bluuebunny/crossref_metadata_2025 huggingface dataset:
Anomalous Left Coronary Artery from the Pulmonary Artery : Effect of Coronary Anatomy on Clinical Course
Authors: Tyrrell Michael J. , Duncan Walter J. , Hayton Robert C. , Bharadwaj Baikunth B.
Published: November 2007

Nine children and 1 adolescent with anomalous left coronary artery from the pulmonary trunk (ALCA) were studied between 1970 and 1982. Serial angiographic and hemodynamic data are compared with the clinical course. Four patients had separate conus coronary arteries with a major contribution to collateral flow. Eight patients survived various surgical procedures with 1 late death, 1 awaits operation, and 1 died in infancy.

The authors' data show a significant potential for improvement in left ventricular function as shown by an increase in LV ejection fraction on medical therapy alone (5/6 patients), including all 4 with separate conus coronary arteries.

The authors conclude that medical treatment alone may be indicated for a time in selected patients with ALCA, and a subgroup with a separate conus coronary artery may have a more favorable natural history.
Serum Ionized Calcium A Predictor of Therapeutic Response To Slow Calcium Channel Blockade in Essential Hypertension
Authors: Midtbø Kjell , Hals Ottar
Published: November 2007

In 20 patients with mild to moderate essential hypertension, serum ionized calcium was determined before and after four weeks of treatment with 240 mg verapamil sustained release bid. Pretreatment systolic blood pressure was inversely correlated to serum ionized calcium (r = — 0.44, p = 0.05). Mean blood pressure was significantly (p < 0.001) reduced (from 161/100 to 145/88 mm Hg), but mean serum ionized calcium did not change during treatment (from 1.23 to 1.24 mmol/L).

A significant inverse correlation (r = -0.56, p = 0.01) was found between pretreatment serum ionized calcium and reduction in systolic blood pressure during verapamil treatment. Thus serum ionized calcium in untreated essential hypertensive patients may predict the blood pressure response to the slow calcium channel blocker verapamil.
Diagnosis of Aortic Dissection. Comparison of Investigatory Methods—Case Report
Authors: Hitter Erwin , Ranquin Ronald , Mortelmans Lieven , Parizel Gaston
Published: November 2007

A case is presented of a patient with an acute aortic dissection, rapidly followed by thrombosis of the false channel. The classical aortoangiography failed to give adequate information, whereas newer, less invasive investigation methods gave images that finally led to the correct diagnosis. The value of these methods in the diagnosis of aortic dissection is discussed.
Thromboangiitis Obliterans (Buerger's Disease) in an Elderly Man After Cessation of Cigarette Smoking — A Case Report
Authors: Lie J.T.
Published: November 2007

Thromboangiitis obliterans (Buerger's disease) is an occlusive vascular disease that occurs almost exclusively in young male tobacco users. A unique case is documented here in which Buerger's disease affecting the upper limbs was diagnosed in a sixty-two-year-old man who was a cigarette smoker but had stopped smoking fifteen years earlier.
"Sick Sinus Syndrome in Dermatomyositis" — A Case Report
Authors: Badui Elias
Published: November 2007

A forty-five-year-old woman with a history of dermatomyositis for the past fifteen years developed sick sinus syndrome during an exacerbation of her illness. This association has not been previously described in the literature, as far as the author can determine.
Behçet's Disease with Chylothorax—Case Report
Authors: Konishi Tokuji , Takeuchi Hideyuki , Iwata Jiro , Nakano Takeshi
Published: November 2007

Behçet's disease is a systemic disease primarily affecting the eye, genital, and oral mucosa but is known to have various rare complications.' A patient with a twenty-year history of Behçet's disease was admitted owing to dyspnea caused by massive chylothorax. Administration of corticosteroid, heparin, and urokinase was ineffective, but the thoracic fluid was well controlled by pleuropexy with Broncasma Berna. Chylothorax complicating Behçet's disease is extremely rare, having been reported in only 2 cases.2,3
Neuromyopathy in Venous Insufficiency
Authors: Taheri Syde A. , Teter James J. , McHugh William B. , Cullen Julie , Gabriele Nicholas
Published: November 2007

Since July, 1985, the authors have studied 23 patients with history and physical findings of venous insuffi ciency syndrome (VIS) confirmed by venous pressure, muscle biopsy, as cending and descending venography, electromyography, and nerve con duction velocity studies. Clinically, swelling appears to be the most im portant symptom, along with high ve nous pressure, particularly ambula tory venous pressure, correlated with venography findings. Muscle atrophy was present in 18 cases. Electromyo graphy and nerve conduction velocity studies yielded abnormal findings in 20 of 23 cases. The authors suggest that nerve conduction velocity and EMG studies could perhaps be used as noninvasive tests for diagnosis and follow-up of cases with VIS.
Left Ventricular Thromboembolic Occlusion of the Popliteal Artery Treated Nonoperatively with Local Urokinase Infusion — A Case Report
Authors: Weisman Irwin D. , Stanchfield Warren R. , Herzog Charles A. , Ney Arthur L. , Blake David P.
Published: November 2007

