bluuebunny/crossref_metadata_2025 huggingface dataset:
Prevalence of Varicose Veins in an Italian Elderly Population
Authors: Canonico Silvestro , Gallo Ciro , Paolisso Giuseppe , Pacifico Fabio , Signoriello Giuseppe , Sciaudone Guido , Ferrara Nicola , Piegari Vittorio , Varricchio Michele , Rengo Franco
Published: July 2008

The prevalence of varicose veins (VV) in the elderly population of the Campania Region, in Southern Italy, was estimated. A random sample of the people aged more than 65 years was drawn by means of a stratified multistage sampling design warranting that observed percentages were direct estimates of population percentages. The investigation covered 1319 subjects, 560 (42.5%) men and 759 (57.5%) women, their ages ranging from 66 to 96 years with an average value of 74.2 years, who were interviewed and visited by trained physicians. W were defined as any reticular or truncal visible vari cosities of the lower limbs, and investigated symptoms were heaviness, pain, nightly cramps, edema, eczema, hyperpigmentation, and ulceration. Some variables were studied as risk factors: age, sex, lifetime occupation, smoking, alcohol, hypertension, diabetes, and obesity; previous treatment and use of elastic stockings were also studied. Statistical associations were evaluated by Chi-square test, a two-tailed P value of 0.05 being assumed as significance level. In total, 391 (29.6%) subjects were reported to be affected by W, but the clinical examination was positive in only 362 (27.4%) with a good corre- spondence between answers and clinical findings. Prevalence was greatly affected by sex, the percentage being two times higher in women (35.2%) than in men (17%). W developed after a pregnancy in 40.5% of women, but a high percentage of women (38.2%) also reported menopause as a time starting point. No significant association between reported risk factors and W was found among men, whereas obesity was strongly related to W in women. One or more symptoms were reported in 92.1% of persons affected by W, but no previous therapy was reported by 58.9% of subjects. Only 16.9% of patients used elastic stockings with a significant difference between men (7.4%) and women (20.2%).
Arterial Calcifications in β-Thalassemia
Authors: Aessopos Athanassios , Samarkos Michael , Voskaridou Ersi , Papaioannou Dimitris , Tsironi Maria , Kavouklis Emmanuel , Vaiopoulos George , Stamatelos George , Loukopoulos Dimitris
Published: July 2008

The purpose of this study was to define the incidence of arterial calcifications in patients with β-Thalassemia. β-thalassemia patients have been shown to present a high preva lence of angioid streaks and skin lesions characteristic of pseudoxanthoma elasticum (PXE). Given the fact that vascular involvement in the form of arterial calcifications is also a common manifestation of PXE, the authors investigated radiographically the presence of arterial calcifications in β-thalassemia patients.

They studied 40 patients with β-thalassemia over 30 years of age. Forty healthy, age- and sex-matched subjects were chosen as a control group. Radiographs of the tibias were performed in order to disclose arterial calcifications. The occurrence of PXE skin lesions and of angioid streaks (AS) was also investigated. Arterial calcifications were detected in the posterior tibial artery in 22 (55%) β-thalassemia patients and in six (15%) controls (P<0.01 for the comparison). PXE skin lesions and AS were found in eight (20%) and 21 (52%) patients respectively. A total of 34 patients (85%) had at least one of the three lesions, namely, arterial calcifications, angioid streaks, and/or PXE-like skin lesions. Stepwise logistic regression analysis did not reveal prognostic value in independent variables such as transfusions, chelation therapy, pseudoxanthoma elasticum skin lesions and/or angioid streaks, diabetes, hemoglobin, serum ferritin, and uric acid.

It was concluded that arterial calcifications are common in older β-thalassemia patients. This finding could be a manifestation of an acquired PXE syndrome associated with β-thalassemia, and consequently, vascular events complicating PXE should be expected in these patients.
Pancardiac Tuberculosis
Authors: Darwish Y. , Mushannen B. , Hussain K.M.A. , Nititham K. , Dadkhah S. , Atkinson J. , Zar F. , Kogan A.
Published: July 2008

The authors report a very unusual and unique case of pancardiac tuberculosis in a 25- year-old man who presented initially with atrial flutter with 1:1 conduction. Echocardiographic findings, computerized tomography images, and pathology speci mens are presented. After initiation of antituberculous therapy, the patient converted to normal sinus rhythm.
Preservation of Skin Vasoconstrictor Responses in Chronic Atherosclerotic Peripheral Vascular Disease
Authors: Nukada Hitoshi , van Rij Andre M. , Packer Stephen G. K. , Patterson A. , Nukada Hitoshi
Published: July 2008

Peripheral neuropathy is often found in ischemic limbs with nondiabetic atherosclerotic peripheral vascular disease (PVD). Sensory symptoms such as burning pain are common in severely ischemic limbs, and sympathectomy has been undertaken for ischemic rest pain. The authors assessed noninvasive quantitative skin vasomotor reflexes in toes and standard systemic cardiovascular autonomic tests in 44 PVD subjects with varying severity of limb ischemia, 30 age-matched control subjects, and nine PVD subjects associated with diabetes. Skin vasoconstrictor reflexes to inspiratory gasp, Valsalva maneuver, and postural change, and the postischemic reactive hyperemic response, were evaluated by the measurement of skin blood flow on toe pads by use of a laser Doppler flowmeter. Vasoconstrictor responses were not significantly different between PVD toes, even in severely ischemic limb, and age-matched controls. Reactive hyperemia was significantly less in PVD than in controls. Cardiovagal and systemic vasoconstrictor reflexes were also evaluated. All PVD subjects showed normal systemic cardiovascular reflexes. In contrast, these reflexes were severely impaired in diabetic PVD. The authors demonstrated that skin vasoconstrictive sympathetic reflex is preserved in chronically ischemic limbs with PVD, suggesting that sympathetic nerve fibers are relatively resistant to chronic ischemia.
Association of Subclavian and Jugular Vein Thrombosis: Color Doppler Sonographic Evaluation
Authors: Kröger K. , Gocke C. , Schelo C. , Hinrichs A. , Rudofsky G.
Published: July 2008

