bluuebunny/crossref_metadata_2025 huggingface dataset:
Compositional and Structural Alterations of Arterial Glycosaminoglycans Associated with the Complications Brought About by Thalassemia Major
Authors: Cardoso Luiz E. M. , Mourão Paulo A. S.
Published: July 2008

A biochemical analysis of glycosaminoglycans was performed in arteries of a fifteen-year-old white male who died of β thalassemia major. The patient presented the severe clinical complications resulting from hemochromatosis, which was evidenced at autopsy and by histologic examination. The arteries under study comprised the thoracic and abdominal aortas and the iliac and pulmonary arteries, which were compared with the same arteries from normal individuals. Data on total glycosaminoglycan and total collagen, including the determination of the relative contents of the different glycosaminoglycans, suggest an as yet undescribed fibrotic process in the thalassemic arteries. Also altered were the proportions of the disaccharides making up chondroitin sulfate and heparan sulfate. A reduction in the molecular weight of arterial heparan sulfate, presumably with free radical involvement, was also detected. All these changes in the extracellular matrix may be ascribed to the presence of large amounts of iron in the tissue, and as such they should be expected in other disorders with chronic iron overload.
Coronary Artery Aneurysms
Authors: Dagalp Zehra , Pamir Gülgün , Alpman Ahmet , Ömürlü Kenan , Erol Çetin , Oral Derviş
Published: July 2008

Two patients who had angiographically proven coronary artery aneurysms are presented. The clinical pictures of these patients were similar to that of patients with atherosclerotic coronary artery disease. Both had severe angina pectoris, and the second patient (case 2) had had myocardial infarction. Their coronary artery aneurysms were single, fusiform (case 1) and saccular (case 2) in shape and not associated with extensive coronary atherosclerosis. They were treated medically and did well.
Bronchial Arteriovenous Malformation in a Child with Hemoptysis
Authors: Sharifi Mohsen , Messersmith Richard , Newman Barry , Chung Youngran , Lakier Jeffrey B.
Published: July 2008

Pulmonary arteriovenous (AV) malformations occur sporadically and in the pediatric population are most commonly associated with hereditary hemorrhagic telangiectasia. Hemoptysis is an infrequent presentation in this age group. Pulmonary angiography is considered to be the definitive diagnostic modality. The authors describe an otherwise healthy eleven-year-old girl who presented with massive hemoptysis secondary to a large bronchial AV malformation unrelated to any congenital anomalies. The pulmonary angiogram appeared normal and the diagnosis was established by digital subtraction aortography. Successful embolotherapy was performed by selective injection of polyvinyl alcohol particles into the culprit bronchial artery.
Secondary Prevention of Coronary Heart Disease in Patients with Extracoronary Atherosclerosis: A Need for Accuracy of Low Density Lipoprotein Determination
Authors: Senti Mariano , Pedro-Botet Juan , Rubiés-Prat Juan , Vidal-Barraquer Francesc
Published: July 2008

According to the new guidelines of the National Cholesterol Education Program (NCEP) for secondary prevention in adults with evidence of coronary heart disease or other clinical atherosclerotic disease, lipoprotein analysis is required and classification is based on low density lipoprotein (LDL) cholesterol.

The aim of the present study was to analyze the reliability of calculated LDL cholesterol by the Friedewald formula compared with measured LDL cholesterol after separation by ultracentrifugation in 202 male patients with extracoronary atherosclerosis (100 patients with ischemic cerebrovascular disease and 102 patients with peripheral vascular disease) and in 117 healthy control subjects.

Calculated LDL cholesterol coincided with measured LDL cholesterol, with less than 10% error, in 118 patients (58.4%) with extracoronary atherosclerosis and in 87 controls (74.4%). Calculated LDL cholesterol was overestimated, with an error of 10% or more compared with measured LDL cholesterol, in 34.6% of patients and 22.2% of controls, and underestimated in 6.9% and 3.4%, respectively. Despite a good correlation between calculated and measured LDL cholesterol, the intraclass correlation coefficients demonstrate a poor concordance between calculated and measured LDL cholesterol, both in patients and controls. The authors underline the need for caution in assessing the reliability of calculated LDL cholesterol.
Coronary Artery Spasm In The Transplanted Human Heart A Case Report
Authors: Dalal Jyotsna N. , Brinker Jeffrey A. , Resar Jon R.
Published: July 2008

This report describes a patient manifesting spontaneous and catheter-induced coronary artery spasm in a transplanted, denervated heart. This diagnosis should be considered in patients undergoing posttransplant coronary angiography. Intracoronary nitroglycerin should routinely be administered prior to coronary artery injections during posttransplant angiography.
Coexistence of Cerebral Venous Sinus and Internal Carotid Artery Thrombosis Associated with Exogenous Sex Hormones A Case Report
Authors: Ryu Shan-Jin , Chien Yu-Yi
Published: July 2008

A forty-six-year-old premenopausal woman developed headache, nausea and vomiting, left hemiparesis, and seizure two days after parenteral use of progesterone and estradiol. Diabetes mellitus (DM) was found during admission. Computed tomography showed a hemorrhagic infarct in the right frontal lobe and increased density in the superior sagittal sinus (SSS). Left carotid angiography found occlusion of the left internal carotid artery (ICA). Right carotid angiograms failed to show the SSS and inferior sagittal sinus, suggestive of venous sinus thrombosis. Coexistence of the cerebral artery and the venous sinus occlusion has been described infrequently. In this case, the authors postulate that the use of estradiol and progesterone and the underlying DM increased vascular thrombogenicity, which provided a common denominator for thrombosis of both the ICA and the venous sinus.
TcPO 2 Measurement Reproducibility During Stress in Stage II Obliterative Arterial Disease
Authors: Mouren X. , Caillard Ph. , Massonneau M. , Thébault B.
Published: July 2008

Distal transcutaneous oxygen pressure measurement (TcPO2) is a noninvasive method of evaluating tissular hypoxemia in peripheral arterial disease. The poststress area of hypoxemia is a useful technique for globally quantifying different parameters represented by TcPO2 curves during exercise. Although its use is increasingly widespread, the reproducibility of this method is poorly documented.

