bluuebunny/crossref_metadata_2025 huggingface dataset:
Abdominal Aortic Aneurysms in Familial Hypercholesterolemia—Case Reports
Authors: Kita Yoshihito , Shimizu Masami , Sugihara Norihiko , Shimizu Kuniyoshi , Miura Motohiro , Koizumi Junichi , Mabuchi Hiroshi , Takeda Ryoyu
Published: July 2008

Familial hypercholesterolemia (FH) is a genetic disease characterized by high serum cholesterol levels and premature coronary atherosclerosis. Hyper cholesterolemia is one of the factors promoting the arteriosclerotic process and is a major cause of aortic aneurysm. Few data are available, however, about abdominal aortic aneurysms (AAAs) in patients with FH. In this study, the clini cal and angiographic characteristics of AAAs found in patients with FH were investigated. Thirty-one cases (23 men, 8 women, aged fifty ± fourteen years) were examined by coronary angiography, thoracic and abdominal aortography, and clinical data. Abdominal aortography detected abdominal aneurysms in 8 cases (26%), all of whom were men, including 4 cases (50%) that were compli cated by diabetes mellitus. The abdominal aneurysm patients manifested severe coronary atherosclerosis, severe abdominal aortic irregularity, and higher blood pressure than the nonaneurysm FH patients. These findings suggest that AAAs are an important and prevalent feature in FH, especially in men with diabetes mellitus and high blood pressure.
Bilateral Perinephric Fluid Accumulation: An Unusual Manifestation of Pulmonary Hypertension—A Case Report
Authors: Pentimone Ferdinando , Meola Mario , Del Corso Laura
Published: July 2008

This is the case report of a forty-seven-year-old man with an ostium secun dum atrial septal defect and a very high grade of pulmonary hypertension, associated with a large bilateral perinephric fluid accumulation. The fluid accu mulation was remarkably reduced after eleven phlebotomies over a twelve- month period. A pathogenetic relation with the Eisenmenger's syndrome is discussed. No previous report of this association has been found in a survey of the literature.
An Undocumented Effect of Lidocaine Revealed by Computerized Electrocardiography
Authors: Leor Ron , Rabinowitz Babeth , Hod Hanoch , Kaplinsky Elieser
Published: July 2008

The influence of an intravenous push of lidocaine 1 mg/kg followed by 2 mg/min infusion on total QRS amplitude and R-to-S duration in leads V2-V4 of the electrocardiogram was studied in 11 patients who were hospitalized in the coronary care unit. A computerized system sampled the amplitude and timing of peak R and S waves of 1100 QRS complexes of leads V2-V4, starting two minutes before the first push of lidocaine. Curves of amplitude and R-to-S dura tion versus time were obtained in all patients. QRS amplitude in V2 and V3 increased significantly in 10 of 11 patients (p < 0.005). The mean voltage in crease for all patients was 0.1±0.07 millivolt. The authors also observed a mild prolongation of R-to-S duration (0.8±1.0 millisecond p < 0.02). This new find ing, obtained by a simple computerized system, may possibly have potential future practical clinical application as a feedback parameter for closed-loop control systems for the administration of lidocaine.
Thromboangiitis Obliterans (Buerger's Disease) in Women (A Reevaluation)
Authors: Yörükoglu Yavuz , Ilgit Erhan , Zengin Mustafa , Nazliel Kemal , Salman Ergun , Yucel Ertan
Published: July 2008

Thromboangiitis obliterans (TAO) is an occlusive vascular disease tradition ally known to be almost exclusive to young male smokers. The disease was con sidered to be extremely rare in women, seen only as isolated, novel case reports in the literature. In the past decade, however, a dramatic increase in the inci dence of female TAO has been observed.

In this paper the authors report 7 cases of clinically and angiographically verified female TAO. The world literature in regard to the diagnostic criteria, changing incidence, and etiology is reviewed. They conclude that the increased use of tobacco among young women in the past two to three decades is responsi ble for this dramatic change.
Cellular and Humoral Immune Responses to Vascular Components in Thromboangiitis Obliterans
Authors: Hada Masao , Sakihama Toshiko , Kamiya Kihachiro , Tasaka Kachio , Ueno Akira
Published: July 2008

Cellular and humoral immune responses to vascular components were stud ied in 10 patients with thromboangiitis obliterans (TAO), including 3 in the mild stage of the disease and 7 in the active or severe stage. In this study the authors used the following vascular components: collagen Types I, III, IV, and V; elas tin ; and laminin. The cell-mediate reactivity (CMR) to these proteins was mea sured with an antigen-specific proliferation of peripheral mononuclear cells and evaluated by the stimulation index (SI), which is the ratio of thymidine incorpo ration in the presence and in the absence of antigen. The humoral immunologic response (HIR) to these vascular components was measured by an enzyme- linked immunosorbent assay (ELISA) and evaluated by the optical density (OD) index, which is the ratio of optical density (OD) in the patients' serum to that in the healthy male controls' serum. The stimulation index of collagen Types I and IV was significantly higher in patients with TAO than in healthy controls (p < 0.02). CMR to collagen Type V, elastin, and laminin was high in patients with active or severe TAO as well. However, similar statistical differences in mild TAO did not exist in the CMR. The OD index in collagen Types I, IV, and V was statistically higher in the patients than in the healthy controls (p < 0.01).