In case of clinical symptoms of subclavian vein thrombosis a phlebographic or color Doppler sonographic investigation should be performed. Phlebography is a sensitive method to exclude the thrombosis in the subclavian vein but not in the jugular vein. Color Doppler sonography additionally gives information about the surrounding tissue and the jugular vein. The authors analyze their color Doppler sonographic data, first, to evaluate the association of internal jugular and subclavian vein thrombosis and, second, to demonstrate the necessity for a color Doppler investigation. Of 213 patients who suffered from a thrombosis, 93 had a subclavian vein thrombosis, 64 had a combined thrombosis in the internal jugular and subclavian vein, and 56 had an isolated internal jugular vein thrombosis. There is a high association between subclavian and internal jugular vein thrombosis, and a color Doppler investigation of both the subclavian and internal jugular veins is necessary.
Suppressive Effect of Simvastatin on Intramural Small Coronary Arterial Lesions in Cholesterol-Fed Rabbits
Authors: Kato Hiroyuki , Okada Ryuuichirou , Oogushi Kazuhisa , Emura Sei , Kishikawa Hayato , Kawazoye Seiji , Fukuoka Mami , Takashima Toshinobu , Ohmori Keizo
Published: July 2008

The aim of this study was to examine the suppressive effect of simvastatin on intramural coronary arterial lesions in cholesterol-fed rabbits. In one experiment, six groups of rabbits were fed laboratory chow alone or with added 0.1%, 0.2%, 0.3%, 0.5% or 1.0% cholesterol for 16 weeks. In another experiment, four groups of rabbits were fed a 0.5% cholesterol diet and treated with simvastatin at 1, 3, or 5 mg/kg/day or placebo. In each rabbit, the levels of serum total cholesterol (TC) were determined at 1-week intervals to calculate the integrated values. The lesion induction ratio was defined as the ratio of intramural coronary arteries 50-150 μm in diameter with arterial lipoidosis to the total number of arteries of the same diameter. In the two experiments, there were positive correlations between the lesion induction ratio and integrated TC (r=0.785, P < 0.0001 and r=0.763, P<0.0001, respectively). The slopes of the regression lines for integrated TC obtained in the two experiments were similar, but the lesion induction ratio in the simvastatin-treated group was always lower, by about 14%, in comparison with that in the nonsimvastatin-treated group. These findings suggest that simvastatin induces lesion reduction not only by reducing the levels of circulating cholesterol but also by directly suppressing the development of lipoidosis.
Cocaine-Induced Peripheral Vascular Occlusive Disease
Authors: England John D. , Krupski William C. , Gutierrez Amparo
Published: July 2008

Two patients with cocaine-induced peripheral vascular occlusive disease are presented. A 37-year-old man was admitted to the hospital for evaluation of severe pain and numbness of his feet. He had used cocaine prior to admission. Arteriography showed bilateral occlusions of superficial femoral, popliteal, and trifucation arteries. Despite repeated infusions of urokinase, he developed progressive bilateral gangrene of both legs necessitating bilateral below-knee amputations. The second patient developed similar symptoms after smoking cocaine. Arteriography showed vasospasm bilaterally from the iliac arteries distally. IV nitroglycerin infusion caused resolution of the vasospasm and ischemic symptoms.
Pseudoaneurysm of the Descending Thoracic Aorta Following Streptococcus pneumoniae Bacteremia
Authors: Marinella Mark A.
Published: July 2008

Reported here is the case of an 82-year-old man with underlying atherosclerotic vascular disease who developed an aortic pseudoaneurysm following Streptococcus pneumoniae bacteremia. The patient experienced severe midthoracic back pain in association with fever, chills, leukocytosis, and an elevated erythrocyte sedimentation rate. Computed tomography revealed a pseudoaneurysm of the descending thoracic aorta with displacement of intimal calcification, which was likely due to infection and subsequent ulceration of an atheroscle rotic plaque from preceding S. pneumoniae bacteremia. The patient declined surgical inter vention and, despite antibiotic therapy, died shortly after presentation.
Aortic Valve Stenosis as a Cause of Major Systemic Embolism
Authors: Kaul Harald , Gutzwiller Jean-Pierre , Schneider Kurt , Dirsch Olaf , Häusermann Markus
Published: July 2008

This is the first documented case of a patient suffering from embolic occlusion of the left brachial artery caused by a large embolus growing on a lesion of a stenosed calcified aortic valve. Supported by their own additional observations the authors suggest that severe calcified aortic valve stenosis should be considered as an indication for anticoag ulation in the period before surgical valve replacement.
Right Coronary Artery Arising from the Left Aortic Sinus in a Heart with Left Coronary Dominance: A Post-Mortem Description
Authors: Sañudo J.R. , Mirapeix R.M. , Da Silva N. , Reig J.
Published: July 2008

