bluuebunny/crossref_metadata_2025 huggingface dataset:
Detection of the Spatial Distribution of Late Potentials by Body Surface Mapping Using Forty-Five Unipolar, Leads
Authors: Nakai Kenji , Syobuzawa Minoru , Itoh Chuichi , Miyakawa Tomohisa , Kato Masataka , Onishi Tetsu , Kasanuki Hiroshi , Hosoda Saichi
Published: November 2007

For evaluating the spatial location of late potentials (LPs), the authors designed a new system for the body surface mapping of signal-averaged, filtered ECGs using forty-five thoracic unipolar leads (5 x 9 array). The signals from patients with old myocardial infarction (MI,N = 7) and arrhythmogenic right ventricular dysplasia (ARVD, N = 1) were amplified and passed through a bandpass (100-300 Hz) filter. The departure maps, LP isopotential maps, and LP30 area maps were generated and superimposed. The LP30 duration was determined as the section between the filtered QRS endpoints and points thirty milliseconds (ms) before. Isopotential maps of the LPs showed distinct positive and negative regions. In 7 cases with MI, the extreme was related to the zones indicated by the departure maps, and the LP30 area maps also corresponded to the departure areas. In 1 case of ARVD, endocardial fragmented activity directly recorded at the right ventricle closely corresponded with the region on the LP30 area map.

In conclusion, body surface LP isopotential maps and LP30 area maps may provide useful information concerning the spatial distribution of endocardial fragmentation.
Cardiac Rupture Following Acute Myocardial Infarction in Systemic Lupus Erythematosus: Case Report
Authors: Takayanagi Kan , Nakamura Yuji , Kishimoto Michita , Ouami Hiroshi , Shibata Seiichi
Published: November 2007

A thirty-three year-old woman with systemic lupus erythematosus (SLE) suffered from acute myocardial infarction. Prednisolone 20 mg/day was used because the signs of SLE, such as fever and decreased serum C3, levels, became aggravated on the fifth hospital day of acute myocardial infarction. Fatal cardiac rupture occurred on the twenty-second hospital day. At autopsy, extensive myocardial infarction with coronary artery thrombi and diffuse coronary arteritis were revealed. The rare clinical picture of a fatal cardiac rupture in the later phase of acute myocardial infarction and the precise dosage of prednisolone for her SLE are described.
A Hepatocellular Carcinoma of Massive Arterioportal Shunts Without Tumor Stain Treated with CDDP Two-Route Chemotherapy—A Case Report
Authors: Matama Sumio , Ishii Kohdoh , Satoh Kiyotaka , Sohtome Shigeru , Sasaki Kenichi
Published: November 2007

Massive arterioportal shunts without tumor vessels or tumor stain are some times encountered in advanced cases of liver cirrhosis. Massive arterioportal shunts without tumor stain that responded well to intensive chemotherapy with cis-diamminedichloroplatinum II are reported.
Use of IV Radionuclide Total Body Arteriography To Evaluate Arterial Bypass Shunts—A New Method— A Review of Several Cases
Authors: Yang David C. , Uday Jain Chandra , Patel Devayani , Gould Lawrence , Schaefer Harold , Maghazeh Paul , Giovanniello Joseph
Published: November 2007

Currently, Doppler ultrasound and contrast angiography are the main imaging procedues being used to evaluate arterial bypass shunts. IV radionuclide total body arteriogra phy (TBA) is another useful imaging procedure for evaluation of bypass shunts.

The authors reviewed 33 patients, 19 women and 14 men, ranging in age from forty-three to eighty-five, who had TBA done after arterial bypass surgery. Ten patients had multiple shunts and 5 had multiple follow-up studies. In total there were 80 shunts, including 43 femoropopliteal, 16 axil lofemoral, 1 axillopopliteal, 13 cross over femorofemoral, and 7 aortofe moral shunts. Sixty-two of the 80 shunts were patent, 14 were oc cluded, and 4 had partial occlusion. The results were confirmed by Dop per studies, contrast angiograms, an d/or surgical exploration without false positives or false negatives. Since the radiotracer used was 99mTc labeled red blood cells, a MUGA study can also be performed immedi ately following TBA in the same in jection. Twenty-eight patients had gated cardiac blood pool studies (MUGA) done; 16 had abnormal wall motion and diminished ventricular function.

TBA requires only a single IV in jection of radiotracer (less than 1 cc) in the upper limb. The imaging times for total body arterial and perfusion images are seventy seconds and five minutes respectively.

Both total body arterial and per fusion images clearly demonstrated the entire course of shunts (single or multiple); underlying and coexisting arterial abnormalities, e g, occlusive disease (27 patients), or aneurysm (3 patients); and related perfusion changes in the extremities. TBA has unique features. It permits a com plete, excellent visualization of the bypass graft without the hazard of contrast media injection. It is a sim ple and a virtually noninvasive proce dure, particularly useful for preoperative workups and post operative follow-ups.
Use of Doppler Flow Velocity Waveform Analysis in Detection of Initial Diabetic Microangiopathy
Authors: Bernardi Daniele , Ferreri Andrea , Bartoli Paolo , Ieri Aldo , Russo Paolo Lo , Teloni Paolo , Bonechi Igino
Published: November 2007

Doppler flow velocity waveform analysis (FVWFA), recorded from the dorsalis pedis artery (DPA) and the radial artery (RA), was performed on 36 women in attempting to detect an initial diabetic microangiopathy (DM).

