bluuebunny/crossref_metadata_2025 huggingface dataset:
Study On Peripheral Circulation Using Macroaggregated Serum Albumin Labelled With Radioactive Iodine
Authors: Shida Hisao , Ohara Itaru
Published: November 2007

The existence of anatomical and functional arteriovenous shunts was demon strated in the limbs by injecting radioiodinated macro-aggregated serum albu min into the feeding main artery. The size of shunt included those with about 20-50 μ. Consequently, the degree of shunt could be analyzed.

Scintiscanning after intraarterial injection of radioiodinated macroaggre gated serum albumin into the limb may be used as one of the ancillary methods for the diagnosis of peripheral vascular diseases. Especially, the study is useful when the findings are compared with that of peripheral arteriography.

In order to detect occlusions of arterial trees of the limbs without resorting to arteriography in those with peripheral arterial occlusive lesions, scanning of a suspected area of the extremities with a scintillation detector after injection of 131I labelled macroaggregated serum albumin (abbr. 131I MAA) into the main feeding artery was carried out. Occasionally, the site of occlusion of the main artery which was demonstrated by arteriography was consistent with the find ings by scintiscanning. 1,2 However, the results were not highly successful. Jones et al3 in 1965 reported that when 131I MAA was injected into the femoral artery, normal and abnormal patterns of regional blood flow had been observed. In our study, it became obvious that regional blood flow was greatly influenced with the collaterals depending on the site, extent and period of occlusion. In this study, the anatomical and functional collateral blood flow in man with occlu sive vascular disease will be described.
The Incidence and Significance of Gas Gangrene in a Diabetic Population
Authors: Kahn Otto
Published: November 2007

One hundred consecutive patients with Diabetes Mellitus and lower limb complications (infection and/or gangrene) needing elective surgery were screened for gas gangrene. The incidence was found to be 10 per cent (one being due to Clostridium welchii). With orthodox conservative treatment, no mortal ity was encountered.
Budd-Chiari Syndrome Due To Obstruction of the Inferior Vena Cava
Authors: Nojek C. , Rufilanchas J. , Juffe A. , Tellez G. , Durantez A. , Eguaras M. , Figuera-Aymerich D.
Published: November 2007

Two cases of Budd-Chiari syndrome caused by membranous occlusion of the proximal portion of the inferior vena cava are presented. Both were treated surgically, using the modified technique of Kimura in one case, and a resection with direct vision and extracorporeal circulation in the other. Both patients progresed well. We discuss the etiology and pathogenesis of the syndrome, the diagnostic means that can be used, and the importance of early treatment.
Exercise Testing in Young Asymptomatic Diabetic Patients
Authors: Rubler Shirley , Arvan Stephen B.
Published: November 2007

The cardiovascular response to submaximal bicycle exercise was studied in a group of 19 asymptomatic diabetic patients aged 18 to 39, including 11 males and 8 females and 18 control subjects (9 males and 9 females, aged 20 to 34 years). The maximum heart rate achieved by the control subjects (group I), 175.9 ± 8.9 beats/min, was greater than that achieved by the diabetic patients (group II), 159.4 ± 17.8 beats/min, (P < 0.01 ). The work load at which the maximum heart rate was reached was lower in diabetic males, 681 ± 155.4 kg m/min, than in healthy males, 866.7 ± 139.9 kg m/min, (P < 0.02). Although systolic blood pressure elevations were comparable during exercise and the postexercise period, the increase in diastolic blood pressure during exercise in the diabetic patients was greater than in control subjects (P < 0.001). This difference, however, was only observed in the males and not in the females. The difference in diastolic blood pressure was again noted between the groups in the postexercise period; that of group II was higher than that of group I (P < 0.01). This was particularly notable in the older diabetics (aged 31 to 40 years). One patient in group II developed ischemic ST segment changes, and 1 subject in each group was found to have J junction depression of 1.0 mm or more. The implications of these findings are discussed in relation to the possible pathophysiology of the diabetic patients.
Systolic Hypertension and Cardiac Mortality of Takayasu's Aortoarteritis
Authors: Swinton Neil W. , Cook Guillermo A.
Published: November 2007

Long-term observations of a 35-year-old woman who died from refractory congestive heart failure due to Takayasu's aortoarteritis are reported. Severe systolic hypertension was documented in the prepulseless phase. After the loss of all limb pulses, but relative sparing of carotid vessels, serial ophthalmodynametric retinal pressures suggested that central aortic pressure remained high during her terminal cardiac illness. Postmortem pathologic examination showed a narrowed, severely atherosclerotic aorta with variable occlusions of all branch vessels. The loss of capacitance and volume of the aorta appears to be the cause of systolic hypertension and refractory pump failure of the left ventricle.
Sudden Death and the Floppy Mitral Valve Syndrome
Authors: Kleid Jack J.
Published: November 2007

A 38-year-old female with a history of palpitations, premature ventricular contractions, and a systolic murmur collapsed suddenly and died. Postmortem studies showed shortened chordae tendinae and myxomatous transformation of both mitral leaflets. As this syndrome becomes more clinically recognizable it appears that its benignancy is diminishing. Thus, it is felt that patients with findings of ventricular extrasystoles and a systolic murmur should have a careful cardiac evaluation to determine the presence of the floppy mitral valve or ballooning mitral leaflet syndrome and that appropriate measures for treatment be taken when necessary.
Diagnosis of Ventricular Conduction Defects
Authors: Talbot S.
Published: November 2007

A total of 1342 electrocardiograms demonstrating intraventricular con duction defects were reviewed. Criteria for distinguishing different types of conduction defects and combinations of such defects are presented.

