticardiolipin antibodies strongly suggested the diagnosis of the antiphos pholipid syndrome.

There are reports of at least three other cases of pyoderma gangrenosum associated with the antiphospholipid syndrome. This clinical case adds further evidence to the possible link between these disorders and warrants a search for anticardiolipin antibodies in patients with pyoderma gangrenosum.
Carotid-Subclavian Bypass for Subclavian Artery Revascularization: Long-term Follow-up and Effect of Antiplatelet Therapy
Authors: Wittwer Thorsten , Wahlers Thorsten , Dresler Christoph , Haverich Axel
Published: July 2008

Subclavian artery stenosis is found in up to 25% of supraaortic lesions. Bypass grafting is the procedure of choice but controversies exist concerning the optimal technique and the effect of postoperative antithrombotic therapy on long-term patency.

The authors retrospectively analyzed 40 patients with carotid-subclavian bypasses. Stenoses were documented preoperatively by arteriography. Patency was determined by clinical, ultrasound, or arteriographic examinations. Cumulative patency rates were calcu lated by Kaplan-Meier method and analyzed by Tarone-Ware test.

Graft materials were Dacron (32), polytetrafluoroethylene (seven) or saphenous vein (one). Indications for surgery included vertebrobasilar insufficiency (22.5%), upper extremity ischemia (22.5%), and the combination of both (55.0%). Perioperative mortality and morbidity were 2.5% and 10.0%, respectively. Patients were followed up from 0 to 134 months (mean 61 ±39 months). Cumulative 5-year patency rate was 83.3%. Anticoagulation with acetylsalicylic acid (ASA) led to significantly better 5-year patency rates (100%) as compared with the combination of ASA and dipyridamole (64.0%, p=0.013) or no anticoagulation (70.0%, p=0.016).

Carotid-subclavian bypass led to excellent long-term patency rates and can provide durable relief of symptoms with minimal perioperative morbidity and mortality. Therefore, it is a worthwile procedure to correct proximal subclavian artery stenosis. Postoperative medication with ASA seems to increase long-term bypass function significantly.
Experimental Study of Cardiac Lymph Dynamics and Edema Formation in Ischemia/Reperfusion Injury— with Reference to the Effect of Hyaluronidase
Authors: Yotsumoto Goichi , Moriyama Yukinori , Yamaoka Akihiro , Taira Akira
Published: July 2008

This study is designed to evaluate the effect of hyaluronidase on the canine myocardial edema derived from ischemia/reperfusion injury. The mongrel dog's heart received 90 minutes of ischemia under cardiopulmonary bypass consisting of 30 minutes of normoth ermia alone and 60 minutes of hypothermia with cardioplegic arrest. Reperfusion for 60 minutes was added thereafter. Two kinds of cardioplegic solution, 4°C St. Thomas' Hospital solution with or without 3000 units/L of hyaluronidase, were prepared. The solution was given antegradely every 30 minutes during cardioplegic arrest. Cardiac lymph was collected continuously from the afferent duct of the cardiac lymph node by cannulation. Hyaluronidase in the cardioplegic solution increased cardiac lymph volume significantly and improved postischemic recovery of cardiac function. A high level of adenosine triphosphate was maintained at that time. The myocardial water content at the end of reperfusion revealed a minimum increase with hyaluronidase use. Active drainage of cardiac lymph by hyaluronidase alleviates the myocardial edema formation, thereby preserving cardiac function.
Arm Edema, Subclavian Thrombosis, and Pacemakers
Authors: Ciocon Jerry O. , Galindo-Ciocon Daisy
Published: July 2008

