bluuebunny/crossref_metadata_2025 huggingface dataset:
Haemorheological Markers in 89 Patients with Stage II Peripheral Vascular Disease (PVD)
Authors: Ciuffetti Giovanni , Parnetti Lucilla , Mercuri Michele , Senin Umberto
Published: November 2007

Although it is universally accepted that the grade of reduction of district blood flow in PVD is directly correlated to alteration of the haemorheological pattern, there is still no uniformity of opinion regarding the existence of a spe cific rheological alteration in PVD. The scope of our study was to discover the existence of possible PVD-specific markers; we thus carried out a comparative evaluation of the rheological characteristics in blood of controls and patients affected with PVD. Eighty-nine males between the ages of 50 and 65 years (me dian 58 ± 1 SE) were studied, all with a stage II vascular pathology with clinical onset of less than three months. Exclusion criteria were: diabetes mellitus, hy perlipaemia, stable hypertension, presence of vascular disease in other districts, cardio-circulatory problems and serious medical or surgical pathologies, pre vious vascular surgery, a history of acute thrombo-embolic episodes, and chronic alcoholism. Each patient, after a drug wash-out of 20 days, was moni tored for haemorheological parameters. At the same time, the above parame ters were measured in a group of 50 male controls of the same age range. All 139 subjects were smokers (10-15 cigarettes average per day). Our results indicate that modification in the bio-humoral (fibrinogen and plasma globulins) parame ters, a reduced red blood cell filterability and a relative increase in the number of activated polymorphonucleate cells are probably specific haemorheological markers of the clinical onset of PVD.
The Long Term Effects of Percutaneous Transluminal Angioplasty for Treating Patients with Renovascular Hypertension: Case Studies
Authors: Ohta Hiromichi , Takabatake Toshikazu , Yamamoto Yoshiharu , Ishida Yoh-ichi , Hara Hiromoto , Ushiogi Yasuyuki , Nakamura Saburo , Kawabata Masahiko , Hashimoto Naoteru , Sasaki Tohru , Sato Shigehiko , Yamada Yuh-ji , Hattori Nobu
Published: November 2007

Percutaneous transluminal angioplasty was performed on 10 patients with unilateral renovascular hypertension (7 with atheromatous and 3 with fibro muscular stenoses) who were then followed for an average of 42 months (range, 24 to 67 months). Dilatation of the stenosis was initially successful in all patients except one who had severe atheromatous stenosis. Among patients with ather omatous disease, normotension was attained for 40, 25 and 24 months in 3 patients given no antihypertensive medication and for 67 and 55 months in 2 patients given only nicardipine. The remaining one patient had a recurrent stenosis 3 months after angioplasty. All patients with fibromuscular dysplasia have been normotensive without any hypotensive medication for more than 4 years. Plasma renin activity declined within one week after angioplasty and remained unchanged thereafter in all patients except the one case suffering from a recurrent stenosis. Renal blood flow and glomerular filtration rate re mained increased after angioplasty. These results suggest that hypertension can be controlled and renal dysfunction in patients with renal artery stenosis caused by atheroma or fibromuscular dysplasia improved for long periods by percuta neous transluminal angioplasty. The antihypertensive effect obtained by this procedure was more valuable for the patients with fibromuscular dysplasia than in those with atheromatous disease.
Simultaneous Occurrence of Type A and Type B Wolff-Parkinson-White Conduction Abnormalities: Case Report
Authors: Chia B.L. , Choo Maurice H.
Published: November 2007

A 50 year-old woman with recurrent palpitations presented with electrocardiographic changes of simultaneous type A and type B Wolff-Parkinson-White conduction abnormalities suggesting the presence of multiple anomalous pathways.
Knotting of a Bypass Graft Catheter: Report of a Case
Authors: Gaw Johnny , Matthews Nur P. , Samant Dinesh R. , Gadgil Uday G. , Venkataraman Kalyanasundaram
Published: November 2007

A case of knotting of a bypass graft catheter during coronary arteriography is presented. An arteriotomy had to be done to remove the catheter. A possible mechanism causing this complication and precautions to avoid it are described.
Double-Blind Comparison of Ketanserin with Placebo in Patients with Essential Hypertension
Authors: Wellens D. , Peeters G. , Baeten B. , Sieben G. , Symoens J.
Published: November 2007

Two double-blind multicenter trials were performed to compare the antihy pertensive action of ketanserin, at an oral dosage of 20 mg three times daily, with that of placebo over a period of four to six weeks. A subset of patients was treated in a crossover fashion for either four weeks (36 patients) or six weeks (24 patients).

The patients had essential hypertension, with a diastolic blood pressure ≥ 95 mmHg measured in sitting position at the end of a placebo run-in period of at least one week.

In a first trial, 78 of 82 patients completed the four-week study period, where the mean drop of the systolic/diastolic blood pressure was -14/-12 mmHg in the ketanserin group (n = 32) versus — 8/ — 5 mmHg in the placebo group (n=46). This difference is statistically significant (p = 0.05/p < 0.01). In 13 patients who after the initial ketanserin treatment were further treated with placebo in crossover for four weeks, the blood pressure rose slightly (+1/+3 mmHg). In the alternative group (n =23), the blood pressure fell by -10/-7 mmHg after placebo and decreased further by -10/-8 mmHg after ketanserin.

