bluuebunny/crossref_metadata_2025 huggingface dataset:
Nonatherosclerotic Aneurysm of the Left Circumflex Coronary Artery Presenting with Accelerated Angina Pectoris: Response to Medical Management
Authors: Khan Ijaz A. , Dogan Ozgen M. , Vasavada Balendu C. , Sacchi Terrence J.
Published: July 2008

Coronary artery aneurysm is defined as coronary dilatation with a diameter of more than 1.5 times the adjacent normal coronary artery. Most of the coronary aneurysms remain asymptomatic. More than 90% of coronary aneurysms are of atherosclerotic origin. Nonatherosclerotic coronary aneurysms are rare, and the majority of them are diffuse. Among the three major coronary arteries, the left circumflex artery is the least commonly involved. The management strategies for nonatherosclerotic coronary aneurysms are not clear, and each case should be managed on an individual basis depending on the clinical context. Here described is a case of a discrete nonatheroscle rotic aneurysm of the left circumflex coronary artery in a 46-year-old man who presented with accelerated angina pectoris and was treated medically. The patient was free of symptoms on 2-year follow-up. The clinical perspectives of the nonatherosclerotic coronary aneurysm are discussed.
Bilateral Pulmonary Artery Aneurysm Associated with Bilateral Pulmonary Thromboembolism, Superior Vena Caval Thrombosis, and Chagas' Disease
Authors: de Godoy José Maria Pereira , Batigália Fernando
Published: July 2008

The authors report a case of bilateral pulmonary artery aneurysm in a patient with chronic Chagas' disease and compensated congestive heart failure in whom clinical clues suggested pulmonary thromboembolism, and the actual nature of the lesions was discovered at the time of conventional imaging investigations. This case shows the rarity of bilateral pulmonary aneurysm associated with bilateral pulmonary throm boembolism and the importance of an awareness of this condition in the differential diagnosis for lung masses.
Tissue Response to an Expanded Polytetrafluoroethylene External Valve Support Device: A Histologic Study in Dogs
Authors: Nicolaides A.N. , Lennox A. , Agus G. , Geroulakos G. , Sabetai M. , Artese L. , Belcaro G.
Published: July 2008

Expanded polytetrafluoroethylene (ePTFE) external valve support devices (EVS) have been used successfully in patients to restore valve function in leg veins with incompetent valves when incompetence is due to dilatation of the vein walls or elongation of the valve leaflet edges. To assess tissue response to these devices, the authors implanted 12 of them in dogs, wrapping the devices around veins in the head and neck. The dogs recovered from the implantation procedure uneventfully, and the veins remained patent on color flow Doppler scanning. Gross and histologic evaluations of vein segments and attached EVS devices after sacrifice of the dogs 30 days postoperatively showed that the ePTFE devices did not affect vein patency or the cellular composition or architecture of vein walls. There were no adverse tissue reactions to the EVS and no thrombus formation in the veins to which the EVS had been applied. Tissue attachment to the EVS was apparent in all specimens. These histologic results support clinical experiences indicating that the ePTFE EVS device is safe to use in external valvuloplasty for the treatment of venous incompetence.
Superficial Vein Valve Repair with a New External Valve Support (EVS)
Authors: Incandela L. , Nicolaides A.N. , Agus G. , Errichi B.M. , Cesarone M.R. , De Sanctis M.T. , Ricci A. , Sabetai M. , Mondani P. , De Angelis R. , Bavera P. , Griffin M. , Geroulakos G. , Belcaro G.
Published: July 2008

The aim of this international multicenter trial was to evaluate the effects of a new surgical device (Gore External Valve Support-EVS) and technique for external valvuloplasty of the long saphenous vein (LSV). Patients with superficial venous disease and venous hyper tension due to pure superficial venous incompetence were randomized into two treatment groups, the first treated with "conventional treatment" (ligation or stripping) and the second with external valvuloplasty with the EVS. Patients with uncomplicated varicose veins within the age range of 35-65 years were included. Incompetence with presence of functional cusps at the saphenofemoral junction (SFJ), with vein dilatation were the main inclusion criteria. The EVS comprised of a GORE-TEX® patch material (including a nitinol frame) that is placed around the vein, producing a reduction in the caliber of the vein. Also the vein section becomes elliptical. These combined actions are aimed to reduce incompetence, allowing a better closure of the cusps. The EVS was placed at the SFJ after limited dissection of the vein and ligation of collaterals. The procedure was randomized as an alternative to simple ligation or stripping (according with the procedure commonly used in the center). The associated ligation of distal incom petent veins was allowed. The main outcome measures of the study were evaluated by color-duplex (morphologic findings and evaluation of reflux) and with ambulatory venous pressure (AVP) or air-plethysmography (APG). Main endpoints of the first year of the study and main subject of this report (mainly concerning safety within the first year of follow-up) were considered presence/absence of reflux; patency of the veins; mobility/function of vein cusps; occurrence of thrombosis; tolerability of the device; and increased complexity and operating time needed for the EVS. At 1 year 30 patients had been randomized (14 EVS implanted, 16 controls). Reflux was absent in all EVS patients, all treated veins were patent, and all cusps were mobile. No thrombosis had been observed and the tolerability of the device was very good. The increased complexity required by placing the EVS was limited (5-12 minutes more). In conclusion results of the first year show efficacy and tolerability of the EVS. In selected patients (superficial LSV incompetence, reflux-dilatation, functional SFJ cusps, incompetence mainly due to enlargement of the vein), the EVS could be an effective alternative to "destructive" ligation and/or stripping of the vein. Prolonged follow-up will indicate the clinical poten tials of the EVS.
Effects of Shock Waves on the Microcirculation in Critical Limb Ischemia (CLI) (8-Week Study)
Authors: De Sanctis M.T. , Belcaro G. , Nicolaides A.N. , Cesarone M.R. , Incandela L. , Marlinghaus E. , Griffin M. , Capodanno S. , Ciccarelli R.
Published: July 2008