The time of intrinsicoid deflection was of great value and may be used to distinguish lesions of the main fascicles and peripheral Purkinje con duction defects. However multiple peripheral defects affecting a large area of myocardium can produce a pattern identical to left bundle branch block.

It is suggested that intrinsicoid deflection time should be measured from the beginning of the QRS to the onset of the longest downslope at or after the peak of the R wave. It should be carefully related to the voltage of the dominant wave of the QRS complex in each lead. If intrinsicoid deflection is delayed in a limb lead that does not show the maximum voltage of the QRS, a peripheral left ventricular conduction defect is present; but if the lead does show the maximum voltage of the QRS, the defect may be central or peripheral.

Another useful electrocardiographic feature was the direction of both the initial and terminal QRS forces in the 12-lead electrocardiogram. Such analysis often resolved the diagnosis of hemiblocks when the axis was indeterminate.
Long-Term Effects of Furosemide and Hydrochlorothiazide in Patients With Essential Hypertension
Authors: Finnerty Frank A. , Maxwell Morton H. , Lunn John , Moser Marvin
Published: November 2007

In a double-blind study the long-term effects of diuretics in uncompli cated mild and moderate essential hypertension were investigated. A total of 52 outpatients completed 24 months of treatment with either furose mide at a dose of 40 mg twice daily (26 patients) or hydrochlorothiazide at a dose of 50 mg twice daily (26 patients).

Throughout the 2 years of the study, both furosemide and hydro chlorothiazide significantly lowered the mean supine blood pressure from baseline levels. The fall was less with furosemide than with hydrochloro thiazide, although the difference between the two drugs reached statistical significance at only three of the eight time points. Serum electrolytes were used as major indicators of safety. The cumulative incidence of hypokalemia of 8% for the furosemide group compared to that of 62% for the hydrochlorothiazide group.

Although diuretics, alone or combined with other blood pressure-lower ing drugs, have been used for many years to treat essential hypertension, information on their continued efficacy and safety is scarce. Short-term trials had shown that furosemide (Lasix(®)) resembled the thiazides in its antihypertensive properties,1-3 despite its different mode of action on the kidney. A cooperative study in hypertensive patients was therefore under taken at three clinical centers to investigate the long-term effects of furose mide on blood pressure and on serum electrolytes, and to compare them with those of hydrochlorothiazide.
Effects of Nitroglycerine Ointment On the Apexcardiogram and Systolic Time Intervals
Authors: Wayne Howard H.
Published: November 2007

Ten patients with angina pectoris and a previous myocardial infarction were administered nitroglycerine (NTG) ointment, sublingual NTG, and a placebo ointment in a double-blind study. Left ventricular function was monitored noninvasively over 3 hours. Two patients showed no response to any of the NTG preparations and were excluded from the results. Left ventricular function improved in all remaining patients after both the sublingual NTG and the NTG ointment, but not the placebo ointment. This improvement was evidenced by a redution in a wave amplitude and duration of the apexcardiogram (ACG). At the same time the isovolumic relaxation time increased significantly and indicated a reduction in left atrial pressure. Also, a simultaneous improvement in the slope of the systolic wave indicated improved wall motion. The ΔLVET decreased, presumably because of a decrease in venous return due to peripheral pooling. None of these parameters changed significantly during the con trol period or after application of the placebo ointment.

The onset of the effect after sublingual NTG was 3-5 minutes with a duration of 15-30 minutes. The NTG ointment had its onset of action at 20-30 minutes, a peak effect at 90 minutes, and a still significant effect at 3 hours. These findings clearly demonstrate the improvement in left ven tricular function that occurs in patients with ischemic heart disease in the absence of chest pain, and suggests that continual usage would be benefi cial even in patients with infrequent angina.
Arterio-Venous Shunting in Renal Transplant . Rejection
Authors: Zimmerman Robert , Sprayregen Seymour
Published: November 2007

Arterio-venous (A-V) shunting has been reported with renal transplant rejection in one previous case. Two additional cases with this finding are presented. The pathophysiologic basis of A-V shunting and its possible prognostic significance are discussed.
Arterial Flow in The Lower Leg Correlated With Plasma Levels of Two Formulations of Papaverine Hydrochloride
Authors: Lee Bok Y. , Trainor Frieda S.
Published: November 2007

In patients with severe peripheral vascular disease (mean arterial flow of 40 ml/min), a suspension of papaverine in a soft gelatin capsule produced plasma levels almost three times higher than those following treatment with a sustained- release tablet formulation. The higher plasma levels resulted in significantly greater vasodilation with increased distal arterial flow. The onset of peak pulsatile flow with the soft gelatin form came sooner than with the sustained- release form. However the durations of vasodilation were similar with both papaverine preparations. The vasodilatory activity of papaverine appeared to be greater in the sympathectomized leg.