In a second trial, 24 patients completed a two by six week crossover treat ment. In 12 patients assigned to the sequence placebo-ketanserin, there was a drop of the systolic/diastolic blood pressure by — 7/ — 4 mmHg after placebo and an additional drop by — 26/ —10 mmHg after ketanserin. In the other 12 pa tients, who received the sequence ketanserin-placebo, the blood pressure de creased by -21/-15 mmHg during ketanserin and rose again by + 11/+8 mmHg during placebo. In both treatment groups, the antihypertensive action of ketanserin was significantly superior to that of placebo.

The heart rate was not significantly influenced by ketanserin in any of these groups. Orthostatic hypotension was not observed in any of these patients.

It is concluded that ketanserin is a well-tolerated antihypertensive agent, whose blood pressure-lowering effect is significantly superior to that of placebo.
Balloon Rupture During Coronary Angioplasty
Authors: Simpfendorfer Conrad C. , Dimas Alexios P. , Zaidi Adnan , Hollman Jay , Franco Irving , Knezinek Valerie , Hobbs Robert E.
Published: November 2007

Out of a total of 1,500 percutaneous coronary angioplasties (PTCA), 55 (3.6%) were associated with balloon rupture. Lesion calcification was noticed in 7 of these 55 patients (12.7%). Balloon rupture occurred at a mean pressure of 10.7 atmospheres. All balloons were retrieved without difficulty. Intimal tears were noted in 18 (32.7%) cases. Three patients required bypass surgery. In 29 patients restudied angiographically, the restenosis rate was 38%.

Balloon rupture during PTCA does not seem to be associated with detrimen tal consequences.
Effects of Beta Adrenergic Receptor Agonists and Antagonists in Diabetics with Symptoms of Postural Hypotension: A Double-Blind, Placebo-Controlled Study
Authors: Cleophas Ton J. M. , Kauw Frans H. W. , Bijl Cees , Meijers Jacques , Stapper Gerard
Published: November 2007

Eleven patients with hyperadrenergic diabetic postural hypotension and va gal neuropathy were treated in a double-blind, placebo-controlled study with different beta-agonists and antagonists. A single dose of the beta2-agonist terbu taline (5 mg) and the beta1 + 2-agonist orciprenaline (10 mg) did not reduce the fall in systolic pressure on standing up, despite a significant increase in both supine and standing heart rates. The beta1-antagonist with intrinsic sympathi comimetic activity (ISA) acebutolol (200 mg) and the beta1-antagonist metopro lol (50 mg) did not influence the fall in systolic pressure either, despite a significant decrease in supine and standing heart rates and disappearance of increase in heart rate on standing up. Only the beta1 + 2-antagonist propranolol and the beta1+2-antagonist with ISA pindolol (5 mg) could significantly reduce or practically abolish the fall in systolic and diastolic pressure on standing up. This was accompanied by a slight decrease of heart rates and disappearance of difference between supine and standing heart rates, as seen with the other beta- antagonists. Thus, only beta 2-blockade reduced or abolished the fall in systolic pressure on standing up in our patients. These data were confirmed by a three- week crossover trial in 10 of these patients.
Pulmonary Artery Agenesis Presenting as Massive Hemoptysis — A Case Report
Authors: Mehta Atul C. , Livingston Douglas R. , Kawalek Wayne , Golish Joseph A. , O'Donnell James K.
Published: November 2007

Massive hemoptysis is the expectoration of approximately 600 ml of blood in twenty-four hours. Major causes of massive hemoptysis are tuberculosis, bronchiectasis, pulmonary neoplasm, fungus ball, bronchial adenomas, lung abscess, intrabronchial rupture of an aortic aneurysm, cystic fibrosis, pulmonary infarction, and pulmonary trauma. Other, less common causes include Good-pasture's syndrome, broncholiths, pulmonary varix, A-V malformation, and bleeding disorders. Agenesis of the pulmonary artery usually occurs in association with congenital cardiac anomalies, and isolated unilateral absence of the pulmonary artery is uncommon. About 10% of the patients with pulmonary artery agenesis develop inconsequential hemoptysis, but massive hemoptysis is a very rare complication of this anomaly. The following is a case report of a twenty-nine-year-old man with agenesis of the left pulmonary artery, who presented with massive hemoptysis requiring embolization and, eventually, pneumonectomy.
Radiation-Induced Aneurysm of the Basilar Artery—A Case Report
Authors: Gomori John M. , Levy Pavel , Weshler Zeev
Published: November 2007

A dolichoectatic basilar artery aneurysm, following irradiation for nasopharyngeal carcinoma, is described and discussed.
Plethysanography: History and Recent Advances
Authors: Winsor Travis , Winsor David Wiley
Published: November 2007

A short historical note on plethysmography is given and the development of the modern computerized pneumoplethysmograph is described. The computer-aided pneumoplethysmogram (CAP), with proper programming, makes possible numerous computations that give new, useful, and rapid information about the patient. New applications of the CAP will quickly develop and the data collected will be quickly analyzed and displayed.
Gas Exchange Across Abnormal Interstitial Tissue in Pulmonary Sarcoidosis—Results of Therapy
Authors: Demeter Stephen L.
Published: November 2007

Sarcoidosis is a granulomatous, inflammatory disorder that can affect any organ in the body. The interstitium of the lung is a frequent area of involvement. This tissue comprises the alveolar-capillary unit of the lung with the pulmonary vasculature affected either on a primary or (usually) secondary basis. Measurements of gas exchange across this tissue should be expected to parallel disease activity. Five patients with histologic and/or radiographic evidence of interstitial lung disease were evaluated by serial exercise studies over time with respect to therapy. Preexercise and postexercise values were obtained, for exercise is felt to make these measurements more sensitive to changes in gas transfer. Good correlations were seen in all five patients. Exercise studies are concluded to be of value in patients with interstitial lung disease due to sarcoidosis and may prove to be a sensitive form of follow-up during therapeutic intervention.
Transcutaneous Oxygen Tension Behavior in the Different Stages of Peripheral Vascular Disease and Its Correlation With Ankle/Arm Pressure Ratio and Calf Blood Flow
Authors: Mannarino Elmo , Maragoni Giorgio , Pasqualini Leonella , Sanchini Roberto , Rossi Pietro , Orlandi Ugo
Published: November 2007

