bluuebunny/crossref_metadata_2025 huggingface dataset:
Anomalous Origin of the Right Coronary Artery from the Ascending Aorta: Case History
Authors: Goldstein Philip R. , Pittman David E. , Gay Thomas C. , Brandt Craig S.
Published: November 2007

A patient is described with an anomolous right coronary artery arising high above the left sinus of Valsalva. This patient is unique because the other 2 cases with such an anomolous origin of a right coronary artery had bicuspid aortic valves; this patient had a normal tricuspid aortic valve.
Deep Venous Thombosis: An Overview
Authors: Hufnagel Charles A.
Published: November 2007

The patients at high risk of deep venous thrombosis are defined. Factors in the formation of intravenous thrombi are described. The roles of endothelium, formed elements, clotting factors, and their interrelationships are correlated. Diagnostic modalities and their application are described, and the commonly used medical and surgical therapies are specifically outlined.
Successful Embolization of Multiple AV Foot Lesions—A Case History
Authors: Shetty P.C. , Beninson J. , Collison D.W. , Burke T.H.
Published: November 2007

A 39-year-old white female with multiple arteriovenous malformations of the left foot had had surgical ligation on her left dorsalis pedis artery at age 12 with no clinical improvement. She was placed into a leotard at age 16 and was able to function but would tire very easily and her left foot was twice the size of her right one.

In May 1988, she had four large feeder vessels off the posterior tibial artery and two off the anterior tibial artery embolized by use of 1,000 microns PVA particles, occlusive spring coils, and detachable balloons.

Her foot shrunk and is now smaller than her normal right foot; she does not tire, and she now wears a knee length stocking to help prevent other channels from opening.
Effect of High-Dose Furosemide in Refractory Congestive Heart Failure
Authors: Marangoni Egidio , Oddone Alessandro , Surian Maurizio , Panciroli Claudio , Galloni Gianfranca , Masa Antonella , Caizzi Vincenzo , Belletti Sebastiano , Cominesi Walter Raimondi , Orlandi Mario
Published: November 2007

High-dose firosemide is considered effective in primary renal sodium re tention but is not generally recom mended in congestive heart failure. In order to evaluate efficacy and safety of high-dose furosemide (>500 mg/day), the authors studied 20 patients (pts) resistant to therapy (including furose mide <500 mg/day) selected from 161 pts admitted for chronic heart failure. All refractory pts (15 men and 5 women, mean age sixty ± 12 years) were in NYHA class IV and showed hyponatremia (130±5 mEq/L) and im paired renal function (BUN 31±14 mg/dL, serum creatinine 1.3±0.3 mg/dL and BUN/creatinine ratio 23±7). In addition to digitalis, dopa mine, angiotensin-converting enzyme inhibitors, or vasodilators, IV high- dose furosemide (775±419 mg/day, 500-2000) was given for ten±five days under daily clinical and laboratory monitoring.

Three pts died of low-output syn drome while 16 pts were upgraded to NYHA class III and 1 pt to class II; a mean weight reduction of 7.3±2.9 kg in ten+five days (0.80±0.4 kg/day) and a mean di uresis increase of 88±57% oc curred. The maximal dose of furosemide did not correlate with serum creatinine but did correlate with BUN/creatinine ratio (r = 0.78, p<.001). Pts were discharged on with chronic heart failure, and 43 % in the subgroup in NYHA class IV with hyponatremia. High dose furosemide was effective for rapid removal of ex cess water and salt in "furosemide-re sistant" congestive heart failure. The relationship between renal impair ment and maximal furosemide doses seems to confirm the role of renal pharmacokinetics in the appearance of furosemide resistance.
B-Mode Imaging and Histomorphometric Evaluation of Carotid Atherosclerosis
Authors: Tanganelli P. , Bianciardi G. , Centi L. , Salvi M. , Weber G. , Susta A. , Ciuffetti G. , Mercuri M. , Parnetti L. , Senin V. , Tazza A. , Moggi L.
Published: November 2007

The quantitative and qualitative evaluation of atherosclerotic lesions by the ultrasonography has presented several problems, above all, the determination of accuracy and reproducibility of this methodology in humans. The present study aims to evaluated the results of B-mode imaging of extracranial carotid arteries in patients selected for surgery as compared with histologic results of the observations of the samples obtained by endarterectomy. Shrinkage effects of the histologic samples were taken into consideration. Several bidimensional images of atherosclerotic lesions, as obtained by ultrasound at different incident angles, were used to establish their maximum thickness. The maximum degree of the vessel stenosis calculated by ultrasound showed a high correlation (Y=0.47X+42.4, se=0.11, r=0.5, p<0.001) compared with the one obtained by histology. The imaging methodology provided however, a mean overestima tion of the stenosis of about 7%. Relationships among the amount of calcium (p<0.03); necrotic core p<0.056); and echogenic types, ie, soft, mixed, and hard; have been suggested by a statistical trend. The results suggested that of the vascular lumen due to advanced atherosclerotic lesions. Qualitative inter pretation of atherosclerosis by B-mode imaging, ie, morphologic characteristics, seem, at present, to be of value, but more investigations in depth are needed.
Lymphangiomyomatosis Newer Concepts in Pathogenesis and Management—Case Reports
Authors: Naegeli Charles D. , Cordasco Edward M. , Meden G. , O'Donnell James K. , MacIntyre William J. , Dishner W.
Published: November 2007