The authors report the post-mortem description of the coronary arterial circulation of an 81-year-old man. The heart showed a concordant atrioventricular and ventricle- arterial disposition. The coronary artery distribution presented left dominance. No myocardial scars were observed. The ostium of the right coronary artery (RCA) was located in the left aortic sinus just in front of the opening of the left coronary artery. The ostium was slit-like and its maximun diameter was 5 mm. The RCA began between the aorta and the pulmonary trunk and ended as a small right marginal artery. The absence of heart disease and the man's survival until an advanced age were probably due to the fact that the RCA supplied only a small portion of the right ventricle, given the left coronary dominance.
Referral Pattern and Outcome in Men and Women Undergoing Coronary Artery Bypass Surgery
Authors: Hussain K.M.A. , Kogan A. , Estrada A.Q. , Kostandy G. , Foschi A.
Published: July 2008

Women with coronary artery disease are less likely to undergo coronary artery bypass surgery, and this may represent a potential referral bias in favor of men. A higher in- hospital mortality rate in women compared with men has been reported earlier. Accumulating evidence currently suggests, however, that variables other than gender, such as advanced age, late referral, angina classification, diabetes mellitus, concurrent medical conditions, the number of diseased vessels, the caliber of coronary arteries, and the decreased body surface area in women may have accounted for this difference. In fact, when these variables are taken into account, female gender is no longer a statisti cally significant predictor of operative mortality. Women appear to have comparable immediate and late survival rates. Recurrent angina, perioperative myocardial infarc tion, congestive heart failure, incomplete revascularization, and early and late graft reoc clusion following surgery are, however, more prevalent in women. Men and women show differences in recovery experiences after discharge following bypass surgery.

When coronary bypass surgery is offered to women, the decision should be individ ualized, based on the patients' perioperative baseline clinical risk factors and coronary anatomy. Coronary artery bypass surgery should not be withheld in women who are considered to be appropriate candidates for fear of a reduced success rate.
Acute Mesenteric Ischemia After Open Heart Surgery
Authors: Schütz A. , Eichinger W. , Breuer M. , Gansera B. , Kemkes B.M.
Published: July 2008

Acute mesenteric ischemia is a rare but severe complication after open heart surgery. Its incidence (0.2-0.4%) is quite low, but mortality rates are ranging between 70% and 100%.

From October 1992 to December 1996, 4,640 patients underwent open heart surgery with cardiopulmonary bypass: 74.6% coronary artery bypass graft (CABG) operations, 23.2% valve replacement including aortic repairs, and 2.2% corrections of congenital heart diseases or tumors of the heart. The overall mortality rate (30 days) was 3.4%, and after CABG, 2.9%.

Twelve patients (0.26%), following CABG (one combined with aortic valve replace ment, one with mitral reconstruction, and one with carotid disobliteration) developed signs of acute mesenteric ischemia in the early postoperative period (day 1 to 5). In all patients various abdominal symptoms, leukocytosis, acidosis, hyperlactatemia, hyperos molality, renal failure, and, finally, hemodynamic instability were observed. Eleven patients underwent emergency laparotomy. Mesenteric angiography was done if possible in still stable patients (n=7); it showed severe stenosis or occlusion prior to the operation in each case. Other diagnostic methods were not reliable. In six patients (55%) during the first look, extensive bowel necrosis was found and in five patients an ischemic intestine but no necrosis was detected. Of these, three patients were affected by extensive bowel gangrene at the second look. In the fourth patient a disseminated peripheral ischemia of the entire small intestine was found intraoperatively. After mechanical release and stim ulation normal bowel function could be reestablished. One patient underwent percuta neous transluminal angioplasty prior to the laparotomy. Bowel perfusion was still dete riorated but no necrosis was found intraoperatively. These patients were the only survivors in the investigated group; 10 of 12 patients (83.3%) died in the early postop erative period (day 1 to day 6). Predisposing factors for mesenteric ischemia are: arte riosclerotic patients after CABG (100%), age >70 years (91.7%), hyperosmotic dehy dration (100%), and cardiac ischemia in 25%.

Mesenteric ischemia is a fatal complication with high mortality rates after open heart surgery, especially in older, dehydrated patients with generalized atherosclerotic vessel disease. As the acute mesenteric ischemia usually starts during anesthesia or in the early postoperative period, setting of immediate diagnosis is very difficult. With the occur rence of typical symptoms diagnostic and therapeutic procedures (angiography and laparotomy) must be done very urgently owing to the life-threatening mesenteric process. When mesenteric gangrene already has taken place, the prognosis is very poor, despite extensive resection. Prevention can be exercised by avoiding perioperative hyperosmotic dehydration of patients at high risk.
The Determination of Metabolite M 17 and Its Meaning for Immunosuppressive Cyclosporin Therapy
Authors: Khoschsorur G. , Auer T. , Lanzer G. , Petritsch P. , Holzer H. , Tscheliessnigg K.H.
Published: July 2008

Cyclosporin A (CyA) is intensively metabolized by the hepatic cytochrome p450 III monooxygenase A system in the human liver, the most important metabolites being M1, M17, and M21. Because CyA and its metabolites have nephrotoxic, hepatotoxic, and neurotoxic side effects, CyA dosage must be calculated to avoid the risk of organ rejection through underdosage and toxic organ damage through overdosage or accumulation of metabolites.

In this study, we determined the whole-blood concentrations of cyclosporin and metabolite M17 by high-pressure liquid chromatography (HPLC) and by monoclonal specific and polyclonal nonspecific fluorescence polarization immunoassay (Abbott) in patients after immunosuppressive treatment.