The practical utility of transuctaneous oxygen tension (TcPO2) has been eval uated in 22 normal subjects and in 54 patients suffering from peripheral vascu lar disease (PVD) at various stages (II, III, IV), to define its clinical use in the diagnosis of PVD. Basal TCPO 2 values can distinguish normal subjects only from stages III and IV PVD patients. In the case of stage II PVD patients the evaluation of the half-recovery time of TcPO2 basal values after an induced ischemia of the limb is mandatory. The study also showed that there are no significant statistical correlations among the TcPO2 values, Doppler, and ple thysmographic parameters.
Effects of Pentoxifylline and Prostaglandin E1 on Cold Blood Perfusion Studied by Red Blood Cell Deformability
Authors: Sakai Akira , Kikuchi Yuji , Ohshima Norio , Hori Motokazu
Published: November 2007

The effects of pentoxifylline and prostaglandin E1 (PGE1) on red blood cell deformability during cold blood perfusion were studied by means of a filtration method. The deformability of normal red blood cells decreased with the temperature transition from 20° to 15°C (transit time: 3.5, 5.8, 25, and 99 seconds at 37°, 20°, 15°, and 10°C respectively). The effects of both pentoxifylline and PGE1 were not noticeable at 37°C but became significant with hypothermia (5.0, 12, and 48 seconds at 20°, 15°, and 10°C, respectively, in samples with pentoxifylline of 0.3 mg/ml; 5.3, 13, and 46 seconds at 20°, 15°, and 10°C, respectively, in those with PGE1 of 40 ng/ml).

The results in this study suggest that pretreatment of blood by pentoxifylline or PGE1 could improve coronary microcirculation perfused with cold blood cardioplegic solutions owing to significant improvement of the deformability of red blood cells.
Exercise Radionuclide Assessment of Left Ventricular Function Before and After Coronary Bypass Surgery
Authors: Lewis Ronald L. , Videll Jerry S. , Strong Michael D. , Maranhao Vladir , Lumia Frank J.
Published: November 2007

The effects of elective saphenous vein coronary artery bypass surgery on left ventricular ejection fraction were assessed by using exercise first-pass radionu clide angiography in 66 consecutive patients. All patients with left main coro nary artery or concomitant valvular disease were eliminated from the study. Before surgery, 7 patients had normal postexercise left ventricular function (Group 1), 33 had normal resting left ventricular function with an abnormal response to exercise (Group 2), and 26 had an abnormal resting left ventricular ejection fraction with an abnormal response to exercise (Group 3). Following surgery, patients in all three groups had no change in mean resting left ventricu lar ejection fraction; however, patients in Groups 2 and 3 had significant im provement in mean postexercise left ventricular ejection fraction (p < 0.0001 and p < 0.0054 respectively), whereas patients in Group 1 did not. Previous studies reported improvement in postexercise ejection fraction in patients with reduced resting left ventricular function and with an ischemic response to exer cise (Group 3). But this is the first study to confirm improvement in postexercise function in patients with normal resting function and an ischemic response to exercise (Group 2).
Prominent Somnolence and Cerebellar Syndrome in Subclavian Artery Thrombosis—A Case Report
Authors: Golcman Luis , Berginer Vladimir M. , Szendro Gabriel , Hoda Jelinus , Louson Zeev
Published: November 2007

A patient suffering from acute left subclavian artery thrombosis presented with an unusual syndrome of prominent somnolence, right cerebellar signs, and left upper extremity ischemia. Clinical, angiologic, and electrophysiologic stud ies confirmed a brain stem and reticular formation dysfunction due to vertebro basilar ischemia. Urgent thromboembolectomy led to neurologic improvement and satisfactory revascularization of the involved upper limb.
Congenital Brachial Artery Aneurysm in an Infant — A Case Report
Authors: Lie J.T. , Hayes Cauley W. , Feintuch Theodore A.
Published: November 2007

An arterial aneurysm of any kind is rare in infancy, and one that occurs in the brachial artery is probably even more rare; when such an aneurysm is asymptomatic and congenital, it must be exceedingly rare. One such unique case is described herein, together with a brief review of the literature.
Acute Cardiogenic Pulmonary Edema: Clinical and Noninvasive Evaluation
Authors: Bier Alan J. , Eichacker Peter Q. , Sinoway Lawrence I. , Terribile Sachiko M. , Strom Joel A. , Keefe Deborah L.
Published: November 2007

Left ventricular echocardiograms performed within ninety-six hours of ad mission were prospectively correlated with the clinical course in 87 consecutive patients admitted with acute pulmonary edema. Patients were stratified into four groups based on their two-dimensional echocardiogram: hyperdynamic, normal, mildly reduced, and severely reduced. Echocardiographic estimates of left ventricular function were compared with their ejection fraction measured by the gated radioisotope technique. The authors found that 48% of the patients were either normal or hyperdynamic (38% and 10% respectively). Patients in these two groups had a greater incidence of left ventricular hypertrophy (wall thickness > 13mm) (66% vs 39%, p < .05), hypertension on admission (BP > 160/100) (66% vs 41%, p=.05), and smaller end-diastolic dimension (p < .05) than those with decreased left ventricualr function. The authors con clude that echocardiography is a good screening test of left ventricular function in patients presenting with pulmonary edema. Patients with normal or in creased left ventricular systolic function should be evaluated for correctable or treatable causes of acute pulmonary edema.
Treatment of Diabetic Neuropathy with Pentoxifylline: Case Report
Authors: Kalmansohn Robert B. , Kalmansohn Richard W. , Markham Charles H. , Schiff David L.
Published: November 2007

