bluuebunny/crossref_metadata_2025 huggingface dataset:
Association Between Physical Activity and Endogenous Fibrinolysis in Peripheral Arterial Disease: A Cross-sectional Study
Authors: Gardner Andrew W. , Killewich Lois A.
Published: July 2008

The purpose of this study was to determine whether daily physical activity was independently related to endogenous fibrinolysis in subjects with peripheral arterial disease (PAD). One hundred and six subjects with peripheral arterial disease (PAD) and intermittent claudication were characterized on the activity level of tissue plasminogen activator (tPA, the activator of fibrinolysis), the activity level of plasminogen activator inhibitor (PAI-1, the inhibitor of fibri nolysis), daily physical activity, ambulatory function, and demographic information. Subjects were separated into low (n = 36), moderate (n = 34), and high (n = 36) physical activity tertiles based on a 48-hour monitoring period with use of an accelerometer. The tPA activity of the low physical activity group (1.30 ±0.16 IU/mL) was 21 % and 19% lower (p < 0.05) than that of the moderate (1.65 ±0.18 IU/mL) and the high (1.61 ±0.15 IU/mL) physical activity groups, respec tively. The PAI-1 activity of the low physical activity group (21.41 ±1.14 AU/mL) was 15% and 23% higher than that of the moderate (18.61 ±1.34 AU/mL) and the high (17.47 ± 1.14 AU/mL) physical activity groups, respectively. Group differences in tPA activity and PAI-1 activity persisted after our controlling for group differences in measured and self-reported ambulatory measures. Daily physical activity is related to a more favorable endogenous fibrinolytic profile in PAD subjects with intermittent claudication. Subjects who expend fewer than 175 kcal/day in physical activities (approximately 35 minutes) are particularly susceptible to having a prothrombotic state. Subjects should be encouraged to participate in at least 35 minutes of physical activity each day to enhance fibrinolysis.
Prolongation of QT Interval as a Predictor of No-Reflow Induced by Rotational Atherectomy
Authors: Tomoda Haruo , Aoki Naoto
Published: July 2008

Although coronary rotational atherectomy (RA) is widely applied to clinical cases, the incidence of coronary no-reflow associated with it is higher than in percutaneous transluminal coronary angioplasty (PTCA) and stenting. This study was undertaken to predict no-reflow by using conventional electrocardiograms (ECGs). A total of 105 patients who underwent RA (group 1) and 40 who underwent PTCA (group 2) were studied. Eight patients of group 1, all of whom had long calcified coronary lesions, were complicated with no-reflow following RA. Standard 12- lead ECGs were recorded before and throughout the interventional procedures. Maximum and minimum QT intervals and QT dispersion were measured and corrected by heart rate. Corrected and uncorrected QT intervals and QT dispersion were significantly prolonged by RA in group 1 patients without no-reflow: maximum QTc, 428 ±28 ms → 485 ±53 ms, p<0.001. The increases in QT intervals were more remarkable in group 1 patients with no-reflow: maximum QTc, 434 ±15 ms → 552 ±39 ms, p<0.001. Of the 33 patients with maximum QTc ≥500 ms, 8 were complicated with no-reflow. No patients with maximum QTc < 500 ms had no-reflow. There was no significant increase in QT intervals in group 2. Adsorption of calcium ions from the myocardium by pulverized calcified atheromatous debris when these pass through coronary capillaries, resulting in transient myocardial hypocalcemia, was considered as a possible mechanism of QT prolongation. Because QT prolongation appears during the initial RA trial, prolonged QT intervals could be a predictor of no-reflow. It is recommended to avoid repetitive RA if marked QT prolongation is observed at the initial RA trial.
The Effect of Valsalva Maneuver on P Wave in 12-Lead Surface Electrocardiography in Patients with Paroxysmal Atrial Fibrillation
Authors: Altunkeser Bülent B. , Özdemir Kurtuluş , Gök Hasan , Yazici Mehmet , Içli Abdullah
Published: July 2008

The previous studies relating to the effect of the Valsalva maneuver on P wave do not provide detailed information. In those studies, the parameters related to P wave duration during the release phase of the Valsalva maneuver were evaluated. The authors evaluated P wave amplitude as well as P wave duration during the strain phase of the Valsalva maneuver. Thirty- seven normal subjects and 36 patients with paroxysmal atrial fibrillation (PAF) were included in the study. Twelve-lead surface electrocardiography (ECG) was obtained from all the patients before and during the strain phase of the Valsalva maneuver. The authors evaluated the para meters related to both P wave duration and P wave amplitude. The highest P wave voltage was expressed as the P wave amplitude maximum (P amp max), the lowest P wave voltage as the P wave amplitude minimum (P amp min), and the P wave amplitude dispersion (P amp dispersion) as "the P amp max — the P amp min." Also, the maximum P wave duration was expressed as the P maximum (P max), the minimum P wave duration as the P minimum (P min), and the P wave dispersion as "the maximum P wave duration (P max) — the minimum P wave duration (P min)." All these parameters were measured before and during the strain phase of the Valsalva maneuver. P max, P dispersion, P amp max, and P amp dispersion were higher in patients with PAF compared to those of normal subjects before the Valsalva maneuver. In normal subjects, P max, P wave dispersion, P amp max, and P amp dispersion values were significantly higher in the strain phase of the Valsalva maneuver than before (p<0.01, p < 0.0 1, p<0.05, and p<0.05, respectively). In the patients with PAF, P max, P wave dispersion, P amp max, and P amp dispersion values were significantly lower during the strain phase of the Valsalva maneuver than before. In conclusion, in the patients with PAF, P wave parameters were decreased during the strain phase of the Valsalva maneuver, approaching to the normal levels.
Some Effects of Sustained Compression On Ulcerated Tissues
Authors: Roberts Geoff , Hammad Lina , Collins Carol , Shearman Cliff , Mani Raj
Published: July 2008

