bluuebunny/crossref_metadata_2025 huggingface dataset:
A Study of the Semeiological Reliability of Dorsalis Pedis Artery and Posterior Tibial Artery in the Diagnosis of Lower Limb Arterial Occlusive Disease
Authors: Nuzzaci Giuseppe , Giuliano Giovanni , Righi Daniele , Baroncelli Tiziana , Lotti Alessandro , Marinoni Marinella
Published: November 2007

Routine diagnosis of suspected occlusive arterial disease of the lower limbs are often based on the pulse absence at the dorsalis pedis artery. However many of these diagnoses are not confirmed after more thorough tests, and this fact arises the problem of the semeiological reliability of the above mentioned artery. Researches carried out by several authors in normal individuals on the dorsalis pedis artery yielded controversial results. Three hundred-sixty subjects free of occlusive arterial disease were then examined by means of clinical and Doppler investigation in order to assess the semeiological reliability of the dorsalis pedis artery in the diagnosis of occlusive arteriopathy of lower limbs, when compared to the posterior tibial one. The conclusion is drawn that a greater semeiological reliability must be attributed to the latter, due to its lesser "absence" incidence.
Carotid Ultrasonography - The New "Gold Standard" Surgical and Angiographic Correlation
Authors: Weintraub Michael I. , Lambert Dianne , Rothman Allan L.
Published: November 2007

Atherosclerotic plaques and high grade stenosis in the carotid circulation are responsible for symptoms of cerebral and retinal ischemia. Identification of these lesions by angiography has been the "gold standard" for which the decision of endarterectomy depended. The recent introduction of high resolution carotid ultrasonography has allowed us to compare thirty-seven surgical specimens with the results of preopertive screening with angiography. UCI had a 97% correlation whereas angiography was accurate only 70%. More importantly there were ten negative angiograms in patients with clinically active ulcerative plaque disease. If surgery were based solely on the angiographic appearance of ulcerative plaques or high grade stenosis, then less than half of the patients have received the correct treatment. UCI deserves to be considered the new reference standard.
Coxsackievirus B4 Infection Of Sympathetic Ganglia In Squirrel Monkeys
Authors: Burch George E. , Chu Kang-chu , Soike Kenneth F.
Published: November 2007

Lumbar sympathetic ganglionitis was found by light microscopy in 2 of 17 (12%) squirrel monkeys (Saimiri sciureus) experimentally infected with Coxsackievirus B4. This finding shows that viruses can cause ganglionitis which, in turn, must cause autonomic nervous system dysfunction. Such viral ganglionitis may explain some diseases, including cardiovascular ones, of poorly understood or unknown etiology which present with manifestations of dysfunction of the sympathetic nervous system.
Hypertension in the Elderly
Authors: Coodley Eugene L.
Published: November 2007

Hypertension in the older population has a serious prognosis and this is true even for isolated systolic hypertension. There is a markedly increased risk of stroke, cardiovascular disease and central nervous system in such patients.

The hemodynamics in hypertension of the elderly differs in a number of parameters from hypertension in the younger patient. In addition, drug metabolism is markedly altered by the aging process. This combination of factors requires a selective choice of agents for the management of hypertension in the elderly. The role of various drug modalities and their efficacy is reviewed in this presentation.
Focal Vascular Headaches With Focal Arterial Disease An Ultrasonographic Analysis
Authors: Weintraub Michael I. , Lambert Dianne , Rothman Allan L.
Published: November 2007

The relationship between migraine and premature stroke and heart disease has been firmly established in the literature. The probable mechanism relates to release of vasoactive agents locally that produce intimal changes and if chronic may lead to permanent changes to the artery. We have attempted to identify individuals at risk for premature stroke utilizing the highly accurate B-mode real time carotid ultrasonogram. Sixteen patients demonstrated varying degrees of focal dilatation or plaque disease and 44% had abnormal Doppler flow stud ies. Since many of these patients were asymptomatic during the examination it is suggested that vascular changes may be more persistent than were previously suspected. These plaques, in the setting of increased platelet aggregability may be responsible for the augmented risk of stroke. Precise identification of these individuals can be easily accomplished with B-mode real time scanning (High resolution), and will allow for safe followup if specific dietary or drug interven tions are contemplated.
Takayasu's Disease in Middle-Aged Women. A Clinicopathologic Study
Authors: Di Giacomo V. , Meloni F. , Transi M.G. , Nigro D. , Sciacca V.
Published: November 2007

Of ten patients with Takayasu's disease (TD), all women, hospitalized in our Service in the last 5 years, seven were more than 38 years old. In these subjects the mean age at diagnosis was 41.2 years. These findings confirm that, in Italy as in other Western countries, including the United States, the diagnosis of TD is usually made later than in Asia and Latin America. This circumstance is proba bly related to actual later onset of the disease. In most of our cases both the anamnestic data and the angiographic findings demonstrated an evolution of the disease with further involvement of other arteries. Several arterial biopsies consistently showed, within a diffuse sclerosis, more or less extensive inflamma tory aggregates characterized by a lymphoplasmacellular infiltration often asso ciated with giant cells. Such a pattern testifies to the persistence of an active arteritis even a long time after the onset of the disease — "persistent active arteritis" instead of "residual arteritis." Pointing out such an evolution of the TD in every stage, our clinicopathologic study emphasizes the importance of a careful followup of the patients; it also advises continuous treatment with corti costeroid drugs, sometimes associated with immunosuppressors, to attain a re duction of the inflammatory process.
Main Systolic Blood Flow Patterns in the Left and Right Ventricular Outflow Tracts Determined by Doppler Echocardiography
Authors: Itoh Kouichi
Published: November 2007

