bluuebunny/crossref_metadata_2025 huggingface dataset:
Sustained Classic Clinical Spectrum of Thromboangiitis Obliterans (Buerger's Disease)
Authors: Wysokinski Waldemar E. , Kwiatkowska Wieslawa , Sapian-Raczkowska Bozena , Czarnacki Maciej , Doskocz Romana , Kowal-Gierczak Barbara , Wysokinski Waldemar E.
Published: July 2008

Thromboangiitis obliterans (TAO) has been reported to become less common in general population but more common in women, and in elderly patients. The authors looked at the clinical characteristics of TAO in Poland where there was no significant decrease of smoking and the extent of aging of the general population is less profound. They retro spectively reviewed the records of 377 patients with the diagnosis of TAO hospitalized in their institution from 1970 to 1995. If young smoking males demonstrated distal- extremity ischemia with no bruits audible over major arteries, upper limbs involvement, or superficial thrombophlebitis, the diagnosis of TAO was considered certain. When at least one of those criteria was missed, and in men older than 35 years, but in all females, typical arteriographic findings were required for the diagnosis of TAO. Connective-tissue disease, hyperlipidemia, diabetes, and hypercoagulable state were excluded. Three hundred forty-two men (91%), and 35 (9%) women had a mean age of 29.5 years at the onset of the disease (the oldest patient was 50 years old). The prevalence of TAO in southwest Poland is 8.1/100,000 and the incidence of the disease steadily declines; there was no increase of TAO in women. Three hundred thirty-seven (89%) experienced rest pain, 321 (85%) had ischemic necrosis, and 233 (62%) thrombophlebitis at some time in the course of the disease. Raynaud's phenomenon occurred in only 39 patients (10%). Those patients who had quit smoking had a 50% decrease of the disease recur rences compared to their smoking period. Because the cause of declining incidence of TAO is obscure, the authors critically evaluated previously used explanations of this phenomenon. They did not confirm the observation of a change in the TAO clinical spectrum: occurrence in women did not increase, the aging of the TAO population was not observed. In Poland TAO is still a disease affecting the peripheral circulation of young smoking males with recurrent episodes of superficial thrombophlebites and common involvement of the upper extremities; Raynaud's phenomenon is rather infre quent. Smoking cessation ameliorates the course of the disease but does not invariably stop further exacerbations.
Internal Jugular Vein Thrombosis, Lemierre's Syndrome; Oropharyngeal Infection with Antibiotic and Anticoagulation Therapy
Authors: Nakamura Shin , Sadoshima Seizo , Doi Yasufumi , Yoshioka Maki , Yamashita Shigeru , Gotoh Hiroki , Onoyama Kaoru , Nakamura Shin
Published: July 2008

The authors present a case of Lemierre's syndrome that is an uncommon septic throm bophlebitis of the internal jugular vein. A 31-year-old man developed pharyngeal pain one month before hospital admission when he suffered from a severe headache and painful swelling of the left side of his neck. He was diagnosed with tonsillitis. Contrast- enhanced computed tomography and magnetic resonance imaging of the neck revealed the presence of an occlusive thrombosis of the left internal jugular vein and an inflamed mesopharynx. His symptoms and the jugular vein thrombus showed remarkable improve ment after administration of antibiotic and anticoagulation therapy. No pulmonary embolism or other metastatic infection were observed. It was suggested that accurate diagnosis during early treatment is essential to obtain a successful prognosis for Lemierre's syndrome.
Plasma Homocysteine and Lipoprotein Profile in Patients with Peripheral Arterial Occlusive Disease
Authors: Richter Volker , Janke Christian , Purschwitz Kathrin , Klötzer Bernd , Geisel Jürgen , Herrmann Wolfgang , Rassoul F.
Published: July 2008

Several studies have identified moderate hyperhomocysteinemia (HCy) as an indepen dent risk factor for atherosclerosis. The purpose of this case control study was to determine lipoprotein profile and homocysteine concentration in serum of 85 male patients with peripheral arterial occlusive disease (PAOD) and in 51 normolipidemic age- matched male controls. Cholesterol, triglycerides, and high-density lipoprotein (HDL) cholesterol as well as subfractions HDL2 and HDL3 cholesterol, low-density lipoprotein (LDL) cholesterol, apo B, apo A-I, and lipoprotein particles LpA-I and LpA-I:A-II were measured in serum. Homocysteine, folic acid, and vitamins B6 and B 12 were determined with the help of high-pressure liquid chromatography. The 677 C → T mutation in the methylenetetrahydrofolate reductase (MTHFR) gene was analyzed in PAOD patients. Patients with peripheral arterial occlusive disease showed a significantly higher mean concentration of homocysteine than control subjects (p< 0.001). There was a negative correlation between the levels of homocysteine and vitamin B12 as well as folic acid (for vitamin B12: r=-0.40 and for folic acid: r=-0.38). The prevalence of hyperhomocys teinemia (Hcy > 16 μmol/L) in the patients was 45% in contrast to 8% in controls. HDL cholesterol, HDL3 cholesterol, Apo A-I, and Lp A-I were significantly reduced in patients and triglycerides were elevated. The elevated plasma homocysteine concentra tion is frequently seen in homozygous carriers of a point mutation (677 C → T) in the methylenetetrahydrofolate reductase gene, as the product of this gene is an enzyme, participating in homocysteine remethylation. The homozygous state for the 677 C → T mutation was found in 13.3% of PAOD patients.
Percutaneous Transluminal Coronary Angioplasty Performed 24-48 Hours After the Onset of Acute Myocardial Infarction Improves Chronic-Phase Left Ventricular Regional Wall Motion
Authors: Nakabayashi Takayuki , Hayashi Takahiro , Inoue Yoshikazu , Ikeda Akiko , Morii Hideki , Naito Norikatsu , Ishikawa Kinji , Kanamasa Ken
Published: July 2008

