bluuebunny/crossref_metadata_2025 huggingface dataset:
Association Analysis of Common Variants of
ELN, NOS2A, APOE
and
ACE2
to Intracranial Aneurysm
Authors: Mineharu Youhei , Inoue Kayoko , Inoue Sumiko , Yamada Shigeki , Nozaki Kazuhiko , Takenaka Katsunobu , Hashimoto Nobuo , Koizumi Akio
Published: March 2006

Background and Purpose—

Previous studies have shown positive evidence of linkage of the intracranial aneurysm (IA) at chromosome 7q11, 17cen, 19q13, and Xp22. These regions contain
elastin
(
ELN
),
nitric oxide synthetase 2A
(
NOS2A
),
apolipoprotein E
(
APOE
), and
angiotensin-I converting enzyme 2
(
ACE2
), which are considered to be promising candidate genes for IA. We aimed to examine the association of single-nucleotide polymorphisms (SNPs) with IA in these candidate genes.

Methods—

To identify polymorphisms in
NOS2A
and
ACE2
, all exons and exon-intron boundaries were screened by direct sequencing in 30 randomly selected controls. The program tagSNPs was used to select an optimal set of haplotype-tagging SNPs. For
ELN
and
APOE
, SNPs were selected from previous reports. These selected SNPs were then genotyped in 362 cases with IA and 332 residential area matched controls. THESIAS software was used to investigate the association of alleles and haplotypes with IA by adjusting with covariates.

Results—

We genotyped 8 SNPs in
ELN
, 8 SNPs in
NOS2A
, 3 ε alleles in
APOE
and 1 SNP in
ACE2
. No alleles or haplotypes of 4 candidate genes revealed any significant association with IA.

Conclusions—

Investigated polymorphisms in this study were not associated with IA.
Calcium Dobesilate for Chronic Venous Insufficiency: A Systematic Review
Authors: Ciapponi Agustín , Laffaire Enrique , Roqué Marta
Published: March 2006

Chronic venous insufficiency (CVI) causes much discomfort and sick leave. Many randomized clinical trials (RCTs) have shown a beneficial effect of calcium dobesilate, but consensus is lacking about efficacy and safety. The authors report a meta-analysis of the effectiveness and safety of calcium dobesilate in CVI. Ten RCTs (778 patients) in which calcium dobesilate for CVI was compared with placebo met the inclusion criteria. Only 3 trials (608 patients) were of good methodological quality. Calcium dobesilate significantly improved night cramps and discomfort nearly twice as well as placebo, with the number needed to treat (NNT) being 8 (95% CI 4-50) and 4 (95% CI 3-7), respectively. Frequency of adverse events was not significantly different from placebo. Subgroup analysis found a differential response with respect to disease severity, with greater improvements in pain, heaviness, and malleolar swelling being seen in the severe group than in the mild group. Calcium dobesilate improved paresthesias significantly more than placebo in the severe but not in the mild group and the effect on leg volume was also significantly better in the severe group (-7.2% vs -1.6%). No difference in effect was found for different doses of calcium dobesilate (1,000 or 1,500 mg/day). Sensitivity analyses did not affect the results. Current evidence suggests that calcium dobesilate is more effective than placebo in improving some CVI symptoms, that there is higher efficacy in more severe disease, and that a dose of 1,000 mg/day is as effective and safe as 1,500 mg/day. Further adequately powered trials are needed to further evaluate these hypotheses.
Sex Difference in the Effect of ACE-DD Genotype on the Risk of Premature Myocardial Infarction
Authors: Petrovič Daniel , Bregar Dejan , Guzic-Salobir Barbara , Skof Erik , Span Matjaz , Terzić Rifet , Petrovič Mojca Globocnik , Keber Irena , Letonja Mitja , Zorc Marjeta , Podbregar Matej , Peterlin Borut
Published: March 2006

In this association study the authors compared the insertion/deletion (I/D) angiotensin-I converting enzyme (ACE) gene polymorphism in females and males with premature myocardial infarction (MI). I/D ACE gene polymorphism was tested in 738 subjects: 302 patients with MI (151 men and 151 women) and 436 healthy subjects (207 men and 229 women). In women the ACE-DD genotype was not associated with MI (OR 1.1, 95% CI 0.6-2.1, p=0.6), whereas the ACE-DD genotype conferred a 2-fold independent risk for MI in men (95% CI=1.2-3.4; p=0.013) after adjustment for cardiovascular risk factors. The authors found evidence for the sex difference in the effect of the ACE-DD genotype on MI risk. The ACE-DD genotype conferred a 2-fold independent risk for premature MI in males.
Angiographic and Long-Term Outcomes of “Rescue” Stenting versus PTCA in Failed Thrombolysis in Acute Myocardial Infarction
Authors: Tadros George M. , Islam M. Ashequl , Mirza Ayoub , Blankenship James C. , Iliadis Elias A.
Published: March 2006

Percutaneous transluminal coronary angioplasty (PTCA), when performed early after clinically failed thrombolysis, improves acute infarct-artery patency in up to 90% of cases. Limited data are available regarding the role of rescue stenting in this setting. From January 1995 to December 1999, the authors studied all consecutive patients treated with rescue PTCA or rescue stenting within 12 hours of onset of chest pain and clinically failed thrombolytic therapy at their institution. Baseline demographic characteristics, infarct-related artery location, lesion class, left ventricular function, and incidence of multivessel disease were similar between groups (23 patients in each group). Preprocedural TIMI flow 0 was more common in PTCA patients (p=0.025). Quantitative coronary analysis revealed similar incidence of calcification, thrombus burden, minimal lumen diameter (MLD), and lesion length between groups. Post-procedural TIMI 3 flow was more common in stent patients; however, this was not statistically significant (p=0.18). Greater final MLD (p<0.001), less residual stenosis (p<0.001), and a trend toward larger reference vessel diameter (p=0.13) were observed in favor of stent patients. At 6-month follow-up, there was no difference in the incidence of death, myocardial infarction, or readmission for unstable angina between groups. More stent patients (60% vs 27%, p=0.06) were angina free as compared to PTCA patients. Despite similar in-hospital clinical outcomes, the study suggests better angiographic results and 6-month morbidity with rescue stenting.
An Epidemiologic Study of Acute Coronary Syndromes in Northwestern Greece
Authors: Papathanasiou A. I. , Pappas K. D. , Korantzopoulos P. , Leontaridis J. P. , Vougiouklakis T. G. , Kyrgiou M. , Dimitroula V. , Michalis L. K. , Goudevenos J. A.
Published: March 2006