The study comprised two groups of women affected by non-insulin-depen dent diabetes mellitus, 6 patients (pts) of reproductive age (1), 12 pts in meno pause (II), and two groups of age-matched healthy controls (C) (III and IV). Clinical signs of initial DM were present in group I. All the examined pts were nonsmokers and normotensive and without cardiopathy, signs of diabetic macroangiopathy, collagen vascular disease and/or Raynaud's phenomenon, and renal failure.

Four waveform dimensions capable of separating different degrees of periph eral obstructive arteriolar disease were determinated on velocity tracing and the results used in a single best discriminant equation.

The resultant discriminant score (DS), derived by FVWFA on DPA, showed a highly accurate rate of separating the young pts with DM from both C and the pts in menopause without DM. Furthermore, the resultant DS was statistically not different in groups II, III, and IV.

In conclusion, FVWFA on DPA, in this experience, has proved to be an accurate and sensitive method in the detection of initial DM.
Coronary Artery Dissection—A Case Report
Authors: Fronc Henry C. , MacMillan Robert M. , Kimbiris Demetrios
Published: November 2007

Coronary artery dissection, both spontaneous and catheter-induced, is asso ciated with a significant morbidity and mortality. The authors present a case of a middle-aged woman with spontaneous right coronary artery dissection caus ing inferior wall myocardial infarction and left coronary artery dissection at the time of coronary arteriography. It is suggested that emergency aortocoronary bypass surgery be performed preceded by insertion of an intra-aortic balloon in acute evolving cases where coronary anatomy is favorable to limit infarction and avert loss of life.
Patency Rate of Implantable Devices During Long-Term Intraaterial Chemotherapy
Authors: Huk Igor , Entscheff Petko , Prager Manfred , Schulz Franz , Polterauer Peter , Funovics Josef
Published: November 2007

Intrarterial implantable drug delivery systems have been considered as an alternative method for treating patients with unresectable liver malignancies. However, catheter problems with external implanted devices have resulted in limited application of chemotherapy. The introduction of subcutaneous devices offers an opportunity for long-term locoregional chemotherapy. Twelve external intraarterial catheters were implanted into 12 patients and 52 subcutaneously placed devices into 51 patients, all with various hepatic malignancies. Retrospec tive analyses comparing those two intraarterial systems were conducted taking into account the function and complication rate (hepatic artery thrombosis, infection, leaking, hemorrhage, and dislocation). The follow-up time for the external system was two to eight months (median five weeks), the thrombosis rate 33.3%, and the infection rate 25%. One instance of severe bleeding from the hepatic artery occurred during chemotherapy. One catheter dislocated. For the subcutaneously implanted intraarterial devices the follow-up time was five to forty-one months (median sixteen months), the thrombotic complication rate 17.3%, and the infection rate 7.6% (all patients with simultaneous bowel sur gery). Catheter dislocation one year later required reimplantation; in 1 patient therapy had to be discontinued because of a catheter leak. The overall function rate was 71.3% with a median follow-up time of eight months. Anticoagulation therapy for subcutaneously implanted devices starting from the beginning of intraarterial chemotherapy is recommended to achieve long-term patency. No implantation should be performed simultaneously with bowel surgery. The sub cutaneously placed intraarterial devices had a higher function rate and were available for a longer period as compared with external implanted catheters.
Steroid Anabolic Drugs and Arterial Complications in an Athlete—A Case History
Authors: Laroche Gilles P.
Published: November 2007

Serious side effects and complications have been attributed to anabolic and androgenic steroids when used for medical reasons or when taken in sports in hopes of increasing strength and, hence, performance. The author presents a case of an athlete who experienced two metachronous arterial complications after taking these drugs: a cerebrovascular accident caused by a carotid artery throm bus that partially embolized to the brain and, later, a severe ischemic episode in a lower limb caused by a diffused distal arterial thrombosis. This patient repre sents the first reported case of vascular events in an otherwise healthy athlete taking androgens to increase his skeletal muscle mass.
Therapy of Ischemic Cardiomyopathy with Pentoxifylline
Authors: Barnett J. Craig , Touchon Robert C.
Published: November 2007

Abnormal blood rheology is a known characteristic of coronary artery disease. The authors evaluated the effects of pentoxifylline on the exercise capacity ejection fraction and symptoms of 9 patients with ischemic cardiomyopathy. All patients had signs and symptoms of left ventricular dysfunction. All had at least two major vessels obstructed as determined by coronary angiography. Pentoxifylline 400 mg three times daily was administered for twelve weeks. Seven of 9 patients re sponded with increases in ejection fraction and exercise tolerance. Exercise tolerance correlated with improvement or lack of improvement in ejection frac tion. For all patients at twelve weeks post-therapy mean ejection fraction in creased 9.8% over baseline (p = .07), total treadmill time increased 15 % (p = .27), and mean double product increased 13% (p = .03). Anginal symptoms were significantly improved over baseline at twelve weeks of therapy (p>.001), as well as dyspnea on exertion (p = .03). Pentoxifylline was well tolerated. Pentoxifylline may benefit ischemic cardiomyopathy by improving coronary perfusion owing to favorable alterations in hemorheologic properties.
Long-Term Evaluation of Indobufen in Peripheral Vascular Disease
Authors: Belcaro G. , De Simone P.
Published: November 2007

Indobufen—an inhibitor of platelets aggregation—has been used in 306 pa tients with intermittent claudication due to peripheral vascular disease. Patients were treated and followed up for one year. One patient of every 3 treated with indobufen was treated with ASA, and a control group of patients receiving no treatment was also followed up. The authors studied by means of a treadmill exercise test the pain-free walking distance (PFWD), the global walking distance (GWD), and the recovery time after exercise. The treatment period was com pleted by 290 patients: 204 claudicants, 51 claudicants with diabetes, and 35 with a short PFWD and GWD (>150 m). Indobufen was more effective than ASA in improving the PFWD and GWD in all groups. There were also fewer side effects with indobufen, and cardiac morbidity and mortality was also reduced.