Lymphangiomyomatosis was first reported more than forty years ago. Al though its incidence is rare, its occurrence is being increasingly recognized and has been the subject of a growing number of case reports in recent years. This study adds 2 more cases to the file. Both cases involved young women with the characteristic symtoms of dyspnea, cough, abdominal discomfort and swelling, chest pain, and hemoptysis, with abundant formation of refractory chylous, serous ascites. Although the progression of the disease differed in each case, pulomonary function was affected in a similar way by the presence of obstructive and restrictive defects and a decrease in diffusing capacity. Underlying abnor malities were dilated lymphatics, thickened lymphatic walls, and muscular pro liferation of leiomyomatous origin, leading to bronchial restriction. The authors point to the subtlety required in arriving at a differentiated diagnosis of lymphangiomyomatosis lymphangioleiomyomatosis and the difference between the two conditions. They also make particular recommendations in respect to the importance of preliminary hormone receptor tests and to the wisdom to be exercised in ligating a main lymphatic duct in the chest to control the formation of ascites. Pheumothorax, a frequent manifestation of lymphangiomyomatosis, is found to be the result of chronic air trapping due to a combination of narrowing of conducting airways and disruption of normal lung parenchyma.
High Density Lipoprotein Inhibits Low Density Lipoprotein Binding and Uptake by Bovine Aortic Endothelial Cells
Authors: Alexander J. Jeffrey , Miguel Remedios , Graham Debra
Published: November 2007

The antiatherogenic effect of high density lipoprotein (HDL) has been attrib uted to either an inhibition of cholesterol uptake or to reversed cholesterol transport from peripheral cells. In order to determine whether HDL competi tively blocks receptor-mediated low density lipoprotein (LDL) binding and up take, bovine aortic enothelial cells (BAECs) were cultured in Dulbecco's modified Eagles Medium (DMEM) containing 10% LDL-free fetal bovine serum, and incubated with 125I-LDL in concentrations of either 10 or 25 μg protein/mL. Varying amounts of HDL (0-200 μg/mL) were added to the media. Following a twenty-four hour incubation period at 37°C, 125I-LDL binding and uptake were measured.

At the lower concentration of 125I-LDL, which represents high-affinity recep tor binding, there was no significant difference in either binding or uptake within the range of HDL concentrations studied. At the higher concentration of LDL, however, there was a marked inhibition of 125I-LDL binding (p<.006) and uptake (p<,001; ANOVA), which did not saturate at the highest HDL concentrations used. These data suggest that HDL does not influence high-affinity, receptor-me diated binding and uptake of LDL but that its effect is seen at a concentration of LDL representing nonspecific binding. The lack of saturation at increasing concentrations of HDL also indicates that HDL-receptor interaction is not essen tial for the effect.
How Long Can a Coronary Reperfusion Catheter Be Placed in Acute Coronary Occlusion Following Failed Transluminal Coronary Angioplasty?—A Case Report
Authors: Miyamoto Akira , Mizuno Kyoichi , Hakamada Naohiro , Seguchi Hidetaka , Satomura Kimio , Isojima Kazushige , Kurita Akira , Nakamura Haruo
Published: November 2007

A coronary reperfusion catheter (CRC) is designed to preserve antegrade coronary flow when abrupt coronary closure occurs during percutaneous trans luminal coronary angioplasty (PTCA). Insertion of the catheter to an occluded coronary artery for a few hours has been reported to be effective for myocardial salvage: however, it is unknown how long the catheter can be kept in place without causing extension of myocardial ischemia. The authors experienced a case in which the CRC was kept in place for twenty-four hours for anticoagulant therapy of an occluded coronary artery following failure of PTCA. This case suggests that adequate anticoagulant therapy can prolong the period during which a CRC can be kept in place if emergency coronary bypass surgery cannot be performed immediately after failure of coronary angioplasty.
Comparison of Coronary Angiographic Features and Oral Dipyridamole Thallium 201 Tomography
Authors: Jain Avanindra , Hunter Myers G. , Rowe Mathew W. , Dehmer Gregory J. , Robinson Debra S.
Published: November 2007

Coronary angiography and left ventriculography is commonly used to identify those patients with incomplete infarctions and therefore, a need for revascular ization. The authors compared coronary angiography and left ventriculography with thalliumm 201 tomography using oral dipyridamole to identify patients with potential ischemia in the infarct zone indicating viable tissue. Forty-five patients (37 men, 8 women) with acute myocardial infarctions (29 anterior, 16 inferior) who received intravenous thrombolytic therapy were studied. On the basis of the left ventriculograms, only 16 patients were judged to have residual function in the infarct zone . Six of these patients had no thallium redistribution in the infarct zone, indicating lack of residual ischemia. Of the 29 patients with no residual function in the infarct zone, 18 had redistribution in the infarct zone, suggesting residual ischemic myocardium and thus viable tissue . Among the 32 patients with open infarct vessels, 15 had no redistribution in the infarct zone, but of the remaining 13 patients with occluded infarct vessels, 9 had redistribution in the infarct zone indicating residual ischemia and thus viable tissue . The authors' data suggest that neither wall motion analysis by left ventriculography nor the an giographic status of the infarct vessel identifies those patients with residual ischemia as evidenced by thallium tomography using oral dipyridamole.
The Effect on Skin Blood Flow of Short-Term Venous Hypertension in Normal Subjects
Authors: Cheatle T.R. , Chittenden S.J. , Coleridge Smith P.D. , Scurr J.H.
Published: November 2007

Plugging of skin capillaries by activated white blood cells is one of the proposed mechanisms by which skin damage may be initiated in chronic venous insuffi ciency . The aim of this study was to determine whether a microcirculatory deficit was induced in the skin by raising the venous pressure proximally for thirty minutes.

