bluuebunny/crossref_metadata_2025 huggingface dataset:
Serum Drug Concentrations in Patients with Ischemic Heart Disease After Administration of a Sustained Release Procainamide Preparation
Authors: Zema Michael J. , Mirando Timothy
Published: November 2007

Despite widespread marketing of a sustained release preparation of pro cainamide hydrochloride (PROCAN-SR, Parke-Davis), published literature demonstrating its efficacy in maintaining uniform serum drug levels over a 6-hour dosing interval is derived from only normal healthy volunteers.

Thirty-three patients with ischemic heart disease, ages 30-88 years, were administered 1-4g/24 hours (mean dose 34 mg/kg/day) of PROCAN-SR in 4 equally divided doses on a Q6H schedule. After achievement of steady-state equilibrium drug concentration, procainamide and N-acetylprocainamide levels were determined by high-performance liquid chromatography on sera obtained from blood samples drawn 2, 3.5 and 5 hours after an oral dose.

Mean maximal procainamide and N-acetylprocainamide serum concentra tions were 4.6± 1.8 ug/ml and 4.2±2.1 ug/ml respectively. Mean minimal concentrations were 3.5± 1.7 ug/ml and 3.6±2.0 ug/ml respectively. The mean change in drug concentration was small (1.1 ug/ml procainamide and 0.6 ug/ml N-acetylprocainamide) with procainamide and N-acetylprocainamide con centrations varying only by 27 and 15 percent respectively.

These data demonstrate in a population of patients with ischemic heart disease, that Q6H dosing with a sustained release procainamide hydrochloride preparation (PROCAN-SR, Parke-Davis) is associated with only a small ac ceptable variation between maximal and minimal serum procainamide and N-acetylprocainamide concentrations. This preparation should, therefore, offer greater patient convenience and compliance without sacrificing antiar rhythmic efficacy.
The Acute Effects of Nifedipine on Calf and Forefoot Blood Flow in Patients with Peripheral Arterial Insufficiency
Authors: Lorentsen E. , Landmark K.
Published: November 2007

The calcium-blocking agent nifedipine, which possesses vasodilating po tency, was tested in 8 patients with peripheral arterial insufficiency. 10 mg sublingually significantly decreased systolic arm and ankle blood pressure. Neither blood flow nor local peripheral resistance in the calf and the forefoot at rest and the calf during postischemic reactive hyperemia changed significantly. During postischemic hyperemia in the forefoot, the drug significantly reduced peak blood flow and increased local peripheral resistance. The drug-induced reduction in forefoot peak blood flow was correlated to the fall in systolic arm and ankle blood pressure. It is suggested that nifedipine may shorten the claudication distance in patients with peripheral arterial insufficiency.
Electrophysiologic Properties of Furosemide in Man
Authors: Gould Lawrence , Chokshi A.B. , Patel S. , Gomes G.I.
Published: November 2007

Furosemide has been extensively used in the treatment of heart failure and its effect on cardiovascular dynamics are well established.1 Clinical relief of the symptoms of pulmonary congestion frequently precedes any demonstrable diuretic effect, suggesting that extra renal factors may also be involved.2 More recent studies on the extra-renal action of furosemide showed an increase of venous capacitance as an early hemodynamic effect of the drug.3

In spite of furosemides wide use in the treatment of heart failure and hypertension, there is no information on the electrophysiologic properties of the drug in man. The present study involving 8 human subjects was undertaken to determine what effect intravenously administered furosemide has on the human conduction system.
The Success Rate of Fibrinolytic Therapy in Fresh and Old Thrombosis of the Iliac and Femoral Veins
Authors: Theiss Wolfram , Wirtzfeld Alexander , Fink Ulrich , Maubach Peter
Published: November 2007

Since it is still a wide-held belief that fibrinolytic therapy can clear thrombi from deep veins only while they are fresh, we retrospectively analyzed the phlebographic results obtained in 85 patients with thrombosis of the iliac and/or femoral veins with symptoms present for 1 day to 8 weeks prior to treatment. Streptokinase, urokinase, or both drugs successively were administered in these patients for a mean of 9 days (range: 2 to 26 days). Complete or partial resolution of the thrombotic occlusion was obtained in 94%, 82%, and 69%, respectively, in those patients who presented within 3 days, 1 to 2 weeks, and 3 to 4 weeks after the first appearance of symptoms. With a delay of 5 to 8 weeks the results were uniformly poor with only 1 partial recanalization in 7 patients.
Noninvasive Assessment of the Autonomic Nervous Tone in Angina Pectoris: An Application of Digital Plethysmography with Auditory Stimuli
Authors: Matoba Tsunetaka , Ohkita Yasuo , Chiba Michio , Toshima Hironori
Published: November 2007

To assess the relationship between autonomic nerve activity and the angi nal attack, we examined the daily variation of the autonomic tones employing digital plethysmography with auditory stimuli, and also tested the daily varia tion of exercise capacity. Thirteen of 45 cases (28.9%) of spontaneous angina, excluding Prinzmetal's angina, complained of typical chest discomfort or pain especially in the morning. They manifested an augmented level of the au tonomic nerve activity and positive stress testing. The remainder did not demonstrate these abnormal findings in the morning. For the 13 cases, calcium antagonists were given orally immediately after awakening. This resulted in the complete relief from chest discomfort or pain. These findings suggest that an autonomic imbalance plays an important role in the pathogenesis of this type of anginal attack. Thus, the estimation of the daily variation of autonomic nerv ous tone would be valuable for the diagnosis and treatment of angina pectoris.
Are Pressure-Volume Relations at End-Systole a Reflection of Left Ventricular Myocardial Contractility?
Authors: Ahmed S. Sultan , Regan Timothy J.
Published: November 2007

