bluuebunny/crossref_metadata_2025 huggingface dataset:
A Unique Complication During Coronary Angiography: Peripheral Embolism by Selective Right Coronary Engagement
Authors: Jain Deepak , Kurz Thomas , Katus Hugo A. , Richardt Gert
Published: July 2008

"Micro" and "macro" peripheral embolisms during coronary angiography have been described. In all these cases, the aorta or the left heart chambers have been the source of embolus. A patient who during coronary angiography for acute inferior myocardial infarction experienced acute embolism of the left common femoral artery. The source of the embolus was a thrombus-filled right coronary artery, and the precipitating cause was its selective engagement with a diagnostic Judkins right catheter. A brief review of literature is also presented.
Large Atherosclerotic Left Main Coronary Aneurysm
Authors: Pineda Guillermo E. , Khanal Sanjaya , Mandawat Mahendra , Wilkin James
Published: July 2008

Coronary artery aneurysm (CAA) is a rare disorder, characterized by an abnormal dilatation of a localized portion of the coronary artery. It is usually diagnosed incidentally by coronary angiography. Over 50% of coronary artery aneurysms are of atherosclerotic origin. The natural history of coronary aneurysms is not well understood. Their presence is not always considered to be an operative indication; rather, the severity of the associated coronary artery disease (CAD) is what dictates a surgical approach. In the absence of obstructive CAD, the definitive treatment for this condition is unclear. The authors present the case of an isolated saccular left main coronary aneurysm with no associated flow-limiting CAD. The patient was treated medically with antiplatelet and anticoagulant medication with no adverse events at 3, 6, 9, and 12 months of follow-up.
Alcohol Consumption and Risk for Increased Aortic Pulse Wave Velocity in Middle-Aged Japanese Men
Authors: Nakanishi Noriyuki , Yoshida Hiroshi , Kawashimo Haruhito , Suzuki Kenji , Nakamura Koji , Tatara Kozo
Published: July 2008

A 9-year longitudinal study was performed to prospectively examine the association of alcohol consumption with development of increased aortic pulse wave velocity (PWV) in 1,358 Japanese men aged 35 to 59 years with a PWV less than 8.0 m/sec and without antihypertensive medication. Three hundred fifty-nine men developed increased aortic PWV of 8.0 m/sec or more during 10,598 person-years follow-up. After controlling for potential predictors of aortic PWV, the relative risk for increased aortic PWV compared with that in nondrinkers was 1.05 (95% confidence interval [CI], 0.70 to 1.58) for those who drank 0.1 to 22.9 g/day of ethanol, 1.58 (95% CI, 0.89 to 1.91) for those who drank 23.0 to 45.9 g/day of ethanol, 1.77 (95% CI, 1.24 to 2.53) for those who drank 46.0 to 68.9 g/day of ethanol, and 1.81 (95% CI, 1.23 to 2.66) for those who drank 69.0 or more g/day of ethanol (p for trend < 0.00 1). The relative risk for increased aortic PWV in current drinkers vs nondrinkers was stronger among men with a body mass index (BMI) less than 24.2 kg/m2 and nonsmokers than among men with a BMI 24.2 kg/m2 or more and current smokers, respectively. These results suggest that alcohol consumption is closely associated with risk for increased aortic PWV in middle-aged Japanese men.
The Effects of Right Ventricular Involvement on Heart Rate Variability and Ventricular Late Potentials in Acute Inferior Myocardial Infarction
Authors: Ülgen Mehmet S. , Toprak Nizamettin
Published: July 2008

Depressed heart rate variability and presence of ventricular late potentials in acute myocardial infarction are associated with a poor prognosis. Although it is known that the abnormalities vary according to anterior or inferior location of acute myocardial infarction, the relationship with right ventricular acute myocardial infarction is not clear. The effects of right ventricular myocardial infarction on heart rate variability and ventricular late potentials are studied. The study was performed with a total of 46 patients (38 males; aged 56 ± 13 yr, range, 33 to 70 yr). Twenty-six patients had isolated inferior myocardial infarction while 20 patients had accom panying right ventricular involvement. For all patients, ambulatory Holter recordings between 24 and 48 hours following myocardial infarction, echocardiography in first 48 hours, and signal- averaged electrocardiography with submaximal exercise at average day 6 (range, 5 to 8 days) were performed. Heart rate variability and signal-averaged electrocardiography recordings were repeated after discharge (average, 39 days).