TcPO2 was monitored three times at twenty-four hour intervals in 5 patients with stage II obliterative arterial disease during a treadmill walking test. In order to get uniform measurement conditions, each patient remained lying and then stood until TcPO 2 became stable. The stress duration was calculated so that the pain step could not be reached.

TcPO2 curves were digitized and a specific image analyzer was used to make replicate measurements. The area under the curve was computed, the horizontal axis determining the mean TcPO2 value at rest, the vertical axis representing the end of the exercise period. The corresponding areas under the curves ranged from 34 to 2212 mm2 (573.60; SD 826). Significant correlation coefficients were obtained among replicate measurements (first-second day, first-third day). However, owing to the wide range of area values, the authors decided to compute and use the coefficient of variation (STD/mean), since it was more representative of reproducibility. The mean of its value for 5 patients was 21%. Observation of the examination conditions resulted in several findings, especially the ability of certain patients to adapt their efforts to the exercise. These results indicate that TcPO2 poststress area measurements are reproducible, but the conditions of the exercise have to be rigorously defined and may still be improved.
Acute Exposure to Carbon Monoxide Does Not Affect Plasma Lipids, Lipoproteins, and Apolipoproteins
Authors: Leaf David Alexander , Kleinman Michael T.
Published: July 2008

Study objectives: To examine the effects of acute exposure to carbon monoxide and hypoxia on plasma lipids, lipoproteins, and apolipoproteins. Design: Random-order assignment to blinded, inhaled exposures of carbon monoxide and hypoxia. Setting: Research laboratory of ambulatory subjects. Subjects: 10 elderly, male nonsmokers with chronic stable angina. Intervention: Random-order two-hour inhaled exposure to clean air at sea level, carbon monoxide at sea level, carbon monoxide at high altitude, and clean air at high altitude. Measurements: Fasting plasma lipids, lipoproteins, and apolipoproteins before and after exposures.

Results: No differences were noted between fasting plasma lipid, lipoprotein, or apolipoprotein levels before and after exposures. Conclusion: Acute exposure to carbon monoxide and high altitude does not affect fasting plasma lipid, lipoprotein, or apolipoprotein levels.
Granule-Laden Perivascular Cells Observed in Rabbits with Experimental Cerebral Atherosclerosis
Authors: Kato Hiroyuki , Okada Ryuuichirou , Takashima Toshinobu , Ohmori Keizo , Sunaga Toshiaki
Published: July 2008

Granule-laden perivascular cells distributed around the fine vessels in brain of hypertensive rabbits fed a cholesterol diet were examined by electron microscopy. Perivenule granule-laden cells contained secondary lysosomes, residual bodies, Golgi vesicles, fusion vesicles, and vacuoles. In periarteriole granule-laden cells, secondary lysosomes and vacuoles were not prominent. Findings indicated that the granule-laden cell may be a histiocyte that appears during the vascular reaction to hypertension and hypercholesterolemia. This vascular reaction may occur more strongly in the veins than the arteries.
Dipyridamole Technetium-99M Sestamibi Imaging in the Diagnosis of Syndrome X
Authors: Palleschi L. , Gianni W. , De Vincentis G. , Banci M. , Sottosanti G. , Ierardi M. , Scopinaro F. , Marigliano V.
Published: July 2008

In a middle-aged woman with anginal chest pain and a normal-appearing angiogram, dypiridamole technetium-99m Sestamibi scintigraphy, a noninvasive method, provided the diagnosis of syndrome X and was used in follow-up to monitor the course of disease.
Uhl's Anomaly A Case Report
Authors: Felice Philip V. , Mavrogeorgis Evangelos
Published: July 2008

The authors present a patient with Uhl's anomaly and discuss the management over a twenty-year period.
The Menstrual Cycle and Raynaud's Phenomenon
Authors: Greenstein D. , Jeffcote N. , Ilsley D. , Kester R.C.
Published: July 2008

Fluctuations in female sex hormones may be responsible for the high prevalence of Raynaud's phenomenon (RP) observed in premenopausal women. These hormones are known to act on central and peripheral thermoreceptors. In an attempt to establish whether cold sensitivity is altered during the menstrual cycle 50 premenopausal women were investigated. Of these, 26 had primary RP and 24 acted as controls. Each subject was exposed to environmental heating and cooling at three stages of the menstrual cycle to coincide with peaks and troughs in hormone levels. These stages were menstruation, periovulation, and during the midluteal phase. Finger hemodynamics was assessed by means of venous occlusion strain gauge plethysmography and fingertip temperature. Core temperature was assessed with an oral thermocouple. The results show that cold sensitivity was altered during the menstrual cycle in both groups with the fastest finger rewarming pattern during menstruation. Moreover, a significant difference was observed in core temperature between the two groups during the midluteal phase. As a group, subjects with RP failed to show a significant rise in core temperature following ovulation. The authors conclude that the menstrual cycle is associated with changes in the effect of cold on digital blood flow.
Brain Ischemia Following Bilateral Carotid Occlusion During Development of Hypertension in Young Spontaneously Hypertensive Rats—Importance of Morphologic Changes of the Arteries of the Circle of Willis
Authors: Kusuda Kenji , Ibayashi Setsuro , Sadoshima Seizo , Ishitsuka Takao , Fujishima Masatoshi
Published: July 2008

The present study was designed to examine the effect of morphologic changes of the arteries of the circle of Willis on cerebral blood flow (CBF) and metabolism in young spontaneously hypertensive rats (SHR). CBF in the parietal cortex was measured by the hydrogen clearance method before and during a one-hour bilateral carotid artery occlusion (BCO), and supratentorial brain metabolites were determined by standard enzymatic methods at a one-hour BCO. The internal diameters of the main arteries of the circle of Willis were estimated morphologically.