Acute coronary syndromes (ACS) represent the most common cause of morbidity and mortality in the Western world. Relative epidemiologic data for Greece, a Mediterranean country, are sparse. The aim of the study was to determine the incidence and the clinical presentations of ACS. Over a 1-year period we conducted a prospective, population-based survey of ACS cases in an isolated area of northwestern (NW) Greece with 170,000 inhabitants. Every patient living in the study area, aged <80 years, without history of coronary artery disease, who presented with symptoms suspicious for ACS and was hospitalized for at least 24 hours was eligible for inclusion in the study. For sudden cardiac deaths, relative information was obtained from the autopsy report or the physician who documented death. Additional information regarding timing and associated conditions was obtained from relatives. The diagnosis and classification of the studied cases was performed according to World Health Organization and European Society of Cardiology criteria. The authors identified 352 patients (265 men, 87 women, mean age 62.5 ±10 and 68 ±9.5 years, respectively) with first-appeared ACS (174 non-ST elevation, 105 ST elevation, 73 sudden cardiac deaths). Fifty-six patients with other forms of ischemic heart disease (stable angina, heart failure, and silent ischemia) were not included in the analysis. Moreover, 154 patients with chest pain and normal appearing EGG at rest, normal values for enzymes (CK, troponin), and negative exercise testing, as well as 77 patients with normal findings from coronary angiography studies, were also excluded. The annual incidence for the age group of 30-79 was 39/10,000 inhabitants (60.6 for men and 19 for women). The incidence of ACS increased with age in both sexes and was higher in men even after the age of 70. About one third of the ACS and half of the sudden cardiac deaths occurred in the age group of 70-79. Only 3 patients were successfully resuscitated. ACS are common in this area of NW Greece and the majority of them present in a form amenable to therapeutic manipulations. Twenty percent of patients died suddenly, and a very small percentage of these were successfully resuscitated. Preventive measures and acute management facilities need to be improved, even in a Mediterranean country where the incidence of ischemic heart disease is relatively lower than in northern European countries.
Bridge Over Troubling Spasm: Is the Association of Myocardial Bridging and Coronary Artery Spasm a Distinct Entity?
Authors: Low Adrian F. , Chia Boon-Lock , Ng Wai-Lin , Lim Yean-Teng
Published: March 2006

The association of coronary artery spasm and myocardial bridging is very uncommon and may represent a distinct clinical entity. Three patients are described, presenting with acute coronary syndrome associated with myocardial bridging and coronary artery spasm. The relationship and respective roles of myocardial bridging and spasm, however, remain uncertain and may be consequent to a direct effect on endothelial function from the compressive effect of myocardial bridging. The role of intracoronary nitroglycerin in these patients is unresolved.
Hypereosinophilic Syndrome Associated with Heterozygous Factor V Gene Mutation: An Unusual Combination Resulting in an Acute Coronary Syndrome and Recurrent Cerebral Stroke
Authors: Engelmann Markus G. , Kolbe Tilman , Faul Christian , Steinbeck Gerhard
Published: March 2006

The authors report the first case of a patient with a hypereosinophilic syndrome associated with heterozygous factor V gene mutation, resulting in an acute coronary syndrome and recurrent cerebral stroke despite effective anticoagulation. A 40-year-old man presented with an acute coronary syndrome accompanied by a brachiofacial right-sided hemiparesis and dysarthria. Diagnosis of a hypereosinophilic syndrome was established by blood testing, myocardial biopsy, and bone marrow analysis. Eosinophilic infiltration was present in the myocardium, accompanied by proliferation in the endomyocardium and a pneumonic infiltrate. Although effective anticoagulation with heparin was administered, a recurrent stroke occurred while blood eosinophils were being normalized by corticosteroid treatment. A coexisting heterozygosity of the factor V mutation was demonstrated, and it is hypothesized that this might have contributed to the recurrent thromboembolic episodes. In patients with hypereosinophilic syndrome and recurrent thromboembolic episodes, other thrombophilic diseases, including factor V mutations, should be considered, and long-term coagulation should be contemplated.
Cerebral Infarction Due to Giant Cell Arteritis
Authors: Hu Zhiping , Yang Qidong , Yang Li , Li Jinghe , Tang Jiangguang , Zhang He
Published: March 2006

The objective of this report was to explore the clinical features of patients with cerebral infarction due to giant cell (temporal) arteritis (GCA) and its characteristic changes in pathology, and on computed tomography (CT) and magnetic resonance imaging (MRI). Three cases of cerebral infarction due to GCA, treated during the past 2 years, were analyzed. Their clinical manifestations were observed carefully, their temporal artery biopsies were performed, their immunohistochemistries were done, and CT as well as MRI were used. The results showed that all the patients had new-onset headache and temporal artery abnormality when the disease began, and there was tremor on the right limbs of 1 patient; temporal artery biopsies revealed evidence of inflammatory cell infiltration in the arterial wall, mainly including T-lymphocytes and macrophages; small cerebral infarction foci were found on CT and MRI; and the responses to corticosteroid therapies were good. The results suggest that it is important to recognize the clinical features of cerebral infarction due to GCA, including the changes of pathology and on CT and MRI. In some cases, special attention is paid to differentiating between atherosclerotic infarction and infections to avoid misdiagnosis.
The Relationship Between Lower Extremity Functional Strength and Severity of Peripheral Arterial Disease
Authors: Atkins LeighAnn M. , Gardner Andrew W.
Published: March 2006