Recently streptokinase and urokinase have been shown to be useful in the nonoperative treatment of thromboembolic disease. Urokinase is emerging as a safer and more effective thrombolytic agent when applied either to definitively lyse spontaneous thrombosis where no underlying structural lesion is present or to serve as an adjunct prior to surgical reconstruction or transluminal angio plasty. The authors report a case of a high-risk cardiac patient in whom an embolic occlusion of the distal popliteal artery was completely recanalized by using a localized catheter infusion of urokinase. The source of the embolus was a left ventricular thrombus. No serious bleeding or proximal or distal embolic complications occurred. The potential hazards of fragmentation of the embolic source in the presence of systemic thombolysis, distal trifurcation embolization, and concomitant use of heparin are reviewed.
Restriction by Nitrendipine of Excessive Concentration of Free Intracellular Calcium Ions in Ventricular Myocardium of Hypertensive Rats
Authors: Gasser Robert , Frey Markus , Young Kun Byon  , Fleckenstein-Grün Gisa
Published: November 2007

In earlier investigations it has been found that high arterial blood pressure of salt-sensitive DAHL rats (DAHL-S) that received a diet con taining 8% NaCl could be normalized by chronic treatment with specific calcium antagonists, as for instance, nitrendipine or anipamil. Parallel measurements on heart and arterial vasculature with atomic absorption spectrometry revealed that there was a rise in absolute calcium content upon development of hypertension, whereas under the influence of ni trendipine, not only the blood pres sure and heart weight but also myocardial (and arterial) tissue cal cium content remained in the physio logic range.

In the present study, an additional determination of the free intracellu lar calcium ion concentration with Ca-sensitive microelectrodes was car ried out. For technical reasons, the measurements were restricted to iso lated resting rat papillary muscles (stretched to optimal length in a per fusion bath of 1.5 ml at 30°C in nor mal Tyrode solution). The impale ment of the electrodes was considered adequate when the heights of Ca po tential and membrane potential were constant for more than twenty min utes. In order to produce severe sys temic hypertension, a group of six-week-old DAHL-S rats was fed with an 8% NaCl diet over five weeks. Another group of DAHL-S rats received additionally 150 mg/kg nitrendipine twice a day orally. Salt- resistant DAHL-R rats, also fed with an 8% NaCl diet, served as controls.

The findings of this preliminary study are as follows (n = 5 in each group):
Transluminal Dilatation of the Internal Carotid Artery in Fibromuscular Dysplasia—A Case History
Authors: van den Hoven R.W. , Mali W.P.Th.H. , Theodorides Th.
Published: November 2007

In a fifty-one-year-old female patient, bilateral fibromuscular dysplasia of the internal carotid artery was treated during surgery with intraluminal dilata tion. The backflow excludes the occurrence of cerebral embolism. The method and its possibilities are discussed.
Q and Non-Q Wave Myocardial Infarction: Current Views
Authors: Kouvaras George , Chronopoulos George , Cokkinos Dennis V.
Published: November 2007

The new terminology "Q and non-Q wave myocardial infarction" (MI) tends to replace the traditional terms "transmural" and "subendocardial" MI since the anatomy cannot be accurately predicted by electrocardiography. Although some subtypes of non-QMI display a favorable early or in-hospital prognosis, the long-term outlook seems less benign, particularly when early or late recurrence of MI occurs. Coronary arteriograms show an equal number of diseased vessels in both types of MI, but complete coronary artery occlusion is less frequent in non-QMI. The management of patients with non-QMI should be mainly directed to preventing extension or recurrence of MI by using either drugs such as thrombolytic agents and drugs against coronary artery spasm or invasive techniques like percutaneous transluminal coronary angioplasty.
Cardiovascular Complications of Aluminum Phosphide Poisoning
Authors: Khosla S.N. , Nand Nitya , Kumar P.
Published: November 2007

Aluminum phosphide is widely used as a grain preservative. Recently some reports have appeared in the literature in which serious toxic effects of this agent have been reported, and a number of fatal complications, including shock and cardiac dysrhythmias, have been increasingly seen. Of 25 cases of aluminum phosphide poisoning the authors observed over a period of two years, 16 cases (64%) had evidence of cardiac dysfunction. Despite adequate treatment, 40% of the patients died. A plea is being made for recognition of these fatal complications and for early institution of adequate treatment.
The Resting Cardiointegram: Correlation with Stress Thallium Perfusion Studies
Authors: Gould Lawrence A. , Betzu Robert , Judge David , Lee Jae , Taddeo Matilda , Yang David
Published: November 2007

The cardiointegram is a noninvasive technique for the analysis of the electrical signals of the heart obtained by a transformation of the voltage versus time format by a series of integrations. The stress thallium perfusion study is a widely used test for the detection of coronary artery disease. In order to evaluate the correlation between the resting cardiointegram and the stress thallium 201 perfusion study, 20 patients with normal resting electrocardiograms underwent stress thallium tests and resting cardiointegrams. The cardiointegram was determined on two resting complexes of leads I, II, V4, V 5, and V6 and called abnormal if five of ten complexes deviated outside a normalized template. There was concordance of the cardiointegram and the thallium study in 16 of 20 patients (80%). The sensitivity for the detection of coronary artery disease was 71%, and the specificity was 80%. The overall accuracy was 74%. Thus in patients with normal electrocardiograms, the cardiointegram is a useful noninvasive test for the detection of coronary artery disease.
Value and Limitations of Calcium Channel Blockade In the Treatment of Pulmonary Hypertension Associated with CREST — Case Reports
Authors: Pressly Thomas A. , Winkler Anne , Alpert Martin A. , Jackson Robert W. , Mukerji Vaskar , Benge J. Michael , Sharp Gordon C.
Published: November 2007