Sustained leg compression is the first line of treatment for patients with chronic venous ulcers. The success rates of this treatment vary, and the mode(s) of action are not well understood. In this study, tissue oxygen tension (TcPO2), surface pH, and reactive hyperemia measure ments were made to observe changes associated with sustained compression in patients with chronic venous ulcers. Patients with chronic venous ulcers (n = 20, 13 F, 7 M, median age 65.5 years, median ulcer size 13.9 cm2) were assigned to the same treatment, wound dressings, and 4-layer bandaging during a 24-week period. Duplex ultrasound, venous refilling time, skin tissue oxygen, and ulcer surface pH were measured at defined time points. Ulcer areas were calcu lated from contour traces done at regular dressing changes. The difference between ulcer surface pH and control values measured proximally on the same leg diminished with healing (p = 0.02), which occurred despite the evidence of deep venous reflux. Ulcers with smaller initial areas healed quicker (p=0.003). A greater likelihood of healing was observed in women (p = 0.017). Sustained compression may potentiate healing by acting on the microcirculation in ulcerated tissues.
Adrenal Adenoma Presenting with Torsade de Pointes
Authors: Sade Elif , Oto Aytekin , Oto Ali , Öner Zafer , Daver Altunay , Önalan Orhan , Bilezikci Banu , Tokgözoglu Lale
Published: July 2008

A case of primary hyperaldosteronism due to an adrenal adenoma with near syncope and torsade de pointes is described. A woman patient had a history of high blood pressure and severe hypokalemia that was the cause of her ventricular arrhythmia, which was controlled by administering potassium supplementation but no antiarrhythmic medication. Adrenal adenoma was identified on axial computerized tomography. This case report suggests that there may be a chance of complete cure from torsade de pointes if the underlying cause of QT prolongation can be identified.
An Unusual Primary Left Ventricular Hydatid Cyst Complicated by Cardiac Tamponade and Mitral Regurgitation
Authors: Maden Orhan , Atak Ramazan , Yetgin Ertan , Senen Kubilay , Aras Dursun , Kütük Emine
Published: July 2008

Cardiac involvement in hydatidosis is rare but because of potentially lethal complications, its recognition is of great importance. The authors present a 55-year-old woman admitted to the clinic with cardiac tamponade and moderate mitral regurgitation caused by a hydatid cyst located at the inferoposterior wall of the left ventricle.
An Overview on Peripheral Vascular Disease in Blackfoot Disease-Hyperendemic Villages in Taiwan
Authors: Tseng Chin-Hsiao
Published: July 2008

The arsenic-related peripheral vascular disease found to be endemic along the southwestern coast of Taiwan is reviewed. In the early 20th century a strange disease involving the lower extremities characterized by typical clinical symptoms and signs of progressive arterial occlusion was reported in a confined area located along the southwestern coast of Taiwan. The disease was locally called "blackfoot disease" because of its gangrenous appearance involving the feet of the patients. The prevalence of this disease ranged from 6.51 to 18.85 per 1,000 population in different villages. Epidemiologic studies revealed that blackfoot disease was associated with the consumption of artesian well water containing high levels of arsenic. High co-occurrence of blackfoot disease and arsenic-related skin lesions such as hyperpigmentation, hyperkeratosis, and skin cancer was also observed. Recent studies also confirmed the asso ciation of preclinical peripheral vascular disease with arsenic exposure in a dose-response pattern. Subclinical arterial insufficiency and defects in cutaneous microcirculation can also be demonstrated in seemingly normal subjects living in the endemic villages. The incidence of clinical manifestation of blackfoot disease decreased dramatically after the implementation of tap water in these villages over the past 2-3 decades. The atherogenicity of arsenic could be associated with its effects on hypercoagulability, endothelial injury, smooth muscle cell proliferation, somatic mutation, oxidative stress, and apoptosis. However, its interaction with some trace elements and its association with hypertension and diabetes mellitus could also explain part of its higher risk of developing atherosclerosis.
Clinical Evaluation of the Efficacy and Safety of Calcium Dobesilate in Patients with Chronic Venous Insufficiency of the Lower Limbs
Authors: Arceo Adalberto , Berber Arturo , Treviño Carlos
Published: July 2008

Several venotonic drugs have been used in the treatment of chronic venous insufficiency (CVI) of the lower limbs, most of them from natural sources. Calcium dobesilate, from synthetic origin, has been shown to improve clinical symptoms of these venous conditions. Three hundred fifty-two patients with CVI in grades I and II of Widmer's classification were included from an open population between January 1999 and June 2000; patients received calcium dobesilate 500 mg every 8 hours for 9 weeks. A basal recording and recordings every 3 weeks were made of heaviness, pain, cramps, and paresthesias of the lower limbs with a severity scale, and edema was assessed by measurement of the circumference of ankles and calves. Two hundred eighty-six patients (81.3%) were women and 66 (18.7%) were men with a mean age of 45.7 ±14.1 years; 200 patients (56.8%) were grade I and 150 (42.6%) were grade II of Widmer's classification, and two patients had no classification, with a mean duration of symptoms of 6.5 ±7.4 years. All of the symptoms had a significant reduction from the first to the final visit of treatment; 70% of the patients complained of moderate to severe heaviness of the lower limbs at the beginning of the study, whereas 10% of the patients presented this symptom at the end of treatment. Likewise, 75%, 37%, and 41% of the patients, respectively, complained of moderate to severe pain, cramps, and paresthesias of the lower limbs at the beginning of the study, with a reduction in this prevalence to 6%, 2%, and 4%, respectively, at the end of treatment (p<0.001, Wilcoxon test). In regard to edema of ankles and calves, a significant reduction in circumferences was registered in both sites at the end of treatment; for instance, the mean circumference of the right ankle was reduced from 23.78 ±0.27 to 22.71 ±0.31 cm while the right calf had a reduction from 35.08 ±0.41 to 33.83 ±0.5 cm (p<0.001, paired t test). Side effects were registered in 17.9% of the patients. This trial shows that calcium dobesilate had significant efficacy in the improvement of all the symptoms in patients with CVI, achieving this effect with an acceptable safety profile.
Exercise-Induced Bidirectional Ventricular Tachycardia with Alternating Right and Left Bundle Branch Block-Type Patterns
Authors: Khan Ijaz A.
Published: July 2008