The pressure-volume relation at end-systole is reportedly altered by changes in contractility. To explore the potential of this ratio in man 185 subjects including 23 normals (Group I) were studied. In 35 patients of Group II (16 with mitral stenosis, 7 with atrial septal defect, and 12 with cor pulmonale) ESP/ESV like an index of contractility measuring force-velocity-length rela tionship (Cy Ix) was insignificantly different from Group I (ESP/ESV and Cy Ix in I = 1.73 ± .31 mmHg/sec, 1.46 ± .09 cm/sec/cm vs 1.44 ± .10, 1.31 ± .05 in II respectively.) With significantly reduced Cy Ix (1.03 ± .04, P<0.00001) ESP/ ESV was likewise reduced (1.16 ± .07, P<0.007) in 108 patients with compen sated LV disease (34 with alcoholic cardiomyopathy, 16 coronary artery dis ease, 30 aortic valve disease, 8 hypertension and 16 with other heart muscle disease.) Like the Cy Ix (0.70 ± .05, P<0.001) ESP/ESV was even lower (0.84 ± .13, P<0.05) in 14 patients with decompensated LV (Group IV). It was insensitive to changes in pressure (angiotensin and volume (dextran). However unlike the Cy Ix it did not vary with acute changes in inotropy (exercise and pacing).

The correlations between ESP/ESV and ejection fraction and contractility index in the entire series though weak, were significant (r = .50 and .20 respectively, each P<0.006). Exclusion of patients with aortic valve disease and hypertension in the analysis tended to improve the relationship between the contractility and end-systolic pressure-volume parameters. In the latter two subgroups neither the ESV nor the ESP/ESV ratio related to the contractil ity index, both parameters however did correlate significantly with the ejection fraction. These results indicate that end-systolic pressure-volume relations provide useful measures of LV performance in man, though not expressing the contractility either in all patients or under all situations.
The Normal Doppler Venous Examination
Authors: Baker William H. , Hayes Andrew C.
Published: November 2007

The clinical diagnosis of acute deep vein thrombosis (DVT) is but 50% accurate when compared to the results of contrast venography.1,2,3 This clinical inaccuracy had led to the dependence of the physician upon laboratory diag nosis. Whereas contrast venography is the gold standard of diagnosis, its expense, special equipment, personnel, and discomfort make it unsuitable for evaluating large numbers of patients. For this reason, numerous noninvasive tests utilizing plethysmographic and Doppler techniques have been developed to evaluate patients with suspected venous disease, and when expertly per formed have a degree of accuracy of approximately 90%.4,5,6,7 This degree of accuracy coincides with the experience of our peripheral vascular laboratory using the Doppler venous examination.

Based on these statistics, our current practice is to evaluate patients sus pected of having DVT with a Doppler venous examination (Figure 1). If the test is abnormal or equivocal, contrast venography is usually obtained and an ticoagulation recommended. Contrariwise, if the Doppler venous examination is normal, venography is not obtained, and anticoagulation treatment is not recommended. This practice should reduce the number of venograms in a patient population that is not at an increased risk of pulmonary embolism or repeated deep venous thrombosis. To evaluate the validity and safety of this practice, one hundred eighty-six patients with normal Doppler venous exami nations in whom contrast venography was not obtained were evaluated and form the basis of this report.
Extensive Coronary Collateral Formation in a Patient with Untreated Acromegaly
Authors: Goldberg Emanuel , Berger Marvin , Garber Michael
Published: November 2007

A case of acromegaly with extensive coronary collateralization is reported. Growth hormone may have played a role in this neovascularization.
Hereditary Multiple Exostoses. A Rare Cause of Arterial Insufficiency
Authors: Norton de Matos A. , Mergulhão Mendonça J. , Caetano Pereira M.
Published: November 2007

The authors describe a case in which an exostosis of the femur produced thrombosis of the third portion of the right femoral artery in a male of 34.
Ventricular Fibrillation in Acute Myocardial Infarction
Authors: Gupta M.C. , Singh M.M. , Singh Ram
Published: November 2007

Ventricular fibrillation (VF) developed in 7.42% patients with acute myocardial infarction (AMI). It was more frequent among patients with anterior myocardial infarction compared to inferior myocardial infarction.

On the basis of sequence of events, cases of ventricular fibrillation (VF) were classified in to Primary (P), Secondary (S) and Agonal (A).

57.69% cases had SVF, 30.76% had AVF and only 11.53% cases had PVF. In all cases of PVF, ECG was normal prior to the development of VF and developed abruptly without any warning.
Pressure Contour Analysis in the Assessment of Arterial Stenosis
Authors: Murie J.A. , Quin R.O. , Forrest H. , Sheldon C.D.
Published: November 2007

Femoral artery pressure contour can be measured directly by percutaneous needle puncture and may be a useful indicator of proximal vessel stenosis. Pressure waveform in 53 limbs was compared with radiological appearance of the aorto-iliac segment. Forty-one limbs were graded angiographically as normal and 12 as stenosed. Pressure contour was studied at rest and after intra-arterial injection of papaverine. The following parameters were examined:

1. systolic pressure at rest

2. systolic pressure after papaverine

3. per cent reduction of systolic pressure after papaverine

4. pulse pressure at rest

5. pulse pressure after papaverine

6. per cent reduction in pulse pressure after papaverine

7. maximal gradient (dp/dt) at rest

8. maximal gradient after papaverine: p<0.001 (Figure 5b)

9. maximal gradient after papaverine : p<0.05 (Figure 6) maximal gradient at rest

A significant difference between the angiographic normal and stenotic groups was found in the values of all parameters. p<0.001 for 1 to 8 inclusive; p<0.05 for 9. Good discrimination between groups was achieved only by 3, 6 and 8. Three produced the best discrimination: systolic pressure reduction after papaverine ≥ 14 per cent indicating stenosis (1 in 12 false negative) and < 14 per cent indicating no stenosis (no false positive).
Beneficial Effect of Papaverine Plus Raubasine in Peripheral Arterial Insufficiency
Authors: Brevetti Gregorio , Chiariello Massimo , Verrienti Salvatore , Spena Michele , Desiderati Maurizio , Condorelli Mario
Published: November 2007

It has been demonstrated that, in most arteriopathic patients, vasodilators induce the vascular steal phenomenon, i.e. the shunting of blood from the ischemic to the normally perfused areas. It is conceivable, therefore, that vasoconstrictors may improve in the opposite way, reducing the blood flow to the normal zones and increasing it to the ischemic. A "reverse vascular steal" caused by the simultaneous IV injection of a vasodilator and a β- blocker has been previously shown; however, the chronic treatment of arteriopathic patients with β-adrenoceptor blocking drugs often results in increased evidence of peripheral arterial insufficiency; therefore, the combi nation of a vasodilating drug with a β-blocker is limited in the clinical practice.

The aim of this study was to investigate the efficacy of the combination of the vasodilator papaverine hydrochloride with a drug having vasoconstrictive action without the undesirable side effects of β-blockers. Accordingly, rau basine (40 mg) was given p.o. associated with papaverine (300 mg) in 10 arteriopathic patients, who presented a significant reduction of blood flow in the affected limb after the administration of 300 mg p.o. of papaverine alone. The measurements of blood flow were performed by impedance plethysmog raphy and the results are expressed as ml/minute/100 ml of tissue. Venous blood samples were also taken simultaneously with the plethysmographic recordings to evaluate papaverine plasma concentrations. Data obtained by this study indicate that papaverine alone induces a significant reduction of blood flow starting from the time of its maximal plasma concentration. Raubasine alone does not induce any change in blood flow, while the combination of the 2 drugs significantly increases the blood supply to the affected limb.

These favorable results, probably related to the ability of raubasine to induce a reverse vascular steal, suggest that the combination of this drug with a vasodilator such as papaverine may represent a new approach in the treatment of peripheral arterial insufficiency.
The Limitations of the Digitalized Pulse Timing Oculoplethysmography in the Diagnosis of Bilateral Significant Carotid Stenosis
Authors: AbuRahma A.F. , Boland James , Osborne L.
Published: November 2007

To critically analyze the accuracy of the Zira-OPG unit in the diagnosis of carotid stenosis, 161 patients (309 carotid arteries) out of 2500 patients tested were reviewed in comparison with angiogram. For practical purposes these patients were divided into several groups: 92 out of 101 normal arteries by OPG were confirmed by angiogram (91% true negative). Fifty-three out of 61 arteries with significant unilateral stenosis by OPG were confirmed by angiogram (87% true positive). Thirty-two out of 40 patients with significant stenosis on one side and mild on the other were picked by the OPG (80% true positive). Fifteen out of 27 patients with bilateral significant stenosis were confirmed by OPG (56%). Twelve out of 13 completely occluded arteries were confirmed by OPG. This unit is practical in detecting normal arteries, unilateral significant stenosis and bilateral disease if one side is mild but very limited in bilateral significant stenosis.
The Use of Common Carotid Waveform Analysis in the Diagnosis of Carotid Occlusive Disease
Authors: Langlois Yves , Roederer Ghislaine O. , Chan Anthony , Strandness D.E.
Published: November 2007

Duplex scanning with spectral analysis of the pulsed Doppler signal are currently used to detect and classify disease at the carotid bifurcation. Al though the sensitivity of the test exceeds 90%, the method has a lower speci ficity which ranges between 8 and 50%. The poor specificity is due to the difficulty in distinguishing flow disturbances normally present at the carotid bifurcation from those produced by minimal amount of disease. In order to improve the ability of the method to predict normalcy, new features measured from the low common carotid waveform are evaluated on 150 sides. The difference of frequency from the systolic peak (a) to the point of first zero slope after peak systole (b) was used to define the ratio (a-b)/a. A ratio greater than 0.5 was associated with 76% of the normal sides and only 7% of the diseased sides. A ratio below 0.5 was associated with 83% of the diseased sides. This ratio, when used alone, can improve the specificity of the method to 76%.
Barlow's Syndrome Associated with Coronary Fistula
Authors: Macieira-Coelho Eduardo , Pais Fernando , Monteiro Fernando , da Conceicao José Manuel , Garcia Alves Mario , Pereira Luisa
Published: November 2007

In an asymptomatic patient, the first reference to the association of mitral valve prolapse and coronary fistula is described and a pathogenic connection discussed.
Noninvasive Venous Pressure Measurements in Different Venous Diseases
Authors: Bartolo M. , Nicosia P.M. , Antignani P.L. , Raffi S. , Ricci S. , Marchetti M. , Pittorino L.
Published: November 2007

We use from some years the doppler method for noninvasive meas urements of venous pressure and about seven years ago we communicated the early results.1-3

We have confirmed the reliability and sensitivity of the method carrying on our clinical work.