The main blood flow velocity patterns in the LVOT and RVOT were re corded by pulsed Doppler echocardiography in 28 normal healthy cases, in two athletes, and in 85 patients with atrial septal defects, pulmonary regurgitation, tetralogy of Fallot, aortic regurgitation, mitral stenosis, aortic stenosis, mitral regurgitation, hypertrophic cardiomyopathy, ischemic heart disease, and pul monary hypertension. Blood flow velocities were displayed using a graphic sys tem to form a real time sonogram, using Fast Fourier Transformation. In the normal group, the blood flow velocity was 1.69 KHz in LVOT, and 1.71 KHz in RVOT. In AR and T/F but not MS, there was high blood flow velocity in the LVOT, and the peak of blood flow velocity was shifted to mid-to late systole. In ASD and VSD with a L-R shunt, high blood flow velocity occurred in the RVOT, and the peak velocity shifted to eary systole. Pulmonary hypertension occa sionaly produced a W- or V-shaped curve.

In normal subjects, a small "a" wave could be detected in the LVOT record ing. The "a" wave began at point B on the AML tracer of the M-mode echocar diography, reached maximum velocity at point C, and returned to zero (baseline) at point C'. The "a" wave was coincident with the R wave of the ECG, and with the Ia of the phonocardiogram (PCG). The normal velocity of the "a" wave was 602 Hz, and the a/H ratio was 0.36. In cases of HCM and IHD, the "a" wave velocity and the a/H ratio correlated with the end diastolic pressure and the peak dP/dT.

These data suggest that the Doppler blood flow patterns in the LVOT and RVOT can indicate volume overload in the right and left ventricles, and that the "a" wave velocity and a/H ratio can provide new information concerning car diac performance.
The Diagnosis of Myocardial Infarction by Computer-Derived Protocol in a Municipal Hospital
Authors: Poretsky Leonid , Leibowitz Ian H. , Friedman Sandor A.
Published: November 2007

The evaluation of an emergency room patient with acute chest pain is often difficult. Recently, computers have been employed to develop protocols for identifying which patients are likely to have acute myocardial infarctions and to benefit, therefore, from admission to a relatively scarce coronary care unit bed. We have tested the latest computer-derived instrument in a municipal hospital and found it to be less reliable than the clinical judgement of physicians.
A Case of Aortitis Syndrome with Severe Coarctation of the Aorta
Authors: Ashizawa Naoto , Suzuki Shin , Kobayashi Masao , Aoi Wataru , Hashiba Kunitake
Published: November 2007

A 17 year old female with aortitis syndrome was reported. The blood pres sure of upper extremities was 204/88 mmHg which was higher than that of lower extremities (88/mmHg). Chest X ray showed marked rib notchings at the lower border of the right 7th and 8th rib and left 8th ribs. Stenosis of the thoracic aorta was observed at the upper border of the 9th rib and the lower border of the 10th rib with marked development of collateral circulation. After 6 months treatment with steroids, inflammation signs were improved and thick ness of the aorta was decreased which was detected by computed tomography. However, blood pressure was not decreased by the combined antihypertensive treatment.
Low Dose Ventriculography Using a Poor Man's Video Image Processor
Authors: Janssen Johan H.A.
Published: November 2007

During revascularisation procedures repeated left ventriculography using iodine contrast materials may be an unnecessary burden on left ventricular performance. We therefore investigated in 10 patients the diagnostic quality of low dose ventriculography using a video image processor which enhanced digi tal left ventricular images. It is concluded that low dose ventriculography using up to 70% dilution of contrast can be diagnostic in 90% of all cases, depending of the side of interest.
Captopril for the Treatment of Patients with Hypertension and Peripheral Vascular Disease
Authors: Catalano M. , Libretti A.
Published: November 2007

Many epidemiological studies have shown up the frequent association of ar terial hypertension (HT) with atherosclerosis of different localizations. How ever, many of the drugs used to treat HT are contraindicated in patients with peripheral vascular disease (PVD), because they cause unfavorable metabolic changes or vasoconstriction.

The aim of the present study was to assess the effect of a proven hypotensive drug, captopril, on the peripheral circulation. The drug appeared to be effec tive in improving blood flow to lower limbs, prolonging the pain. Free interval and increasing the angle/arm arteral pressure index.
Angiographic Changes Thirty Minutes Following Percutaneous Transluminal Coronary Angioplasty
Authors: Sanders Michael
Published: November 2007

In order to ascertain whether coronary angiography performed immediately after the completion of successful percutaneous transluminal coronary angio plasty (PTCA) can be used as an index of the final outcome of the procedure, angiography was repeated thirty minutes post PTCA in twenty consecutive pa tients undergoing elective PTCA. Comparison of the pre PTCA, immediate post PTCA and thirty minutes post PTCA angiograms showed that the initial angio graphic success of 77.8% improvement in lumen diameter from pre PTCA to immediate post PTCA was reduced by 16.2% to 61.6% thirty minutes later. We conclude that angiographic changes continue to occur in the immediate post PTCA period and that the immediate post PTCA angiogram may not represent the true outcome of the procedure.
Hemostatic Balance Index in TIA Patients: Sex-Related Changes
Authors: Lippi Gualtiero , Arnetoli G. , Accardi R. , Doni A.
Published: November 2007