Seventeen subjects with no evidence of venous or arterial disease had laser Doppler velocimetry performed in the gaiter region of the leg; 8 different subjects had the measurement done on the dorsum of the hand. Peak hyperemic response following three minutes of ischemia was measured before and after a thirty-min ute period of sustained venous hypertension applied by a proximal tourniquet inflated to 80 mm Hg.

A decrease in the peak flow: baseline flow ratio (median ratio 2.25 before, 1.70 after, p <0.02) and an increase in the time taken to reach maximal hyperemia (median time ten seconds before, twenty seconds after, p<0.01) were observed after the period of venous hypertension in the lower limb . The second parameter, but not the first, was significantly affected in the upper limb .

The authors conclude that a microvascular deficit in the skin is demonstrable after a short period of venous hypertension . This is consistent with the white-cell- trapping theory, but other possible explanations are discussed.
Physical Overdistension Converts Ventricular Cardiomyocytes to Acquire Endocrine Property and Regulate Ventricular Atrial Natriuretic Peptide Production
Authors: Gu Jiang , D' Andrea Michael , Seethapathy Muralidharan , McDonnell Constance , Cichon Romuald
Published: November 2007

Atrial natriuretic peptide (ANP) is present in adult atria but at very low concentrations in normal adult mamma lian ventricles. In the atria, the produc tion of ANP is regulated by physical distension of the atrial wall. The same phenomenon was investigated in the ventricles of rats and men. Cardiac tis sues from human ventricular aneurysm (n = 5), spontaneously hypertensive rats (n = 30), and rats that had overloaded left ventricles induced by surgery (n = 84) were studied with the methods of light microscopic immunocytochemis try, electron microscopic immunogold staining, and RNA-RNA tissue in situ hybridization. It was found that the levels of ANP gene expression, ANP im munoreactivity, and ANP-containing specific granules in the overburdened ventricles were elevated and their de grees of fluctuation were directly pro portional to the force of physical dis tension applied to the ventricular car diomyocytes. In rats, ANP mRNA and ANP immunoreactivity returned to the control level seven days after the ventri cular overload was surgically released. The changes of ANP and its mRNA in the ventricles were related more closely to the changes of intraventricular pres sure than to cardiocytic hypertrophy. In addition, ANP immunoreactivity was demonstrated in Purkinje cells and peri arteriolar cardiomyocytes in the ventri cles of normotensive rats. In conclusion, physical overstretch of the ventricle wall is likely to be the triggering factor affect ing ventricular cardiomyocytes to ac quire endocrine property, and also to regulate the production of ventricular ANP, thereby contributing to the con trol of the blood volume and the blood pressure.
Effects of Vasodilators on Venous Tone in Vivo in Dogs
Authors: Ogawa Shozo , Narita Goro , Nomura Hideo , Yasuma Fumihiko , Miyaguchi Kazuhiko , Hayashi Hiroshi , Sotobata Iwao
Published: November 2007

The authors investigated, in vivo, the effects of four vasodilators on venous tone in dogs. Baseline venous tone was determined from the pressure: diameter relationships in the inferior vena cava (VSIVC) and femoral vein (VSFV) as measured during several seconds of occlusion of the proximal inferior vena cava. All of the slopes were nearly linear. All vasodilators were adminstered in dosages sufficient to lower blood pressure by approximately 20%; these dosages also decreased systemic vascular resistance by 15% to 30%. Isosorbide dinitrate reduced VSIVC from 7.17 ± 0.81 to 5.81 ± 0.73 mmHg/mm and VSIVC from 59.4 ± 13.5 to 37.2 ± 6.6 mmHg/mm. Neither nifedipine nor nisoldipine altered VSIVC or VSFV. However, prazosin decreased VSIVC from 13.2 ± 3.3 to 10.7 ± 2.7 mmHg/mm and VSFV from 43.5 ± 11.3 to 29.9 ± 8.8 mmHg/mm. These results suggest that isosorbide dinitrate and prazosin decrease venous tone in vivo, whereas nifedipine and nisoldipine do not.
ACE Inhibitors in the Elderly
Authors: Posvar Edward L. , Sedman Allen J.
Published: November 2007

As the population with hypertension becomes older, it is important to determine the properties of angiotensin-converting enzyme (ACE) inhibitors in the elderly. The pharmacokinetics and efficacy of captopril, enalapril, and a new once-daily ACE inhibitor, quinapril for the treatment of hypertension in young and elderly patients are reviewed, and the safety profiles of these agents in young and elderly patients are discussed. Although the safely profile of all three drugs is very favorable, quinapril tended to be better tolerated by patients of all ages in comparative clinical trials.
Treatment of Hypertensive Urgencies with Oral Nifedipine, Nicardipine, and Captopril
Authors: Komsuoglu Baki , Şengün Bahtiyar , Bayram Ali , Komsuoglu Sezer Şener
Published: November 2007

Sixty-five patients with unclomplicated hypertenive urgencies were treated in the emergency and cardiology departments with 20 mg nifedipine, 20 mg nicardipine, or 25 mg captopril in a randomized study. The study population consisted of 65 patients ranging in age from forty-one to seventy-one. Blood pressure and heart rate were assessed for six hours after intake of the antihyper tensive agents. Within sixty minutes nifedipine reduced blood pressure by an average of 74.7 mmHg for the systolic and 35.4 mmHg for the diastolic. Average heart rate increased significantly by 11.6 beats/min at within thirty minutes. Nicardipine and captopril produced equivalent falls in systolic (-81.6 and -79.4 mmHg) and diastolic (-37.3 and -33 mmHg) blood pressure respectively, but did not increase heart rate significantly. The antihypertensive effect of each drug was maintained until six hours after medication.