These autoimmune epiphenomena to vascular components in TAO suggest that autoimmune mechanisms are related to vasculitis of TAO patients. When it is considered that CMR was found in active or severe TAO, but not in mild TAO, CMR does not seem to be the initiator of vasculitis. These differences in immune reactivities suggest that the autoimmune epiphenomena to the vascular components might be related to the exacerbation and perpetuation of TAO.
Postpartum Acute Myocardial Infarction Successfully Treated with Intravenous Streptokinase— A Case Report
Authors: Roberts David H. , Rodrigues Erwin A. , Ramsdale David R.
Published: July 2008

A twenty-three-year-old woman had an acute myocardial infarction during the early postpartum period successfully treated with intravenous strepto kinase. The possible mechanisms of postpartum myocardial infarction are re viewed, and the clinical implication for the use of streptokinase in this situation is discussed.
Complete Recanalization of Total Occlusion in Abdominal Aorta by Intra-aortic Infusion of a Thrombolytic Agent— A Case Report
Authors: Ashida Keiichi , Imaizumi Masatoshi , Isaka Yoshinari , Moriwaki Hiroshi , Matushita Koji , Iichi Osamu
Published: July 2008

Complete recanalization was achieved by intra-aortic infusion of urokinase in a case of complete occlusion of the abdominal aorta. The patient was a fifty- nine-year-old man with atrial fibrillation, hypertension, and diabetes mellitus who was admitted because of intermittent claudication and pain in both lower extremities at rest. Angiography demonstrated complete obstruction of the ab dominal aorta, but the bilateral iliac arteries were visualized via collaterals. Urokinase was administered intra-aortically in a total dose of 1,200,000 U dur ing the first day and a total dose of 960,000 U during the second day. The aorta and the iliac arteries recanalized after this treatment, and complete recanaliza tion associated with disappearance of subjective symptoms was observed after one month of treatment with warfarin. The present case suggests the usefulness of intra-arterial infusion of urokinase for the treatment of complete occlusion of the abdominal aorta.
Analysis of Familial and Individual Risk Factors Among Patients with Ischemic Vascular Dementia and Alzheimer's Disease
Authors: Mortel Karl F. , Wood Stacey , Pavol Marykay A. , Meyer John S. , Rexer Jennie L.
Published: July 2008

The purpose of this study was to determine relative contributions of first- degree familial and individual risk factors to clinical manifestations of two ma jor age-related dementias.

The authors interviewed 183 patients with dementia of the Alzheimer's type (DAT) and 137 patients with ischemic vascular dementia (IVD) together with family members and caregivers. Information was also obtained from medical records and collateral sources as required. Risk factor data within a predictive model for differentiating the two dementias were evaluated.

There was a greater incidence of family history of degenerative and dement ing neurologic disorders in DAT than in IVD. Both groups were equivalent for family histories of cerebrovascular disease. Despite familial equivalence, pa tients with IVD had a greater individual incidence of risk factors for cerebro vascular disease. Analysis by gender revealed three observations. Among DAT patients, family history for degenerative and dementing neurologic disorders proved to be significantly greater among women than among men. This risk factor did not, however, predict individual diagnoses for DAT. Women with IVD were more likely to have a family history of cancer than men. Multiple regres sion analyses revealed that reduced educational levels in women predicted greater liability for IVD than for DAT. Hypertension, heart disease, and diabe tes mellitus were all risk factors for IVD, but not for DAT.

Conclusions: Individual and familial historical data provide useful informa tion concerning identification, pathogenesis, prevention, and treatments for vascular dementia but little predictive information for identifying patients with Alzheimer's disease.
Simultaneous Recording of Blood Volume Shifts in Different Vascular Beds in Man by a Versatile Scintigraphic Method
Authors: Baccelli Giorgio , Terrani Sergio , Pacenti Paolo , Omboni Ezio , Bergonzi Mario , Reggiani Paolo , Sardella Franco , Catalano Michele , Bianchi Roberto
Published: July 2008

A device was developed to record the blood volume changes occurring in the lung and calf during postural changes, physical exercise, and the Valsalva ma neuver in man.

The changes in regional counting rates from the right middle lung and the calf mirrored the well-known changes in venous return that are expected to occur in response to the above-mentioned external stimuli. Thus a sustained decrease in lung blood volume was noted on assumption of the erect posture as well as during the forced expiration of the Valsalva maneuver. In addition a rapid increase and a sharp decrease in lung blood volume took place at the very onset and at the very end of walking, respectively. The calf blood volume de clined immediately at the onset of walking, increased slightly in the ensuing two minutes, and returned to baseline quickly at the termination of walking.

The authors' method enables real-time equilibrium blood pool scintigraphy to be recorded continuously and simultaneously from different districts over sustained periods of time irrespective of the posture and the physical activity performed by the patient. Their method might improve knowledge of the sys temic circulatory responses to selective physiologic and therapeutic interven tions in health and disease.
Hemorheologic Approach in the Treatment of Diabetic Foot Ulcers
Authors: Ramani Ananthakrishnan , Kundaje G.N. , Nayak M.N.
Published: July 2008

Pentoxifylline, a new trisubstituted methyxanthine derivative, is the most well known of a new group of hemorheologic agents. It has been shown to im prove hemorheologic abnormalities associated with diabetes and atherosclero sis. The authors examined the role of pentoxifylline in the treatment of diabetic foot ulcers. Forty diabetic patients with foot ulcerations were included in the study, 20 of whom received conventional therapy and 20 received pentoxifylline (400 mg three times a day) in addition. Healing of ulcers after eight weeks of treatment was significantly higher in those on pentoxifylline, and the patients needed less multilating surgery. Administration of pentoxifylline in addition to conventional therapy was significantly superior in the management of diabetic foot ulcers.
Absence of Enhancement of Spontaneous Echocardiographic Contrast by Thrombocytosis in a Patient with Left Ventricular Aneurysm, Primary Thrombocythemia, and von Recklinghausen Neurofibromatosis: A Case Report
Authors: Monsuez Jean-Jacques , Janier Michel , Van-Cao Alix Nguyen , Le Gall Jean-Roger
Published: July 2008

A thirty-eight-year-old man with primary thrombocythemia, von Reck linghausen neurofibromatosis, and myocardial-infarction-related left ventricu lar aneurysm with spontaneous echocardiographic contrast was followed up, suggesting that:

1. Neurofibromatosis may promote silent myocardial infarction or ischemia. Whether involvement of cardiac sensory nerves is a possible underlying mechanism remains nevertheless uncertain.