The soft gelatin formulation of papaverine may be an orally active vasodila tor, maintaining a distal runoff after reconstruction of a large artery, and may be effective in sustaining a longer vasodilatory effect in patients with small vessel disease, when surgical procedures may not be applicable.
Tetralogy of Fallot Associated With Uncommon Lesions
Authors: Weaver Michael D. , Chen James T. T. , Jackson Donald C. , Lester Richard G. , Serwer Gerald A.
Published: November 2007

A patient presented with a unique combination of cardiovascular abnor malities : tetralogy of Fallot, absent pul monary valve, stenosis of peripheral pul monary arteries, and partial anomalous pulmonary venous connection to the azy gos vein. The salient aspects and associ ated lesion of each of these abnormalities are described.
Gaisböck's Syndrome: Its Hematologic, Biochemical and Hormonal Parameters
Authors: Stefanini Mario , Urbas John V. , Urbas John E.
Published: November 2007

The syndrome of plethora without splenomegaly, leukocytosis, or throm bocytosis was described by Gaisböck in 1905. It was reevaluated in 25 patients through the study of numerous hematologic and biochemical parameters. Sta tistically significant findings included mild obesity; elevation of blood pressure (especially diastolic); decrease in plasma volume with relative increase in red cell count, hemoglobin, hematocrit, viscosity of blood, elevation of plasma proteins, serum cholesterol, triglycerides, uric acid, and plasma renin; and increased excretion of urinary sodium. The reduction in plasma volume seemed related to the elevation of the diastolic blood pressure, and favorable through temporary therapeutic results were produced by some antihypertensive agents.

The elevation of serum cholesterol, triglycerides, and uric acid, the increased blood viscosity, and the elevated plasma renin were reminescent of the biochem ical changes observed in some instances of hypertension and atherosclerotic disease. They may explain why patients with the Gaisböck's syndrome belong to the high risk group of hypertensive individuals who often develop cardiovascu lar complications. While its long-term effects remain to be evaluated, treatment with nondiuretic antihypertensive drugs may help reduce the incidence of these complications.
Echocardiographic Demonstration of Tricuspid Valvulitis and Right Atrial Thrombus Complicating an Infected Artificial Pacemaker: A Case Report
Authors: Chan W. , Ikram H.
Published: November 2007

A right ventricular artificial demand pacemaker was implanted into a 59-year- old man with supra-Hisian complete heart block. His postoperative course was complicated by Staphylococcal aureus septicemia, which was controlled with antibiotics. A year later, S. aureus was again isolated from the blood. Echo cardiography showed thickening of the tricuspid valve leaflet and multiple echoes in the right atrium. Autopsy find ings included tricuspid leaflet thickening and an overlying right atrial thrombus. The echocardiogram is thus useful in lo calizing an infected valve in bacterial endocarditis and in demonstrating the presence of the thrombus.
Effect of Age, Cardiovascular Disease, and Vasomotor Changes on Transmission of Arterial Pressure Waves Through the Lower Extremities
Authors: Carter Stefan A.
Published: November 2007

Pressure waves were recorded by indwelling needles in the femoral and foot arteries. At the foot the systolic and pulse pressures were greater and the dicrotic wave more prominent. These changes during transmission increased during vasoconstriction and decreased during vasodilatation. The ratio of the distal to femoral pulse pressure (amplification) increased from 1.13 ± 0.05 during body heating to 1.47 ± 0.06 during body cooling ( P < 0.01), and from 1.14 ± 0.10 during infusion of trimethaphan to 1.42 ± 0.02 during cooling ( P < 0.05). Amplification was also significantly greater following inhalation of amyl nitrite and during and after Valsalva maneuver. Greater pulse pressure at the foot paralleled greater amplitude of individual harmonics. Phase velocities decreased with increasing frequency and tended to level off at a value similar to the foot-to-foot pulse wave velocity. The findings are consistent with peripheral reflections of the waves which increase during vasoconstriction.

In the absence of procedures that elicit vasoconstriction or vasodilatation, amplification averaged 1.35 ± 0.03 in control subjects less than 35 years of age, and 1.24 ± 0.06 in older subjects ( P > 0.05). Amplification also did not differ significantly between control subjects and patients with hypertension or is chemic heart disease. In the absence of pronounced vasodilatation or encroach ment on the lumen by atherosclerotic plaques, systolic and pulse pressures at the foot should be higher than in proximal pulses. These findings provide a firm basis for interpreting measurements of distal systolic pressures by using blood pressure cuffs when examining patients with occlusive arterial disease in the extremities.
Ischemia of Toes as a Presenting Symptom in Primary Thrombosis: A Case Report
Authors: Walden R. , Zweig A. , Adar R.
Published: November 2007

Although thrombotic occlusion of small vessels in thrombocytosis is alleg edly well recognized, it has been reported only rarely. We treated 4 patients with primary thrombocytosis in whom ischemic toe lesions with normal peripheral pulses were the presenting and only symptoms. The symptoms preceded diagno sis by 5 years, 3 years, 1 year, and 1 month respectively. Treatment of the hematologic disorder resulted in disappearance of the toe lesions. Thrombocy tosis should be routinely searched for in patients with ischemic toes and normal peripheral pulses.
Assessing Opacification and Flow Rates of Contrast Media in Neonate and Pediatric Cardiac Catheterization
Authors: Prickett Charles , Johnson John Leslie
Published: November 2007

The accuracy and advantages of determining the flow rates of opaque media in catheters used in the infant and pediatric age group is essential in obtaining proper opacification with minimum toxicity to the patient. Flow rates expressed as cubic centimeters per second and grams of iodine per second were determined by using representative standard pediatric catheters in various sizes and lengths. Three representative opaque medias were used to determine these findings. Although present-day injector pumps are frequently calibrated in delivery rates, they cannot be applied directly to the cardiac catheters usually used with infants and small children.
Right-Heart Catheterization in Coronary Artery Disease
Authors: Friedman Howard S.
Published: November 2007

The performance of routine right-heart catheterization on patients under going study for coronary artery disease is a subject of controversy. Accordingly, data from 100 consecutive patients who had coronary arteriography and right- heart catheterization were analyzed. Seventy-nine had significant (>70% ste nosis) coronary disease (group I), and 21 had patent coronary vessels (group II). Although group I patients had a lower ejection fraction (EF) 53 ± 2 vs 65 ± 2%, P < 0.05) and stroke work index (SW) (52 ± 2.2 vs 69 ±4.2 Gm-m/m2, P < 0.001) than group II patients, systolic pulmonary artery (PA) pressure (31 ± 1.6 vs 26 ± 1.2 mmHg, NS), pulmonary arteriolar resistance (PAR) (2.3 ± 0.2 vs 1.7 ± 0.2 u,NS), and cardiac index (CI) (3.1 ± 0.3 vs 3.1 ± 0.2 L/min/m2, NS) were not different.