Diabetic neuropathy includes a heterogenous group of neuropathic syndromes associated with diabetes mellitus. One form of diabetic neuropathy is distal symmetric polyneuropathy, which is characterized at a late stage by intractable pain. This pain is generally refractory to present modalities of therapy except for narcotics. Pentoxifylline offers a new approach to therapy, reducing the blood viscosity and improving perfusion of ischemic microcirculation. A case report will be presented of intractable painful peripheral neuropathy responding dramatically to pentoxifylline therapy.
Alterations in Serum Lipid Concentrations Before and After Myocardial Infarction in a Patient with Hyperlipoproteinemia and Sarcoidosis—A Case Report
Authors: Umeki Shigenobu
Published: November 2007

This report describes a sarcoidosis patient with a type II-b hyperlipoproteinemia who suffered acute myocardial infarction during corticosteroid therapy for sarcoidosis and whose blood lipid levels were assessed before and after the infarction. After the infarction occurred, lipoprotein analysis revealed a type II-a hyperlipoproteinemia concomitant with high free fatty acids, phospholipids, and HDL-cholesterol values; an increased ratio of total cholesterol to triglycerides; and a decreased ratio of very low density lipoproteins to total lipoproteins, suggesting that changes in types of hyperlipoproteinemia may be associated with the onset of myocardial infarction.
An Unusual Case of Occlusive Thromboaortopathy (Takayasu's Disease)—A Case Report
Authors: Disler Laurence , Hide Gareth
Published: November 2007

A case of Takayasu's disease presenting in a young man as a solid abdominal mass is described. The literature is reviewed and classifications of the disease are discussed.

Occlusive thomboaortopathy, also known as "pulseless disease" or Takayasu's disease, was first described in 1908 by Takayasu, who observed cataracts and peculiar arteriovenous anastamoses around the optic papillae in a young woman.1 It is a vasculitic disorder of uncertain etiology occurring mainly in young women and may involve part or most of the aorta, as well as the pulmonary artery. Early features include fever, malaise, weight loss, and a high ESR, and, later on, absent pulses, aneurysms, hypertension, and heart failure may occur. The authors describe an unusual case of Takayasu's disease in a young black South African man.
Noninvasvie Testing of Cerebral Perfusion Reserve Prior to Coronary Artery Bypass Graft Surgery
Authors: Levine Ross L. , Lagreze Hans L. , Berkoff Herbert A. , Thrnipseed William D. , Hanson Joan M. , Sunderland John J. , Nickles Robert J. , Rowe Bruce R.
Published: November 2007

Cerebral perfusion reserve testing using fluorine-18-fluoromethane and pos itron emission tomographic brain scanning to define cerebral blood flow abnor malities was performed in 5 patients being considered for combined coronary and carotid reconstructive surgery. Blood flow testing during normocapnia and following hypercapnia was utilized in these patients to determine the hemody namic significance of known extracranial carotid artery occlusive lesions. Re serve diminution in 2 of these patients prompted combined surgery, whereas normal reserve values in the other 3 prompted coronary surgery alone. Results obtained in this preliminary series show how preoperative noninvasive testing of cerebral perfusion reserve adds to the diagnostic evaluation of patients with widespread vascular disease.
Evolutionary Trends in Carotid Atherosclerotic Plaques: Results of a Two-Year Follow-up Study Using an Ultrasound Imaging System
Authors: Senin Umberto , Parnetti Lucilla , Mercuri Michele , Lupattelli Graziana , Susta Adelaide , Ciuffetti Giovanni
Published: November 2007

A two-year follow-up on 118 atherosclerotic lesions of the extracranial carotid tract observed in 70 patients was carried out using real-time high-reso lution echotomography.

The following plaque characteristics were monitored: the echogenic patterns (soft, intermediate, hard, and mixed), the surface aspects, and the degree of stenosis. The aim of the study was to evaluate plaque evolution, in relation both to the degree of vessel stenosis produced and to the echostructural characteris tics of the lesion. After two years 68% of the lesions remained unchanged while the degree of vessel stenosis increased in 32%; no case of regression was ob served. Intrinsic factors appearing to condition an increase in degree of stenosis were "mixed" and "hard" echogenic pattern, an irregular lesion surface, and an initial degree of stenosis of more than 50%. A modification in the echogenic pattern, which generally tended to progress toward more highly reflecting echo genic levels was observed in 27% of the lesions studied.
Prevalence and Prevention of Deep Venous Thrombosis of the Lower Extremities in High-Risk Pulmonary Patients
Authors: Ibarra-Pérez Carlos , Lau-Cortés Enrique , Colmenero-Zubiate Sylvia , Arévila-Ceballos Norma , Humberto Fong J. , Sánchez-Martínez Ricardo , Dominguez María Victoria , Elizalde-González José
Published: November 2007