Patients with different resorption and metabolization rates showed high individual variations. CyA concentrations in patients with good liver function and low concentra tions of CyA metabolites showed a good correlation between the HPLC and the FPIA (TDx-monoclonal assay) methods in ranges between 25 and 180 ng/mL. TDx-mono clonal was not always as precise as HPLC. In cases of metabolic disorders, we found false high CyA concentrations assayed with the immunologic method, caused by a cross- reaction of the elevated metabolite concentration. We found that HPLC rendered more information about the extent of immunosuppressive activity and the metabolization rate and showed a good correlation with the concentration of metabolite M17 and total metabolites measured with the Abbott CyA polyclonal kit.
Effect of Felodipine on Arterial Blood Flow and Venous Function at Rest in Patients with Mild Essential Hypertension
Authors: Bicchi Maurizio , Vedovini Giovanni , Cappelli Roberto , Arrigucci Stefano , Righi Giovanni Andrea , Forconi Sandro
Published: July 2008

Felodipine is a second-generation dihydropyridine calcium antagonist used to treat mild to moderate arterial hypertension. The authors used venous occlusion plethysmography to study the effect of this drug on lower limb arterial inflow and venous outflow in 10 at rest patients with mild essential hypertension. They also sought correlations between changes in district blood flow and blood pressure. Plethysmography was carried out at 8 AM and 4, 8, and 24 hours later at baseline (after washout), on the first day of treatment with a single daily administration of 10 mg felodipine ER, and after 7 and 30 days of treatment. The drug was given after the 8 AM evaluation. The authors determined rest flow, maximal venous incremental volume (MVIV) at 40 mmHg and 60 mmHg, and gradient of venous volume between 60 and 40 mmHg divided by the pressure difference (DV/DP) as index of venous distensibility. On the days of plethysmographic evaluation, arterial blood pressure and heart rate were measured continuously over 24 hours by the ABPM (Ambulatory Blood Pressure Monitoring). The results were analyzed by ANOVA.

Rest flow, MVIV, and DV/DP were stable at the baseline evaluation. On days 1, 7, and 30 of treatment the rest flow after 4 and 8 hours was significantly greater than at 8 AM but had always returned to normal after 24 hours. No other plethysmographic parame ters changed significantly; in particular venous outflow remained unchanged. Mean arterial, systolic, and diastolic blood pressure were significantly reduced, compared with baseline, following treatment on the first day and after 7 and 30 days' treatment. There was no effect on heart rate. The authors conclude that felodipine is useful for the treatment of mild essential hypertension, since it reduces arterial resistance without altering venous capacitance or distensibility.
A Case of Rapidly Progressive Pulmonary Aneurysm as a Rare Complication of Behçet's Syndrome
Authors: Başak Mesut , Gül Sabahattin , Yazgan Yusuf , Çankir Zeki , Danaci Mehmet , Demirtürk Levent , Tüzün Hasan , Yurdakul Sabahattin
Published: July 2008

One of the severe complications of Behçet's syndrome is pulmonary arterial involvement. The authors report a patient with Behçet's syndrome who had the complications of multiple pulmonary arterial aneurysms presenting with hemoptysis and right ventricular thrombus. He underwent emergency surgery because of failure of intensive immunotherapy and died 2 months after the surgery.
Reduced Number of Circulating Monocytes After Institution of Insulin Therapy—Relevance for Development of Atherosclerosis in Diabetics?
Authors: Persson Sylvi Ulrika , Larsson Hans , Odeberg Hakan
Published: July 2008

Twelve patients with Type II diabetes mellitus, insufficiently controlled with oral hypo glycemic agents, were studied before, after 2 months, and after 4 months on insulin therapy. For comparison the same variables were also studied in 10 healthy subjects. From the start, in the diabetic group, the authors found alterations in the hemorheologic parameters indicated by increased values for whole blood viscosity, plasma viscosity, red cell transit time (RCTT), and decreased values for white cell initial relative filtration rate (IrFR). In hematologic parameters they found increased values for mean corpuscular volume (MCV), leukocyte count, counts of neutrophils and monocytes, and a decreased count of lymphocytes. They also found increased values in the lipid parameters P-triglyc erides and Apo B/Apo A-I ratio, risk factors of coronary atherosclerosis. After 4 months of insulin treatment whole blood and plasma viscosity were still increased, but there was a partial improvement of lipoprotein abnormalities. Red and white cell filterability, however, tended to normalize. These results indicate that changes in blood cell filter ability do not necessarily influence in vitro measurements of blood viscosity. The change in RCTT during the insulin treatment was associated with a decreased MCV and the change in white cell IrFR with a decrease in the number of monocytes. This change of white cell filterability during insulin therapy, probably due to a reduced number of monocytes, may be of interest in the study of atherosclerosis and circulatory disease in diabetics.
Silent Myocardial Ischemia After Myocardial Infarction: Severity of Coronary Artery Disease, Impact on Left Ventricular Systolic and Diastolic Functions and Prognosis
Authors: Özgül Sami , Kudaiberdieva Gulmira Z.
Published: July 2008

The aim of the present study was assessment of the relationship of silent myocardial ischemia with clinical, coronary angiography findings, and left ventricular systolic and diastolic function, and its prognostic significance in patients early after myocardial infarc tion. One hundred nineteen male patients (mean age 48.2 ± 1.2 years) with first Q wave myocardial infarction entered the study. Routine coronary angiography, 24-hour Holter electrocardiographic recordings, and two-dimensional and Doppler echocardiography with assessment of left ventricular systolic and diastolic function were performed in all the patients. Prospective follow-up was done during 1 year. Patients with signs of silent myocardial ischemia early after myocardial infarction had more severe coronary artery disease, pronounced disturbances of left ventricular systolic and diastolic performance, and adverse prognosis than those without ischemia appearance during Holter recordings.
Cerebral Vascular Accidents in Young Patients with Essential Thrombocythemia: Relation with Other Known Cardiovascular Risk Factors
Authors: Randi Maria Luigia , Fabris Fabrizio , Cella Giuseppe , Rossi Carla , Girolami Antonio
Published: July 2008

Background and purpose: Since the advent of routine automated blood cell counts, an increased platelet count often is detected fortuitously in asymptomatic individuals. In the past, essential thrombocythemia (ET) was thought to be linked to an increase incidence of hemorrhagic complications, whereas thrombosis is now considered more frequently. Actually, the risk of thrombosis cannot be predicted in an asymptomatic patient with essential thrombocythemia.