Systolic PA pressure in group I correlated with left ventricular end-diastolic pressure (LVEDP), SW, and EF, but these relationships were not strong (r < 0.57, all P < 0.01). Eight patients had a PA pressure greater than 50 mm Hg (66 ± 3.8 mm Hg). All had multivessel disease, extensive asynergy, significant mitral regurgitation, and severe left ventricular dysfunction (CI: 2.2 ± 0.3 L/ min/m2; LVEDP: 33 ± 2 mm Hg; SW: 28 ± 5.5 gm-m/m2 ; EF: 25 + 2%); all were considered inoperable. Six other group I patients also had an EF less than 30% but had lower systolic PA pressures. Four of these had hemodynamic findings indistinguishable from those with severe PA hypertension, whereas 2 had localized aneurysms and no mitral regurgitation, and both survived an open-heart operation.

Thus this study supports the view that routine right-heart catheterization in coronary artery disease does not provide additional information that might help in determining patient prognosis or suitability for coronary by-pass surgery.
Action of Cinnarizine on the Hyperviscosity of Blood in Patients with Peripheral Obliterative Arterial Disease
Authors: Di Perri Tullio , Forconi Sandro , Guerrini Maurizio , Pasini Franco Laghi , Del Cippola Roberto , Rossi Carlo , Angnusdei Donato
Published: November 2007

Cinnarizine, a drug capable of improving blood flow, was studied for its action on blood viscosity and its main components in patients affected by peripheral obliterative arterial diseases (POAD). Both acute and chronic ad ministration of the drug diminished the increased whole-blood viscosity in patients, without affecting plasma and serum viscosity, hematocrit, plasma fibrinogen concentration, and plasma osmolality. Since cinnarizine also led to a significant increase of peripheral muscular blood flow, it was hypothesized that this action may be due to an increased deformability of the red cells, and may play a considerable role in the therapeutic approach to POAD.
Septal Aneurysm and Right Ventricular Obstruction: A Case Report
Authors: Silvestre Agenor , Benchimol Alberto , Desser Kenneth B. , Sheasby Connie
Published: November 2007

A 32-year-old man with a history of ven tricular septal defect presented with systolic and diastolic murmurs and vectocardiogra phic evidence of right ventricular hyper trophy. Echocardiography demonstrated a prominent systolic bulging of the inter- ventricular septum into the right ventricle. Left ventricular angiograms indicated that the ultrasonic abnormality was based on an aneurysm of the membranous septum which produced a 35 mm Hg gradient within the right ventricle. After plication of this aneu rysm, murmur and abnormal septal protru sion were not recorded.
Changing Diastolic Closure Rates (E to F Slopes) in a Patient With Mitral Stenosis: A Case Report
Authors: Ambrose John A. , Friedman Howard S.
Published: November 2007

A patient with mitral stenosis and atrial flutter was found to have a normal diastolic closure rate (E to F slope). Fol lowing cardioversion, the typical echo cardiographic features of mitral stenosis were found. After various interventions that increased heart rate, however, the diastolic closure rate increased. This re port demonstrates, therefore, that the E to F slope is not always a fixed value in mitral stenosis and that under certain conditions it may even appear to be nor mal.
Episodic Hypertension Caused by Recurrent Renal Artery Lesions Following Transplantation: A Case Report
Authors: Ramos E. , Karmi S.A. , Dagher F.J.
Published: November 2007

A kidney transplant patient developed recurrent hypertension on two successive occasions associated with lesions of the renal artery. The first episode of hyper tension was caused by renal artery ste nosis and was surgically corrected; the second was caused by a sizable pseudo- aneurysm at the site of arterial anasto mosis which was resected, and arterial continuity was successfully re-estab lished.
Progression of a Dural Arteriovenous Malformation Resulting in an Intracerebral Hematoma. A Case Report
Authors: Enker Stanley H.
Published: November 2007

A progressing, essentially extracranial arteriovenous malformation with purely external carotid feeders can involve the intracranial vasculature by enlargement of its drainage area. Thus it can cause cerebral dysfunction by an intracranial bleed or raised intracranial pressure due to venous engorgement. A case is de scribed to support this possibility.
Effect of Gonadectomy on Isoproterenol-Induced Myocardial Infarction
Authors: Wexler B.C. , Greenberg B.P.
Published: November 2007