In conclusion, nifedipine, nicardipine, and captopril show similar efficacy in the treatment of hypertensive urgencies. The authors believe that these drugs can be used as first-line therapy in the treatment of hypertensive urgencies safely and effectively.
Differentiation of Abnormal Blood Flow Patterns in Coronary Arteries Based on Doppler Catheter Recordings
Authors: Denardo Scott J. , Yock Paul G. , Hargrave Victor K. , Srebro James P. , Ports Thomas A. , Talbot Lawrence
Published: November 2007

Abnormal arterial blood flow patterns have been implicated as etiologic factors in thrombosis and atherosclerosis. Intravascular pulsed Doppler ultrasound techniques with fast-Fourier transform analysis offer the opportunity to measure these abnormalities. The authors hypothesized that statistical analysis of radial-directed beam spectra could be used to distinguish disturbed from nondisturbed flow and that analysis of conventional axial-directed beam spectra could then be used to distinguish laminar high-shear from laminar low-shear flow. They developed a scaled-up in-vitro model of coronary flow consisting of a glycerol/H 2O test fluid flowing through an acrylic cylinder at Reynolds numbers spanning the typical physiologic range within the coronary arteries. A scaled-up Doppler catheter with the capacity for 90° reflection of the beam was placed centrally. Disturbed flow was created by introducing a flow screen, and altered shear rates were produced by changing the Reynolds number. For the radial-directed beam studies, the coefficients of variation of the Doppler spectra for the disturbed flow states were significantly greater than for the nondisturbed flow states (p < 0.01). For the axial-directed beam studies, the coefficients of variation of the Doppler spectra for the laminar high-shear flow states were significantly greater than for the laminar low-shear flow states (p < 0.01). They conclude that abnormal blood flow patterns can be differentiated by the selective use of radial-directed and axial-directed Doppler catheter recordings.
Pentoxifylline in the Treatment of Distal Diabetic Neuropathy
Authors: Cohen Steven M. , Mathews Thomas
Published: November 2007

Painful diabetic distal sensory neuropathy is a disabling and common complication of diabetes mellitus. There is evidence that microvascular changes resulting in ischemia to the vasa nervorum may contribute to this problem. Pentoxifylline has been shown to improve circulation through partially occluded peripheral vessels and has been postulated to be of potential benefit. Forty adult type II diabetics were enrolled in a double-blind, placebo-controlled study utilizing pentoxifylline for six months. Visual analog scores, nerve conduction studies, and physical examinations were used to evaluate response to treatment, At the end of the six-month trial, there was no significant difference in the patients' pain between the pentoxifylline- and placebo-treated groups. The authors conclude that pentoxifylline is not useful in the treatment of painful distal diabetic neuropathy.
Duplex Ultrasonographic Insonation and Visualization of Intracerebral Arteries
Authors: Montefusco-von Kleist Cheryl M. , Rhodes Barbara A.
Published: November 2007

Until now, clinical, noninvasive interrogation of intracranial vessels has con sisted only of insonation via transcranial Doppler. Such devices have utilized a 2.0 MHz, continuous wave probe with Doppler spectral waveform display. Clinical application of these techniques has required precise location of cranial "windows" and has been hampered by the extreme anatomic variability of both cranial bony structures and intracerebral arteries. The lack of simultaneous in tracranial arterial visualization has limited the clinical applicability of transcranial Doppler technology.

Recently, the authors have utilized a 2.25 MHz curved phased array probe with a pulsed Doppler to image and insonate simultaneously the intracerebral arteries. Colorflow imaging of both near- and far-field regions is the necessary first step for vessel localization and identification. Once this is accomplished, the image of each artery in turn is amplified and gray scale tuning is employed to permit direct visualization of the arterial walls and lumen. Pulsed Doppler waveform analysis is performed simultaneously and along the entire visible ar tery length. In this manner the arteries of both right and left hemispheres are examined in detail.

We have found the duplex technique to be superior to the use of Doppler alone in the examination of intracerebral vessels. The ability to visualize and insonate simultaneously eliminates the uncertainty caused by anatomic varia tion. These advantages, long applied to the evaluation of peripheral vessels, are now available for use in the diagnosis of intracranial arterial disease.
Analysis of Blood Flow Patterns in Aortic Aneurysm by Cine Magnetic Resonance Imaging-
Authors: Matsuoka Hiroshi , Shigematsu Yuji , Ohtani Takashi , Sumimoto Takumi , Hamada Mareomi , Hiwada Kunio , Miki Hitoshi , Sadamoto Kazuhiko
Published: November 2007

Cine magnetic resonance imaging (MRI) (0.5-T) using rephased gradient echo technique was performed in 5 normal volunteers and 14 patients with aor tic aneurysm to study the patterns of blood flow in aortic aneurysm. In the transaxial section, blood flow in normal aorta appeared as homogenous and high intensity during systole. Blood flow in aneurysm appeared as inhomoge neous flow enhancement with flow void. In the sagittal scan, the homogenous flow enhancement in normal aorta was also observed during systole, and its apex of flow enhancement was "taper." The blood flow patterns in aneurysm were classified as "irregular," "zonal," "eddy," and "obscure," depending on the contrast of flow enhancement and flow void. Their apexes were "taper" or "round." When the size of aneurysm became larger, the flow pattern in aneu rysm tended to become "eddy" or "obscure" and the flow enhancement became "round." Though the exact mechanism of abnormal flow patterns in aneurysm remains to be determined, cine MRI gives helpful information in assessing blood flow dynamics in aneurysm.
Interdisciplinary Treatment of Morbidity in Benign Chest Pain
Authors: Cott Arthur , McCully Jane , Goldberg William M. , Tanser Paul H. , Parkinson William
Published: November 2007