During the first 24 to 48 hr, time domain parameters (SDNN, and SD1) were significantly lower (SDNN1: 62 ± 17 vs 100 ±20 ms, p = 0.001; SD: 37 ± 10 vs 50 ± 16 ms, p = 0.03) in patients with isolated inferior MI than in those with right ventricular involvement, whereas root-mean- square voltage (RMS-SD1) showed no significant difference in both groups (28 ±7 vs 35 ±8 ms). In post-discharge heart rate variability recordings, there were no significant differences (SDNN2 : 86 ± 13 vs 95 ± 15 ms; SD2: 48 ± 11 vs 57 ± 13 ms; RMS-SD 2: 32 ± 14 vs 35 ±9 ms).

In pre-discharge tests, the mean value of low-amplitude signals (LAS1) was higher (26 ±9 vs 33 ± 11 ms, p = 0.03) in patients with isolated inferior myocardial infarction than in those with right ventricular involvement, while other signal-averaged electrocardiography parameters were not significantly different (filtered QRS1 102 ±5 vs 105 ± 10 ms, RMS-40, : 44 ± 13 vs 26 ± 10 μ V; incidence of ventricular late potentials: 23% vs 30%, p = NS, respectively). In post- discharge tests, all of signal-averaged electrocardiography parameters were similar in both groups (filtered QRS2: 112 ± 12 vs 114 ±8 ms, LAS2: 28 ±9 vs 32 ± 13 ms, RMS-402: 36 ± 10 vs 34 ± 11 μV, and frequency of ventricular late potentials2: 23% vs 30%, p = NS).

These data suggest that right ventricular involvement in an acute inferior myocardial infarction is associated with improved heart rate variability parameters but not ventricular late potentials in pre-discharge period. However, the influence of right ventricular involvement on heart rate variability parameters fades away in the post-discharge period.
Acute Hemodynamic Effects and Angina Improvement with Enhanced External Counterpulsation
Authors: Stys Tomasz , Lawson William E. , Hui John C. K. , Lang Gudrun , Liuzzo John , Cohn Peter F.
Published: July 2008

Enhanced external counterpulsation (EECP) is an effective noninvasive treatment for coronary artery disease. The mechanism of action is felt to be hemodynamic. The complex hemody namic effects have been simply quantified by calculating a previously described effectiveness ratio (ER).

The EECP Clinical Consortium, a clinical registry of 37 centers, prospectively enrolled 395 chronic stable angina patients (79 women, 316 men, mean age 66 years) to examine the relation of the ER to posttreatment improvement in Canadian Cardiovascular Society angina class (CCS). Women and the elderly underwent planned subgroup analysis. The ER was calcu lated during the first and last hours of a 35-hour course of EECP treatment.

After EECP, CCS improved by at least 1 class in 88% of patients, 87% of men and 92% of women (p = NS), and in 89% of patients ≤ 66 years and 88% of patients > 66 years old (p = NS). The initial and final ER were similar in patients with and without improvement in CCS. Significant first-hour ER differences were seen between men and women (0.96 ±0.03 vs 0.76 ±0.04, p < 0.005), and between ages ≤ 66 and > 66 years old (1.04 ±0.04 vs 0.81 ±0.03, p < 0.0001). However, all subgroups responded equally well to EECP treatment.