The authors investigated the capacity of percutaneous transluminal coronary angioplasty (PTCA) performed 24-48 hours after the onset of acute myocardial infarction (AMI) to improve regional left ventricular wall motion. Twenty-four patients were divided into two groups: a PTCA group who received successful PTCA (14 cases) and a non-PTCA group (10 cases) who did not receive PTCA. Left ventricular end-diastolic volume (LVEDV) increased significantly (p < 0.01) from 57 ±14 mL/m 2 during the acute phase to 83 ± 16 mL/m2 during the chronic phase in the non-PTCA group, whereas no signifi cant change in LVEDV was seen in the PTCA group (69 ±26 vs 76 ±16 mL/m2). In addition, in patients with 99% stenosis/thrombolysis in myocardial infarction (TIMI) grade 3 flow, increases in regional left ventricular wall motion (Δsd/chord) at the infarcted site between the acute and chronic phases were significantly greater in the PTCA group than in the non-PTCA group (2.49 ± 1.05 vs 0.67 ±0.65, p <0.01). PTCA performed 24-48 hours after the onset of AMI improved wall motion at the infarcted site.
Antiplatelet Is Superior to Anticoagulant Treatment After Coronary Stenting: Fewer Coronary and Other Events Within 30 Days After Stenting
Authors: Alexopoulos Dimitrios , Stefanadis Christodoulos , Olympios Christoforos , Voudris Vasilis , Hatzimiltiadis Stavros , Sionis Dimitriis , Vavouranakis Emmanouel , Vrahatis Antonis , Fakiolas Constantine , Pissimisis Evagellos , Stefanidis Alexander , Zairis Michael , Pavlides Gregory , Vitakis Spyros , Louridas George , Cokkinos Dennis , Toutouzas Pavlos , Foussas Stefanos
Published: July 2008

Stent prosthesis is a high efficacious method with low complication rates. However, the ideal adjunctive therapy following stent implantation remains controversial. The authors compared the effectiveness and complication rates of aspirin-ticlopidine antiplatelet therapy vs anticoagulant therapy with acenocoumarol within 30 days following stent prosthesis. They prospectively studied 404 patients following stent prosthesis while randomly receiving anticoagulant (Group A: 201 patients) vs antiplatelet treatment (Group B: 203 patients). Groups A and B were similar in demographic data (age, gender), stent location, clinical presentation, indication of stenting, and type of implanted stent. Chi-square test, t test, and Wilcoxon test for two samples were used for statistical analysis of the results. Stent implantation was attempted in 434 cases. This was successful in 70/85 (82%) of the bailout, 122/135 (90%) of the suboptimal, and 212/214 (99%) of the elective cases. In 201 patients anticoagulant treatment with acenocoumarol was administered for 4 weeks (group A), while 203 received antiplatelet treatment with ticlo pidine (group B). The need for reintervention was less and total cardiac events were fewer in group B than in group A: three (1.5%) and nine (4.4%) vs 18 (9%) and 29 (14.4%), p < 0.0008 and p < 0.006 respectively. Hemorrhagic complications and total noncardiac events were fewer in group B than in group A: six (3%) and six (3%) vs 18 (9%) and 19 (9.5%), p < 0.01 and p < 0.007 respectively. The length of hospital stay was shorter in group B than in A, p < 0.0001. In conclusion, in this study of intracoronary stenting the authors had a high success rate in 434 attempted cases. Antiplatelet therapy was accompanied by fewer cardiac and noncardiac 1 month events when compared with anticoagulant therapy, supporting its role as the adjunctive treatment of choice post- stenting for the time being.
Giant Aneurysm of the Splenic Artery
Authors: Medjoubi Sid-Ali , Tissot Alain , Jurado Andres , Hibon Jacques , Terris Claude , Bornet Pierre
Published: July 2008

Giant aneurysms of the splenic artery larger than 10 cm are rare. The size of splenic aneurysms rarely exceeds 3 cm. Aneurysms that are often symptomatic because of their size must be treated rapidly before rupture. An etiologic and diagnostic evaluation with computed tomography and selective angiography of the visceral arteries is essential before treatment. Operative indication is imperative for these aneurysms. Their mass with portal compression and dense adhesions to adjacent organs allow only aneurysmal exclusion by proximal and distal ligation with preservation of the spleen. The control of the proximal splenic artery is often difficult, justifying the choice of the surgical access. A case of surgically treated giant splenic artery aneurysm associated with right benign renal lesion is presented with a review of the literature on this subject.
Effect of Beta-Blocker on Metabolism and Contraction of Doxorubicin-Induced Cardiotoxicity in the Isolated Perfused Rabbit Heart
Authors: Ryomoto Teruhiko , Ishikawa Kinji , Kawabata Hitoshi
Published: July 2008