In order to evaluate the occurrence of hemostatic disorders, 37 patients with transient ischemic attacks (TIAs) and 50 control subjects were studied by means of the Hemostatic Balance Index (H.B.I.) derived from Raby's Thrombo dynamic Potential Index (T.P.I.) and Fearnley's Whole Blood Diluted Lysis Time (W.B.D.L.T.). Results showed a significant increase in T.P.I. and a ten dency to a decrease in fibrinolytic activity in the TIA group: H.B.I. was shown to be significantly increased, thus indicating a pro-thrombotic imbalance in these patients. The occurrence of similar changes in TIA females when com pared to male patients marks the importance of plasmatic factors in the mech anism of thrombotic disorders in females with cerebrovascular disease.
Cardiovascular Manifestations in Systemic Lupus Erythematosus. Prospective Study of 100 Patients
Authors: Badui Elias , Garcia-Rubi David , Robles Elsa , Jimenez Javier , Juan Lourdes , Deleze Margarita , Diaz Arturo , Mintz Gregorio
Published: November 2007

One hundred consecutive female patients with active systemic lupus erythe matosus (SLE) were studied from the cardiovascular point of view by means of non invasive methods. Seventy percent of the cases presented some type of car diovascular anomaly. Seventy four percent of the resting electrocardiograms were abnormal as well as 72% of the M mode echocardiograms and 55% of the cardiac X ray series. The most frequent observed complications were: pericar ditis and or pericardial effusion (39%), arterial hypertension (22%), ischemic heart disease (16%), myocarditis (14%), congestive heart failure (10%), pulmo nary hypertension (9%), valvular heart disease (9%), pleural effusion (7%) and cerebro vascular accident (3%). We analized each one of these complications and found of special interest the high incidence of ischemic heart disease which is more frequent than has been hitherto reported. Ischemic heart disease was observed in two types of patients: a) Those with long term steroid therapy. In these, the mechanism seems to be an atherosclerotic disease probably induced by the chronic use of steroids. The management of these cases do not differ from other types of coronary heart disease due to atherosclerosis. b) Those with frank episodes of vasculitis in whom the basic mechanism is an inflammatory process of the coronary arteries and its treatment is fundamentally that of the vasculitis. We consider necessary to study routinely all patients with SLE through non invasive cardiological methods.
Unusual Electrocardiographic Abnormality in Leptospirosis: Case Reports
Authors: Ram Parshu , Chandra Michael S.
Published: November 2007

Unusual ECG changes of marked ST segment elevation in leads V1 to V3 are reported in four cases of severe icteric leptospirosis for the first time. These changes normalized rapidly with initiation of therapy and recovery in three patients. One patient died within hours of admission. The causes for the changes are not clear.
Reversibility of Muscular Ischemia: A Histochemical Quantification by the Nitroblue Tetrazolium (NBT) Test
Authors: Chachques Juan C. , Fabiani Jean N. , Perier Patrick , Swanson Jeffrey , Dreyfus Gilles , Carpentier Alain
Published: November 2007

The degree of muscular ischemia and its reversibility can be quantified in the early stages. This histochemical enzymatic study utilized Nitroblue tetrazolium (NBT) which when reduced by tissue dehydrogenase produces a blue pigment: "formazan." Seventy Wistar rats were subjected to transient hindlimb ischemia by means of a tourniquet for 3, 6, 9, 12, 15 and 18 hours, followed by reperfu sion. Microsurgical muscle biopsies were obtained in each rat at 1 and 12 hours, and 3, 7, 14 days after reperfusion. Time increased in muscle staining demon strated a succino-dehydrogenase deficit confirmed by clinical and histopatho logical follow-up. NBT staining time was 2 minutes (± 8 sec.) in the control group, between 2 and 6 minutes in the reversible ischemia group (rats with 3 and 6 hours of tourniquet), and more than 9 minutes (± 14 sec.) in the irrevers ible ischemia group (animals with more than 9 hours of tourniquet). In vascular surgery and in limb reimplantation this protocol is a practical method of evalu ating cytoplasmic enzymatic activity and the status of myofibrillar oxidation in the early phases of ischemic injury, before histologic changes are clearly deline ated.
Instead of "Plethysmography": "Kenoseography" and "Plesmonegraphy"
Authors: Voorhoeve R. , Bremer J.M.
Published: November 2007

The recording of volume changes in health and disease has from old been designated as "Plethysmography." This was supposed to be a correct term for the recording (graphein) of an increase in volume (plethysmos). The present paper shows that the choice of this term was not felicitous, and suggests an alternative. The first "plethysmographic" recordings are ascribed to Glisson (1622) and Swammerdam (1737).1 Since Glisson and Swammerdam did, in fact, record the volume of muscle to be constant on contraction, their measurements should probably have been referred to as "isography." This, however, is merely a historical matter. Presently venous outflow measurement is a common proce dure to establish the diagnosis of deep vein thrombosis. Venous outflow is deter mined by recording the decrease in volume of a limb which occurs after release of a congestion cuff. As this is quite the opposite of what is meant by "Plethys mography," another indication is needed for this examination. It appears that a suitable alternative can be taken from ancient Greek medical literature.
Digital Pressure-Flow Relationships in Subjects with Raynaud's Phenomenon
Authors: Wise Robert A. , Wigley Fredrick M. , Malamet Raymond
Published: November 2007

