bluuebunny/crossref_metadata_2025 huggingface dataset:
Study of the Antiischemic Action of EGb 761 in the Treatment of Peripheral Arterial Occlusive Disease by TcPo2 Determination
Authors: Mouren X. , Caillard Ph. , Schwartz F.
Published: July 2008

In a randomized, placebo-controlled, double-blind, parallel study of 20 patients, the anti ischemic effect of EGb 761 (Ginkgo biloba Extract) was studied by measuring the tran scutaneous partial pressure of oxygen (TcPo2) during exercise. Transcutaneous oximetry during exercise provides a good, noninvasive estimation of local arterial perfusion and constitutes a real index of local and regional capillary perfusion.

Twenty patients between the ages of forty-four and seventy-three years suffering from claudicating atherosclerotic arterial occlusive disease in stage II according to the Leriche and Fontaine classification, diagnosed for more than a year and stable for three months, were included.

The eligible patients received placebo for fifteen days under single-blind conditions. At the end of this preinclusion period, the eligibility criteria were checked and the patients were randomized to two treatment groups. The first group received 320 mg per day of EGb 761 for four weeks and the second group received placebo. The treadmill walking test was performed under standardized conditions at the same time of day and by the same investigator.

In a comparison of the differences before and after treatment, the areas of ischemia decreased by 38% in the EGb 761 group but remained essentially stable (+5%) in the placebo group. This difference between groups is significant (F [1.18] =4.91; P=0.04) and the 95% confidence interval for the difference ranges from 0.89 to 3.87.

This study confirmed significantly the rapid antiischemic action of EGb 761 and its value in the management of peripheral arterial occlusive disease at the stage of inter mittent claudication.
Combined Type B Aortic Dissection and Fusiform Abdominal Aortic Aneurysm
Authors: Van Schil P. , De Vries D. , Vanmaele R. , Demey H.
Published: July 2008

Two patients are described with a combined type B aortic dissection and a fusiform abdominal aortic aneurysm, the dissection not involving the aneurysm. In a seventy- year-old man a type B aortic dissection and a large abdominal aneurysm were found. An infrarenal aortic bifurcation graft was inserted. He died fifteen months later of cardiogenic shock. In a sixty-six-year-old man diagnosis of a primary aortoduodenal fistula was made together with a limited type B dissection. A straight aortic interposi tion graft was inserted. He died eleven months later of the complications of a secondary aortoduodenal fistula.

Although combination of aortic dissection and abdominal aneurysm is a rare occur rence, conservative management of the aortic dissection and interposition graft for the abdominal aneurysm was successful as initial treatment in these 2 patients.
Three-Dimensional Surface Display in Blood Pool Gated SPECT
Authors: Indovina Angelo G.
Published: July 2008

In 14 patients (4 in good health and 10 with coronary heart disease) a blood pool gated single photon emission computed tomography (SPECT) was executed. The transaxial slices of the cardiac blood pool were reconstructed. A three-dimensional surface display was employed for the analysis of the tomographic data. A fixed distance, a fixed threshold (50%), and some different planes of view were employed. The test permitted visualiza tion of the ventricular and the atrial movements in all patients. The right ventricle was clearly seen in the right anterior oblique plane of view. The aortic beating was seen. In normal patients the left ventricle, clearly seen in left anterior oblique plane, shrank to a thin shank. In 4 patients with septum infarct the blood pool was seen to persist in the septum area in front of the lateral wall shrinking (akinesis). The opposite happened in patients with anterolateral wall coronary artery disease.

Three-dimensional surface display of blood pool gated SPECT shows a real three- dimensional picture of the dynamic heart and is a new noninvasive approach to the heart patient.
Thoracic Aortic Thrombosis as a Cause of Bowel Ischemia
Authors: Sharifi Mohsen , Sorkin Richard , Lakier Jeffry , Chaitra Sharada
Published: July 2008

Acute occlusion of the superior mesenteric artery (SMA) is a devastating disease with a high mortality rate. Among its causes is thromboembolism from the heart or from an aortic aneurysm. The authors report a sixty-four-year-old woman who sustained acute occlusion of the SMA from a very large thrombus located on the medial wall of the thoracic aorta, unrelated to an aneurysm. The thrombus was pedunculated and occupied over two thirds of the aortic lumen. Transesophageal echocardiography (TEE) proved to be a valuable tool in diagnosis. The appearance of the thrombus on computed tomo graphic scan very closely resembled a type B aortic dissection and may have been inter preted as such if the TEE result had not been available.
Effects of Progressive Vascular Occlusion on Slope and Intercept of the Pulmonary Artery Pressure-Flow Relationship
Authors: Shian Gu  , Prewitt Richard M. , Schick Usha , Ducas John
Published: July 2008

Pulmonary hemodynamics may be described by mean pulmonary arterial pressure (PAP)-cardiac output (CO) plots. The slope of the PAP-CO relationship may define the incremental resistance (IR), and the extrapolated pressure intercept (PI), the effective outflow pressure. The authors investigated the effects of progressive pulmonary vascular occlusion on the IR and PI of the PAP-CO plot.

Nine experimental and nine time control dogs were studied. In the former group, PAP-CO plots were obtained in three conditions: (1) Baseline, (2) following occlusion of the right pulmonary artery, and (3) following occlusion of the right pulmonary artery and blood flow to the left upper lobe. Following progressive occlusion, there was a corresponding increase in the IR of the PAP-CO plot, from 1.95 to 3.62 to 5.16 mmHg.1-1.min (all P < 0.05). In contrast to the increase in IR, PI remained constant. Over the same interval, there were no changes in IR or PI in the time control group.