The effect of β-blocker (propranolol) on the metabolism and contraction of doxorubicin- induced cardiomyopathy during pacing or ischemia was examined by the phosphorus 31-nuclear magnetic resonance (31 P-NMR) in Langendorff hearts of chronically treated rabbits after cumulative doses of 16 mg doxorubicin/kg. After 8 weeks of doxorubicin treatment, β-blocker (propranolol) was given orally over a period of 2 weeks for a cumu lative dose of 1.4 mg/kg. Isolated hearts were paced at higher heart rates, or hearts were perfused on low flow. Adenosine triphosphate (ATP), creatine phosphate (PCr), inorganic phosphate (Pi), pH, left ventricular systolic developed pressure (LVDev P), and coronary flow were measured. The hearts were divided into three experimental groups: Group I consisted of controls, Group II consisted of doxorubicin treatment, and Group III consisted of doxorubicin treatment with propranolol. Group II showed a significant decrease of ATP during pacing (48 ±2%) and during low flow (61 ±6%) compared with Group I (86 ±9% at pacing, 94 ±6% on low flow). But Group III showed a significantly marked improvement of ATP during pacing (95 ±10%) and during low flow (83 ±3%) compared with Group II. Furthermore, Group II showed a significant decrease of LVDev P during pacing (69 ±6 mm Hg) and during low flow (63 ±3 mm Hg) compared with Group I (101 ±5 mm Hg at pacing, 95 ±9 mm Hg on low flow). But Group III showed a significantly marked improvement of LVDev P during pacing (93 ± 5 mm Hg) and during low flow (83 ± 14 mm Hg) compared with Group II. In conclusion, propranolol had a significant beneficial effect on metabolism and contraction during high-energy demand and during low oxygen supply of doxorubicin cardiomyopathy.
Isolated Dissection of the Celiac Artery
Authors: Matsuo Ryu , Ohta Yuko , Ohya Yusuke , Kitazono Takanari , Irie Hiroyuki , Shikata Tatsuru , Abe Isao , Fujishima Masatoshi
Published: July 2008

Isolated arterial dissection, which occurs with the absence of aortic dissection, has been reported in carotid and renal arteries but rarely in visceral arteries. A case of isolated celiac artery dissection is reported here. A healthy 58-year-old man experienced sudden upper abdominal pain, which continued for several days. A body computed tomogram (CT) showed a multiple low-density wedge-shaped area in the spleen, which was diagnosed as splenic infarction, and an aneurysm with thrombus in the celiac artery. A selective angiogram showed dilatation of the celiac artery with wall irregularity, and proximal occlusion of the hepatic artery. The distal hepatic artery was fed by collateral arteries from the superior mesenteric artery. Splenic infarction was probably due to the embolism from the thrombus in the dissected celiac artery. The absence of other vascular lesions and causes or risks for the arterial dissection would suggest the occurrence of spontaneous dissection. The dissection of visceral arteries should be considered in diag nosing acute abdominal pain.
Coronary Angioplasty and Stenting in Orthotopic Heart Transplants: A Fruitful Act or a Futile Attempt?
Authors: Sharifi Mohsen , Siraj Yaser , O'Donnell Jacqueline , Pompili Vincent J.
Published: July 2008

Accelerated allograft coronary artery disease remains the major cause of mortality after the first year of transplantation. Despite the extensive use of stents and angioplasty in coronary artery disease, there is a paucity of data about the efficacy of such interventions in orthotopic heart transplants. The authors herein report the outcome of those patients in their institution who had undergone percutaneous coronary artery angioplasty and stenting at a late stage of their transplantation. Within a 12-year period, 106 adult patients underwent orthotopic heart transplantation at their institution. Eight of these patients with 17 lesions underwent deployment of nine stents and eight angioplasties 8.1 ±3.2 years posttransplantation. There were 15 denovo and two restenotic lesions. The indications for intervention were presence of symptoms in five patients and severity of lesions in three asymptomatic patients detected on their follow-up angiogram. All patients had angiographic worsening of lesions at their follow-up angiogram. The initial procedural success for both stented and angioplastied lesions was 100%. Within a mean angiographic follow-up of 261 days, all balloon angioplastied lesions had developed restenosis, whereas within a mean period of 67 days, 50% of stented lesions had developed restenosis. On the follow-up angiogram, deterioration of the nontreated segments were noted throughout the coronary arterial tree; however, the immediate proximal and distal parts of the target segments demonstrated an exaggerated hyper proliferative response as compared to other sites. The overall median time to the detection of restenosis for both stented and angioplastied lesions was 5.2 months (inner quartile 2.5-6.2 months). The authors conclude that angioplasty and stenting late in the course of transplantation is associated with a significant restenosis rate and in such patients earlier or alternative catheter-based interventions must be considered.
Superior Vena Cava Syndrome Due to Permanent Transvenous Pacemaker Electrodes: Successful Treatment with Combined Thrombolysis and Angioplasty
Authors: Tan Chun Wang , Vijitbenjaronk Prasert , Khuri Bahij
Published: July 2008

Superior vena cava syndrome is a rare complication of permanent transvenous pacing electrodes. Multiple treatment options are available, namely thrombolytics, venoplasty, stenting, surgery, and combinations of the above, yet initially the optimal approach is uncertain. Whether plain balloon angioplasty provides durable and satisfactory long- term results is equally uncertain. The authors report a patient treated with a combination of local thrombolytic therapy and balloon venoplasty with good long-term outcome at two years of follow-up.
Transition from Classic Aortic Dissection to Aortic Intramural Hemorrhage
Authors: Yoshino Hideaki , Kachi Eisei , Matsue Shuhei , Yotsukura Masayuki , Ishikawa Kyozo
Published: July 2008

A 64-year-old man was hospitalized with chief complaints of chest and back pain. A diagnosis of Stanford type A aortic dissection with a false lumen extending from the ascending to the descending aorta was made based on the results of computed tomog raphy (CT). A CT obtained the following day showed resolution of the false lumen and increased brightness of the aortic wall, typical of aortic dissection with intramural hemor rhage. Although previous studies have described a gradual transition from aortic intra mural hemorrhage to aortic dissection with a false lumen, there are no reports of the transition from an aortic dissection with a false lumen to the intramural hemorrhage type of aortic dissection. This patient is of interest when considering the pathogenesis of aortic dissection with intramural hemorrhage and the relationship between the intra mural hemorrhage and false-lumen types of aortic dissection.
Quantitative Assessment of Peripheral Arterial Obstruction in Raynaud's Phenomenon: Development of a Predictive Model of Obstructive Arterial Cross-Sectional Area and Validation with a Doppler Blood Flow Study
Authors: Seitz Walter S. , Kline Howard J. , McIlroy Malcolm B.
Published: July 2008