In order to determine whether subjects with Raynaud's phenomenon have altered digital hemodynamics in the warm basal condition, we characterized the digital pressure-flow relationships in seven subjects with Raynaud's phenome non and compared the results with age and sex matched control subjects. Digital pressure-flow relationships were measured by the use of a plethysmographic technique during passive elevation of the arm. Normal subjects demonstrated a positive finger systolic pressure at zero flow (48.3 mmHg), indicative of a criti cal closing pressure, however, the closing pressure was significantly higher in the subjects who had a history of Raynaud's phenomenon (64.7 mmHg, p < .001). In contrast, there was no significant difference found in the conduc tance measured as the slope of the pressure-flow relationship. Subjects with Raynaud's phenomenon demonstrated a correlation between finger systolic pressure and critical closing pressure suggesting that these subjects may regu late arterial pressure through a critical closing pressure mechanism.
Spontaneous Major Intra-Abdominal Arteriovenous Fistulas: A Report of Several Cases
Authors: Astarita Denis , Filippone Dennis R. , Cohn Joseph D.
Published: November 2007

Most major intra-abdominal fistulas result from trauma or surgery. Sponta neous fistulas are rare with less than 100 reported cases since 1831. From a review of hospital records, five such spontaneous fistulas were identified among 215 cases of abdominal aortic aneurysm between 1975 and 1983. These cases are presented and supplemented by 73 similar cases collected from a literature re view for discussion of the salient features of clinical presentation and manage ment of spontaneous major fistulas.

Major intra-abdominal arteriovenous fistulas usually present with a machin ery bruit over a pulsatile mass, but may present more subtly with pain and otherwise unexplained hematuria. Because these fistulas lead to refractory heart failure, surgery should be expeditious. Closure should be performed from within the aneurysm with arterial and pulmonary artery pressure monitoring. Care must be taken to prevent pulmonary embolization.
Graft-enteric Erosion in Patients with Retained Defunctionalized Aortic Prostheses: A Report of Two Cases
Authors: Kress David C. , Acher Charles W. , Turnipseed William D.
Published: November 2007

Two patients who underwent "redo" aortic graft replacement in which the original thrombosed graft was oversewn but not removed subsequently devel oped graft-enteric erosions that involved the oversewn graft. Each patient un derwent successful removal of all intraabdominal graft material, oversewing of the aortic stump and extraanatomical bypass. These cases emphasize the need to remove any defunctionalized graft material and to cover all new and retained graft with soft tissue at the time of aortic graft reoperation if graft-enteric ero sion is to be avoided.
The Anticholinergic Side Effects of Disopyramide and Controlled-Release Disopyramide
Authors: Teichman Sam
Published: November 2007

Until now, the potential antiarrhythmic benefits of disopyramide have been restricted by anticholinergic side effects. These side effects have included xeros tomia (dry mouth, nose or eyes), abdominal discomfort, nausea, constipation and, most importantly, urinary hesitancy and retention. A sustained-release form of pyridostigmine, an acetyl-cholinesterase inhibitor, has been shown to a) prevent the anticholinergic side effects of disopyramide when used prophylacti cally and b) to eliminate or attenuate these symptoms if they are already present. Pyridostigmine has no measurable effect on disopyramide's antiar rhythmic properties. This represents a beneficial new drug interaction which will improve tolerance of disopyramide and increase patient compliance with disopyramide-containing regimens.
Validity of Out-Patient Screening in Arteriosclerosis to Identify Multiple Lesions
Authors: Catalano Maria , Libretti Arnaldo
Published: November 2007

A total of 594 patients admitted for cerebrovascular disease (CVD) and for peripheral vascular disease (PVD), were examined in a study aimed at clarify ing by a simple, inexpensive out-patient method, a) the relationship existing between the different locations of the vascular disease: brain, lower limbs, coro naries ; b) the prevalence in the patients studied of risk factors such as hyperten sion, hyperlipidaemia and diabetes, and of migraine.

The results were as follows: a) of the patients admitted for CVD, 44% also presented arteriosclerosis in other locations; this figure was 32% for PVD cases; b) hypertension was found in 38.5% of CVD and 27% of PVD cases; diabetes in 11.5% of CVD and in 18% of PVD cases; hyperlipidaemia in 31 % of CVD and 24% of PVD cases; migraine in 11% of CVD and 1% of PVD cases.
Effects of Diltiazem on Occupational Raynaud's Syndrome (Vibration Disease)
Authors: Matoba Tsunetaka , Chiba Michio
Published: November 2007

An open trial on the therapeutic effect of diltiazem, a calcium antagonist, was conducted on occupational Raynaud's syndrome (vibration disease). Seventeen men with vibration disease were studied. The mean age was 54 years. No patient had cardiovascular disease. Primary and secondary cases of Raynaud's phenomenon were excluded. Diltiazem, 30mg orally 3 times daily, was given to the patients for 6 weeks. Before and after this treatment period, we evaluated the subjective symptoms (11 items including Raynaud's phenomenon, numbness of hands and arms, stiffness of shoulder and neck, and others) and peripheral function (by cold water immersion test, vibration and pain sensations for fingers, tapping test, and momentary grasp strength test), and did laboratory blood tests (12 variables). The "effective" rates of subjective symptoms evaluating by the method of 5 steps and the peripheral function was 69.6% and 52.9%, respectively. The overall effectiveness of diltiazem therapy was assessed by collectively evaluating the changes in subjective symptoms, peripheral functions, and the occurrence of side effects. No side effects occurred during the treatment period. Thus, the collective effectiveness of diltiazem was 64.7%. In conclusion, diltiazem, a calcium antagonist, can be effective in the long-term treatment of patients with vibration disease.
Hemodynamic Response to Oral Prenalterol in Dilated Decompensated Cardiomyopathy as a Result of Cardiac and Vascular Effects
Authors: Guazzi Maurizio D. , Agostoni Pier Giuseppe , Doria Elisabetta , Loaldi Alessandro , Pepi Mauro , Polese Alvise
Published: November 2007

The initial antifailure efficacy of beta-adrenergic agonists is generally lost during prolonged treatment. The reasons are not fully understood. In 11 patients with advanced cardiac decompensation due to dilated cardiomyopathy, prenalterol, a selective beta 1 adrenergic agonist, improved the left ventricular contractility after acute intravenous and during prolonged oral administration. However, after periods of treatment ranging from 2 to 18 weeks, blood pressure and systemic vascular resistance were raised in each patient. These changes resulted in an increase of the left ventricular afterload which was such as to overwhelm the effects of the enhanced contractility, and to extinguish the initial improvement of the cardiac function and of the clinical condition.