Exercise-induced ventricular tachycardia in young adults may occur with various structural heart diseases or with structurally normal heart. The structural heart diseases reported to cause exercise-induced ventricular tachycardia in this patient population include arrhythmo genic right ventricular dysplasia, hypertrophic cardiomyopathy, dilated cardiomyopathy, myocarditis, congenital heart disease, and myocardial ischemia. The conditions well identified to cause exercise-induced ventricular tachycardia with structurally normal heart are congen ital long-QT syndrome and familial polymorphic ventricular tachycardia. Exercise-induced ventricular tachycardia may display polymorphic, monomorphic, or bidirectional morphologies. A case of exercise-induced catecholamine-sensitive bidirectional ventricular tachycardia with alternating right and left bundle branch block patterns is reported in a young boy in the absence of structural heart disease, the conditions causing bidirectional ventricular tachy cardia, and family history of such an event or sudden cardiac death. The bidirectional tachy cardia typically displays right bundle branch block in right precordial leads with alternating polarity of the QRS-complex in frontal plane leads but in this case the bidirectional morphology of tachycardia was caused by alternating right and left bundle branch block-type patterns. The conditions causing bidirectional ventricular tachycardia are digoxin toxicity, ischemic heart disease, hypokalemia, myocarditis, and familial polymorphic ventricular tachycardia syndrome but the exact cause in this patient remained obscure, and the possibility of an underlying elec trical or ion channel disease of the heart could not be ruled out.
Left Ventricular Pacemaker Lead Insertion Through the Foramen Ovale
Authors: Altun Armagan , Akdemir Osman , Erdogan Okan , Aslan Ozgur , Ozbay Gultac
Published: July 2008

This report describes a patient with a 6-year-old pacemaker lead in the left ventricle. Both transthoracic and transesophageal echocardiography unequivocally showed that the lead enters the left ventricle via the foramen ovale and the mitral valve. The patient did not suffer from a thromboembolic event; therefore, we did not proceed with extraction. The importance of this case report is to emphasize the conditions and precautions of proper pacemaker implantation.
Recent Advances in Peripheral Angioplasty and Stenting
Authors: Faries Peter , Morrissey Nicholas J. , Teodorescu Victoria , Gravereaux Edwin C. , Burks James A. , Carroccio Alfio , Kent K. Craig , Hollier Larry H. , Marin Michael L.
Published: July 2008

Utilization of percutaneous interventions for arterial and venous occlusive lesions continue to increase. With the progression of the technology supporting these therapeutic measures, the results of these interventions may be expected to improve. In general, a comparison of tech niques for revascularization demonstrates similar initial technical success rates for surgery and percutaneous transluminal angioplasty. Angioplasty is often associated with lower proce dural morbidity and mortality rates. Conversely, surgery frequently provides greater long-term patency. Late failure of percutaneous therapies may often be treated successfully with rein tervention, however. The continued accumulation of experience with PTA and stenting will ultimately define its role in the management of occlusive disease.
Identification of Viable Myocardium in Patients with Chronic Coronary Artery Disease and Myocardial Dysfunction: Comparison of Low-Dose Dobutamine Stress Echocardiography and Echocardiography During Glucose-Insulin-Potassium Infusion
Authors: Yetkin Ertan , Senen Kubilay , Ileri Mehmet , Atak Ramazan , Battaoglu Bektas , Yetkin Ozkan , Tandogan Izzet , Turhan Hasan , Cehreli Sengül
Published: July 2008

Low-dose dobutamine stress echocardiography (LDDSE) is one of the methods most used to assess myocardial viability. Glucose-insulin-potassium (GIK) has been shown to increase contraction of the ischemic zone. The aim of this study was to compare LDDSE and echocar diography during GIK infusion for detection of myocardial viability in patients with chronic coronary artery disease (CAD) and myocardial dysfunction. Twenty-one patients who had chronic CAD and myocardial dysfunction were included in the study. Glucose-insulin-potassium protocol consisted of a fixed dose of insulin (100 μU/kg/hour IV) and a variable glucose/potassium infusion rate. GIK echocardiography was made at baseline and after 60 minutes of GIK infusion. During continuous electrocardiographic, blood pressure, and echocar diographic monitoring, an intravenous infusion of dobutamine (3 μg/kg body weight/min) was started with an infusion pump and continued for 5 minutes and then increased to 5 μg/kg/min and 10 μg/kg/min for another 5 minutes. The detected viable myocardium was defined as 1 or 2 scores decreasing in at least 2 adjacent abnormal segments during LDDSE and GIK echocar diography. Viability was detected in 19% (52 segments) of the asynergic segments at baseline with GIK echocardiography and 16% (44 segments) of those segments with LDDSE (p > 0.05). Left ventricular wall motion score index at baseline was 2.24 ±0.35 and it decreased signifi cantly during both LDDSE (p = 0.004 vs 2.11 ±0.36) and GIK echocardiography (p=0.001 vs 2.09 ±0.32). The agreement between LDDSE and GIK echocardiography for detection of myocardial viability was 95%. This study shows that GIK echocardiography is similar to LDDSE for detection of myocardial viability. With the support of further clinical studies GIK echocar diography can be used to detect myocardial viability in patients with chronic CAD.
Euthyroid Sick Syndrome in Acute Ischemic Syndromes
Authors: Pavlou H.N. , Kliridis P.A. , Panagiotopoulos A.A. , Goritsas C.P. , Vassilakos P.J.
Published: July 2008

