bluuebunny/crossref_metadata_2025 huggingface dataset:
Effect of the Kallikrein Inhibitor Aprotinin on Myocardial Ischemia and Necrosis in Man
Authors: Ceceña-Seldner Felipe A. , Villarreal Jorge
Published: November 2007

The effect of administration of aprotinin, a serine esterase inhibitor capable of inactivating kallikrein, on the extent and severity of acute myocardial is chemic injury and subsequent necrosis, was studied in 25 patients. Another group of 25 patients who did not receive aprotinin served as a control group. We administered 100,000 kallikrein inhibitor units (KIU) of aprotinin as a bolus dose, followed by a continuous infusion (4 ml/min) that contained 10,000 KIU/kg in 240 ml of dextrose/water solution, to all 25 patients admitted to the hospital within 30 to 60 minutes after the onset of acute myocardial ischemia.

To measure the effect of aprotinin, three parameters were studied; the sum of S-T segment elevations (ΣST), the development of Q waves, and the predic tion of infarct size by measuring the disappearance rate of creatine phosphoki nase (MB CPK isoenzyme).

The average ΣST in the treated group decreased from 40.5 ± 7.00 mv to 12.95 ± 4.60 mv (P < 0.01); in contrast the control group's ΣST did not change significantly, from 54.25 ± 8.02 to 51.7 ± 6.8. Deeper Q waves evolved in the control group compared to the treated group: ΔQ (6 hours) = 1.0 ST (15 min) + 1.19 (25 patients, r = 0.78); and in the treated group ΔQ (6 hours) = 0.66 ST (15 min) + 0.91 (25 patients, r = 0.65) (P < 0.025).

In the control group the estimated infarct size was 57.4 ± 4 CPK-gram- equivalents (CPK-g-Eq). There was significantly less damage in the treated group: 19 ± 2 CPK-g-Eq (P < 0.01). Thus we conclude that aprotinin dimin ishes myocardial damage.
Cardiac Arrest in a Physician-Directed Cardiac Rehabilitation Program: A Clinical and Angiographic Profile of Two Cases
Authors: Rothfield D. , Werres R. , Rommer T.C. , Pongpoonsuksri V.
Published: November 2007

Two cases of ventricular fibrillation occurring during a physician-directed exercise program are described. Both were successfully resuscitated. No single clinical parameter can predict which patient is at increased risk for exercise-in duced ventricular fibrillation. We conclude that all cardiac patients who wish to exercise should do so only with physician supervision.
Effect of Therapy With the Pneumatic End-Diastolic Leg Compression Boot on Peripheral Vascular Tests and on the Clinical Course of Peripheral Vascular Disease
Authors: Dillon Richard S.
Published: November 2007

The Circulator Boot™ is a new end-diastolic pneumatic leg compression device. This report describes its effect on 6 normal young people, 8 ambulatory patients with mild peripheral arterial disease, and 21 consecutive patients (of whom 18 were hospitalized) with severe peripheral arterial disease in 25 legs. The courses of 4 patients are discussed in detail. Significant beneficial effects were documented by subcutaneous PO2 levels, pulse volume measurements, ankle blood pressure measurements, and Doppler ultrasound tracings. Twenty- two of the 25 severe legs benefitted clinically from therapy. Immediate thera peutic effects from the boot are attributed to decreases in venous pressure, in terstitial fluid pressure, vasoconstriction, and viscosity, and to increases in car diac output, pulse pressure, and fibrinolysis in the treated leg. The long-term beneficial effects of boot therapy may be related to improved collateral flow and to the rechanneling of obstructed vessels.
Intravenous Regional Guanethidine Treatment in Peripheral Vascular Disease
Authors: Olshwang D. , Beer G. , Magora F.
Published: November 2007

Twenty-eight patients with spastic and obstructive vascular disease were treated with intravenous regional guanethidine (IRG). The drug was injected into the affected hand or foot in doses of 10 or 20 mg, respectively. Temper ature and strain-gauge plethysmography curves of the extremity were recorded before treatment, and three to four times during the subsequent 10 days. The effects of IRG, as observed by clinical laboratory examinations, were good in 8 of 12 patients. But in patients suffering from Bürger's disease or from major vessel obstructive disease, the results were not as good. However, in most pa tients IRG proved beneficial in relieving pain, an effect which sometimes out lasted objective improvements. IRG treatment is a simple and safe method for prolonged chemical sympathectomy.
Detection of Retroperitoneal Hemorrhage After Translumbar Aortography by Computerized Tomography
Authors: Yandow Donald , Wojtowycz Myron , Alter Albert , Crummy Andrew
Published: November 2007

Thirty-seven patients were examined by CT scan within 24 hours of translumbar aortography. Eighteen of them had signs of hemorrhage, of which psoas asymmetry was the most common. Para-aortic densities and obliteration of the aorta were the next most frequent manifestations. CT scanning can be a useful tool in selected cases to detect or follow hemorrhage after aortography by the translumbar approach.
Effect of Potassium Infusion on the Human Conduction System
Authors: Gould Lawrence , Ramana Reddy C.V. , Becker William H. , Oh K.C. , Kim S.G.
Published: November 2007

His bundle electrograms were recorded in 12 patients before and after the intravenous administration of 5 mEq of potassium. Antegrade and retrograde refractory periods were determined with the extrastimulus technique. The AH interval was 84 ± 7 msec before and 89 ± 7 msec after potassium ( P < 0.05). The AH interval at an atrial pacing rate of 140/minute was 129 ± 13 msec be fore and 143 ± 16 msec after potassium ( P < 0.02). The effective refractory pe riod of the atrium was 264 ± 9 msec before and 280 ± 9 msec after potassium ( P < 0.001). Thus small amounts of potassium delay conduction at the atrial and AV nodal level.
Platelet Aggregation Measured by the Screen Filtration Pressure Method in Hypertensive Patients
Authors: Pagnan A. , Faggiotto A. , Visona A. , Davanzo S. , Pessina A.C. , Dal Palú C.
Published: November 2007

In this study platelet aggregation was measured by the screen filtration pressure method in 2 groups of hypertensives separated according to age. They were perfectly matched for levels of various "risk factors", with normotensive "controls".