The purposes of this study were to (1) determine if peripheral arterial disease (PAD) severity is related to deficits in lower extremity functional strength, (2) identify covariates that might affect the relationship between lower extremity functional strength and severity of PAD, and (3) determine if the relationship between lower extremity functional strength and severity of PAD still persists after statistically controlling for significant covariates. A total of 144 patients were grouped into tertiles according to disease severity. Patients having an ankle-brachial index (ABI) of 0.76 to 0.90 were classified as having mild PAD (high ABI group), 0.51 to 0.75 classified as having moderate PAD (moderate ABI group), and 0.36 to 0.50 as having severe PAD (low ABI group). Lower extremity functional strength was assessed using the chair-stand test where the time to complete 5 consecutive stand-to-sit transfers was recorded. Patients were also characterized on ambulatory function and clinical characteristics. The moderate ABI group took significantly (p<0.05) less time (13.49 ±0.49 s) to complete the chair-stand test than the low ABI group (15.86 ±0.63 s). Both daily physical activity level and total 6-minute walk distance were identified as significant covariates (p<0.05) of lower extremity functional strength. After controlling for daily physical activity level and total 6-minute walk distance, no significant differences (p>0.05) in the time to complete the chair-stand test existed between the ABI groups. These findings indicate that the greater impairment in lower extremity functional strength in patients with severe PAD is explained by their lower physical activity level and poorer overall walking ability.
Hypothesis: A Potential Role for the Vasa Vasorum in the Maintenance of Vein Graft Patency
Authors: Dashwood Michael R. , Anand Radhi , Loesch Andrzej , Souza Domingos S.R.
Published: March 2006

Autologous saphenous vein is the most commonly used conduit for coronary artery bypass surgery with more than 50% grafts occluding within 10 years. In conventional preparation the vein undergoes considerable surgical trauma with damage to the outer layers during harvesting. Within these regions are situated the vasa vasorum and small vessels providing oxygen and nutrients to the vessel wall. Certain vasa vasorum terminate in the vessel lumen where it is suggested that they have a physiological role. Preservation of the vasa vasorum of saphenous veins used as bypass conduits may play an important role in the maintenance of graft patency.
Intima-Media Thickness and Arterial Distensibility in Behçet’s Disease
Authors: Alan Sait , Ulgen Mehmet S. , Akdeniz Sedat , Alan Bircan , Toprak Nizamettin
Published: March 2006

The etiology of Behçet’s disease, a systemic vasculitis, is unknown. Vascular involvement may be seen in 25% of patients with Behçet’s disease. Vasculitis make the prognosis of Behçet's disease severe. The aim of this study is to examine the structural and functional changes and relations of these changes with progression and prognosis of Behçet’s disease. For this purpose, 40 patients with Behçet’s disease and 40 healthy volunteer control subjects were analyzed, additionally patients with Behçet’s disease were divided into 2 subgroups as those with vascular complications and those without vascular complications. Intima-media thickness and arterial distensibility were measured in all subjects with carotid artery ultrasonography. Carotid artery distensibility was significantly lower in the patient group compared to the control group (0.67 ±0.2, 0.93 ±0.4, p<0.05), and carotid artery IMT was significantly higher (0.59 ±12, 0.80 ±0.11, p<0.05). A statistically significant increase in IMT has been detected (0.77 ±11, 0.86 ±11, p<0.05) in patients with Behçet’s disease with vascular involvement compared to patients with Behçet’s disease without vascular involvement, arterial distensibility in patients with vascular disease was similar with those who has no vascular disease (0.69 ±0.25, 0.63 ±0.25, p>0.05). There was a significant negative linear regression between arterial distensibility and systolic blood pressure (SBP) (B=-1x10-2, p<0.05), and a significant positive linear regression has also been found between IMT and SBP and diastolic blood pressure (DBP) and pulse pressure (PP) (B=6.8x10-3 for SBP, p<0.05, B=6.9x10-3 for DBP, p<0.05, B=6x10-3 for PP, p<0.05). As a result, IMT increases and AD decreases in patients with Behçet’s disease compared to results in the control group. Although more studies are required for this subject, use of noninvasive parameters such as IMT and AD, which reflect the structural and functional characteristics of vasculature, may be useful to define disease progression and subjects at high risk.
Reversible Atrial Lead Dysfunction of DDD Pacemaker After Recent Inferior Myocardial Infarction
Authors: Chen Chiliang , Fang Ching-Chang , Wang Shih-Pu
Published: March 2006

A patient with DDD pacemaker had pacing dysfunction following an inferior myocardial infarction. The threshold of that implanted right atrial pacing lead was abnormally high but the generator was normal. A temporary lead was inserted into the high right atrium near the appendage and near the low atrium for testing of threshold, which was abnormally high in these 2 places. Forty days after stent implantation in the proximal segment of the right coronary artery, the threshold spontaneously returned to normal. The change threshold of electrode-tissue interface in the right atrium was suspected due to hibernation of right atrium ischemia.
Permanent Myocardial Dysfunction Caused by High-Voltage Electrical Injury
Authors: Atak Ramazan , Turhan Hasan , Erbay A. Riza , Yetkin Ertan , Ileri Mehmet
Published: March 2006