These findings indicate that changes in the slope of the PAP-CO plot correspond to changes in the number of parallel vascular units.
Change of the Degree of Septal Hypertrophy in Hypertrophic Obstructive Cardiomyopathy Under Procainamide Treatment
Authors: Schwartz J. , Rafael C. , Rozenfeld V. , Abu-Much Z. , Schoham H.
Published: July 2008

The authors describe a patient with hypertrophic obstructive cardiomyopathy (HOCM) with decrease in septum thickness following procainamide treatment.
Sudden Cardiac Death Rate in an Area Characterized by High Incidence of Coronary Artery Disease and Low Hardness of Drinking Water
Authors: Bernardi Daniele , Dini Frank Lloyd , Azzarelli Andrea , Giaconi Antonella , Volterrani Cesare , Lunardi Maurizio
Published: July 2008

From January 1992 to January 1993 the incidence of sudden cardiac death among the population of the Media Valle del Serchio area (Tuscany, Italy), composed of a popula tion of 35,000, was found to be twice that of the European average; 32 cases have been reported over this period in that area (9 per 10,000 in the examined year), with a male/female (M/F) ratio of 2.5:1 (23 M, 9 F). In Italy the mean incidence of sudden death was calculated as 6/10,000 and in Europe 5/10,000.

In the examined population hypertension was the coronary risk factor present most frequently (87%). A previous diagnosis of coronary artery disease was documented in 21 cases (66%); 5 of these exhibited previous myocardial infarction and 3 previous myocar dial infarction associated with left ventricular heart failure. In 7 subjects no previous cardiovascular disorders were discovered. Prodromal symptoms had been reported in 20 cases (62%), which included chest pain in 8 and dyspnea in 8.

In the examined geographic area a high prevalence of coronary artery disease was verified through the records of the Public Health Service, which documents the main causes of mortality in Tuscany, and through the hospitalization data and the services provided for ischemic heart disease at the local coronary care unit compared with the national average. Moreover, research was accomplished on physical and chemical prop erties of drinking water in the same area, and this revealed a very low total hardness due to the paucity of calcium and magnesium salts.

In conclusion, this research demonstrated a close relationship between the incidence of sudden death and the incidence of ischemic heart disease in a mountain area with low-hardness drinking water.
Cerebral Infarction in a Young Adult Associated with Protein C Deficiency
Authors: Kato Hiroyuki , Shirahama Masashi , Ohmori Keizo , Sunaga Toshiaki
Published: July 2008

Protein C deficiency is a cause of thromboembolic disease. Venous thrombosis is the most common clinical manifestation. Arterial thrombosis is unusual and involvement of the intracranial arteries is especially rare. Herein the authors describe a case of cerebellar infarction associated with protein C deficiency and review the relevant medical literature. A thirty-year-old man was hospitalized because of dysarthria, right limb ataxia, and a gait disturbance. Cranial computed tomography disclosed an infarction in the right cerebellar hemisphere and brachium pontis. Three months earlier the patient had had a transient ischemic attack with truncal ataxia and gait disturbances. On admission, the protein C antigen was 57% and protein C activity was 45%. Investigation of family members revealed protein C deficiency in an uncle. Literature review of stroke cases associated with protein C deficiency revealed that most had had a previous vascular event and/or a positive family history or had used oral contraceptives chronically. Protein C deficiency should be considered in young stroke patients with a positive family history of vasooc clusive disease, previous ischemic events, or chronic oral contraceptive use.
Classification of Congenital Arterial and Venous Vascular Malformations
Authors: Bartels Claus , Horsch Svante
Published: July 2008

Arterial and venous vascular malformations due to congenital abnormalities rarely occur in the daily practice of vascular surgeons. These malformations represent a heteroge neous group of isolated or multiple congenital abnormalities, sometimes associated with complex congenital syndromes. Correct recognition and classification of these rare abnor malities may sometimes be difficult. No systematic classification of arterial and/or venous vascular malformations due to congenital abnormalities is currently available. On the basis of embryologic and pathophysiologic considerations, a rational and simple classifi cation of arterial and venous vascular malformations due to congenital abnormalities can be performed.

This contribution presents an appropiate classification of clinically important arterial and venous vascular malformations due to congenital abnormalities.
Direct In Vivo Visualization of Right Cardiac Anatomy by Fiberoptic Endoscopy Hemodynamic Effects and Image Validation
Authors: Fujimura Osamu , Lawton Mark A. , Koch Cheryl A.
Published: July 2008

The authors tested the ability of a balloon-tipped fiberoptic endoscope to accurately visualize and identify right-heart anatomy in 7 anesthetized dogs. A 3.6-mm-diameter fiberoptic endoscope with a latex balloon covering the distal tip was inserted into the right atrium, where the balloon was inflated with air in 5 mL increments. Heart rate did not show changes. Mean arterial pressure and cardiac output started to show signifi cant decreases with a balloon volume at 25 and 20 mL, respectively (n = 7). Visual image quality was excellent with a balloon volume of 10 mL or greater. With a balloon volume of 7-10 mL, the visual field was 15-20 mm in diameter. Right-heart anatomy including the right free wall, ostium of the coronary sinus, atrioventricular node area, tricuspid valve, right ventricular structures, and pulmonary arteries was clearly and accurately identified. Additionally, spatial relationships among these structures could be estab lished. Furthermore, there was an excellent concordance between endoscopically observed images and postmortem findings.