No significant difference in platelet aggregate filtration pressure (PAFP) was found between hypertensives and normotensives. Contrary to normoten sive subjects, there was no significant increase in the PAFP values with age in the hypertensives. This might be due to the significantly higher blood urea values in the hypertensives as compared to the normotensives. An inverse relationship between blood urea concentration and PAFP values was in fact confirmed by in vivo and in vitro studies.
Hybrid Exercise Echocardiograph
Authors: Berberich Stephen N. , Zager James R. S.
Published: November 2007

A technique is proposed using the advantages of M-mode echocardiogra phy for specific chamber measurement and 2-dimensional recordings for spatial orientation. Using data derived from radionuclide experience, a com bined echocardiographic exercise test was developed.

This test was used to evaluate 22 patients being studied for ischemic heart disease. Results in these patients suggest good sensitivity and specificity. The test may be of value in improving upon standard exercise testing.
Venous Plethysmography: Measuring Techniques and Normal Values
Authors: Pointel J.P. , Gin H. , Drouin P. , Vernhes G. , Debry G.
Published: November 2007

A fixed procedure of strain gauge plethysmography in a control population aged between 20-30 years allows normal values for venous parameters (venous distensibility, emptying, and resistance) and capillary filtration coefficient, to be determined. High speed recording reveals two phases in venous emptying, one passive, purely elastic, and a second active phase, resulting from venous constriction.
Amputation of the Ischemic Limb: Selection of the Optimum Site by Thermography
Authors: Spence V.A. , Walker W.F. , Troup I.M. , Murdoch G.
Published: November 2007

This report describes the value of infrared thermography in assessing the optimum level of amputation of an ischemic limb. Interpretation of thermo- grams and the factors that can significantly alter the thermal image of the lower limbs are detailed. Results from 104 patients demonstrate that the thermographic method is a reliable indicator of the level of a major limb amputation. A rationale for the inadequacy of the method when attempting to determine the outcome of a partial foot amputation is considered.
Interruption of the Aortic Arch With Complete Transposition of the Great Arteries
Authors: Schneeweiss Adam , Shem-Tov Abraham , Blieden Leonard C. , Deutsch Victor , Neufeld Henry N.
Published: November 2007

The association of complete trans portation of the great arteries and com plete interruption of the aortic arch is very rare. This combined lesion was diagnosed clinically in a 1-day-old in fant in whom it caused cyanosis of the upper half of the body. The diagnosis was confirmed angiocardiographically. We believe this is the youngest patient in whom this diagnosis was made in vivo.
Platelet Adhesiveness: Methodology for Testing in Humans
Authors: Jacobi E. , Bremer G. , Richter O.
Published: November 2007

Platelets play an important role in the pathogenesis of early thrombus formation and might even be involved in initiating the process of atheroscle rosis.

Various platelet adhesiveness test methods are discussed. Results of an in vitro test in about 600 patients with various diseases are given.

The effect from anti-platelet drugs like dipyridamole and acetyl salicylic acid in preventing increase of platelet adhesiveness due to a biologic stressor are compared with those obtained with isoxsuprine.

Platelets play an important role in the pathogenesis of early thrombus formation. Platelets might also be involved in initiating the process of atherosclerosis. Therefore, it is understandable that various test methods to measure platelet behavior has been developed.
Comparison of Safety and Efficacy of Buflomedil and Naftidrofuryl in the Treatment of Intermittent Claudication
Authors: Rosas Guillermo , Cerdeyra Cristina , Lucas Miguel A. , Parano Jorge R. , Villa Juan J.
Published: November 2007

In a group of 58 patients with peripheral arteriopathies, we have studied efficacy and safety of buflomedil hydrochloride and naftidrofuryl. Both drugs have been shown to have vasoactive properties evaluated through walking capacity and time of hyperemia. According to our results, buflomedil is more effective and safe than naftidrofuryl in the treatment of patients with intermittent claudication.
Ratio of Total Amplitude to Diastolic Wave on the Apexcardiogram. Findings in Aortic Regurgitation and Other Cardiac Lesions
Authors: DeSa'Neto Artur , Reyns Philippe , Desser Kenneth B. , Benchimol Alberto
Published: November 2007