Stimulation of the presynaptical beta-receptors facilitating norepinephrine release or of the renin secretion by this beta1 agonist, may be the causes of the systemic vasoconstriction and of the loss of effectiveness in the long run.
CL115,347, an Analogue of Prostaglandin E2
Authors: Cooke E.D. , Bowcock Sally A. , Watkins C.J. , Rustin M.H.A. , Kirby J.D.T.
Published: November 2007

The beneficial effects of intra-arterial or intravenous infusion of the prostanoid products of anachridonic acid, PGE and prostacyclin (PGI2) are well documented. More recently an analogue of PGE2, (CL 115,347, American Cynamid Co.) has become available. This substance is absorbed transdermally from a patch placed on the skin.

In a placebo-controlled trial the vasodilatory effect of single incremental dosage, 500 mcg, 1000 mcg and 1500 mcg, was measured in a temperature-/humidity controlled laboratory in normal subjects and in patients with primary and secondary Raynaud's phenomenon. The optimal dosage proved to be 1000 mcg; the effect may last for 84 hours; higher dosage may be associated with a "steal" phenomenon.
Chronic Venous Insufficiency — Clinical and Therapeutic Approach
Authors: Goitia Hugo F. , Dipietro Antonio , Gatta Felix
Published: November 2007

Chronic venous insufficiency is defined as a state of venous hypertension that is shown by two big syndromes: the edematous and the indurating hypodermitis.

The common characteristic of this pathology is the claudication of the valve function; the most frequent cases being in descending order, are the following: 1) Post-traumatic syndrome, 2) Essential insufficiency, 3) Artenovenous fistula, 4) Angioplasies. 1
Arrhythmias Associated with Intermittent Outpatient Dobutamine Infusion
Authors: David Shukri , Zaks Jeffrey M.
Published: November 2007

The use of intermittent outpatient dobutamine infusion has recently been studied as an alternative therapy modality for patients with refractory conges tive heart failure. We studied the arrhythmogenic effects of intermittent outpa tient dobutamine infusion in two patients with NYHA class IV heart failure. The patients received dobutamine at 5mcg./kg./min. for four hours per day for an eight week period. Ambulatory Holter monitoring was obtained during the infusion periods and compared to infusion-free periods. A significant increase of complex ventricular- arrhythmias, including multifocal PVC's and ventricu lar tachycardias, was observed during the infusion period. The incidence of complex ventricular ectopy was dose related and could be suppressed to baseline levels with appropriate antiarrhythmic therapy. We concluded that dobutamine is extremely arrhythmogenic when used in patients with heart failure and that this effect was controllable with antiarrhythmics. Extreme caution and careful monitoring is required for this new therapeutic modality in the treatment of refractory heart failure.
Effects of Intravenous Glycerol on Cerebral Blood Flow and Tissue Metabolism in Acute Cerebral Ischemia in Spontaneously Hypertensive Rats
Authors: Fujishima Masatoshi , Ishitsuka Takao , Yoshida Fujio , Ibayashi Setsuro , Shiokawa Osamu , Sadoshima Seizo
Published: November 2007

The effects of antiedematous agent with intravenous 10% glycerol on cere bral blood flow (CBF) and metabolism were studied in acute cerebral ischemia experimentally induced by bilateral carotid artery occlusion in spontaneously hypertensive rats (SHR). CBF was measured by the hydrogen clearance tech nique and brain tissue metabolites such as lactate, pyruvate and ATP in the ischemic brain frozen in situ were determined by the enzymatic method.

In comparison with saline-infused SHR, the reduction of CBF in the thala mus following carotid occlusion was significantly small in the glycerol treated SHR. Supratentorial ATP concentration in the 3 hr-ischemic brain was reduced in both groups of rats, but its reduction was significantly smaller in the glycerol- infused group than the other. Lactate and lactate/pyruvate ratio tended to be less increased in the glycerol rats, indicating that ischemic metabolism was re strained by the treatment.

The present results strongly suggest that intravenous glycerol is effective against acute cerebral ischemia from the view point of cerebral hemodynamic and metabolism.
Prevention and Management of Ischemic Complications of Vein Harvest Incisions in Cardiac Surgery— Case Reports
Authors: Scher Larry A. , Samson Russell H. , Ketosugbo Anukware , Gupta Sushil K. , Ascer Enrico , Veith Frank J.
Published: November 2007

Leg wound complications following saphenous vein harvest for coronary re vascularization are uncommon. We have encountered five patients in whom unrecognized arterial occlusive disease contributed to wound necrosis. All re quired vascular reconstruction in addition to local wound care to achieve heal ing. Careful preoperative attention to symptoms of arterial insufficiency is recommended and appropriate modification of lower extremity incisions may reduce the frequency of this complication. Prompt recognition and appropriate arterial revascularization should avoid prolonged morbidity if ischemic necrosis of leg wounds does occur. If arterial reconstruction is required, PTFE is an acceptable graft material if the remaining saphenous vein is inadequate for use.
Direct Communication of a Pulmonary Artery with Left Atrium—Report of a Case with Balloon Occlusion Studies and Successful Correction: A Case Report
Authors: Vasudevan S. , Tajmul Hussain A. , Subramanian N.
Published: November 2007