Reversible vasospasm has been hypothesized to underlie the development of pulmonary hypertension in patients with CREST. Drugs that prevent arterial spasm have been used to treat pulmonary hypertension with variable results. The disparate pulmonary hemodynamic responses to calcium channel blockade reported herein suggest that CREST patients with mild pulmonary hypertension may have a component of reversible vasospasm responsive to vasodilator therapy, whereas patients with moderate to severe puhnonary hypertension may have fixed vessel lesions precluding a satisfactory response to calcium channel blockade.
Prevention of Vasospastic Angina by Alcohol Ingestion: Report of 2 Cases
Authors: Matsuguchi Takeyuki , Araki Haruo , Nakamura Naonori , Etoh Yasuyuki , Okamatsu Shuichi , Takeshita Akira , Nakamura Motoomi
Published: November 2007

The authors report 2 patients with vasospastic angina in whom alcohol ingestion was effective in preventing angina. Coronary angiography revealed no organic coronary stenosis but demonstrated coronary artery spasm during angina attacks. In 1 patient, alcohol ingestion every six hours completely suppressed frequent spontaneous angina. In the other patient, alcohol ingestion markedly prolonged the duration of the exercise on treadmill testing by preventing exercise-induced coronary spasm.
Serum Copper, Magnesium, Zinc, Calcium, and Potassium Changes Following Acute Myocardial Infarction
Authors: Bakos Salem N. , Ahmed Hamid K. , Nasser Tariq A. K.
Published: November 2007

When analyzed within seventy-two hours of admission to the coronary care unit, the mean values of serum copper and magnesium were lower in patients with acute myocardial infarction than in noncardiac patients. Zinc values showed no difference.

Because the reduction of serum copper in males was statistically significant, the authors suggest that a lowering of serum copper, especially in males, can be useful in the diagnosis of recent infarction and could possibly have other impli cations.

Significant elevations of serum calcium and of serum potassium were also demonstrated.
Oxygen Free Radicals and Heart Failure
Authors: Prasad Kailash , Kalra Jawahar
Published: November 2007

We hypothesize that oxygen free radicals are involved in the genesis and maintenance of volume and pressure overload heart failure. Pressure and vol ume overload would produce myocardial ischemia. During ischemia there will be an increase in xanthine and xanthine oxidase; and a decrease in the superox ide dismutase and glutathione peroxidase activity leading to an increase in the oxygen free radicals. A decrease in the cellular pH during ischemia would re lease phospholipase which would, in turn, release arachidonic acid from phos pholipids. Leukotrienes and prostaglandins will be synthesized through arachidonic acid metabolism. During this synthesis not only oxygen free radi cals will be produced but also there will be formation of leukotriene, LTB4, which is known to activate neutrophil and hence increased secretion of oxygen free radicals. Increased circulatory catecholamines due to compensatory mech anism would also lead to an increase in the oxygen free radicals. Oxygen free radicals are known to depress Ca++ binding and uptake of sarcoplasmic retic ulum which would lead to a decrease in the myocardial contractility. We have shown that oxygen free radicals depress cardiac function and cardiac contractil ity. It is, therefore, suggested that oxygen free radicals might be involved in the development of heart failure. The use of agents that reduce the amount of oxy gen free radicals would be of value in the prevention and treatment of heart failure.
Role of Platelets in Diabetic Microangiopathy— An Additional Factor
Authors: Chitre Ajit P. , Velaskar Dilip S.
Published: November 2007

A study of platelet aggregation in 324 diabetes mellitus (DM) patients and 24 patients with microvascular complications of DM (retinopathy) is reported. Platelet aggregation tests showed that DM patients can be divided into two groups: "normal" and "prone." The mean reading and standard deviation (SD) of the normal group was found to be 22.6% (SD 6.99%). The mean reading and standard deviation of the prone group was found to be 60.5% (SD 12.7%) re spectively. All patients with microangiopathy had a significant increase, all of them being in the prone range, with a mean of 69.5% (SD 7.2%). Platelet hyper function appears to be a high-risk factor for the development of diabetic mi croangiopathies. A hypothesis postulating platelet hyperfunction as an additional factor along with altered glycoprotein metabolism and explaining the chain of events in the genesis of diabetic microangiopathies is presented.
Three-Year Follow-Up of Risk Factors Correlated with New Atherothrombotic Brain Infarction in 708 Elderly Patients
Authors: Aronow Wilbert S. , Gutstein Hal , Lee Neung H. , Edwards Mildred
Published: November 2007

A prospective study correlated cigarette smoking, systolic or diastolic hypertension, diabetes mellitus, hypercholesterolemia, low serum high-density lipoprotein cholesterol, hypertriglyceridemia, and obesity with development of new atherothrombotic brain infarction in 192 elderly men and 516 elderly women. Mean follow-up was 36 ± 6 months (range 19-39). New atherothrombotic brain infarction occurred in 24 of 192 men (13%) and in 63 of 516 women (12%), difference not significant. Risk factors for atherothrombotic brain infarction in elderly men were cigarette smoking (p < 0.001), systolic or diastolic hypertension (p < 0.001), and diabetes mellitus (p < 0.005). Risk factors for atherothrombotic brain infarction in elderly women were systolic or diastolic hypertension (p < 0.001), diabetes mellitus (p < 0.001), and obesity (p < 0.005).
Noninvasive Method for Measurement of Elasticity in Aortic Wall Using Cineradiography
Authors: Sugahara Tetuo
Published: November 2007