Utilizing the apexcardiogram, the ratio of total amplitude to the height of the total diastolic wave was determined. Compared with a mean (± 1 SD) value of 21 ± 4% for normal subjects there were statistically significant differences in those patients with isolated aortic regurgitation (30 ± 10%, P = 0.01), aortic stenosis (12 ± 11%, P < 0.025) and mitral insufficiency (14 ± 8%, P < 0.025). There were no significant changes of this ratio in subjects with combined aortic stenosis and insufficiency (24 ± 9%, P < 0.25), triple vessel coronary artery disease (19 ± 7%, P < 0.25) and mitral valve prolapse (23 ± 10%, P < 0.35). There was a trend for higher ratio values in patients with greater angiographic evidence of aortic insufficiency, but no correlation between the ratio and left ventricular end-diastolic pressure. These altera tions of the apexcardiogram accord with hemodynamic findings in the presence of each respective lesion. It is concluded that this ratio is useful for the noninvasive assessment of isolated aortic regurgitation, aortic stenosis and mitral insufficiency.
Lymphatic Abnormalities in Protein-Losing Gastropathy, Especially in Ménétrier's Disease
Authors: Miura Soichiro , Asakura Hitoshi , Tsuchiya Masaharu
Published: November 2007

Histopathologic and lymphographic studies were performed in 4 patients with protein-losing gastropathy to elucidate the degree of lymphatic disorders and their contribution to clinical features. Histologic examination of gastric mucosa showed various degrees of hyperplasia of the surface epithelium and cystic dilatation of glands, which were considered to be characteristic findings of protein losing gastropathy. Moreover, in 3 of 4 patients there were edematous change of the lamina propria or the submucosa, and marked lymphangiectasia was seen in the submucosa of 3 patients and in the lamina propria of the other. Performed lymphograms showed an increase in the number of lymphatic vessels and lymph nodes in the iliopelvic and lumbar regions of 2 of the patients. This high incidence of lymphatic abnormalities in patients with protein-losing gastropathy suggested that such systemic lymphatic disorders were an important etiologic factor. However, such ab normalities in lymphatic system were not demonstrated in all cases of protein-losing gastropathy. Therefore, lymphatic disorders were not consid ered to be the primary cause of gastric protein loss, but the important factor that modifies the variety of lost protein and its clinical features.
Invasive and Noninvasive Phonocardiography And Orifice-View Aortography in the Diagnosis of Left Ventricular Outflow Obstruction
Authors: Stein Paul D.
Published: November 2007

Phonocardiography and orifice-view aortography for the detection of val vular and subvalvular stenosis is reviewed. Intracardiac phonocardiography may be useful in detecting a left ventricular outflow tract obstruction, and in distinguishing it from other conditions that can produce an apparent pressure gradient during cardiac catheterization. The frequency analysis of heart sounds on noninvasive phonocardiograms may be useful in identifying sub- clinical aortic stenosis. Orifice-view aortography can show the anatomy of deformed aortic valves and is useful in measuring the orifice area. In patients with heavily calcified valves, plain orifice-view roentgenograms may enable one to assess the valve area. Therefore the use of these techniques in selected patients may help establish a definitive diagnosis.
Heart Block in Marfan's Syndrome
Authors: Keidar Shlomo , Grenadier Ehud , Cohen Leon , Palant Avraham
Published: November 2007

Marfan's syndrome is classified as a heritable disorder of connective tissue in which the supporting structure is involved in clinical and pathologic alterations. In its classic form the syndrome is associated with abnormalities of the eye, aorta, and the skeleton. Conduction disturbances and ventricular arrhythmias have rarely been described in this syndrome. In this brief case report a patient with symptomatic heart block, prolonged atrial-His interval and ventricular arrhythmia in whom a permanent ventricular pacemaker has been implanted, is described.
Acute Myocardial Infarction Induced by Ergotamine Tartrate: Possible Role of Coronary Arterial Spasm
Authors: Yasue Hirofumi , Shingo  , Omote  , Takizawa Akinori , Nagao Masao
Published: November 2007

A 45-year-old woman with almost normal coronary arteries suffered from acute inferior myocardial infarction after taking 2 tablets (2.0 mg) of ergotamine tartrate for headache. She had had attacks of variant angina and spasm of the right coronary artery had been demonstrated during the attack. After the recovery from myocardial infarction the intravenous injection of ergonovine maleate 0.05 mg induced spasm of the right coronary artery again. We conclude that acute myocardial infarction in this patient was probably caused by coronary arterial spasm induced by ergotamine tartrate.
Restoration of Pulmonary Perfusion by a Serotonin Antagonist
Authors: Kalenda Z. , Hölzenspies A.J.
Published: November 2007

R 41 468, a selective serotonin receptor blocking agent, was found to improve pulmonary perfusion in patients with venous air embolism, in patients with adult respiratory distress syndrome (ARDS), and in certain cases of impairment of the pulmonary circulation during prolonged major surgery accompanied by blood transfusion.

Continuous monitoring of end-tidal CO2 (FETCO2) by means of infra-red capnography combined with blood gas estimations were the principle meth ods of assessment used.
Duration of Hospital Stay and Post- Myocardial Infarction Morbidity and Mortality: A Kaiser-Permanente Experience
Authors: Skoulas Achilles , Alloo Robert G. , Weisbart Myron H. , Manelis Marc A.
Published: November 2007

Among 209 evaluable consecutive patients (mean age 57 years) admitted in 1978 and 1979 for acute myocardial infarction, 186 survived. The mean hospital stay of the survivors was 9.7 days. Of these patients, 99 (53%) with complicated myocardial infarction had a mean hospital stay of 11.2 days; 87 (47%) with uncomplicated infarction had a mean stay of 7.9 days.

All patients were followed for at least 6 months. During the 6-month post- hospitalization interval, the overall mortality was about 6%. Of the 12 patients who died, 11 had complicated, and 1 had uncomplicated myocardial infarction.

The reinfarction rate in 6 months was 4% for complicated and 2% for uncomplicated infarction. Congestive heart failure was 3% for complicated and zero for uncomplicated infarction.