A 10 year old cyanotic boy had direct communication between right pulmo nay artery and left atrium. During cardiac catheterization, the catheter-tip bal loon occlusion of this communication resulted in restoration of arterial oxygen saturation to normal levels, predicting that surgical interruption of the com munication would be curative. Successful surgical correction was achieved by interruption of the communication.
Acute Hemodynamic Effects of Nifedipine During Supine Exercise in Patients with Prior Myocardial Infarction
Authors: MacMillan Robert M. , Se Do Cha  , Maranhao Vladir
Published: November 2007

Twelve male patients age 36-66, 8 on clinical doses of beta blocker, with old transmural myocardial infarction underwent rest and matched workload exer cise before and 30 min after 20 mg sublingual nifedipine during cardiac cathe terization. For the group, resting heart rate, aortic pressure, pulmonary wedge pressure, systemic vascular resistance, cardiac index, and left ventricular ejec tion fraction were normal. Exercise duration was 12.5 ± 1.5 min. Comparing exercise before and after nifedipine, heart rate, cardiac index, and mean veloc ity circumferential fiber shortening increased, while mean aortic pressure, sys temic vascular resistance, pulmonary wedge pressure, right atrial pressure, left ventricular end-diastolic volume and left ventricular end-systolic volume de creased with no significant change in double product, pulmonary arteriolar re sistance and left ventricular ejection fraction. Therefore, for the range of left ventricular dysfunction in this study group and with 8 patients concurrently on beta blocker, nifedipine 20 mg s.l. produced significant improvement in hemo dynamics at rest and exercise.
Platelet Hyperaggregability, Blood Prostacyclin and Dipyridamole
Authors: Solvay H. , Kahn M. , Cloarec M. , Van De Merckt J. , Sneppe R. , Schram E. , Fenollar J.V.
Published: November 2007

This study demonstrates the presence of PGI2 in blood and its influence on platelet retention tests, possibly by the intermediate of a releasing system in the columns, which is followed by a proximate recuperation on the erythrocyte sites after the passage.

The presence of prostacyclin on the erythrocyte sites seems to depend upon the red cell deformability in relation to the good condition of their erythrycote ATP reserve.

The load of the erythrocyte sites increases with the daily dose of dipyrida mole. The maximum load of the sites appears to be reached with a daily dose of dipyridamole 450mg.

Approximately 10% of the atherosclerosis patients who have been treated by dipyridamole keep their platelet hyperaggregability and their abnormally low ered prostacyclin level.
Intra Arterial Ketanserin in Peripheral Vascular Disease
Authors: Boas R.A.
Published: November 2007

An open study utilizing a serotonergic S2 antagonist, ketanserin, in a single 10mg intra arterial dose, was undertaken in eleven patients suffering various micro-vascular ischemic diseases. Ipsilateral limb blood flow improved 50%, skin temperatures rose 2.5°C and venous oxygen tensions measured in the dis eased foot showed modest elevation. The changes were significant and compara ble to those achieved with chemical sympathectomy. These findings suggest ketanserin may have a place in the treatment of microvascular ischemic disease. However, systemic and contralateral flow induced changes suggested regional specificity was not obtained with arterial injection.
Effect of Different Amounts of Blood Transfusion Given at Different Speeds on Left Ventricular Filling Pressure in Cases of Chronic Severe Anemia
Authors: Nand Nitya , Gupta M.S. , Sharma Manju
Published: November 2007

Pulmonary capillary 'wedge' pressure (PCWP) was measured before and after transfusion of 1 and 2 units of blood @ 5 and 10 ml/min. in 40 adult cases of chronic severe anemia (CSA). The cases were randomly divided into 4 sub groups of 10 cases each.

Following blood transfusion (BT), PCWP increased significantly in all the 4 subgroups (p < 0.001). The highest rise in PCWP was recorded when 2 units of blood were transfused at a rate of 10 ml/min, and the rise was minimum when 1 unit of blood was transfused @ 5 ml/min. Out of the two variables—speed and amount of BT—the amount was more important.

It is, therefore, concluded that administration of 2 units of blood in case of CSA at a rate of 5 or 10 ml/min is not desirable and that transfusion of 1 unit of blood @ 5 ml/min is quite safe.
Interstitial Vasculitis—Interstitial Lung Disease: Case Studies
Authors: Demeter Stephen L.
Published: November 2007

Six patients with interstitial lung disease were tested in a serial fashion to determine response to medications. All patients had biopsy-proven interstitial lung disease. Exercise testing with measurements of PaO2, PaCO2, and DLCO (the diffusing capacity to carbon monoxide) were made before and after exer cise to determine the response to medications.