EECP is effective in improving CCS in chronic stable angina patients; it has comparable effects in men and women and across a broad range of ages. The hemodynamic effect of EECP (ER) does not predict improvement in CCS and may indicate that other factors, such as neuro- hormonal changes, may have a significant role in mediating the observed EECP benefits.
Biochemical Risk Factors for Cardiovascular Disease in an Aged Male Population: Emerging Vascular Pathogens
Authors: Lippi Giuseppe , Arosio Enrico , Prior Manlio , Guidi Giancesare
Published: July 2008

The progressive increase of deaths and morbidity from cardiovascular disease (CVD) in most developed societies has led to the formulation of preventive strategies and application of several diagnostic guidelines. However, there is emerging evidence that most panels and algo rithms are inadequate and require urgent revision and updating. Therefore, the aim of this study was the evaluation of a wide cardiovascular risk profile in elderly male patients with acute myocardial infarction (AMI) or peripheral occlusive disease (POD). The risk profile was assessed by measuring conventional serum lipid and lipoprotein levels and emerging parame ters : lipoprotein(a) (Lp[a]), homocysteine (Hcy), and C-reactive protein (CRP).

The concentration of triglycerides, Lp(a), Hcy and the total cholesterol/high-density lipoprotein (TC/HDL) ratio were significantly higher in both classes of patients than in a popu lation of matched healthy controls and, similarly, patients with CVD displayed lower plasma values of HDL. No significant differences were observed for TC, low-density lipoprotein (LDL), and CRP. Patients with POD exhibited a marked atherogenic profile, as attested by substan tially increased values of Hcy, Lp(a), triglycerides, and TC/HDL ratio. The frequency distribu tions of Lp(a) and Hcy concentrations were markedly shifted toward upper values in both classes of patients than in controls. In multivariate regression analysis, Lp(a) and Hcy were the best predictors for AMI, whereas Lp(a), Hcy, and the TC/HDL ratio were the best predic tors for POD. Taken together, these data suggest that Lp(a) and Hcy excesses might exert a central role in the development of atherosclerotic disease in elderly male patients. Thereby, the inclusion of those tests, along with the TC/HDL ratio and other more conventional analyses in panels for the evaluation of the cardiovascular risk might be profitable in terms of effectual prevention.
The Value of Hemodynamic Changes Induced by Carotid Sinus Massage on the Diagnosis of Coronary Artery Disease
Authors: Ulgen Mehmet S. , Karadede Aziz , Alan Sait , Toprak Nizamettin
Published: July 2008

The aim of this study is to investigate the value of hemodynamic changes induced by carotid sinus massage (CSM) on the diagnosis of coronary artery disease (CAD). A total 108 patients (mean age, 54 ±10 years, range 33-70) who had no significant stenosis in the carotid artery by duplex ultrasonography (USG) and no history of syncope were included in this study. Carotid sinus massage was performed before coronary angiography with monitoring of electrocardio graphy and blood pressure. The patients were divided into three groups according to response to CSM: group 1 patients had a decrease in blood pressure or < 10 beats/minute (bpm); group 2 patients had a decrease between 10 and 20 bpm; and group 3 patients had >20 mm Hg decrease in blood pressure or > 20 bpm. Coronary angiography was performed after CSM in all patients. There was single-vessel disease (VD) in 23 cases, two-VD in 24 cases, and three-VD in 35 cases. Coronary angiography results were normal in 26 cases. The changes in systolic and diastolic blood pressures and heart rate before and after CSM correlated with number of VD. These changes were highest in patients with three-VD, but lowest in patients with normal coronary angiography. The number of diseased vessels and total coronary artery score were lowest in group 1, but highest in group 3. The specificity and sensitivity of CSM-induced > 10 mm Hg in blood pressure (BP) or > 10 bpm changes in heart rate in the diagnosis of CAD were 85% and 71 %, respectively. The positive and negative predictive values were 93% and 49%, respectively in the diagnosis of CAD. At the end of this study, we concluded that CSM induced the fall in blood pressure and heart rate and was correlated with number of diseased vessels and the score of coronary artery disease. As dichotomized values, the decrease of > 10 mm Hg in blood pressure and/or >10 bpm has highest specificity, sensitivity, and positive predictive value in the diagnosis of CAD.
Myocardial Infarction with Normal Coronary Arteries in a Patient with Primary Antiphospholipid Syndrome
Authors: Laganà Bruno , Baratta Luigi , Tubani Luigi , Golluscio Vincenzina , Delfino Massimo , Fanelli Filippo Rossi
Published: July 2008