Comparing these findings with reported series of patients with longer hospitalizations, we found no evidence that shortened hospitalization ad versely affects mortality or morbidity.
Myocardial Protection by Lidoflazine during One-Hour Normothermic Global Ischemia
Authors: Daenen W. , Flameng W.
Published: November 2007

The cardioprotective effects of lidoflazine, a drug with calcium homeostatic properties, were studied in 12 dogs (6 drug-treated and 6 controls) subjected to 1-hour normothermic global ischemia. None of the control dogs could be weaned from the extracorporeal bypass after 30 minutes of reperfusion. In contrast, all acutely pre-treated animals were able to support their own circulation. Recovery of pre-ischemic values in this group was 97 ± 3% for systolic aortic pressure, 69 ± 7% for diastolic aortic pressure, 97 ± 10% for left ventricular pressure, and 84 ± 11% for cardiac output.

Electron microscopy and calcium cytochemistry were done on left ventric ular biopsies taken before, during, and after ischemic arrest.

In the control group, severe damage to the sarcolemma and the mitochon dria was found at the end of the ischemic period and became more prominent after 5 and 30 minutes of reperfusion. There was great accumulation of calcium in the damaged mitochondria. In the lidoflazine-treated dogs, these lesions were largely prevented.

These findings suggest a strong cardioprotective effect of lidoflazine during severe myocardial ischemia.
Prinzmetal's Angina: Atypical Angiographic Features of Atypical Angina Pectoris
Authors: Slack John D.
Published: November 2007

Clinicians have puzzled over the coronary physiology associated with atypical angina pectoris for the past century. Recent recognition of coronary artery spasm, which has been so thoroughly documented with coronary angiography, has resolved many of these conceptual difficulties. However, several features of coronary artery spasm, both spontaneous and secondary to provocation with ergonovine maleate, remain poorly understood. This paper addresses the management problems associated with spontaneously occurring spasm in the setting of pre-existent atherosclerotic coronary artery disease, angiographically severe spasm unassociated with symptoms of an gina pectoris or signs of myocardial ischemia, and the precipitation of angina pectoris by ergonovine maleate administration unaccompanied by demon strable epicardial coronary artery spasm. The rationale, indications and therapeutic efficacy of a new class of agents known as slow channel inhibitors or calcium antagonists are discussed.
Prevention and Treatment of Early Postoperative Deep Vein Thrombosis in Africans: A Nigerian Experience with Dihydroergotamine Mesylate
Authors: Ofoegbu R.O. , Osime U.
Published: November 2007

Post-operative deep vein thrombosis is regarded as rare among Africans, even though there are no known specific factors existing in the African population which either increase or decrease the incidence of deep vein thrombosis in the surgical patient. But by using human fibrinogen labeled with radioactive iodine (125I), despite its limitations in detecting thrombi proximal to the femoral veins, we were able to demonstrate those which were still at the subclinical stage of the disease process apart from overt cases of deep vein thrombosis (DVT). Whereas, miniheparinization and treatment with Dextran 70 may be better, accepted methods of prophylaxis in the immediate post-operative days, in 38 consecutive post-operative cases stud ied, we were able to show the benefits of dihydroergotamine mesylate in the prevention of deep vein thrombosis among Nigerians. It was also shown that since DVT may occur in the femoral segments without a concomitant involvement of the calf veins, assertions based only on data obtained from clinical examinations of the calf for evidence of DVT are bound to be understatements of the true incidence.
Venous Plethysmography Applied in Pathologic Conditions
Authors: Boccalon H. , Chikhany G. , Lozes A. , Vaislic C. , Puel P. , Enjalbert A.
Published: November 2007

The clinical diagnosis of acute deep vein thrombosis (DVT) of the lower limbs has always been a difficult problem. A great deal of investigation has been made in order to detect this disease.1-3 This paper deals with 1 aspect of the noninvasive investigation of acute DVT, strain gauge plethysmography (SGP). 4-8 Our intention is to study the sensitivity and reliability of this test, especially in the difficult diagnosis of acute DVT, using a new SGP tech nique.9,10
Ophthalmodynamometry: Comparative Study of Obstruction of the Central Retinal Artery and Thrombosis of the Internal Carotid Artery
Authors: Sayegh Fouad N.
Published: November 2007

A comparative study of obstruction of the central retinal artery and thrombosis of the internal carotid artery was done. The ophthalmodyna mometry method (ODM) was used. The statistical analysis of the 2 indepen dent groups shows that ODM allows a differential diagnosis between both conditions within the first and fourth weeks after the manifestation of ocular ischemia. During the second and third weeks, it is not possible to localize the site of obstruction. One concludes that the time factor is an important criterion for the differential diagnosis between obstruction of the central retinal artery and the internal carotid artery when ODM is used.
Effect of Calcium-Entry-Blockers on Arterioles, Capillaries, and Venules of the Retina
Authors: Nihard P.
Published: November 2007

In 48 cases with well-documented retinal vasculopathy, the therapeutic effect of cinnarizine and flunarizine over a period of several months to 3 years has been clinically evaluated. Objective measurements comprised determination of visual field and acuity, funduscopy, three-mirror funduscopy, and fluorangiography with determination of capillary leakage and circulation time.