Elasticity in the aortic wall was determined noninvasively by measuring the maximal and minimal external diameter of the pulsing thoracic aorta by use of cineradiography in combination with esophagography. Pulse wave velocity and the cross-sectional area were calculated from these values, and their relationship to aging and arteriosclerotic disease were evaluated. The changes of pulse wave velocity and cross-sectional area obtained by this method represent quantitatively the degrees of arteriosclerotic change and aging of the aortic wall.
Coronary Artery Aneurysms and Congestive Heart Failure — Possible Long-Term Course of Kawasaki Disease in an Adult — A Case Report
Authors: Sakai Yoshihiko , Takayanagi Kan , Inoue Teruo , Yamaguchi Hirokazu , Hayashi Terumi , Morooka Shigenori , Takabatake Yutaka , Sato Yoshinobu
Published: November 2007

Multiple coronary artery aneurysms, rarely seen in patients with atherosclerotic heart disease, can be frequently observed in children with Kawasaki disease. However, their long-term clinical courses still remain obscure. A thirty-nine-year-old male came to our clinic because of congestive heart failure. A left ventriculogram revealed highly reduced wall motion. A coronary angiogram showed left main trunk aneurysm with complete occlusion of the left anterior descending artery and ramification of the right coronary artery close to the ostium. Six months after discharge, he died suddenly. On autopsy, aneurysms were observed in the left main trunk and right coronary artery, together with an old anteroseptal myocardial infarction. Although he did not have a clear history of febrile disease in childhood, he was highly suspected to be a long-term survivor of Kawasaki disease because of the unique form and distribution of the coronary artery aneurysms.
Experimental Evaluation of the Mitroflow Pericardial Heart Valve Prosthesis. Part II. Pathologic Examination
Authors: Hassoulas J. , Rose A.G.
Published: November 2007

The results of the morphologic and histopathologic examination of 37 bovine pericardial heart valve prostheses that were retrieved after experimental im plantation in Chacma baboons for periods of one to twelve months are pre sented in this study.

The implanted prostheses consisted of 33 Mitroflow valves, size 21 mm, that belonged to four different groups according to the method of preparation of the pericardium (process I to IV) and 4 commercially available Ionescu-Shiley valves, size 19 mm. All implantations were in the mitral position, except 1 Mi troflow and 1 Ionescu-Shiley prosthesis, which were implanted in the tricuspid position.

Moderate or abundant noninfected thrombotic deposits were found on the cusps of 13 of the 33 Mitroflow valves (39%). The Ionescu-Shiley valves shared this tendency, perhaps to a lesser extent, for the formation of thrombus on the valve cusps. Results of transmission electron microscopy, scanning electron mi croscopy, and calcification analysis are also presented.

In this experimental study, the authors did not identify any significant char acteristics in the Mitroflow bovine pericardial heart valve prosthesis that would lead to improved or extended durability of this device over the commercially available Ionescu-Shiley bovine pericardial heart valve prosthesis and probably over any other glutaraldehyde-treated bioprosthesis. They would suggest, therefore, that any clinical investigations of the prosthesis be undertaken very cautiously.
Efficacy of Indobufen in the Treatment of Intermittent Claudication
Authors: Signorini G.P. , Salmistraro G. , Maraglino G.
Published: November 2007

The aim of this trial was to assess the activity of indobufen compared with placebo in peripheral occlusive arterial disease of the lower limbs of atheroscle rotic or diabetic origin. Fifty-two outpatients were admitted to the randomized, double-blind study and were given either an indobufen 200-mg tablet (28 sub jects) or placebo (24) for six months.

Painfree walking distance on a treadmill at a constant speed (4 km/h) and slope (10°) was assessed before and after three and six months' treatment. The painfree walking distance before treatment with indobufen or placebo averaged 153 ± 23.02 (mean ± SE) and 199 ± 30.58 (mean ± SE) meters respectively.

After six months' treatment with active drug or placebo, this parameter reached 610 ± 115.36 (p < 0.01) and 243 ± 32.49 (p > 0.05) meters respec tively. The difference between the two treatments was statistically significant in favor of indobufen (p < 0.01 Dunn's test).
Altered in Vitro Hemostasis, Clotting, and Thrombolysis After Oral Nifedipine in Normal Volunteers
Authors: Rademaker Marius , Meyrick-Thomas Richard H. , Kirby John D. T. , Kovacs Iren B.
Published: November 2007

In this study the authors used the Haemostatometer, a new instrument to monitor the pattern of hemostatic plug formation that occurs in holes in poly ethylene tubing through which nonanticoagulated blood is flowing under stand ard conditions. The pattern and speed of blood coagulation, subsequent to hemostasis, was also monitored. Simultaneously, the time until expulsion of he mostatic plugs formed was measured and considered as spontaneous thrombo lysis time (STT). In 10 healthy volunteers, blood samples were drawn and tested before and ninety minutes after administration of 10 mg oral nifedipine. After nifedipine, the initial phase of primary hemostasis was delayed (p < 0.05), the clotting time lengthened (p < 0.01), and the STT shortened (p < 0.01). The au thors conclude that the effect of nifedipine on hemostasis and thrombolysis could contribute to its therapeutic efficacy.
The Interdependence of Hypertension, Calcium Overload, and Coronary Spasm in the Development of Myocardial Infarction
Authors: Gasser Robert N. A.
Published: November 2007

It is a well-known fact that sys temic hypertension is one of the ma jor risk factors for myocardial in farction (MI). Extensive studies on hypertensive rats revealed that cal cium is excessively elevated in the myocytes, as well as in the coronary artery wall of these animals, which results in a higher resting tension and a stronger contractile response of those muscle strips.