Now we report the results of a more extensive observation.
Cerebral Venous and Arterial Thrombosis in Pregnancy and Puerperium: A Study of 135 Patients
Authors: Srinivasan K.
Published: November 2007

Cerebral venous thrombosis occurring in puerperium is about 10 to 12 times more frequent in India than in Western countries. A clinical study of 135 patients with cerebrovascular accidents in early puerperium is reported. Corti cal vein thrombosis is common and arterial thrombosis rare (6/135). The illness usually occurs within the first two weeks, after normal delivery at full term, in a multiparous woman, with multi-focal seizures, stupor or coma, regressing focal signs or at times as pseudotumour cerebri. Deep leg vein thrombosis and pelvic sepsis are rare. Mortality has been high reaching 28 to 33 percent in both Indian and Western countries. With the use of anticoagulants in some selected patients and earlier; energetic, supportive and symptomatic measures in others the mortality could be reduced to less than 20 percent. The quality of survival is good since those who survive have only minimal physical disability.
Popliteal Venous Aneurysm as a Source of Pulmonary Emboli in a Male: Case Report
Authors: Jack Clifford R. , Sharma Rajinder , Babu Vemuri Ramesh
Published: November 2007

A 48 year old male was admitted with pulmonary emboli. Subsequent investigation revealed the most probable source to be a left sided popliteal venous aneurysm. A second venogram performed shortly after the first did indeed reveal thrombus originat ing in the aneurysm and propagating up the superficial femoral vein. Popliteal venous aneurysm is an extremely rare entity, which heretofore has been described only in female patients.
Ergonovine Provocation in Post Partum Myocardial Infarction
Authors: Salem Deeb N. , Isner Jeffrey M. , Hopkins Patricia , Konstam Marvin A.
Published: November 2007

Post-partum myocardial infarction is rare and the pathophysiology obscure. This report describes a 30-year-old lactating female in whom an infero-lateral wall myocardial infarction was documented 5 months following a normal pregnancy and delivery. Coronary angiography revealed normal coro nary arteries, a finding described previously in 3 such patients. Contrary to previous speculations, however, provocative testing with ergonovine pro duced no evidence of coronary artery spasm.
A Histochemical Study of the Metabolism of Rat Renal Arteries and Arterioles
Authors: Cannon M. Samuel
Published: November 2007

A histochemical study of the metabolism of rat renal arteries and arterioles. Rat renal arteries and arterioles were examined histochemically to determine their metabolic profiles. Succinate, malate and NAD-isocitrate dehydrogenase, cytochrome oxidase and ubiquinone were assessed to determine aerobic metabolism. Glucose-6-phosphate dehydrogenase and DPN diaphorase were evaluated to determine hexosemonophosphate-shunt activity. Anaerobic metabolism was evaluated via lactate dehydrogenase, and the substrate, glycogen. Gomori's lipase, β-hydroxybutyrate dehydrogenase and amounts of neutral fat and free fatty acids were assessed as indicators of lipid utilization. Myosin ATPase activity was evaluated as an index of ATP utilization for contraction. Deoxyribonucleic and ribonucleic acids were appraised as indicators of protein synthesis. In general, the oxidative enzymes and myosin ATPase demonstrate considerable activity in renal arteries and arterioles which suggests aerobic metabolism and ATP usage. Renal arteries and arterioles also appear capable of anaerobic metabolism as indicated by strong lactate dehydrogenase reactivity and by the presence of slight to moderate quantities of glycogen, while high levels of glucose-6-phosphate dehydrogenase and moderate amounts of deoxyribonucleic acid suggest a potential for nucleic acid and protein synthesis. In arteries and arterioles, strong reactivity for β-hydroxybutyrate dehydrogenase, minimal lipase activity, and the absence of fatty acids with substantial amounts of neutral fat, indicate limited lipid catabolism.
Deep Posterior Compartment Pressure in the Evaluation of Venous Insufficiency of the Lower Extremity — A Preliminary Report
Authors: Taheri Syde A. , Yacobucci Gerald N. , Williams James , Elias Steven
Published: November 2007

A new method of assessing the extent of venous insufficiency in the lower extremity at the tissue level was tested on thirteen limbs with various degrees of venous insufficiency as evidenced by clinical signs and descending venography. Deep posterior compartment pressures in standing patients correlated well with standing venous pressures in these same limbs. Eighty-three percent of those limbs with deep posterior compartment pressures above 30 mmHg had objective clinical signs of venous insufficiency, namely edema, stasis dermatitis and/or stasis ulcer. Descending venography results were compared in six of these limbs, however, no correlation with compartment pressures could be found from this small sample. With further study, deep posterior compartment pressures using the slit catheter technique may prove to be a valuable aid in the diagnosis of venous insufficiency.
Pulsed Doppler Assessment of Deep Femoral Artery Hemodynamics: A Preliminary Report
Authors: Marquis C. , Meister J.-J. , Mooser E. , Mosimann R.
Published: November 2007

The functional capability of the deep femoral artery (DFA) as a collateral channel is an important feature in patients suffering peripheral arterial occlusive disease (PAOD). A noninvasive method of indirect quantification of the DFA blood flow volume is presented.

In normal lower limbs, it was found that the common femoral artery (CFA) mean blood flow volume was maintained at 59% of its resting value when the superficial femoral artery (SFA) was occluded by a pneumatic cuff placed around the thigh. The reduction of the mean flow volume is mainly due to an increase of the diastolic backward flow, while the maximum systolic flow remains constant.