The most prominent features were disappearance of cotton wool nodules, improvement of visual function and capillary perfusion, inhibition of capillary leakage, and a positive hemokinetic effect in arteriolar, capillary, and venous beds. Degeneration of post-ganglionic fibers was partly restored. In some patients with glaucoma, the aspect of the optic disc was normalized. It is concluded that selective calcium-entry-blockers clearly improve tissue perfusion in ischemic areas.
Retroperitoneal Fibrosis From Aortic Aneurysm Causing Vena Cava Obstruction: a Case Report
Authors: Houle Bruce J.C. , Ellwood Robert A.
Published: November 2007

The first case is reported of inferior vena cava obstruction secondary to peri-aortic fibrosis associated with a chronic aortic rupture.
Hereditary Factors in Takayasu's Disease
Authors: Isohisa Ichiro , Numano Fujio , Maezawa Hidenori , Sasazuki Takehiko
Published: November 2007

In an attempt to provide support for the genetic link theory as related to the etiology of Takayasu's disease, we analyzed simultaneously A, B, and D loci of HLA antigens in 75 Japanese patients with the disease. Serving as control were 128 healthy Japanese. A statistically significant high frequency of BW52 and DHO was confirmed with the levels being 25.6 and 10.4, respectively, in the X2 test. A haplotype of A9-BW52-DHO was frequently evident in these patients as compared to the controls, and here also the statistical difference was significant. There appears to be a closer relationship of the gene to BW52 than to DHO.

A survey of the homozygote of BW52 revealed 6 of 75 patients with BW52; however, statistically speaking, this rate did not differ from the expected one. Thus, our analysis of HLA illustrates the genetic factors involved in Taka yasu's disease. The genes are located between the B and D loci and are closer to BW52 than DHO and these genes have a dominant character.
Diverse Clinical Manifestations of Pheochromocytomas
Authors: Badui Elias , Mancilla Raul , Szymanski Juan J. , Garcia-Rubi David , Estanol Bruno
Published: November 2007

Many difficulties are encountered by clinicians in attempting to diagnose pheochromocytomas. We describe several patients with unusual clinical features. These include sudden death, cerebral hemorrhage, refractory con gestive heart failure, acute abdominal pain, and hypercalcemia. In 2 patients, the rare association of this tumor and pregnancy was observed. Two subjects had sudden death, 1 during a pneumoencephalogram and another during an epidural block. The clinicians should be aware of these manifestations of pheochromocytomas.
Chronic Congestive Heart Failure: Observations at Abdominal Ultrasound with a Comparison of Abdominal Veins in Healthy Individuals
Authors: Kaude Juri V. , Jakobson Peeter
Published: November 2007

Findings observed at abdominal ultrasound in 8 patients with chronic congestive heart failure were hepatomegaly and dilated inferior vena cava which did not change its caliber during respiration. In some cases, distended hepatic or renal veins were also present. In a control group without known hepatic, cardiac, or renal disease, the veins were narrower, and the caliber of the inferior vena cava always responded to respiration, being widest at the end of inspiration and collapsed at Valsalva maneuver.
Timing of Periarterial Blood Removal for the Prevention of Vasonecrosis
Authors: Alksne John F. , Branson F. Josephine
Published: November 2007

In an attempt to provide some data on the time interval during which surgical removal of subarachnoid blood would be beneficial for the prevention of the vasospasm-vasonecrosis syndrome, we have performed experiments on the femoral arteries of rabbits. Blood was allowed to clot around the exposed femoral artery and then removed at 24, 36, 48, and 72 hours. These experiments reveal that after 24 hours of blood contact the arteries appear normal, whereas after 36 hours or more of blood contact a definite pathologic reaction is present. On the basis of these animal experiments, we recommend that if an attempt is to be made at the prevention of delayed neurologic deterioration by surgical removal of clotted blood from around the cerebral arteries, the surgery should be performed within 36 hours or as soon there after as possible.
Indication for Translumbar Aortogram
Authors: Sung James P. , O'Hara Vincent S.
Published: November 2007

Percutaneous transfemoral or to a lesser degree the transaxillary catheter ization for peripheral angiography is the procedure of choice by most radiol ogists. Under certain circumstances, however, these vessels may not be suitable or accessible for such studies. We have performed 330 translumbar aortograms and have found translumbar aortogram to be a safe and simple procedure that may be used as an alternative to the other methods for evaluating aortofemoral occlusive disease, particularly when the femoral artery becomes inaccessible.
Effect of Coronary Vasodilating Drug on Myocardial Work
Authors: Winsor Travis , Winsor David W. , Krohn Bernard G. , Bernett Jorge R.
Published: November 2007

The purpose of this paper is to show, by noninvasive measurements, previously undocumented effects on cardiac work of the nitrate coronary vasodilator Pentaerythritol Tetranitrate (Peritrate®). The chew-and-swallow 40-mg tablets of this drug were given to 10 patients of type II AHA classifica tion. The Diastolic Time Tension Index/Systolic Time Tension Index Ratio increased significantly from 1.15 (±0.11 SEM) to 1.46 (±0.13), p<0.05. The Double Product decreased significantly from 9813 (±606) to 8336 (±497), p<0.01. The Triple Product also decreased significantly from 3223 (±235) to 2425 (±206), p<0.01. The percent diastole of the R-R interval increased signifi cantly from 65% (±2.44) to 70% (± 1.73) p<0.05, while no significant change in heart rate occurred (63.2 bts/min to 62.4 bts/min). Correspondingly, there was a decrease of systolic time interval, from 0.33 second (±0.2) to 0.29 second (±.01) p<0.01. A significant decrease in blood pressure was also noted. Sys tolic BP dropped from 155 (±8.0) to 134(±7.2),p<0.01. Diastolic BP dropped from 89.2 (±2.8) to 79.2 (±2.2), p<0.01. This study shows that Peritrate produced significantly favorable changes in all the cited indicators of cardiac work.
Immunologic Aspects of Heart Disease
Authors: DeCarvalho Sergio
Published: November 2007