In conclusion indobufen showed its activity and safety in chronic treatment of patients with peripheral disease, and we suggest that it may be used for long periods without side effects.
Spontaneous Cerebral Embolism from Decending Thoracic Aortic Aneurysm—A Case Report
Authors: Arnold Steven E. , Biller José
Published: November 2007

A case in which an eneurysm of the proximal descending thoracic aorta was the likely source of retrograde cerebral embolism is described. Atherosclerotic disease of the descending thoracic aorta should be considered as an unusual source of cerebral emboli.
Intervascular Occlusion of Canine Renal, Splenic, and Vertebral Arteries Using Electromagnetic Field Focusing (EFF) Probe
Authors: Yamanashi William S. , Saksanen Seppo J. , Valentine Jimmie L. , Powers Matthew , Phillips Steven W. , Wagner Benny D. , Hill Deborah , Lewis John E.
Published: November 2007

Electromagnetic field-focusing (EFF) probe is a precision surgical and inter ventional tool. Use of the device produces maximum temperature in excess of 1800°C by convergence of radio-frequency (RF) induced eddy currents in biolog ical tissues. Applications of the EFF probe in angioplasty, aneurysm thrombosis, and neurosurgery have been previously reported. In the present work, the EFF probe was guided'under fluoroscopic control and used to occlude renal, splenic, and vertebral arteries in dogs. The occlusion was typically accomplished with about one minute of RF power application. Histology of the treated vessel three to six weeks posttreatment showed total occlusion consisting of intimal and subintimal changes and organized thrombus in the lumen. This suggests that the EFF probe in comparison with other procedures is an inexpensive, relatively safe precision interventional tool for performing an occlusion for experimental and therapeutic purposes.
The Use of Magnetic Resonance Imaging in the Study of Endema
Authors: Wang Jin-Zhao , Mezrich Reuben S. , Kostis John B.
Published: November 2007

A method of studying edema using magnetic resonance imaging (MRI) is presented. Three patients with lower extremity edema due to congestive heart failure were imaged with a 0.6 tesla system before and after diuresis. Edge detection algorithms were utilized to precisely outline regions of interest for quantification. Water and nonwater elements were separated within the region of interest to quantify water content. The results show that: (1) Edema can be quantified by use of MRI. (2) Subcutaneous edema is distributed along defined planes (ie, nonuniformly). (3) Increased water content is present not only in the subcutaneous tissue but also in deeper lying muscle.
Circadian Blood Pressure Pattern in Patients with Treated Hypertension and Left Ventricular Hypertrophy
Authors: Klein Werner , Zweiker Robert , Eber Bernd , Dusleag Johann , Brussee Helmut , Rotman Brigitte
Published: November 2007

Left ventricular hypertrophy in hypertensives is an important determinant of prognosis. In the present study 45 patients with treated essential hypertension were divided into two groups: 23 patients had normal left ventricular dimension and 22 patients had echocardiographic signs of left ventricular hypertrophy (LVH). All patients were adequately treated during daytime, but ambulatory blood pressure monitoring showed a distinct abnormal pattern in the LVH group characterized by a lack of blood pressure reduction during the night; 16 of 22 patients with LVH had no blood pressure decline during the night, whereas 17 of 23 patients without hypertrophy showed this reduction (P < 0.01). In conclusion, patients with hypertension and LVH often reveal a lack of blood pressure decline during the night, which may be the reason for the development of left ventricular hypertrophy (and thus should be managed by a different circadian blood pressure therapy) or which may be the consequence of progressive structural changes in the resistance vessels, along with the development of left ventricular hypertrophy.

It is suggested that patients with hypertension and left ventricular hypertrophy should have ambulatory twenty-four hour blood pressure monitoring.
Pericardiac Extravasation During Intravenous Digital Subtraction Angiography: A Case Report
Authors: Senaati Sassan , Farid Nazir , Guran Salih , Balkanci Ferhun
Published: November 2007

The authors reported a case, pericardiac extravasation of contract medium during an intravenous angiographic (IV DSA) procedure. To their knowledge this is the first such case in the literature. They suggest modifications of the IV DSA method to avoid this complication.
Transient Myocardial Ischemia During Holter Registration Before and After Coronary Angioplasty
Authors: Johansson Sten R. , Sánez Miguel , Emanuelsson HÅkan
Published: November 2007

Purpose: Revascularizing procedures like percutaneous transluminal coro nary angioplasty (PTCA) aim at reducing the incidence and severity of myocardial ischemia. To evaluate this, continuous Holter ST analysis is a possible method.

Design: 41 patients (35 men, 6 women) with stable angina pectoris had continuous twenty-four-hour two-channel Holter registration (V5/aVF -analogous leads) recorded before and after PTCA. Transient myocardial ischemia (TM) was defined as 0.1 mV ST depression or more 80 msec after the J point for one minute or more.

Findings: PTCA was successful for 37 patients (90%). Eleven of these had a total of 53 episodes of TM, 36 (68%) before and 17 (32%) after PTCA (p<0.05). Fifteen episodes (28%) were symptomatic, and 38 (72%) were asymptomatic. Six patients had TM after successful PTCA, 5 of whom had one-vessel disease and a clinically uncomplicated course. One patient had multivessel disease, with only one vessel dilated. Follow-up angiograms for 9 of the 11 patients with TM revealed 5 restenoses. There was no significant correlation between TM after PTCA and subsequent restenosis (p>0.05).