Over many years coronary spasm has been claimed by various authors to be greatly involved in the patho physiology of the early phase of acute MI (AMI). It can be shown that thrombocytes that aggregate at the injured vessel wall next to athero slcerotic plaques release vasocon strictive factors that induce series of severe spasms at the sites with defec tive endothelium that end up in myocardial infarction; the patho physiologic pathway is called the thromboischemic reentry mechan ism. This local contractile response may be enhanced in the presence of systemic hypertension since intracel lular calcium is elevated in the coro nary smooth muscle.

On the other hand, it has been shown that heart muscle fibers un dergo severe alterations finally re sulting in necrotization, as soon as free calcium ions penetrate exces sively through the sarcolemma mem brane into the myoplasm so that the capacities of the calcium binding or extrusion processes become overpow ered ; this is especially the case during ischemia. Since free intracellular cal cium is already ten times elevated in the myocytes in systemic hyperten sion, the myocardium may be more vulnerable to further calcium over load owing to the ischemia and ne crotization is augmented.

The elevation of intracellular Ca of the myocytes of the cardiovascular system in systemic hypertension en hances the pathologic response of the coronary arteries and the myocar dium. This work gives a complete overview of the pathophysiologic principles involved in AMI occurring with systemic hypertension.
Acute Pulmonary Thromboembolism Treated Successfully by Balloon Angioplasty—A Case Report
Authors: Handa Koichi , Sasaki Yasushi , Kiyonaga Akira , Fujino Masanori , Hiroki Tadayuki , Arakawa Kikuo
Published: November 2007

Acute pulmonary thromboembolism frequently occurs in patients on pro tracted bed rest and by itself can cause acute right ventricular failure. The authors report findings in a patient with this disorder treated successfully by balloon angioplasty.
Upper Extremity Radionuclide Venography in the Diagnosis and Management of Venous Disease Associated with Intravenous Catheters
Authors: Dhekne Ramesh D. , Moore Warren H. , Peters Charles , Dudrick Stanley J. , Long Stephen E.
Published: November 2007

The utility of upper extremity ra dionuclide venography (RNV) in the assessment of suspected catheter-re lated central venous thrombosis (CRVT) was evaluated in 40 patients with subclavian venous catheters. Twenty normal patients (Group A) served as controls and their veno graphic patterns were analyzed by using four criteria: (1) delayed tracer transit time, (2) nonuniformity of flow and venous pooling, (3) jugular venous reflux, and (4) collateral ve nous filling. Control studies dis played no collaterals as a distinguishing characteristic but demonstrated the other three fea tures to a variable degree. Of 106 ex tremities suspected of CRVT, 67 (Group B) were initially considered to have normal RNV findings (no col laterals). Contrast venography con firmed a normal pattern in 3 but identified CRVT with collaterals in 3 others. Retrospective review of the RNV studies confirmed faint collat erals in these latter 3. The 39 remain ing extremities (Group C) showed abnormal RNV findings; contrast venography and postmortem studies confirmed the presence of venous dis ease in 5 patients. The authors be lieve that RNV is a reliable, noninvasive procedure for early diag nosis of venous occlusion associated with subclavian venous catheters.
Effect of a 1.5 Tesla Magnetic Field on Greenfield Filters in Vitro and in Dogs
Authors: Williamson Michael R. , McCowan Timothy C. , Walker Craig W. , Ferris Ernest J.
Published: November 2007

The authors have tested four Greenfield filters for deflection in a 1.5 Tesla magnetic field and found large variations in the amount of deflection among filters. They also placed two filters in dogs and checked the filter for migration by taking radiographs before and after magnetic resonance imaging (MRI) scans. They found no evidence of migration. They conclude that, while most Greenfield filters respond to a magnetic field, the chance of migration of a filter because of an MRI scan is small. Therefore, MRI scanning of patients with Greenfield filters has little risk.
A Simple Method for Rapid Estimate of Pulmonary Venous Admixture
Authors: Chiarla Carlo , Giovannini Ivo , Siegel John H. , Coleman William P. , Boldrini Giuseppe , Castagneto Marco
Published: November 2007

Data from 2,298 measurements of pulmonary venous admixture (QS/QT) per formed in 733 patients were analyzed and processed in order to develop a method for rapid and reliable estimation of QS/QT by a simplified approach. Formulae and charts were obtained, which are easily suitable for use in all settings, and permit estimation of QS/QT with an 85%-93% control of its varia bility (r2 = 0.85-0.93, p < 0.0001) simply on the basis of the measured arterial and central venous O2 tensions or saturations.
Acute Effect of Lidocaine on Coronary Blood Flow and Myocardial Function
Authors: Gee David , Wilson Richard , Angello Debra
Published: November 2007

The acute effects of lidocaine on coronary blood flow, hemodynamic parameters, and wall function were studied in 14 anesthetized pigs. Lidocaine was infused intravenously as a bolus (dosage range from 1.5 to 4.0 mg/kg). At ten to thirty seconds after infusion, coronary blood flow reached 154±38% (mean±SD) of the baseline resting flow (p < 0.001). The double product, an estimate of myocardial oxygen demand, decreased from a baseline value of 9221 ±2174 to 8008±1923 mmHg beats/min (p<0.01). Sixty seconds postinfusion myocardial function decreased from baseline wall thickening of 46±25% to 41±17% (p=0.04). An acute bolus of lidocaine appears to transiently increase coronary blood flow, by decreasing coronary vascular resistance, and also decrease myocardial function. Thus, an acute lidocaine bolus may favorably alter the myocardial oxygen supply/demand ratio.
Suppression of Exercise-Induced Ventricular Arrhythmias by Propranolol and Diltiazem in a Woman Without Organic Heart Disease—A Case Report
Authors: Yano Katsusuke , Miyauchi Katsumi , Mitsuoka Takao , Hashiba Kunitake
Published: November 2007