Patients and methods: A total of 41 young patients (age range, 18 to 45 years) affected by ET and diagnosed in agreement with the Polycythemia Vera Study Group criteria are reported. Common risk factors, such as hypertension, smoke, obesity, dyslipidemia, and diabetes, have been registered. Particular attention has been given to cerebral vascular accidents (CVA) both of the arterial and venous systems. Platelet number, platelet serotonin content, and platelet aggregation under collagen, adenosine diphosphate (ADP), and adrenalin stimuli were evaluated.

Results: Nine out of the 41 patients affected by ET had CVAs, four of which occurred in the venous system. No difference in platelet function tests has been observed between patients with or without CVA. Six out of the 9 patients with ET and CVA had at least one atherosclerotic risk factor: four were heavy smokers, one had hypertension, and one had hypertension and obesity. (continued on next page) Conclusions: Cerebral vascular accidents are confirmed to be frequent in patients with essential thrombocythemia, even at a young age. However, the presence of at least one atherosclerotic risk factor associated with increased platelet number seems to favor thrombotic complications. In particular, cigarette smoking seems to be related to arterial CVAs in essential thrombocythemia.
Thromboangiitis Obliterans (Buerger's Disease) with Intestinal Involvement
Authors: Garcia A. Núñez , López Cubero L. , Rico Zalba L. , Molíns Otero A. , Gómez Octavio J. , Arribas A.
Published: July 2008

Thromboangiitis obliterans (TAO) or Buerger's disease is a nonatherosclerotic vascular disease of unknown etiology that occurs almost exclusively in young male tobacco users. The involvement of the medium-sized and small arteries and veins leads to ischemic complaints and trophic changes in the limbs. The authors report a case of Buerger's disease in a 29-year-old man, a heavy smoker, affecting the lower limbs and mesenteric vessels.
A New Description of Arterial Function: The Compliance-Pressure Loop
Authors: Li John K.-J.
Published: July 2008

Hypertension and atherosclerosis are associated with reduced arterial compliance, which is the principal component that reflects the dynamic behavior of the arterial system. Hence, change in arterial compliance has been used as a compass of arterial wall prop erties, as well as an effective parameter for assessing therapeutic treatment efficacy. The arterial compliance-blood pressure loop concept is introduced here for assessment of arterial function. Aortic pressure and flow were measured in experimental dogs during normal and acute hypertension. The compliance-pressure loops were constructed from pulsatile blood pressure waveforms and the corresponding compliances. The features of the loop are that, for any given heart beat, arterial compliance is seen to be maximal in early systole to facilitate ventricular ejection, compliance decreasing during the re mainder of systole owing to increased blood pressure and reduced aortic flow, compli ance in diastole increasing as pressure declines. The arteries are stiffer with reduced compliance in hypertension. Thus, the compliance-pressure loop can provide an effective characterization of the dynamic behavior of the arterial system in terms of pressure-flow relation and blood vessel properties.
An Unusual Presentation of Simultaneous Bilateral Popliteal Artery Embolism
Authors: Fernandez Bernardo B. , Grove Mark , Carman Teresa L.
Published: July 2008

We present what we believe is the first case in the literature of carcinoma of the lung presenting de novo as an intracardiac mass with bilateral, simultaneous popliteal artery embolization.

Arterial thromboembolism of cardiac origin and in situ thrombosis of a preexisting atherosclerotic lesion or aneurysm account for the majority of cases of acute lower extremity ischemia. Less common causes include trauma, aortic dissection, venous ischemia, and foreign body or tissue embolization. Although the history, physical exam ination, and electrocardiographic findings may provide a likely explanation in many cases, noninvasive studies such as echocardiography may help further elucidate the embolic source.
Diagnostic Value of Spiral-CT Angiography in Comparison with Digital Subtraction Angiography Before and After Peripheral Vascular Intervention
Authors: Görich J. , Aschoff A.J. , Orend K.-H. , Mickley V. , Sokiranski R. , Brambs H.-J. , Rilinger N. , Kramer Stefan C.
Published: July 2008

To evaluate spiral-computed tomography (CT) angiography in primary diagnosis and/or in noninvasive follow-up after vascular intervention, we compared spiral-CT angiography and conventional angiography before and after vascular intervention. Helical-CT exam inations before and after percutaneous transluminal angioplasty (PTA) or stent implan tation were performed in 10 patients (mean age 63 years) with symptomatic peripheral arteriosclerotic disease. Stenoses were located in the iliac, femoral, or popliteal artery. CT examinations were done with a spiral-CT in double detector technique (CT Twin, Elscint). The parameters were as follows: slice thickness: 5.5 mm, increment: 2.7 mm, pitch: 1.5, contrast medium: 150 mL, flow rate: 2.5 mL/second, delay: 30 seconds. For evaluation, transverse planes as well as maximum intensity projections and 3-D reconstructions were used. The possible scan length reached from the aortic bifurcation down to about 10 cm below the ankle trifurcation. Preinterventional digital subtraction angiography (DSA) was superior to CT angiography (CTA: 94%, maximum intensity projection [MIP] alone: 65%), although high-grade stenoses were detected by both methods. After intervention, a resolved stenosis and improved peripheral flow could be detected by helical-CT as well as by intraarterial angiography in every patient (100%). In the primary diagnosis of vascular changes, intraarterial DSA remains the method of choice. Nevertheless, spiral-CT angiography shows comparable results after percutaneous intervention and becomes a noninvasive alternative in the postinterventional follow-up.
Effect of Coronary Collateral Circulation on Exercise Stress Test
Authors: Pamir Gülgün , Çağlar Nail , Oral Derviş , Aslan S. Murat , Kumbasar Deniz
Published: July 2008