Shock waves (SWs) are used to control and decrease pain in several clinical conditions (eg, painful elbow and shoulder, etc). This clinical effect may be due to cellular stunning of the tissues (particularly nervous components) in the area treated with SW. It may also be the consequence of unknown metabolic actions on tissues, which may include changes in cellular permeability and the liberation of proteins and mediators locally acting on pain and nerve endings. The aim of this study was to evaluate the reduction in pain and the microcirculation improvement induced by SWs treatment in an 8-week study in patients with chronic limb ischemia (CLI). Patients with CLI (15 with rest pain only and 15 with rest pain and limited distal necrosis) were included. The treatment was based on a 30-minute SWs session, three times weekly for 2 weeks. Clinical and microcirculatory evaluation were performed with laser Doppler PO 2 and PCO2 measurements. Pain was measured with an analogue scale line. A Minilith SL1 (Storz Medical, Switzerland) litotriptor was used. The parabolic reflector is coupled to the skin with a silicon water cushion. Focal pressure was adjusted between 6 and 70 Mpa in eight steps. The energy flux density was variable from 0.03 to 0.5 mJ/mm2. Focal diameter and distance were defined (depth of target within the patient's foot of about 70 mm). The coded intensity used in this study was between 6 and 8 and the application time was 20 min (at four impulses per second). Twenty-eight of the 30 patients with CLI (15 with rest pain only and 13 with necrosis) completed the study. The treatment was well tolerated. Blood pressure was unchanged after 8 weeks while the increase in laser Doppler flux was significant (p<0.05) (at all measurements after treatment). The ORACLE score at 1 and 8 weeks was decreased (p < 0.05). The same trend was observed with the analogue scale line for pain (p < 0.05). PO2 increased (p < 0.05) and PCO2 decreased (p < 0.05). Tibial pressure did not change. All patients observed an increase in their subjective pain-free walking distance. The improvement was still present after 8 weeks. In a separate subset of 37 patients (mean age 60 ±9 years; males) with CLI, a SWs dose-finding evaluation was performed. Flux changes were measured at the dorsum of the foot. Three treatment plans were used: (a) 20-minute SW treatment only once; (b) 20-minute SWs treatment every 2 days for 1 week; (c) 20 minutes every day for 1 week. Treatments were well tolerated. A different increase in flux was observed on the basis of different treatments. Flux vari ations generally indicated that increased SWs dosage was associated with proportional flux increase. Flux improvement was still present after 4 weeks. SWs treatment in CLI produced changes both in the microcirculation and on pain. These preliminary results are comforting and open new research options to be explored in the near future.
Comparison of the One-and-a-Half-Year Results of Closure of Patent Ductus Arteriosus by Transcatheter Coils Placement with Surgical Ligation
Authors: Lee Pi-Chang , Weng Zen-Chung , Fu Yun-Ching , Hsing Hseuh-Ping , Lu Jen-Her , Hsieh Wang-Hun , Jan Sheng-Ling , Meng C. C. Laura , Hwang Betau
Published: July 2008

Patent ductus arteriosus (PDA) is a common type of congenital cardiovascular lesion. It usually needs surgical ligation in a full-term baby after 1 year of age. Transcatheter implantation of coils was introduced for the closure of small- to moderate-sized PDA in 1992. From November 1995 to November 1998, the authors closed the PDA in 153 patients by transcatheter implantation of coils and by surgical ligation in 10 patients. One hundred fourteen of them were studied for more than 1½ years. The regular follow- up studies, including physical examination; electrocardiography; and pulsed, continuous- wave, and color Doppler flow mapping, were performed on day one and day 2, and 1 week, 1 month, 3 months, 6 months, and 1 year after the procedure. The results of the closure of PDA by surgical ligation or coil placement were compared and analyzed in all the patients.
Criteria Predictive of Limb Viability at 1 Year in Patients with Chronic Severe Ischemia-TcPO 2 and Demographic Parameters
Authors: Habault P. , Eveno D. , Le Lamer S. , Ledemeney M. , Haon C. , Chomard D.
Published: July 2008

Following an earlier study, the investigators sought to identify and define objective prog nostic criteria of viability at 1 year of a limb with severe chronic ischemia. A study was undertaken in 116 patients (118 limbs) (74 men and 42 women), with a mean age of 71.9 years for men and 81.6 years for women. Static transcutaneous oxygen pressure (TcPO 2) was measured with a verticalization sensitization test and inhalation of oxygen on JO and viability of the limb noted 1 year later. Logistic analysis was made of 13 oximetry parameters and two demographic parameters (age and gender). Results were analyzed in absolute terms and by tissue oxygenation ratio (TOR) (ratio between absolute TcPO2 at the foot and at a chest reference electrode). Six factors appeared to be prog nostic factors of limb viability at 1 year, statistically significant at 6% according to threshold values: age, verticalization TcPO2, TcPO2 after 1 minute's inhalation of oxygen, TcPO2 after 4 minutes' inhalation of oxygen, and slope of TcPO 2 and slope of TOR between 1 and 4 minutes' inhalation. A 1 year viability index integrating these criteria is suggested.
A 25-Year-Old Patient with Low Cardiac Risk Factors Having a Combination of Variant Angina and Severe Coronary Arterial Lesions
Authors: Hara Yuji , Komatsu Jiro , Hiasa Go , Ohtsuka Tomoaki , Suzuki Makoto , Shigematsu Yuji , Ohkura Takafumi , Hamada Mareomi , Hiwada Kunio , Hara Yuji
Published: July 2008