2. Platelets, whose role in the genesis of spontaneous echocardiographic con trast has been advocated, are probably not involved in this phenomenon, even in large numbers.
Mobile String-like Thrombus on the Calcified Aortic valve in Cardioembolic Stroke—A Case Report
Authors: Yasaka Masahiro , Tsuchiya Takashi , Yamaguchi Takenori
Published: July 2008

The calcified aortic valve has been associated with being a possible source of emboli in cardioembolic stroke. However, thrombus on the calcified aortic valve has not been identified with two-dimensional echocardiography. A seventy-two- year-old woman with calcified aortic stenosis was admitted with brain embo lism. She had not previously received any platelet antiaggregant or anticoagulant. At admission, two-dimensional echocardiography demonstrated a mobile string-like abnormal echo attached to the calcified aortic valve, which showed regression and enlargement repeatedly during admission. No symptoms or clinical data suggested infective endocarditis or nonbacterial thrombotic en docarditis. After commencement of antiplatelet therapy, the abnormal echo re gressed and disappeared. She continued to take the medication for seven months and then discontinued.

Three months later, she developed recurrence of stroke, and an abnormal echo on the calcified aortic valve was again detected by two-dimensional echo cardiography. The authors believe that the abnormal echo on the calcified aortic valve was thrombus and that it was the embolic source. Calcified aortic valve may thus be a causative lesion for mobile string-like thrombus. Two-dimen sional echocardiography should be performed repeatedly in patients with calci fied aortic valve and brain embolism.
Forward Doppler Ophthalmic Artery Flow in Patients with Extracranial Carotid Artery Occlusion—A Case Report
Authors: Lee Tsong-Hai , Ryu Shan-Jin , Chen Sien-Tsong , Liu Yan-Han , Tseng Kong-Yeng
Published: July 2008

The authors report 2 cases of common carotid artery (CCA) occlusion and 4 cases of extracranial internal carotid artery (ICA) occlusion with forward Dop pler ophthalmic artery flow. The compression test during Doppler study showed that the ophthalmic artery flow was reduced to zero when compressed contralateral to the CCA in 1 case of CCA occlusion and when compressed ipsilateral to the CCA in all 4 cases of ICA occlusion. The angiograms showed that in the 2 cases of CCA occlusion, 1 had the ophthalmic artery originating from the anterior communicating artery, and the other had subclavian steal syndrome with a reversed vertebral flow. In 3 of the 4 cases of ICA occlusion, the ophthalmic artery was found to originate from the ipsilateral middle menin geal artery.

Their findings suggest that in cases of extracranial carotid artery occlusion, the forward ophthalmic artery flow is supplied from the contralateral CCA in cases of CCA occlusion and from the branches of the ipsilateral external carotid artery in cases of ICA occlusion, and the vertebrobasilar system plays a less important role.
Isolated Tuberculous Pericarditis Still Exists: A Case History
Authors: Schwartz J. , Rabinovitz H. , Rozenfeld V. , Leibovitz A. , Stelian J. , Habot B.
Published: July 2008

A fifty-four-year-old woman from a high socioeconomic class developed acute isolated tuberculous pericarditis, three years after her sister had recov ered from such disease. She was treated successfully by a triple drug regimen including isoniazid, rifampin, and ethambutol.
Clinical and Angiographic Determinants of Initial Percutaneous Transluminal Coronary Angioplasty Success
Authors: Ilia Reuben , Kolanski Dan , Setaro John , Brennan Joseph , Cabin Henry , Cleman Michael , Remetz Michael
Published: July 2008

Clinical and anatomic determinants of primary success of percutaneous transluminal coronary angioplasty were retrospectively evaluated in 299 pa tients. Successful angioplasty (residual stenosis <50%) was achieved in 350 (94%) of 373 lesions. The success rate in patients chronically treated with aspi rin was higher than that of patients not treated with aspirin (95% versus 86%, P < 0.03). An additional finding was that the success rate in patients referred for coronary, angioplasty because of acute myocardial infarction or postinfarction angina was lower than that of those without these characteristics (89% versus 96%, P < 0.01). No other clinical features studied influenced the outcome of coronary angioplasty. The, angiographic characteristics of the lesions not differ between patients with successful or failed angioplasty except for the de gree of stenosis,prior to the procedure, being lower in patients with successful procedure (92.4 ± 7.6%, versus 97.3, ± 3.1%), P < 0.002). Thus coronary angioplasty can be performed with a high rate of success. Long-term pretreat ment with aspirin may have a beneficial effect.
Prophylaxis of Recurrent Deep Venous Thrombosis. A Randomized, Prospective Study Using Indobufen and Graduated Elastic Compression Stockings
Authors: Belcaro Giovanni , Laurora Giuseppe , Cesarone Maria Rosaria , De Sanctis Maria Teresa
Published: July 2008

After an episode of deep venous thrombosis (DVT) 224 patients were ran domized into four groups: a control group (A; 63 subjects); one receiving pro phylaxis with indobufen (B; 60 patients)—an oral antiplatelet agent; one using graduated elastic compression stockings (C; 53); and one receiving prophylaxis with both indobufen and graduated stockings (D; 48). Patients were monitored over a three-year period with color duplex scanning repeated every three months. In 46% of the controls there was at least one episode of recurrent DVT (RDVT). In patients receiving indobufen (group B) and using graduated com pression stockings (group C) the incidence of RDVT was significantly lower (5% and 9.43%, respectively). The incidence of RDVT was further significantly re duced by the combination of the two methods (group D) (2.08%).