This reports an arm edema that was initially treated as cellulitis and later diagnosed to be subclavian thrombosis due to pacemaker wire irritation. We present an 87-year-old Caucasian man with 5 weeks duration of left arm swelling and pain that was treated with two courses of antibiotics. An axillary venous Doppler study was interpreted as normal with no evidence of venous thrombosis. However, a venogram showed evidence of thrombosis involving the left innominate, subclavian, and axillary veins with multiple collateral veins diverting the blood to the contralateral side and into the superior vena cava. Intravenous anticoagulation was initiated and subsequently the patient was main tained on warfarin (Coumadin). The thrombosis subsequently improved and the original pacemaker was maintained. Arm edema are commonly mistaken for cellulitis, causing a delay in a more definite diagnosis of subclavian thrombosis. In a setting of a patient with pacemaker, subclavian thrombosis should be considered even with a normal screening venous ultrasound test. The incidence, manifestation, venous Doppler, and venogram findings are reviewed and discussed. Upper arm edema and superior vena cava syndrome are the most common presentation of this subclavian thrombosis associated with pace makers. Venous ultrasound tests may be normal and a venogram is usually required to establish a diagnosis.
Relationship Between Free-Living Daily Physical Activity and Ambulatory Measures in Older Claudicants
Authors: Gardner Andrew W. , Womack Christopher J. , Sieminski Debra J. , Montgomery Polly S. , Killewich Lois A. , Fonong Tekum
Published: July 2008

The purpose of this study was to determine the relationship between free-living daily physical activity and ambulatory measurements in peripheral arterial occlusive disease (PAOD) patients with intermittent claudication. Thirty-four older, nonsmoking PAOD patients with intermittent claudication (age = 69.0 ± 6.0 years, ankle/brachial index [ABI] =0.63 ±0.18) were recruited from the Vascular Clinic at the Baltimore Veterans Affairs Medical Center and from radio and newspaper advertisements. Energy expenditure of physical activity (EEPA) was determined by using doubly labeled water and indirect calorimetry techniques. Patients were also characterized on claudication distances and peak oxygen uptake during a graded treadmill test, 6-minute walking distance, weight, body mass index, and percent body fat. The claudication patients were sedentary, as EEPA was 362 ±266 kcal/day. EEPA was related to the 6-minute walk distance (369 ±68 meters; r=0.629, P<0.001), to the number of steps taken during 6 minutes (605 ±99 steps; r=0.485, P=0.008), to the treadmill distance to maximal claudication (313 ±131 meters; r=0.470, P=0.010), and to the time to relief of pain (6:21 ±3:57 min:sec; r=-0.417, P=0.017). None of the other ambulatory and body composition measure ments were correlated with EEPA. In conclusion, a reduction in free-living daily physical activity was associated with a decrease in ambulatory ability and with more severe inter mittent claudication in older PAOD patients.
Congenital Isolated Apical Ventricular Septal Defects
Authors: Atalay Semra , Imamoğlu Ayten , Dilek Levent , Altug Nahide , Tutar Ercan , Gümüş Halil
Published: July 2008

The diagnosis of apical ventricular septal defects (VSDs) is difficult and the ratio of spon taneous closure is not well known. At the Ankara University Pediatric Cardiology Department, between the years 1992 and 1997, 33 patients were identified by color- flow Doppler (CFD) imaging as having a small defect at the apical portion of the ventric ular septum. The age range was 1 day to 13 years. All patients were asymptomatic with normal telecardiograms and electrocardiograms. There were grade 2-3/6, pansystolic murmurs at the apex or closer to the apex in 19 patients. In 30 patients, narrow and short colored jets were seen at the apex of the heart, distal to the moderator band. The jets were wide in three patients. These defects were difficult to image and required specific angulation of the transducer. Of the 23 patients who had follow-up examina tions, at 3 months to 3.5 years, there was spontaneous closure in ten (43.5%). To the authors' knowledge, this report is the largest series of isolated apical trabecular ventric ular septal defects (t-VSDs). In their experience, color-flow imaging is more sensitive in detecting a small apical VSD. They conclude that although the closure of apical VSD is not the rule, the prognosis is excellent.
Basic Fibroblast Growth Factor Increased Regional Myocardial Blood Flow and Limited Infarct Size of Acutely Infarcted Myocardium in Dogs
Authors: Miyataka Masaru , Ishikawa Kinji , Katori Ryo
Published: July 2008