In conclusion, balloon-tipped fiberoptic endoscopy can accurately visualize normal intracardiac structures with no or minimal hemodynamic compromise.
Myocardial 18F-FDG-PET
Authors: Locher Johannes Th. , Frey Lukas D. , Seybold Klaus , Jenzer Hansruedi
Published: July 2008

Myocardial positron emission tomography (PET) with 18F-Fluordeoxyglucose (FDG) is increasingly used for the detection of viable tissue in the infarcted myocardium. Previous studies show that the variable metabolic conditions determine the regional distribution of this tracer and that the inhomogeneities of uptake often observed even in the normal myocardium may relate to substrate availability. The authors tried to stimulate the myocardial FDG uptake by either the technically easier method of glucose loading or by the euglycemic hyperinsulinemic clamp (EHC) technique. In their hands both methods could be considered as equally practicable but differing in some important details in regard to both the study protocol (tracer dose, optimal scanning time) and the reproducibility of results. The EHC allows a quick stabilization of the metabolic environment and resulted in an earlier and markedly increased FDG uptake. However, the important standardization of the method was performed by a computer- controlled system only for the glucose and insulin infusions. Their experiences show that the EHC provides a useful framework for assessing altered cardiac metabolism and possibly describes changes after therapeutic interventions more precisely than the commonly used glucose-loading technique.
Noninvasive Physiological Assessment of Vascular Wall Sclerosis Using Carotid Pulse Tracing and Cine Magnetic Resonance
Authors: Honda Toshio , Hamada Mareomi , Matsumoto Yuji , Matsuoka Hiroshi , Hiwada Kunio
Published: July 2008

In order to evaluate vascular wall sclerosis, the authors compared parameters of carotid pulse tracing with ascending aortic wall distensibility by using cine magnetic resonance (MR). Cine MR and carotid pulse tracing were performed in 20 healthy volunteers (mean age fifty-six years). They measured the interval from aortic second heart sound (A2) to the dicrotic notch (DN) (A2-DN interval), and the height from dicrotic notch to top/total height of carotid pulse tracing (b/a ratio). Ascending aortic distensibility was calculated from the following formula: max area - min area/min area x pulse pressure. There were significant positive correlations (r=0.70) between the A2-DN interval and ascending aortic distensibility and between b/a ratio and ascending aortic distensibility (r=0.63).

The measurement of A2-DN interval and b/a ratio using carotid pulse tracing is a useful method for assessing ascending aortic wall sclerosis.
Myocardial Infarction Secondary to Coronary Aneurysm in Systemic Lupus Erythematosus
Authors: Sumino Hiroyuki , Kanda Tsugiyasu , Sasaki Toyoshi , Kanazawa Norio , Takeuchi Hideo
Published: July 2008

The authors report a thirty-seven-year-old woman with systemic lupus erythematosus (SLE), a coronary aneurysm, and myocardial infarction. SLE was diagnosed at twenty- three years of age and treated with prednisolone. Seven years later, she developed inferior myocardial infarction, and coronary angiography showed an aneurysm in the proximal right coronary artery without associated stenosis. At the age of thirty-seven years, she died from cerebral infarction and sepsis. Autopsy revealed an aneurysm (6 mm in diameter) in the proximal right coronary artery and an old inferior myocardial infarc tion. Histologic examination showed recanalization and fibrosis in the media of the aneurysm wall. This case suggests that coronary aneurysm may cause myocardial infarc tion in SLE and that aneurysm formation may be a sequela of arteritis.
Right Coronary Ostium Agenesis with Anomalous Origin of the Right Coronary Artery from an Ectasic Circumflex Artery
Authors: Ayala Fernando , Badui Elias , Murillo Hector , Madrid Rosalba , Almazan Arturo , Rangel Alberto , Gutierrez-Vogel Samuel
Published: July 2008

In this report the authors present a case with right coronary ostium agenesis with anomalous origin of the right coronary artery from an ectasic circumflex artery, which, according to the literature review, they consider to be a unique case.
Intrathrombus Administration of Tissue Plasminogen Activator in Acute Cerebrovascular Occlusion
Authors: Frey James L. , Greene Karl A. , Khayata Mazen H. , Dean Bruce L. , Hodak John A. , Spetzler Robert F.
Published: July 2008

Intraarterial thrombolysis for acute cerebrovascular occlusion has achieved recanalization at a 50-90% rate. Clinical outcome has been unpredictable. The authors sought to test the hypothesis that intrathrombus administration of recombinant tissue plasminogen activator (rt-PA) would improve recanalization rate and to assess the possibility that clinical outcome would be predicted by the extent of collateral flow. Seven patients with acute cerebrovascular occlusion (less than six hours in 6, twenty-four hours in 1) were treated with intrathrombus rt-PA at 1 mg/minute. Examinations were scored on a five- point motor scale. Collateral flow was assessed angiographically. Vessels recanalized in 5 patients, 3 of whom had good outcomes. Vessels failed to recanalize in 2 patients, 1 of whom had good outcome. Good collateral flow was evident in all 4 patients with good outcome and in none of those with poor outcome.