In conclusion, RDVT is common and often asymptomatic and can be effec tively prevented by prophylaxis with indobufen or graduated compression and more effectively by the combination of the two methods.
Relief of Acute Lower Limb Ischemia with Percutaneous Fenestration of Intimal Flap in a Patient with Type III Aortic Dissection—A Case Report
Authors: Kato Noriyuki , Sakuma Hajime , Takeda Kan , Hirano Tadanori , Nakagawa Tsuyoshi
Published: July 2008

Acute right lower limb ischemia developed in a patient with type III aortic dissection. Aortography revealed complete occlusion of the right common iliac artery by dissecting intima. Immediately percutaneous transfemoral fenestra tion with angioplasty balloon catheter was performed and marked improvement was obtained in clinical symptoms and angiographic findings. Unfortunately the patient died of rupture of the thoracic aorta about eleven hours after the proce dure. The cause of death was not thought to be related to this procedure. The authors conclude that percutaneous fenestration should be considered as the treatment of choice for visceral or limb ischemia due to acute aortic dissection.
Diagnosis of High-Grade Stenosis of Innominate Artery
Authors: Verlato F. , Avruscio G.P. , Milite D. , Salmistraro G. , Deriu G.P. , Signorini G.P.
Published: July 2008

Although pathology of the innominate artery (IA) is not frequent, it causes relevant impairment of extracranial circulation and sometimes cerebrovascular events. Definite differentiation of high-grade stenosis from occlusion of the IA has not been obtained until with (C.W.) Doppler and duplex system ultrasound, and thus the direct evaluation of IA is not reliable by noninvasive methods. In this study the authors suggest an indirect method, of evaluation of IA pathology based on the study of carotid, subclavian, and verte bral arteries (VA), with echo-Doppler-color-flow (EDCF) (with linear-phase ar ray, Probes of 7.5 and 5 MHz). In the last two years they studied 6 patients with, IA pathology, (2 with occlusion (occ), 1 with stenosis of 80% and 3 with subocclu sive stenosis >90%. In both patients with occ, right VA flow was inverted, and also the right common carotid (CC) was involved (occ in 1 case and inverted flow in the other ; in the 3 subocclusive stenoses a lowered systolic flow in the CC was recorded (48 vs 85cm/sec, 41 vs 77, and 23 vs 109). In the 80% stenosis, besides the inverted flow in VA, only a reduced diastolic flow in CC was also recorded (19 vs 33 cm/sec measured in the left side). All patients with high grade stenosis were successfufly confirmed by an angiographic study, including the different different degree of stenois.

Five of the 6 patients underwent surgical correction with a restored flow in the previously involve, artery. Only 1 patient with occlusion is waiting for surgi cal correction. In conclusion this study shows that ECDF can be a useful tool in the of IA pathology and in differentiation of occlusion from high grade stenosis by indirect signs in the supra-aortic circulation.

G.P. Signorini, M. D. Servizio di Angiologia Ospedale Civile di Padova Via Giustiniani 2 Padova 35128, Italy
Myocardial Hypertrophy, Angiotensin, and ACE Inhibitors
Authors: Re Richard N.
Published: July 2008

The renin-angiotensin system has long been known as a potent determinant of cardiovascular homeostasis and a powerful regulator of vascular hemody namics. Over the last twenty years, it has become clear that components of the renin-angiotensin system are present in and, in many instances, synthesized in local tissues. The role of some of these local renin systems is now becoming clear, but the role, if any, of local production of angiotensin II in the heart and vasculature remains unknown. Recent evidence indicates that angiotensin II can serve as a growth factor for a variety of cell types including those in the cardio vascular system, and it thus appears possible that systemically or locally pro duced angiotensin II could subserve important functions in the determination of heart and vasculature structure. Clinical studies tend to corroborate this possi bility. The potent effects of converting enzyme inhibition on the regression of left ventricular hypertrophy, the demonstration that the administration of these agents following myocardial infarction reduces detrimental cardiac remodeling, and the finding that converting enzyme inhibition prolongs survival in conges tive heart failure patients all point to an important role of angiotensin II on cardiovascular function and raise the distinct possibility that angiotensin II growth effects are involved in these beneficial responses. Additionally, recent data demonstrate conclusively that under certain circumstances and in certain cell types locally produced angiotensin II can serve as an autocrine growth regu latory factor, further adding support to the idea that local renin systems may play an important role in the determination of cardiovascular structure.
Concentric Left Ventricular Hypertrophy in Patients with Takayasu Arteritis
Authors: Hashimoto Yuji , Oniki Toshiyuki , Kaneko Eiji , Hata Akihiro , Matsumura Akihiko , Kobayashi Takahiro , Numano Fujio
Published: July 2008