Basic fibroblast growth factor (bFGF), a growth factor potent in promoting angiogen esis, has been shown to reduce infarct size in experimentally induced acute myocardial infarction. However, the effect of bFGF on regional myocardial blood flow (Qm) in the acutely infarcted myocardium has not been well clarified. In 20 open-chest dogs, the left anterior descending (LAD) coronary artery was occluded and animals were maintained in this condition for 4 weeks. In eight of these dogs, bFGF (300 μg) was injected into the myocardium supplied by the LAD and the artery was ligated (bFGF group), and in the other 12 dogs, saline was injected (control group). Nonradioactive colored microspheres were used to measure Qm. The amount of viable myocardium as percent of visual field in the microscope and the extent of fibrosis scored histologically from 0 to 5 in the infarcted area 4 weeks after occlusion were measured. In the outer layer, the Qm values immediately after and 4 weeks after occlusion were 26 ± 2% and 70 ± 6%, respectively, in the control group, and 46 ± 5% and 121 ± 13%, respectively, in the bFGF group. The Qm at both times in the bFGF group was significantly higher than the corresponding control group values (p < 0.01). The Qm at 4 weeks in the inner and the middle layers also significantly increased in the bFGF group. There was more viable myocardium (control vs bFGF group; 41 ± 5 vs 61 ± 7%, p<0.05) and less fibrosis (3.1 ± 0.2 vs 2.0 ± 0.4, p < 0.01) at the outer layer in the bFGF group. It was found that bFGF caused a marked increase in Qm, an increase of viable myocardium, and a decrease of fibrosis in the infarcted myocardium in dogs.
Immunolabeling of Type IV Collagen, Laminin, and α-Smooth Muscle Actin Cells in the Intima of Normal and Varicose Saphenous Veins
Authors: Porto Luís Cristóvão , Pantoja Ferreira Maria Auxiliadora , Monte Alto Costa Andrea , da Silveira Paulo Roberto Mattos
Published: July 2008

Smooth muscle cells (SMC) of normal and varicose human saphenous intima were studied on cryostat sections by immunohistochemistry with α-smooth muscle actin (ASMA), type IV collagen, and laminin antibodies and also by transmission electron microscopy. The findings suggest two structurally distinct subtypes of smooth muscle cells with thin and thicker external lamina. Thin external lamina SMC were characterized by laminin, type IV collagen, weaker external lamina reactivity, and intense cytoplasmic α-smooth muscle actin immunoreactivity. Ultrastructurally, they exhibited abundant cyto plasmic microfilaments and thin external lamina. These cells were found isolated or, more frequently, clustered in fascicles close to the subendothelium in focal or zonal cushions, or in diffuse enlargement of the intima. In contrast, thicker external lamina smooth muscle cells were intensely immunolabeled for laminin and collagen IV, showing irregular cytoplasmic ASMA reaction. Single or clustered thicker external lamina SMC were seen predominantly in zonal cushions and in intima diffuse enlargement. It is very likely that these cells secrete these matrices in a nonpolarized fashion. The thicker external lamina of these SMCs showed a fine granular amorphous aspect sometimes intermingled with microfibrils. These external lamina were interposed between neigh boring cells and exposed to collagen fibrils and elastic fibers. The cells also exhibited rarefaction of the cytoplasmic filaments. Intermediary cells exhibiting both features were rarely seen. Thicker external lamina SMC should be discussed in the context of an adaptive/proliferative response leading to dysfunction of the fibroelastic properties of the vein wall.
Combined Protein C Deficiency and Protein C Activated Resistance as a Cause of Caval, Peripheral, and Cerebral Venous Thrombosis
Authors: Pugliese Domenico , Nicoletti Giuseppe , Andreula Cosma , Ciccone Marco , Triggiani Giovanni
Published: July 2008