A thirty-five-year-old woman without organic heart disease who has exercise-induced ventricular arrhythmias suppressed by propranolol and diltiazem is reported. Treadmill exercise provoked reproducibly nonsustained ventricular tachycardia (NSVT) and salvos of ventricular premature contraction (VPC). QRS morphology of these ventricular arrhythmias showed left bundle branch block pattern and right axis deviation. Oral propranolol (20 mg) and diltiazem (90 mg) prevented exercise provocation of NSVT and VPC. However, oral mexiletine (200 mg) and procainamide (500 mg) could not prevent exercise provocation of these ventricular arrhythmias. No ventricular arrhythmias could be induced by any form of ventricular extrastimulations. Right ventricular pacing at a rate of 210 beats/minute provoked NSVT of which the QRS morphology was similar to that of exercise-induced NSVT. Triggered activity may be a possible electrophysiologic mechanism for exercise-induced ventricular arrhythmias in this patient, although other mechanisms such as reentry and enhanced automaticity could not be completely excluded.
Acute Anterior Wall Myocardial Infarction Secondary to Blunt Chest Trauma—A Case Report
Authors: Lee Don W. , Garnic J. Daniel , Barlow Griffith C.
Published: November 2007

Cardiac injuries following nonpenetrating chest trauma have been reported. These include cardiac arrhythmias, septal damage, valve damage, coronary fistula, coronary artery damage, ventricular aneurysm, cardiac rupture, and myocardial infarction. Myocardial infarction as a complication of chest trauma has been reported in very few cases. In this report the authors describe a patient who developed anterior wall myocardial infarction secondary to a blunt chest trauma.
A Pressor Effect of Noncardioselective Beta-Blockers in Mildly Hypertensive Patients During Acute Hospitalization
Authors: Cleophas Ton J. M. , Stapper Gerard J.
Published: November 2007

Pressor effects of noncardioselective beta-blockers have been demonstrated in situations of increased sympathetic activity; however, data are limited and the clinical significance of this finding is in doubt. The present study was performed to supply data about the effect of noncardioselective beta-blockers on the stress of acute hospitalization. Of 2,989 patients acutely admitted to a 50-bed unit of general internal medicine in a 647-bed teaching hospital, 234 had used beta-blockers without intrinsic sympathicomimetic activity (ISA) for at least six weeks because of mild hypertension; 199 were evaluable, 56 using nonselective, 143 using selective beta-blockers. The authors found a marked pressor effect of noncardioselective beta-blockers as compared with selective (mean arterial pressure 125 versus 102 mm Hg, p < 0.001). In the patients who could continue their outpatient medication this effect could be attributed to an overall increase of total peripheral resistance and disappeared within five days of admission. In the patients admitted because of unstable angina pectoris (nonselective n = 15, selective n = 48) myocardial oxygen demand as estimated by the double product (systolic blood pressure heart rate) was significantly higher in the nonselective group (12.926 versus 9.581 mmHg.beats/min, p<0.01). The present study supports the need for more controlled data to determine the ultimate place of noncardioselective beta-blockers in situations of increased sympathetic activity.
Noninvasive and Invasive Diagnosis of a Huge Congenital Aneurysm of the Left Atrium: A Case Report
Authors: Dusleag Johann , Klein Werner , Eber Bernd , Gasser Robert , Weinrauch Viktor , Rotman Brigitte
Published: November 2007

An intrapericardial aneurysm of the left atrium in a twenty-eight-year old asymptomatic woman is reported. The aneurysm was diagnosed by two-dimensional echocardiography and the specific intraaneurysmatic flow pattern was described by color blood flow imaging. To the authors' knowledge such a noninvasive diagnosis of a left atrial aneurysm has never been reported in the literature before. The diagnosis was confirmed by angiocardiography. The aneurysm was successfully resected. The patient was discharged without medication and continues to do well.
Atherosclerosic Dissection of the Cervical Internal Carotid Artery — A Case Report
Authors: De Baets P. , Delanote G. , Jackers G. , De Puydt P. , Wilms G.
Published: November 2007

Atherosclerosis as a cause of spontaneous dissection in the cervical internal carotid arteries has been described in only a few cases. The authors present a surgically and pathologically proven case of dissection on the base of atherosclerosis of the cervical internal carotid artery. A resection of the pathologic segment with arterial reconstruction by direct anastomosis with a venous patch graft was performed. The postoperative course was uneventful.
Permeability of Intracranial Blood Vessels to Endogenous Serum Albumin
Authors: Heck Albert F.
Published: November 2007

The blood-brain barrier to endogenous serum albumin labeled with Evans blue was studied by standard fluorescence microscopic techniques in cats. Systematic studies confirm that, except in certain well-known loci (hypothalmic median eminence, subfornical organ, area postrema, etc.), blood vessels within brain tissue are impermeable to endogenous albumin. But studies also demonstrate that in virtually all arteries at the base and over the surface of the brain and brain stem, labeled albumin passes readily through endothelium and the vascular wall to the adventitia. These observations are discussed in the context of current concepts of intracranial vascular permeability and, in terms of general biology, the possible consequences of the permeability to serum albumin of intracranial, extraparenchymal blood vessels on the composition and physiology of cerebrospinal fluid and in the pharmacokinetics of antibiotics, anticonfulsants, and antineoplastic and vasoactive agents.
The Vascular Resistance of Arterial Stenoses in Series
Authors: Kilpatrick D. , Webber S.D. , Colle J-P.
Published: November 2007

The vascular resistance of stenoses in series has been studied in vitro by use of fiber optic laser Doppler anemometry to measure the cross-sectional areas of the stenoses. Pressure gradients across each of the stenoses were measured while both the severity and the separation of the stenoses were altered. The individual resistances were compared with the combined resistance.