Although aortic regurgitation (AR) in patients with Takayasu arteritis (TA) is believed to be caused by dilatation of the aortic ring or thickening of the aortic cusps, the pattern of left ventricular hypertrophy (LVH) in these patients has not been described. To clarify the geometry of the LV in patients with TA that had been documented both echocardiographically and hemodynamically, the authors evaluated 22 patients with TA and severe AR (group 1), 10 with TA and systemic hypertension (group 2), and 17 with isolated severe AR of other etiolo gies (group 3). M-mode echocardiography showed that LV dimensions were smaller in groups 1 and 2 than in group 3 and that wall thickness was greater in group 1 than in group 3. The concentric hypertrophic ratio (CHR = wall thick ness/LV end-diastolic dimension + wall thickness) was larger than group 1 (p < 0.001) and group 2 (p < 0.01) than in group 3. CHR was similar in groups 1 and 2. Systolic blood pressure was significantly increased in group 2 and showed a tendency to increase in group 1 as compared with group 3. The results confirmed the presence of concentric LVH related to a pressure overload in patients with TA, even when TA was complicated by severe AR.
Right Atrial Thrombus Mimicking Myxoma and Bilateral Pulmonary Artery Aneurysms in a Patient with Behçet's Disease—A Case Report
Authors: Sayin Ayla Gurel , Vural Fikret Sami , Bozkurt A. Kursat , Oz Buge , Uygun Nesrin
Published: July 2008

A case of Behçet's disease, in which superior vena cava syndrome was the presenting feature is reported. Magnetic resonance imaging and echocardio graphy revealed a mass lesion in the right atrium. This patient developed bilat eral pulmonary artery aneurysms postoperatively and represents one of the bizarre manifestations of Behçet's disease.
Transluminal Angioplasty of a Single Coronary Artery Anomaly During Acute Myocardial Infarction— A Case Report
Authors: Baljepally Rajagopal M. , Pollock Stephen H. , Magram Martin Y.
Published: July 2008

This report describes successful angioplasty of a total coronary occlusion in a single-ostium coronary anomaly in a patient presenting with an acute myocar dial infarction.
Colorflow Duplex Ultrasonography Determines the Presence and Nature of Vasculogenic Headaches
Authors: Montefusco Cheryl M. , Maupin LeAnn
Published: July 2008

Eighteen consecutive patients with severe headache syndromes underwent noninvasive interrogation to explore the intracranial vascular involvement in their headaches. The authors used a colorflow duplex scanner with a 2.25 MHz, tightly curved, phased-array transducer to insonate and visualize the terminal segments of the vertebral arteries; the anterior, middle, and posterior cerebral circulations; and the basilar artery. Blood flow velocities and vessel caliber were obtained during a headache-free period and during a grade 8-10 headache in all patients. Comparisons of these data indicated that 14 of the 18 patients had demonstrable arterial changes associated with their headaches. Of these 14, 4 patients were found to have marked vasospasm of at least two of the arteries in the Circle of Willis and/or the vertebrobasilar system. The remaining 10 pa tients had headaches associated with intracerebral vasodilation. The authors conclude that color flow duplex ultrasonography of the intracerebral arteries is capable of determining the presence and mode of vascular headache develop ment.
Clinical and Hemodynamic Effects of Stepwise Lowering of Hemoglobin Concentration in Patients with Intermittent Claudication
Authors: Celsing Fredrik , Eriksson Maria , Markström Ulf , Rosfors Stefan
Published: July 2008

This study evaluates the effect of stepwise lowering of the hemoglobin (Hb) concentration on maximal walking distance (MWD) and hemodynamics in pa tients with intermittent claudication. The results in a study group (n = 6) were compared with those of a control group (n = 6) whose members were not sub jected to venesections. An average decrease of Hb concentration from 151 ± 4 to 121 ± 3 g/L did not significantly influence MWD, the result being 282 ± 62 meters before venesections and 255 ± 54 meters after three to five (mean four) repeated venesections.

Transcutaneous oxygen pressure was measured at the dorsum of the foot before and after exercise and did not change with a gradual decrease of the Hb concentration. Maximal heart rate, painfree walking distance, ankle pressure, and blood lactate concentration were also unchanged. An average venesection volume of about 1.4 liters whole blood within fourteen days, without isovolemic replacement, did not change the blood volume, which was 5.1 ± 0.4 liters be fore and 5.0 ± 0.5 liters after venesections.

In conclusion, hemodilution accomplished by venesections did not have a clinically or physiologically beneficial effect in patients with severe intermittent claudication. However, hemodynamics and clinical symptoms were not affected by a considerable decrease in the arterial oxygen content within the normal Hb concentration range.
The Value of Captopril Renal Scintigraphy in Assessing the Results of Percutaneous Transluminal Renal Angioplasty and in Following up Renovascular Hypertension—A Case Report
Authors: Eren Nevnihal , Ünal Seher , Nisanci Yilmaz , Adalet Kamil , Deligönül Ubeydullah , Meric Mehmet
Published: July 2008

Percutaneous transluminal renal angioplasty (PTRA) was performed in a patient with bilateral renal artery stenoses diagnosed noninvasively by captopril renal scintigraphy and confirmed by renal arteriography. The captopril renal scintigraphy parameters returned to normal in correlation with improved blood pressure response fifteen days after PTRA. Five months later hypertension re appeared and the repeated captopril renal scintigraphy suggested left renal ar tery stenosis. PTRA was repeated and a stent was implanted with reversal of blood pressure, and captopril renal scintigraphy findings returned to normal levels. Six months after second PTRA, the blood pressure increased to hyper tensive levels, and captopril renal scintigraphy indicated left renal artery steno sis. The renal arteriography, however, revealed a new stenosis at the left renal artery ostium. The PTRA with a second stent implantation was performed suc cessfully. The captopril renal scintigraphic parameters and the blood pressure were again normalized after the last intervention and remained normal for thir teen months of follow-up.
Spontaneous Pneumopericardium—A Case Report
Authors: Abdalla Mazen , Gould Lawrence , Bharathan Thayyullathil
Published: July 2008