With increase in age, systemic arterial pressure at rest was significantly raised, while cortical CBF tended to decrease and calculated cerebral vascular resistance increased. During BCO, CBF and supratentorial metabolism (adenosine triphosphate and lactate/pyruvate ratio) tended to be better preserved in two-month-old rats as compared with those in one- or three-month-old rats. The internal diameter of the posterior commu nicating artery (PcomA) was significantly smaller in the one-month-old group than in the other groups, while the diameter of the internal carotid artery was significantly smaller in rats aged three months than those in rats aged one or two months.

It is indicated that cortical CBF reduction and impairment of supratentorial metabo lism following occlusion of carotid arteries, at least in part, depend on the morphologic changes of the arteries of the circle of Willis associated with age and development of hypertension in young SHR.
An Open-Ended-Pattern Coronary Circulation: Demonstration of Its Potential "Self-Cure" Role in Obstructive Coronary Artery Disease
Authors: Antonellis John , Kostopoulos Konstantinos , Rabaouni Athina , Margaris Nikolaos , Kranidis Athanasios , Salahas Anastasios , Ifantis George , Koroxenidis Gabriel
Published: July 2008

A case of open-ended-pattern coronary circulation that protected the left ventricle when one large vessel was occluded is presented.
Pulmonary Vascular Sling Responsible for Esophageal and Tracheal Obstruction
Authors: Yurdakul Yurdakul , Arsan Sinan , Farsak Bora , Peker Oktay , Celiker Alpay , Girbolar Adem
Published: July 2008

The disease of pulmonary vascular sling is a rare congenital condition. When it does occur it is often in conjunction with tracheal compression. The authors report herein a newborn with this anomaly presenting with a tracheal and esophageal compression.
Paraumbilical Vein Aneurysm
Authors: Ohhira Motoyuki , Matsumoto Akinori , Ohhira Masumi , Murazumi Kazuhiko , Ohta Hitoyoshi , Ono Minoru , Kohgo Yutaka
Published: July 2008

Two cases of paraumbilical vein aneurysm are reported. The patients were diagnosed as having cirrhotic liver with portal hypertension. Angiography and contrast-enhanced computed tomography demonstrated a dilated paraumbilical vein arising from the left branch of the portal vein. Furthermore, localized dilatation of a paraumbilical vein was demonstrated. The focal aneurysmal dilatation of the dilatated paraumbilical vein is rare.
Prevalence and Correlates of Symptomatic Peripheral Atherosclerosis in Individuals with Coronary Heart Disease and Cholesterol Levels Less Than 240 mg/dL: Baseline Results from the Cholesterol And Recurrent Events (CARE) Study
Authors: Wilt Timothy J. , Davis Barry R. , Meyers David G. , Rouleau Jean-Lucien , Sacks Frank M.
Published: July 2008

Purpose: To determine the prevalence and correlates of symptomatic peripheral athero sclerosis in individuals with a history of myocardial infarction (MI) and cholesterol levels lower than 240 mg/dL.

Materials and Methods: A cross-sectional analysis was conducted at baseline of 4159 participants in the Cholesterol and Recurrent Events (CARE) Study. Symptomatic diffuse atherosclerosis was defined as a history of MI plus lower extremity or cerebrovascular atherosclerosis or claudication by Rose questionnaire.

Results: The prevalence of symptomatic diffuse atherosclerosis was 12.9%; 353 partici pants (8.5%) had lower extremity disease and 219 (5.3%) had cerebrovascular disease. After controlling for other variables, diffuse atherosclerosis was associated with age (Odds Ratio [OR] = 1.44 per ten-year increase), systolic blood pressure (OR=1.13 per 10 mm Hg increase), a history of multiple myocardial infarctions (OR= 1.76), diabetes (OR=1.76), hypertension (OR=1.38), reduced exercise performance (OR=1.55), current smoking status (OR=2.87), and lower alcohol intake (OR=0.97 per drink per week). There was no association with race, gender, or lipid levels.

Conclusions: The presence of clinically evident diffuse atherosclerosis is common and is associated with several modifiable risk factors. Early identification of these individuals could affect treatment and clinical outcomes.
Effects of Verapamil and Magnesium Sulfate on Electrophysiologic Changes During Acute Myocardial Ischemia and Following Reperfusion in Dogs: Comparative Effects of Administration by Intravenous and Coronary Sinus Retroperfusion Routes
Authors: Yamamoto Katsuhito , Bando Shigenobu
Published: July 2008

The authors evaluated the effects of verapamil (Ve) and magnesium sulfate (Mg) on the electrophysiologic changes induced in dogs during acute myocardial ischemia and following reperfusion. The effects of their intravenous (IV) administration and adminis tration by coronary sinus retroperfusion (CSR) were also compared. Sixty-five dogs were divided into five groups : Ve-IV: 9 dogs, 0.1 mg/kg; Ve-CS: 9 dogs, 0.05 mg/kg; Mg-IV: 12 dogs, 20 mg/kg; Mg-CS: 11 dogs, 10 mg/kg, control: 24 dogs. The left anterior descending coronary artery was ligated for ten minutes, then quickly reopened. The changes in ventricular effective refractory period (ERP) and intramyocardial conduction time (ICT) were determined during ischemia and following reperfusion.