Resistance at a stenosis is a nonlinear function of the severity of the stenosis. The resistance is a complex function of the perfusion pressure and the cross-sectional area of the stenosis and cannot be accurately predicted from a single plane angiographic image. With multiple stenoses an approximate assessment of the combined effect can be obtained by summing the value of the resistance for each stenosis but not the degree of the stenoses. The nonlinear relationship of resistance to stenosis severity means that if one stenosis is more severe than the other, the combined effect can be regarded as the same as the effect of the more severe stenosis acting by itself. The distance between the stenoses does not change their combined effect.
Follow-up Study of Morbidity in Patients with Angina Pectoris and Normal Coronary Angiograms and the Value of Investigation for Esophageal Dysfunction
Authors: Schofield Peter M.
Published: November 2007

A postal questionnaire was used to assess the symptoms, use of medical facilities, and employment status of patients with angina pectoris and normal coronary angiograms following cardiac catheterization. In a retrospective study of 187 patients, 66 had left ventricular dysfunction demonstrated by abnormal regional wall motion and 121 had normal left ventricular function. At follow-up twelve to forty-six months following catheterization, 89% with left ventricular dysfunction and 82% with normal ventricular function had continued to experience chest pain. There was no significant change in the admission rate to hospital because of chest pain or the proportion of patients who were working, after catheterization as compared with before, in either group. Some patients with left ventricular regional wall motion abnormalities appeared to have progressive left ventricular dysfunction.

In a prospective study of 63 patients, detailed investigation of esophageal function was performed. Twenty-two patients had left ventricular wall motion abnormalities. The majority of the 41 patients with normal left ventricular wall motion had esophageal abnormalities that were treated appropriately. At follow-up six to twenty-four months following catheterization significantly fewer patients with normal left ventricular function continued to experience chest pain compared with those with left ventricular dysfunction. Following catheterization the hospital admission rate fell significantly and the proportion of patients working increased significantly in the group with normal left ventricular function. The hospital admission rate and employment status of patients with left ventricular dysfunction did not change significantly following angiography. These findings suggest, therefore, that investigation for and treatment of esophageal dysfunction should be performed in patients with angina pectoris, normal coronary angiograms, and normal left ventricular function.
Light Reflection Rheography and Thoracic Outlet Syndrome
Authors: Antignani P.L. , Pillon S. , Di Fortunato T. , Bartolo M.
Published: November 2007

The authors have studied with a light reflection rheograph (LRR) 112 cases: 54 patients with suspected "thoracic outlet syndrome" (TOS) in the functional phase, 28 patients with phlebothrombosis localized in upper limbs, and a control group of 30 healthy subjects to evaluate the upper limbs' venous outlet. They recorded a good correlation among results obtained with LRR, clinical examination, Doppler, and phlebographic examination. The data obtained lead them to propose this methodology as an important examination in the evaluation of upper thoracic pathology.
Clinical Study of Late-Stage Postthrombotic Lower Extremities
Authors: Sun Jian-Min , Zhang Pei-Hua
Published: November 2007

Through clinical and venographic study of 353 diseased limbs, the authors advocate a new classification for the postthrombotic syndrome of the deep veins of the lower extremity. The postthrombotic lower extremities may be divided into two types: (1) lesions of the whole lower extremity, consisting of the completely obstructed, partially recanalized, and completely recanalized types; (2) local lesions, such as segmental obstruction of the iliac, iliofemoral, superficial femoral, femoropopliteal veins, and the tibioperoneal venous trunk and the venous plexus in calf muscles. Each type has its characteristics related to the duration of symptoms and clinical features, and their management is not the same at all.

The authors suggest that clinically this new classification may be of great help in estimating the status of the diseased limb and in selecting proper method of treatment.
Transcutaneous Electrical Nerve Stimulation (TENS) for Treatment of Severe Angina Pectoris Refractory to Maximal Medical and Surgical Management—A Case Report
Authors: Magarian Gregory J. , Leikam Becky , Palac Robert
Published: November 2007

This report describes the use of a transcutaneous nerve stimulator for the treatment of severe angina pectoris in a young man refractory to maximal medical management after coronary angioplasty and coronary bypass surgery. Its successful use resulted in a marked clinical improvement and an impressive reduction in hospitalizations and other utilization of health care resources. Consideration for use of a transcutaneous nerve stimulator should be given in similar patients when all other accepted medical and surgical treatment modalities fail to provide adequate pain control.
Objectifying Exercise Ischemia in Peripheral Vascular Disease: A Study in 120 Patients
Authors: Caillard Philippe , Mouren Xavier , Pujade Bertrand , Blanchemaison Philippe , Elbeze Yves , Pr Cloarec Maurice
Published: November 2007

This study presents the results of transcutaneous oxygen pressure (TcPO2) monitoring during a treadmill test walk performed in the early stages of peripheral obliterative vascular disease. The study population consisted of a first group of 50 known arteriopathic patients presenting, on questioning, with intermittent claudication; a second group of 50 known arteriopathic patients void of any symptoms of intermittent claudication; and a third group, which was a control cohort of 20 nonarteriopathic, nonclaudicating patients.