Adult male and female Sprague-Dawley rats were subjected to an isopro terenol-induced myocardial infarction. Six weeks before the induction of myo cardial infarction, some of the animals had been orchiectomized or ovari ectomized. The animals were autopsied at regularly timed intervals on days 1, 2, 3, 8, and 15 after myocardial infarction. The gonadectomized animals mani fested less severe untoward changes, survived in greater numbers, and experi enced superior repair of their damaged hearts. Circulating levels of enzymes (e.g., CPK, GOT, GPT, and LDH), lipids, glucose, and BUN rose and fell during the acute necrosis and repair phases with distinct differences between the intact and castrated animals. Reciprocal changes in the weight of the adrenal and thymus glands, coupled with dynamic changes in circulating corticosterone levels, reflected marked temporal changes in the spectrum of adrenal steroids being secreted, as well as gonadal hormone mediated changes affecting adreno cortical function. The implications of these findings are that adrenocortical, androgenic, and estrogenic hormones condition the nature of the patho physiologic response to acute myocardial infarction in rats.
Electrophysiologic Properties of Nitroprusside in Man
Authors: Gould Lawrence , Ramana Reddy C.V. , Kim S.G. , Oh K.C.
Published: November 2007

The effects of nitroprusside on His bundle electrograms, when given intra venously for 10 minutes, were studied in 14 patients with heart disease. Record ings were made at varied heart rates using atrial and ventricular pacing. Nitro prusside significantly reduced the AH interval, but it had no effect on the HV interval. Functional and effective refractory periods were measured by the ex trastimulus technique. The functional refractory period of the AV node as well as the effective refractory period of the ventriculoatrial conduction system sig nificantly decreased after nitroprusside infusion. This improvement in con duction can probably be explained by the systemic hypotension produced by nitroprusside, which reflexly will increase sympathetic drive to the heart and decrease vagal tone.
Changes of Cardiac Output Caused by Aging: An Impedance Cardiographic Study
Authors: Luisada A.A. , Bhat P.K. , Knighten V.
Published: November 2007

The various parameters of cardiac output were studied in 132 healthy subjects from 20 to 89 years of age by impedance cardiography. This noninvasive method supplied data that were similar to those found by others by dye dilution methods.

All parameters of cardiac output decrease with age. However, we found a difference between the two sexes in the rate of decrease of the cardiac index: women had a more marked drop at an earlier age and then a steady course, while men had a progressive decrease from the youngest to the oldest group.
Correlation of the Resting and Exercise Doppler Ankle/Arm Index to Angiographic Findings
Authors: AbuRahma A.F. , Boland James , Diethrich Edward B.
Published: November 2007

The diagnosis of peripheral vascular occlusive disease has until recently been confirmed only through angiography. However, a noninvasive diagnostic test using Doppler-shift ultrasonography has shown great promise as a method of refining the diagnosis of peripheral vascular occlusive disease. The purpose of this study was to correlate the ankle/arm index (resting versus exercise) to the arteriographic findings and to outline a practical grading system of the se verity of the occlusive disease based on our Doppler index findings. From 500 arterial Doppler studies of 500 patients (1,000 limbs) at the Arizona Heart Insti tute, 93 limbs that had arteriograms and resting and exercising ankle/arm in dices were examined. The resting index was found to be an insensitive index of the severity of the disease. The exercise index did correlate very well with the arteriographic findings: 85% of patients with an excercise index greater than 0.9 were normal or had minimal disease. Most patients with an index of 0.8 to 0.89 had mild disease; 75% of patients with an index of 0.7 to 0.79 had moderate dis ease ; 98% of patients with index of less than 0.69 had severe disease.
Triple Therapy for Acute Deep Thrombophlebitis
Authors: RuDusky Basil M.
Published: November 2007

Therapy for patients with extensive thrombophlebitis is often inadequate with available methods. The reluctance of most physicians in private practice to use streptokinase or urokinase is understandable when one considers the cost, hospitalization, length of stay and risks involved. This article discusses a unique and previously unreported mode of drug therapy in these patients, consisting of a combination of drugs designed to combine the antithrombotic and thrombus antipropagating effects of warfarin, the anti-inflammatory effect of trypsin-chy motrypsin enzymes, and the antiplatelet aggregating, antiadhesion, and pos sible enhanced fibrinolytic effects of aspirin with added buffered protection (Ascriptin A/D).

This treatment program has been a safe, efficient, economical, and highly effective one for a very costly, common, and disabling disease. It therefore ful fills the ideal criteria for any form of therapy, provided one is knowledgable of its content, and adheres to its contraindications as well as to the basic appli cation of the drugs involved. It is hoped that further investigations along these lines will continue until an ideal solution is reached. Although this is a pre liminary report, this study will continue in its present form, and will be ex panded to include a series of patients on the aspirin-enzyme combination with out the use of warfarin.
Value of Impedance Plethysmography in Suspected Venous Disease of the Lower Extremity
Authors: Liapis Christos D. , Satiani Bhagwan , Kuhns Margaret , Evans William E.
Published: November 2007

We tested the correlation between impedance plethysmography (IPG) and venography (VG) in evaluating patients with suspected venous thrombosis of the lower extremity. Three hundred and eight limbs in 205 such patients were evaluated by both IPG and VG. With the results of the venograms as standards, 169 limbs (55%) were classified as "normal" and 139 limbs (45%) as "abnormal." Acute deep venous thrombosis (DVT) was present in 65 limbs, 47 of which had DVT of the major veins, popliteal and above. The correlated IPG was positive in 43 limbs, with a sensitivity of 91%, a specificity of 89%, and P < 0.001.
Bacterial Endocarditis on Calcification of the Mitral Anulus Fibrosus: Report of an Unusual Case
Authors: Chaitin Barbara , Goldman Ronald L. , Burton Stanley
Published: November 2007