A 25-year-old man with low cardiac risks underwent coronary arteriography because of chest pain at rest. His only risk factors for coronary artery disease was smoking. Both right and left coronary arteries were ectatic and the left anterior descending artery was obstructed. In the acetylcholine provocation test, the left circumflex coronary artery showed severe constriction. Thus, this patient was diagnosed as having a combination of variant angina and occlusive coronary artery disease.
Stroke: Epidemiology, Clinical Picture, and Risk Factors
Authors: Tegos Thomas J. , Kalodiki Evi , Daskalopoulou Stella-Styliani , Nicolaides Andrew N.
Published: July 2008

The aim of this review is to present the current knowledge regarding stroke. It will appear in three parts (in part II the pathogenesis, investigations, and prognosis will be presented, while part III will consist of the management and rehabilitation). In the current part (I) the definitions of the clinical picture are presented. These include: amaurosis fugax, vertebrobasilar transient ischemic attack, and stroke (with good recovery, in evolution and complete). The role of the following risk factors is discussed in detail: age, gender, ethnicity, heredity, hypertension, cigarette smoking, hyperlipidemia, diabetes mellitus, obesity, fibrinogen and clotting factors, oral contraceptives, erythrocytosis and hematocrit level, prior cerebrovascular and other diseases, physical inactivity, diet and alcohol consumption, illicit drug use, and genetic predisposition. In particular, regarding the carotid arteries, the following characteristics are analyzed: atheroma, carotid plaque echomorphology, carotid stenosis, presence of ulcer, local variations in surface deforma bility, pathological characteristics, and dissection. Finally the significance of the cerebral collateral circulation and the conditions predisposing to cardioembolism and to cerebral hemorrhage are presented.
Hyperinsulinemia, Lipoprotein (a), and Chlamydia pneumoniae Antibodies—Are They Risk Factors or Serologic Predictors for Progression of Coronary Artery Disease?
Authors: Tontsch Daniela , Noll Bernd , Schaefer Juergen Rolf , Herzum Matthias , Maisch Bernhard , Goeke Burkhard
Published: July 2008

The authors studied 134 patients with unstable angina pectoris symptoms and 32 subjects without coronary artery disease (CAD) for the presence of classical risk factors such as hypercholesterolemia, smoking, and family history of CAD. In addition they analyzed plasma insulin levels, lipoprotein (a) (Lp[a]) levels, and antibody titers against Chlamydia pneumoniae. All patients had a heart catheterization. Patients with diabetes mellitus were excluded from the study. Fasting insulin, low-density lipoprotein (LDL) cholesterol and Chlamydia pneumoniae immunoglobulin G (IgG) and IgA antibody titers did not show any difference in CAD from healthy control subjects, whereas Lp(a) was increased and high- density lipoprotein (HDL) decreased in CAD patients. These data indicate that lipoprotein (a), low HDL cholesterol, and smoking, but neither hyperinsulinemia nor elevated Chlamydia pneumoniae titers, are risk factors or predictors for CAD.
Acute ECG Changes and Chest Pain Induced by Neck Motion in Patients with Cervical Hernia
Authors: Güler Niyazi , Bilge Mehmet , Eryonucu Beyhan , Cirak Bayram
Published: July 2008

We report two cases of acute cervical angina and ECG changes induced by anteflexion of the head. Cervical angina is defined as chest pain that resembles true cardiac angina but originates from cervical discopathy with nerve root compression. In these patients, Prinzmetal's angina, valvular heart disease, congenital heart disease, left ventricular aneurysm, and cardiomyopathy were excluded. After all, the patient's chest pain was reproduced by anteflexion of head, at this time, their ECGs showed nonspecific ST-T changes in the inferior and anterior leads different from the basal ECG. ECG changes returned to normal when the patient's neck moved to the neutral position. To our knowledge, these are the first cases of cervical angina associated with acute ECG changes by neck motion.
Acute Reversible Cardiomyopathy and Thromboembolism After Cisplatin and 5-Fluorouracil Chemotherapy
Authors: Cheriparambil Kuruvilla Mani , Vasireddy Hemalatha , Kuruvilla Anita , Gambarin Boris , Makan Majesh , Saul Barry I.
Published: July 2008

Acute development of cardiomyopathy and occlusive thromboembolic events following cisplatin and 5-fluorouracil (5-FU) is rare but frequently lethal. The authors report the successful management of such an event in a 52-year-old man with squamous cell carcinoma of the soft palate. The possible pathophysiological mechanisms are discussed.
Evaluation of Electron Beam Tomographic Coronary Arteriography with Three-Dimensional Reconstruction in Healthy Subjects
Authors: Lu Bin , Dai RuPing , Bai Hua , He Sha , Jing BaoLian , Zhuang Nan , Gao RunLin , Yang YueJin , Chen JiLin , Budoff Matthew J.
Published: July 2008