Implications: TM is common in patients with stable angina pectoris. The incidence significantly decreases after successful PTCA, but TM is seen also with a clinically uncomplicated course. In multivessel disease this is consistent with incomplete revascularization, whereas in single-vessel disease the most likely cause is intermittent spasm or thrombosis. TM after successful PTCA does not seem to be a predictor of restenosis.
Pyoderma Gangrenosum with Cutaneous T-Cell Lymphoma Manifested as Lower Extremity Ulcers—Case Reports
Authors: Kitahama Akio , Roland Phillip Y. , Kerstein Morris D.
Published: November 2007

Patients with extensive lower extremity ulcerations initially thought to be vascular disease were subsequently proved to have pyoderma gangrenosum and malignant lymphoma. Both patients died of sepsis; one patient exhibited hypogammaglobulinemia involving immunoglobulins IgA, IgG, and IgE; in the second patient, a polyclonal excess involving IgA and IgE was present.
Effect of Blood Glucose Level in Acute Cerebral Ischemia in Spontaneously Hypertensive Rats — Survival and Brain Pathology
Authors: Ibayashi Setsuro , Sadoshima Seizo , Ogata Jun , Yao Hiroshi , Okada Yasushi , Fujishima Masatoshi
Published: November 2007

The present study was designed to examine the effect of blood glucose level on survival and pathologic changes of the cortical neuronal cells during and af ter three-hour incomplete cerebral ischemia, which was induced by bilateral carotid artery ligation in spontaneously hypertensive rats (SHRs). Blood glu cose levels were varied by intraperitoneal infusion of 50% glucose (hyperglyce mia) or insulin with hypertonic saline (hypoglycemia) or hypertonic saline (normoglycemia).

None of the hyperglycemic or normoglycemic animals died during three-hour ischemia, whereas 45% of hypoglycemic animals died (p > 0.001). The survival rate for twenty-four hours after recirculation was in the following ascending order: hypoglycemia, normoglycemia, and hyperglycemia.

Neither hypoglycemia nor hyperglycemia (38-392 mg/dL) in nonischemic animals developed any morphologic changes in the cerebral cortex. However, both the ischemic and recirculated brains showed various degrees of histologic changes such as shrinkage of the neuronal cells with cytoplasmic vacuoles, perineuronal edema, and swelling of neuropils. Such ischemic damage of the brain was more marked in hypoglycemic animals than in hyperglycemic or nor moglycemic ones during ischemia, as well as one hour after recirculation.

The results suggest that cerebral ischemia and its outcome become more deleterious in hypoglycemic than in normoglycemic and hyperglycemic states. On the other hand, hyperglycemia is not necessarily a disadvantage in acute cerebral ischemia with or without reperfusion in this model.
Tissue Plasminogen Activator Release and Plasminogen Activator Inhibitor Levels in Coronary Artery Disease
Authors: Meyers David G. , Haire William D. , Rasmussen Julie K. , Boyd Eric J.
Published: November 2007

Unstable angina and Q wave myocardial infarction are associated with in traluminal coronary thrombosis, a process to which impaired fibrinolysis may contribute. The authors examined the extrinsic fibrinolytic system, including tissue plasminogen activator antigen, plasminogen activator inhibitor activity and an tigen, and euglobulin clot lysis time before and after venous occlusion in 56 pa tients undergoing coronary angiography for chest pain syndromes and in 16 healthy controls. Fibrinolysis variables were similar (with > 95% confidence) in the patients with thrombus-associated coronary syndromes as compared with those with chest pain syndromes not due to coronary thrombosis. These fibrino lytic variables were also similar to those in patients without coronary artery dis ease and in healthy controls. Their data suggest that defective fibrinolysis is not involved, at least systemically, in the pathogenesis of thrombus-associated coro nary artery syndromes.
Splenic Vein Aneurysm: MR Appearance — A Case Report
Authors: Campbell Soo Mary Scott , Khoury Maroon B. , Lupetin Anthony R.
Published: November 2007

A presumed pancreatic head mass by non-contrast CT examination, was proven to be a splenic vein aneurysm by enhanced CT, MRI, sonography and arteriography. Dangerous percutaneous aspiration was avoided.
Same-Day Angioplasty and Diagnostic Catheterization: Safe and Effective but Riskier in Unstable Angina
Authors: Breisblatt Warren M. , Ruffner Robert J. , Uretsky Barry F. , Reddy P.S.
Published: November 2007