The objective of this study was to develop a method for the analytical assessment of arterial obstruction in conditions of Raynaud's phenomenon capable of providing diag nostic criteria. Numerous attempts have been made to determine and quantify arterial obstruction in terms of Doppler ultrasound measurements of arterial blood velocity. Absent from these methods is a formulation that allows an assessment of arterial obstruc tion based on the obstructed area as derived from direct measurement. The authors used spectral analysis of velocity signals from a pulsed, range-gated Doppler ultrasonic instru ment to make quantitative measurements of arterial blood flow velocity in hands of normal subjects and persons with Raynaud's phenomenon. They measured the peak and mean velocity during the cardiac cycle and the time integral of the velocity signal over the cardiac cycle. These measurements for two distinct hemodynamic states induced by temperature changes allowed them to calculate the fractional change in arterial cross- sectional area produced by the change in temperature through the application of a hydraulic model of digital arterial circulation. They found an equation expressing frac tional obstructed area expressed as: dA/A = 2( dD - τ dν - ντ)/( D + ν dτ), where D is the time integral of the velocity signal; τ is the blood flow interval, ν is the blood velocity; and dD, dτ and dv are the differences in D, τ, and ν at two different hemodynamic states produced by two different temperature states. Their findings suggest that over a temper ature range of 35°-25°C, normal subjects experience 0.05/°C reduction in cross-sectional area while Raynaud subjects experience a reduction of 5.8%/°C.

The results, based on findings in 13 subjects, suggest that Doppler ultrasound can differentiate persons with Raynaud's phenomenon from normal subjects. Additionally, the hydraulic model appears to offer the potential of assessing relative stenotic area in other arterial obstructive diseases.
Diagnosis of Coronary Artery Disease with Tl-201 SPECT in Patients with Left Bundle Branch Block: Importance of Alternative Interpretation Approaches for Left Anterior Descending Coronary Lesions
Authors: Tandogan Izzet , Yetkin Ertan , Ileri Mehmet , Ortapamuk Hulya , Yanik Ahmet , Çehreli Sengul , Duru Erdal
Published: July 2008

Left bundle branch block (LBBB) is a strong predictor of mortality in the presence of coronary artery disease (CAD). Noninvasive evaluation of CAD in these patients has some difficulties. Exercise-induced electrocardiographic ST segment changes are nondiagnostic, and several scinti graphic studies have reported false-positive anteroseptal and septal perfusion defects up to 80%. The authors aimed to assess the diagnostic accuracy of thallium-201 (Tl-201) exercise myocardial single photon emission computerized tomography (SPECT) in comparison with coronary angiog raphy (CAG) for detection of CAD in patients with LBBB. Seventy-seven consecutive patients suffering from chest pain with complete and permanent LBBB were included in the study. All patients (40 women, 37 men, mean age = 54 ±7 years) were studied with TI-201 exercise SPECT and coronary angiography. TI-201 exercise SPECT for diagnosis of left anterior descending (LAD) artery lesions was interpreted by using three different approaches: method A (conventional approach), method B (involvement of anterior and septal wall regardless of apical wall), and method C (apical approach: involvement of anterior septal and apical wall). Methods A and B gave a sensitivity of 100% each but a specificity of 47% and 56%, respectively. Although method C gave a higher value of specificity than that of methods A and B (98% vs 47% and 56%, respectively p < 0.05), the sensitivity of method C significantly decreased in respect to methods A and B (33% vs 100% p<0.01). Isolated septal defects were evaluated separately. Isolated septal defects on exercise Tl-201 SPECT were detected in 11 patients, and none of them had CAD according to CAG results. Isolated septal wall involvement had a sensitivity of 0% and a specificity of 74%. The sensitivity and specificity of Tl-201 SPECT for diagnosis of CAD in the right coronary and left circumflex artery territories were 91% and 89%, respectively. In conclusion, the apical approach increased the specificity and decreased the sensitivity of the test. Isolated septal defects seem to have no value for diagnosis of CAD in patients with left bundle branch block.
An Unusual Increase of Blood Anti-beta 2-glycoprotein-I Antibody but not Antiphospholipid Antibody in Cerebral Ischemia
Authors: Chen Wei-Hsi , Liu Jia-Shou
Published: July 2008

An abnormal increase in anti-beta2-glycoprotein I antibodies (aβ2GPI) is capable of producing thrombosis and the vasculopathy-simulating antiphospholipid antibody (aPL). However, it is rarely described in cerebral ischemia without an association with aPL. The authors report a middle-aged man who experienced recurrent cerebral ischemia and diffuse cerebral stenosis without the apparent traditional cardiovascular risk factor. He was free of antiphos pholipid/cofactor syndrome (APCS) and systemic lupus erythematosus (SLE). An increase of blood aβ2GPI was detected in serial measurements. The aPL, Venereal Disease Research Laboratory (VDRL) test, Coombs' test, and antinuclear factor were negative. Activated partial thromboplastin time was normal. This patient is a reminder to consider aβ2GPI in an unex plained recurrent cerebral thrombosis and cerebral artery stenosis even when the typical clinical manifestation or laboratory data of APCS is absent.
Increased Autoantibodies Against Oxidized Low-Density Lipoprotein in Coronary Circulation in Patients with Coronary Spastic Angina
Authors: Ogawa Hisao , Soejima Hirofumi , Takazoe Keiji , Miyamoto Shinzo , Kajiwara Ichiro , Shimomura Hideki , Sakamoto Tomohiro , Yoshimura Michihiro , Kugiyama Kiyotaka , Kimura Masahiro , Yasue Hirofumi
Published: July 2008