The purposes of this study were to assess the occurrence of euthyroid sick syndrome in patients with acute myocardial infarction (AMI) or unstable angina (UA), and the relationship with β-blocker or thrombolytic therapy. Plasma triiodothyronine (T3), reverse T3 (rT3), free T3 (FT3), thyroxine (T4), free T4 (FT4), thyroid-stimulating hormone (TSH), thyroxine-binding globulin (TBG), and albumin (ALB) levels were determined in 95 patients (59 males, 36 females, aged 58.4 ±9) with AMI and 19 patients (13 males, 6 females aged 54.7 ± 12.3) with UA for 5 consecutive days from the onset of the acute syndrome and 1 month later. Patients were divided according to β-blocker therapy and thrombolytic therapy. There was a significant T3 decrease and rT3 increase in all patients during the first 5 days following admission (p < 0.05). FT3 and FT4 remained unchanged during the study. In patients with complicated infarctions, the rT3 increase and the T3 decrease were significantly greater compared to those with uncom plicated infarctions (p < 0.03). TSH, T4, TBG, and ALB were significantly (p<0.05) decreased only in complicated infarctions. No differences were observed between patients with or without thrombolysis or patients with or without β-blocker treatment. The apparent decrease in T3, the increase in rT3 levels and the decreased TSH and T4 levels, show clearly that the euthyroid sick syndrome (low T3) occurs not only in AMI but also in UA. In addition, these hormonal changes are not affected by β-blocker therapy and thrombolysis does not influence the occurrence of the syndrome. The degree of T3 decrease is proportional to the severity of cardiac damage and may have a possible prognostic value.
Role of Lead aVR in Evaluation of 12-Lead Electrocardiogram
Authors: Siddiqui Mumtaz A. , Khan Ijaz A.
Published: July 2008

Diagnostic information obtained from the evaluation of the unipolar lead aVR in electrocardio graphy (ECG) is not fully appreciated, and therefore, the lead aVR is often overlooked in the routine evaluation of the 12-lead ECG. Lead aVR may supplement clinical information, aiding in the management of several cardiovascular conditions. The role of the lead aVR in evaluation of various clinical conditions is reviewed.
Peripheral Vasodilatory Dysfunction in Adult Patients with Congenital Heart Disease and Severely Elevated Pulmonary Vascular Resistance
Authors: Nakamura Motoyuki , Yoshida Hiroaki , Naganuma Yujiro , Kon Hisashi , Sugawara Shoma , Hiramori Katsuhiko
Published: July 2008

Several studies have demonstrated that pulmonary vascular abnormalities precede alterations in aortic circulation downstream in animal models of heart failure. The relationship between increased pulmonary vascular resistance (PVR) and agonist-induced limb vasodilatory response remains unknown in patients with congenital cardiovascular shunt lesions (CSL). The authors hypothesized that patients with CSL and severely elevated PVR will show a defective vasomotor response in the peripheral vascular bed. To examine this hypothesis we measured forearm blood flow (FBF) responses to the endothelium-dependent vasodilator acetylcholine and the endothelium-independent vasodilator sodium nitroprusside. The values for these FBF responses were compared with PVR in adult patients with CSL (n = 20) and healthy age- and sex-matched controls (n = 15). When patients with CSL were divided into 2 subgroups by median value of PVR, in the lower PVR subgroup, acetylcholine-induced FBF changes were selectively and significantly lower than in the healthy control group (p < 0.05). In the higher PVR subgroup, FBF responses to both acetylcholine and sodium nitroprusside were significantly blunted compared to healthy controls (both p<0.01). In addition, when FBF changes above baseline for each dose of acetylcholine and sodium nitroprusside were cumulated and used as acetylcholine response and sodium nitroprusside response, the sensi tivity and specificity for identifying patients with Eisenmenger's type of CSL was 100% and 80% by acetylcholine response, and 67% and 80% by sodium nitroprusside response, respec tively. In conclusion, adult CSL patients with elevated PVR and severe pulmonary arterial hypertension showed generalized vasodilator dysfunction in the forearm vasculature. This result suggests that upper limb resistance vessel dysfunction may be an indicator for advanced stage of adult patients with CSL.
Dynamic Left Ventricular Outflow Obstruction: A Reversible Mechanical Complication of Acute Myocardial Infarction
Authors: Safi Arshad M. , Rachko Maurice , Kwan Tak , Tang Aylmer , Stein Richard A.
Published: July 2008

Dynamic left ventricular outflow obstruction is a less well-known mechanical complication of acute myocardial infarction. Early diagnosis is important because initiation of proper manage ment and avoidance of precipitating factors can lead to complete recovery. A patient is described who presented with acute myocardial infarction and in whom significant left ventric ular outflow tract obstruction developed. Adequate therapy with β blockers and calcium channel blockers led to complete resolution of the obstruction.
Pseudoaneurysm of the Saphenous Vein Graft Related to Artificial Rubber Pericardium
Authors: Harada Tomohiro , Ida Takao , Koyanagi Toshiya , Kasahara Katsuhiko , Naganuma Fumio , Hosoda Saichi
Published: July 2008