In this study, patients who have recovery-only ST segment depression in exercise stress test were chosen. It is proposed that coronary collateral circulation could improve with stress-increased coronary perfusion, and accordingly, patients with recovery-only ST segment depression were evaluated by coronary angiography for grading the coronary collateral circulation. Twenty-one men and five women were assigned to the study group. Sixteen men and two women who had exercise-induced ST segment depression were assigned to the control group. Age and gender of both groups were not statistically different (p > 0.05) . The reason for terminating the exercise stress test was chest pain in two of 26 patients in the study group versus 15 of 18 in the control group (p < 0.001 ) . In both groups coronary collateral frequency and grade were directly correlated with the severity of the coronary artery disease (p < 0.001 in the study group, and p < 0.05 in the control group). When both groups were compared for the frequency of significant coronary collateral circulation, 14 of 26 patients in the study group versus 4 of 18 patients in the control group had significant coronary collateral circulation (p=0.035). The authors conclude that recovery-only ST segment depression correlates well with the frequency of significant coronary collateral circulation, and coronary collaterals may prevent myocardial ischemia during exercise.
Coronary Angiography in Qatar: The First Ten Years
Authors: Gehani A.A. , Horak J. , Hajar H.A. , Chaikhouni Amer
Published: July 2008

Cardiac catheterization in Qatar was initiated in July 1982. In ten years, a total of 3900 procedures were performed at Hamad General Hospital. Computerized data registry has been maintained since 1982. Isolated coronary angiography was done in 2911 patients; of these, 2635 (90.5%) were men, and 276 (9.5%) were women, the average age of the patients was 47 ± 9.2 years (range, twenty-five to eighty-eight). Patients' nationality was Qatari in 492 (17%), and other Arabs in 610 (21%), and 1512 (52%) were from the Asian subcontinent. Myocardial infarction was the most common indication (43%) . Single-vessel disease was found in 638 (22%), two-vessel disease in 630 (22%), three- vessel disease in 950 (33%), and nonsignificant coronary artery disease in 693 (24%) patients. Morbidity related to the coronary angiography was reported in 147 (5%) patients, but there was no mortality related to the procedure. In 822 (28%) patients, the age was forty years or younger. The angiographic findings of these younger patients were compared with those of the older ones. Younger patients were usually men of Asian subcontinental origin with a recent myocardial infarction (MI). Often, they had normal coronary arteries or single-vessel disease. Patients of Asian subcontinent origin were usually young male patients with a recent MI, who receive streptokinase, and have single- vessel disease.
99mTc SESTAMIBI Scintigraphic Evaluation of Skeletal Muscle Disease in Patients with Systemic Sclerosis: Diagnostic Reliability and Comparison with Cardiac Function and Perfusion
Authors: Rinaldi E. , Ierardi M. , Tiberio N.S. , Boccabella G. Luca , Barbieri C. , Scopinaro F. , Morelli Sergio , DeSantis Marcello , Banci Maria
Published: July 2008

The diagnosis of skeletal muscle involvement in patients with systemic sclerosis (SSc) is usually based on clinical, laboratory, electromyographic, and bioptic evidence of muscle disorder, whereas SSc cardiac disease is well established by nuclear medicine techniques (radionuclide ventriculography and myocardial scintigraphy).

Previous reports have retrospectively hypothesized a possible relationship between cardiac and muscle involvement in scleroderma patients.

In order to improve overall diagnostic accuracy in the qualitative/quantitative assess ment of skeletal muscle involvement in these patients and to compare these results with those obtained at the cardiac level, diethylenetriaminepentaacetic acid (DTPA)-99mTc radionuclide ventriculography and 99mTc SESTAMIBI myocardial and muscular scinti graphic examinations were performed in 10 SSc patients and in five healthy subjects.

Muscular radioactivity, as assessed at thigh and calf levels by means of a segmental score, was significantly decreased in SSc patients in comparison with healthy subjects (global score value 15.6 ±2.2 vs 22.7 ± 1.6, p < 0.001), as well as right ventricular ejection fraction (RVEF, 34.3% ±5.3 vs 53.6% ±4.2, p<0.001) and myocardial segmental perfusion (global score value, 19.6 ± 2 vs 25.9 ± 1.1, p < 0.01 ) .