Three patients were treated with corticosteroids and three patients with cy totoxic medications. Results of serial testing of gas transfer correlated with im provement of interstitial lung disease as characterized by resting Pa02, symptoms, and maximal duration of exercise. The value of serial exercise test ing is of great help in some, but not all patients. The value of serial testing of patients with interstitial lung disease is discussed.
Cutaneous Cholesterol Emboli with Infarction Clinically Mimicking Heparin Necrosis —
Authors: Zaytsev Polina , Miller Kenneth , Pellettiere Edmund V.
Published: November 2007

Cutaneous necrosis secondary to anticoagulation (heparin and warfarin) and cholesterol (atheromatous) emboli can be similar clinically and histologically. A unique case is reported of cholesterol emboli clinically mimicking heparin ne crosis. The patient was a 57 year old white male who underwent coronary angio plasty and was treated with intravenous heparin. Shortly after he developed large ecchymotic areas at the level of the umbilicus and distally which pro gressed to eschar. Renal failure ensued and he died secondary to stress ulcers. Cholesterol emboli were demonstrated in small muscular arteries of the dermis and panniculus along with a full thickness infarct. Because of the increasing popularity of angioplasty utilizing a retrograde femoral approach plus heparin anticoagulation, it is important to recognize the difficulty in making a clinical diagnosis when cutaneous necrosis supervenes. An incisional biopsy of the skin is recommended.
Tuberculous Aortitis Presenting with an Aortoduodenal Fistula: A Case Report
Authors: Goldbaum Thomas S. , Lindsay Joseph , Levy Charles , Silva Carlos A.
Published: November 2007

An elderly man with tuberculous aortitis presented with massive gastrointes tinal bleeding resulting from an aortoduodenal fistula. Aortic resection was suc cessful, and he has done well over a 12 year period. The organism was recovered from the aorta and also seen on section of the neighboring lymph nodes. Although tuberculous aortitis is rare, it should be considered in a patient with a prior history of tuberculosis who has developed evidence of aortic dis ease, aneurysm, or massive gastrointestinal bleeding.
Successful Treatment of Acute, Severe Aortic Regurgitation Caused by Takayasu's Arteritis: A Case Report
Authors: Nakano Takeshi , Isaka Naoki , Takezawa Hideo , Kusagawa Minoru
Published: November 2007

Acute, severe aortic regurgitation due to dilatation of the aortic root was studied in a 16-year-old Japanese female with Takayasu's arteritis. The patient was admitted because of acute pulmonary edema followed by systemic illness characterized by fever, anorexia, and general fatigue. The echocardiogram and aortogram demonstrated acute, severe aortic regurgitation due to dilatation of the aortic root. She was successfully treated with aortic valve replacement and steroid. Microscopic examination of the aortic wall demonstrated granuloma tous lesions with multinucleated giant cells. Now, three years later, she remains asymptomatic and hemodynamically stable.
Right Bundle Branch Block: A Rare Manifestation of Digitalis Toxicity—Case Report
Authors: Gould Lawrence , Patel Chandrakant , Betzu Robert , Judge David , Lee Jae
Published: November 2007

A case of intermittent right bundle branch block due to digoxin intoxication is presented. The diagnosis was made by repeated electrocardiograms and ele vated serum digoxin levels. The mechanism of intermittent right bundle branch block is discussed and the pertinent literature is reviewed.
Limitations of Echocardiography in the Diagnosis of Left Atrial Myxoma: A Case Report
Authors: Vopat Richard L. , Alpert Martin A. , Flaker Greg C. , Curtis Jack J. , Webel Richard R. , Sanfelippo John F.
Published: November 2007

The classical echocardiographic features of left atrial myxoma are quite dis tinctive but do not comprise the full spectrum of abnormalities encountered. This case demonstrates atypical echocardiographic features of left atrial myx oma that initially obscured the correct diagnosis. Our findings underscore the potential limitations of echocardiography in the diagnosis of left atrial myxoma.
Effects of Alcohol on the Heart: Current Views
Authors: Kouvaras George , Cokkinos Dionisios
Published: November 2007

Chronic and heavy alcohol consumption has deleterious effects upon the car diovascular system and may cause congestive cardiomyopathy. Evidence of car diac malfunction has been found in chronic alcoholics without overt heart fail ure by invasive and noninvasive methods.

Ethanol is the incriminated factor having a direct cardiotoxic effect. Elec tron microscopy and cardiac muscle biopsies show that ethanol may cause changes on plasmalemmal, mitochondrial, and sarcoplasmic membranes.

The clinical picture and general management of alcoholic cardiomyopathy do not differ substantially from those of congestive cardiomyopathies of any type. It has, however, been demonstrated that cessation of alcohol consumption may lead to an improved prognosis, even to restoration of normal cardiac func tion, in individuals with preclinical and mild manifestations of cardiac dysfunc tion.

The literature on the possible association of coronary heart disease with alco hol seems to be ambiguous. It has, however, been postulated recently that mod erate alcohol intake may have a protective role against coronary heart disease, in contrast to alcoholic intemperance, which may be a factor favoring coronary heart disease.
Prevention and Treatment of Supraventricular Tachycardia Shortly After Coronary Artery Bypass Grafting: A Randomized Open Trial
Authors: Janssen Johan , Loomans Leonie , Harink Joukje , Taams Meindert , Brunninkhuis Leo , van der Starre Peter , Kootstra Gert
Published: November 2007

Supraventricular arrhythmias continue to complicate the postoperative course of patients following coronary artery bypass grafting. In a randomized, open, controlled trial we assessed the value of two different beta-blocking agents in the prevention and treatment of these arrhythmias. Of 151 consecutive pa tients undergoing coronary artery surgery, 39 were treated with metoprolol and 41 were treated with sotalol (a beta blocker with class III antiarrhythmic prop erties). Fifty patients served as a control group and received no prophylactic therapy. Twenty-one patients were eliminated from the study for various rea sons, making a final total of 130 in the study group.

In the metoprolol group 15.3% of patients developed supraventricular tachycardia SVT after coronary artery surgery, which was significantly less (p < 0.05) than the incidence observed in the control group. However, in the group of patients receiving sotalol, 2.4% developed SVT (p < 0.01 compared with the control group).