In a few patients with various degrees of stenosis of the DFA, we observed a much greater drop in mean CFA blood flow volume than in normal subjects.

On the basis of this preliminary study, we conclude that:

—When the normal SFA is occluded, pulsatile flow through the CFA is maintained.

—Occlusion flow reflects the runoff and the compliance of the DFA bed.

—Occlusion flow is diminished in patients with DFA stenosis.

It is suggested that this non-invasive test might help the physician to assess the involvement of the DFA in PAOD. Further investigation is needed to establish the correlation between quantitative occlusion blood flow volume and the degree of DFA stenosis.
Changes in the Rheologic Properties of Blood after a High Altitude Expedition
Authors: Palareti Gualtiero , Coccheri Sergio , Poggi Mario , Tricarico Maria Gabriella , Magelli Mario , Cavazzuti Francesco
Published: November 2007

The changes in blood rheologic properties induced by exposure to high altitude plus heavy and prolonged physical strain were investigated in 14 climbers of an Italian expedition to Himalaya (maximum altitude reached m 7350). In blood samples collected immediately after return, alterations of some haemorheologic parameters were observed in comparison with baseline values, and namely an increase in relative blood viscosity, fibrinogen and erythrocyte filtration time along with a fall in platelet count. Treatment with a drug acting on the red cell deformability (Pentoxifylline) appeared to prevent the changes in blood viscosity and erythrocyte filterability. In the 9 climbers whom we were able to re-examine after three months, all altered parameters were found to be restored to baseline values. These results contribute to the knowledge of the pathogenesis of high altitude disease and stress the significance of altered haemorheology as one of the mechanisms possibly involved in the vascular events observed in this condition.
The Provocative Test and Their Diagnostic Value in Sinus Node Failure
Authors: He-Chang Yan
Published: November 2007

Exercise and pharmacologic tests were used for evaluation of the sinus node and S-A function. In all 10 normal persons, the heart rate raised above 90/min without development of cardiac arrhythmia. Among 13 patients with sinus node failure, only 1 had the heart rate raised to 90/min after exercise test and 7 above 90/min after medicinal induction. Cardiac arrhythmia, which is characteristic in sinus node failure, may appear during the test, provide an important clue in making a diagnosis. Criteria for the provocative tests are described. During the test, it is necessary to be on guard against any untoward effects. The patients in this study have been all uneventful throughout.
Nonsurgical Removal of a Kinked Right Coronary Catheter
Authors: Patel Rameshbhai , Kumar Samuel , Hameedi Shahid
Published: November 2007

Cardiac catheterization is a commonly performed procedure affording valu able data. Catheter related complications such as catheter knotting, fracture, and collapse have been reported. Occasionally surgery is needed to extricate an entrapped catheter when nonsurgical means are unsuccessful. We describe a case of kinking of a right coronary catheter during transfemoral coronary arte riography, so that the catheter could not be withdrawn. A simple, nontraumatic method facilitated removal of the kinked catheter and permitted completion of the procedure, obviating the need for surgery.
Whole Blood and Red Cell ATP Content in Patients With Peripheral Vascular Disease: The Effect of Cigarette Smoking and Oxpentifylline
Authors: Maughan Ronald J. , Broom John , Smith George , Leiper John B. , Ah-See Antoine K. , Engeset Jetmund , Evan-Wong Alex , Davidson Ronald J.L.
Published: November 2007

The relationship between erythrocyte ATP content and the presence of atherosclerotic peripheral occlusive vascular disease was investigated. In 20 elderly patients with severe peripheral vascular insufficiency (10 male, 10 female; age 68.8 ± 12.5 years; Mean ± SD) the mean erythrocyte ATP content was 1.57 ± 0.16 mmol/litre. In a sex and age matched group (69.1 ± 9.6 years) with no signs or symptoms of peripheral or myocardial ischaemia, erythrocyte ATP content did not differ significantly (1.49 ± 0.29 mmol/litre). In young healthy volunteers, there was no difference in erythrocyte ATP content between males and females or between cigarette smokers and non-smokers, nor were the values for the young group different from those obtained from the elderly patients. The effect of oxpentifylline administration on erythrocyte ATP levels in patients with peripheral vascular disease was also studied. Administration of oxpentifylline (1.6 g per day in divided doses) over 7 days had no effect on erythrocyte ATP content in 10 patients (5 male, 5 female) with ischaemic lower limbs. These results suggest that measurement of erythrocyte ATP content is unlikely to be a useful index in the assessment of peripheral vascular disease.
Current Status of the Vascular Laboratory in the Diagnosis of Deep Vein Thrombosis
Authors: AbuRahma Ali F. , Osborne Linda
Published: November 2007

The frequency of venous disease probably surpasses that of heart disease and stroke.