The authors observed a shortening of the ERP and a prolongation of the ICT in the control group versus an attenuation of those effects in all other groups. The ERP was shortened to a lesser extent in the Mg-IV group than in the Ve-IV group. Drug adminis tration by CSR inhibited the changes in ERP and ICT to a greater extent than IV admin istration, even though the dose given by CSR was one-half the IV dose. Ventricular fibril lation (Vf) occurred in 12 of 24 dogs (50%) in the control group during ischemia, and in 5 of 12 dogs (41.7%) following reperfusion. Vf occurred during ischemia and following reperfusion, respectively, in 22.2% and 0% in the Ve-IV and Ve-CS groups, in 25% and 22.2% in the Mg-IV group, and in 9.1% and 10% in the Mg-CS group. Thus, verapamil and magnesium sulfate inhibited the electrophysiologic changes and prevented ventric ular arrhythmias during myocardial ischemia and following reperfusion.

Administering the antiarrhythmic agent by coronary sinus retroperfusion may be useful for treating patients with acute myocardial infarction with intractable arrhyth mias, according to these experimental results.
Bilateral Internal Carotid Artery Disease Secondary to Cervical Radiation
Authors: Horimoto Masashi , Kodama Natsuko , Takamatsu Hidehiko
Published: July 2008

A patient with radiation-induced bilateral carotid artery disease is presented. A fifty-six- year-old man was admitted to hospital for evaluation of recurrent transient ischemic attacks. He had received cervical radiation for pharyngeal squamous cell carcinoma five years earlier. The radiation was directed at the cervical fields bilaterally and the anterior cervical field using x-rays for a total of 120 Gy. Computed tomography of the brain obtained at admission revealed a low-density area in the right parietal lobe. Carotid arte riograms revealed a completely occluded right internal carotid artery and a severely narrowed left internal carotid artery. There was good collateral supply from the posterior communicating arteries to the internal carotid arteries, bilaterally. The patient was medically treated with anticoagulant and antiplatelet therapy and has been free of subse quent cerebral ischemic attacks.
Unusual Right Coronary Artery Runoff with Right and Left Main Coronary Artery Aneurysm
Authors: Tomaru Akihisa , Kudou Makoto , Baba Jun , Goto Yoshihisa , Miura Shigeru , Takikawa Kazutoshi , Yamazaki Tatuo , Miho Otoya
Published: July 2008

A rare case of unusual right coronary artery runoff with right and left main coronary artery aneurysm is presented. The discussion is mainly from the etiologic point of view.
Unusual Appearance of Intracranial Fibromuscular Dysplasia
Authors: Belen Deniz , Bolay Hayrunnisa , Firat Murat , Akpmar Gökhan , Bertan Vural
Published: July 2008

Fibromuscular dysplasia (FMD) of intracranial arteries is seen rarely and usually limited to the intrapetrosal internal carotid artery or carotid siphon. The authors report a case with recurrent subarachnoid hemorrhage diagnosed angiographically as FMD with extensive involvement of intracranial arteries. Angiography showed large fusiform dilata tions and multiple aneurysms along the left intracranial internal carotid artery into its major branches, middle cerebral and posterior communicating arteries, and tip of the basilar and posterior cerebral arteries. Such an angiographic appearance has not been previously reported. Radiologic findings are demonstrated and possible pathophysiologic mechanisms are discussed.
White-Coat Normotension and Blood Pressure Variability
Authors: Prattichizzo Fernando Antonio , Galetta Fabio
Published: July 2008

The objective of this study was to assess blood pressure variability in patients with clinical normotension and ambulatory hypertension (the so-called white-coat normotension).

In 58 white-coat normotensives (mean age 64.2 ± 14.9 years; male/female ratio = 1.5:1) the authors evaluated blood pressure variability using the twenty-four-hour coef ficient of variability. Fifty-eight essential hypertensives with the same age and sex distri bution were recruited as a control group.

The coefficient of variability in white-coat normotension was greater than in the control group (14.8/16.1 ± 4.2/3.8% vs 13.5/15.1 ± 3.3/3.1%), but this difference was not statistically significant.

These findings suggest that white-coat normotension is the result of a specific relaxing response to medical visits and not the expression of an elevated blood pressure variability. It is probably due to the reverse of the alerting response, which causes white- coat hypertension.
Impairment of the Postural Venoarteriolar Response in Young Type 1 Diabetic Patients
Authors: Yosipovitch Gil , Schneiderman Jacob , van Dyk David J. , Chetrit Angella , Milo Guy , Boner Geoffrey
Published: July 2008

The skin blood flow and venoarteriolar response (VAR) in the feet of young type 1 diabetic patients were studied with laser Doppler flowmetry. The findings were correlated with diabetic microangiopathy in 24 young patients without neuropathy—14 with diabetic microangiopathy, 10 without—and 10 healthy controls. In type 1 diabetic patients the skin blood flow, after lowering of the leg, was significantly higher in the microangiopathic patients than in the healthy controls, 5.3 ± 1.4 vs 3 ± 1.5, (P < 0.01). The VAR index was significantly lower in both groups of diabetics as compared with controls.