Primary antiphospholipid syndrome is associated with an increased risk of vascular throm bosis. The authors describe a young patient without any risk factor for coronary artery disease who was admitted to the hospital because of a transient cerebral ischemic attack. Standard EKG showed signs of a previous silent inferior wall myocardial infarction, confirmed by echocar diography, technetium-99 scintigraphy, and left ventricular angiography. Coronary arteries appeared normal at angiography. Blood tests showed the presence of antiphospholipid anti bodies and lupus anticoagulant. Since there is evidence that these antibodies are associated with an increased risk of microvascular thrombosis, the authors conclude that this silent myocardial infarction could be caused by a cardiac microvascular disease accompanying the antiphospholipid syndrome.
Platelet-Dependent Thrombin Generation in Patients with Unstable Angina Pectoris
Authors: Hasumura Yukihisa , Aoki Nobuo , Kawano Koichi , Homori Masashi , Maki Akira , Hioki Yoshiko , Ishikawa Kyozo , Yoshino Hideaki
Published: July 2008

Platelet-dependent thrombin generation was assessed during both unstable and stable periods in 59 patients with unstable angina and at rest in 31 healthy controls. Thrombin generation during the unstable period was significantly greater than that at rest in the healthy control group (p < 0.0001) and that during the stable period (p < 0.0001). Changes in thrombin gener ation were related to the time after onset of unstable angina, not to degree of improvement in the severity of coronary stenosis.
Giant Hiatal Hernia Presenting with Stable Angina Pectoris and Syncope
Authors: Akdemir Ilyas , Davutoglu Vedat , Aktaran Sebnem
Published: July 2008

A 70-year-old woman with giant hiatal hernia presented with stable angina pectoris and three syncope attacks in the previous 3 months. Chest radiography showed marked cardiomegaly and an air-fluid level at the basal region of the heart. A mixed type large hiatal hernia that distorted the heart was detected in contrast-enhanced computed tomography and esophago gastroduodenography. Postprandial nonsustained ventricular tachycardia was present on 24- hour Holter ECG monitoring. The patient's symptoms were attributed to giant hiatal hernia and improved following surgery.
Stenotrophomonas maltophilia Endocarditis: A Systematic Review
Authors: Khan Ijaz A. , Mehta Nirav J.
Published: July 2008

The disease characteristics, management, and outcome of Stenotrophomonas maltophilia endocarditis were evaluated by examining the reports on the subject identified through a comprehensive literature search. Twenty-three (17 male) cases of S. maltophilia endocarditis were identified. Mean age was 41 ± 15 years. All patients presented with fever. Prosthetic valves were involved in 12 (52%) cases. Among native valves, the aortic valve was most frequently involved (50%), followed by the tricuspid valve (36%). Twenty (87%) patients had underlying risk factors for the development of endocarditis, including prior valvular or congen ital heart disease surgery (60%), intravenous drug abuse (32%), and infected intravascular lines (18%). The endocarditis was postoperative in 14 patients. Seventeen (74%) patients experienced complications including septic embolism (23%), cardiac abscesses (23%), and congestive heart failure ( 18%). A combination of two or more antibiotics was used in all cases except one. The frequently used antibiotics were aminoglycosides (59%), trimethoprim sulfamethoxazole (48%), and penicillins (48%). One half of the patients required cardiac surgery, but the proportion of surgically treated cases was higher among prosthetic valve endocarditis (62%). Mortality was 39% and was equally distributed between patients with prosthetic and native valve endocarditis. The S. maltophilia endocarditis carries high compli cation and mortality rates. The antibiotic regimen should consist of a combination of multiple antibiotics guided by the sensitivity panel. Early surgery may be considered in patients not responding to antibiotic treatment and in those with prosthetic valve endocarditis.
Angiography-Guided Routine Coronary Stent Implantation Results in Suboptimal Dilatation
Authors: Johansson Benny , Olsson Hans , Wennerblom Bertil
Published: July 2008