Pseudoaneurysm is an unusual complication of coronary artery bypass grafting. Such aneurysms are caused by technical surgical failures, or inflammation of the sternum and medi astinum following sternotomy observed as an early or mid-term complication of cardiac surgery. This case was an 80-year-old man with a piece of artificial rubber pericardium used for complete closure of the pericardium. A large pseudoaneurysm developed in the body of the saphenous vein graft 15 years after surgery. The old rubber synthetic pericardium was severely degenerative, which induced inflammation and disrupted the saphenous vein graft.
Vascular Disorders Preceding Diagnosis of Cancer: Distinguishing the Causal Relationship based on Bradford-Hill Guidelines
Authors: Naschitz Jochanan E. , Kovaleva Julia , Shaviv Naomi , Rennert Gad , Yeshurun Daniel
Published: July 2008

The literature investigating the association between vascular disorders and malignant neoplasms does not comprehensively review the full spectrum of vascular disorders associated with cancer, or provide proof that cancer is an etiologic factor in the development of these disorders. This paper investigates the causal role of cancer in the pathogenesis of vascular disorders, based on the Bradford-Hill criteria of causation. The Medline database was searched for articles on vascular disorders preceding the diagnosis of cancer (VDPCD). Included in the analysis were vascular disorders caused either by direct tumoral involvement of vessels or by paraneoplastic mechanisms. Vascular disorders caused by adverse reactions to anticancer therapy were excluded from analysis. Seven categories of VDPCDs were recognized: venous thromboembolism, arterial thrombosis and embolism, nonbacterial thrombotic endocarditis, migratory superficial thrombophlebitis, vasculitis, thrombotic microangiopathy, and leukothrom bosis. To establish causality of the association between VDPCDs and malignancy, the degree of fulfillment of the Bradford-Hill criteria was assessed. A strong association was found in the literature between venous thromboembolism and cancer (OR 2.3-14.9 and SIR 1.3-4.4). Consistency and temporality of the association were confirmed in all VDPCD variants. Seven Bradford-Hill criteria were fulfilled for cancer associated with venous thromboembolism, six criteria for superficial phlebitis and cancer, and five criteria for each of the other VDPCDs. In conclusion, these data support the causal role of cancer in the pathogenesis of all seven cate gories of VDPCDs. Recognition of such a causal link between cancer and various vascular disorders may promote an earlier cancer diagnosis.
Effects of Policosanol and Lovastatin in Patients with Intermittent Claudication: A Double-Blind Comparative Pilot Study
Authors: Castaño Gladys , Más Rosa , Fernández Lilia , Gámez Rafael , Illnait José
Published: July 2008

Policosanol is a cholesterol-lowering drug with concomitant antiplatelet effects. The present study was undertaken to compare the effects of policosanol and lovastatin on patients with moderately severe intermittent claudication. The study had a 4-week baseline step, followed by a 20-week double blinded, randomized treatment period. Twenty-eight patients who met study entry criteria were randomized to policosanol 10 mg or lovastatin 20 mg tablets once daily. Walking distances in a treadmill (constant speed 3.2 km/hr, slope 10°, temperature 25°C) were assessed before and after 20 weeks of treatment. Both groups were similar at random ization. Compared with baseline, policosanol increased significantly (p<0.01) the initial claudi cation distance (ICD) from 160.39 ±15.82 m to 211.31 ±21.48 m (+33.7%) and the absolute claudication distance (ACD) (p<0.001) from 236.39 ±25.44 m to 288.09 ±28.47 m (+24.3%); meanwhile both variables remained unchanged after lovastatin therapy. Changes in ICD and ACD were significantly larger in the policosanol than in the lovastatin group (p<0.01). Policosanol, but not lovastatin, significantly increased (p < 0.05) the ankle/arm index, although between-group differences were not significant. The frequency of patients reporting improve ment on quality of life domains was greater in the policosanol than in the lovastatin group. Policosanol significantly (p< 0.00 1 ) lowered total cholesterol (TC) and low-density lipoprotein- cholesterol (LDL-C) by 17.5% and 31.0%, respectively, and meanwhile increased (p<0.01) high- density lipoprotein-cholesterol (HDL-C) levels by 31.5%. Lovastatin reduced (p<0.01) TC (18.0%), LDL-C (22.6%), and (p<0.05) triglycerides (9.8%). In addition, policosanol, but not lovastatin, moderately, but significantly, reduced (p < 0.05) fibrinogen levels, so that final values and percent changes in both groups were different (p<0.01). Treatments were well tolerated. Only 1 lovastatin patient withdrew from the study because of a nonfatal myocardial infarction. Five lovastatin patients, but none from the policosanol group, experienced 6 adverse events (AE) (p<0.01). The present results indicate that policosanol, but not lovastatin, is a suitable alternative to manage patients with intermittent claudication because of pleiotropic properties beyond its cholesterol-lowering effects.
Toe Pressure Measurements Compared to Ankle Artery Pressure Measurements
Authors: Kröger Knut , Stewen Christian , Santosa Frans , Rudofsky Gottfried
Published: July 2008