Percutaneous transluminal coronary angioplasty was performed at the time of the diagnostic catheterization in 188 patients (215 lesions) at a University Hospital in order to assess the efficacy of this approach and the potential role it should play in the evaluation and treatment of patients. Patients either presented for diagnostic catheterization for evaluation of stable coronary disease (79 patients) or for unstable or new onset anginal symptoms (109 patients). Lesions were graded as to whether they were simple or complex; and post angioplasty films were reviewed for success rate, and degree of revascularization. Patients who were referred for stable anginal symptoms had a slightly higher success rate (91%) compared to those who were referred for new onset or more unstable symptomatology (85%, p = ns). Additionally, lesions morphology was judged to be more complex in unstable patients, as 67% had complex lesions with the presence of thrombus or ulcerated plaque in 56% of these stenoses. Angioplasty success was high for simple lesions in all patients, but was most unfavorable for complex stenoses in patients who presented with unstable symptoms (81% success rate). In patients who presented with new onset or unstable symptoms multivessel disease was present in 69% and angioplasty was more often geared at dilating a culprit stenosis leaving only 49% of these patients with complete revascularization. On the other hand, in 76% of those patients who presented with stable angina complete revascularization was a common outcome. Length of hospital stay was considerably shorter at 2.9 ± 0.8 days in those patients who presented with stable symptoms. Complication rate was only 2.5% in this patient group, but in those with unstable or new onset angina, complication rate was 11% and would appear to reflect the complex morphology of the lesions that were dilated. In patients with suitable anatomy low risk lesions, and appropriate indications, same day angioplasty is an effective option. But in patients with unstable symptoms and complex stenoses the increased complication rate may warrant a more conservative strategy.
The Influence of CLS 2210 on the Course of Myocardial Infarction: A Pilot Study in Man
Authors: Szlavy Laszlo , Repa Imre , Hachen Hans Jürg
Published: November 2007

To assess the effect of CLS 2210 (a new formulation of calcium dobesilate) on the evolution of acute myocardial infarction, 100 patients presenting their first infarct were distributed, according to their sequential admissions to the hospital, into CLS 2210-treated group (50 patients) or a comparison group (50 patients not receiving CLS 2210). The two groups were similar in age, sex, predisposing factors, and site of infarction.

Intravenous infusion of CLS 2210 was begun within six hours of onset of chest pain and continued for seventy-two hours. Thereafter, it was given, as oral capsules, in a dose of 1,000 mg every eight hours throughout the hospitalization. Before and during the trial, blood samples were drawn for the measurements of serum concentrations of creatine kinase (CK), and twelve-lead electrocardiograms (ECGs) were obtained serially in each patient. All objective data were analyzed on a coded basis without reference to the treatment.

In the comparison group, thirty-six to forty-eight hours was required for CK to fall to 50% of the baseline value, whereas in the CLS 2210-treated group it reached 50% of the baseline in eighteen to twenty-four hours. For each infarction site, a statistically significant fall was reached earlier in the CLS 2210 group. CK, the ECG index, and the sum of the ST segments showed earlier and more rapid improvement in the CLS 2210 group than in the comparison group.

The consumption of narcotic analgesic agents and nitroglycerin was substantially less in the CLS 2210 group than in the comparison group. Similarly, lidocaine infusion was employed for 1.2 ± 0.03 days in the CLS 2210-treated patients, whereas the comparison group received lidocaine for 5.7 ± 0.23 days because of continuing cardiac arrhythmias. The agent was well tolerated and no untoward side effects were recorded during the trial.

The findings so obtained with CLS 2210, in this pilot study, could have important clinical implications in designing protocols for further trials.
Impedance Cardiography for Repeated Determination of Stroke Volume in Elderly Hypertensives: Correlation with Pulsed Doppler Echocardiography
Authors: Antonicelli Roberto , Savonitto Stefano , Gambini Claudio , Tomassini Pia F. , Sardina Marco , Paciaroni Enrico
Published: November 2007

In this double-blind, crossover study the authors have validated stroke volume determination by impedance cardiography against the pulsed Doppler echocardiographic method in elderly hypertensives. They found a good correlation between the stroke volume values obtained by the two methods over a range of values from 30 to 130 mL. The coefficient of linear regression was about .95 at each visit. The mean of the differences was -0.73 mL with a standard deviation of 8.46. Given that individual differences are normally distributed, the values corresponding to 2 standard deviations of the mean define a range covering 95% of the observed differences. From the distribution of the data around the mean plot it appears that, in comparison with pulsed Doppler, impedance cardiography tends to slightly underestimate stroke volumes of >90 mL and to overestimate values of <50 mL.

The results of this study indicate that impedance cardiography may represent a reliable alternative to pulsed Doppler echocardiography for the noninvasive estimation of cardiac output at rest in elderly patients.
Venous Gangrene (Phlegmasia Cerulea Dolens) Complicating Heart Failure from Severe Mitral Stenosis—A Case History
Authors: Lau Chu-Pak , Leung Wing-Hung , Wong Cheuk-Kit , Cheng Chun-Ho
Published: November 2007

Gangrene of the left upper limb was found to complicate severe mitral stenosis presenting with heart failure in a sixty-eight-year-old woman with a documented left atrial thrombus. Arterial obstruction as the cause of gangrene was excluded by Doppler-assisted assessment of the peripheral pulses. Venous gangrene can complicate severe mitral stenosis and must be distinguished from arterial embolization, in which urgent surgical treatment is imperative.
Serum Lipoprotein (a) Levels in Men with Peripheral Vascular Disease
Authors: Nogués Xavier , Seni Mariano , Pedro-Botet Juan , Rubiés-Prat Juan , Vidal-Barraquer Francesc
Published: November 2007

The authors quantified serum lipoprotein (a) (Lp) (a) by enzymoimmunoanalysis in 86 outpatient men suffering peripheral vascular disease (PVD) and in 53 age-matched healthy men. They further measured serum cholesterol, serum triglycerides, low density lipoproteins-cholesterol, high density lipoproteins (HDL)-cholesterol and serum apolipoprotein B. Serum triglycerides were significantly increased in patients with PVD versus controls (148 ± 8 and 114 ± 7 mg/dL, mean ± SEM). HDL-cholesterol levels were significantly lower in patients versus controls (36 ± 1 and 43 ± 2 mg/dL, respectively). Serum Lp(a) levels in patients with PVD were 20 ± 2 mg/dL, whereas in controls they were 16 ± 3 (p: NS). Serum Lp(a) concentrations were identical in smoker and nonsmoker patients. There was no correlation between Lp(a) concentration and the other lipid parameters. Conversely, as occurs in coronary heart disease and in cerebrovascular disease, Lp(a) does not seem to be a marker for PVD, although a trend toward a higher mean levels was found.
Hemodynamic and Hemorheologic Effects of IV Dilevalol in Hypertensive Patients
Authors: Laghi Pasini F. , Pecchi S. , Guideri F. , DeFranco V. , Damiani P. , Galigani C. , Saletti M. , Verzuri M.S. , Blardi P. , Di Perri T.
Published: November 2007

The authors evaluated the effect of Dilevalol infusion on blood pressure, heart rate, central hemodynamics, and rheologic parameters in hospitalized inpatients affected with mild or moderate hypertension.