Intrathrombus administration of rt-PA is technically feasible. Favorable clinical outcome is more likely in the presence of good collateral flow. In the absence of good collateral flow, ultra-early intervention may be necessary.
Does Increased Lipoprotein (a) Impair the Effectiveness of Thrombolysis With Streptokinase?
Authors: Tokgözoğlu S. Lale , Ozmen Ferhan , Kabukçu Mehmet , Karanfil Aydin , Aytemir Kudret , Ozkuyumcu Cumhur , Ugurlu Şevket
Published: July 2008

Although lipoprotein (a) [Lp(a)] has been shown to interfere with thrombolysis in vitro, its effects on thrombolytic therapy in patients with acute myocardial infarction (MI) are not clear. The authors evaluated 32 male patients ages thirty-five to seventy-five (mean fifty-two ±ten) with the diagnosis of acute MI who underwent thrombolytic therapy with 1,500,000 units of intravenous streptokinase. All patients underwent coronary angio graphy within seven days of the infarction from which the thrombolysis in myocardial infarction (TIMI) flow grades of the infarct-related artery, coronary scores, and ejection fraction were determined. Anterior MI was found in 19 patients (59.4%), inferior MI in 12 (37.5%), and posterolateral MI in 1 patient (3.1%). They found that 6 patients (18.8%) had TIMI flow 0 to 1, and 26 patients (81.2%) had TIMI flow grade 2 or 3. The Lp(a) levels ranged from 0.1 to 60 mg/dL with a mean of 8.6 ±17 mg/dL. Eight (25%) of the patients had Lp(a) levels above 30 mg/dL. The TIMI flow rates were not found to be lower in patients with high Lp(a) levels (P > 0.05), and there was no significant corre lation between the TIMI flow rates and the Lp(a) levels (r=0.28). There was a good correlation between coronary scores and Lp(a) levels ( r=0.87).

They conclude that although there is a good correlation between the extent of coronary atherosclerosis and Lp(a) levels, Lp(a) is not a strong predictor of the outcome of thrombolytic therapy.
Left Coronary Sinus of Valsalva Aneurysm: an Extremely Rare Malformation
Authors: Tahir Mohammed Z. , Rustom Majd , Khalid Al Ebrahim
Published: July 2008

The authors describe a sixty-four-year-old man who underwent coronary angiography for angina pectoris and was found to have a left coronary sinus aneurysm—an extremely rare malformation.
Comparative Study of Left Ventricular Function in Patients with Unstable Angina, Non-Q Wave Myocardial Infarction and Stable Angina Pectoris: Assessment with Atrial Pacing and Digital Ventriculography
Authors: Hussain K.M.A. , Gould L. , Pomerantsev E.V. , Angirekula M. , Bharathan T.
Published: July 2008

To compare left ventricular global and segmental function at rest and during right atrial pacing in patients with unstable angina, non-Q wave myocardial infarction, and stable angina (class III angina), low-dose digital subtraction ventriculography was performed at rest and after abrupt cessation of pacing in 42 patients with unstable angina, 8 patients with non-Q wave myocardial infarction and 15 patients with stable angina during selective coronary arteriography.

Left ventricular ejection fraction was significantly lower at rest in patients with unstable angina (P < 0.01) and non-Q wave myocardial infarction (P < 0.05) and during pacing (P < 0.01). These two groups of patients had significantly higher values of left ventricular end-diastolic and end-systolic volumes at rest and during pacing as compared with stable angina group. In comparing various clinical patterns of unstable angina, ejection fraction was significantly (P < 0.05) lower during pacing in patients with crescendo angina than in new-onset angina. However, ejection fraction was significantly (P < 0.01) lower in crescendo angina only at rest as compared with rest angina. The length of zone of severe hypokinesia was greater in unstable angina (P < 0.01) as well as in non-Q wave myocardial infarction (P < 0.05) both at rest and during pacing as compared with stable angina. Contractility of region of hypokinesia during pacing was higher (P < 0.01) in stable angina than in unstable angina and non-Q wave myocardial infarction. In analyzing segmental function in various subgroups of unstable angina, the authors found that the length of total hypokinesia was significantly higher (P < 0.05) (Abstract continued) during pacing in crescendo angina than in new-onset angina. Contractility of region of hypokinesia was lowest at rest and during pacing in patients with crescendo angina.

This study demonstrates that patients with unstable angina as well as non-Q wave myocardial infarction were characterized by more pronounced global and segmental left ventricular dysfunction at rest and during pacing as compared with patients with stable angina, which may explain the poorer prognosis in the former two groups. This study also shows that patients with crescendo angina have more profound left ventricular global and regional dysfunction as compared with patients with new-onset as well as rest angina.
Diagnostic Value of the Arithmetic Sum of the ST Segment of Inferior and V2 Leads, II + V2, III + V2 and aVF + V2 in Identifying the Artery Responsible for Inferior Acute Myocardial Infarction
Authors: Prieto-Solis J.A.
Published: July 2008

In order to evaluate electrocardiographic changes in the diagnosis of the artery respon sible for inferior myocardial infarction, a prospective study was performed on inferior and V2 ST segment deviation and its correlation using the arithmetic sum: II+V2, III+V2, and aVF+V2. A group of 66 patients with inferior acute myocardial infarction (AMI) was studied. A standard 12-leads electrocardiogram was performed within six hours of the onset of chest pain. Coronary arteriography was performed on each of the patients between one and twelve weeks after infarction. Right coronary artery (RCA) lesion was found in 46 patients, 27 at a proximal level and 19 at a distal level; in 20 patients the left circumflex coronary artery was affected.

The isolated value of the magnitude of the inferior ST segment is not an efficient parameter for identifying the artery responsible for inferior AMI. In lead V2 all the patients with a lesion of the left circumflex artery showed ST segment depression ≥ 1 mm (P < 0.001) and all those presenting ST segment elevation had stenosis of the proximal RCA.

The most useful parameters for identifying the artery responsible for inferior AMI, with 100% specificity are: (1) for occlusion of the RCA, the arithmetic sum of ST segments: aVF+V2 > 0, with 86.9% sensitivity (P < 0.001); (2) for occlusion of the left circumflex artery III+V2 < 0, with 90% sensitivity (P < 0.001); and (3) for proximal occlusion of the RCA: aVF+V2 ≥ 1, with 96.2% sensitivity (P < 0.001).