The Trans-Atlantic Inter-Society Consensus (TASC)-recommended absolute toe pressure is < 30-50 mm Hg for definition of chronic critical limb ischemia (CLI). Toe pressures can be measured by different techniques. The authors analyzed the clinical use of the Doppler technique and an automatic device with optical sensors and estimated their value in docu mentation of chronic critical limb ischemia compared to ankle artery pressures. Three different investigations were performed: (1) In 16 healthy subjects the digital artery pressures were measured by using 3 different optical sensors (transmission, reflection, and microcirculation sensor) and compared to the systolic brachial pressure. (2) In 50 patients with and without peripheral arterial occlusive disease the toe pressures at digits 1 and 2 of both feet were determined by Doppler technique (8 MHz) and by optical sensors (cuff width constant 1.5 cm) and were compared to the ankle artery pressure determined by Doppler technique. (3) In 175 patients the toe pressures were measured at 1 toe and the ankle artery pressures were deter mined. In this group they estimated the clinical use of the toe pressure in regard to the defi nition of CLI (toe pressure <50 mm Hg) compared to the ankle pressure <70 mm Hg. The digital artery pressures measured with the different optical sensors, and the systolic brachial pressures were not significantly different and the correlation coefficients were around 0.7. In 21 of 50 patients the toe pressure at D1 and D2 could not be measured by Doppler technique because with the applied cuff no Doppler signal could be detected at the tip of the toe, but in 24 of these 29 patients the optical measurement was possible. Mean toe pressures at D1 were 108 ±45 mm Hg and D2 102 ±45 mm Hg, which were statistically not different. The correlation coefficient for the highest ankle artery pressure and the highest toe pressure determined by the Doppler technique was 0.389; for the highest ankle artery pressure and the toe pressure measured by the optical sensors it was 0.369, and for the toe pressures measured by Doppler technique and the optical sensors it was 0.506. Defining systolic ankle artery pressure ≤ 50 to 70 mm Hg as the golden standard for CLI, the sensitivity of optical toe pressure measurement for the detection of CLI was 8%, the specificity was 96%, the positive predictive value 12%, and the negative predictive value was 94%. Independent of technique the absolute systolic toe pressures did not correlate with the absolute systolic ankle pressures. The optical measurement was more suitable for toe pressure measurement because it could be used in 90% of all patients. All in all, toe pressure measurements are more useful to exclude CLI than to prove it.
Extent and Severity of Atherosclerotic Vascular Disease in Patients Undergoing Coronary Angiography The Kuwait Vascular Study
Authors: Thomas Christus Singh , Varghese Kiron , Habib Farida , Abraham Mullaseril Thomas , Hayat Nasser Jowhar , Cherian George
Published: July 2008

Only a few angiographic studies have correlated the presence and severity of coronary artery disease with atherosclerosis in other arteries. The presence of disease in more than 1 area clearly has important implications on management. One hundred and seventy eight patients had angiographic evaluation of their peripheral arteries and abdominal aorta after routine diagnostic coronary angiography. The extent and severity of vascular disease was correlated with those of coronary artery disease. Of the 178 patients, 73.6% were men (mean age ± sd was 52.93 ±10.12 years). Hypercholesterolemia (59%), systemic hypertension (56.7%) and diabetes mellitus (50.6%) were the major risk factors. Triple-vessel coronary artery disease was present in 48.9%, and 13.5% had normal coronaries. A new atherosclerotic vascular disease score, which reflects the presence and severity of atherosclerotic vascular disease elsewhere, was seen to correlate significantly with the extent of coronary artery disease. Of particular interest was the involvement of the first part of the vertebral artery in 41.6% of patients. The combined involvement of the abdominal aorta, renal artery, and iliac artery segments (together referred to as the lower body segment) was seen almost exclusively in those with 2- or 3-vessel coronary artery disease. Also there was a direct correlation between the extent of coronary artery disease and the score in the lower body segment as opposed to the upper body segment (subclavian, vertebral, and internal mammary arteries). The presence of atherosclerotic vascular disease correlated with the severity of coronary artery disease, particularly in respect to disease in the lower body segment. Thus early detection of such disease in the iliac or femoral arteries has a potential for early diagnosis of significant coronary artery disease.
Right Ventricular Foreign Body: Percutaneous Transvenous Retrieval of a Greenfield Filter from the Right Ventricle
Authors: Arjomand Heidar , Surabhi Satish , Wolf Nelson M.
Published: July 2008

A 55-year-old man suffered head injury during a motor vehicle accident. He underwent a prophylactic inferior vena cava Greenfield filter placement. The filter migrated and lodged in the right ventricle at the level of the tricuspid valve. Successful percutaneous, transvenous retrieval of the Greenfield filter from the right ventricle was carried out.
Prospective Evaluation of Hypertensive Patients with Carotid Kinking and Coiling: An Ultrasonographic 7-Year Study
Authors: Oliviero Ugo , Scherillo Giovanna , Casaburi Cosma , di Martino Marilena , di Gianni Angela , Serpico Raffaella , Fazio Serafino , Saccà Luigi
Published: July 2008

The aim of this study was to determine the incidence of vascular events during a 7-year follow- up evaluation in a group of 34 hypertensive patients with kinking of the internal carotid artery and 36 well-matched hypertensive control subjects. The carotid intima-media thickness (IMT) was measured at three points of the carotid bifurcation and at three points of carotid kinking on the ultrasonographic posterior wall. The mean IMT measured in the segment of the angular bending was lower than the mean values detected at the bifurcation in normal subjects and in hypertensives without carotid elongation (p<0.01). At the carotid bifurcation of the same side of the kinking, there was an arterial IMT that was significantly lower as compared to the contralateral axis and to the measurements obtained in other hypertensive subjects. During a 7-year follow-up study, 10 vascular events occurred in the hypertensives with carotid kinking and 14 in the controls, without significant differences between the 2 groups. In hypertensives with carotid kinking, the mean IMT measured on the angular bending and at the ipsilateral carotid bifurcation was significantly lower than the values obtained at the contralateral bifur cation and in the other hypertensive subjects. In the 7-year follow-up study, moreover, the presence of carotid kinking does not impact the incidence of vascular events in the hyperten sive population. Thus, the presence of carotid kinking in hypertensive subjects may not be considered a further risk factor for ischemic events.
Disease of Proximal Part of Vertebral Artery in Patients with Coronary Artery Disease
Authors: Thomas Christus Singh , Habib Farida , Varghese Kiron , Abraham Mullaseril Thomas , Hayat Nasser Jowhar , Cherian George
Published: July 2008