All forms of heart disease, whether caused by streptococcus group A, aseptic heart injury, virus, hypersensitivity, autoimmune conditions, or graft- versus-host reactions, have in common allogenic transformation of the myocardial cell membrane and production of multifunctional autoantibodies, in addition to cause-specific antibodies, some of which cross-react with heart tissue. The outcome of this immunologic insult depends on the ability of the host's immunoregulatory mechanisms to dispose swiftly of the offending anti gen and antibody or their complexes. Heart disease often results when these mechanisms, exemplified here, are not intact or when they function inappro priately in genetic or acquired settings and in varying haplotype frames.
The Effect of Age, Blood Pressure and Gender on the Incidence of Premature Ventricular Contractions
Authors: Kostis John B. , McCrone Katherine , Moreyra Abel E. , Hosler Maryhelen , Cosgrove Nora , Kuo Peter T.
Published: November 2007

In order to study the effect of age, blood pressure and gender on premature ventricular contractions (PVCs), 24-hour ambulatory electrocardiography was performed on 338 apparently normal subjects (Group I; 209 men, 129 women, age 17 to 69, mean 48.5 ± 11.7) and on 100 subjects with normal hearts proven by extensive invasive and noninvasive testing (Group II; 51 men, 49 women, age 16 to 68, mean 48.8 ± 10.2). Apparently normal subjects (Group I) had a higher prevalence of PVCs (61.8% vs. 39.0%, p<0.001) and of complexity (16.3% vs. 4.0%, p<0.003) than subjects with normal hearts (Group II). The distribution of subjects according to PVC frequency was bimodal in Group I and unimodal in Group II.

PVC prevalence increased with age in both the apparently normal group (p<0.001), and in the group with normal hearts (p<0.025). On the contrary, apparently normal (Group I) men had almost twice the PVC prevalence (74.6% vs. 41.1%, p<0.001) and complexity (20.1% vs. 10.1%, p<0.25) than appar ently normal women, while gender had no effect on PVC prevalence in subjects with normal hearts (Group II). Systolic blood pressure was also associated with PVC prevalence (p<0.001) and complexity (p<0.02) in apparently normal subjects (Group I) but not in subjects with normal hearts (Group II).

These data indicate: that apparently normal subjects have higher preva lence of PVCs and of PVC complexity than subjects with normal hearts,

FIG. 1. Distributions of Normal (Top) and Apparently Normal (Bottom) Subjects Accord ing To The Number of PVC Per 24 Hours.

probably because of undetected cardiac disease; that the increase in PVC prevalence with age is not necessarily due to cardiac disease; and that PVC complexity in apparently normal subjects should raise the suspicion of cardiac disease especially in men, in subjects with hypertension and in the older age group.
Long-Term Use of Gemfibrozil (Lopid®) in the Treatment of Dyslipidemia
Authors: Lewis James E.
Published: November 2007

This report describes the results of long-term treatment for blood lipid regulation with a new drug, gemfibrozil (Lopid®). During a short-term placebo-controlled phase, gemfibrozil had significantly reduced triglycerides, VLDL-cholesterol, and total LDL-cholesterol, and had significantly increased HDL-cholesterol and the HDL-cholesterol to total cholesterol ratio. It had not, however, greatly affected total cholesterol and LDL-cholesterol. In the long term phase of the study the improvement attained during the controlled phase was maintained. More important, the lipoprotein values that had not shown improvement in the controlled phase showed definite beneficial changes. The types and incidence of adverse reactions during the long term treatment were similar to those observed during the controlled period. The results of the study indicate that gemfibrozil is effective and relatively safe for the long term treatment of lipid irregularities.
Traumatic Rupture of the Ascending Aorta: A Case Report
Authors: Violon D. , Steppé R. , Welch W. , Primo G.
Published: November 2007

A patient with a rupture of the ascending aorta after a non-penetrating chest trauma is presented.

The aortic tear, angiographically demonstrated, was situated just above the left coronary ostium.

Only three examples of angiographically established cases of rupture of the ascending aorta were found in the literature. The point that the distal tip of the catheter should be placed proximally in the ascending aorta, is emphasized. After operation the patient went well.
Arterial Segmentation of the Human Spleen by Post-Mortem Angiograms and Corrosion-Casts
Authors: Katritsis E. , Parashos A. , Papadopoulos N.
Published: November 2007

In a series of seventy adult human spleens, obtained from embalmed dissecting-room cadavers and post-mortem bodies, the extrasplenic division and intrasplenic architecture of the terminal branches of the splenic artery and of its polar arteries were studied via extrasplenic dissection, angiograms and injection-corrosion casts. The results showed that the splenic artery is divided into two (85.7%), or three (14.3%) primary branches, each of which is sub divided, mostly, into two to four secondary branches. Moreover, a superior polar artery (60.0%) and inferior polar arteries (80.0%) are given from the splenic trunk or from one of its primary branches. The human spleen is divided accordingly into two or three main arterial segments, separated by a definite avascular plane. Also, a rather constant avascular plane separated the polar segments from the remaining of the organ. Each main segment is also sub divided, usually into two to four less constant secondary segments, the ar chitecture of which and the avascular planes between them are very variable. The findings of this study and other relative studies consist the anatomical basis for highly conservative surgical management, as an alternative to splenectomy, in cases of splenic rupture.
Renal Haemodynamics in Essential Hypertension Assessed by 133-Xenon Washout and Selective Renal Angiography
Authors: Gatta Angelo , Merkel Carlo , Pessina Achille C. , Milani Loredano , Sacerdoti David , Zuin Renzo
Published: November 2007

The renal and intrarenal haemodynamic pattern in 17 patients with essential hypertension of different severity and duration was studied by means of the 133-Xenon washout technique and the selective renal angiography.