No specific marker was observed for distal occlusion of the RCA. The value of the arithmetic sum of the ST segment: III+V2 between 0 and 0.9 was the most significant, with 94.7% sensitivity and 95.7% specificity (P <0.001).
Deep Venous Thrombosis in Assir Region of Saudi Arabia Case-Control Study
Authors: Igbinovia A. , Malik G.M. , Adetayo Grillo I. , Seidi O.A. , Egere J.U. , Mazen Hachem M. , Al-Shehri Mohammad Y.
Published: July 2008

In a five-year case-control study (1988 to 1993) at Assir Central Hospital (ACH), Abha (8,000 feet above sea level), Saudi Arabia, 92 of 129 patients suspected of deep venous thrombosis (DVT) were studied with ascending contrast venography (CV) (74 patients, 80.4%) or Doppler ultrasonography (DUS) (18 patients, 19.6%). Female-to-male ratio was 2.3 to 1. Age range of patients was twelve to ninety years; mean age was 44.45 yrs ±17.38 years. DVT hospital incidence was 18 per 10,000 admissions.

The most common associated factors included immobilization due to chronic diseases (21.7%), trauma and surgery (19.6%), and pregnancy and oral contraceptives usage (16.3%). The most common symptom and sign were limb pain and tenderness (95.6%). Limb swelling was noted in 93.5% of patients. The left lower limb was more commonly affected than the right. There was a definite increase of DVT during the winter months. Altitude was not a contributory factor. Pulmonary embolism was the greatest complication.
Failure to Detect Free Radicals in the Isolated Perfused Rat Heart
Authors: Piette Lawrence H. , McNamara J. Judson , Premaratne Shyamal , Zhang Wei
Published: July 2008

Oxygen free radicals have been indirectly implicated in reperfusion injury following ischemia in the isolated rabbit heart. The authors moved to detect free radicals in an isolated rat heart model as a prerequisite to studying its effects during ischemia and reperfusion. Several different spin trapping agents and electron paramagnetic resonance (EPR) spectroscopy were used to detect free radicals being generated during ischemia and reperfusion. The possible roles of ferrous iron and hydrogen peroxide generation in reperfusion injury were also investigated. No free radical "bursts" were detected with any of the spin traps used in this model during ischemia or reperfusion. Hydrogen peroxide and hydroxyl free radicals do not appear to be involved in tissue reperfusion injury. This study suggests that free radicals are not produced in clinically significant quantities under these conditions to account for ischemic myocardial damage.
Changing Prevalence of Coronary Heart Disease Risk Factors and Cardiovascular Diseases in Men of a Rural Area of Crete from 1960 to 1991
Authors: Voukiklaris George E. , Kafatos Antony , Dontas Anastasios S.
Published: July 2008

This study compares the prevalence of coronary heart disease (CHD), risk factors (RF), and cardiovascular diseases (CVD) among Cretan men from a rural area examined in 1960 and 1991. The study population consisted of 148 men in 1960 and 42 men in 1991 of the same age group (fifty-five to fifty-nine years old) and from the same rural area. All men had a complete examination of the cardiovascular system and a resting electrocardiogram (ECG). Systolic BP (SBP) ≥140 mmHg was found in 42.6% of the subjects in 1960 and in 45.2% in 1991 (NS). Diastolic BP ≥ 95 mmHg was found in 14.9% of the subjects in 1960 as opposed to 33.3% in 1991 (P < 0.02). Total serum cholesterol (TSCH) ≥ 260 mg/dL ~6.7 mmol/L) was found in 12.8% of the subjects in 1960 and in 28.6% in 1991 (P < 0.01). Heavy smokers (≥ 20 cigarettes/daily) were 27.0% in 1960 as compared with 35.7% in 1991 (P:NS); 5.4% of the subjects in 1960 had light physical activity (PA) as compared with 14.3% in 1991 (P < 0.01); 74.7% of the subjects were farmers in 1960 as compared with 43.6% in 1991 (P < 0.1). The prevalence of CHD was 0.7% in 1960 as compared with 9.5% in 1991 (P < 0.001). Hypertensive heart disase was found in 3.4% of the subjects in 1960 and 4.8% in 1991 (NS). The prevalence of all major CVD was much higher in 1991 (19.1%) as compared with 1960 (8.8%) (P < 0.01). In conclusion, the prevalence of CHD RF and CVD was much higher in 1991 than in 1960 for Cretan men of the same age group. This higher prevalence seems to be related to dietary and life-style changes that have taken place in Crete during the last thirty years.
Prospective Study of Vascular Events and Cerebral Perfusional Chang Following Transient Ischemic Attacks
Authors: Mortel Karl F. , Meyer John S.
Published: July 2008

A prospective case-control study was carried out to clarify associations of cerebr transient ischemic attacks (TIAs) and other stroke risk factors with progression and exa erbation of cardiovascular and cerebrovascular disorders; 243 neurologically norm controls and 123 TIA patients without prior history of stroke were followed up for mean interval of 4.4 years. Of TIA patients, 26 (21%) developed other events (excludi recurrent TIAs); 10 died of vascular causes (8.1%). Of controls, 44 (18%) develope events; 13 died of vascular causes (5.4%) and 3 from cancer. TIA patients were at 2 times greater risk than normal controls for stroke or death from vascular causes. The were predominantly male with significantly higher associations of risk factors for strok including hypertension, heart disease, diabetes mellitus, smoking, hyperlipidemia, alcoh consumption, and limited education. Controls developing vascular events compared wi controls who did not were older, more frequently male, and with greater incidences heart disease. TIA patients had lower rates of cerebral perfusion compared with contro that persisted throughout the study, with similar rates of decline related to aging amor both groups. Among TIA patients, stroke risk factors were more prevalent than amor controls. The longer their duration, the greater the incidence and the more rapid the rate of severe often fatal cardiovascular complications
Deep Vein Thrombosis as a Predictor of Cancer
Authors: Ahmed Zahoor , Mohyuddin Zahoor
Published: July 2008