Electrical injury, particularly alternating current, may lead to disease of conducting tissue or to myocardial damage, or even may cause sudden death. In the present case, the authors report a 22-year-old man who sustained extensive upper extremity trauma from a high-voltage electrical injury and manifested clinical signs of left ventricular heart failure.
Pseudo-Lesion of Internal Mammary Artery Graft and Left Anterior Descending Artery During Percutaneous Transluminal Angioplasty
Authors: Zanchetta Mario , Pedon Luigi , Rigatelli Gianluca , Olivari Zoran , Zennaro Marco , Maiolino Pietro
Published: March 2006

New lesions appearing during coronary angioplasty may be due to spasms, dissection, and thrombosis. Straightening of the tortuous vessels by guidewire may produce transient angiographic pseudo-lesions, which mimic severe artery damage. An additional case is reported, in which simultaneous artifactual lesions involved the internal mammary artery and the left anterior descending coronary artery, mimicking thrombosis and dissection. Recognition of this entity is essential to avoid unnecessary interventions and potentially harmful complications.
Inferior Vena Cava Filter Ensnarement by Central Line Guide Wires
Authors: Chattar-Cora Deowall , Tutela Rocco R. , Tulsyan Nirman , Patel Roshani , Cudjoe Ernest A. , Onime Godfrey D.
Published: March 2006

Ensnarement of inferior vena cava filters with central line guide wires is an infrequent complication that has been sporadically reported. The authors present 4 patients who experienced this complication. They review the literature, make recommendations to avoid this preventable complication, and recommend what to do once the complication occurs.
Association of Serum Total Homocysteine with the Extent of Ischemic Heart Disease in a Mediterranean Cohort
Authors: Vrentzos George , Papadakis John A. , Malliaraki Niki , Zacharis Evagelos A. , Katsogridakis Kostas , Margioris Andrew N. , Vardas Panos E. , Ganotakis Emmanuel S.
Published: March 2006

High total homocysteine (tHcy) concentrations increase coronary disease risk. Therefore, the authors examined the relation between tHcy concentrations and the number of stenotic arteries in patients with ischemic heart disease (IHD). They enrolled 155 patients with IHD (135 men) who had undergone selective coronary angiography during the previous 2 years. These patients were divided into 4 groups according to the number of vessels (0, 1, 2, and 3) with ≥70% stenosis. They also reviewed the major coronary risk factors for each patient (age, gender, hypertension, diabetes mellitus, dyslipidemia, cigarette smoking, obesity), and measured serum concentrations of tHcy, folate, vitamin B12 and lipids. There was a significant positive correlation (rs=0.19; p=0.017; n=155) between tHcy serum concentration and the extent of coronary atherosclerosis, expressed by the number of coronary arteries with significant stenosis. Moreover, the number of affected vessels displayed a significant positive correlation with the presence of diabetes mellitus (rs=0.30; p<0.0001; n=155) and serum concentrations of lipoprotein (a) (rs=0.25; p<0.05; n=67) and a negative correlation with apolipoprotein A-I serum concentration (rs=-0.27; p<0.01; n=67). In this study, the serum concentrations of tHcy correlated with the extent of coronary atherosclerosis, independently of other classical risk factors, with the exception of diabetes mellitus.
Histopathologic Signs for the Inflammatory Role of Chlamydia pneumoniae in the High-Grade Atherosclerotic Coronary Artery Wall
Authors: Legan Mateja , Vraspir-Porenta Olga , Kese Darja , Zorc-Pleskovic Ruda , Zorc Marjeta
Published: March 2006

The aim of the study was to prove the long-lasting and continuously harmful effect of chronic Chlamydia pneumoniae (CPn) infection on vessel walls in patients with diffuse coronary artery disease (CAD). In surgically obtained endarterectomized atherosclerotic plaques grade VI-VIII (Stary classification) from 10 patients with diffuse coronary artery disease and chronic (7) or past (3) CPninfection, signs of inflammatory response of the vessel wall on infectious agents were studied. In all 10 endarterectomized plaque step serial sections, immunologic signs of vessel wall response were present (positive T- and B-lymphocytes, macrophages, and capillarogenesis). In 8 of 10 patients’ atherosclerotic plaque, unique features of active vasculitis in the neoarteriolar wall as well as arteriologenesis, were found. Seven of these 8 patients had serologically proven chronic CPninfection, and 1 had past infection. Features of vasculitis as well as arteriologenesis were absent in 2 patients who recovered from CPninfection at the time of surgery. In the endarterectomized segments of 3 randomly chosen patients in this study, the polymerase chain reaction method revealed positive DNA of CPn.Two of these patients had chronic infection, but the third had only a past CPninfection. This study provides evidence that CPninfection has continuous and a long-lasting inflammatory response in the high-grade atherosclerotic coronary artery vessel wall.
Evidence of Left Ventricular Dysfunction in Asymptomatic Elderly Patients with Non-insulin-dependent Diabetes Mellitus
Authors: Karvounis Haralampos I. , Papadopoulos Christodoulos E. , Zaglavara Theodora A. , Nouskas Ioannis G. , Gemitzis Konstantinos D. , Parharidis Georgios E. , Louridas Georgios E.
Published: March 2006