In this study, the authors evaluated the performance characteristics of contrast-enhanced electron-beam tomography (EBT) with three-dimensional reconstruction in defining the coronary artery lumen in healthy subjects. Thirty patients with normal coronary angiograms by selective coronary arteriography (SCA) underwent contrast-enhanced EBT examination. Measured parameters included degree of luminal enhancement, intravascular contrast-to-noise ratio (CNR), and diameter and length of visualized lumen. Ventricular cavity, aortic blood pool, and coronary artery attenuation were found to be significantly different before and after intravenous injection of contrast material (p < 0.001). CNR decreased from proximal to distal segments within each vessel (p < 0.001), with a peak of 11.2 ±2.3 occurring in the proximal left anterior descending coronary artery (LAD) to a low of 4.8 2.0 in the distal left circumflex (LCX). Luminal diameters visualized by EBT had no significant difference with that of SCA (p > 0.05). Therefore, EBT angiography with three-dimensional reconstruction allows for noninva sive coronary arteriography revealing long segments of the major coronary arteries in normal subjects.
Differences in Beat-to-Beat Variability of the QT Interval Between Day and Night
Authors: Kostis William J. , Belina John C.
Published: July 2008

The objective of this study was to evaluate the beat-to-beat variability of the QT interval during the day and night. A new algorithm was used to detect the onset of the QRS, the apex of the T wave, and end of the T in ambulatory electrocardiographic recordings. Beat-to-beat variability of QT, QaT, and QTc during the day and night was studied in the time, frequency, and chaotic domains. Participants were adults without clinical evidence of heart disease. Although the QT duration was higher (p = 0.0001) at night, the beat-to- beat variability of this interval was lower: in the time domain (decreased standard deviation, p = 0.0005), in the frequency domain (decreased low-frequency power of the spectra, p = 0.004), and the chaotic domain (tighter clustering of the points in the Poincaré plots). The high-frequency to low-frequency ratio of the power spectra of the QT (and the RR) was higher (p = 0.03) at night. Beat-to-beat QT variability in the time, frequency, and chaotic domains is decreased at night with shift of the QT modulation to higher frequencies corresponding to respiration and representing vagal preponderance. The techniques presented here and the findings in normal subjects may be useful in eval uating the risk for arrhythmic events in patients with heart disease.
Short- and Long-Term Results of Abciximab Versus Aspirin in Conjunction with Thrombolysis for Patients with Peripheral Occlusive Arterial Disease and Arterial Thrombosis
Authors: Schweizer Johannes , Kirch Wilhelm , Koch Reiner , Müller Axel , Hellner Grit , Forkmann Lutz
Published: July 2008

Acute peripheral occlusive arterial disease is an important cause of morbidity and mortality, particularly among older persons. Catheter-directed thrombolytic therapy is the treatment of choice but has limitations: long lytic times, occlusions refractory to throm bolysis, and a high rate of restenosis. We conducted a pilot study to evaluate the use of the platelet GP IIb/IIIa receptor antagonist abciximab versus aspirin in conjunction with thrombolysis in patients with acute peripheral occlusive arterial disease associated with arterial thrombosis.

A total of 84 patients were randomized into two equal groups to receive 5 mg recom binant tissue plasminogen activator intravenously and 500 IU heparin/hour along with either 500 mg acetylsalicylic acid or a bolus of 0.25 mg/kg abciximab followed by 10 μg/min abciximab over 12 hours (heparin reduced to 250 IU/hour). Primary efficacy criteria included the number of rehospitalizations, reinterventions, and amputations during the following 6 months. Secondary endpoints were the changes in the Fontaine stage, Bollinger index (vessel occlusion), ankle-to-brachial ratios, distance to claudication after 6 months, and the duration of the initial local lysis treatment.

Adjunctive use of abciximab reduced the rates of rehospitalization, reinterventions, and amputations versus results with the use of aspirin (10 vs 14 occurrences, respec tively ; 9 vs 11; 3 vs 5; when summed, intergroup difference p < 0.05). Secondary periph eral occlusive arterial disease variables became highly significant versus aspirin (p < 0.001 or greater) at 3 and 6 months after treatment. The duration of lysis was markedly shorter upon addition of abciximab versus aspirin (75 vs 110 min; p < 0.001). No major bleeding complications or embolisms occurred. These preliminary results indicate that abciximab may have a useful role when used adjunctively with a thrombolytic agent in older persons with acute peripheral occlusive arterial disease and arterial thrombosis.
Evaluation of Dysrhythmia in Children with Muscular Dystrophy
Authors: Oguz Deniz , Olguntürk Rana , Tunaoglu Fatma Sedef , Gücüyener Kivilcim , Köse Gülşen , Ünlü Mustafa
Published: July 2008

Myocardial involvement and dysrhythmia are common findings with muscular dystrophy and are among the leading causes of death. The authors evaluated rhythm and conduc tion abnormalities in children with muscular dystrophy by electrocardiography, signal- averaged electrocardiography, and Holter monitoring. Twenty-nine patients (mean age, 8 years) and 29 healthy control subjects were included in the study.

Sixty-two percent of patients had electrocardiographic abnormalities defined as deep Q waves in V 6, tall R waves in V1, and QRS axis deviation. The cardiomyopathy index was significantly greater in the patient group whereas QT and QTc dispersion values showed no significant difference. Holter monitoring revealed premature atrial and ventricular contractions more frequently than normal. However all were classified as Lown I and II. Mean heart rate was significantly higher in the patient group. The elec trocardiograms of 41% of the patients showed late potentials. No relationship with these changes and cardiac function was observed. During the study, one patient died whose cardiomyopathy index was longer and had late potentials detected with signal- averaged electrocardiography.