An association between cancer and venous thrombosis has long been recognized. In an attempt to find whether venous thrombosis can serve as a reliable predictor of subsequent cancer, 196 cases of confirmed venous thrombosis treated over a seven-year period were reviewed.

Of a total of 196 cases, 113 were found to suffer from primary type deep venous thrombosis (DVT), whereas 83 were allocated to secondary type DVT. Of 113 cases with primary DVT, 23 had suffered from recurrent episodes, whereas 90 had only a single episode. From the secondary DVT group of 83 patients, 14 suffered from recurrent episodes and 69 had a single episode.

Of the patients in the primary DVT group, 2.65% (3/113) developed cancer subsequently, whereas none was detected among the group of 83 patients who had secondary DVT. In the group of 113 patients with primary DVT, the incidence was higher among those who had recurrent episodes (4.34%, 1/23) than among those who had a single episode (2.22%, 2/90). The overall incidence of cancer among 196 cases of DVT was found to be 1.53% (3/196).

The findings do not support the routine screening of all DVT patients by expensive diagnostic modalities. These patients should rather be assessed by careful clinical examinations and baseline investigations. The detailed investigations should be resorted to if there is any suggestion of presence of occult malignancy by these simpler means. One should be more vigilant in case of patients suffering from primary type DVT, for the incidence in this group is significantly higher.
Cardiovascular Effect of Oral Calcium Supplementation: Echocardiographic Study in Patients with Essential Hypertension
Authors: Dazai Yasunobu , Kohara Katsuhiko , Iwata Takeru , Sumimoto Takumi , Hiwada Kunio
Published: July 2008

Oral calcium (Ca) supplementation mildly reduces blood pressure. The authors studied the effects of Ca supplementation on the cardiovascular system in patients with mild to moderate essential hypertension. Twelve patients aged forty-nine to seventy years (7 men and 5 women, mean age with 60.3 ±7.2 years) participated. The investigators orally administered Ca (1.0 g/day for one week) under hospitalization, adding to a dietary intake of Ca (0.6 g/day). Left ventricular function and systemic arterial compliance were evaluated by M-mode and pulsed Doppler echocardiographies before and after seven days of Ca supplementation. Left ventricular contractility and afterload were not changed. Preload indicated by end-diastolic volume was significantly decreased after Ca supplementation (109.6 ±8.5 vs 107.3 ±8.2 mL, P < 0.05). Myocardial relaxation evaluated by IIa-mitral valve opening time (87.7 ±6.7 vs 82.1 ±6.2 ms, P < 0.01) and maximum descending rate of the left ventricular posterior wall (10.6 ± 1.0 vs 12.4 ±1.0 cm/s, P < 0.01), and atrioventricular net compliance assessed by the descending slope of rapid filling flow in the left ventricular inflow tract (2.63 ±0.24 vs 2.26 ±0.17 m/s2, P < 0.05), as well as systemic arterial compliance (2.05 ±0.20 vs 2.73 ±0.26 mL/mmHg, P < 0.01) were significantly improved by Ca supplementation. Oral Ca supplementation improved the disturbed left ventricular diastolic function and systemic arterial compliance.
A Serious Complication of Percutaneous Mitral Valvuloplasty: Systemic Embolism. How Can We Decrease It? Case History
Authors: Demirtaç M. , Usal A. , Birand A. , Şan M. , Batyraliev T. , Niyazova Z.
Published: July 2008

Systemic embolism is a potential and severe complication of percutaneous balloon mitral valvuloplasty (PBMV). The incidence of systemic embolism during PBMV has been reported to be less than 5% and only 0.6% with the Inoue technique. This is less than that reported in closed commissurotomy series and about the same as in open commissurotomy.

In the authors' series of 50 cases, the incidence of systemic embolism was 2% (1 case). The patient had mitral restenosis (after closed commissurotomy) with mild to moderate valvular and subvalvular calcification, and cerebral embolism occurred during the procedure. To prevent systemic embolism, the authors' standard policy was to perform transesophageal echocardiography (TEE), computed tomography, and magnetic resonance imaging before the procedure and to give heparin during the procedure and two months preceding it in cases with atrial fibrillation or with a history of previous embolism and to limit manipulation of the catheter in the left atrium.