A 26-year-old woman suffered concomitant inferior vena cava, iliac, and femoral vein thrombosis and cerebral venous thrombosis. Ten days before symptom onset she had started using an oral contraceptive that contained low-dose ethynilestradiol and gestodene. Both protein C deficiency and protein C activated resistance were detected. To our knowledge, the association of cerebral, caval, and ilio-femoral-popliteal venous thrombosis has not been described previously. The severity of the clinical features could be a consequence of the two combined thrombophilic mechanisms and of the continuation of the oral contra ceptive. A thrombophilic disorder should be considered in young patients with throm boembolic disease. Because of the high prevalence of the genetic deficiency causing protein C activated resistance, it is probably worthwhile to perform general screening before prescription of oral contraceptives.
Constitutive Endothelial Nitric Oxide Synthase (ecNOS) Gene Expression in Human Monocytes
Authors: Calò Lorenzo , Davis Paul A. , Milani Monia , Antonello Augusto , Cantaro Salvatore , D'Angelo Angela , Fagiolo Umberto
Published: July 2008

This study evaluates using a polymerase chain reaction (PCR)-based molecular biological approach to study the gene expression of the constitutive endothelial isoform of nitric oxide synthase (ecNOS) in human monocytes. When PCR was carried out with specific primers for ecNOS, 302 bp product was amplified, which sequence analysis determined as having 100% identity to the reported human ecNOS isoform gene sequence. The data presented here demonstrate a reliable technique for assessing ecNOS mRNA levels in circulating human monocytes. This then permits use of this easily available cell to monitor ecNOS levels and provides a means to investigate mechanisms involved in controlling NO synthase levels as well as NO synthesis.
Safety of Endovascular Treatment in High-Cardiac-Risk Patients with Limb-Threatening Ischemia
Authors: Rossi Elisabetta , Citterio Franco , Castagneto Marco , Pennestri Faustino , Loperfido Franco
Published: July 2008

Vascular surgery can be safely performed in approximately 60% of patients with advanced peripheral vascular disease, because of the high frequency of concomitant coronary artery disease and consequent increased risk of perioperative cardiac compli cations. The aim of this study was to validate the hypothesis that endovascular revascu larization could be safely applied to high-cardiac-risk patients with a lower incidence of perioperative cardiac complications. One hundred and fourteen patients with peripheral vascular disease referred for revascularization underwent preoperatively a clinical and echocardiographic evaluation, at rest and under dipyridamole stress test, to assess the cardiac risk. Patients with high clinical score (according to Goldman and Detsky), or low left ventricular ejection fraction at rest, or positive dipyridamole stress test, were consid ered at high cardiac risk. To record adverse cardiac events, all patients were monitored during surgery, postoperatively, and followed up for 18 months after hospital discharge. Forty-eight patients (42%) were found to be at high cardiac risk. In this high-cardiac-risk group, endovascular surgery was performed in 37/48 patients (77%) (group A), while the remaining 11/48 patients (23%) were bypassed with open surgery (group B). Postop erative cardiac complications occurred in 16% of patients in group A and in 45% of patients in group B with two deaths (p < 0.05). At follow-up, 51% of patients in group A and 44% of patients in group B had suffered late cardiac events (p = ns), with 10 deaths in group A and three deaths in group B (p = ns). Limb salvage rate was similar in the two groups (95% group A, 100% group B; p = ns). These data show that high-cardiac-risk patients with limb-threatening ischemia have significantly less perioperative cardiac complications when treated by endovascular procedures instead of bypass surgery. Follow-up data on cardiac events confirm the severity of concomitant coronary artery disease in patients with peripheral vascular disease.
Mechanism of Rethrombosis After Thrombolytic Therapy: Angioscopic Findings and Investigation of the Coagulation System in Dogs
Authors: Maki Akira , Shirato Chiaki , Ohguchi Masahisa , Aoki Nobuo , Ochiai Nobuhiko , Taguchi Shigeru , Aoki Isao , Ishikawa Kyozo
Published: July 2008