The resistance of the atherosclerotic lesion counteracts the expansion of the stent, resulting in suboptimal stent expansion. Intravascular ultrasound provides more precise information on stent expansion than coronary angiography but adds cost and time to the percutaneous trans luminal coronary angiography procedure. The aim of this study was to evaluate the need for intravascular ultrasound at routine angiography-guided high pressure stent implantation by comparing stent expansion with predefined intracoronary ultrasound criteria for optimal stent implantation. In 32 patients, 48 stents (35 NIR, 12 AVE, and 1 Cordis) were implanted in A, B, and C stenoses using a high-pressure inflation technique until an optimal result was achieved according to angiography. Stent expansion was then evaluated by intravascular ultrasound as minimal lumen diameter, minimal lumen area, proximal and distal stent area, and a minimal lumen area symmetry index. These variables were then compared with the nominal stent size in vitro. Finally the stents were also evaluated with respect to the MUSIC criteria, ie, strict criteria regarding symmetry, apposition, and vessel geometry according to intravascular ultra sound after stent expansion. Forty-five stents could be completely analyzed. The mean balloon inflation pressure was 12.8 (range, 10-17) atm. The nominal stent size was not achieved in any patient. Minimal lumen diameter attained 77% and minimal lumen area 78% of expected nominal values (p< 0.0001), distal stent area 88% (p< 0.001), and proximal stent area 92% (ns). Application of the MUSIC criteria showed that almost all stents (96%) had good stent apposition and symmetry index. Optimal proximal stent entrance was found in 70%. Optimal minimal lumen area in comparison to the reference areas was present in 41%. This lead to fulfilling of all MUSIC criteria in 47% of the stents. If nominal stent size had been achieved, symmetry index and apposition would have been fulfilled in all cases and optimal minimal lumen area increased to 75%. Acceptable proximal entrance however would have decreased to 55% and the fulfillment of all MUSIC criteria would increase only to 52%. In routine angiography- guided stent implantation in stenoses with a wide range of severities using modern stents and high pressure inflation technique to reach a visually optimal result, the nominal stent size was never achieved mainly due to residual intrastent stenosis. If nominal stent size had been achieved, the results would have improved only marginally and would still be suboptimal in almost half of the stents. These results highlight the shortcoming of angiography and the need for intravascular ultrasound in choosing correct stent size.
Ischemic Renal Disease in Kuwait
Authors: Sheikh M. , Nampoory M.R.N. , Sinan T. , Al-Ali A. , Johny K.V.
Published: July 2008

Ischemic renal disease (IRD) is a frequent cause of end-stage renal disease. Its prevalence is mainly known from autopsy or retrospective arteriographic studies.

This prospective study was conducted in 115 subjects selected from 732 patients with advanced chronic renal failure (CRF). Only patients with clinical features suggestive of IRD were selected for this study. In addition to detailed clinical and laboratory evaluation, captopril renal scintigraphy was performed in selected cases. All subjects underwent renal arteriog raphy and all were followed up for 18.4 ± 11.4 months. Renovascular disease was seen in 15 patients and significant bilateral renal artery disease leading to IRD was observed in 13 (11.3%). Hence the prevalence of IRD in the advanced CRF patients was 1.7%. The majority of patients with IRD (8 [61%]) were above 46 years of age and there were more men than women (10:3).

Atherosclerotic renovascular disease was the most common (10 [77%]), even though arthritis (1 [7.6%]), and fibromuscular dysplasia (2 [15.3%]) were also observed. Serum crea tinine at time of presentation was significantly higher in patients with IRD (784 ±292, p = 0.043) compared to those who did not have IRD (359 ± 126). Corrective procedures were performed in 5 patients. After treatment the improvement in serum creatinine in patients with IRD at 3 and 6 months (166 ±32 and 173 ±47, respectively) was significantly different (p≤0.05) compared to those who were not treated (610 ± 194 and 645 ±220, respectively). Hyper lipidemia, coronary artery disease and peripheral vascular disease were more prevalent in patients who had IRD compared to those with renal failure. The incidence of diabetes mellitus were similar in both groups.