Oxidized low-density lipoproteins are important in the progression of atherosclerosis. Autoantibodies against malondialdehyde-modified low-density lipoproteins have been reported to be predictive of the progression of atherosclerosis. This study sought to examine whether plasma levels of autoantibodies against oxidized low-density lipoprotein increase in the coronary circulation in patients with coronary spastic angina. The authors examined plasma antioxidized low-density lipoprotein antibody levels (activity unit values (AcU)/mL) simulta neously in the coronary sinus and the aortic root in 20 patients with coronary spastic angina, 23 patients with stable exertional angina, and 15 control subjects by measuring plasma levels of immunoglobulin G (IgG) autoantibodies against malondialdehyde-modified low-density lipoproteins by enzyme-linked immunosorbent assay. The plasma antioxidized low-density lipoprotein antibody levels (AcU/mL) in the coronary sinus increased in coronary spastic angina (38 ± 16) compared with stable exertional angina (23 ±7) and control subjects (20 ±6) (p≤0.0001). The levels (AcU/mL) in the aortic root also increased in coronary spastic angina (33 ± 12) compared with stable exertional angina (23 ±7) and control subjects (20 ±6) (p<0.005). Furthermore, the coronary sinus-arterial differences of the levels (AcU/mL) were also higher in coronary spastic angina (5 ±9) than in stable exertional angina (0 ±6) and healthy subjects (-1 ±5) (p < 0.05). The generation of malondialdehyde-modified low-density lipoproteins is reported to be associated with atherothrombosis. These findings suggest that elevated levels of autoantibodies against malondialdehyde-modified oxidized low-density lipoproteins in coronary circulation are associated with the development of atherothrombosis from the progression of atherosclerosis rather than with the extent of coronary atheroscle rosis in patients with coronary spastic angina.
Effect of Coronary Angiography on Plasma Endothelin-1 and Nitric Oxide Concentrations
Authors: Örem Asim , Örem Cihan , Alioglu Yurdan , Vanizor Birgül , Erdöl Cevdet
Published: July 2008

Endothelium takes part in the regulation of vascular tone through the production of endothe lium-derived relaxing factor, nitric oxide (NO), and the contracting factor endothelin-1 (ET-1). Induction of ET-1 and NO is influenced by many stimuli including hypoxia and shear stress. Some of these stimuli may arise during coronary angiography (CAG). In this study, the authors aimed to show endothelial response in patients undergoing CAG by evaluating plasma ET-1 and NO end-products including nitrite and nitrate concentrations. Twenty-four male patients with a mean age of 54.3 years (age range: 37-70) were included in the study. The patients had no coronary atherosclerotic lesions established by CAG. The mean time of the CAG procedures was 24.8 minutes, with a range of 19-33 minutes. Immediately before blood sampling, systolic and diastolic blood pressures were recorded. The mean blood pressures before and after CAG were 140/90 and 150/95, respectively. End products of NO radical, nitrite and nitrate (NOx), in plasma were used as a marker for the production of NO radical. ET-1 concentrations were measured by ELISA method. Significant increases in ET-1 concentrations were observed during CAG while no change observed in NOx concentrations. Duration of the CAG procedure was found to be correlated with the percent increase of the plasma ET-1 concentrations during CAG (r = 0.45, p<0.05, Figure 1), but not with NOx concentrations. Plasma ET-1 concentrations in patients who were cigarette smoking were found higher than those of patients who were nonsmokers (1.26 ±0.38 and 2.97 ±0.87 fmol/L, respectively). It was concluded that endothe lial cells show increased ET-1 production as a response of some mechanical or emotional stimuli during CAG procedure that may play an important role in the regulation of vascular tonicity and some pathological processes. The authors suggest that duration and manipulation of CAG may be an important factor in plasma ET-1 concentrations.
Mitral Valve Prolapse in Patients with Pure Rheumatic Mitral Stenosis: An Angiographic Study
Authors: Rezaian Gholam Reza , Emad Ali
Published: July 2008

Of 122 adult patients suspected of having rheumatic mitral stenosis, 112 fulfilled the hemody namic and angiographic criteria for pure, isolated mitral stenosis. There were 88 females and 24 males with an age range of 16 to 60 years. The left ventriculograms (30° right anterior oblique) were subjectively assessed for gross bulging of the mitral valve leaflets beyond the mitral fulcrum into the left atrium during a beat with maximal opacification. Seventeen percent of cases had typical evidence of mitral valve prolapse, which is much higher than the 3% to 5% rate reported for the general population. This phenomenon was independent of the patients' age, sex, hemodynamic findings, and/or their underlying cardiac rhythm, thus implying the direct role of rheumatic mitral stenosis in the genesis of secondary mitral valve prolapse.
Safety and Feasibility of Two-Dimensional Echocardiography and Myocardial Perfusion Imaging in Patients with Chest Pain
Authors: Paventi Saverio , Parafati Maria A. , Di Luzio Enza , Pellegrino Carmine A.
Published: July 2008