Information is lacking about the prevalence of, and the best method of pre venting deep venous thrombosis (DVT) of the lower extremities in patients forty years or older with pulmonary disease that keeps them in bed for three consecu tive days or more and who are thus at high risk of developing DVT or pulmo nary embolism (PE). In this study, 192 high-risk patients, aged forty to ninety-two, received 125I fibrinogen and had daily radioactive scans, venous Doppler, and strain gauge plethysmography. Four preventive methods were used until patients became ambulatory: graded compression stockings (GCS) in 39, elastic bandages (EB) in 33, subcutaneous administration of 5,000 USP units of heparin (HEP) bid in 39, and oral administration of 0.5 g of acetylsalicyclic acid (ASA) bid in 35. Results were compared with those in 46 patients in a control group (CG). Twelve patients in CG, none in GCS, 4 in EB, 1 in HEP, and 2 in ASA developed DVT proved by contrast venography. There was a statistically significant difference between GCS and CG (P < 0.0003), HEP and CG (P < 0.0022), and ASA and CG (P < 0.0148) but not between EB and CG (P > 0.10); no significant differences were found between any pair of prophy laxis groups. The significant differences could not be attributed to differences in age, sex, or length of stay in bed. PE occurred in 3 patients in CG and 1 in EB. Hemorrhagic complications occurred in 7 patients in HEP and 4 in ASA, re quiring exclusion of 2 patients and 1 patient, respectively, from the study. GCS, HEP, and ASA are effective methods of preventing DVT in high-risk pulmonary patients, in whom the disease is highly prevalent (26%). Effectiveness, invasive ness, simplicity of use, side effects, and price should be considered in choosing among them.
Hemodynamic Effects of Nebivolol in Men: Comparison of Radionuclide Angiocardiography with Systolic Time Intervals
Authors: De Crée Jean , Franken Philippe , Vandevivere Johan , Geukens Hedwig , Verhaegen Herman
Published: November 2007

In a subacute experiment the au thors studied the effects of a four teen-day treatment with nebivolol, 5 mg once a day, in 10 healthy male vol unteers with a mean age of thirty- one, twenty-five to thirty-nine years, by comparing the results of the rest ing ratio of the preejection period (PEPc) to the left ventricular ejection time (LVETc), as measured by sys tolic time intervals (STI), with the results obtained by equilibrium ra dionuclide angiocardiography (ERNA), using technetium 99m-la beled autologous red blood cells as a marker. A submaximal treadmill ex ercise test performed before and dur ing treatment demonstrated that nebivolol significantly (p s 0.01) re duced peak exercise heart rate and systolic blood pressure from a mean value of 158 ± 5.4 bpm to 131 ± 4.3 bpm and from 171 ± 4.9 mmHg to 144 ± 4.5 mmHg respectively. The data from the STI and ERNA were calculated and analyzed indepen dently by two observers. A highly sig nificant (r=0.8182, p=0.0038) correlation was found between the changes of stroke volume (SV) and PEPc/LVETc during treatment with nebivolol. Furthermore end-diastolic volume significantly (p=0.03) in creased from a mean value of 177 ± 10.1 ml to 198 ± 6 ml and stroke vol ume significantly (p=0.01) increased from 120 ± 6.8 ml to 136 ± 6.3 ml. Systemic vascular resistance tended to decrease from a mean value of 11.4 ± 1.28 units to 10.6 ± 1.10 units. No changes could be observed either in ejection fraction or in cardiac output. The ratio of the PEPc/LVETc, as mea sured with STI, significantly (p=0.03) improved from a mean value of 0.34 ± 0.011 to 0.30 ± 0.010, and these changes were due to both a decrease of PEPc and an in crease of LVETc. The postexercise LVETc, which is a marker of the posi tive inotropy of the exercise, signifi cantly (p=0.002) shortened with 49 ± 4.6 msec in control conditions and also during treatment with nebivolol with 30 ± 4.6 msec (p=0.002). From all these data it appears that nebivolol, unlike classical beta-block ers, beneficially influences cardiac function at rest, owing to a combined effect on both preload and afterload. These ancillary hemodynamic activi ties of nebivolol may be useful in the treatment of elderly hypertensive pa tients with left ventricular damage.
High-Output Congestive Failure Due to Arteriovenous Fistula Resulting from Lumbar Disc Surgery — A Case Report
Authors: Bialy Ted , Gooch A.S. , Shahriari Ali
Published: November 2007

A patient is described who developed high-output congestive failure following surgery to a lumbar disc. Diagnosis of arteriovenous fistula was suggested by the signs of high-output state and a continuous bruit heard over the low back scar. Confirmation was demonstrated by abdominal aortography. Corrective surgery resulted in resolution of congestive failure.
Complete Right Bundle Branch Block (CRBBB) with Three Different Mean Frontal Plane QRS Axes — A Case Report
Authors: Kanemoto Nariaki
Published: November 2007

A routine ECG of a seventy-year-old man, who had been followed for five years because of complete right bundle branch block (CRBBB) with first-degree atrioventricular (AV) block, showed CRBBB and three different mean frontal plane QRS axes suggesting normal conduction, bradycardia-dependent left anterior hemiblock, and tachycardia-dependent left posterior hemiblock—all within the same tracing. Holter recording demonstrated transient advanced AV block, and a permanent pacemaker was implanted.
Pulsed Doppler Assessment of Tricuspid Regurgitation: Usefulness of Regurgitant Signal Patterns for Estimation of Severity
Authors: Carreras F. , Borrás X. , Augé J.M. , Pons-Lladó G.
Published: November 2007