The results show a high frequency of skeletal muscle involvement in patients with SSc. Moreover, scleroderma patients with muscle disorders, as evidenced by scintigraphy, show a comparable occurrence of cardiac involvement, even in the absence of clinical signs of cardiac dysfunction.
Coronary Vasospasm at the Site of Myocardial Bridge
Authors: Morioka Norikatsu , Hara Yuji , Shigematsu Yuji , Hamada Mareomi , Hiwada Kunio , Kodama Koji
Published: July 2008

Two patients with angina pectoris and postmyocardial infarction angina due to coronary vasospasm at the site of myocardial bridge are described. Intracoronary injection of isosorbide dinitrate led to resolution of coronary vasospasm on acetylcholine provocation test, and vasospastic angina pectoris has been well controlled after treatment with calcium channel blockers.
Shock Waves in Vascular Diseases An in-Vitro Study
Authors: Nicolaides A.N. , Marlinghaus E.H. , Cesarone M.R. , Incandela L. , De Sanctis M.T. , Dhanjil S. , Laurora G. , Ramaswami G. , Artese L. , Ferrero G. , Ricci A. , Barsotti A. , Ledda A. , Steigerwalt R. , Griffin M. , Belcaro G.
Published: July 2008

Three human aortic specimens were used for this in-vitro study on the effects of shock waves on the arterial wall. Specimen one was from a normal (for age) healthy aorta. The full abdominal lengh was used (including mesenteric and renal arteries and the aortoiliac bifurcation), divided into six pieces (3 cm). The pieces were placed and fixed into degassed water. Shock waves (SW) were focused onto the aortic wall by means of a B-mode ultrasound imager. An SW generator (Minilith SL1, Storz Medical AG, Kreuzlingen, Switzerland) was used for setting of energy flux density between 0.03 and 0.5 mJ/mm2. The six aortic pieces (excluding piece 1, placed in water and left untreated as control) were treated with SW at increasing energy levels. A second aortic specimen of a man with arteriosclerotic plaques was also used and the experiment repeated at energy levels 1, 5, and 8. Another specimen of normal thoracic aorta was exposed at energy levels 1 and 8 only. Energy levels delivered onto the aortic walls were selected from theoretically destructive levels to minimal levels known not to alter vascular tissues. High-resolution ultrasounds of the aortic segments were performed with a 10 MHz high- resolution, broad-band (ATL 3000, USA) probe in water before and after SW applica tion to detect structural changes in the wall after SW. Histology was performed with a standard hematoxylin-eosin staining.

(Abstract continued)

Results: The aortic pieces did not show macroscopic damages at visual examination, and at the ultrasound examination no visible changes were observed even at higher levels of SW energy. Also no effects were seen by histology. In conclusion, no damaging effects were observed, visually, by ultrasound, or by histology. At these energy levels SW appear to be safe and do not produce any damage to the aortic wall. Therefore, SW could be considered a safe, nondamaging procedure for potential treatment (ie, thrombolysis) in which vessel walls could be involved. Theoretically it is possible that functional changes could be observed in vivo including cell permeability modifications and other alterations (including changes in the potential of the cells in SW fields to modify themselves and to divide). At the energy levels described in this study SW could, theoretically be, safely used for vascular applications (ie, treating venous and arterial thrombi or in arterial plaques modification) without altering major, structural, arterial wall characteristics. Lesions or alterations that have a different density from the normal wall (thrombi or plaques) could be differently sensitive to the same dosage of SW. These differences in acoustic impedance characteristics could be used for potential treatments with SW without damaging the arterial wall.
Present Status of HMG Reductase Inhibitors in Treatment of Dyslipidemia
Authors: Kalmansohn Richard W. , Schiff David L. , Kalmansohn Robert B.
Published: July 2008

HMG reductase inhibitors have significant desirable effects on patients with dyslipidemia. Multiple factors are involved in these desirable effects. Other factors that might play a role in the risk of coronary artery disease are fibrinogen concentration, homocysteine, Lp (a), small dense LDL, insulin resistance, and infection with chlamydia.

High-dose reductase inhibitors may be indicated in select patients. The ideal end point may be 150 mg/dL for adults.
Intermittent Claudication and Risk of Cardiovascular Events
Authors: Martone Vincenzo Domenico , Perna Sergio , Cacciatore Francesco , Corrado Salvatore , Di Donato AnnaMaria , Di Iorio Antonietta , Brevetti Gregorio
Published: July 2008

To determine the natural history of intermittent claudication, 110 patients were followed up for a mean period of 24.4 ±1.2 months. Four patients died during the follow-up. Of the survivors, 24 experienced a nonfatal cardiovascular event, myocardial infarction being the most frequent. Cumulative cardiovascular morbidity was 29% at 3 years. Cox proportional-hazards analysis showed initial ankle-brachial pressure index (ABPI) as a significant predictor for nonfatal cardiovascular events (p<0.002). With an initial ABPI >0.70, cardiovascular morbidity rate was 12% compared with 33% for those with initial ABPI ranging from 0.70 to 0.50, and 60% for those with ABPI <0.50 (p<0.005). Critical limb ischemia occurred in only four patients, amputation was required in two, and arterial reconstruction in five. Of the 85 patients who participated in the treadmill test, maximum walking capacity worsened in 26% and improved in 27%. This study eluci dates the neglected area of cardiovascular morbidity in intermittent claudication. It has shown that ABPI identifies a subgroup of patients for whom the risk of cardiovascular events is especially pronounced. On the other hand, based on objective evaluation of the patient status, the relatively benign prognosis for the claudicant limb has been confirmed.
Massive Bilateral Pulmonary Embolism in a Patient with Subsequent Occurrence of Severe Mitral Regurgitation Due to Ruptured Chordae Tendineae
Authors: Estrada A.Q. , Kogan A. , Dadkhah S. , Foschi A. , Hussain K.M.A.
Published: July 2008