The accurate identification of patients at high risk for acute coronary syndromes among those seen in the emergency department with possible myocardial ischemia and nonischernic elec trocardiograms is a problem. Two-dimensional echocardiography and myocardial perfusion imaging with 99m-technetium sestamibi can identify patients at low and high risk; however, comparative studies are lacking. The authors studied 555 patients considered at low or moderate risk for myocardial ischemia in our emergency department on the basis of the presenting history, and results of physical examination and electrocardiography. These patients underwent echocardiography and myocardial perfusion imaging within 4 hours of presentation. Endpoints included myocardial infarction, percutaneous transluminal coronary angioplasty, and positive results on stress perfusion imaging. Both imaging procedures were performed in the emergency department on 370 patients. Overall agreement between the two techniques was high (concordance, 89%) in the patients who had myocardial infarction or underwent coronary angiography. Agreement between the two techniques is high when used in patients with possible myocardial ischemia. Both techniques helped identify patients at high risk who required admission and those who could be safely discharged.
Dilated Cardiomyopathy of Becker-Type Muscular Dystrophy with Exon 4 Deletion
Authors: Saotome Masao , Yoshitomi Yuji , Kojima Shunichi , Kuramochi Morio
Published: July 2008

The authors report a 47-year-old man with Becker-type muscular dystrophy presenting with dilated cardiomyopathy. Left ventriculography showed diffuse severe hypokinesia: left ventric ular end-diastolic volume index 193 mL/m2, left ventricular end-systolic volume index 143 mL/m 2, and left ventricular ejection fraction 26%. Skeletal muscle biopsy demonstrated a dystrophic process. Genetic analysis revealed a deletion of exon 4. There was a difference in immunos taining pattern between skeletal muscles and cardiac muscles. Severe cardiac dysfunction in this case may be associated with the damage in dystrophin-deficient fibers.
Venous Thromboembolism from Air Travel
Authors: Belcaro Gianni , Geroulakos George , Nicolaides Andrew N. , Myers Kenneth A. , Winford Michelle
Published: July 2008

The LONFLIT study was planned to evaluate the incidence of deep venous thrombosis (DVT) occurring as a consequence of long flights. In the Lonflit 1 study 355 subjects at low-risk for DVT and 389 at high-risk were studied. Low-risk subjects had no cardiovascular disease and used no drugs. All flights were in economy class. The average flight duration was 12.4 hours (range, 10-15 hr). The mean age of the studied subjects was 46 years (range 20-80 yr, SD 11; 56% males). DVT diagnosis was made by ultrasound scans after the flights (within 24 hours).

In low-risk subjects no events were recorded while in high-risk subjects 11 had DVT (2.8%) with 13 thromboses in 11 subjects and 6 superficial thromboses (total of 19 thrombotic events in 389 patients [4.9%]).

In the Lonflit2 study the authors studied 833 subjects (randomized into 422 control subjects and 411 using below-knee stockings). Mean age was 44.8 years (range, 20-80 yr, SD 12; 57% males). The average flight duration was 12.4 hours. Scans were made before and after the flights. In the control group there were 4.5% of subjects with DVT while only 0.24% of subjects had DVT in the stockings group. The difference was significant. The incidence of DVT observed when subjects were wearing stockings was 18.75 times lower than in controls.

Long-haul flights are associated to DVT in some 4-5% of high-risk subjects. Below-knee stockings are beneficial in reducing the incidence of DVT.
Clinical Characteristics Influence Aortic Root Dimension and Blood Flow Velocity in Healthy Subjects
Authors: Demir Mesut , Acartürk Esmeray
Published: July 2008

The aim of this study was to determine if aortic root dimension and blood flow velocity correlate with clinical and echocardiographic characteristics of healthy individuals. To assess the aortic root dimension and blood flow velocity in a healthy population, 503 subjects (253 women and 250 men) aged 18 to 66 years (mean, 36.9 ±11.9 years) who were normotensive, free of clinically apparent heart disease and any drug at the baseline examination were included in the study. M-mode echocardiographic measurements were performed according to the criteria recommended by the American Society of Echocardiography. Aortic blood velocity was obtained by pulsed wave Doppler echocardiography. Correlations between aortic root dimension and blood flow velocity and age, gender, body surface area, waist/hip ratio, and echocardiographic parameters such as left ventricular mass, ejection fraction, and left ventricular systolic and diastolic dimensions were evaluated by using regression analysis and Student's t test. Men had greater aortic root dimension (p < 0.001). There were correlations between aortic root dimensions and age, body surface area, waist/hip ratio, and left ventricular mass in both genders (p < 0.05). No correlation was found with left ventricular dimensions and ejection fraction. Aortic blood flow velocity correlated only with age (r = 0.32, p < 0.001). There was no gender difference in aortic blood flow velocity. This study shows that age, gender, body surface area, and waist/hip ratio should be considered in the evaluation of aortic root dimension. However, only age has an important impact on aortic blood flow velocity in both genders.
What is the Optimal Evaluation Time of the QT Dispersion After Acute Myocardial Infarction for the Risk Stratification?
Authors: Kabakci G. , Önalan O. , Kemal Batur M. , Yildirir A. , Çağrikul R. , Açil T. , Tokgözoğlu L. , Oto A. , Özmen F. , Kes S.
Published: July 2008