Diabetic cardiomyopathy is a distinct entity in diabetic patients with congestive heart failure, who have no angiographic evidence of significant coronary artery stenosis. The aim of this study was to evaluate left ventricular (LV) function in 24 elderly patients (mean age 67 ±2 years) with type 2 diabetes, who were asymptomatic and had no history of hypertension, or coronary or valvular heart disease. LV systolic indices (ejection fraction [EF] and fractional shortening [FS]), diastolic indices (E wave, A wave, E/A ratio, isovolumic relaxation time [IVRT] and deceleration time [DT]) and the myocardial performance index (MPI) were evaluated with echocardiography. Compared to controls (24 age- and gender-matched normal subjects), the E wave was reduced (0.60 ±0.10 m/sec vs 0.72 ±0.08 m/sec, p<0.05), the A wave was increased (0.77 ±0.07 m/sec vs 0.68 ±0.06 m/sec, p<0.05), the E/A ratio was decreased (0.78 ±0.20 vs 1.06 ±0.18, p<0.001) and both IVRT and DT were prolonged (0.115 ±0.01 sec vs 0.09 ±0.01 sec, p<0.001 and 0.240 ±0.04 sec vs 0.180 ±0.03 sec, p<0.001, respectively). The MPI was significantly increased (0.640 ±0.170 vs 0.368 ±0.098, p<0.001). LV diastolic function and the MPI are markedly impaired in asymptomatic elderly patients with type 2 diabetes.
Microcirculatory Efficacy of Topical Treatment with Aescin + Essential Phospholipids Gel on Transcutaneous PO2 in Venous Insufficiency
Authors: Cesarone M. R. , Belcaro G. , Ippolito E. , Ricci A. , Ruffini M. , Dugall M.
Published: March 2006

A gel including aescin, essential phospholipids (EPL), and heparin (EG) has been used for many years for local treatment of venous, microcirculatory alterations (varicose veins, chronic venous insufficiency). Bruises, swelling, thrombophlebitis, and contusions are effectively treated with this compound. The aim of this study was the evaluation of the efficacy of the effects of an AEPL (aescin+EPL) gel on the microcirculation in subjects with chronic venous insufficiency, venous hypertension (CVH), and venous microangiopathy. Transcutaneous PO2 was measured at the perimalleolar region. After 2 weeks of treatment, all individual values (100%) were significantly increased (p<0.05). In all patients, PO2 increased, indicating a decrease in level of venous microangiopathy. Considering transcutaneous skin PO2, treatment with AEPL in areas of venous microangiopathy is beneficial in the prevention of ulceration and improves skin healing.
Variations in Plasma Free Radicals with Topical Aescin + Essential Phospholipids Gel in Venous Hypertension: New Clinical Data
Authors: Ricci A. , Ruffini I. , Cesarone M. R. , Cornelli U. , Corsi M. , Belcaro G. , Ippolito E. , Dugall M.
Published: March 2006

The aim of this study was the evaluation of the effects of Aescin + essential phospholipids (AEPL) gel on plasma free radicals (PFRs). In this study, ten patients with venous hypertension, no ulcerations or infections, venous microangiopathy, and varicose veins were treated with topical AEPL applied in a standard protocol. AEPL was applied for 2 weeks, three times daily at the same skin region (perimalleolar internal region at defined distance from the medial malleolus and from the anterior edge of the tibia). In subjects with venous hypertension, PFR values were higher than 420 Carr units. After treatment, the values of PRF decreased to almost normal as an effect of the massage with AEPL gel. The decrease in value was observed in all treatment subjects. A ranking system indicates that the AEPL preparation is active in all subjects who have venous microangiopathy. The decrease in PFR value was greater than 30% in all treatment subjects (p<0.05). The decrease in PFR can be considered an important indication of an improvement in skin perfusion, which protects the skin from deterioration and eventually from venous ulcerations. The evaluation of PFR is an important new physiologic parameter that can be associated with other noninvasive tests to study the microcirculation and its evolution and improvement with systemic or topical medical treatment.
Efficacy of Topical Treatment with Aescin + Essential Phospholipids Gel in Venous Insufficiency and Hypertension
Authors: Ruffini I. , Belcaro G. , Cesarone M. R. , Dugall M.
Published: March 2006

Aescin and essential phospholipids (AEPL) in a gel was used in a microcirculatory model to assess the effects on skin perfusion in chronic venous insufficiency and severe venous hypertension. The aim of this efficacy study was to evaluate the efficacy of an AEPL gel on the microcirculation measuring transcutaneous skin PO2 and PCO2 in subjects with chronic venous insufficiency, venous hypertension (CVH), and venous microangiopathy. Transcutaneous PO2 and PCO2 were measured at the internal perimalleolar region. After 2 weeks of treatment with AEPL, all TcPO2 individual values were increased and all PCO2 values were decreased (p<0.05). Average values were significantly changed toward normal. Therefore, considering skin PO2 and PCO2 variations, local treatment with AEPL in areas of venous microangiopathy is very effective in improving skin perfusion and nutrition and, possibly, in preventing venous ulcerations.
Importance and Advantages of Intermittent External Pneumatic Compression Therapy in Venous Stasis Ulceration
Authors: Alpagut Ufuk , Dayioglu Enver
Published: March 2006

Venous ulcers are seen following postthrombophlebitic syndrome with venous insufficiency and can begin as a result of minor trauma. In this retrospective study the authors examined the value of external intermittent pneumatic compression therapy in chronic venous ulcers. Results in 1,250 patients with postthrombophlebitic syndromes, 235 of these patients with leg ulcers, revealed that this modality of therapy shortens the therapy duration, lowers the total therapy cost, and hastens the return to active life in comparison to the classical therapy with compression stockings and antiaggregant or low-dose oral anticoagulant therapy. In the light of their findings they propose the wider use of this adjuvant therapy.
Relation of Chlamydia Pneumoniae Infection to Documented Coronary Artery Disease in Shiraz, Southern Iran
Authors: Zibaeenezhad M. J. , Amanat A. , Alborzi A. , Obudi A.
Published: March 2006