A study on the value of pulsed Doppler in the detection and quantitative assessment of tricuspid regurgitation (TR) has been conducted on 33 consecu tive adult patients with valvular heart disease. Only 1 patient had to be excluded owing to a technically inadequate Doppler examination. Data for comparison were obtained from a right heart catheterization performed within a twenty- four-hour interval from the Doppler study. Sensitivity and specificity in the detection of the lesion were 88% and 100%, respectively. A previously unde scribed pulsed Doppler method for the estimation of the degree of TR was tested, based on the consideration of two distinctive patterns of the regurgitant Doppler signal: type I: a protosystolic regurgitant signal with progressively fad ing intensity along systole; and type II: a homogeneously intense pansystolic signal. Correlation between these patterns and the angiographic degrees of TR showed that milder lesions correspond to the type I Doppler pattern, whereas significant regurgitations present a type II pattern, this allowing a clinically useful method of assessment of TR.
Circulatory Effects of Intravenous and Oral Atenolol in Acute Myocardial Infarction
Authors: Midtbø K. , Silke B. , Verma S.P. , Reynolds G.W. , Hafizullah M. , Taylor S.H.
Published: November 2007

The hemodynamic dose-response effects of intravenous (0.05 and 0.10 mg/kg) and oral (50 and 100 mg) atenolol were compared in a randomized between-group study of 24 men within seventeen hours of an acute uncompli cated myocardial infarction; 6 subjects were evaluated in each of the four groups. Hemodynamic variables were determined over a one-hour control per iod, following which the randomized dose of atenolol was administered and measurements repeated at 15 (intravenous therapy only), 30, 60, 90, 120, 180, 240, 300, and 360 minutes.

The peak hemodynamic effect was similar and independent of either the dosage or route of administration. In all groups atenolol reduced heart rate and cardiac and stroke volume indices. The pulmonary artery occluded pressure and systemic vascular resistance index were transiently increased. Mean arte rial pressure was significantly reduced only in the oral group with the highest pretreatment pressure. Maximum changes developed between fifteen and thirty minutes after intravenous dosing and between two and three hours after oral dosing. However, substantial reductions in cardiac index (-0.6 L/min/m2; p < 0.05) were already achieved at sixty minutes following oral dosing. The dura tion of pharmacodynamic activity was for two to three hours following intraven ous and for the study duration (four to six hours) after oral dosing. These data confirm the hemodynamic safety of atenolol after acute myocardial infarction.
Surgonomics: The Costs of Ruptured Abdominal Aortic Aneurysm
Authors: Munoz Eric , Kassan Martin A. , Chang John B.
Published: November 2007

Surgical care costs continue to rise at a rate greater than overall U.S. eco nomic growth. Government and industry have vowed to slow the growth of health care spending. Prospective payment systems using the Diagnostic Related Group (DRG) mechanism are being phased in for payment of in-patient hospital care. One expected effect of the DRG payment scheme is a more careful finan cial analysis of the components of surgical care.

The purposes of this study were to examine a vascular procedure, ruptured abdominal aortic aneurysm (RAAA), performed at a large teaching hospital during a ten-year period; to characterize patients by cost (hospital charges ex clusive of physician fees) and outcome; and to test the hypothesis that an IDEN TIFIER, here the presence or absence and duration of hypotension (less than 90 mm Hg systolic), could predict differences in cost and outcome. The results, in conjunction with historic data, were used to quantify aggregate hospital ex penditures for this condition by survivor and the identifier.

The results indicate: (1) mortality is higher for the hypotensive patient than for the normotensive patient (p < 0.05) and is related to the duration of hypoten sion ; (2) lowest mean charges per patient were in the hypotensive more than thirty minutes group ($5,587) followed by normotensive ($28,298), then hypo tensive less than thirty minutes ($43,876); and (3) the mean charges for each survivor were $42,447 for normotensive patients versus $107,572 for hypoten sive patients. These data suggest that the hypotensive identifier may predict: (a) lower charges per patient in one group (ie, hypotensive more than 30 minutes), since this group tends to have a rapidly fatal outcome; (b) increased charges per survivor for all hypotensive patients; and (c) higher mortality for RAAA. Ag gregate annual expenditures (hospital charges) for RAAA in the United States using our model were $167,517,000 in 1983; however, the aggregate expendi tures necessary to yield 609 survivors annually with RAAA and hypotension less than thirty minutes were $30,671,806 (ie, $50,364 per survivor), whereas the aggregate annual expenditures to yield 202 survivors with RAAA and hypoten sion more than thirty minutes were $56,712,257 (ie, $280,753 per survivor).
Study on Reaction of Subpapillary Venous Plexus in Patients with Arterial Occlusive Diseases of Lower Extremity by Reflective Spectrophotometry
Authors: Kimura Tadahiro , Tsushima Nobuko , Yoshizaki Satoshi , Nakayama Ryu
Published: November 2007

The reactions of the subpapillary venous plexus were observed by analyzed fractional blood volume of tissue (Vb) in patients with arterial occlusive dis eases, Fontaine's stage I-II, using the reflective spectrophotometer.

The sole skin of 11 normal subjects, 17 patients with arteriosclerosis obli terans (ASO), and 14 patients with thromboangiitis obliterans (TAO) were scanned by the light reflectance of four specially selected wavelengths, including isobestic points (586 and 569 nm) and peaks in the spectra of oxyhemoglobin and deoxyhemoglobin (577 and 560 nm) in referring to time. Sampling area was the subpapillary venous plexus histologically because the depth for receiving reflectance is about 1.0 mm from the sole skin surface. One series observations was divided into five steps depending on the modes of combination of the ap plied pressure to ankle cuff and tilting. The Kubelka-Munk equation was uti lized to calculate blood volume (Vb).