This study tested the hypothesis that functional morbidity in benign chest pain can be modified independently of symptoms through interdisciplinary med ical and cognitive-behavioral intervention. Analyses used data collected in a sixteen-week trial of interdisciplinary treatment for disability in benign chest pain. One hundred four chest pain patients having normal coronary arteriograms (NCA) (n = 14) or mitral valve prolapse (MVP) with no other known cardiac or arterial disease (n = 90) were assigned to individual treatment, group treat ment, self-monitoring attention control, or a wait-list control group. Results in dicate that interdisciplinary intervention, in group or individualized format, was successful for improving short-term and long-term (follow-up range = six to sixteen months) functional status, in both MVP and NCA patients. Correlational analysis indicated that functional improvements were not dependent on reduc tions in the frequency of symptoms. In fact, significant reductions in disability were obtained in those treated patients (13 of 43) who reported no reduction, or an actual increase, in the frequency of chest symptoms. These data indicate that disability in benign chest pain may be modified independently of symptoms by an integration of medical and cognitive-behavioral strategies.
Intimal Cell Population and Location in Arteries of Japanese Children and Youth
Authors: Nakamura Hiroyuki , Sakurai Isamu
Published: November 2007

It seems important to study initial changes in any sort of disease to elucidate its pathologenesis. Arterial atherosclerosis varies in its severity and extent be tween each artery. By macroscopic and immunocytochemical studies on aortas and coronary arteries of young Japanese people, the following results were ob tained. Fatty streaks are more frequently discovered in aortas than in coronary arteries, while coronary arteries tend to disclose a higher frequency of diffuse intimal thickening with more smooth muscle cells and fewer macrophages. But there is not much difference in frequency of fibrous plaques between the two arteries. Lesions of localized elevation appear to have many more macrophages in coronary arteries. There must be significant structural and functional differ ences in the "normal" state between aortas and coronary arteries, which may suggest that it is necessary to pay attention to the characteristics specific to each artery in studying the pathogenesis of atherosclerosis.
Intracardiac Extension of a Calcified Ovarian Hemangioma— A Case Report
Authors: Tamburino Corrado , Russo Giovanni , Incognito Carmela , Battaglia Giuseppe , Monaca Vincenzo , Lomeo Alberto , Abbate Mauro
Published: November 2007

The authors report a case of a fifty-five-year-old woman with clinical and echocardiographic diagnosis of right atrial myxoma. At fluoroscopy and phle bography a mobile calcified peduncle was appreciable originating from the left ovarian vein. This passed through the inferior cava to the right atrium where it wound round itself and extended into the right ventricle during diastole. The authors suspected the presence of a vascular leiomyoma.

The tumor and its peduncle were removed by pulling through the right atri um during extracorporeal circulation. The site of origin was confirmed at pelvic surgery.
Evaluation of Reflex Cold Provocation by Laser Doppler Flowmetry in Clinically Healthy Subjects with a History of Cold Hands
Authors: Gasser P. , Müller P. , Mauli D. , Stäubli C.
Published: November 2007

The aim of the present study was to investigate capillary blood flow and the reaction to cold provocation by means of laser Doppler flowmetry (LDF) and measurement of skin temperature at the fingertip of 39 healthy subjects who had a history of cold hands and feet but were free of any clinically significant vasospastic symptoms. A group of 39 sex- and age-matched healthy subjects without such complaints served as the control.

The anamnestic complaints about cold hands and feet could be substantiat ed by the presence of a lower baseline skin perfusion and temperature. However, the maintenance of the normal range of reagibility to a reflex contractile stimu lus with an unaltered potential to recover distinctly separates these subjects from patients with Raynaud's disease.
Evaluation of the Antihypertensive Effect of Lisinopril Compared with Nifedipine in Patients with Mild to Severe Essential Hypertension
Authors: Eber Bernd , Brussee Helmut , Rotman Brigitte , Kramer Rudolf , Klein Werner
Published: November 2007

For several reasons, increasing numbers of patients with hypertension are treated with angiotensin-converting enzyme inhibitors and calcium channel block ers. In a twenty-four week, double-blind, randomized, parallel study, the anti hypertensive effect of lisinopril (20 to 80 mg qd) and nifedipine (20 to 80 mg bid) were compared in 21 patients. Fourteen patients received lisinopril (mean dose 35 mg), and 7 patients received nifedipine (mean dose 54 mg). By the end of week 12, 8 patients had responded (supine diastolic pressure ≤ 90 mg) to lisinopril and 5 to nifedipine. At the end of the study supine systolic/diastolic blood pressure was reduced from 172/104 to 149/92 mmHg with lisinopril and from 171/102 to 158/94 mmHg with nifedipine. No significant difference be tween the two treatments was detected. Three patients were reported to have at least one clinical adverse experience during the active treatment period, 1 in the lisinopril group and 2 in the nifedipine group. No serious clinical adverse experiences were recorded.