After a dose-finding phase and a washout period of one week, 10 patients aged fifty to seventy-two-years (median 61.5) were given either a single dose of Dilevalol 60 mg or placebo, and seven days later they underwent the other treatment, according to a single-blind, crossover design. Central hemodynamic measurements were performed by means of M-mode echocardiography, and hemorheologic parameters were evaluated by means of strain-gauge plethysmography. The maximal increase in lower extremity flow at rest had been obtained with the infusion of 60 mg Dilevalol during dose-finding, and so this dose was chosen for the second part of the study. The infusion of Dilevalol significantly increased rest flow and decreased blood viscosity, but the changes in central, parameters were not considered clinically relevant, although statistically significant. Blood pressure decreased without significant changes in heart rate.

Thus, the acute administration of Dilevalol reduced blood pressure, without affecting heart rate and central hemodynamics, confirming the vasodilating effect of the drug. A significant improvement was also shown on blood viscosity in these hypertensive patients.
A Digital Splenoportography: More Sensitive Method of Detecting Spontaneous Splenorenal Shunt
Authors: Farid Nazir , Balkanci Ferhun , Guran Salih , Senaati Sassan , Besim Aytekin
Published: November 2007

Splenoportography was performed upon 195 pediatric patients, including 137 by conventional technique and 58 by digital subtraction technique. The results obtained were compared, and it was found that the percentage of diagnosis of spontaneous splenorenal shunt was higher with digital than with conventional technique. In conclusion digital technique is a more sensitive and safer method than the conventional method.
Double Aortic Arch Associated with Coarctation of Both Limbs: A Case Report
Authors: Okuda Yasuyuki , Takeda Kan , Ooi Maki , Nakagawa Tsuyoshi , Yamaguchi Nobuo
Published: November 2007

A case of double aortic arch with coarctation of both limbs is described. The patient, a thirteen-year-old girl, demonstrated only the symptoms of coarctation and had no intracardiac anomalies. Discrete coarctation of bilateral limbs distal to the subclavian artery was shown by aortography. Although either double aortic arch or coarctation of the aorta is not so rare, the combination of these two anomalies is quite unusual. This is the third case in the world literature.
Transcranial Doppler Sonography: Collateral Pathways in Internal Carotid Artery Obstructions
Authors: Rosenkranz Karen , Langer Ruth , Felix Roland
Published: November 2007

Fifty-four patients with stenoses and occlusions of the extracranial internal carotid artery (ICA) demonstrated by intravenous digital subtraction angiogra phy (IVDSA) were studied by extracranial duplex and transcranial Doppler. Two hundred healthy volunteers served as control group.

Intracranial collateralization was demonstrated in 32 patients with ICA stenoses >80% and occlusions. Twelve patients with unilateral and 8 patients with bilateral ICA obstructions >80% showed collateral supply via the anterior (ACA) and/or posterior cerebral artery (PCA). In 5 cases of unilateral ICA oc clusion and in 7 patients with bilateral ICA stenoses >80% and occlusions, the ophthalmic artery and ACA and/or PCA served as collateral vessels. Five pa tients with ICA occlusions showed leptomeningeal anastomoses in the region of the postocclusive middle cerebral artery (MCA).

All 54 patients showed normal time-mean flow velocity in the postobstruc tive MCA. In unilateral ICA stenoses >80% and occlusions, the pulsatility in dex in the ipsilateral MCA was reduced in comparison with the contralateral side, indicating that this parameter is more sensitive to hemodynamic effects of ICA obstructions than time-mean velocity.
Noninvasive Cardiovascular Studies in Patients with Inflammatory Myopathy
Authors: Byrnes Timothy J. , Baethge Bruce A. , Wolf Robert E.
Published: November 2007

The authors prospectively performed echocardiographic and Doppler studies on 13 patients with inflammatory myopathy to evaluate ventricular function, to assess valve morphology and function, and to obtain hemodynamic data. No patient had a reduction in left ventricular function or evidence of significant val vular disease. Hemodynamic assessment suggested evidence of pulmonary hyper tension in 9 patients. They conclude that cardiomyopathy in association with inflammatory myopathy is unusual and that the suggestion of pulmonary hyper tension is unexplained and merits further evaluation.
A Case of Arrhythmogenic Right Ventricular Dysplasia Associated with FANA Positiveness—A Case Report
Authors: Özkan Mehmet , Öztek Ibrahim , Okay Tugrul , Basaran Yelda , Bayezid Ömer , Ozdemir Mehmet , Yakut Cevat
Published: November 2007