In conclusion, standard electrocardiography, cardiomyopathy index, signal-averaged electrocardiography, and Holter monitoring are valuable and reliable monitoring methods in children with muscular dystrophy.
Embolic Stroke Secondary to an Aortic Arch Tumor
Authors: Urrutia Victor , Jichici Draga , Thomas Carole E. , Nunes Linda W. , Schwartzman Robert J.
Published: July 2008

An acute stroke from an aortic arch tumor is reported. These tumors are rare and have to be differentiated from atheromas. Aortic atheromas commonly present with embolic phenomena and occasionally as masses. Aortic tumors are more likely to produce obstruc tive phenomena, presenting as a coarctation or dissection. Magnetic resonance imaging with gadolinium can facilitate the diagnosis. A literature review of aortic masses and their diagnosis and treatment are presented.
Pulmonary Hypertension Associated with Liver Cirrhosis: An Echocardiographic Study
Authors: Auletta Maria , Oliviero Ugo , Iasiuolo Luigi , Scherillo Giovanna , Antoniello Salvatore
Published: July 2008

Conflicting results about the prevalence of pulmonary hypertension, ranging from 0.25% to 20%, in liver patients with portal hypertension, have previously been reported. The aim of this study was to evaluate pulmonary arterial pressure in a consecutive series of cirrhotic patients, using a noninvasive method. A complete clinical, laboratory, ultra sonographic, and endoscopic evaluation were performed in 83 consecutive liver patients assessed according to Child's classification and Pugh's score and according to evidence of ultrasonographic and/or endoscopic signs of portal hypertension. A complete echocar diographic evaluation was also performed and pulmonary arterial systolic pressure (PASP) was estimated by measuring tricuspidal regurgitation, using the modified Bernoulli equation. These same evaluations were performed by the same observers in a group of 60 healthy volunteers. The results showed a surprisingly high prevalence (about 20%) of pulmonary hypertension. Patients with more severe liver damage and portal hypertension showed a high prevalence for pulmonary hypertension. A progression in the frequency of portopulmonary hypertension (PPH) was found in Child's classification A to C, and in patients without to patients with evidence of portal hypertension. However, increased PASP was detected in some patients belonging to Child's class A, without evidence of portal hypertension. (continued on next page)

In conclusion, the echocardiographic examination (a noninvasive technique), appears suitable for detecting pulmonary hypertension in patients with compensated liver cirrhosis, and can elucidate some aspects of the clinical course of the so-called PPH syndrome.
Emergency Bedside Echocardiography as a Tool for Early Detection and Clinical Decision Making in Cases of Suspected Pulmonary Embolism
Authors: Karavidas Apostolos , Matsakas Evangellos , Lazaros George , Panou Fotis , Foukarakis Manolis , Zacharoulis Apostolos
Published: July 2008

Massive pulmonary embolism (PE) constitutes the most unexpected cause of death in necropsy. Consequently, prompt diagnosis and treatment is considered imperative. This article reports the case of a 37-year-old man who presented with cardiogenic shock due to PE as detected with bedside echocardiography in the emergency department. The authors wish to emphasize the usefulness of emergency bedside echo-Doppler for a prompt diagnosis and treatment of this life threatening condition.
Coronary Spastic Angina Induced by Anticholinesterase Medication for Myasthenia Gravis
Authors: Suzuki Makoto , Yoshii Toyofumi , Ohtsuka Tomoaki , Sasaki Osamu , Hara Yuji , Okura Takafumi , Shigematsu Yuji , Hamada Mareomi , Hiwada Kunio
Published: July 2008

Myasthenia gravis (MG) is characterized by weakness of skeletal muscles because of a decrease in the number of available acetylcholine receptors at neuromuscular junctions. Anticholinesterase medication is widely used to treat MG, but muscarinic side effects sometimes appear and limit the drug usage. To their knowledge, the authors present the first case of coronary spastic angina quite possibly induced by anticholinesterase medica tion to treat MG. The appearance of coronary spastic angina in the present case is likely mediated through the increase of acethylcholine by anticholinesterase medication.
Cannabis Arteritis Revisited
Authors: Disdier Patrick , Granel Brigitte , Serratrice Jacques , Constans Joël , Michon-Pasturel Ulrique , Hachulla Eric , Conri Claude , Devulder Bernard , Swiader Laure , Piquet Philippe , Branchereau Alain , Jouglard Jacqueline , Moulin Guy , Weiller Pierre-Jean
Published: July 2008

The purpose of this paper was to revisit the old concept of cannabis arteritis first described in the 1960s and report 10 new cases. Ten male patients, with a median age of 23.7 years developed subacute distal ischemia of lower or upper limbs, leading to necrosis in the toes and/or fingers and sometimes to distal limb gangrene. Two of the patients also presented with venous thrombosis and three patients were suffering from a recent Raynaud's phenomenon. Biological test results did not show evidence of the classical vascular risk factors for throm bosis. Arteriographic evaluation in all cases revealed distal abnormalities in the arteries of feet, legs, forearms, and hands resembling those of Buerger's disease. A collateral circulation sometimes with opacification of the vasa nervorum was noted. In some cases, arterial proximal atherosclerotic lesions and venous thrombosis were observed. All patients were moderate tobacco smokers and regular cannabis users. Despite treatment with ilomedine and heparin in all cases, five amputations were necessary in four patients. The vasoconstrictor effect of cannabis on the vascular system has been known for a long time. It has been shown that delta-8- and delta-9-tetrahydrocanabinols may induce peripheral vasoconstrictor activity. Cannabis arteritis resembles Buerger's disease, but patients were moderate tobacco smokers and regular cannabis users. These cases show that prolonged use of cannabis could be an additive risk factor for juvenile and young adult arteritis. Cannabis arteritis is a forgotten and severe occlusive vascular disease occurring in young adults. Search for cannabis use may be an important tool for a better knowledge of arteritis in young smokers.
Lower Extremity Strength Deficits in Peripheral Arterial Occlusive Disease Patients with Intermittent Claudication
Authors: Scott-Okafor Hellena R. , Silver Kenneth K. C. , Parker James , Almy-Albert Tresa , Gardner Andrew W.
Published: July 2008