Endocarditis restricted to the base of the mitral valve and an adjacent calcified anulus is rare. This report describes a hitherto unre corded complication: massive intramural hemorrhage of the left atrium.
Local Urokinase in Arterial Thromboembolism
Authors: Fiessinger J.N. , Vayssairat M. , Juillet Y. , Aiach M. , Janneau D. , Cormier J.M. , Housset E.
Published: November 2007

Selective intra-arterial urokinase (UK) is effective in treating recent ar terial thromboembolism. However, usually only partials lysis is achieved and this treatment seems less effective than intravenous streptokinase. At a dose of 37,500 UCTA/hour it does not produce systemic fibrinolysis. This pro tocol substantially reduces the risk of systemic bleeding and embolism and extends its applicability to operative patients. The combination of surgery and UK seems particularly promising in patients with atherosclerotic arterial thrombosis.
Cardiovascular Findings with Bronchogenic Cyst
Authors: Folger Gordon M. , Lewis Joseph W.
Published: November 2007

A child with a bronchogenic cyst is described who manifested clinical findings indicative of pulmonary arterial stenosis. Compression of the right pulmonary artery by the cyst with a significant pressure gradient between the proximal and distal segments of the right pulmonary artery was verified at surgery. The post-operative follow-up findings have confirmed relief of the stenosis with absence of the murmur originating from it.

We have recently reported 1 pulmonary arteriographic findings in a case of bronchogenic cyst confirming the single previously existing report by Selke et al.2 of pulmonary arterial compression and distortion by this entity. We now report a case of a child who had prominent cardiovascular findings which subsequently were proven due to external pulmonary arterial compres sion by a bronchogenic cyst.
Uncomplicated Sinus of Valsalva Aneurysm Detected by Echocardiography in an Asymptomatic Patient: Case Report
Authors: Zoneraich Samuel , Zoneraich Olga , Gupta Mohinder P. , Garvey Julius
Published: November 2007

Echocardiography was extremely useful in detecting a distinctive echo graphic pattern with uncomplicated right sinus of Valsalva aneurysm. The patient was clinically asymptomatic. The chest x-ray showed a normal cardiac silhouette. Electrocardiographic abnormalities including first degree atrio-ventricular block, right bundle branch block, and left anterior hemi block observed during a routine cardiac clinic visit led to the echocardi ographic investigation.

The right sinus of Valsalva aneurysm protruded high into the septum and into the left ventricular chamber adjacent to the interventricular septum.

At surgery, the aneurysm was closed by the placement of a Dacron elastic patch.
Further Observations of the Digital Plethysmography in Response to Auditory Stimuli and Its Clinical Applications
Authors: Matoba Tsunetaka , Mizobuchi Hiroshi , Ito Tadashi , Chiba Michio , Toshima Hironori
Published: November 2007

Further observations of the digital plethysmography with auditory stimuli and its clinical applications were performed in patients with vibration disease and heart diseases. The responsive pattern to the auditory stimuli in the digital plethysmogram could be faithfully reproducible if it elapses more than 5 minutes apart between the first stimulus and the second one. The responsive patterns were divided into four types: normal (N), hyperreactive (I and D) types and hyporeactive (P) type.1 The values of urinary catechol amine increased in parallel to the activity level of the autonomic nerve. The hyperreactive type (D) had the highest value of urinary catecholamine, and vice versa. With regard to the age, the elderly was prone to show hyporeactive (P) type, and the young tended to be hyperreactive (D) type. Psychologic factors were examined by Cornell medical index. Neurosis was not necessarily related to the hyperreactive type. In clinical applications, it was observed by this method that the autonomic imbalance in patients with vibration disease, angina pectoris, or hypertension was recovered by the treatment, and the abnormal types of the response recovered to N type. In conclusion, the digital plethysmography with auditory stimuli as one of the autonomic nerve function tests would be much useful and non-invasive method for observation of clinical course and decision of the severity.
The Clinical Impact of the Newer Research in Blood Rheology: An Overview
Authors: Dintenfass Leopold
Published: November 2007

Over the last two decades concepts of hemorheology became established and required methods and techniques developed. Progress was made in the formation of a field of clinical hemorheology. The role of viscosity factors in various disorders has been established, especially in heart disease and dia betes. It has been recognized that hyperviscosity can be present if any one of the blood viscosity factors is increased, even if the viscosity of whole blood appears normal or even subnormal. While hyperviscosity may result in ischemic and thromboembolic episodes, the causes of hyperviscosity may include cancer, genetic abnormality, infection, metabolic disorders, and many others. The basic causes can be, in their turn, affected and reinforced by hyperviscosity. Superimposition of an added hyperviscosity factor onto al ready elevated blood viscosity might lead to precipitation of ischemic epi sodes. This review deals with the correlations between hyperviscosity and heart disease and among diabetes, cancer, and chronic anxiety. The predic tive value of hyperviscosity with respect to ischemic episodes and cancer metastases is discussed.
Clinical Relevance of Blood Viscosity and Red Cell Deformability Including Newer Therapeutic Aspects
Authors: Dormandy John A. , Yates C.J.P. , Berent G.A.
Published: November 2007

Peripheral ischemia is mostly due to narrowing of the vessels, although blood supply is also influenced by the hemorheologic properties of the blood.