The purpose of this study was to angioscopically observe the process of thrombolysis after intracoronary administration of thrombolytic agents and to investigate the effects of these agents on coagulation/fibrinolysis systems in dogs. The coronary endothelium was removed and thrombus formation was confirmed by angioscopy. In the tissue plas minogen activator (tPA) group (n=8), complete thrombolysis occurred in all animals, but thrombolysis was incomplete in the urokinase (UK) group (n=6). The plasma level of plasmin α2-plasmin inhibitor complex peaked at 15 minutes after treatment in both the tPA and UK groups. Plasma thrombin-antithrombin III (TAT) complex decreased tran siently at 15 minutes after tPA administration but increased at 30 and 60 minutes (P<0.05). In the UK group, plasma TAT also showed a transient decrease followed by an increase, which was minimal compared with that in the tPA group. Plasma TAT decreased transiently after infusion of tPA and subsequently increased to above the pretreatment level, suggesting a risk of rethrombosis after successful recanalization.
Septal Panniculitis Induced by Atenolol
Authors: Fragasso Gabriele , Ciboddo Gianfranco , Pagnotta Paolo , Chierchia Sergio L.
Published: July 2008

The authors report a case of septal panniculitis induced by atenolol in a patient with coronary artery disease. Several tender, erythematous, suppurated subcutaneous nodules appeared over the metacarpal-phalanx and interphalanx joints of both hands. Hematology indicated a transient inflammatory immunomediated disorder, with an increase of cytotoxic suppressor lymphocytes and presence of antinuclear antibodies. The dramatic inflammatory involvement of the subcutaneous connective tissue could have eventually progressed toward fibrosis, if atenolol had not been withdrawn. This raises the possibility that retroperitoneal fibrosis, a recognized adverse effect of beta blockers, may just represent the terminal phase of undetected connective tissue inflammation occurring in districts not easily explorable before overt manifestations of the disease. Since retroperitoneal fibrosis has already been associated with migratory panniculitis and described as mesenteric panniculitis, it is tempting to speculate that these manifestations originate from the same mechanisms.
Plasma Soluble P-Selectin in Acute Myocardial Infarction: Effects of Coronary Recanalization Therapy
Authors: Aoki Naoto , Tomoda Haruo
Published: July 2008

P-selectin is translocated from platelets and endothelial cells to initiate the first step in a sequence of events leading to the adherence of leukocytes, possibly inducing reperfu sion injury and the no-reflow phenomenon in acute myocardial infarction (AMI). This study was undertaken to investigate plasma P-selectin in AMI patients undergoing coronary recanalization therapy.

A total of 40 patients were studied: 20 patients with AMI who underwent coronary recanalization by direct percutaneous transluminal coronary angioplasty (PTCA), 10 patients with AMI who underwent thrombolytic therapy by tissue-type plasminogen activator (TPA), and 10 patients with stable angina pectoris who underwent elective PTCA. Blood samples were obtained from systemic arteries before and immediately after PTCA or thrombolytic therapy. Plasma-soluble P-selectin was measured by enzyme immunoassay. Plasma P-selectin was significantly higher in AMI than in stable angina pectoris (176.6 ± 12.9 ng/mL vs 91.4 ± 9.5 ng/mL, p<0.001). Plasma P-selectin did not change significantly as a result of elective PTCA in patients with stable angina (from 91.4 ± 9.5 ng/mL to 87.9 ± 7.9 ng/mL). Plasma P-selectin was decreased by direct PTCA in all of the 20 patients with AMI (from 176.2 ±17.7 ng/mL to 141.7 ±12.6 ng/mL; p<0.001, paired t-test), whereas it was increased by thrombolysis using TPA in nine of the 10 AMI patients (from 177.4 ±17.2 ng/mL to 248.8 ±17.3 ng/mL, p<0.005).

Increased P-selectin activity in AMI appeared to be attenuated by direct PTCA, but augmented by thrombolysis, possibly due to direct stimulatory effects of TPA on P-selectin expression. This may lead to less favorable results in salvaging the ischemic myocardium by thrombolytic than mechanical coronary recanalization therapy in AMI.
Patients with a Malignant Tumor Have More Extended Thrombosis Than Patients Without
Authors: Kröger K. , Fischer A. , Hinrichs A. , Gocke C. , Rudofsky G.
Published: July 2008