The authors describe a case of spontaneous pneumopericardium that re solved completely, despite placement of the patient on mechanical ventilation.
Electrocardiographic Diagnosis of Left Ventricular Hypertrophy in the Presence of Right Bundle Branch Block in Cases with Essential Hypertension
Authors: Nalbantgil Istemi , Önder Remzi , Kiliçcioglu Bülent , Işler Mehmet
Published: July 2008

Right bundle branch block was diagnosed in electrocardiograms of 37 of 1085 patients with essential hypertension. Echocardiographically left ventricu lar hypertrophy was diagnosed in 14 of these 37 patients. Eighteen electrocar diographic (ECG) criteria, which were previously recommended, were deter mined in these 37 patients.

The sensitivities of five criteria were found to be better than 50%. These are SV 1 ≥ 2 mm; RV6 > RV5; S III + (R + S) maximum precordial lead ≥ 30 mm; P/PR ≥ 1.6; R a VL ≥ 11 mm. However, their specificities ranged from 56.5% to 95.6%. When the combination of RV6 > RV5 and S III + (R + S) maximum precordial lead ≥ 30 mm was used, sensitivity was 57.1 and specificity was 100%.

It is concluded that the presence of right bundle branch block these ECG criteria can be used for the diagnosis of left ventricular hypertrophy.
Apolipoproteins C-II and C-III in Peripheral Arterial Disease
Authors: Alessandri Cesare , Basili Stefania , Maurelli Marina , Andreozzi Paola , Colletta Anna , Paradiso Michele , Cordova Corrado
Published: July 2008

Apolipoprotein (apo) C-II and apo C-III serum concentrations were investi gated in 119 normotriglyceridemic male subjects with peripheral arterial dis ease (PAD) or coronary heart disease (CHD) or without clinical manifestations of atherosclerotic disease. All subjects included in the study had similar blood levels of total cholesterol ( < 400 mg/dL). High-density lipoproteins cholesterol (HDL-C) subfractions and apo A-I serum levels were significantly lower in CHD patients, as were apo A-I/apo B and HDL-cholesterol/total cholesterol ratios. Apo C-II and apo C-III showed similar serum concentrations in all three groups of subjects, but apo C-II/apo C-III ratio was significantly lower in PAD patients as compared with that in CHD patients and control subjects.

This study confirms that PAD may be associated with a particular lipopro tein derangement that primarily involves very low-density lipoprotein catabo lism.
Occurrence of Non-Hodgkin's Lymphoma in Williams Syndrome—Case Report
Authors: Felice Philip V. , Ritter Seymour D. , Anto Joseph
Published: July 2008

The authors present a case of a twenty-nine-year-old woman with Williams syndrome and non-Hodgkin's lymphoma. The patient had been told that she had had an atrial septal defect from the time of her birth.
Does Cholesterol Depletion Have Adverse Effects on Blood Rheology?
Authors: Fawcett J.P. , Menkes D.B.
Published: July 2008

Blood viscosity (η B) at shear rates 10 and 100s-1, plasma viscosity (η P), hematocrit (Hct), and whole blood cholesterol (Chol) were measured in 50 patients with a history of myocardial infarction or unstable angina pectoris. Erythrocyte morphology was also studied by scanning electron microscopy to determine the proportion of nondiscocytic erythrocytes (NDE). There was a significant positive correlation between Chol and ηP ( r = 0.41, P < 0.004) and a highly significant negative correlation ( r = -0.69, P < 0.001) between Chol and Tk, a viscometric index of erythrocyte rigidity based on relative blood viscosity at high shear (ηB/ηP) corrected for Hct. This latter result indicates Chol reduction in this population may increase erythrocyte rigidity Twenty-five patients with Chol values in the range 4.0-8.0 mmol/L were commenced on a standard lipid-lowering diet and after eight weeks half were also given pravastatin (40 mg daily). After thirty-two weeks Chol had fallen significantly more in the pravastatin group (28%) than in the diet only group (11%, P = 0.005). There was no change in ηP for either group but a signifi cant increase in Tk for the pravastatin group only ( P = 0.011). The change in total choles terol (ΔChol) for each patient over thirty-two weeks was negatively correlated with both the change in the index of erythrocyte rigidity (ΔTk) ( r = -0.40, P = 0.044) and the change in the proportion of nondiscocytic erythrocytes (ΔNDE) ( r = -0.47, P = 0.026). These data suggest that cholesterol reduction within the normolipemic range may be associated with unfavorable changes in blood rheology
Evaluation of Aortic Distensibility in Patients with Essential Hypertension by Using Cine Magnetic Resonance Imaging
Authors: Honda Toshio , Yano Kazuo , Matsuoka Hiroshi , Hamada Mareomi , Hiwada Kunio
Published: July 2008

In order to evaluate the exact distensibility in various parts of aorta in hypertensive patients, the authors performed cine magnetic resonance (MR) in 30 normal control (NC) subjects and 30 hypertensive (HT) patients whose age and sex were matched. Cine MR was carried out at transverse sections in the ascending, descending, and abdominal aorta. Aortic diameter and area were measured in the frames of the maximum and the minimum aortic area. Aortic distensibility was calculated from the following formula: (Max area — Min area)/(Min area x ΔP), where ΔP is pulse pressure. Cardiac parameters were measured with echocardiography in all subjects. Aortic distensibility was signifi cantly lower in HT patients than in NC subjects at each transverse section (P < 0.01). Minimum diameter index (Min diameter/body surface area) and cardiac function parameter showed no significant differences between NC and HT groups.