In conclusion, lisinopril and nifedipine are both effective in reducing blood pressure in patients with mild to severe hypertension. Lisinopril qd and nifedi pine slow release bid produce similar decreases in blood pressure after twelve weeks of therapy and the safety profiles of the two drugs are similar.
Skin Flow The Venoarteriolar Response and Capillary Filtration in Diabetics. A 3-year Follow-Up
Authors: Belcaro G. , Nicolaides A.N. , Volteas N. , Leon M.
Published: November 2007

Resting skin blood flow (RF) and the venoarteriolar response (VAR = the vasocontrictor response on standing) have been studied in 100 patients with dia betic neuropathy, in 100 diabetics without neuropathy, and in 100 normal sub jects by laser Doppler flowmetry. Capillary filtration was also studied with strain gauge plethysmography. The authors followed up these patients by evaluating their microcirculation again after three years.

At the beginning of the study in patients with neuropathy, RF and capillary filtration were increased. The VAR and the microangiopathy index (MI = VAR/RF) were reduced in all diabetics, to a greater extent to those with neuropathy.

After three years the authors observed an increase in capillary filtration as sociated with a further impairment in VAR and MI, suggesting progression of microangiopathy in both groups of diabetics.

These results suggest that the postural control of blood flow in the skin of the foot is impaired in diabetic microangiopathy, particularly in neuropathics. Increased skin blood flow and capillary filtration and the impaired venoarterio lar response cause edema and may contribute to the thickening of capillary base ment membranes and the progressive evolution of diabetic microangiopathy.
A Four Year Clinical and Echographic Follow-up of Asymptomatic Carotid Plaque
Authors: Fabris F. , Poli L. , Zanocchi M. , Bo M. , Fiandra U. , Fonte G.
Published: November 2007

Eighty-five patients with asymptomatic carotid plaque—a diagnosis revealed by B-mode high-resolution echotomography—were followed up for four years; the echoplaque changes were compared with the clinical history. Eight patients died (2 from stroke, 4 from myocardial infarction, and 2 from lung tumor) and were excluded from the follow-up. Three patients underwent carotid thromboen darterectomy (TEA) (1 bilateral), and these 4 carotids were not considered in the total series.

At the first echo Doppler evaluation of 150 carotids, plaques were observed in 112; 38 vessels were free of lesions.

Of the 150 carotids, 8 revealed a new plaques. In regard to the echogenic pattern, 95 of the 112 plaques (84.8%) remained unchanged, 16 (14.3%) progressed, and regression of a small homogeneous plaque was observed in 1 patient (0.9%). An increase of the degree of vascular stenosis, was observed in 23 of the 150 carotids (15.3%).

Cerebral ischemic symptoms occurred in 5 patients. In 1 patient who suffered from stroke, a new, soft, dyshomogeneous plaque in the carotid of the side of the lesion was observed. In 3 patients (2 with strokes, 1 with transient ischemic attack) the occlusion of a previous severe stenosis was observed. The fifth pa tient had a stroke on the side of an unchanged, ulcerated hemodynamic lesion.

A valid criterion for identifying a risky plaque should be the joint evaluation of the echostructural characteristics and the degree of stenosis.
Clinical Application of Magnetic Resonance Imaging of the Heart and Great Vessels
Authors: MacMillan Robert M. , Ivanoff John , Tulchinsky Mark , Chandrasekaran K.
Published: November 2007

This report reviews the clinical applications of magnetic resonance imaging, (MRI) for the heart and great vessels based on the first 120 patients studied with 1.5 Tesla scanner. Cine scans were obtained in 85% of patients studied with the remainder having T1 spin-echo imaging. MRI provides high-resolution multiplanar images for defining abnormalities in cardiac structure and is especially useful for congenital heart disease. Cine MR evaluates cardiac dynamic functions such as left ventricular volumes and ejection fraction, left ventricular segmental wall motion, and valvular function. It is also useful for detection of aortic and pul monary arterial disease and diseases of the pericardium. It is concluded that MR has broad applications for diagnosis of cardiac and great-vessel disorders.
Contemporary Treatment of Venous Lower Limb Ulcers
Authors: Hiatt William R.
Published: November 2007

The postphlebitic syndrome is a significant management problem that af fects a large number of patients. Primary prophylaxis of deep-vein throm bophlebitis would reduce the risk of developing the postphlebitic syndrome and should be considered in high-risk patients. Patients who have had a phlebitis should be monitored with noninvasive tests of the deep venous circulation for the development of venous valve incompetence. Patients with venous hyperten sion should be placed in compression stockings to prevent the postphlebitic syn drome. In patients who progress to venous ulceration, several aggressive measures must be undertaken. Systemic treatment includes management of obesity, edema, immobility, poor nutrition, and comorbid illnesses. Some pa tients may require a short hospitalization of bed rest, lower limb elevation, and daily dressings and wound care. Outpatient therapy requires sustained com pression of 35 to 40 mmHg at the ankle for many months to allow the ulcer to heal. The standard bandage material is Unna's boots, which is applied every one to two weeks by a trained nurse. Cadexomer iodide is an effective local treat ment that helps debride the ulcer and accelerate healing. Finally, pentoxifylline therapy has also been shown to significantly improve the healing of venous ul cers.
Venous Occlusion Secondary to Subluxation of the Shoulder — A Case Report
Authors: Friedman Sandor A. , Doshi Rashmikant , Patel Rajendra , Hedayati Reza
Published: November 2007