The mean and the cortical renal blood flows were on average significantly decreased as compared to the controls. A good agreement was found between the reduction in renal perfusion and the degree of vascular abnormalities as shown by angiography; on the contrary no correlation was found between the impairment in renal blood flow and the degree and/or duration of hypertension.
Transdermal Absorption of Nitroglycerin from Microseal Drug Delivery (MDD) System
Authors: Karim Aziz
Published: November 2007

A recent important advance in biopharmaceutics has been the utilization of controlled delivery of drugs to the systemic circulation through the intact skin. With the conventional tablet and capsule dosage forms, the amount of drug absorbed through the gastrointestinal (GI) tract varies depending on the quan tity and types of food in the stomach, on the GI motility and transit time. Acid and/or alkaline labile drugs may be deactivated prior to absorption from the GI tract while some drugs also get deactivated by GI microbial flora. In the case of drugs with a high hepatic extraction ratio, the absorbed drug may be largely deactivated by first-pass metabolism before reaching the systemic circulation. Drug absorption through the GI tract can therefore result in variable and/or unpredictable blood levels. Some of this variability can be minimized by administering controlled-release tablet or capsule formulations. However, these dosage forms cannot eliminate the inherent variability associated with first-pass metabolism.
Noninvasive Assessment of Left Ventricular Wall Stress in Chronic Congestive Heart Failure Patients
Authors: Gould Lawrence , Gopalaswamy C. , Chandy F. , Abdou O.
Published: November 2007

In 1969, our group first reported that the intravenous administration of phentolamine can improve cardiac performance in patients with heart failure. 1 Positive inotropism and a reduction in afterload were shown to be the mechanisms that led to cardiac improvement. Since that time the literature is replete with articles attesting to the benefits of vasodilator drugs in the treat ment of acute and chronic heart failure.

A reduction in impedance or afterload should produce beneficial hemodynamic effects in patients with left ventricular volume overload due to aortic insufficiency or mitral insufficiency. This has been verified using an intravenous infusion of nitroprusside, 2,3 phentolamine4 and hydralazine.5,6

The effects of vasodilators on left ventricular wall stress can now be evaluated noninvasively. Recently Wilson and his group7 documented that nitroglycerin can effectively reduce the peak and end systolic wall stress in patients with aortic regurgitation. These authors concluded that the beneficial action of nitroglycerin on muscle mechanics might retard left ventricular enlargement and hypertrophy and consequently delay the onset of myocardial dysfunction.

Prazosin is an oral drug with sustained vasodilator properties similar to nitroprusside which is widely used in the treatment of heart failure. This drug is a quinazoline derivative structurally unrelated to other vasodilator drugs pre sently available. It acts principally by blockade of vascular alpha-adrenergic receptors. It selectively blocks the postsynoptic or alpha 1 receptor while having little affinity for the pre-synoptic or alpha 2 receptor.
Double-Blind Study of Papaverine Hydrochloride on the Efficacy in the Treatment of Intermittent Claudication
Authors: Seino Yoshihiko , Rose Harold B. , Kanazawa Masakuni , Vyden John K. , Wall Francis J.
Published: November 2007

A double-blind, placebo-controlled, parallel groups study design was utilized to evaluate the efficacy and the safety of papaverine HCL (PA, 300- 1,500 mg/day) in the treatment of intermittent claudication. The study was in two phases: Phase I-6 weeks duration with treadmill claudication tests and doppler ankle/brachial pressure studies every 2 weeks to establish disease stability; Phase II-12 weeks double-blind evaluation of PA versus placebo (PL) with treadmill claudication tests and doppler ankle/brachial pressure studies every 4 weeks. Intermittent claudication was documented by symptoms, his tory and objective evidence of decreased blood supply to the lower ex tremities : decreased resting and post-exercise ankle/brachial pressure indices (A/B Pr), diminished segmental pulse-volumes and physical findings. Data were collected to determine the distance to initial pain (IP), rapidly increasing pain (RIP) and absolute claudication (AC) during treadmill tests and also the changes in resting and post-exercise A/B Pr.

In 20 patients who completed this study, the distance to RIP was increased 43% by PA and decreased 2% by PL (p=0.012). PA increased the distance to AC by 29%, but was decreased by 1% in PL (p=0.039). The A/B Pr studies showed significant less decrease in 1 minute and 2.5 minutes post exercise A/B Pr at 12 weeks in PA patients as compared to those in PL patients.
Cross-Striated Undulant Structure of the Aorta in Neonates, Children and Young Adults
Authors: Tanimura Akira , Cho Takanori , Nakashima Teruyuki
Published: November 2007

Some aortas of neonates and of children have intimal wrinkles which run closely packed and horizontally across the longitudinal axes. In the beginning of this century this structure was called "Wellenlinien", but there has been little investigation concerning their formation. Some wrinkle structures showed the transformation to atherosclerotic foci in infants. These wrinkles seemed to play an important role for atherogenesis in young subjects.