From these findings, it is suspected that hypertension is a strongly contributing factor that promotes aortic sclerosis.
Complications of Duplex Carotid Imaging
Authors: Dick Maroun T. , Cape Charles A.
Published: July 2008

Although duplex carotid imaging is a safe diagnostic procedure, 3 neurologic and 2 cardiac adverse events have been associated with its performance in the past twenty-five years. This is a report of a man who had a transient cerebral ischemic attack during duplex imaging. An intraarterial digital subtraction angiogram showed 50% stenosis of the left internal carotid artery and 30% stenosis of the right internal carotid artery. Magnetic resonance imaging showed multiple small infarctions in both cerebral hemi spheres and the brainstem. At left carotid endarterectomy, the atherosclerotic plaque removed had several small ulcers.
"Vasoactivators"—a New Concept for Naturally Secreted vasoconstrictor Substances
Authors: He Guo-Wei , Yang Cheng-Qin
Published: July 2008

Many vasoconstrictor substances have been demonstrated as being vasodilators through the mechanism of endothelium-derived relaxing factor (EDRF) release. The authors have hypothesized that all naturally secreted vasoconstrictor substances may potentially be vasodilators as well in order to maintain an adequate physiological vascular tone. To test this hypothesis, they studied the effect of thromboxane A2—a naturally secreted vaso constrictor substance released from platelets, which has not been demonstrated as an EDRF stimulus, using its stable analog U46619 in the porcine coronary artery (CA). The results have shown that U46619 is a stimulus for EDRF biosynthesis/release. This effect may be blocked by the specific inhibitor of EDRF biosynthesis/release NG-nitro-L-arginine (L-NNA). Therefore, this study supports the aforementioned hypothesis. The authors suggest that naturally secreted vasoconstrictor substances may be more accurately termed "vasoactivator" substances. These vasoactivators, according to the balance between their constrictive or relaxing effects, may be classified as (1) Type I: vasoconstriction-predom inant type such as acetylcholine (ACh), and U46619 in porcine which mainly cause contraction in endothelium-intact arteries; (2) Type II: balanced type such as norepi nephrine (NE) and 5-hydroxytryptamine (5-HT) in porcine CA, which cause little contrac tion in endothelium-intact arteries but cause a great contraction when the endothelium is denuded. Usually, the receptor subtypes located in the endothelium and smooth muscle stimulated by any one of these vasoactivator substances are different. All these charac teristics of vasoconstrictor substances may play an important role in maintaining an adequate vascular tone.
Serial Changes in Coagulant Activities After Thrombolytic Therapy for Acute Myocardial Infarction
Authors: Goto Shinya , Kawai Yohko , Abe Sumihisa , Takahashi Eiichi , Handa Shunnosuke , Ogawa Satoshi , Watanabe Kiyoaki , Hori Shingo , Ikeda Yasuo
Published: July 2008

Early reocclusion and bleeding complications are still unresolved problems in throm bolytic therapy for acute myocardial infarction (AMI). In the present study, 16 patients treated with either fibrin-specific tissue-type plasminogen activator (t-PA) or nonspecific urokinase (UK) were studied to determine the effects of thrombolytic therapy on serial hemostatic states. Hemostatic states of each patient were estimated by measuring various plasma markers at one- to two-hour intervals during the first six hours of therapy, daily during the next three days, and subsequently on day 7.

Two markers of plasma thrombin generation, thrombin antithrombin III complex (TAT) and prothrombin fragment 1+2 (F 1+2), showed an activated coagulant state imme diately after thrombolytic therapy The amount of thrombin generation indicated by these markers showed significant positive correlation with direct markers of fibrinolysis such as fibrin degradation products (FDP), while it did not show any correlation with the markers for plasmin generation. The potential for coagulation as indicated by prothrombin time (%) decreased with thrombolysis using fibrin nonselective agents, owing perhaps to destruction of coagulant factors by free plasmin. ( continued on next page)

Fibrinolytic activity induced by thrombolytic therapy for AMI caused transient activa tion of the coagulant system, which could contribute to early reocclusion. Fibrin nonse lective agents decreased the potential for coagulation by destroying clotting factor through the generation of free plasmin. These data provide theoretical support for simultaneous administration of anticoagulant therapy with fibrin-specific thrombolytic agents.
Reopening Phenomenon in Cardioembolic Stroke Observed by Duplex Carotid Ultrasonography Case Reports
Authors: Omae Tsuyoshi , Yamaguchi Takenori , Tsuchiya Takashi , Yasaka Masahiro , Omae Teruo
Published: July 2008

The authors attempted to detect the reopening of an occluded artery within the carotid axis of acute cardioembolic stroke patients noninvasively by using duplex carotid ultra sonography. The timing of reopening as related to hemorrhagic transformation was also studied. For assessing the reopening phenomenon, quantitative measurement of flow velocity in the bilateral common carotid arteries was repeated in 10 patients who also underwent repeated angiography or autopsy The ratio of the end-diastolic flow velocity (nonaffected/affected) was related to angiographic or autopsy findings. In 17 patients including the 10 cases mentioned, the occurrence of hemorrhagic transformation was related to the timing of reopening. The hemorrhagic infarction in this study was defined to be a hyperdense area in the basal ganglia on computed tomography. A significant decrease in the ratio of the end-diastolic velocity was observed in 6 patients, in whom the repeated angiography demonstrated reopening of the artery. Of the remaining 4 patients not showing a significant change, only 1 patient was found to have reopening. Reopening was detected in 12 of 17 cases. The timing was 2.5 hours after onset in 1, between days 2 and 5 in 6 cases, and after day 6 in 5 cases. Hemorrhagic infarction was found in 5 of the cases with reopening on days 2-5.
Front-Loaded Infusion Therapy of rT-PA During Active Menstruation
Authors: Lee Don W. , Garza Juan L.
Published: July 2008