In conclusion laser Doppler flowmetry is an easy and reliable noninvasive technique to evaluate skin blood flow abnormalities in the feet of young type 1 diabetic patients, including those without neuropathy. The VAR has been found abnormal in the feet of young diabetic patients with and without microangiopathy, regardless of the presence of peripheral neuropathy.
Coumarin-Induced Skin Necrosis Following Heparin-Induced Thrombocytopenia and Thrombosis A Case Report
Authors: Shahak Adi , Posan Emoke , Szücs Gabriella , Rigo Janos , Boda Zoltan
Published: July 2008

A severe thrombotic thrombocytopenic status, induced by heparin in a sixty-nine-year-old woman undergoing total hip joint arthroplasty, was treated by switching the anticoagu lant therapy to coumarin, which induced skin necrosis. There appeared to be a possible causal relation between the severe immune reaction to heparin and the condition that predisposed to skin necrosis in the presence of coumarin. In patients who express a strong immune response to heparin, a different anticoagulant approach other than use of coumarin congeners appears to be justified..
Acute Myocardial Infarction During Pregnancy and Puerperium Review
Authors: Badui Elias , Enciso Roberto
Published: July 2008

The purpose of this review is to analyze the possible parameters that lead to the devel opment of what is a rare event—acute myocardial infarction (AMI) during pregnancy and puerperium. Through the Index Médicus, 109 publications on the subject were obtained. Since the first well-documented case by Katz in 1922, 136 patients have been reported, and from these reports the following data have been gathered: the average age was 32.1 years. This event is more frequent during the third trimester and puerperium of the first and second pregnancies. In 42.6% of the patients no coronary risk factors were observed, but when present, hypertension and cigarette smoking were the most common. The anterior wall along or in combination with any other anatomic area was affected in 73% of cases. Coronary angiograms, when taken, appeared normal in 47%. The maternal mortality rate was 26/136 (19.1%) and was higher during the third trimester, labor, and puerperium. Eight patients (8/26) (30.7%) had sudden death. In 5 of these, (62.5%) coronary thrombosis was found. In 18/26 deaths, an autopsy was performed; 9/18 (50%) had coronary thrombus formation and in 7/18 (39%) variable degrees of atherosclerosis were detected. On the other hand, the fetal mortality rate was 16.9%; however, in only 52% was death coincidental with that of the mother. Coronary artery spasm associated with a probable hypercoagulability state was the most likely mechanism in the majority of these patients, followed by atherosclerotic heart disease and coronary dissection—the last being secondary most likely to hormonal changes.

During the AMI these patients should be studied by a medical team composed of a cardiologist, gynecologist, and anesthesiologist. A complete cardiologic work-up should be made to decide individually about further pregnancies.
Wine Consumption and Other Dietary Variables in Males Under 60 Before and After Acute Myocardial Infarction
Authors: Cleophas Ton J. M. , Tuinenberg Ellen , van der Meulen Jan , Zwinderman Koos H.
Published: July 2008

In France there are few cardiac deaths in spite of high animal fat intake. France and Italy have the highest overall intake of alcohol in the world. Obviously, there is an inverse association between coronary heart disease (CHD) and alcohol intake in these countries. Although in the past decade several-large scale population studies have confirmed the beneficial effect of alcohol on CHD, these studies may not have been sensitive to control all the confounding variables.

No one so far has explored the possibility that the French may be protected by their low level of life stress. In 1993 we conducted a case-control study (n = 118) to examine psychological variables in a group of Dutch males under sixty years of age, before and after acute myocardial infarction (MI). After adjustment for total cholesterol, blood pressure, and smoking, a number of psychological factors appeared to be independently associated with an increased risk of MI. For the present study the same group of patients was assessed for consumption of different types of alcoholic beverages, coffee, sugar, high-fat diet, and vegetables.

In the univariate analysis patients appeared to have consumed more red wine (odds ratio [OR] 0.2, P = 0.03) and controls more spirits (OR 4.0, P = 0.005). After adjustment for total cholesterol, blood pressure, and smoking as well as the independent psycholog ical factors, red wine lost its significance (OR 0.4, P = 0.17) whereas the OR for spirits even rose (OR 6.0, P = 0.01).

The beneficial effect of wine may be an expression of a relatively low level of life stress. Alcohol itself is not protective but rather a strong risk factor of MI.
Assessing the Independent Effect of Dietary Counseling and Hypolipidemic Medications on Serum Lipids
Authors: Fleming Richard M. , Ketchum Kristy , Fleming Diane M. , Gaede Ruth
Published: July 2008

Determination of changes in total cholesterol (TC) and triglyceride (TG) levels has focused primarily on hypolipidemic drug effects. Changes resulting from dietary effect alone versus diet and drug effect have not yet been fully established.

Seventy subjects were enrolled into four treatment groups to determine the impact of diet and drug effect upon TC and TG. Group 1 (n = 28) served as the control group and received no dietary counseling or drug therapy. Group 2 (n = 22) received dietary coun seling. Group 3 (n = 7) underwent dietary counseling for six months and drug therapy for eighteen months. Subjects in groups 1-3 were monitored for eighteen months. Patients in group 4 (n = 13) were followed up for thirty-six months. No intervention occurred during the first eighteen months, and hypolipidemic medications were used during the second eighteen-month period.

Subjects in groups 1 and 4 received no specific dietary counseling and demonstrated no significant improvement over the course of the study. Patients in groups 2 and 3 showed significant reductions in both TC and TG. The improvement in TC seen for patients in group 3 was reduced after dietary counseling ceased.