It is concluded that the patients with ASO might have a dysfunction, not of the subpapillary venous plexus, but of the venular valve, whereas patients with TAO might have a dysfunction of both the subpapillary venous plexus and venu lar valve.
Transcutaneous Oxygen Tension (TcPO2) Measurement as a Diagnostic Tool in Patients with Peripheral Vascular Disease
Authors: Lusiani Luigi , Visona Adriana , Nicolin Patrizia , Papesso Barbara , Pagnan Antonio
Published: November 2007

Transcutaneous oxygen tension (TcPO2) was measured through Clark's elec trode at the dorsum of the foot in 52 healthy controls whose ages ranged from twenty to sixty-five years (mean 45.05 ±14.09) and 36 nondiabetic patients with peripheral vascular disease (PVD) (5 stage I, 16 stage II, 4 stage III, 11 stage IV), under standardized conditions at rest and during recovery from limb ische mia obtained with pneumatic cuff compression for 3 minutes.

At rest the TcPO2 averaged 71.20±14.26 mm Hg (range 46-92) in the con trols and 51.56±26.38 in the PVD patients (p < .01). A wide overlap was ob served between the two groups and among the different stages of the disease, and consequently, the diagnostic value of TcPO2 at rest was limited (sensitivity equal to 32%). During the recovery from ischemia the time constant (recovery half-time, T½) averaged 38.01±7.23 sec in the controls and 55.84 ± 19.82 in the PVD patients (p < .01). The T½ added to the diagnostic value of the method, making it more sensitive (55%), especially for stage II patients. The TcPO2 at rest was lower with increasing severity of the disease; both the TcPO2 at rest and the T½ correlated with the ankle-arm pressure index in the diseased limbs (r = .48 and - .41 respectively, p < .001).

The method showed a limited degree of reproducibility in the controls when the right and the left lower extremity were compared in each subject; in fact, the intrasubject variance of TcPO2 and T½ was of the same magnitude as the intersubject variance (F=1.73 and 1.26 respectively), and the standard devia tions of the difference between lower extremities was elevated (13.32 mm Hg for TcPO2 and 7.80 sec for T½). Moreover, the T½ decreased with increasing age in the controls (r = - .47, p < .001).

The authors conclude that, although it is a good indicator of the severity of PVD, the TcPO2 has a limited diagnostic value in this kind of patients, owing to the wide range of normalcy, to the low degree of reproducibility in a single individual, and to the influence of the age factor.
Disturbances of Cutaneous Microcirculatory Autoregulation in Arterial Occlusive Disease
Authors: Van den Brande Pierre
Published: November 2007

Skin blood flux at the dorsum of the foot was measured during local heating — by use of laser Doppler flowmetry — in 6 healthy subjects, 6 claudicants, and 6 patients with rest pain.

Significantly different flux increases were noted among the three groups during the first six minutes of heating. Healthy subjects showed an initial rapid increase, followed by an abrupt reduction in flux through a probable myogenic autoregulatory microcirculatory control mechanism. In patients the flux in crease was slow and continuous, well correlated with the distal perfusion pres sure ; autoregulatory control was diminished or absent.

With less than 100 mmHg perfusion pressure the microvessels are probably constantly dilated through a reduced sympathetic vasoconstriction tone, and further autoregulatory mechanisms are impaired.

Measuring of functional behavior of cutaneous microcirculation under low arterial inflow pressure could represent a method for sensitive diagnosis of arte rial insufficiency.
Electromagnetic Field Focusing Probe (EFFP) — A New Angioplasty Tool
Authors: Yamanashi William S. , Yassa Nabil A. , Hill Deborah L. , Lewis John E. , Patil Angelo A. , Lester Patrick D.
Published: November 2007

An electromagnetic field focusing probe (EFFP) consists of a radiofrequency generator, solenoidal coil, and a hand-held or catheter probe. The probe is oper ated in the near field (distance within one wave length of an electromagnetic field source) of a coil, which induces eddy current in a biological tissue. The induced eddy current is converged maximally at the tip of the probe upon con tact of the tip with the tissue. The probe produces very high temperatures de pending on the wattage selected.

In this study, the EFFP was used to evaporate atheromatous plaques in hu man cadaver abdominal aorta specimens, which were then studied histologi cally. Gas produced by this technique was analyzed and the volume found to be related to power delivered, but in such small amounts as to be of no embolic significance. While temperature varied with wattage and time of application, it was maximal at the probe tip and easily controlled, resulting in clean oblitera tion of plaque.
A Community Detection Program For Abdominal Aortic Aneurysm
Authors: Collin Jack , Araujo Leandro , Walton Jackie
Published: November 2007

This study aimed to discover the prevalence of undiagnosed abdominal aortic aneurysm in the community in men aged sixty-five to seventy-four. All 1,392 men in this age group registered with twenty general medical practitioners were invited for free health screening at hospital and 746 attended. The abdominal aorta was imaged by ultrasound and its anteroposterior diameter measured. An abdominal aortic aneurysm was present in 6.3% and the aneurysm was 4.0 cm or more in diameter in 2%.
Comparison of the Subacute Hemodynamic Effects of Atenolol, Propranolol, Pindolol, and Nebivolol
Authors: De Crée Jean , Cobo Carlos , Geukens Hedwig , Verhaegen Herman
Published: November 2007