The authors report use of intravenous (IV) tissue plasminogen activator (TPA) to treat acute anterior wall myocardial infarction in a forty-two-year-old woman during the active menstrual period. The patient received the TPA with the front-loading system with excellent result. Hemoglobin remained unchanged. This case demon strates that TPA infusion can be used in a menstruating woman without causing a dangerous hemorrhage.
Cerebellar Vermis Bleeding in a Patient with Hemophilia A
Authors: Kitazono Takanari , Okada Yasushi , Sadoshima Seizo , Utsunomiya Hidetsuna , Fujishima Masatoshi
Published: July 2008

A seventeen-year-old man with hemophilia A developed nausea, vomiting, and unsteady gait after mild head trauma. Magnetic resonance imaging clearly demonstrated localized bleeding in cerebellar vermis. Quick administration of factor VIII concentrates prevented further extension of the bleeding and the patient completely recovered without neuro logic impairment. In hemophiliac patients, careful evaluation of intracranial lesions is desired after head trauma even if they show only nonspecific symptoms.
Local Transdermal Glyceryl Trinitrate Has an Antiinflammatory Action on Thrombophlebitis Induced by Sclerosis of Leg Varicose Veins
Authors: Berrazueta J.R. , Fleitas M. , Salas E. , Amado J.A. , Poveda J.J. , Ochoteco A. , Sánchez de Vega M.J. , Ruiz de Celis G.
Published: July 2008

To test the antiinflammatory and analgesic effects of transdermal glyceryl trinitrate (GTN) the authors carried out a double-blind, randomized, controlled clinical study in 21 patients with mild to moderate leg varicose veins who underwent vein sclerotherapy in both legs. GTN or placebo ointment was applied in a blinded protocol along the surface of the sclerosed vein every eight hours until disappearance of inflammation signs. The varicose vein in one leg was treated with GTN and compared with placebo for the vein of the other leg used as control of thrombophlebitis (TP) signs. Fifteen minutes after first application inflammation signs were observed in all cases.

The intensity of inflammation signs was assessed as 26% (10.4 ±4.1) in GTN-treated veins and as 61.5% (24.6 ±6.3) ( P < 0.001) in the placebo-treated veins. One hour later only 63% of cases in the GTN group and all cases in the placebo group showed signs of TP ( P < 0.001). The reduction in the intensity of signs at this time was 7.7 ±3.9 in the GTN group and 19.7 ±6.3 in the placebo group ( P < 0.001). All veins in the GTN group were free of signs of TP in less than forty-eight hours. In the placebo group, 45% of veins required more than forty-eight hours for complete disappearance of signs of TP ( P < 0.001). The authors conclude that GTN has an antiinflammatory effect in TP induced by sclerotherapy. This action may be related to the nitric oxide released from GTN, through a direct action on the vein and the surrounding inflamed tissue.
Benefits of Rate-Responsive Pacing in Patients with Sick Sinus Syndrome
Authors: Nishino Masami , Ito Tatsuo , Miyawaki Miwa , Nakagawa Takahiko , Kuryu Toshiki , Tanahashi Hideo , Yamada Yoshio , Abe Hiroshi
Published: July 2008

The effect of changing a rate-responsive pacemaker program (which reacts to evoked QT interval) to fixed-rate ventricular pacing was studied in 10 patients with sick sinus syndrome (SSS). After the patients had been in the rate-responsive mode (VVIR) for at least one year, the exercise capacity (maximal oxygen consumption [peak VO2], anaerobic threshold [AT], and cardiac output [CO] at these points) was examined. Three hours later on the same day, the pacemaker was reprogrammed to the fixed-rate pacing (WI) and the exercise capacity was examined again (VVI-S). One month later, a similar exercise test was also done in the VVI mode (VVI-L). There was no significant difference in peak VO2 and AT between VVIR and VVI-S, but both peak VO 2 and AT were significantly lower in VVI-L than in WIR. However, there were no significant differences in the CO at peak VO2 or AT between any of the pacing modes. These findings indicate that a WIR pacemaker should not be reprogrammed to the VVI mode in SSS patients, because the change can cause the exercise capacity to deteriorate.
Platelet Indices in Patients with Occlusive Carotid Artery Disease
Authors: Valkila Eeva H. , Salenius Juha-Pekka , Koivula Timo A.
Published: July 2008

During the period 1965-1984 a total of 279 patients underwent carotid endarterec tomy at the Tampere University Hospital; 160 of them were reexamined twenty-eight to two hundred nine months later to investigate whether there are any long-term differ ences in platelet properties according to the endpoint that led to operation. Platelet count, mean platelet volume (MPV), and plateletcrit were estimated and compared with the respective values for controls. Classified according to the indication for operation, patients with stroke had a significantly higher platelet count, 292×109/L (SE 11), than patients with transient ischemic attack (TIA), 255×109/L (SE 5, p < 0.01), or controls, 267×109/L (SE 6, p < 0.05). Patients with stroke or TIA had a higher MPV than the controls. When the patients were grouped according to their physical condition at the time of the control examination, the largest platelets, 10.84×10-15L (SE 0.40), were found in the group of patients who felt well but who had a symptom or finding assumed to be due to a carotid disease.