Recent research has revealed that abnormally high blood viscosity can be a contributing cause in ischemia. Therapeutically decreasing the blood viscosity improves the ischemia by increasing flow through the narrowed vessels and may as such offer a valuable alternative to surgery. Different possible therapeutic approaches for decreasing blood viscosity and the related clinical evidence are discussed.
Influence of Non-Selective and Selective Beta Adrenoceptor Blockade on Isoxsuprine-Dependent Hemodynamic and Rheologic Changes
Authors: Di Perri T. , Forconi S. , Guerrini M. , Pecchi S. , Pieragalli D. , Cappelli R. , Acciavatti A.
Published: November 2007

The infusion of isoxsuprine was followed by an increase of heart rate and calf blood flow and by a decrease of arterial diastolic pressure and blood viscosity both in normal controls and patients with peripheral obstructive arterial disease. The pre-treatment with a non-selective beta adrenoceptor blocker (propranolol) canceled all the isoxsuprine-dependent changes, while the pre-treatment with a selective beta adrenoceptor blocker (metoprolol) abolished only tachycardia and did not influence the increase of calf blood flow and the decrease of blood viscosity. These findings indicate the different role of vascular beta receptors in the regulation of muscular blood flow and suggest the pharmacologic possibility to unmask the beta2-dependent vaso dilation.
Localization of the Origin of Systolic Clicks Using Echo-Pulsed Doppler Technique
Authors: Veyrat Colette , Kalmanson D. , Gourtchiglouian C. , Malergue M.C.
Published: November 2007

Echo-pulsed doppler (EPD) studies were performed in 2 surgically con trolled patients with systolic clicks. The recorded blood samples documented the click to be originated in the right atrium, at the site of the prolapsed anterior tricuspid leaflet in 1 case of heroin-induced tricuspid acute endocar ditis. In the second patient suffering from aortic valve disease, an ejection click was recorded, and could be demonstrated by using EPD, to originate from the aortic leaflet at its time of maximal excursion. EPD appears to be a safe, noninvasive method to solve the problem of the origin of systolic clicks.
Finger Systolic Pressures and Skin Temperatures in Severe Raynaud's Syndrome: The Relationship to Healing of Skin Lesions and the Use of Oral Phenoxybenzamine
Authors: Carter Stefan A.
Published: November 2007

Systolic pressures and skin temperatures were studied in 23 patients with severe Raynaud's syndrome who were given oral phenoxybenzamine. There was a relationship between the measurements and the severity of the disease. Statistically significant correlation was found between the measurements and the time for healing of skin lesions. The chances of early healing are high when digital systolic pressure exceeds 55 mm Hg, the brachial-finger pressure difference is less than 50 mm Hg, and the maximal difference among fingers less than 30 mm Hg. Early healing is also likely when finger temper ature of 10°C or more above room temperature is achieved during "reflex" heating and the difference in temperature among fingers is less than 4°C. Therefore, the measurements are of value in the determination of prognosis.

Rest pain, local tenderness, trophic skin changes, and vasospastic phenom ena improved in the majority of patients soon after beginning treatment with phenoxybenzamine. Some side effects, usually minor, were common but with doses not exceeding 50 mg used in this study they were usually not trouble some and the drug was tolerated well. Phenoxybenzamine is a valuable drug in the treatment of patients with severe vasospastic disease.
Comparative Long-Term Results of Patients with Carotid Artery Stenosis
Authors: Walter Paul , Bänfer Volkmar , Menge Thomas , Staguhn Martin , Kohlmeyer Ernst , Hehrlein Friedrich Wilhelm
Published: November 2007

Of 78 patients with an internal carotid artery stenosis a thrombendarter ectomy was performed in 46 patients whereas 32 patients were treated by conservative methods. The clinical follow-up over a period of 10 years was investigated. The percentage of patients who received drugs for anticoagu lation was equal in both groups. Operated patients acquired a permanent neurologic deficit in 3% and nonoperated patients in 69%. The physical capacity improved in 92% of the operated and in 64% of patients treated conservatively. At the time of reexamination 78% of the operated and 34% of the nonoperated patients were living. The cause of death was cardiac in 42% of both groups and cerebral in 11% of the operated and in 32% of the nonoperated patients.
Subungueal-Splinter Hemorrhage an Early Sign of Thromboangitis Obliterans
Authors: Quenneville J.G. , Prat A. , Gossard D.
Published: November 2007

Subungueal splinter hemorrhage (S.U.S.H.) has been reported in various conditions and may herald a serious systemic disease. It has been related to miscellaneous conditions such as: sub- acute bacterial endocarditis, severe rheumatoid arthritis, uninfected mitral stenosis, trichinosis, peptic ulcer, hy pertension, neoplasm, trauma, and in some cases, is considered idiopath ic.1, 2 Some dermatologic conditions such as psoriasis, dermatitis, and fungal infections may also produce S.U.S.H. 3 It consists of "a homogeneous mass of blood in a layer of squamous cells, ad herent to the under surface of the nail, considered to be of embolic origin."1

In a brief review of pertinent medical literature on thromboangiitis obliter ans, we were unable to find a descrip tion of its occurrence in this disease.2, 4, 5 The earliest lesions described in this condition are "painful vesicles on the pulp of digits with intense hyperhemia and hypersensitivity of the surrounding skin."4 It is our opinion that S.U.S.H. is an earlier and quite useful sign of arte rial involvement as seen in the following cases observed in our vascular disease section.
Influence of an Upward Shift in the V1 Electrode Position on the P-Terminal Force
Authors: Ishikawa Kyozo , Yanagisawa Atsuo
Published: November 2007