In this paper, we will report the result of observations on these structures in neonates, children and young adults.
Alternative Management of Isolated Iliac Artery Aneurysms
Authors: Carson S.N. , Palmaz Julio , Hunter Glenn
Published: November 2007

Isolated iliac artery aneurysms are uncommon and frequently remain unde tected until they reach significant size. Often their first clinical presentation is with rupture of the aneurysm. Direct surgical intervention has been the usual mode of treatment. Successful treatment of iliac aneurysms by alternative approaches in two elderly, debilitated patients is reported. Extraanatomic bypass and catheter embolization were used in both resulting in a minimal in-hospital stay for the patients without morbidity or mortality.
Pulmonary and Hemodynamic Function in Dogs During Exercise: Effects of Lung Autotransplantation
Authors: Montefusco Cheryl M. , Feinstein Samuel , Sabita Rao T. , Veith Frank J.
Published: November 2007

An airtight facemask/mouthpiece assembly has been devised to facilitate the performance of a wide range of pulmonary function tests during treadmill exercise in dogs. Using this appliance, data were obtained from 6 normal dogs and 3 of the same dogs after left lung autotransplantation. All measurements were made during awake, resting conditions and again after 5-7 minutes of moderate exercise. Resting values for pulmonary function tests, hemodynamic parameters, blood gases and pH from both pulmonary and systemic arterial blood samples did not differ significantly between normal dogs and those studied after left lung autotransplantation. During treadmill exercise, cardiac output doubled and pulmonary vascular resistance decreased comparably in both groups of dogs. Heart rates in both groups rose to approximately 22 b/min and blood gases and pH remained normal. These results indicate the facemask/mouthpiece assembly permits normal ventilation during treadmill exercise. In addition, these data support the view that pulmonary auto transplantation per se need not impose obligatory defects in ventilatory and hemodynamic function despite the increased demands of treadmill exercise.
The Effect of Withdrawal of Beta-Adrenergic Blockade on Intermittent Claudication
Authors: Lepäntalo Mauri , von Knorring Johan , Lindfors Olof , Scheinin T.M.
Published: November 2007

Twenty-eight patients with intermittent claudication were studied before and one month after withdrawal of treatment with beta-adrenergic blocking drugs* for hypertension, coronary heart disease or both. Heart rate, blood pressure, ankle/arm systolic blood pressure ratio and ankle pulse volume recording (PVR) at rest and after treadmill exercise were recorded, as well as walking distance, time of recovery from subjective symptoms, restitution time of pressure ratio and PVR. A control group of 14 patients, whose beta- adrenergic blocking drugs were not withdrawn, was also included.

The result can be summarized as showing that withdrawal of beta-blockade was not demonstrably advantageous in patients with intermittent claudication. Significant improvement was observed only during the first month of the trial, a change which was independent of withdrawal of beta-blockade. The relief of subjective symptoms after exercise occurred significantly faster after with drawal of nonselective beta-blockade. Otherwise, there was no difference between nonselective and cardioselective beta-adrenergic blocking drugs.
The Value of Ultrasound in the Diagnosis of Popliteal Artery Aneurysms
Authors: Nan Weiner Shelley , Hoffman Janet , Bernstein Robert G. , Koenigsberg Mordecai
Published: November 2007

Although popliteal artery aneurysms are among the most common type of peripheral artery aneurysm, 1,2,3,4 they may be difficult to diagnose until com plications such as peripheral embolization, acute thrombosis 6 and rupture occur. Pressure on adjacent structures may cause neurological symptoms and venous thrombosis. The diagnosis of peripheral artery aneurysms is usually made by physical examination and arteriography. Recently, ultrasound of the popliteal space has been found to be very useful in the diagnosis of popliteal artery aneurysms.5,6,7

It is therefore important to recognize the value of ultrasound for imaging popliteal artery aneurysms and to use this readily available non-invasive mod ality in patients in which physical examination and/or angiography of the popliteal fossa is equivocal.

We present one case of a popliteal artery aneurysm which was missed by angiography and physical examination in which ultrasound was very important in diagnosing this aneurysm pre-operatively, and two cases in which the ultrasound examination confirmed the presence of the popliteal artery aneurysm but better delineated its size than did angiography.
Cold Pressor Test and Variant Angina
Authors: Kawano Tomoki , Okabe Masanori , Arakawa Kikuo
Published: November 2007

A transient complete coronary occlusion due to spasm was induced by the cold pressor test in a 51-year-old man with variant angina. Arteriography before the test revealed a normal left coronary artery and only minor irregularities of the mid-portion of the right coronary artery. Three minutes after cold stimulation, angina pectoris accompanied by ST-segment elevation was observed in lead II ECG. Simultaneous coronary arteriography during the attack showed a complete occlusion of the proximal right coronary artery due to spasm. The anginal attack together with spastic occlusion disappeared after administration of 0.8 mg of nitroglycerin.

Thus, the cold pressor test can trigger coronary artery spasm and may even lead to a total occlusion in patients with variant angina. Individuals with variant angina may be subjected to additional risk when exposed to cold temperatures.
Collateral Pathways Occurring in Simultaneous Obstruction of the Superior and Inferior Venae Cavae
Authors: Alaguraj Thiagarajan , Arida Edward J. , Mooken Thomas T.
Published: November 2007

The authors report a rare case of angiographically demonstrated simultaneous obstruction of both venae cavae. The case serves to illustrate an interesting and relatively unique mesenteric portal venous mechanism which became effective as a joint collateral pathway for both regions.