Recognition of coincidence of cerebral vascular disease is of importance in patients with coronary artery disease. One hundred and seventy-three patients who underwent coronary angiography were also studied by angiography of subclavian arteries and abdominal aorta. The majority of the patients (128/173; 74%) were men. Risk factors of hypertension, diabetes, and hypercholesterolemia were present in a high percentage of patients. Disease of the proximal part of the vertebral artery was seen in 41.6% (72/173). Presence of vertebral artery disease was significantly correlated with diabetes (p = 0.02), renal artery stenosis (p = 0.003), coronary artery disease (p = 0.05), and iliac artery disease (p = 0.05). The proximal part of the vertebral artery was found to be affected in a high percentage (41.6%) of patients under going coronary angiography.
Myocardial Cytoprotection by Trimetazidine Against Anthracycline-Induced Cardiotoxicity in Anticancer Chemotherapy
Authors: Tallarico Demetrio , Rizzo Vito , di Maio Fernando , Petretto Federica , Bianco Gianluca , Placanica Giuseppe , Marziali Marta , Paravati Vincenzo , Gueli Nicolò , Meloni Fortunato , Campbell Stefano Villatico
Published: July 2008

The ability of trimetazidine (2,3,4, trimethoxybenzylpiperazine dihydrochloride, TMZ) to protect the myocardium against anthracycline (ANT)-induced cardiotoxicity during chemotherapy has been evaluated in female patients with breast cancer. A clinical trial was conducted in 61 patients subdivided into three groups: group 1 (n = 15, G1) treated with standard ANT protocol and cardioprotection by dexrazoxane (DEX) plus TMZ (60 mg, daily dose); group 2 (n = 22, G2) treated with ANT and cardioprotection by TMZ only; and group 3 (n = 24, G3) scheduled to receive ANT therapy and DEX. All the patients submitted to an echocardiographic evaluation of diastolic function (E wave velocity, A wave velocity, isovolumetric relaxation time [IVRT], deceleration time [DT]) at enrollment (TO), at T1 time, at T2 time, and at T3 time. After a 12- month follow-up period, the patients showed a good conservation of diastolic function both in G1 and G2 groups. No statistically significant difference was observed in E wave and A wave velocity and E/A ratio after ANT treatment. TMZ produced a cardioprotective effect, compa rable to DEX protection, against subacute and chronic subclinical cardiotoxicity with no signif icant changes in diastolic function after 1 year of follow-up.
Relation Between Coronary Artery Disease, Risk Factors and Intima-Media Thickness of Carotid Artery, Arterial Distensibility, and Stiffness Index
Authors: Alan Sait , Ulgen Mehmet S. , Ozturk Onder , Alan Bircan , Ozdemir Levent , Toprak Nizamettin
Published: July 2008

Atherosclerosis is a diffuse process that involves vessel structures. In recent years, the relation of noninvasive parameters such as intima-media thickening (IMT), arterial distensibility (AD), and stiffness index (SI) to cardiovascular diseases has been researched. However, we have not found any study that has included all these parameters. The aim of this study is to examine the relation between the presence of coronary artery disease (CAD) and its risk factors to AD, SI, and IMT, which are the noninvasive predictors of atherosclerotic process in the carotid artery. Included in the study were 180 patients who were diagnosed as having CAD by coronary angiography (those with at least ≥ 30% stenosis in the coronary arteries) and, as a control group, 53 persons who had normal appearing coronary angiographies. IMT, AD, and SI values of all the patients in the study were measured by echo-Doppler imaging (AD formula = 2 × (AoS-AoD)/PP × AoD, SI formula = (SBP/DBP)/([AoS - AoD]/AoD). Significantly increased IMT (0.82 ±0.1, 0.57 ±0.1, p < 0.05), decreased AD (0.25 ±0.9, 0.37 ±0.1, p < 0.05), and increased SI (13 ±4, 8 ±3, p < 0.05) values were detected in the CAD group compared to the control group. A significant correlation was found between IMT and presence of diabetes mellitus (DM), systolic blood pressure, total cholesterol, and presence of plaque in carotids, and age. In the coronary artery disease group there was a significant correlation between AD and age, systolic blood pressure, and HDL cholesterol levels, while there was no significant correlation with plaque development. A significant correlation was also found between stiffness index and systolic blood pressure and age; however, there was no relation between number of involved vessels and IMT, AD, and SI. We found sensitivity, specificity, and positive predictive and negative predictive values for CAD diagnosis to be 70%, 75%, 77%, and 66%, respectively. In CAD cases, according to data in this study, IMT and SI increased while AD decreased, and this was detected by carotid artery Doppler ultrasonography. Therefore, it was concluded that these cheaper, noninvasive, and easily available parameters could be used in early diagnosis of CAD.
Clinical Evaluation of Coronary Lesion Characteristics in Acute Myocardial Infarction
Authors: Tomoda Haruo , Aoki Naoto
Published: July 2008