Changes in the coagulability or rheology of the blood are supposed to cause an increased frequency of thrombosis in patients with a malignant tumor. These procoagulopathic disorders may not only increase the frequency of thrombosis but may also enlarge the extent of the thrombosis. The authors retrospectively analyzed, therefore, the extension of thrombosis in patients with and without a malignant tumor. From 1991 to 1995 in the University Hospital Essen 489 consecutive cases of thrombosis were diagnosed. The diagnosis was made by color Doppler sonography or phlebography; 230 patients (47%) suffered from a malignant tumor (110 men, 120 women). To exclude the influence of the patient's age on the extension of the thrombosis the authors distinguished three different age groups. In the tumor group aged from 21 to 40 years they found 10 large (iliacal, femoral, and crural veins), six medium (femoral and crural veins), and four small thromboses (crural veins). In the tumor group aged from 41 to 60 years they found 38 large, 24 medium, and 27 small thromboses. In the group without a tumor aged from 21 to 40 years they found seven large, 13 medium, and 28 small thromboses, and in the group aged from 41 to 60 years, 12 large, 29 medium, and 41 small thromboses. The difference between the two groups supports the assumption that in patients suffering from a malignant tumor, thromboses tend to be more extended than in patients without a malignant tumor.
Absence of the Inferior Vena Cava Causing Repeated Deep Venous Thrombosis in an Adult
Authors: Salgado Ordóñez Fernando , Gavilán Carrasco Juan Carlos , Bermúdez Recio Francisco José , Cuevas Rafael Aguilar , López Teresa Fuentes , González Santos Pedro
Published: July 2008

Agenesis of the inferior vena cava is an uncommon congenital vascular malformation. Although theoretically it may favor venous stasis, it is not normally associated with venous thrombosis. The authors found only three reports of the coexistence of both entities, and only one of these rules out the existence of associated hypercoagulability. They report the case of a patient with a history of repeated venous thrombosis. Magnetic resonance angiography and venography demonstrated complete agenesis of the inferior vena cava and persistence of a cardinal venous system with azygos and hemiazygos continuation, associated with right renal hypoplasia. Studies ruled out hypercoagulability syndrome, either primary or secondary to an occult neoplasm. The authors conclude that venous malformations, although rare, may cause thromboembolic disease, especially in young patients, and that magnetic resonance angiography is a useful diagnostic alter native to conventional phlebography.
Endothelial Derived Vasoactive Factors and Leukocyte Derived Inflammatory Mediators in Subjects with Asymptomatic Atherosclerosis
Authors: Anwaar I. , Gottsäter A. , Hedblad B. , Palmqvist B. , Mattiasson I. , Lindgärde F.
Published: July 2008

To clarify relationships between the (endothelial vasodilatory and vasoconstrictive function) and leukocyte inflammatory mediators in subjects with asymptomatic athero sclerosis, we measured (intraplatelet cyclic 3-5 ¢ guanosine monophosphate [cGMP] and cyclic 3-5 ¢ adenosine monophosphate [cAMP]), plasma endothelin (ET-1), and plasma neopterin in 197 subjects with asymptomatic atherosclerosis (median age 63 years, range 49-69 years). We measured neutrophil protease 4 (NP4), tumor necrosis factor (TNFμ), soluble tumor necrosis factor receptor-1 (sTNFR-1), and neutrophil gelatinase associ ated lipocalin (NGAL) in 152 of the 197 subjects. Intraplatelet cGMP correlated inversely with plasma ET-1 (r=-0.22; p=0.01), which confirms earlier in vitro data of the inhibitory effect of ET-1 on NO production and/or the cGMP mediated inhibitory effect of NO on ET-1 production. Plasma neopterin as well as NP4 correlated directly with intraplatelet cGMP (r=0.24; p<0.01 and r=0.33; p<0.001, respectively). Intraplatelet cAMP correlated directly with plasma TNFμ (r=0.17; p<0.05) and sTNFR-1 (r=0.20; p<0.05). The relationship between leukocyte derived inflammatory mediators and intraplatelet cyclic nucleotides suggest an antiaggregating effect of leukocytes upon platelets, which may constitute a negative feedback mechanism that inhibits platelet acti vation during the atherosclerotic inflammatory process.
Left Ventricular Size and Function in Patients with Noninsulin-Dependent Diabetes and Postinfarction Total or Subtotal Coronary Occlusions
Authors: Dini Frank L. , Volterrani Cesare , Azzarelli Andrea , Lanciani Alessandro , Lunardi Maurizio , Bernardi Daniele , Micheli Giovanni
Published: July 2008