The fallibility of the clinical diagnosis of pulmonary embolism and deep vein thrombosis (DVT) approaches 50% error in both conditions. Because of the serious errors in omission and commission of the clinical diagnosis of venous thrombosis, a variety of noninvasive diagnostic techniques have been developed within the past decade. The purpose of this paper is to analyze these noninvasive venous modalities with more emphasis on what is available in our vascular lab at Charleston Area Medical Center - Charleston Division, West Virginia University Medical Center.
Effect of Serotonin on Albumin and Low Density Lipoprotein Uptake in Perfused Rabbit Femoral Arteries
Authors: Santillan Gregorio G. , Sato Masanori , Bing Richard J.
Published: November 2007

Uptake by the arterial wall of plasma constituents has considerable clinical implication; thus, uptake of low density lipoprotein (LDL) plays an important role in the development of atherosclerosis. Serotonin and other vasoactive mate rial may result in changes in the arterial wall leading to increased uptake of albumin or low density lipoprotein. This study was conducted to determine the effect of serotonin (10-5M 5-hydroxytryptamine) and serotonin-induced arterial constriction on albumin and low density lipoprotein uptake rates in perfused rabbit femoral arteries. The results show that the presence of serotonin inhibits the rate of uptake of both albumin and LDL. The effect on albumin uptake does not have a direct dose response dependence and is linearly dependent on trans mural pressure. In contrast, LDL uptake rates are only slightly affected by pressure. Thus, albumin and LDL uptake processes appear to be due to sepa rate mechanisms.
A Case of Takayasu's Disease Occurred Over Two Hundred Years Ago
Authors: Di Giacomo Vincenzo
Published: November 2007

The author refers to a case described in 1761 by G.B. Morgagni, in which there were all the clinico-pathological features of aspecific aorto-arteritis, as it was pointed out in this century by some Japanese authors. Morgagni's case was a woman 40 years old, whose radial pulses were never perceived for many years before her death; the necroscopic examination showed severe aortic alterations, characterized by ectasias, aneurysms and stenosis, with subclavian obstruction at the origin. The radial arteries, on the contrary, were found unaffected. This case, as well as another reported by Savory in 1856, demonstrates that an ob structive disease of the aorta and its branches had been already noted and de scribed long before in the European Countries in spite of the rarity of this sickness.
Right Ventricular Endomyocardial Biopsy in Undetermined Form of Chagas' Disease
Authors: Mady Charles , Pereira-Barretto Antonio Carlos , Ianni Bárbara Maria , Lopes Edgard Augusto , Pileggi Fúlvio
Published: November 2007

Right ventricular endomyocardial biopsy was carried out in thirty three pa tients with undetermined form of Chagas' disease.

Fragments obtained by this method were analysed under light microscopy with hematoxilin-eosin, and Masson trichromic stains. Thirteen (39.4%) pa tients showed normal myocardial fragments and twenty patients (60.6%) had them altered. Alterations included fiber degeneration, volume changes, intersti tial edema, inflammatory infiltrates and fibrosis.

These data permit to conclude that only part of patients with this form of Chagas' disease have an incipient myocardial attack and that the alterations found in the fragments obtained are mild. The remaining patients would be either individuals with chagasic infection without cardiac disease or have spon taneous healing. This should be considered in the future treatment of the dis ease.
Acute Anterior Wall Myocardial Infarction Secondary to Blunt Chest Trauma
Authors: Anto M. Joseph , Cokinos Stephan G. , Jonas Ernesto
Published: November 2007

We report here a young patient who developed an acute transmural anterior wall myocardial infarction secondary to blunt chest trauma in an automobile accident. At angiography we demonstrated that this patient had sustained a left anterior descending branch intimal tear (Figure 1). Closed chest wall injury with myocardial contusion is a common occurrence in automobile accidents. However, the occlusion of the coronary artery from blunt chest trauma is rare in itself.
Diagnosis of Vasospastic Angina by Analysis of Heart Rate Response to Exercise: Effects of Different Levels of Work Load
Authors: Sato Iwao , Hasegawa Yasuhiro , Ohe Tohru , Funahashi Tohru , Tomobuchi Yoshiaki , Shimomura Katsuro
Published: November 2007

To examine alterations in control function of the heart, which may account for the pathophysiologic condition precipitating coronary arterial spasm, heart rate response to exercise in vasospastic angina was evaluated by using our previously developed method of frequency analysis. We also examined the effects of three different levels of work load on the heart rate response to treadmill exercise in 9 patients with vasospastic angina and 7 normal controls: stage 1 (2.5 Km/h, 10%), stage 3 (4.5 Km/h, 10%), and stage 5 (5.5 Km/h, 14%). The transfer function of heart rate control in vasospastic angina was characteristically different from that in normal controls: lower gain and more delayed phase angle of the system. Although this abnormality was observed in every test at 3 different levels of work load, the abnormality was more striking in tests at lower levels of work load: stage 1 or 3. The moderately light exercise test at stage 3 is most suitable as a test for detecting abnormal heart rate response to exercise in vasospastic angina because the exercise test at stage 1 had a poor S/N ratio.
Subacute Massive Thromboembolic Occlusion of a Main Pulmonary Artery Report of a Case Successfully Treated by Thrombolytic Therapy and Review of the Literature
Authors: Woods Bartholomew O'B. , Beamis John F. , Bettencourt Paul E. , Persson Alfred V.
Published: November 2007

Subacute massive thromboembolic occlusion of the left main pulmonary artery in a 52-year-old woman is described. This disease remains a rare entity with a much less dramatic presentation than acute massive pulmonary embolus. The presenting symptom was unexplained dyspnea. Physical signs and laboratory tests were nonspecific. The perfusion scan is the best screening test for this disorder. Antemortem diagnosis is established by pulmonary angiography. A literature review undertaken to ascertain the incidence of this entity as well as to recommend treatment of choice, be it medical or surgical therapy, was unrewarding. We decided to use thrombolytic therapy and found a marked improvement in the patient's symptoms and perfusion scan after 24 hours. Although thrombolytic therapy is commonly indicated for acute massive pulmonary embolism, we believe this mode of therapy should also be the initial treatment for subacute massive pulmonary thromboembolism.
Prognosis After Myocardial Infarction- Prediction in Ambulatory Patients by Use of the Bedside Valsalva Maneuver
Authors: Zema Michael J.
Published: November 2007