This is the case report of a forty-five-year-old woman who manifested clini cal findings characteristic of arrhythmogenic right ventricular dysplasia (ARVD) except for fluorescent antinuclear antibody (FANA) positiveness. To the authors' knowledge, this is the first report of FANA positiveness associated with ARVD.
Selective Coronary Angiography Versus Two-Dimensional Echocardiography for Diagnosis of Left Atrial Thrombi
Authors: Babic U.U. , Popovic Z. , Vucinic M. , Djurisic Z. , Pejcic P. , Grujicic S.
Published: November 2007

Coronary angiographic findings indicative for left atrial thrombi (neovas cularization in the region of the left atrium) were compared with echocardio graphic ones. Of 214 patients who had mitral surgery, the authors had all the available data for 161 (31 of whom had left atrial thrombi). The presence of a neovascularization had a sensitivity of 61%, a specificity of 100%, predictive accuracy of 100%, and predictive value of 92%, while echocardiography had a sensitivity of 52%, specificity of 96%, predictive accuracy of 76%, and predic tive value of 89%. There was no difference in the sensitivity of both methods for the detection of thrombi located in the left atrium as a whole cavity (p< 0.05) However, coronary angiography was superior to echocardiography in the diag nosis of thrombi located in the left atrial appendage (p < 0.05).

The diagnosis of left thrombi could be improved by using both methods (speci ficity 77%, predictive value 95%). Thus, selective coronary angiography is a useful diagnostic method, in addition to echocardiography, in the diagnosis of left atrial thrombi.
Can Rheologic Variables be of Prognostic Relevance in Arteriosclerotic Diseases?
Authors: Resch K.L. , Ernst E. , Matrai A. , Buhl M. , Schlosser P. , Paulsen H.F.
Published: November 2007

The hypothesis that blood rheology is of prognostic value in patients with arteriosclerotic diseases was tested in a prospective study of 843 patients at a rehabilitation clinic. They were tested for blood serum and plasma viscosity, hematocrit, fibrinogen, red cell aggregation and deformability, erythrocyte sedimentation rate, white cell count, cholesterol, and triglycerides. End points were defined as a second stroke or myocardial infarction or cardiovascular death within two years of the initial examination. Patients suffering such end points as compared with matched pairs (n = 74; matching criteria: identical manifesta tion of arteriosclerosis, identical sex and similar age and risk factors) had sig nificantly higher native blood viscosity (p = 0.002), red cell aggregation (p = 0.01), serum viscosity (p = 0.01), fibrinogen (p = 0.02), and cholesterol (p = 0.01). It is concluded that rheologic factors are associated with the prognosis in patients with arteriosclerotic diseases.
Metabolic, Hemodynamic, and Electrocardiographic Responses to Increased Circulating Adrenaline: Effects of Pretreatment with Class 1 Antiarrhythmics
Authors: Hansen Ole , Johansson Bengt W. , Gullberg Bo
Published: November 2007

In order to study the effects of treatment with class 1 antiarrhythmics on the metabolic, hemodynamic, and electrocardiographic responses to adrenaline, 12 healthy volunteers were infused on four occasions, after pretreatment with placebo, disopyramide, mexiletine, and flecainide, respectively, with adrenaline at a rate producing serum adrenaline concentrations comparable with those seen in acute myocardial infarction. After pretreatment with placebo adrenaline caused significant falls in serum potassium, serum magnesium, serum calcium, and se rum phosphate and a significant increase in blood glucose. Adrenaline also caused a significant increase in heart rate and systolic blood pressure and a significant fall in diastolic blood pressure. On the electrocardiogram a significant prolon gation of QTcduration and a flattening of the T-wave amplitude were seen. Pretreatment with disopyramide had no effect on the hemodynamic response to adrenaline but caused a significant prolongation of Qtcduration before the adrenaline infusion. Pretreatment with mexiletine was associated with a signifi cantly greater fall in serum potassium during adrenaline infusion, and pretreat ment with flecainide with a greater fall in serum magnesium, as compared with placebo pretreatment Flecainide also caused a significant prolongation of the QRS duration before adrenalin infusion, and after all the active pretreatments a prolongation of QRS duration was seen during adrenaline infusion. The meta bolic and hemodynamic changes during adrenaline infusion may not only reduce the antiarrhythmic efficacy of antiarrhythmics but may also increase the risk of proarrhythmic effects in a clinical setting. These results may help to explain why treatment with antiarrhythmics seems to be without beneficial effect on mor tality in post-myocardial infarction patients.
Platelet Accumulation After Laser Angioplasty— A Scintigraphic Assessment
Authors: Mohan S. Ram , Hawker R.J. , Wolinski A.P. , Dunham J.A. , Grimley R.P. , Downing R.
Published: November 2007

Indium 111-labeled platelet scintigraphy was performed to evaluate platelet deposition in response to different levels of ND:YAG laser/thermal energy. A dose-related increase in platelet deposition was observed. In clinical studies after laser-assisted balloon angioplasty, intense platelet deposition was observed in 2 patients who subsequently developed clinical arterial thrombosis. The pathogenesis of reocclusion appears, however, to be more complicated and ill understood. The authors suggest further extensive studies incorporating several parameters in the evaluation of the pathogenic factors involved in reocclusion after laser angioplasty. Such studies should also consider the role of arterial injury produced by the balloon catheter after laser-assisted balloon angioplasty.
Detection of Coronary Artery Calcification by X-ray Computed Tomography and Its Significance: A New CT Scoring Technique
Authors: Tamiya Eiji , Matsui Hiroshi , Nakajima Toshiaki , Hada Yoshiyuki , Asano Ken-ichi
Published: November 2007

In order to study the utility of X-ray computed tomography (CT) for the evaluation of coronary stenosis, the authors developed a scoring system for calcification seen through CT and compared the results with coronary angiographic (CAG) findings (Friesinger's scoring system).