The authors believe that a close scrutiny in the selection of patients, improved technology of the dilating system, good experience with PBMV, and adequate heparinization are also of great importance in the prevention of thromboembolic complications.
Computed Tomography and Magnetic Resonance Findings in Long-standing Patent Ductus Case Reports
Authors: Sharma Supriya , Mehta Atul C. , O'Donovan Peter B.
Published: July 2008

Two adult patients with patent ductus arteriosus (PDA), resulting in Eisenmenger's syndrome, were evaluated by computed tomography and Magnetic Resonance imaging of the chest, which clearly demonstrated the patent arterial duct as well as the morphologic features of long-standing pulmonary arterial hypertension. Massively dilatated, calcified pulmonary arteries were seen, and the arterial duct was identified as a vascular channel between the distal aortic arch and the main pulmonary artery.
A Rare Case of Arteriosclerosis Obliterans Without Prominent Risk Factors Complicated by Idiopathic Thrombocytopenic Purpura A Case Report
Authors: Yamagishi Sho-ichi , Ohta Masayoshi , Segawa Chikako , Abe Toshio , Sawada Taisei
Published: July 2008

An eighty-four-year-old man was admitted to the hospital because of pain at rest in the lower extremities. On physical examination, trophic changes of the skin and petechiae in the limbs were observed. Computed tomographic scan of the abdomen showed focal renal infarctions and calcification of the descending aorta. Moreover, radionuclide imaging of the arterial system revealed complete obstructions of the two right iliac arteries and the left external iliac artery, where collateral flows were observed. Laboratory examination showed a severe thrombocytopenia caused by immunoglobulin G (IgG)-type autoantibody against platelets. He was diagnosed as having arteriosclerosis obliterans complicated by idiopathic thrombocytopenic purpura, although no known risk factors promoting atherosclerosis other than age were evident. In such a case with hemorrhagic diathesis, a hemorheologic agent and the vasodilator prostaglandin could confer advantages in relieving and controlling the ischemic leg pain without hemorrhagic complications. Moreover, small doses of the initial predonisolone therapy for ITP might also be recommended to avoid thrombus formations in the atherosclerotic lesions.
Asymmetric Hypertrophic Cardiomyopathy Diagnosed by Echocardiography and Magnetic Resonance Imaging
Authors: Kozelj M. , Pavcnik D. , Surlan M.
Published: July 2008

The authors present 3 patients with asymmetric hypertrophic cardiomyopathy, which was diagnosed by echocardiography. Magnetic resonance imaging, however, proved superior in visualizing the cardiac anatomy of the left ventricle and enabled myocardial evaluation with determination of the location, severity, and extent of the abnormality. Magnetic resonance imaging can also differentiate unusual asymmetric hypertrophy from other pathologic states.
Hydatid Disease Presenting as Cardiac Tamponade
Authors: Demirtaş Mustafa , Usal Ayhan , Şan Mustafa , Birand Ahmed
Published: July 2008

Although hydatid disease has been reported in almost all human tissues, cardiac involve ment is uncommon. The authors report a case of cardiac hydatid disease presenting with cardiac tamponade. The diagnostic value of transthoracic and transesophageal echocar diography, computed tomography, and angiography in hydatid heart disease is also discussed.
Duplex Sonography of Venous Atheromatosis Found in the Venous Part of Hemodialysis Fistula
Authors: Kröger K. , Ranft J. , Rudofsky G.
Published: July 2008

Manifestation of atherosclerosis is one of the alterations in venous bypass grafts. Its progression and morphology usually cannot be described by sonography. The venous part of a hemodialysis fistula can be compared to a venous bypass graft. The authors investigated the venous part of hemodialysis fistula in 16 patients. They found athero sclerosis in 7 patients. The morphologic findings were similar to arterial atherosclerosis. Looking at the venous part of hemodialysis fistulas may be an adequate model to inves tigate the initiation and progression of atherosclerotic lesions in venous bypass grafts.
Cardiac Catheterization and Selective Coronary Angiography with Tortuous Aorta and Anomalous Coronary Artery
Authors: Kwan Tak , Feit Alan , Garcia Alejandro , Alam Mahmood , Stein Richard A.
Published: July 2008

The authors report a case of selective coronary angiography by use of a modified technique in a patient with tortuous iliac artery, distorted thoracic descending aorta, and anomalous left coronary artery. This approach to such anatomy can decrease the fluo roscopy time and reduce the likelihood of complications.
Do Physicians' Beliefs About Coronary Risk Factors Account for Poor Screening and Treatment Rates?
Authors: Meyers David G. , Steinle Brad T.
Published: July 2008

The authors hypothesized that the widely observed low rates of coronary risk factor screening and treatment among cardiologists could be due to lack of belief in the importance of risk factors. They performed an audit of 160 randomly selected medical records of patients with coronary artery disease and surveyed the attending physicians' ranking of importance of individual risk factors to determine the extent of risk factor screening and treatment done by these physicians. Screening and treatment rates for individual risk factors were highly variable but generally well below expected. There was no correlation among rank orders of screening rates, treatment rates, and physician-rated importance of each risk factor. These results suggest that lack of belief in risk factor importance does not explain failure of physicians to screen for and treat risk factors in coronary patients.
Left Atrial Size Changes in Patients with Paroxysmal Lone Atrial Fibrillation
Authors: Rostagno Carlo , Olivo Giuseppe , Comeglio Marco , Bertini Giovanni , Gensini Gian Franco , Galanti Giorgio
Published: July 2008

Left atrial enlargement has been demonstrated to occur as a consequence of the arrhythmia in patients with chronic atrial fibrillation (AF) in the absence of organic heart disease, whereas contrasting results have been reported in patients with paroxysmal lone AF. In the present investigation the behavior of left atrial size was followed up for an average period of 30.3 months in 20 patients with paroxysmal lone AF since their first arrhythmic episode. No significant changes in left atrial size were found at the end of the follow-up period. In 65% of patients the arrhythmia recurred at least once yearly. Left atrial size at enrollment was not significantly different in these patients from those without recurrences and did not change in either group during follow-up. The results suggest that in patients with lone AF left atrial dilatation occurs only after the arrhythmia becomes chronic. Early restoration of sinus rhythm may interrupt the vicious circle leading to atrial enlargement.
Tolerability and Clinical Efficacy of Desmin in the Treatment of Superficial Thrombovaricophlebitis
Authors: Andreozzi Giuseppe Maria , Signorelli Salvatore , Di Pino Luigi , Martini Romeo , Marchitelli Elsa , Pinto Antonio , Romeo Salvatore , Zamboni Villiam , Palazzini Ernesto
Published: July 2008