Of 18 patients in the control group who developed SVT after randomization, 10 received sotalol and 4 metoprolol to terminate the arrhythmia. The mean time of termination of SVT after drug administration was 2.4±1.8 hours for treatment with sotalol and 13.6±9.8 hours for treatment with metoprolol.

We conclude that sotalol significantly reduces the incidence of supraventric ular tachycardia in the early period after coronary artery bypass surgery.
Myocardial Infarction After Acute Carbon Monoxide Poisoning: Case Report
Authors: Ebisuno Shoji , Yasuno Masao , Yamada Yoshio , Nishino Yoshihide , Hori Masatsugu , Inoue Michitoshi , Kamada Takenobu
Published: November 2007

A 28-year-old man with acute myocardial infarction after carbon monoxide poisoning is reported. He had chest pain after the exposure to carbon monoxide. The electrocardiogram, serum enzymes, and technetium-99m pyrophosphate scintigrams showed anterior myocardial infarction. The coronary angiogram, which was performed one month after the onset, showed no visible atheroscler otic lesion. As to the cause of myocardial infarction, it is assumed that carbon monoxide reduced the oxygen supply to the myocardium and might induce coro nary artery spasm with or without accompanying coronary thrombosis.
Central Inhibition of Sympathetic Overdrive by Clonidine in Acute Myocardial Infarction with Systolic Hypertension. Haemodynamic Study
Authors: Renard Marc , Liebens Isabelle , Waterschoot Patrick , Bernard Roland
Published: November 2007

Intravenous clonidine was used to treat systolic hypertension (systolic blood pressure greater than 160 mm Hg) in 15 patients with acute myocardial infarction and documented sympathetic overactivity (high plasma norepinephrine). Its effects on haemodynamics and blood gases were studied.

After one hour, clonidine significantly reduced the systolic (195±7 to 137±7 mm Hg, p < 0.01) and diastolic (81±4 to 60±3 mm Hg, p < 0.01) blood pressures as well as the systemic vascular resistance (26±2 to 20±1 IU, p < 0.01). The cardiac index was reduced from 2.8±0.2 to 2.4±0.2 l/min.m2, p<0.01. This change was related to a reduction of the heart rate (92±4 to 81±4 beats/ min, p < 0.01) as the stroke index was unchanged. Pulmonary wedge pressure (15±3 to 10±2 mm Hg, p < 0.01) and rate pressure product (18.034±1.159 to 11.274±917 mm Hg, beats/min, p < 0.01) were also significantly decreased. The arterial oxygen tension did not change significantly but there was a significant drop in the mixed venous oxygen saturation (63±2 to 61±2%, p<0.02) and oxygen transport (433±41 to 409±36, p < 0.01).

Clonidine is thus able to normalize blood pressure in acute myocardial infarction ; this is accompanied by a reduction in myocardial oxygen requirements and pulmonary wedge pressure. Oxygen transport to the tissues, however, may be decreased.
Muscular Blood Flow in Patients with Heart Failure
Authors: Bellandi Francesco , De Scalzi Maurizio , de Leonardis Vittorio , Arena Luca , Belli Brunella , Barbagli Susanna , Morace Giandomenico , Cinelli Piero , Morace Giorgio
Published: November 2007

We studied reactive hyperemia in a group of patients with heart failure before and after therapy, since changes in the characteristics of muscular blood flow may influence the functional class of these patients. At the same time we evaluated some echocardiographic parameters too.

When the patients improved clinically, they showed an increase in muscular blood flow at rest and in percent of fractional shortening and a decrease in peripheral vascular resistance. The reactive hyperemia did not change significantly.

This fact probably depends on a maximal response to the postischemic hyperemia and represents the integrity of autoregulatory mechanisms.
Antiaggregative Aspirin Dosage at the Affected Vessel Wall
Authors: Numano Fujio , Maruyama Yoshiaki , Koyama Tadayoshi , Numano Fujie
Published: November 2007

The present study, using patients with Thkayasu's disease (pulseless disease), characterized by segmentally affected arterial lesions and stenotic conditions with a nonspecific inflammatory morbid condition, was designed to assess whether or not a low dose of aspirin can practically exert its preventive effect against the aggregation of platelets that have just passed along a rough-surfaced arterial wall. Twenty Japanese women with Takayasu's disease were selected under the following criteria: (1) A unilateral upper extremity was angiographi cally confirmed to be affected with the disease, while the contralateral limb was almost normal. (2) Systolic blood pressure on the affected side was almost half that on the nonaffected side. (3) The patients showed neither a positive CRP nor an accentuated ESR. In these patients, mean plasma levels of TXB2 and 3 μM ADP-induced platelet aggregation in blood obtained from the affected side were 156.5±17.7 pg/ml, and 59.5 ±6.0%, respectively, which were significantly high as compared with 104.5±17.6 and 41.7±8.8%, respectively, in samples from the nonaffected side. Forty and eighty mg of aspirin per day administered to two randomly composed groups, respectively, showed an improvement in plate let aggregability and TXB2 levels on the nonaffected side. In the affected limbs, though 80 mg/day led to significant decreases in TXB2 levels (108.0 ±7.8 pg/ml, p < 0.05) and platelet aggregability (21.3±7.6%), the 40-mg regimen showed no significant reductions (134.6±9.4 pg/ml, 35.6±17.1%). Plasma levels of 6-keto PGF1α revealed no differences between 40- and 80-mg regimens, or between before and after treatment. These data suggest that a dosage of 80 mg of aspirin per day is effective for long-term treatment in preventing thrombus formation in surface-damaged blood vessels.