In this study, an attempt was made to determine how the P-terminal force (P-tf) was influenced by an upward shift of the V1 electrode in 508 normal subjects, 101 patients with hypertension, 22 with chronic obstructive lung disease (COLD), and 55 with old myocardial infarction. An abnormal V1 P- tf (≤-0.03 mm.sec) was observed in 3.1% of normal subjects, 11.9% of cases with hypertension, 9.1% of cases with COLD, and 21.8% of cases with old myocardial infarction. By shifting the electrode position one intercostal space above the conventional level of V1, an abnormal P-tf was seen in 12.2% of normals, and in 32.7, 36.4, and 43.6% of cases with hypertension, COLD, and old myocardial infarction, respectively. It can be concluded therefore that the P-tf is greatly influenced by a slight upward shift of the V1 electrode, and correct placement of the V1 electrode is essential for P-tf assessment.
Combined Use of Vascular Bypass and Myocutaneous Flap Reconstruction in Salvage of an Ischemic Limb
Authors: Cochran John H. , Edstrom Lee E. , Turnipseed William D.
Published: November 2007

The combined use of traditional vas cular bypass techniques and myocuta neous flap reconstruction was used in the salvage of an ischemic limb with a large pretibial ulcer.
Effects of Buflomedil on Erythrocyte Deformability
Authors: Dormandy J.A. , Ernst E.
Published: November 2007

This brief communication outlines re cent experiments on the effects of buflo medil, a new vasoactive agent, on red cell deformability in patients with leg ischemia. In this randomized, double-blind cross-over study, 10 patients received 200 mg buflomedil and matching placebo intravenously. Red cell filterability in these patients was significantly improved after buflomedil administration versus baseline values with no significant change in filterability versus baseline after placebo administration.
Morphologic Endothelial Response to Meglumine Diatrizoate: An Electron- Microscopic Study
Authors: Raininko Raili
Published: November 2007

Ultrastructural changes in vascular endothelium after an intra-aortic in jection of 65% meglumine diatrizoate, 10 ml/kg, and equiosmolal hypertonic saline were observed using electron microscopy in the rat. Cell shrinkage and expansion of intercellular clefts were found in all specimens from a large artery at 5 and 20 minutes after injection. Some destroyed cells were seen at all times after contrast and hypertonic saline administration, but one-half of the specimens taken at 1 hour were otherwise nearly normal in appearance. In muscle capillaries, the changes were less severe than in the large artery. Despite the large dose, equiosmolal meglumine diatrizoate and saline solu tions produced identical vascular lesions as detected with electron micros copy.
Comparative Study of the Echocardiographic Findings in Hypertensive and Nonhypertensive Cardiomyopathy
Authors: Agatston Arthur , Rubler Shirley , Abenavoli Tancredi , Kaye Susan , Dolgin Martin
Published: November 2007

Thirty adult male patients with advanced myocardial disease were evaluated by echocardiography. Fourteen were hypertensive; 16 were normotensive. In the former group, 7 subjects had hypertension alone; 7 had combined hypertension and alcoholism or ischemia. The latter group included 4 patients with ischemia, 6 patients with alcoholism, and 6 with idiopathic cardiomyopathy. Nine of the 14 hypertensives and 3 of 6 subjects with ischemic disease had diabetes. Compared to the normotensives, the hypertensive subjects had greater posterior wall thickness (10.4 ± 1.3 mm versus 8.3 ±1.1 mm) (p < 0.001), a larger left ventricular mass (expressed as cross-sectional area) (26.8 ± 6.6 cm2 versus 19.6 ± 3.3 cm 2) (p < 0.001) and a larger aortic root dimension (34.9 ± 2.8 mm versus 30.3 ± 5.5 mm) (p < 0.01). Aortic root size was >32 mm in 12 of 16 hypertensive and in only 3 of 16 without hypertension.

Reduction in the percentage of systolic thickening of the septum was more pronounced than that of the posterior wall in all types of cardiomyopathy (1.30 ± 4.0% versus 24.6 ± 16.0%, respectively) (p < 0.001) and excursion of interventricular septum and posterior wall was uniformly depressed. Ischemic heart disease could therefore not be differentiated from other forms of cardiomyopathy by analysis of segmental function.

When cardiomyopathy was associated with mitral insufficiency, the posterior aortic root motion was greater (6.6 ± 1.7 mm) than in its absence (3.4 ± 1.0 mm) (p < 0.001), and the septal excursion was more pronounced with mitral incompetence. Additional echocardiographic features of cardiomyopathy included the uniform presence of multiple systolic echoes and "hammock" appearance of the mitral valve and AC notching of the tricuspid valve.

We conclude that hypertensive cardiomyopathy can be distinguished from nonhypertensive types of advanced heart disease but that ischemic, alcoholic, and idiopathic cardiomyopathies cannot be differentiated by echocardiography.
Double-Blind Controlled Clinical Trial of Ancrod for Ischemic Rest Pain of the Leg
Authors: Lowe G.D.O. , Dunlop D.J. , Lawson D.H. , Pollock J.G. , Watt J.K. , Forbes C.D. , Prentice C.R.M. , Drummond M.M.
Published: November 2007

In a randomized double-blind trial, patients with ischemic rest pain of the leg received 8 days of treatment with intravenous injections of the defibrinating agent, ancrod (Arvin) or saline. Plasma fibrinogen, plasma viscosity, and blood viscosity were significantly reduced during ancrod therapy. After 27 patients had completed treatment, sequential analysis showed no preference for either therapy. In each group two-thirds of the patients claimed improvement in pain after treatment. There were no significant differences between treatment groups in analgesic consumption, Doppler systolic pressure ratio, or surgical intervention in the 6 months following treatment. We conclude that in patients with ischemic rest pain, ancrod therapy is not superior to placebo injections, and that the effect of placebo treatment is considerable.