The possibility that infectious agents may trigger a cascade of reactions leading to inflammation, atherogenesis, and vascular thrombotic events has recently been raised. Chlamydia pneumoniae is one of those that have received the most investigative attention with respect to coronary artery disease (CAD). This study was undertaken for the first time in Shiraz, Iran to determine this relationship. A case-control study was conducted in 167 subjects (81 women and 86 men) who underwent coronary angiography at cardiac catheterization laboratories of Shiraz University of Medical Sciences Hospitals. Immunoglobulin G (IgG), and IgA antibodies to C. pneumoniae antigen were estimated in baseline serum samples from 109 patients (mean age 57 years) experiencing a coronary event and from their matched controls (n=58, mean age 50 years) by ELISA method. The prevalence of IgG and IgA antibodies to C. pneumoniae did not show any case-control differences (82.6% vs 74.1% and 22% vs 15.5%, respectively). These results suggest that although C. pneumoniae was highly prevalent among these patients, it did not appear to be associated with angiographically documented CAD and cannot be regarded as a positive predictor for the development of acute coronary syndrome.
Apolipoprotein E Genotype in Dyslipidemic Patients and Response of Blood Lipids and Inflammatory Markers to Alpha-Linolenic Acid
Authors: Paschos George K. , Yiannakouris Nikos , Rallidis Loukianos S. , Davies Ian , Griffin Bruce A. , Panagiotakos Demosthenes B. , Skopouli Fotini N. , Votteas Vasilios , Zampelas Antonis
Published: March 2006

The objective of this study was to determine the effect of alpha-linolenic acid (ALA) supplementation on blood lipids and inflammatory markers, in relation to apolipoprotein (apo) E genotype. The diets of 50 dyslipidemic male patients were supplemented with 15 mL of flaxseed oil per day for 12 weeks. Retrospectively, 3 apo E genotype variants were found (ε2/ε3, n=7; ε3/ε3, n=33; ε3/ε4, n=10). No significant differences were found among apo E genotypes in any variables at baseline. ALA supplementation produced a small but significant decrease in high-density lipoprotein cholesterol (from 1.12 to 1.08 mmol/L, 43 to 42 mg/dL; p=0.008) and apo A-I levels (from 1.28 to 1.24 g/L, p=0.036) in the ε3/ε3 homozygotes. In addition, ALA supplementation resulted in a significant decrease in the serum concentration of serum amyloid A (SAA) (p=0.014), C-reactive protein (CRP) (p=0.013), macrophage colony-stimulating factor (MCSF) (p<0.001), and interleukin (IL)-6 (p=0.028). Serum SAA and MCSF were also significantly decreased in the ε3/ε4 group (p=0.005 and p=0.017, respectively). In contrast, ALA produced no effects on any of the inflammatory markers in the ε2/ε3 group. ALA may have beneficial effects on inflammation in dyslipidemic carriers of the apo ε3/ε3 and ε3/ε4 genotypes, but not in carriers of the ε2 allele.
Heat Shock Protein Antibody Titers Are Reduced by Statin Therapy in Dyslipidemic Subjects: A Pilot Study
Authors: Ghayour-Mobarhan M. , Lamb D. J. , Vaidya N. , Livingstone C. , Wang T. , Ferns G. A. A.
Published: March 2006

Antibody titers to heat shock protein (Hsp)-60 and -65 are positively related to risk of vascular disease and cardiovascular endpoints. There are few data on the factors that regulate the levels of these antibodies. It is known that the statins have antiinflammatory and immunoregulatory properties. The authors examined the effects of 2 statins, simvastatin (Zocor®) and atorvastatin (Lipitor®) on antibody titers to Hsp-60, -65, and -70 in a group of dyslipidemic patients. Twenty patients attending a lipid clinic, and previously not receiving lipid-lowering treatment, were treated with 10 mg of simvastatin (n=11) or atorvastatin (n=9) for 4 months. An additional 14 patients were recruited from the same clinic at the same hospital as a control group. The medication of these latter patients was unaltered for 4 months and the same parameters were measured as for the statin group. Antibody titers to Hsp-60, -65, and -70 were measured by enzyme-linked immunosorbent assay and lipoprotein profile and highly sensitive serum C-reactive protein (CRP) were measured by routine methods before and after treatment. Pretreatment and posttreatment data were compared by paired t or Mann-Whitney tests. Overall statin treatment was associated with a significant reduction in median antibody titers to Hsp-60 (17.2%, p=0.03), Hsp-65 (15.9%, p=0.003) and Hsp-70 (8.3%, p=0.006), but not in control patients. Both statins caused a reduction in median serum CRP concentrations (45% overall, p<0.05), but significant changes were not observed in the control patients. The effects on Hsp antibody titers were not related to changes in serum CRP concentrations (p>0.05). However, there was a significant correlation between changes in antibody titers to Hsp-60 vs Hsp-65 (p<0.01), Hsp-60 vs Hsp-70 (p<0.05), and Hsp-65 vs Hsp-70 (p<0.001). Statin treatment was associated with a reduction in antibody titers to Hsp-60, -65, and -70. This reduction is not fully explained by the antiinflammatory effects of the statins but may be due to their other immunomodulatory properties.
Coronary Ectasia with Slow Flow Related to Apical Hypertrophic Cardiomyopathy
Authors: Saotome Masao , Satoh Hiroshi , Uehara Akihiko , Katoh Hideki , Terada Hajime , Hayashi Hideharu
Published: March 2006

Coronary ectasia (CE) has been reported to be associated with a high risk of coronary events and caused by several etiologies. The authors present a patient with CE who was noted to have an ECG abnormality in routine health check. Coronary angiography revealed diffuse ectasia in all 3 coronary arteries. The flow of contrast medium was slow and focal squeezing signs were observed in the left coronary artery. Echocardiography indicated mild apical hypertrophy and significant reduction of coronary flow reserve. Exercise thallium scintigraphy exhibited a transient perfusion defect in the inferior region. This is the first case report that a mild apical hypertrophy induced severe CE with slow coronary flow. The authors recommend a long-term prophylaxis of thrombotic complications with antiplatelet agents in patients with CE.
Right Bundle Branch Block in Acute Myocardial Infarction Treated by Primary Coronary Angioplasty and Stenting
Authors: Tomoda Haruo , Aoki Naoto
Published: March 2006