Coronary lesion instability at the onset of acute myocardial infarction (AMI) was evaluated. The mechanism of AMI has been considered to be coronary lesion instability with occlusive thrombus, although more than one half of AMI occurs in clinically stable patients. A total of 313 AMI patients treated by primary percutaneous transluminal coronary angioplasty with provi sional stenting (rate, 41 %) were studied. They were divided into 2 groups: group 1A (n = 211 ), without unstable angina before AMI onset, and group 1B (n = 102), with unstable angina before onset. Moreover, angina patients treated similarly were studied: group 2A (n = 180), with stable angina, and group 2B (n = 204), with unstable angina. Coronary lesion instability at AMI onset was also predicted by C-reactive protein (CRP) levels within 6 hours after onset, before they were affected by myocardial damage. The incidence of repeated AMI and/or target vessel revascularization was 1.9% in group 1A, 7.8% in 1B (p = 0.035), 1.7% in 2A, and 5.9% in 2B (p = 0.043). Event-free survival curves were consistent with each other in groups 1 A and 2A and in groups 1B and 2B. CRP levels on admission were 2.0 ± 1.7 mg/L in group 1A, 3.3 ±4.8 mg/L in group 1B (p < 0.001 ), 2.1 ± 1.7 mg/L in group 2A, and 3.4 ±4.7 mg/L in group 2B (p < 0.001). Thus coronary lesion characteristics at AMI onset appeared to be similar in groups 1 A and 2A and in groups 1B and 2B. A substantial number of patients have stable culprit lesions at the onset of AMI.
8-epi-PGF 2α and 6-oxo-PGFα in Human (Varicose) Veins: Influence of Age, Sex, and Risk Factors
Authors: Meghdadi Susan , Rodrigues Margarida , Oguogho A. , Santler R. , Sinzinger H.
Published: July 2008

The isoprostane 8-epi PGF 2α is a vasoconstrictive, mitogenic, proliferative, and mild proaggre gatory agent. We examined 8-epi-PGF 2α and 6-oxo-PGF1α from venous tissue derived from varicose (venous) surgery by means of a specific radioimmunoassay. A total of 336 samples from 82 patients (50 females, 32 males; aged 22-68 years) were examined. Tissue samples were classified according to normal, dilated, and varicose. Of these, 94 samples from 31 patients (20 females, 11 males; aged 29-64 years) with additional risk factors (cigarette smoking, hyperlipidemia, diabetes mellitus) were determined in the same way. Mean absolute values for 6-oxo-PGF1α are not significantly higher for dilated segments followed by varicose and intact samples. No significant age and sex differences can be monitored. Presence of risk factors, however, results in a significantly diminished 6-oxo-PGF1α, irrespective of morphology. 8-epi-PGF 2α again showed no age and sex dependence, its presence in varicose segments, however, was significantly (p<0.01) decreased. Risk factors resulted in a significantly increased 8-epi-PGF2α. These data indicate that the influence of risk factors on vasomodulatory (iso-)eicosanoids of human veins is more pronounced than the actual morphologic stage. Lower 8-epi-PGF2α in varicose veins may shift the venous tone toward vasodilatation and contribute to development and progression of varicosis.
False Coronary Lumen Originating from Left Main Coronary Artery Dissection Causing Acute Myocardial Infarction
Authors: Mauser Manfred
Published: July 2008

Spontaneous coronary artery dissection is a rare cause of acute myocardial infarction, which is infrequently diagnosed antemortem. The majority of the previously reported cases were found in women of whom a significant proportion presented during pregnancy or the post partum period. A case is presented of an acute myocardial infarction in a 37-year-old woman, unrelated to pregnancy or the postpartum state, with an unusual spontaneous coronary dissection that was angiographically documented 6 days after thrombolytic therapy. Origi nating in a small dissection in the left main coronary artery, a false lumen parallel to the left anterior descending coronary artery (LAD) with a separation of the lumina of up to 1 mm was found with a reentry of the false lumen into the LAD in its mid portion. Both lumina were perfused and the true lumen of the LAD showed a 50% to 60% diameter stenosis. Because no signs of ongoing ischemia could be detected at rest or during exercise, the patient was treated medically. Two months later, repeat coronary angiography documented a complete obliteration of the false lumen with moderate stenosis of the proximal LAD. Pathophysiologic aspects and treatment options of spontaneous coronary artery dissections are discussed.
Correction of AV-Nodal Block in a 27-Year-old Man with Severe Obstructive Sleep Apnea
Authors: Voigt Louis , Saul Barry I. , Lombardo Gerard , Reddy C.V.R. , Kassotis John
Published: July 2008

A 27-year-old morbidly obese man diagnosed with severe obstructive sleep apnea (OSA) and experiencing significant ventricular asystoles at times exceeding 8 seconds, during polysomnography. The bradyarrhythmias were successfully corrected with the application of a nasal continuous positive airway pressure (CPAP) mask. Follow-up 24-hour ambulatory Holter monitoring without the aid of a nasal CPAP mask and repeat polysomnography with a CPAP mask after several weeks of continuous CPAP therapy during sleep revealed no evidence of ventricular asystole, despite no change in the patient's body mass index. We discuss several mechanisms explaining the findings in this particular patient.
Deficiency of Protein S-Mediated Familial Venous Thrombophilia
Authors: Harada Tomohiro , Morita Hiroyuki , Imai Yasushi , Hayashi Doubun , Takeda Norihiko , Maemura Koji , Yazaki Yoshio , Nagai Ryozo
Published: July 2008

Deficiency of protein S causes potential problems of thrombosis. Cases of familial venous thrombosis due to deficiency of protein S were presented. First, an 85-year-old woman had pulmonary thromboembolism due to left deep femoral venous thrombosis, which might be triggered by leg fracture and the long-term treatment with a plaster cast. Next, her 29-year- old granddaughter had episodes of recurrent venous thrombosis in her legs and arms, which might be triggered by the treatment with a plaster cast and abortion. In the latter part, the aspects of risks for thromboembolism, potential problems in gestational period, and an advis ability of thromboprophylaxis in patients with deficiency of protein S are described.