Their study included 143 patients (angina pectoris 53, myocardial infarction 44, control 46) who received both CT and CAG.

Judkins method was selected for CAG, and stenosis ≧75% was defined as significant. Horizontal slices of CT from ascending aorta to cardiac apex at 1 cm intervals were imaged without contrast enhancement.

CT scoring system was as follows: no calcification = 0, the length of calcification less than 1 cm = 1, 1-2 cm = 2, more than 2 cm = 3 points. They then totaled the separate scores of all the slices for each coronary artery. Sensitivity, specificity, and predictive value of CT against coronary stenosis were good (79%, 80%, 69%, respectively).

The correlation between CT and CAG scores was significant (r = 0.644, p < 0.01).

For all coronary arteries, no correlation was found between the CAG and CT findings for patients less than forty-five years of age. However, from 45 years of age upward, the results were significant.

Until now, to the best of their knowledge, no satisfactory system to define the severity of coronary calcification has existed. Density cannot be used, because values are dependent on the area of the region of interest used.

They demonstrated the considerable potential usefulness of CT in predicting the presence of coronary stenosis and analyzing its severity.
Lymphoscintigraphy in Lymphedema of the Lower Limbs Using 99mTc HSA
Authors: Nawaz M.K. , Hamad M.M. , Abdel-Dayem H.M. , Sadek S. , Eklof B.G.H.
Published: November 2007

Edema of the lower limbs is a difficult clinical problem. Edema could be due to stasis, obstruction of the lymphatic channels, or increased production of lymph beyond the drainage capacity of the lymphatic vessels. Sometimes it is difficult to differentiate among these varieties.

Lymphoscintigraphy was performed in 164 patients complaining of swelling of the lower limbs, 2 women patients with lymphedema of the upper limbs fol lowing radical mastectomy, and 5 volunteers. All patients were injected with 1 mCi of 99mT chuman serum albumin intradermally in the medial web on the dor sum of each foot. Data were acquired dynamically for both inguinal regions for forty-five minutes with a gamma camera interfaced with a computer. Static im ages were taken at ninety minutes for both legs and thighs and for the pelvis. Time activity curves were generated for the equal regions of inguinal nodes on both inguinal sides.

The following patterns were recognized: normal pattern in 5 volunteers and in 57 patients, enhanced flow pattern in 17 patients, stasis with mild obstruction in 72 patients, and marked stasis with obstruction in 20 patients.
Evaluation of the Severity of Systemic Sclerosis by Nailfold Capillary Microscopy in 112 Patients
Authors: Joyal France , Choquette Denis , Roussin André , Levington Carry , Senécal Jean-Luc
Published: November 2007

The authors used nailfold capillary microscopy (NCM) to evaluate 112 pa tients with systemic sclerosis spectrum disorders (SSc). Patients were classified as S1 if they had skin involvement proximal to the metacarpo-phalangeal joints. S2 if they had at least two minor SSc American Rheumatism Association criteria, and S3 if they had at least two CREST criteria (calcinosis, Raynaud's, esophageal motility disorder, sclerodactyly, telangiectases), without S1 or S2 criteria. Dis ease duration from the first symptom was similar in all groups (7.17 ± 8.98 years). Disease severity was determined by a total score of seven target organ involve ments. S1 patients had a greater degree of skin and pulmonary involvement, with a mean score of 26.2 ± 17.3. S2 patients had a mean score of 13.8 ± 12.4, and had mostly vascular and digestive involvement, in comparison with S3 patients (7.2 ± 7.2; p<0.001 and p<0.01 respectively).

NCM sensitivity for S1 and S2 was 93.6%. NCM correlated with the degree of target organ involvement (p < 0.01). Three NCM profiles established were: "mild," normal or borderline capillaries; "moderate," other abnormalities with no capillary telangiectases; and "severe," abnormalities other than those of the mild profile, with capillary telangiectases.

The positive correlation observed between the degree of skin and vascular abnormalities and the severity of digestive, renal, musculoskeletal, and pulmo nary involvement permits rapid prediction of target organ involvement by SSc at the first visit.
Comparative Effects of Digoxin and Xamoterol on Arrhythmias in Patients with Mild to Moderate Heart Failure
Authors: Klein Werner , Eber Bernd , Rotman Brigitte
Published: November 2007

The prognosis of heart failure patients is poor and as many as half of the deaths are sudden and thereby presumably attributable to arrhythmias. In the present study the effect of traditional therapy of mild heart failure with digoxin on arrhythmias was compared with the effect of xamoterol, a cardioselective beta1 partial agonist, which has in addition beta-blocking properties at higher levels of sympathetic tone. Fifteen patients (NYHA class II-III) were included in the study. After a two-week baseline period they were randomized to digoxin or xamoterol for four weeks followed by a two-week washout and another four weeks of crossover therapy. Heart rate, blood pressure, and the number of com plex ventricular premature beats remained essentially unchanged with digoxin. With xamoterol heart rate increased from 86 to 93 (ns) but was significantly higher during the night in comparison with digoxin. The number of ventricular prema ture beats decreased from 186 ± 317 to 110 ± 137 and increased to 130 ± 175 after treatment. The number of runs decreased from 11 ± 35 to 2.7 ± 5 and increased to 5.6 ± 9 after therapy. In conclusion, no significant effect of digox in or xamoterol on ventricular arrhythmias was found. However, xamoterol showed a tendency to reduce simple and complex ventricular arrhythmias in pa tients with mild to moderate heart failure.