One hundred survivors of first myocardial infarction were studied prior to hospital discharge by 24 hour ambulatory electrocardiography as well as radio nuclide ventriculography. The bedside Valsalva maneuver, with simple sphyg momanometric determination of arterial pressure response, was performed 6 weeks post infarction and patients were followed for a mean of 22 months. The arterial pressure response pattern provided a semiquantitative estimate of rest ing left ventricular systolic function when related to the radionuclide ejection fraction (SIN, 0.56±0.13; ABO, 0.43±0.18; SQW, 0.16±0.06) (P < 0.02). Ab normal Valsalva responses (ABO and SQW) were found more commonly in patients with diminished left ventricular systolic function and high grade ven tricular arrhythmias. The SQW response pattern was highly predictive of fu ture sudden cardiac death. The bedside Valsalva maneuver, performed 2-4 weeks after hospital discharge, upon the ambulatory patient is a simple, safe, inexpensive and uniformly applicable method which may serve as the basis for a strategy with which to approach the post-infarction patient regarding risk stratification and further clinical management.
Huge Left Atrial Thrombus and Valve Degeneration in a Patient with a Bioprosthetic, Porcine, Mitral Valve
Authors: Zoneraich Samuel , Ballas Mayer , Wessely Zelma , Zoneraich Olga , Greenspan Joshua , Rosner Fred
Published: November 2007

A 43 year old man with a Hancock porcine bioprosthetic valve in the mitral position developed a huge thombus filling the entire left atrium and chronic degeneration of the bioprosthetic mitral valve. The effective valve orifice was less than 2 mm. These severe findings leading to the patient's death remained undetected while he was alive. This case illustrates the great need for a serial phonoechocardiographic studies in all patients with prosthetic valves.
Femoral Artery Flow in Deep Vein Thrombosis: Hemodynamics of Slow Versus Acute Femoral Vein Occlusion
Authors: Shifrin Edward G.
Published: November 2007

There are many reports of reduced flow in the femoral artery following acute occlusion of the femoral vein. Poorer results might also be expected in arterial reconstructive surgery for obliterative vascular disease, in the event of deep vein thrombosis (DVT) of the limb. It is likely that patients develop DVT by a slow process that is totally different from experimental acute occlusion of the femoral vein, which leads to reduction of flow in the femoral artery. To test this hypothesis, a model with slow and gradual femoral vein occlusion was used. The results of this study showed that there was only 13.5% reduction in femoral artery flow during a four-hour gradual occlusion of the femoral vein.

This excludes the possibility that in the presence of gradually occurring processes such as DVT, there is a hemodynamic basis for reduced flow through the femoral artery or through a bypass.
Buerger's Disease in Women. A Case Report with Critical Approach to the Literature
Authors: Cavallaro A. , Meloni F. , Sciacca V. , Transi M.G. , DiGiacomo V.
Published: November 2007

The Authors describe a case of arteritis of the lower limbs in a woman, in which the clinico-angiographical features were suggestive for Buerger's disease, and this was confirmed by histological examination of the left posterior tibial artery. A bilateral lumbar sympathectomy was effective at least in slowing the course of the disease.
Pseudo-Coarctation of the Abdominal Aorta Associated with Renovascular Hypertension
Authors: Kawarabayashi Takahiko , Nishikimi Toshio , Takeuchi Kazuhide , Takeda Tadanao
Published: November 2007

A case of pseudo-coarctation of the abdominal aorta associated with renov ascular hypertension has been reported. The abdominal aorta of the patient was kinked at the level of L1-L2 without a pressure gradient, which was consistent with pseudo-coarctation of aorta. Both renal arteries arose from the aorta at the level of lower T12 and had severe multiple stenoses. We have discussed the possible etiology of the developmental abnormalities of the arterial system in this patient.
On the Therapy of Disturbances of Blood Fluidity
Authors: Mueller Roland
Published: November 2007

Physiology and pathophysiology of blood fluidity are reviewed focussing the clinical relevance of the different hyperviscosity syndroms with particular re spect to the microcirculation and thromboembolic complications. A new thera peutical approach is presented with pentoxifylline*, a drug which largely satisfies the complex requirements of a compound affecting most of the determi nants of disturbed blood fluidity. The presented data of the multifunctional pharmacological properties of pentoxifylline on blood components and vessel wall suggest this drug as indicated for the treatment of the disorders of blood fluidity linked with many diseases. Its antihemostasiological and antithrombotic potential also offers the facility for prevention of postoperative thrombotic events and in vessel surgery to avoid reocclusion.
Red Cell Aggregation in Cardiovascular Diseases and Crucial Role of Inversion Phenomenon
Authors: Dintenfass Leopold
Published: November 2007