This report concerns an apparently healthy woman who presented simultaneously with acute massive bilateral pulmonary embolism and mitral regurgitation, subsequently, a month later, resulting in pulmonary edema secondary to chordae rupture of the mitral valve. The authors believe that massive pulmonary embolism predisposed to chordal rupture in this case. It is suggested that increased awareness of ruptured chordae tendineae as a cause of mitral regurgitation and the prompt use of transesophageal echocardiography will facilitate the early recognition of this potentially fatal, but treatable, cause of mitral regurgitation in patients with pulmonary embolism.
Diagnosis of Renovascular Disease by Extra- and Intrarenal Doppler Parameters
Authors: Malatino Lorenzo S. , Polizzi Gaetano , Garozzo Maurizio , Rapisarda Francesco , Fatuzzo Pasquale , Bellanuova Ignazio , Cataliotti Alessandro , Brozzetti Azelia , Neri Santo , Malfa Pier Antonio , Cotroneo Giovanni Battista
Published: July 2008

It is still a matter of debate as to which parameters should be used for noninvasive diagnosis of renovascular disease by renal Doppler sonography (RDS). The accuracy of RDS in the detection of renal artery stenosis (RAS) was tested in 95 consecutive, moderate to severe hypertensive patients (I-II World Health Organization [WHO] stages). Reno-aortic ratio (RAR) for peak systolic velocity (PSV) was also calculated to assist in the diagnosis of significant (>50%) RAS. Paired receiver-operating characteristic (ROC) analysis was plotted for evaluating the relationship between sensitivity and specificity for each parameter. In a subset of 57 kidneys, the influence of blood pressure and age on intraparenchymal parameters was evaluated. Measurements of maximal peak systolic velocity (PSV) at the site of stenosis, RAR for PSV, and minimum acceleration index in the main renal artery showed high accuracy (areas under the ROC curve 0.97, 0.88, and 0.80, respectively). Among intraparenchymal parameters, early systolic accel eration showed the best area under the ROC curve (0.90), but provided a low positive predictive value (29%) and was significantly influenced by blood pressure (multiple r=0.56; p=0.001). Pulsatility and resistive indices were found to be less powerful as absolute values, and both significantly influenced by blood pressure and age (multiple r= 0.60 and 0.50; p=0.001, p=0.02, respectively). However, interindividual variance of intrarenal indices should be minimized by calculation of side difference, although this procedure would become misleading or impossible in patients with bilateral RAS or a single kidney, respectively. These results support the use of extraparenchymal parameters for noninvasive detection of RAS, and emphasize that intrarenal parameters cannot be considered as absolute values.
Venoarteriolar Response to Experimental Venous Hypertension in Legs with Chronic Venous Insufficiency and in Healthy Legs, Measured Using a Double-Wavelength Laser Doppler Technique
Authors: Malanin Ken , Vilkko Pekka , Kolari Pertti J.
Published: July 2008

The venoarteriolar response (VAR) of the skin in legs caused by experimental venous hypertension was measured using a new, double-wavelength laser Doppler probe technique (543 nm and 780 nm). This enables the measurement of the laser Doppler flux in the superficial and deep layers of the skin simultaneously. The recordings were obtained from the leg with the patient in a recumbent position with a sphygmo manometer cuff around the thigh. The VAR was recorded at the cuff pressures of 30 mmHg and 60 mmHg. Ten patients with chronic venous insufficiency (CVI) and 20 control subjects with healthy legs were investigated.

The VAR increased in relation to the increase of cuff pressure at both wavelengths. There were no significant differences in the VAR between the cuff pressures within or between the legs with CVI and healthy legs. The VAR measured at 780 nm was very significantly greater than the VAR measured at 543 nm in legs with CVI (p<0.005), as well as in healthy legs (p<0.001).

The VAR depends both on the wavelength of the laser Doppler light used and on the degree of venous hypertension. The VAR is not impaired in legs with CVI compared with healthy legs.
Vasodilatory Capacity of Forearm Resistance Vessels Is Augmented in Hypercholesterolemic Patients After Treatment with Fluvastatin
Authors: Schobel Hans P. , Schmieder Roland E.
Published: July 2008

Atherosclerotic vessels are characterized by endothelial and structural abnormalities as indicated by an impaired vasodilation to metabolic requirements. To determine whether effective treatment of hypercholesterolemia may improve vasodilatory capacity of resis tance vessels, the authors examined the impact of 12 and 24 weeks of lipid-lowering therapy with the hepatic hydroxymethylglutaryl coenzyme A (HMG-CoA)-reductase inhibitor fluvastatin (40 to 80 mg/day) on the increment in forearm blood flow during reactive hyperemia in 24 hypercholesterolemic patients (mean age: 56 ±11 years; 15 men/9 women). Changes in forearm blood flow in response to reactive hyperemia were measured by venous occlusion plethysmography.

Serum low-density lipoprotein (LDL)-cholesterol fell from 213 ±32 to 125 ±27 mg/dL (P<0.001) after 12 weeks and remained stable at a level of 125 ± 18 mg/dL after 24 weeks of treatment. Baseline forearm blood flow was similar before and after 12 and 24 weeks of therapy. In contrast, forearm blood flow at peak reactive hyperemia was greater at week 12 (37.0 ±22.9 mL/min/100 mL; P<0.05), and at week 24 (47.1 ±33.5 mL/min/100 mL; P<0.05) than at week 0 (30.5 ± 18.1 mL/min/100 mL). Compared with week 0 (defined as 100%), the percent change in forearm blood flow in response to reactive hyperemia was augmented at week 12 (171 ± 144%; P<0.05 vs week 0) and at week 24 (218 ±228%; P<0.05 vs week 0). Thus, the lowering of high serum LDL choles terol after short-term treatment with fluvastatin increased the blood flow responses during reactive hyperemia in forearm resistance vessels. These data indicate a beneficial effect of HMG-CoA reductase inhibition on structural wall properties of peripheral arteries in human atherosclerosis.