The purposes of this study were to quantify the degree and distribution of lower extremity weakness in patients with peripheral arterial occlusive disease (PAOD) compared to apparently healthy older patients and to determine if performance of a simple functional measure correlates with lower extremity strength. Older patients (n=46), 31 with PAOD (mean age = 69.9 years; mean ankle-brachial index = 0.67) and 15 without PAOD (mean age = 62.6 years; mean ankle brachial index = 1.20), underwent isometric strength testing of hip, knee, and ankle musculature. In patients with PAOD, dorsiflexion strength was 15% lower (p<0.05) in the more affected limb (55 ±4 Newton-meters; mean ±SE) versus the less affected limb (65 ±5 Newton-meters). Overall, the dorsiflexor muscles of the more affected extremity were 22% weaker (p<0.05) in the PAOD group than in the non-PAOD group (73 ±6 Newton-meters). No other significant differences in strength were found between the PAOD and the healthy elderly groups or between the more affected and less affected limbs in the PAOD patients. The time to perform five sequential sit-to- stand transfers using an armless chair was 23% greater (p<0.01 ) in the PAOD group (13.0 ±0.5 s) than in the healthy elderly (10.7 ±0.9 s). In the PAOD patients, dorsiflexor strength was corre lated with chair stand time (r = -0.37, p<0.05). The authors conclude that PAOD patients with intermittent claudication are functionally limited by dorsiflexion weakness, impairing their ability to perform tasks requiring distal lower extremity strength.
QT Dispersion in Single Coronary Artery Disease: Is There a Relation Between QT Dispersion and Diseased Coronary Artery or Lesion Localization?
Authors: Tikiz Hakan , Terzi Tural , Balbay Yücel , Demir Ahmet D. , Soylu Mustafa , Keles Telat , Kutuk Emine
Published: July 2008

It has been shown that QT dispersion (QTD) increases during episodes of myocardial ischemia or infarction. However, no extensive data on the relation between the diseased coronary artery or the localization of stenosis and the QTD are available. The aim of the study was to examine the relation between QTD and diseased coronary artery and lesion localization during exercise stress test in patients with single coronary artery disease without prior myocardial infarction.

One hundred nineteen patients with single coronary artery disease and 53 patients with normal coronary arteries were enrolled in study. All patients underwent exercise stress test with modified Bruce protocol, and QT interval parameters were measured at rest and at minute 2 of the recovery (rec-2) period. QT dispersion at rest was found higher in all single-vessel disease groups compared with that in the control group, and corrected QT dispersion at rec-2 period was also markedly higher in left anterior descending, circumflex, and right coronary artery groups compared with that in the control group. No relation was found between QT dispersion and diseased coronary artery or the lesion localization.

In conclusion, no qualitative difference was found between QT dispersion and diseased coronary artery or proximal or distal lesion localization. However, it was observed that patients with single-vessel disease had wider baseline QT dispersion as compared with that in the control group, which further increased significantly with exercise. This finding supports the idea that severity of localized ischemia rather than extent of coronary artery disease would be expected to have a greater effect on inducible QT dispersion.
Improvement of Left Ventricular Diastolic Dynamics in Prediabetic Stage of A Type II Diabetic Rat Model After Troglitazone Treatment
Authors: Li Yao  , Mizushige Katsufumi , Noma Takahisa , Murakami Kazushi , Ohmori Koji , Matsuo Hirohide
Published: July 2008

Troglitazone, an oral antidiabetic agent, has hypoglycemic effects in insulin-resistant animal models and humans. This study was conducted to evaluate its effect on left ventricular diastolic dynamics of a spontaneous diabetic (DM) rat model. Twenty DM rats and 20 age-matched nonDM rats were used, and 10 of each group were treated with troglitazone as a 0.2% food admixture for 10 weeks. At 5 and 15 weeks of age, Doppler echocardiography and M-mode echocardiography were performed. Troglitazone treatment significantly improved the left ventricular diastolic dynamics of DM rats: deceleration time (msec) of early diastolic inflow decreased significantly (treated 52 ±3 vs untreated 64 ±5, p = 0.0002), and peak velocity of early transmitral inflow (cm/sec) increased significantly (treated 96 ±7 vs untreated 86 ±8, p = 0.0216). The data suggest that troglitazone improves left ventricular diastolic dynamics of a DM rat model at prediabetic stage.
A Huge Mitral Valve Tumor and its Vascularity
Authors: Batur Mustafa Kemal , Yildirir Aylin , Kabakci Giray , Aksöyek Serdar
Published: July 2008

Primary cardiac tumors of the mitral valve are extremely rare; however, they present a major risk of embolization. Therefore, prompt diagnosis and urgent treatment is obligatory. The authors report the case of a 60-year-old man with a huge mitral valve mass and its vascu larity, which was diagnosed by transthoracic echocardiography and selective coronary arteri ography. Our patient's mitral valve tumor had a size of 5.9 X 2.9 cm, which was the largest size reported up to this time in this location. The patient died from a major cerebrovascular event before surgical excision could be performed.
Myocardial Infarction During Sleep Deprivation in a Patient with Dextrocardia
Authors: Delva Nicholas J. , Woo Michael , Southmayd Stephen E. , Hawken Emily R.
Published: July 2008

A patient with dextrocardia who suffered his first myocardial infarction after approximately 26 hours of a diagnostic sleep deprivation protocol is described. The infarction started about 3 hours after a significant improvement in mood, which persisted during and after infarction. Total sleep deprivation may be an acute risk factor for myocardial infarction.
A Long-Term Study of Policosanol in the Treatment of Intermittent Claudication
Authors: Castaño Gladys , Ferreiro Rosa Más , Fernández Lilia , Gámez Rafael , Illnait José , Fernández Julio César
Published: July 2008