Perfusion of the heart muscle remains an important area of studies fraught with great difficulties. An analogue of capillary system has been organized by using in vitro flow of blood from the heart patients in a slit-capillary photo- viscometer. The rate of aggregation of red cells and the morphology of aggre gates have been observed and quantitated in representative cases. A possible role of the sludge-like aggregates is discussed from the viewpoint of the "inver sion phenomenon" which amplifies resistance to flow as a function of rheology (rigidity or deformability) of cell aggregates and single cells. This pattern might be alike that of arterial spasm or can serve as a model for capillary occlusions. A description is given of the new instrument, the slit-capillary photo-viscometer, and stereological parameters obtained in macro- and micro-photography are included. Linear regressions of such parameters against stasis time are highly significant, showing correlation coefficient up to 0.99. These regressions can be compared for slopes and elevations observed in different blood samples, with significance up to 0.001.
The Reliability of Doppler Ultrasound Techniques in the Assessment of Carotid Disease
Authors: Ratliff David A. , Hames Tony K. , Humphries Keith N. , Birch Stephen , Chant Anthony D. B.
Published: November 2007

The reliability of continuous wave (CW) Doppler imaging and Duplex scan ning in the assessment of carotid artery disease has been evaluated prospectively in comparison with biplanar angiography. Of 130 comparisons the sensitivity of Doppler imaging was 89% and specificity 99% in the detection of ≥ 50% inter nal carotid stenosis, and 87% and 99% respectively in the diagnosis of internal carotid occlusion. Of 118 comparisons the sensitivity of Duplex scanning was 93% and specificity 98% in the detection of ≥ 50% internal carotid stenosis, and 93% and 99% respectively in the diagnosis of internal carotid occlusion.

CW Doppler imaging and Duplex scanning are accurate techniques in the diagnosis and categorisation of internal carotid artery disease. CW Doppler imaging is an effective screening technique for the presence of ≥ 50% internal carotid artery stenosis. Duplex scanning also has the potential for improved detection of early internal carotid artery disease and study of the natural history of atherosclerosis.
Spectrum of Renovascular Hypertension in the Young in North India: A Hospital Based Study on Occurrence and Clinical Features
Authors: Sharma B.K. , Sagar S. , Chugh K.S. , Sakhuja V. , Rajachandran A. , Malik N.
Published: November 2007

Occurrence of renovascular hypertension and its etiology is described in this work as seen in north India. Out of 2395 young hypertensives admitted for evaluation during the years 1978-1983, 91 patients (3.8%) were found to be having renovascular hypertension. In all patients suspected diagnosis of RVH was confirmed by the angiography of aorta and main vessels. Idiopathic aor toarteritis, diagnosed in 54 patients (59.4%) was the commonest cause of renov ascular hypertension. In this group renal arterial involvement was found to be bilateral in 26 patients. Twenty-eight patients had isolated renal artery stenosis of unknown etiology. Six had fibromuscular dysplasia, 2 had polyarteritis and one had renal artery aneurysm. Twenty-three patients underwent surgery which included autotransplantation,11 arterial by-pass1 and nephrectomy11 with improved blood pressure control in 15. It is concluded that aortoarteritis seems to be the major cause of renovascular hypertension in the young in this part of the world.
Detection of Shunt Flow in Total Anomalous Pulmonary Venous Connection Using 2D-Doppler Echocardiography
Authors: Itoh Kouichi , Suzuki Osamu , Yano Sadayuki , Shiraishi Hirohiko , Yanagisawa Masayosi
Published: November 2007

Two-D-Doppler echocardiography was used to diagnose two cases of total anomalous pulmonary venous connection (TAPVC). The first case presented the supracardiac type, the second the infracardiac type. Blood flow imagings pro duced by 2D-Doppler echocardiography revealed shunt flow in the common pulmonary veins (CPV) and the vertical, innominate, and portal veins. The shunt flow in the vertical vein was laminar, though the shunt flow in the inflow tract of the right atrium was turbulent. Two dimensional Doppler echocardio graphy is very useful in the detection shunt flow in TAPVC.
Bone Marrow Status of Anaemic Pregnant Women on Supplemental Iron and Folic Acid in a Nigerian Community
Authors: Okafor L.A. , Diejomaoh F.M.E. , Oronsaye A.U.
Published: November 2007

The bone marrow status of 31 consecutive pregnant women who had been on supplemental oral iron and folic acid since early pregnancy at the University of Benin Teaching Hospital was assessed later in pregnancy to test the efficacy of oral iron and folic acid in preventing iron deficiency and/or megaloblastic anae mia in our community. Only those pregnant patients with haemoglobin geno type AA or AS took part in the study. Nobody was excluded except those with CC or SC. 96.77% (30 out of 31 patients) had iron deficiency with no stainable iron in the bone marrow. 35.4% (11 out of 31 patients) had megloblastic changes in the bone marrow. 32.2% (10 out of 31 patients) had a combined iron deficiency and megaloblastic anaemia while only one out of 31 patients (3.23%) had megaloblastic anaemia without concurrent iron deficiency. 60.4% (20 out of 31 patients) had iron deficiency alone without concomitant megaloblastic changes in marrow. The bone marrow in all the patients were normal in other respects except with regards to iron-deficiency and/or megaloblastic status.

The significance of this high incidence of iron-deficiency and/or megaloblas tic anaemia in patients already on routine pre-natal drugs is discussed.
Pulse Wave Reflections at the Aorto-Iliac Junction
Authors: Li John K.-J.
Published: November 2007

For pressure pulses to be transmitted to vital organ vascular beds, minimum loss through vascular branching junctions is necessary.

Experimental measurements of pulse wave velocities and cross-sectional ar eas allowed branching reflections to be quantified.

Wave reflections at normal aorto-iliac junction is minimal. Increased reflec tion occurs when the branch vessel is either narrowed or occluded. Also, geo metric factors dominate over elastic factors in determining the amount of pulse wave reflections at the aorto-iliac junction.