This is the case report of an eighty-seven-year-old woman who was seen be cause of swelling of her left upper extremity and breast of one week's duration. She had a history of severe arthritis of the knees and had been wheelchair-bound for seven years. Venography showed compression of the cephalic vein and throm bosis of the distal basilic vein with extension into the axillary and subclavian veins. To the author's knowledge, this is the first case report of venous throm bosis in association with subluxation of the shoulder.
A Case of Ventricular Tachycardia Refractory to Medical Treatment Related to a Cystic Mass in Left Ventricle— A Case Report
Authors: Özcan Mustafa , Wijers Theodorus Steven , Öztürk Muzaffer , Güzelsoy Deniz , Firatli Inci , Öztürk Servet , Demiroğlu Cem'i
Published: November 2007

This is a case report of a twenty-two-year-old woman who had attacks of ventricular tachycardia that could be prevented by the use of various antiarrhythmic drugs for three months. Electrophysiologic study showed that the mechanism of the tachycardia was "reentry." In cardiac catheterization a non-contractile mass having calcification was seen on the apical portion of the left ventricle. Angiographically, the mass resembled a diverticulum. Recurrence of attacks was terminated by resection of this mass, which had a cystic appearance.
The Impact of Solid-Phase Gastric Emptying Studies in the Management of Children with Dyspepsia
Authors: Aktay Atiye Nur , Werlin Steven L. , Hellman Robert S.
Published: November 2007

Information on the utility of solid-phase gastric emptying studies (SPGES) in the evaluation of children with symptoms of upper gastrointestinal (GI) motor dysfunction is limited. This study was conducted to evaluate the impact of SPGES in the clinical management and outcome of children with upper GI symptoms suggestive of gastroparesis. The records of 45 children who underwent SPGES (31F; 3-17 years) were reviewed. All patients had GI symptoms suggesting gastroparesis. Patients were fed with Tc-99m-sulfur colloid-labeled chicken liver. Adult normal half-life (T1/2) values (F 103±14 minutes; M 66±13.6 minutes) were used. The relationships among symptoms, treatment, and outcome were evaluated. Of the 45 patients 9 had delayed, 16 had rapid, and 20 had normal gastric emptying. Six of 9 patients with delayed gastric emptying responded to cisapride. Four of 16 patients with rapid emptying were diagnosed with the dumping syndrome. Of the children with rapid gastric emptying, 87% were females. Twenty patients with normal emptying were diagnosed with gastroesophageal reflux (8), nonulcer dyspepsia (5), irritable bowel syndrome (2), Helicobacter pylori (1), lactose intolerance (1), eosinophilic gastroenteritis (1), duodenitis (1), and constipation (1). In patients who had SPGES for possible gastroparesis, 20% had gastroparesis, 36% had rapid gastric emptying, and 44% had normal gastric emptying. The high number of females in the rapid gastric emptying group might be secondary to normal adult female T 1/2 values that were used. The practice of using adult normal T 1/2 values in prepubertal girls may need to be revised. Patients with delayed gastric emptying responded to cisapride. Clin Pediatr. 2003;42:621-625
A Look at the Pediatrician as Parent: Experiences with the Introduction of Varicella Vaccine
Authors: Katz-Sidlow Rachel J. , Sidlow Robert
Published: November 2007

Many physicians voiced reservations about routine use of the varicella vaccine for healthy children after its licensing in 1995. Anecdotal evidence suggested that some pediatricians who were parents themselves were electing not to vaccinate their own children against chickenpox. Little has been written about pediatrician-parents' behaviors in caring for their own children, and how these practices may differ from the behavior that these same pediatricians apply in practice. Pediatricians' tacit attitudes toward medical interventions might be better understood from their behaviors as parents than from their clinical practices, which may be influenced by a sense of responsibility to follow guidelines of professional organizations. Varicella vaccination practices were examined to determine whether pediatricians' behaviors in parenting their own children differed from their recommendations for their patients. A mail survey was sent to 1,762 New York State pediatricians selected randomly from the membership directory of the American Academy of Pediatrics. The response rate was 43% (764/1,762); 63% of responding pediatricians were parents. Eighty-five percent of pediatricians recommended varicella vaccine routinely in practice. Of the pediatricians' own eligible children, 88% (256/291) had been vaccinated against chickenpox. We found a high overall rate of compliance with recommendations for routine use of varicella vaccine. Pediatricians who were parents were just as likely as nonparent pediatricians to recommend the vaccine routinely for their patients. Importantly, pediatrician-parents demonstrated no "double standard"; at the time of the study, 88% of pediatricians' own eligible children had been vaccinated against varicella.
Congenital Anorectal Anomalies
Authors: Gans Stephen L. , Friedman Nathan B. , David Joseph S.
Published: November 2007

There are two classifications of anorectal anomalies currently advocated. This pres entation represents one of them and the other is a system strongly recommended by A. H. Bill and his associates in Seattle. Neither system can be legislated but the reader should be aware of both until one takes precedence.
Viral and Drug Hazards in Pregnancy
Authors: Connelly John P. , Reynolds Stephen , Crawford John D. , Talbot Nathan B.
Published: November 2007

Should pregnant mothers be immunized against smallpox? Poliomyelitis?

What is the incidence of fetal loss or major congenital anomalies if a pregnant woman contracts rubella? Poliomyelitis? Rubeola? Mumps? Or varicella? Is there a relationship to the time of the infection during pregnancy and congenital anomalies?

Is there a higher fetal mortality associated with the use of the sulfonylurea drugs for pregnant diabetic mothers?