In an observer-blind four-way crossover study, 7 healthy volunteers received in random sequence, one month apart, atenolol 100 mg od, propranolol (slow release) 160 mg od, pindolol 5 mg tid, and nebivolol 5 mg od for a period of seven days, followed by a single-blind placebo washout period of seven days. The decrease of peak exercise heart rate and systolic blood pressure was significant (p = 0.02) and comparable for the four drugs studied and varied between 15% and 23% for heart rate and between 15% and 20% for systolic blood pressure. Although no statistically significant difference was observed among the four drug regimens, the decrease of peak exercise heart rate was less pronounced with nebivolol than with the three reference beta-blocking agents. The ratio of the preejection period (PEPc) to the left ventricular ejection time (LVET c), an indirect measure of left ventricular performance, tended to increase with atenolol and propranolol and remained unchanged with pindolol. PEP c/LVETc progressively and significantly improved with nebivolol from a control value of 0.37 ± 0.012 to 0.31 ± 0.009 (p = 0.03) after seven days of treatment, owing to a decrease in PEPc and an increase in LVETc, suggestive of a combined effect both on preload and afterload. Postexercise LVETc, an index of the intrinsic positive inotropy of exercise, was significantly suppressed by atenolol, propranolol, and pindolol, but not during treating with nebivolol.

These data suggest that nebivolol is a β1-selective adrenergic antagonist with an unusual hemodynamic profile, probably improving left ventricular compliance.
Echocardiographic Score Versus Wall Motion Index for Risk Stratification After Acute Myocardial Infarction
Authors: Kinney Evlin L. , Wright Robert J.
Published: November 2007

Two-dimensional echo cardiographic wall motion scores are potentially valuable prognostic indicators because of their association with subsequent mortality in patients with acute myocardial infarction. Because wall motion scores are relatively simple to obtain, they could come into widespread use. But wall motion scores have been found to have a low positive predictive accuracy in respect to one- or three-year survival and a low specificity in respect to pump failure. To clarify the value of wall motion scores in risk stratification the authors analyzed the ability of a wall motion index, in combination with other variables, to predict death within a year of acute myocardial infarction. Patients were 149 consecutive men with acute myocardial infarction. There were no exclusion criteria. By Cox regression, the variables most closely related to survival were the presence of a pericardial effusion, the age of the patient, alcoholism, and the E point septal separation. The wall motion index, by comparison, was only weakly related to survival and was therefore dropped from further analyses. The four variables most closely related to survival were then used to derive a predictive echocardiographic score. The score's negative predictive accuracy was 94%, although sensitivity and positive predictive accuracy were low. These data suggest that, even when applied nonselectively, the echocardiographic score, but not the wall motion index, appears to be an efficient way of characterizing the outcome of acute myocardial infarction, in that it reliably detects low-risk patients.
Do Vasospasms Provoke Ocular Diseases?
Authors: Gasser P. , Flammer J. , Guthauser U. , Mahler F.
Published: November 2007

Vasospasms in the eye are often combined with digital vasospasms, as can be diagnosed with a nailfold capillaroscopic local cooling test.

In 16 patients with a history of cold hands and feet the presence of peripheral vasospasms without any underlying disease was demonstrated by means of nailfold video-capillaroscopy. These patients showed the phenomenologic diagnosis of low-tension glaucoma with visual field defects characteristic of glaucoma even though intraocular pressure above 21 mmHg was excluded. The visual field defects were not homonymous, indicating a prechiasmal location of the vascular disturbance.

Ocular vasospasms cause visual field damage that can be aggravated or provoked by cooling one hand in cold water and that often improves after treatment with the calcium channel blocker nifedipine. The results suggest that vasospasms not only are present in Raynaud's disease, migraine, and Prinzmetal's variant angina but also may be an important factor in the genesis of low-tension glaucoma. This is a new finding and may be related to a general vasospastic syndrome.
Prevalence and Risk Factors of Varicose Veins in Japanese Women
Authors: Hirai Masafumi , Naiki Kenichi , Nakayama Ryu
Published: November 2007

The prevalence and risk factors of varicose veins in Japan were investigated in 541 Japanese women. Varicose veins were defined as any dilated, tortuous, and elongated veins of the lower extremity and classified into four types. The total prevalence rate was 45%. Saphenous type was observed in 22%, segment type in 35%, reticular type in 28%, and web type in 16%. Varicose veins in Japan seem to be less common than in the United States and Europe but more prevalent than in Africa. Concerning risk factors for varices, age, sex, heredity, and childbirth were related to the incidence of varicosities, as reported by others. However, these risk factors were shown to differ according to type of varicose veins.
Effect of Pentoxifylline on the Flow of Polymorphonuclear Leukocytes Through a Model Capillary
Authors: Armstrong Michael , Needham David , Hatchell Diane Lillian , Nunn Rashmi Saxena
Published: November 2007

Pentoxifylline is a methylxanthine derivative used to increase blood flow in peripheral atherosclerosis. Pentoxifylline is known to increase whole blood filtration rate, and recent evidence suggests that pentoxifylline increases the filtration rate of polymorphonuclear leukocytes (PMNs). The purpose of this study was to directly observe and quantitate the effect of pentoxifylline on the flow of individual PMNs into a model capillary. Short-term incubation of human PMNs with 10 mM pentoxifylline inhibited cell activation, as judged by a significant reduction in the number of neutrophils forming pseudopods. Furthermore, incubation of PMNs from 6 healthy men with 0.1, 1.0 and 10 mM pentoxifylline significantly decreased the time required for individual cells to be aspirated into a 4 μm pipet under constant pressure by 16 ± 5%, 21 ± 7%, and 41 ± 8%, respectively (mean ± SEM, p≤0.05), compared with control. These experiments are the first direct demonstration of increased deformability in neutrophils treated with pentoxifylline. The results are consistent with the hypothesis that the beneficial effect of pentoxifylline on microvascular perfusion is partly due to an inhibition of PMN stiffness and activation.