Patients with right bundle branch block (RBBB) in acute myocardial infarction (AMI) have a significantly higher mortality rate even with the advent of thrombolytic therapy. This study was undertaken to assess the impact of primary percutaneous transluminal coronary angioplasty (PTCA) and stenting on the outcome of patients with RBBB in AMI. A total of 600 patients with AMI who underwent primary PTCA and stenting (rate: 61%) <12 hours of onset were studied. A 12-lead ECG was obtained at least every 6 hours. Serial creatine kinase was measured, and left ventricular ejection fraction was obtained during the hospital stay. Among 600 patients with AMI, 94 patients (15.7%) had RBBB; it was persistent in 31 (33%) and transient in 63 (67%). In-hospital mortality rate was 7.3% in patients without RBBB, 7.9% in transient RBBB, and 25.8% in persistent RBBB (p<0.02). The incidence of heart failure was 26.5% in those without RBBB, 34.9% in transient RBBB, and 58.1% in persistent RBBB (p<0.001). There was no significant difference among these 3 groups in ventricular arrhythmias and complete atrioventricular block. Peak creatine kinase was 3,214 ±2,293 U/L in those without RBBB, 4,558 ±3,316 U/L in transient RBBB (p<0.001), and 5,635 ±3,920 U/L in persistent RBBB (p<0.001). Left ventricular ejection fraction was 50 ±11% in those without RBBB, 47 ±11% in transient RBBB (p<0.05), and 42 ±13% in persistent RBBB (p<0.001). Patients with AMI treated by primary PTCA and stenting had an increased incidence of transient RBBB, especially following reperfusion therapy, although the clinical outcome was similar to that of those without RBBB. In contrast, there was no satisfactory improvement in clinical outcomes in those with persistent RBBB.
Quantitative Angiographic Analysis of Right Ventricular Global Function in Normal Incidences and in Patients with Coronary Artery Disease
Authors: Batyraliev T. A. , Pershukov I. V. , Birand A. , Erenler O.
Published: March 2006

At present right ventriculography data cannot be accurately estimated owing to the absence of software for quantitative analysis of the right ventricle (RV) volumes and function. The aim of this study was to use existing software for left ventriculography analysis to estimate right ventricular volumes and function in patients without coronary lesions and in those with coronary artery disease (CAD). Thirty-two patients without significant lesions of coronary arteries and 20 patients with CAD were examined with left ventriculography and right atriography. Each examination was performed in 2 projections: 30° right anterior oblique (RAO 30°) and 60° left anterior oblique (LAO 60°) projections. Correction factor (CF) was obtained by finding the ratio between stroke volumes of the left and right ventricles. The mean CF was 0.9243 ±0.2887 for patients without CAD and 0.8758 ±0.2232 for patients with CAD. Such calculation is the easiest and quite accurate method of determining RV volumes and function by using existing software of quantitative angiographic analysis.
Provocation of Microvessel Spasm by Low-Dose Acetylcholine in Patients with Suspected Coronary Artery Disease
Authors: Masaki Nobuyuki , Takase Bonpei , Satomura Kimio , Akima Takashi , Matsushima Yoshihiro , Hosaka Haruhiko , Hamabe Akira , Kurita Akira , Ohsuzu Fumitaka
Published: March 2006

Endothelial dysfunction plays an important role in the pathogenesis of cardiac syndrome X, and intracoronary low-dose acetylcholine infusion is a widely used diagnostic modality for studying the coronary artery endothelial function. The authors herein report 2 cases of cardiac syndrome X with coronary artery endothelial dysfunction and microvessel spasm. The findings of non invasive testing were positive for ischemia. Coronary angiograms appeared entirely normal in both cases. However, the intracoronary infusion of low-dose (1.5-15 µg/minute) acetylcholine demonstrated an impairment of the coronary blood flow response and consequently provoked an ST-segment elevation in an electrocardiogram. The coronary angiograms showed no spasm in the epicardial arteries. These patients are thus suggested to have cardiac syndrome X with microvessel spasms associated with coronary artery endothelial dysfunction.
Radiofrequency Catheter Ablation of Accessory Pathway in a Patient with Ebstein’s Anomaly and Atrial Septal Defect
Authors: Kinoshita Osamu , Agatsuma Toshihiko , Hanaoka Takeshi , Tomita Takeshi , Tsutsui Hiroshi , Yazaki Yoshikazu , Imamura Hiroshi , Hongo Minoru , Ikeda Uichi
Published: March 2006

The authors report the case of a 57-year-old woman with Ebstein’s anomaly and atrial septal defect. She was referred to their hospital for treatment of refractory paroxysmal wide QRS tachycardia. Her 12-leads ECG in sinus rhythm showed ventricular preexcitation of type B Wolff-Parkinson-White syndrome. In a baseline electrophysiological study, a wide QRS tachycardia with right bundle branch block configurations was induced. This tachycardia was orthodromic atrioventricular reciprocating tachycardia with a right inferior accessory pathway. Radiofrequency current was successfully delivered at the inferior site of the atrialized right ventricle. Radiofrequency catheter ablation seems to be useful for supraventricular tachycardia in patients with Ebstein’s anomaly and atrial septal defect.
Large Saccular Aneurysm in a Coronary Arterial Fistula
Authors: Kinoshita Osamu , Ogiwara Fumiaki , Hanaoka Takeshi , Tomita Takeshi , Yokozeki Osamu , Kai Ryuichi , Uchikawa Shin-ichirou , Kogashi Kaoru , Tsutsui Hiroshi , Imamura Hiroshi , Yazaki Yoshikazu , Ikeda Uichi , Hongo Minoru , Kubo Keishi
Published: March 2006