Fifty-six patients with superficial thrombovaricophlebitis of the lower limbs were enrolled in an open and multicenter (4 centers) trial for a period of thirty days. Patients were randomly allocated to three treatment groups to receive a new low-molecular-weight dermatan sulfate (Desmin) at the dose, respectively, of 100 mg once daily by subcuta neous (SC) route, 100 mg twice a day SC, and 200 mg once daily by intramuscular (IM) route. The general and local tolerability and the clinical efficacy of the drug were evaluated by means of clinical, instrumental, and laboratory parameters. Desmin proved capable of effectively improving the symptoms of patients affected by thrombovari cophlebitis, inducing rapid regression by the tenth day of treatment. The daily dose of 200 mg (either SC or IM) was more effective than the 100 mg dose. The systemic toler ability of the drug, administered for the first time for one month, was extremely good, without significant variations in the relevant laboratory tests. Local tolerance (at the site of injection) of the drug was also good.
The Quantitation of Blood Flow/Metabolism Coupling at Rest and After Exercise in Peripheral Arterial Insufficiency, Using PET and 15-0 Labeled Tracers
Authors: Depairon Michèle , Zicot Michel
Published: July 2008

Regional blood flow and oxygen uptake of the lower limbs were studied in 11 patients with arterial insufficiency (10 with severe unilateral, 1 with bilateral intermittent clau dication). Regional muscle blood flow (F), oxygen consumption rate (R), and oxygen extraction fraction (E) were evaluated by positron emission tomography (PET) and bolus inhalation of C15O2 and 15O2 by the patient. Tomograms were recorded at the greatest diameter of legs, at rest and ten minutes after a treadmill walk test leading to the devel opment of ischemic pain in the affected leg. In 5 patients, F and E were correlated with the results of occlusive venous strain gauge plethysmography and with the measure ments of blood gases in one brachial artery and in the femoral vein of the affected limb. Blood flow values measured at rest and after exercise by PET were poorly correlated with the plethysmographic findings. This may be because PET does not interfere with flow as venous occlusion plethysmography does in low peripheral pressure conditions.

The results show that F, R, and E were not significantly different in normal and patho logic legs at rest. The values of F and R were significantly higher in pathologic than in normal lower limbs, ten minutes after exercise, whereas E was not significantly altered by exercise at any side. This suggests that, during the recovery from a walk test, the delayed increase in oxygen uptake is proportional to the delayed hyperemia in the ischemic muscles ("oxygen debt") and probably not linked to a luxury perfusion.
Cardiac Status in Typhoid Fever Cardiac Status in Typhoid Fever
Authors: Nand N. , Sharma M. , Bhutani M. , Singh G.P. , Sharma V.K.
Published: July 2008

Fifty adult patients with culture-proved typhoid fever were subjected to daily clinical, electrocardiographic (ECG), and electrolyte assessment to evaluate and correlate their cardiac status. Transaminases and creatine kinase (CCK-MB) were estimated on alternate days and echocardiographic assessment was done once during hospitalization.

The patients were distributed into groups: I (21) who did not have any ECG or enzymes changes, IIa (17) who had both ECG as well as enzymes changes, IIb (5) who had ECG changes only, and IIc (7) who had elevated enzymes only. Various types of ECG abnormalities were observed in 22 patients. Transaminases were significantly raised (P < 0.001) in group IIa and IIc patients (24). However, CK-MB was significantly raised (P < 0.001) only in the 5 patients of group IIa. There was no relationship among the elevated enzyme levels, severity of disease, and ECG changes. Further, ECG changes were observed during the convalescence stage also, but transaminases were found to be elevated only during the acute stage.

It is concluded that definite injury to the heart occurs during typhoid fever. However, it is difficult to ascertain the exact time and extent of the injury. Further, CK-MB was not found to be superior to transaminases for assessment.
Acute Aortic Thrombosis Acute Aortic Thrombosis
Authors: Barrett Leonard O. , Yelon Jay A. , Evans James T.
Published: July 2008

We report a case of a patient with acute aortic thrombosis. A discussion of the reported literature, presentation, surgical management, and natural history follows. This is an interesting addition to a rare vascular condition.
Chronic Venous Insufficiency-A Well-Known Disorder with Many Question Marks
Authors: Norgren Lars
Published: July 2008

Chronic venous insufficiency (CVI) is a common disorder found in many parts of the world. The pathophysiology of this condition is only partly elucidated, and even the development of varicose veins remains unexplained. Microcirculation is greatly affected by CVI, which occasionally induces skin changes and ulcers. Although varicose veins are a common symptom of CVI, they are absent in many patients. Thus, clinical examination is often insufficient for the diagnosis of CVI. Furthermore, the treatment of a common disorder such as CVI is frequently inadequate. The author discusses the overfrequent use of varicose vein surgery, where compression treatment would seem more appropriate and effective, and the current status of compression in the treatment of deep vein incom petence. He recommends that the various manifestations of CVI should be more thor oughly classified. He also examines how sclerotherapy is used to various extents in different countries. Finally he discusses the use of various drugs in the treatment of CVI. It is clear that the pathophysiology and the treatment of CVI must be further examined, in particular to determine whether prevention is possible.