Dietary intervention is necessary if patients are to statistically significantly reduce TC and TG levels. Drug therapy demonstrated the expected reductions in both TC and TG but did not statistically significantly lower lipid levels without concomitant dietary coun seling. When dietary counseling and hypolipidemic medications are used together, reduc tions in TC and TG values are even greater than those seen with dietary effect alone. Diet control alone appears to significantly reduce TC and TG levels, resulting in reduced need for antianginal medications.
Spontaneous Cerebellar Strokes
Authors: Turgut Mehmet , Ozcan Osman Ekin , Ertürk Özcan , Saribaş Okay , Erbengi Aykut
Published: July 2008

This is a retrospective study carried out by clinical analysis of the authors' experience in 60 patients with cerebellar strokes—of which 39 were spontaneous cerebellar hemor rhage and 21 were cerebellar infarction—to compare the clinical presentation, course, and prognosis. Hypertension was found to be the most important etiologic factor. Clinical differentiation of cerebellar hemorrhage from infarction was not possible, but the management was similar in both entities. Computerized tomography was necessary to make diagnosis of the stroke mechanism. In evaluating outcome, the authors conclude that the most important single factor affecting the prognosis was the early correct diagnosis.
A Noninjury, Diet-Induced Swine Model of Atherosclerosis for Cardiovascular-Interventional Research
Authors: Thorpe Patricia E. , Hunter William J. , Xiao Xing Zhan  , Dovgan Peter S. , Agrawal Devendra K.
Published: July 2008

To investigate whether atherosclerotic vascular disease in the microswine model can be induced by atherogenic diet alone and does not require balloon injury or endothelial denudation as widely stated in the literature, 28 female Yucatan microswine were fed a high-fat, high-cholesterol diet, including 2% sodium cholate, for an average of 310 ± 13 days. Four control swine were placed on a regular diet for an average of 287.2 ± 7.8 days. Selective coronary arteriography and morphologic and histologic studies were performed at the end of this period. Coronary arteries were fixed in vivo by pressure perfusion of formalin. Angiograms and sequential histologic sections were reviewed by a double-blind team. The angiography did not show apparent disease in all vessels but generally revealed mild irregularity. Quantitatively, there was a 30.5 ± 3.5% stenosis (mean ± standard error, P < 0.05 vs. control) in left anterior descending (LAD), 40.7 ± 4.5% of stenosis in right coronary artery (RCA) (P < 0.01 vs. control), and 24.8 ± 3.7% of stenosis in left circumflex artery (LCX).

The lesions were eccentric in 95% of LCA, 95.8% of RCA, and 75% of LCX, and the remainder were concentric lesions. Typical lesions were characterized by significant intimal proliferation, cholesterol clefts, necrotic cores, heavy extracellular fat deposition, and calcification. Control animals had only occasional, minimal intimal lipid deposition in coronary arteries. These findings suggest that the Yucatan microswine is an ideal coronary atherosclerosis animal model for vascular research. Lesions can be induced by atherogenic diet alone. Cholesterol uptake is increased by adding sodium cholate to the feed. Moreover, balloon injury of the intima or media is not required to induce significant atherosclerotic lesions in coronary arteries.
Hemorheologic Effects of Vasodilation in Essential Hypertension
Authors: Wysocki Marian , Andersson Ove K. , Persson Bengt , Bagge Ulf , Braide Magnus
Published: July 2008

Arterial hypertension is often associated with plasma volume contraction and hemocon centration, which negatively affect the vascular flow resistance and microcirculation. Since some antihypertensive drugs can affect blood rheology, the purpose of this study was to evaluate whether acute and long-term arterial vasodilation with cadralazine influ ences rheologic parameters in essential hypertension. Twelve patients with unsatisfacto rily controlled essential hypertension were studied. In the acute double-blind phase of the study the patients were allocated to treatment with either cadralazine or placebo. Intraarterial blood pressure, cardiac output (dye dilution), and blood rheology (viscosity, hematocrit) were registered before and after the first dose of cadralazine. Then 9 patients (3 dropouts) were treated with cadralazine and placebo during two four-week crossover periods and continued with cadralazine medication during the eight-week open phase of the study. Blood pressure and blood hemoglobin were followed during long-term treatment.

A single oral dose of cadralazine caused vasodilation (total peripheral resistance index decreased from 45 to 33 U × m2, P < 0.05), which was accompanied by hemodi lution (hematocrit declined from 46.9% to 42.5%, P < 0.05) and a blood viscosity reduction of more than 10%. Viscosity of 45% suspension of erythrocytes in plasma was also reduced, suggesting a possible modification of the microrheologic factors. The changes in total peripheral resistance correlated negatively with the changes in hemat ocrit. An antihypertensive effect of cadralazine was still observed during the chronic phase of the study, which was not accompanied by hemodilution. It is concluded that arterial vasodilation with cadralazine reduces flow resistance in the circulatory system in hypertension and has acute rheologic effects that disappear during chronic medication.
Comparison of whole-Body Thallium Imaging with Transcutaneous PO2 in Studying Regional Blood Supply in Patients with Peripheral Arterial Occlusive Disease
Authors: Yuefei Liu  , Steinacker Jürgen M. , Opitz-Gress Alexandra , Clausen Malte , Stauch Martin
Published: July 2008

Quantitatively estimating functional reserve of blood supply to the legs in patients with peripheral arterial occlusive disease (PAOD) remains a clinical issue. This study was designed to investigate the regional blood supply to the legs in PAOD patients during exercise by use of thallium 201 (201Tl) whole-body imaging in comparison with transcu taneous PO2 (tcPO2) measurement.