The authors present a case of a large saccular aneurysm in a coronary artery fistula originating from the proximal left anterior descending coronary artery, draining into the main trunk of the pulmonary artery. The diagnosis was made by 3-dimensional computed tomography and coronary arteriography. Congenital coronary artery fistula is not uncommon. With a saccular aneurysm, however, it is very rare. A ruptured aneurysm will induce sudden death if surgical repair is not done.
Routine Reoperative Off-Pump Coronary Artery Bypass Grafting Via Midline Sternotomy: Is It Feasible?
Authors: Hirose Hitoshi , Amano Atsushi , Ruzheng Li , Xiang Zhou
Published: March 2006

Multivessel off-pump coronary artery bypass (OPCAB) has been conducted safely; however, the clinical outcomes of reoperative OPCAB have not been reported clearly. Currently OPCAB is being performed systematically in this institution including reoperative surgeries. Between September 1, 1999, and December 31, 2003, reoperative OPCAB via midline sternotomy was planned for nonemergent patients with normal left ventricular function without valvular disease. The perioperative results of patients who underwent reoperative OPCAB were analyzed. Thirty-five patients were scheduled for OPCAB. Of these, OPCAB was performed in 27 patients, giving OPCAB success rate of 77.1%. Failure of OPCAB was due to graft injury in 2, ischemic EKG change in 1, and dense adhesion and difficulty of dissection in 5 patients. The mean number of grafts with completed OPCAB was 3.0 ±1.5. There were no hospital deaths, strokes, or respiratory or renal failures. One patient (3.7%) developed perioperative myocardial infarction. Postoperative angiography was obtained in 12 patients (26 distal anastomoses), and all anastomoses were perfect except for 1 distal anastomosis stenosis, giving an overall stenosis-free patency rate of 95.1%. During a follow-up period (mean 2.5 ±0.6 years), all patients survived without cardiac event, except 1 patient who underwent catheter intervention. Cardiopulmonary bypass may be required during cardiac dissection to decompress the heart and to facilitate dissection. However, once lysis of the adhesion is completed, reoperative OPCAB can be performed without increasing surgical risks. Midterm results were satisfactory.
Significance of Plasma Nitric Oxide/Endothelial-1 Ratio for Prediction of Coronary Artery Disease
Authors: Kurita Akira , Matsui Takemi , Ishizuka Toshiaki , Takase Bonpei , Satomura Kimio
Published: March 2006

Vascular tone is regulated by vasodilators and vasoconstrictors. Endothelin-1 (ET-1) is the predominant vasoconstrictor peptide that constricts vascular smooth muscle, whereas nitric oxide (NO) is the primary vasodilator peptide that relaxes vascular smooth muscle. In this study, the authors examined whether NO/ET-1 ratio is a useful marker for detecting coronary artery disease (CAD), by comparison with evaluation based on vascular endothelial (VE) function. They measured plasma NOX and ET-1 by using ENO-200 and radioimmunoassay, in 38 subjects with normal (NL) coronary arteries (NL group; mean age, 60 ±12 years) and 25 subjects with CAD (CAD group; mean age, 69 ±6 years). VE function (randomized endothelium-dependent [D] and endothelium-independent [I] VE function) was assessed by measuring brachial artery (BA) diameter by using high-resolution ultrasound (7.5 MHz). Soon after these procedures, symptom-limited exercise testing was performed. There were no statistically significant differences in serum lipid concentrations or VED function between the groups. However, the CAD group had a significantly lower NO/ET-1 ratio (1.2 ±1.1 vs 2.7 ±2.2, p<0.01) and BA diameter after sublingual nitroglycerin (VEID function: 6 ±7% vs 10 ±4%, p<0.05). As expected, the ST segment and treadmill exercise duration were significantly lower in the CAD group. Sensitivity and specificity for detecting CAD by plasma NO/ET-1 ratio (≥2.0) were 90% and 85%, respectively; sensitivity and specificity for detecting CAD by ST depression (≥1 mm) were 80% and 78%, respectively. The present results suggest that plasma NO/ET-1 ratio is a useful biological marker for predicting CAD.
Risk Modification in Patients with Peripheral Arterial Disease: A Retrospective Survey
Authors: Youssef Fahed , Gupta Prakash , Mikhailidis Dimitri P. , Hamilton George
Published: March 2006

Peripheral arterial disease (PAD) is underdiagnosed and undertreated. This is despite the high vascular morbidity and mortality rates associated with PAD. There is also evidence that quitting smoking, improving the lipid profile, lowering the blood pressure, and administering antiplatelet drugs reduce the risk of vascular events in these patients. Secondary prevention for patients with PAD is yet to meet the standard of care for those with ischemic heart disease. The authors surveyed 200 claudicants attending a vascular clinic with additional follow-up in a risk modification clinic. After a median follow-up of 28 months (range: 6-65) there was a significant (p=0.001) improvement in walking distance; 34 patients (17%) had a vascular ischemic event. Of those, 11 patients (5.5%) had worsening intermittent claudication and 9 had a stroke/transient ischemic attack; 9 events (4.5%) were fatal. The lipid targets were met in 76% the patients. Half the smokers quit smoking and 94% of the patients were taking antiplatelet drugs or anticoagulants. Blood pressure reached the accepted target in 87% of the patients. Secondary prevention in patients with PAD may reduce the risk of vascular events. Aggressive risk modification is therefore recommended.