Are progesteroids harmless to the fetus when given to a pregnant woman? Anti-thyroid drugs? Thiazides?
Choanal Atresia
Authors: Montgomery William W. , Connelly John P. , Robinson John C.
Published: November 2007

Unilateral choanal atresia is repaired by simply removing a portion of the posterior nasal septum. The trans- palatal correction of bilateral choanal atresia is explained and illustrated.
Neonatology Review : Infants of Diabetic Mothers
Authors: Van Leeuwen Gerard , Jackson Robert L.
Published: November 2007

The infant of the diabetic mother continues to be a critical problem for the clinician in that approximately 35 per cent of conceptions of diabetic mothers end in intra-uterine or neonatal death. This report outlines the problems posed by these infants, reviews some recent ad vances in knowledge, suggests additional research which must be done, and outlines a program of management.
Basic Science Review : Nonspecific Resistance to Infection
Authors: Florman Alfred L.
Published: November 2007

There is a need for a new strategy for prophylaxis against infection to aug ment the use of vaccines. The prospects for nonspecific resistance enhancers are exciting. This discussion may encourage pediatricians to take another look at factors involved in nonspecific resistance to infection.
Blood Pressure in Children
Authors: Londe Sol
Published: November 2007

From painstaking measurements of the supine blood pressure in 735 healthy boys and 738 healthy girls, this study done in St. Louis, Mo., establishes needed refer ence standards for both 80 and 90 per cent ranges of both systolic and diastolic blood pressure readings.
Special Review : Suicide Among Young Persons
Authors: Faigel Harris C.
Published: November 2007

Suicide now outranks pneumonia, polio, tuberculosis, diabetes, rheumatic fever, kidney disease, appendicitis and leukemia as a cause of death in teenagers. Only accidents and cancer are more common lethal problems. On college campuses today, suicide is second only to accidents as a cause of death. This report at tempts to examine the reasons behind a young person's urge toward self-destruction.
A Simplified Method for Diagnosing Group A Beta Hemolytic Streptococci
Authors: Kramer Irving , Goldstein Eugene
Published: November 2007

This office technic makes possible the identification of group A beta hemolytic streptococci within eight to 24 hours. De signed by men in private practice for fast, accurate results, this method has been used in 700 successive throat cultures from patients seen in the authors' office.
The Biochemistry of Lead
Authors: Berman Eleanor
Published: November 2007

Lead is a cumulative poison. Though prevalent in man's environment, only a fraction of what is ingested is absorbed. Slow acting and subtle, lead is powerful and produces a variety of symptoms with many body tissues vulnerable.
Earlier Puberty
Authors: Hubble Douglas
Published: November 2007

Young people take very seriously in deed the composite of anatomic, physio logic, psychologic and social changes which attend their transition from child hood into adulthood.

Dr. Hubble here considers the sexual aspects of some of these changes which adolescents are today confronting in the United Kingdom, the United States, and other similar countries.
Long-Term Remissions in Childhood Acute Leukemia
Authors: Djerassi Isaac , Abir Esshagh , Royer George L. , Treat Carmen L.
Published: November 2007

Here reported is the present status of studies exploring the possibility of large- scale destruction of leukemic cells by the use of infrequent but regular massive treatments with chemotherapeutic agents, aided by unusual supportive measures. Many noteworthy long remissions have been observed.
Tuberculosis In Adolescents
Authors: Smith Margaret H.D.
Published: November 2007

Tuberculosis in adolescents has de clined in recent years, concurrent with the decrease in tuberculosis in the world pop ulation as a whole. Nevertheless tubercu losis still remains an important cause of death in this age group and poses special problems in diagnosis and treatment.
Therapeutic Review : The Ototoxic Antibiotics
Authors: Meuwissen Hilaire J. , Phil B. , Robinson Geoffrey C.
Published: November 2007

This paper briefly discusses the action of the ototoxic antibiotics on the human labyrinth, reviews their pharmacologic properties and summarizes their clinical indications.
Counselling the Parents of the Mentally Handicapped Child
Authors: Illingworth R.S.
Published: November 2007

"Pediatricians have the unpleasant but important responsibility of breaking the news of mental subnormality to the par ents and then discussing with them the problems involved. We fail in our duty when we shirk this responsibility because of lack of time, laziness, ignorance of how to do it, or failure to be informed of the ways in which we can help."
Cystic Disease of Liver and Kidney with Portal Hypertension
Authors: Bradford William D. , Bradford John W. , Porter Stanley , Sidbury James B.
Published: November 2007

Cystic disease of the liver and kidney has a genetic basis, and is more frequent in females. When portal hypertension accom panies this malformation the patient often presents with sudden, unexpected hemateme sis.

Severe or unusual infections, difficult to treat, represent other problems for the clini cian. One of the two patients here described was found at autopsy to have superimposed signs of cytomegalic inclusion disease in lungs and liver.
Psychologic Approach to Psychosexual Misidentity with Elective Mutism
Authors: Money John
Published: November 2007

Two cases of hyperadrenocortical fe male hermaphroditism illustrate that psy chosexual identity may differentiate inde pendently of genetic, gonadal, hormonal and morphologic sex, and also of assigned sex. One child, assigned as a boy, elected by age 12 to be reassigned as a girl. The other child, assigned as a girl, elected by age 11 to be reassigned as a boy. It was possible to overcome the psychologic handicap of their elective mutism, espe cially by the use, initially, of drawing, writing and modeling.

These cases illustrate the general rule that proper weighting must be given to psychosexual differentiation and the sense of gender identity before a decision for or against sex reassignment can be valid. A sex reassignment can be success fully undertaken if it resolves incongruity between gender identity and assigned sex, or if the gender identity is ambivalently noncommittal. Otherwise sex reassign ment is contraindicated.