Thirty-three patients with PAOD and 10 subjects without PAOD (control) performed an incremental cycle ergometry (CE), while tcPO2 was continuously registered on the involved calf. In the last minute of exercise, 2 mCi of 201Tl was injected intravenously and the 201Tl whole-body images were taken immediately (stress) and four hours (redistrib ution) following stress with a dual-head camera system. Regional blood supply (RBS) (%) was calculated from the geometric mean counts of the region of interest divided by the total counts of the whole body.

The performance of PAOD patients was reduced in doing CE, and tcPO2 fell distinctly in PAOD patients (from 51 to 19 mmHg) whereas it increased in controls (from 57 to 67 mmHg). The RBS in PAOD patients was obviously reduced in comparison with that of controls. While in controls the RBS of the calf (3.1%) at stress did not differ from that at redistribution (3.4%), in PAOD patients the redistribution RBS (2.8%) increased as compared with that of stress (1.5%). There was a hyperbolic relationship between stress RBS of the calf and the velocity of tcPO2 fall in PAOD patients during exercise test (velocity of tcPO2 fall = -0.032 + 0.39/RBS, r2 = 0.54, P < 0.05).

In conclusion, the RBS determined by 201Tl whole-body imaging is comparable to the tcPO 2 measurement in differentiating patients with PAOD from subjects without PAOD during exercise. Regional 201Tl uptake reflects regional blood supply in PAOD patients. There is a hyperbolic relationship between the RBS derived from 201Tl whole-body imaging and tcPO2 in PAOD patients during exercise, implying that in a critical ischemia the lower the RBS is, the more steeply the tcPO2 decreases.
Effect of Spirapril and Hydrochlorothiazide on Platelet Function and Euglobulin Clot Lysis Time in Patients with Mild Hypertension
Authors: Gleerup G. , Petersen J. Roland , Mehlsen J. , Winther K.
Published: July 2008

Thirteen patients with mild hypertension (untreated diastolic blood pressure of 95 to 114 mmHg) received, in random order, three successive treatments of four weeks with placebo, spirapril (6 mg daily), or hydrochlorothiazide (HCT2) (24 mg daily). At the end of each treatment, blood samples for assessment of platelet aggregation and platelet release of platelet factor 4 (PF4) and for assessment of fibrinolysis, estimated by tissue plasminogen activator (t-PA), plasminogen activator inhibitor-type 1 (PAI-1), and euglob ulin clot lysis time (ECLT), were taken, first at rest, then immediately after five to ten minutes of vigorous exercise, and finally after the subsequent hour of recovery rest.

Platelet aggregation induced in vitro by adrenaline significantly decreased during treatment with HCT2, the threshold rising to 10 μM as compared with 1.0 with placebo (P < 0.05) at rest, and the threshold for adenosine diphosphate (ADP) aggregation also rose, from 2 μM to 4 (NS). The resting plasma PF4 value fell, although not significantly, during HCT2 treatment from the placebo value of 3.28 to 2.56 ng/mL.

During spirapril treatment there was no change in the threshold of either adrenaline or ADP for aggregation of platelets sampled at rest, and the PF4 plasma levels showed no significant reductions at rest. However, during exercise PF4 showed an approximate doubling of the resting value irrespective of therapy. This exercise-induced increase in PF4 was significantly reduced by spirapril as compared with placebo (P < 0.05).

ECLT and t-PA did not shift significantly from the placebo level during either therapy. PAI-1 did not change during spirapril therapy, but during HCT2 treatment it fell, although not significantly, to 9.36 IU/mL from 15.91 with placebo (NS).

Spirapril and HCT2 did not produce any unwanted side effect on platelet function or fibrinolysis. HCT2 seems to decrease platelet activity at rest, whereas spirapril seems to some extent to decrease platelet activity at exercise.
Risk Factors for Brain Infarction in Patients with Cushing's Disease
Authors: Mizokami Tetsuya , Okamura Ken , Sato Kaori , Kuroda Takeo , Sadoshima Seizo , Fujishima Masatoshi
Published: July 2008

Two women aged 51 and 52 years old, respectively, developed a brain infarction before and after undergoing treatment for Cushing's disease. A biochemical remission was obtained more than ten years after the onset of signs or symptoms of Cushing's disease. The arteriosclerotic changes of the cerebral vessels progressed even during replacement therapy for posttreatment hypopituitarism after they underwent either ablative surgery or radiotherapy. One patient, who showed the signs of Nelson's syndrome, demonstrated severe progressive cerebrovascular sclerotic changes, especially around the irradiated site. It is thus suggested that hypercortisolemia, external pituitary irradiation, and post treatment hypopituitarism may be risk factors for brain infarction. The early diagnosis and adequate treatment are therefore important to prevent cerebrovascular complica tions in patients with Cushing's disease.
Paradox of Accessory Pathway Block After Radiofrequency Ablation in Patients with the Wolff-Parkinson-White Syndrome
Authors: Ueng Kwo-Chang , Chen Shih-Ann , Chiang Chern-En , Cheng Chen-Chuan , Wu Tsu-Juey , Tai Ching-Tai , Lee Shih-Huang , Chiou Chuen-Wong , Chen Chung-Yin , Wen Zu-Chi , Chang Mau-Song
Published: July 2008