The sequential changes of the corrected QT dispersion (QTcD) were studied in 136 patients 1 day to 30 days after a transmural acute myocardial infarction (AMI) to investigate the optimal measurement time of QT dispersion for risk stratification. The study group included 136 patients (89 men; mean age, 57 ±10 years) with transmural AMI who were treated with throm bolytics (Tr+ group, n = 73) or not (Tr- group, n = 63) and 65 healthy controls (43 men; mean age, 56 ±7 years). Fourteen patients in whom ventricular tachycardia (VT), ventricular fibrilla tion (VF), or sudden cardiac death developed during the 30-day period were also evaluated as major cardiac arrhythmia (MCA) group. ECGs were obtained for each patient on days 1, 3, 5, 10, 15, and 30 after AMI. QTc dispersion in patients with AMI (for every period of QTcD after MI) was significantly more prolonged than in normal controls (49.3 ± 16.3 ms) (p < 0.001). QTcD was significantly greater in patients without thrombolytics than in patients with thrombolytics for every period (days 1, 3, 5, 10, 15, and 30) of QTcD after MI (p < 0.001). The mean of QTcD was significantly greater in patients with MCA than in patients without MCA group for every period (days 1, 3, 5, 10, 15, and 30) of QTcD after MI (p < 0.05). Maximal QTcD was seen on day 10 (p < 0.05 1st vs day 10 for each group) after myocardial infarction, and then reached a plateau for an each group. The ideal time to measure the QTD for risk stratification is at least 10 days after AMI.
Anomalous Circumflex Coronary Artery: Benign or Predisposed to Selective Atherosclerosis
Authors: Samarendra Padmaraj , Kumari Sarita , Hafeez Mohammed , Vasavada Balendu C. , Sacchi Terrence J.
Published: July 2008

Anomalous origin of the circumflex coronary artery from the right sinus of Valsalva is the most common coronary anomaly and is usually considered benign. Although several researchers in the past believed that aberrancy predisposes this vessel to accelerated atherosclerosis, this could not get wide acceptance owing to lack of convincing data. To examine the suggestion that atherosclerosis affects the anomalous circumflex artery more severely, the authors reviewed the clinical and angiographic features of patients with this anomaly identified from 2,684 coronary angiography procedures performed between January 1998 and March 2000 at their institution. The degree of atherosclerotic narrowing in the anomalous artery was compared with that in other coronary arteries in the same patient as well as in the nonanomalous circumflex arteries in controls.

For comparison 3 control subjects were selected for each patient with anomalous circumflex artery, matched by age, sex, and clinical presentations. The results showed earlier and greater degree of atherosclerotic narrowing of the anomalous artery as compared to the other coronary arteries in the same patients as well as to nonanomalous circumflex arteries of age- and gender-matched control subjects with similar clinical characteristics. However, this predilection for atherosclerosis was evident only in anomalous vessels arising from the right side and pursuing a retroaortic course. The anomalous artery was responsible for myocardial infarction in 3 patients, all of whom were 60 years or older. Two of the patients with this anomaly and myocardial infarction underwent successful angioplasty with stent placement for symptomatic relief.
Late Systolic Wave on Brachial Artery Blood Flow Velocity Pattern in Patients with Coronary Artery Disease and its Relation to Vascular Stiffness
Authors: Güler Niyazi , Eryonucu Beyhan , Bilge Mehmet , Etlik Ömer , Erkoç Reha , Sakarya Mehmet Emin
Published: July 2008

Duplex-Doppler study typically exhibits triphasic brachial artery blood flow velocity pattern in subjects classified as normal without clinically evident atherosclerotic complications, heart disease, hypertension, or diabetes mellitus. In this study, the authors described the late systolic wave on the brachial artery blood flow velocity pattern in patients with coronary artery disease and investigated the relation between late systolic wave and vascular stiffness.

Blood flow profile and velocity of the brachial artery were determined noninvasively by ultrasound pulsed-Doppler technique under the guidance of a B-mode ultrasound image in 96 patients with coronary artery disease (CAD). The control group consisted of 23 healthy subjects with no or maximally 2 risk factors (only among age, cigarette smoking, obesity, and gender) for vascular disease. None of the patients and controls had clinical evidence of arterial disorders at upper extremities. In 32 patients (33%) with CAD, a late systolic wave was observed in the brachial artery Doppler study. On the other hand, no late systolic wave was observed in the healthy subjects. In addition, multivessel disease, hypertension, advanced age, diabetes, and smoking were significantly more frequent in patients with the late systolic wave.

In conclusion, peripheral arterial abnormalities induced by vascular stiffness may produce alterations in regional wave reflections, and the normal triphasic pattern of the brachial artery blood flow may change by the appearance of the late systolic wave.
Two-Dimensional Echo Doppler Findings in Juvenile and Adult Onset Ankylosing Spondylitis with Long-Term Disease
Authors: Jiménez-Balderas F.J. , García-Rubi D. , Pérez-Hinojosa S. , Arellano J. , Yáñez P. , Sanchez M.L. , Camargo-Coronel A. , Zonana-Nacach A.
Published: July 2008

The authors' objective was to determine by 2-dimensional echo Doppler (2DECHO) the cardiac abnormalities in juvenile onset ankylosing spondylitis (JOAS) and adult onset ankylosing spondylitis (AOAS) in male patients with long-term disease. Twenty patients with JOAS, 31 with AOAS, and 20 healthy controls of the same age and gender without cardiopulmonary symptoms were studied. Using 2DECHO, the heart dimensions were determined according to American Society of Echocardiography guidelines. The left ventricle ejection fraction (LVEF) was calculated by Teichholz's formula. Cardiomyopathy was established when 2DECHO had diminished LVEF. Statistics used were the Student t and Fisher test, χ2, and ANOVA. Ninety percent of JOAS and 51 % of AOAS patients were B27+ (p = 0.005). The disease duration was 19.3 ±8.8 years in JOAS and 14.8 ± 12.8 years in AOAS (p = NS). Age at the time of the study was 30.7 ±9.9 years in JOAS vs 40.3 ± 12.7 in AOAS (p = 0.003), and vs 40.2 ± 17 years in controls (p = NS). There was a higher frequency of cardiomyopathy in AOAS (32.2%) than in JOAS (25%) and the controls (0%) (p = 0.01). Patients with JOAS had a higher mitral valve gradient (25%) than AOAS patients (19%, p = NS) and controls (0%, p = 0.04). Abnormal aortic ring reflectance was shown in 19% of AOAS vs 0% abnormalities in JOAS and controls (p = 0.01). The aortic root diameter was increased in 58% of AOAS, 30% of JOAS, and 0% of controls (p = 0.001).