Policosanol is a cholesterol-lowering drug with concomitant antiplatelet effects. This study was undertaken to investigate the long-term effects of policosanol administered to patients with moderately severe intermittent claudication. The study consisted of a 6-week single-blind, placebo-controlled run in phase, followed by a 2-year double-blind, randomized treatment step. Fifty-six patients who met study entry criteria were randomized to receive placebo or poli cosanol 10 mg twice daily. Walking distances on a treadmill (constant speed 3.2 km/h, slope 10°, temperature 25°C) were assessed before and after 6, 12, 18, and 24 months of treatment. Both groups were similar at randomization. After 6 months of therapy, policosanol significantly increased (p < 0.0 1) the initial claudication distance from 125.9 ±8.7 m to 201.1 ±24.8 m and the absolute claudication distance from 219.5 ± 14.1 m to 380.7 ±50.2 m. Both variables remained unchanged in the placebo group (p<0.01). These effects did not wear off but improved after long-term therapy, so that final values were 333.5 ±28.6 m (initial claudication distance) and 648.9 ±54.1 m (absolute claudication distance); both significantly greater (p<0.0001) than those obtained in the placebo group, which showed values of 137.9 ±21.8 m (initial claudication distance) and 237.7 ±28.1 m (absolute claudication distance), respectively. At study completion, 21 policosanol and 5 placebo patients attained increases in claudication distance values > 50% (p < 0.001). Policosanol, but not placebo, significantly increased the ankle/arm pressure index. In addition, from month 6 up to study completion, the frequency of patients reporting improve ment of lower limb symptoms was greater in the policosanol group than in the placebo group. The treatment was tolerated well. There were 16 withdrawals (12 placebo, 4 policosanol) from the study. Eight patients in the placebo group experienced a total of 10 serious adverse events, 8 of which were vascular events, compared with none in the policosanol group (p<0.01). In addition, 3 patients in the policosanol group and 3 patients in the placebo group reported mild adverse events during the study. The present results demonstrate the long-term usefulness of policosanol therapy to treat patients with intermittent claudication.
Exercise-Induced Left Bundle Branch Block During Thallium 201 Myocardial Perfusion Scintigraphy
Authors: Bozkurt Murat Fani , Yildirir Aylin , Kabakçi Giray , Caner Biray
Published: July 2008

Exercise-induced left bundle branch block (Ex-LBBB) is a rare entity encountered during exercise testing. The authors present a 53-year-old woman who developed intermittent Ex- LBBB asymptomatically during TI 201 myocardial perfusion scintigraphy. Scintigraphic findings revealed septal-anteroseptal ischemia while the coronary arteriogram appeared normal. False- positive septal-anteroseptal scintigraphic findings suggesting ischemia in patients with persis tent left bundle branch block (LBBB) is well known, but since the LBBB in this case was induced by exercise testing and was spontaneously terminated at rest, scintigraphic findings may be attributed to microcirculatory ischemia, which cannot be detected angiographically, as the cause of Ex-LBBB.
Successful Resuscitation of Patient with Massive Coronary Air Embolism Occluding Two Vessels During Coronary Angiography
Authors: Wen Lieng Lee  , Chin Chung-Shih , Lai Chu-Jen , Ho Hong-Yun , Ting Chih-Tai
Published: July 2008

Massive coronary air embolism is usually disastrous although successful resuscitation has been reported previously. To what extent a patient with coronary air embolism can be resuscitated is not known. The authors report a rare case of massive air embolism to the left coronary arteries and successful resuscitation by vigilantly maintaining an effective driving force to dissipate the air lock.
Comparative Efficacy of Primary Angioplasty with Stent Implantation and Thrombolysis in Restoring Basal Coronary Artery Flow in Acute ST Segment Elevation Myocardial Infarction: Quantitative Assessment Using the Corrected TIMI Frame Count
Authors: Vrachatis Anthony D. , Alpert Martin A. , Georgulas Vassilios P. , Nikas Dimitris J. , Petropoulou Evdokia N. , Lazaros George I. , Michelakakis Nicholaos A. , Karavidis Apostolos I. , Lakoumentas John A. , Stergiou Leonidas , Zacharoulis Apostolos A.
Published: July 2008

Following thrombolysis and primary percutaneous transluminal coronary angioplasty (PTCA) for acute ST segment elevation myocardial infarction, basal flow in the culprit artery is known to influence prognosis. The purpose of this study was to determine if differences exist in basal flow in culprit and nonculprit coronary arteries in patients with acute ST segment elevation myocardial infarction who were treated with thrombolysis or primary PTCA with stent implan tation. Twenty patients were randomized to thrombolysis (with recombinant tissue plasminogen activator) and 24 to primary PTCA with stent implantation within 3 hours of onset of acute ST segment elevation myocardial infarction. Coronary angiography was performed 90-120 minutes after thrombolysis or immediately after PTCA with stent implantation and again at 18-36 hours after intervention in both groups. Patients who failed to achieve thrombolysis in myocardial infarction (TIMI) grade 2 or 3 flow were excluded. The corrected TIMI frame count was used as the index of basal coronary artery flow. Early after intervention the mean corrected TIMI frame count in the culprit coronary artery was significantly lower in the primary PTCA with stent group (27.4 ±7.7 frames) than in the thrombolysis group (39.8 ± 10 frames, p < 0.001). Eight thrombolysis patients (40%) and 20 primary PTCA patients (83%, p < 0.01 ) achieved TIMI grade 3 flow early after intervention. By 18-36 hours after intervention there were no significant differences in the mean correct TIMI frame count between the thrombolysis and primary PTCA with stent groups. There were no significant differences in the mean corrected TIMI frame count between these two groups in the nonculprit coronary artery, either early after interven tion or at 18-36 hours. In successfully reperfused coronary arteries following acute ST segment elevation myocardial infarction, primary angioplasty with stent implantation reestablished TIMI grade 2 or 3 flow faster and more effectively than thrombolysis did.
Microalbuminuria, Pulse Pressure, Left Ventricular Hypertrophy, and Myocardial Ultrasonic Tissue Characterization In Essential Hypertension
Authors: Di Bello Vitantonio , Pedrinelli Roberto , Giorgi Davide , Bertini Alessio , Caputo Maria Teresa , Cioppi Adriano , Talini Enrica , Leonardo Moretti , Dell'Omo Giulia , Paterni Marco , Giusti Costantino
Published: July 2008