Though resting TcPO 2 cannot be used to aid the clinical diagnosis of exercise ischemia it may be useful in revealing asymptomatic chronic resting ischemia (9% of cases in this series). On the other hand, a posteffort (recovery phase) fall in TcPO2 had a predictive positive diagnostic accuracy for ischemia on exercise in 99% of the cases reported here versus 87% for clinical appraisal. In the light of these results, TcPO2 measurements coupled to a treadmill test walk perfectly ascertain exercise ischemia in arteriopathic patients, whether asymptomatic or not, and avoid the false-positive results obtained by clinical evaluation.
Paraprosthetic Cecal Fistula: CT Demonstration— A Case Report
Authors: Arrington Elizabeth R. , Eisenberg Brian , Hartshorne Michael F.
Published: November 2007

A case in which repeated infection defied diagnosis after aortobifemoral bypass graft is reported. The key investigation proved to be computed tomography (CT), which detected the right limb of the graft penetrating the cecum. This is a complication of graft surgery that has not been previously reported.
Effects of Ticlopidine on the Neurologic Outcome and the Hemorheologic Pattern in the Postacute Phase of Ischemic Stroke: A Pilot Study
Authors: Ciuffetti Giovanni , Aisa Giovanni , Mercuri Michele , Lombardini Rita , Paltriccia Rita , Neri Cristiana , Senin Umberto
Published: November 2007

This double-blind pilot study observed the effects of a twenty-one day oral ticlopidine treatment (250 mg/twice daily) on the neurologic outcome and the hemorheologic pattern of 15 patients and 15 placebo-treated controls. Patients and controls (age range sixty-six to eighty-six years) were included in the study within twelve hours of the onset of ischemic stroke, confirmed clinically and by computerized tomography. Scores on Hachinski's Scale and the following he morheologic parameters were monitored weekly for twenty-one days: fibrino gen levels, the whole blood, unfractionated white and red blood cell filterability rates (through 5-micron-pore-diameter filters using a constant-flow positive- pressure system), and the leukocyte count and activation (by microscopic obser vation). The results showed treatment with ticlopidine improved the neurologic outcome (Hachinski's Score +36%, p < 0.03) slightly but significantly (p < 0.001) increased the average values of the whole blood (+ 19%) and red cell (+ 17%) filterability rates and decreased fibrinogen levels (-17%).
Is Macronodular Liver Cirrhosis an Irreversible Lesion? Changes in the Intrahepatic Micro-vasculature Treated with Estradiol Benzoate in Rats
Authors: Ishii Kohdoh , Karube Hitomi , Fujita Yoshikuni , Shibata Hisao , Okudaira Masahiko , Tsuchiya Masaharu
Published: November 2007

Estradiol benzoate (EB), a synthetic estrogen, was injected to macronodular cirrhotic rats, and the reversibility of the lesion was investigated. Macronodular liver cirrhosis (MNLC) was produced by use of carbon tetrachloride plus 3'-Me- DAB. In animals with no treatment, regenerative nodules remained unchanged during an eighteen-week observation period. Microangiograms showed mark edly deranged intrahepatic microvasculatures, including an irregularly con toured vascular tree and rarefaction in the peripheral area. On the other hand, EB treatment exerted conspicuous efficacy on the above-mentioned intrahepatic microcirculatory disorder and on sinusoidal dilatation, which led the livers with MNLC to revert to almost normal appearance. It is concluded that EB provides a salutary effect on the intrahepatic microcirculatory system, by means of which MNLC can be shown to be a reversible lesion.
Dipyridamole Radionuclide Ventriculography in Patients with Coronary Artery Disease: Comparison with Ergometer Exercise
Authors: Konishi Tokuji , Koyama Takao , Aoki Toshikazu , Futagami Yasuo , Nakano Takeshi
Published: November 2007

Intravenous administration of dipyridamole during radionuclide ventriculog raphy (RNV) was performed in 26 consecutive patients with symptomatic coro nary artery disease. The authors compared the results of dipyridamole-RNV with those of ergometer exercise-RNV in detecting myocardial ischemia. During exercise, ST depression, regional wall motion (RWM) abnormalities, and de creased left ventricular ejection fraction (LVEF) were observed in 21 (81%), 23 (88%), and 20 (77%) patients, respectively. However, after intravenous di pyridamole, ST depression, RWM abnormalities, and decreased LVEF were observed in 14 (54%), 15 (58%), and 2 (8%) patients, respectively. Although LVEF usually decreases during myocardial ischemia, LVEF did not decrease (57 ± 11% to 58 ± 10%), even in patients with ST depression, after intravenous dipyridamole. Maintained left ventricular ejection fraction is considered to be a hemodynamic effect of the potent arterial vasodilatation induced by di pyridamole.

These results from dipyridamole-RNV in myocardial ischemia seem to con flict with the results from dipyridamole-thallium studies carried out to deter mine the capacity to detect coronary artery disease. Unknown mechanisms of dipyridamole other than the coronary steal phenomenon may be operative in the genesis of myocardial ischemia.