The aim of this study was to establish the effects of postinfarction total or subtotal coronary occlusion on left ventricular remodeling in patients with noninsulin-dependent diabetes (NIDD) compared with the effects in postinfarct nondiabetic patients. The authors selected 100 patients submitted to coronary angiography between 1 and 5 weeks after acute myocardial infarction (TO: 20.5 ± 15.4 days) and classified into three groups: G1: NIDD with coronary occlusion/subocclusion (n=24), G2: controls with coronary occlusion/subocclusion (n=43), G3: controls without coronary occlusion/subocclusion (n=33). At time zero (TO) the following parameters were evaluated: end-systolic and end-diastolic volume indexes (ESVi, EDVi), ejection fraction (EF), echocardiographic wall motion score index (WMI), presence of left ventricular aneurysm, and triple-vessel coronary disease. The frequencies of major cardiovascular events were recorded during follow-up. Significantly greater ESVi and EDVi were noted in G2 compared with G3 (P<0.0001), while no significant differences were observed between NIDD patients and controls. Although left ventricular global and segmental dysfunctions were increased in diabetics, controls with coronary occlusion/subocclusion presented more pronounced EF reduction (P<0.0001 G2 vs G3) and higher elevation in WMI (P<0.005 G2 vs G3). Cardiac events during follow-up were elevated in G1 and G2, particularly as regards the occurrence of congestive heart failure. The authors conclude that NIDD seems to influence in a positive way left ventricular remodeling associated with postinfarct total or subtotal coronary occlusion.
Carotid Disease in Patients Scheduled for Coronary Artery Bypass: Analysis of 678 Patients
Authors: Birincioglu Levent , Arda Kemal , Bardakci Haşmet , Ozberk Kaan , Bayazlt Murat , Cumhur Turhan , Taşdemir Oguz , Bayazit Kemal
Published: July 2008

The purpose of this article is to investigate the frequency of carotid disease and to identify high-risk groups among patients scheduled for isolated coronary artery bypass grafting (CABG) procedures under nonemergent conditions. A total of 678 consecutive patients underwent preoperative carotid artery duplex scanning (CADS) before CABG procedures. Morphology of carotid artery was determined and five groups were formed. Age, sex, cervical bruit, diabetes mellitus (DM), hypertension, smoking, history of cerebrovascular event (CVE), peripheral vascular disease (PVD), and severity of coronary artery disease were investigated to describe the high-risk group for carotid artery disease. In 41% of patients carotid examination produced normal findings; 46.2% had less than 60% luminal stenoses, 7.1% had 60-79% stenoses, 4.6% had 80-99% stenoses, and 1.2% had total occlusion. Previous cerebral ischemic events (CVE) (p < 0.05), hypertension (p < 0.01), smoking (p < 0.01), advanced age (p < 0.01), and female sex (p < 0.01) were identified as high-risk factors for carotid artery stenoses. There was a linear association between carotid disease and coronary disease (p < 0.05). Documentation of previous CVE, hypertension, smoking, advanced age, female sex, and severe coronary artery disease may be helpful in identifying patients at high risk for carotid artery stenoses.
Crack-Cocaine-Associated Aortic Dissection in Early Pregnancy
Authors: Madu Ernest C. , Shala Bashar , Baugh Dainia , Madu Ernest C.
Published: July 2008

Even though uncommon in pregnancy, aortic dissection is a potentially catastrophic vascular complication, occurring mainly in the late stages of pregnancy. Vascular events, including aortic dissection are recognized complications of crack-cocaine use. The authors report a case of aortic dissection in early pregnancy related to crack-cocaine use. They believe that the combined effects of pregnancy and crack cocaine on the vasculature create the requisite milieu potentiating such catastrophic events as aortic dissection. This paper reviews the possible underlying pathophysiologic mechanisms and the available diagnostic, therapeutic, and management options.