Microalbuminuria (UAE) may be considered a marker of systemic vascular dysfunction, while pulse pressure (PP) is an indicator of the stiffness of vascular conduits. Both these parame ters, together with left ventricular hypertrophy (LVH), are linked to cardiovascular morbidity in hypertensive patients. The aim of this study was the analysis of the possible relationships among UAE, PP, and LVH with ultrasonic myocardial textural parameters, which are altered in hypertensives patients. A group of male (n = 70) essential hypertensive patients (mean age: 58 ±7 yr) was analyzed with a group of age-comparable normotensive healthy subjects as controls (n = 32). Ambulatory blood pressure monitoring (ABPM) was performed with an oscil lometric monitor; UAE was measured by nephelometry. A conventional 2D-Doppler echocar diography (to analyze left ventricular mass: LVM) and a quantitative analysis of the echocar diographic digitized imaging with the use of a calibrated digitization system (to calculate the septum and the posterior wall textural parameters) were performed on all subjects. The myocardial mean gray level was calculated to derive the cyclic variation index (CVI).

The CVI was significantly lower in hypertensives both for the septum (-16.3 ±22.8 vs 34.7 ±15.3%; p < 0.001 ) and for the posterior wall (-15.2 ±23.6 vs 38.2 ±15.4%; p < 0.001 ). A signifi cant negative correlation was found between logUAE and the CVI of the septum (r = -0.42; p<0.001), between the PP and the CVI of the septum (r = -0.40; p<0.002) and between the CVI and the LVM (r = -0.38; p<0.001). Multiple regression analysis having as dependent variable the CVI at septum level showed as significantly related independent variables: PP (p<0.01), logUAE (p < 0.001), and LVM (p<0.05) (multiple R: 0.76, squared multiple R: 0.57; p<0.001 ).

It was found that LVM, logUAE, and PP are all correlated with textural parameters, and the CVI can be considered a sensitive parameter in the identification of an abnormal myocardial texture in hypertension. A high level of arterial stiffness and the presence of vascular dysfunc tion in essential hypertension could participate in the determination of myocardial alterations and permit the identification of patients with the worst prognosis in terms of morbidity or mortality due to cardiovascular events.
Recurrent Ischemia Resulting from Left Internal Mammary Artery-to-Pulmonary Artery Fistula
Authors: Madu Ernest C. , Hanumanthu Sai K. , Kim Chris , Prudoff Adam
Published: July 2008

This report describes a case series of recurrent ischemia after coronary artery bypass grafting resulting from left internal mammary artery-to-pulmonary artery fistula. An angiographic demonstration of this fistula is presented.
Association Between Mitral Annular Calcification and Carotid Atheroma
Authors: Soylu Mustafa , Demir Ahmet Duran , Arda Kemal , Uzun Yücel , Göksel Siber
Published: July 2008

Carotid artery atherosclerosis is a strong predictor of stroke and represents a potential source of cerebral emboli. The aim of this study was to investigate whether an association exists between mitral annular calcification and carotid atheroma. In addition, the characteristics of carotid atheromas were compared between patients with and without mitral annular calcifica tion. The authors found that there was a significant association between the presence of mitral annular calcification and carotid atheroma. Mitral annular calcification in the elderly may be a form of atherosclerosis.
Isolated Pulmonic Valve Endocarditis Caused by Group B Streptococcus ( Streptococcus agalactiae)
Authors: Akram Muhammad , Khan Ijaz A.
Published: July 2008

The pulmonic valve is the least commonly involved valve in infective endocarditis. Pulmonic valve endocarditis is usually associated with tricuspid valve endocarditis, and isolated pulmonic valve endocarditis is exceedingly rare. The predisposing factors for developing pulmonic valve endocarditis include a congenitally anomalous pulmonic valve, intravenous drug abuse, and the presence of indwelling intravenous or flow-directed pulmonary artery catheters. More cases of group B streptococcus endocarditis are being reported. The risk factors for group B strepto coccus endocarditis include diabetes mellitus, cancer, alcoholism, malnutrition, immunocom promised status, intravenous drug abuse, postpartum and postabortion states, and underlying valvular disease. The vegetations of this type of endocarditis are usually large and have a higher tendency to result in embolism. The presentation of group B streptococcus endocarditis is usually acute and may result in rapid valve destruction if not treated promptly. A case of isolated pulmonic valve endocarditis caused by group B streptococcus, Streptococcus agalac tiae, is presented that was diagnosed with multiplane transesophageal echocardiography in a 40-year old, alcoholic, malnourished man, who was successfully treated with intravenous peni cillin G. The literature on the isolated pulmonic valve endocarditis caused by group B strepto coccus is reviewed.