Although pacing technique has demonstrated that the most common site of conduction block in a manifest accessory pathway (AP) was between the AP and the ventricle, most of the block sites have been found to be between the atrium and AP after successful radiofrequency ablation. Furthermore, the block site in a concealed AP after successful radiofrequency catheter ablation has not been reported in the literature, and compar isons between a manifest and concealed AP have not been performed. This study included 219 consecutive patients undergoing successful radiofrequency catheter ablation of a single AP. AP potential was recorded at the successful target site in 76 of 92 (82.6%) patients with manifest APs, and in 99 of 127 (77.9%) patients with concealed APs. All the left-sided APs (including left posteroseptal APs) were ablated by a ventricular approach, and right-sided APs (including anteromidseptal and right posteroseptal APs) were ablated by an atrial approach. The site of conduction block was determined by analyzing and comparing the local electrograms recorded before and after radiofrequency ablation at successful ablation sites. Conduction block of manifest APs was between the atrial-AP (A-AP) in 69 patients (75%) and between the AP-ventricle (AP-V) interface in 7 patients (7.6%), whereas the conduction block of concealed APs occurred between the AP-V in 90 patients (70.9%) and between the A-AP interface in 9 patients (7.1%). Neither the preab lation electrogram nor electrophysiologic characteristics of APs predicted the site of conduction block. Furthermore, neither the location of the APs nor the position of the ablation catheter affected the block site. It was concluded that the most common site of conduction block during successful radiofrequency catheter ablation of a manifest and concealed AP was between the A-AP and AP-V interface, respectively, and the impedance mismatch theory explained only part of the findings.
Immune-Complex Allergic Vasculitis in Association with the Immune-Complex Allergic Vasculitis in Association with the Development of Transverse Myelitis
Authors: Nikol Sigrid , Huehns Tanya Y. , Pilz Günter , von Scheidt Wolfgang
Published: July 2008

A severe vasculitis, probably therapy related, in a sixty-four-year-old man being treated for possible subacute bacterial endocarditis, was associated with the development of transverse myelitis. It is hypothesized that the vasculitis affected the small vessels to the spinal cord in the same way that systemic vasculitis can also cause a transverse myelitis.
Thrombogenesis in Mitral Regurgitation and Aortic Stenosis
Authors: Lip Gregory Y. H. , Rumley Ann , Dunn Francis G. , Lowe Gordon D. O.
Published: July 2008

The exact mechanisms for thrombus formation in patients with valvular heart disease have not been clearly defined. Abnormalities in plasma coagulation factors indicative of a prothrombotic state may in part account for the risk of stroke and thromboembolism in such patients. The aim of this study was, therefore, to determine the effects of mitral regurgitation (MR) and aortic stenosis (AS) on plasma fibrinogen or fibrin D-dimer levels as indices of a thrombogenic (or prothrombotic) state.

A total of 25 patients with valve disease in sinus rhythm were studied: 12 patients (all women; mean age fifty-five years, sem 3.3) with MR; and 13 patients (7 men, 6 women; mean age fifty-seven years, sem 3.5) with AS were studied. Patients with MR had a median plasma fibrinogen that was significantly elevated when compared with female population values (median difference 0.62 g/L; 95% confidence intervals (CI) 0.27 to 1.05, P = 0.0016). However, these patients had a median plasma fibrin D-dimer that was lower than that for population controls (median difference 21 ng/mL; 95% CI 0 to 38, P = 0.05). Patients with aortic valve disease had a median plasma fibrinogen that was significantly increased when compared with population controls (median (continued on next page) difference 0.82 g/L; 95% CI 0.34 to 1.24, P = 0.001). These patients had a plasma fibrin D-dimer level that was similar to population values (median difference 3 ng/mL; 95% CI -25 to 22, P = 0.80).

Patients with MR or AS have higher plasma fibrinogen levels when compared with "normal" population values, suggesting possible hemorheologic abnormalities in these patients. Subjects with MR had lower plasma fibrin D-dimer levels, suggesting lesser intravascular clotting, consistent with clinical echocardiographic studies. Subjects with AS had plasma fibrin D-dimer levels similar to the "normal" population values, suggestive of a different pathophysiological mechanism for thromboembolism. These findings add to an improved understanding of the relationship between clinical observations and the signif icance of plasma fibrinogen and fibrin D-dimer levels in thrombogenesis.
Surgical Treatment of Refractory Venous Stasis Ulcer Due to a Severe Impairment of Calf Muscle Pump Function: Evaluation by Air Plethysmography
Authors: Sugimoto Takaki , Okada Masayoshi , Fukuoka Masato , Uematsu Masahisa , Yoshida Masato , Toyama Hiromichi
Published: July 2008

The authors encountered a forty-nine-year-old man with a lower limb ulcer refractory to intensive conservative therapy. No varicose vein was found anywhere, and the usual phlebographies and foot venous pressure measurement failed to diagnose it as a venous stasis ulcer. A direct phlebography method developed by the authors, in which a thin catheter is inserted into the deep vein, disclosed a reflux of the popliteal vein or a deep muscle branch from which an incompetent perforator arose toward the superficial vein above the ulcer. Air plethysmography (APG) showed a severe impairment of the calf muscle pump function. He underwent a subfascial ligation of two incompetent perfora tors together with a stripping of the great saphenous vein passing under the ulcer. Postoperatively, this ulcer was cured in an early phase, and the calf muscle pump function showed improvement in the APG.
Reducing Cross-Clamping Duration in Aortoiliac Reconstruction After Renal Transplantation
Authors: Albers Maximiano , De Luccia Nelson , Nahas William , Sabbaga Emil , Arap Sami
Published: July 2008

A fifty-two-year-old male renal transplant patient underwent aortoiliac reconstruction with a bifurcated prosthesis for treatment of hypertension and deteriorating allograft function. A modified technique was used that reduced aortic cross-clamping time to twelve minutes. This simple technique is applicable to most patients, reduces warm ischemia to a minimum, and saves time for a careful aortoiliac reconstruction.