The frequency of 2DECHO abnormalities was increased in cardiopulmonary asymptomatic spondylitis patients. Despite the high frequency of B27+, JOAS had a lower frequency of aortic abnormalities than AOAS. Mitral valve gradient was found in JOAS and in AOAS that could contribute to a decreased ejection fraction and to left ventricular dysfunction.
Second Primary Cardiac B-Cell Lymphoma After Radiation Therapy and Chemotherapy
Authors: Yukiiri Kazushi , Mizushige Katsufumi , Ueda Takashi , Kohno Masakazu
Published: July 2008

A 76-year-old man was found to have esophageal squamous cell carcinoma and had been treated with radiational therapy and chemotherapy. Five years later, he was readmitted with dyspnea and marked edema of his extremities and face. An echocardiographic examination revealed a mass lesion in the pericardium with pericardial effusion behind the left ventricular posterior wall, which was near the site of the original esophageal cancer. Coronary arteriography revealed a feeder artery to the mass from the left circumflex branch. No findings indicated a recurrence of the esophageal cancer; cytologic studies showed malignant lymphoma cells of B-cell origin. A second primary cancer of some organs including blood cells might be induced by the carcinogenic effects of ionizing radiation or chemotherapeutic agents. This is the first case of second primary cardiac B-cell lymphoma after combination therapy.
Cardiac Imaging in a Patient with Anomalous Origin of the Left Coronary Artery from the Pulmonary Artery
Authors: Noda Ryosuke , Sasao Hisataka , Kyuma Michifumi , Ichikawa Yoshihiko , Hasegawa Tohru , Endo Akita , Oimatsu Hiroshi , Takada Takehito
Published: July 2008

Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) is an uncommon congenital heart disease and has a high mortality rate in infancy. However, myocardial ischemia does not develop until adolescence or adulthood in about 10% of patients. Moreover, the diagnosis of ALCAPA is often difficult in cases without heart murmur or cardiac symptoms. The authors report the case of a 31-year-old man with ALCAPA. He was admitted to the hospital for evaluation of mild shortness of breath at exercise, but he had no typical chest symptoms due to myocardial ischemia or heart failure until age 31 and he had no heart murmur. Moreover, electrocardiogram did not show an old myocardial infarction or myocardial ischemia. Therefore, the authors did not suspect ALCAPA until they performed transthoracic echocardiography and exercise-stress single photon emission computed tomography (SPECT) with Tc-99m-tetrofosmin. The final diagnosis was established from the results of coronary arteriography. In the present case, a transthoracic echocardiogram showed abnormal coronary circulation, and exercise-stress SPECT revealed reversible myocardial ischemia. Transthoracic echocardiography and myocardial SPECT imaging could be a useful noninvasive tools for diagnosing the ALCAPA.
Association Between Erythrocyte Mean Corpuscular Volume and Peripheral Arterial Disease in Male Subjects
Authors: Mueller Thomas , Haidinger Dieter , Luft Christian , Horvath Werner , Poelz Werner , Haltmayer Meinhard
Published: July 2008

Elevated serum total homocysteine, an established risk factor for peripheral arterial disease, is influenced by the vitamin B12 and folate status. Since these vitamins are inversely correlated with erythrocyte mean corpuscular volume, an investigation of whether mean corpuscular volume is higher in patients with symptomatic peripheral arterial disease than in healthy subjects was performed. Furthermore, a determination of predictors of increased mean corpus cular volume levels in this population free of symptomatic coronary artery disease, cere brovascular disease, and diabetes mellitus was carried out. From 469 consecutive patients with symptomatic peripheral arterial disease, 100 fulfilled study inclusion criteria. Peripheral arterial disease was confirmed by angiography. One hundred age-matched subjects without peripheral arterial disease as verified by ankle-brachial index measurements > 0.9 served as control subjects. Patients with PAD displayed a significantly higher mean corpuscular volume level (94.5 fl) than control subjects (90.9 fl, p< 0.001). Logistic regression analysis showed that current smoking status (p<0.001) and mean corpuscular volume (p = 0.009), but not total homocysteine or lipid parameters discriminated case control status. In addition, logistic regres sion analysis revealed a relationship of mean corpuscular volume with smoking (p = 0.001 ), gamma-glutamyltransferase (p< 0.001), and total homocysteine (p=0.012). This model predicted mean corpuscular volume values with an accuracy of 83%. Elevated mean corpuscular volume is a predictor of symptomatic peripheral arterial disease in the sample studied. A defi ciency of folate and/or vitamin B12 may be responsible for this observation, as indicated by the correlation of mean corpuscular volume with total homocysteine. Due to the additional associ ation of mean corpuscular volume with smoking and gamma-glutamyltransferase, an unhealthy lifestyle with low vitamin intake may cause elevated mean corpuscular volume values in patients with PAD.
Squamous Cell Carcinoma of the Lung Presenting with Cutaneous Leukocytoclastic Vasculitis
Authors: Odeh Majed , Misselevich Ines , Oliven Arie
Published: July 2008

An elderly patient with paraneoplastic cutaneous leukocytoclastic vasculitis (CLV) leading to the discovery of an as-yet asymptomatic, potentially surgically curable squamous cell carcinoma of the lung is presented. This type of vasculitis has not been previously described in association with this type of lung cancer. Since vasculitic paraneoplastic syndromes, including CLV, may develop before the clinical presentation of malignant tumors, the present case and others previously reported strongly suggest that in apparently idiopathic CLV, patients should be evaluated for the presence of occult malignancy that could be curable by early detection.