This study denotes a lower prevalence of IRD in the advanced CRF population; they had more severe renal failure at presentation but specific corrective treatment delayed progression of renal disease significantly.
Effusive Constrictive Pericarditis Due to Rheumatoid Arthritis Revealed by Pericardiocentesis with Simultaneous Pressure Recording
Authors: Harada Tomohiro , Aoyagi Teruhiko , Endo Yoko , Uno Kansei , Takenaka Katsu , Nakamura Fumitaka , Sonoda Makoto , Takahashi Toshiyuki , Yamazaki Tadashi , Hiroi Yukio , Ohno Minoru , Hirata Yasunobu , Nagai Ryozo
Published: July 2008

A 59-year-old man had a history of rheumatoid arthritis. He presented with incurable pericar dial effusion. He was repeatedly treated with pericardiocentesis with only transient attenua tion of his symptoms because the underlying pericardial constriction had been overlooked. This time the authors diagnosed effusive constrictive pericarditis due to rheumatoid arthritis using the hemodynamic findings observed before and after pericardiocentesis.
Cardiomyopathy and Atrioventricular Block in Emery-Dreifuss Muscular Dystrophy
Authors: Kanadaşi Mehmet , Demirtaş Mustafa , Güzel Rengin , Şan Mustafa , Tuncer Ilhan
Published: July 2008

A 32-year-old woman is described as having the following characteristics of Emery-Dreifuss muscular dystrophy: humeroperoneal muscular atrophy and weakness, neck and elbow contractures with sinus bradycardia, first-degree atrioventricular block, and dilated cardiomy opathy. The biopsy specimen of skeletal muscle showed dystrophic character; a cardiac endomyocardial biopsy specimen showed adipose tissue infiltration and deposition of antihuman IgG. Emery-Dreifuss muscular dystrophy is an X-linked recessive myopathy. The patient had no familial background of the disease. This patient might have a sporadic inheri tance pattern with severe cardiac involvement.
Intravenous Immunoglobulin-Related Acute Coronary Syndrome and Coronary Angiography in Idiopathic Thrombocytopenic Purpura
Authors: Crouch Eron D. , Watson Linley E.
Published: July 2008

In acute coronary syndromes, GPIIb/IIIa platelet inhibitors have demonstrated a reduction in recurrent myocardial ischemia. Conversely, one might expect that enhancing platelet activity in patients in acute coronary syndromes would have the opposite effect. We report a patient with idiopathic thrombocytopenic purpura (ITP) that had recurrent myocardial ischemia asso ciated with administration of intravenous immunogloblin (IVIG). Literature is reviewed.
Long-Term Follow-up After Coronary Stent Implantation in Patients with Coronary Artery Disease
Authors: Sasao Hisataka , Endo Akita , Hasegawa Tohru , Ichikawa Yoshihiko , Noda Ryosuke , Oimatsu Hiroshi , Takada Takehito
Published: July 2008

Prospective randomized trials of coronary stenting in patients with coronary artery disease have shown a reduced incidence of cardiac events. However, little is known of the late outcome of patients treated with coronary stenting. The purpose of this study was to evaluate the rela tively long-term clinical outcomes (3 to 6 years) of patients treated with successful coronary stenting. The long-term clinical outcome was studied in 101 consecutive patients (78 males and 23 females) who had undergone successful coronary stent implantation for coronary artery disease in our hospital from October 1994 to September 1997. During a follow-up period of 48.9 ±9.5 months (range, 6-73 months), cardiac events were documented in 37 patients. The rate of survival free of cardiac events was 67% at 3 years. Multiple logistic regression analysis showed that ACC/AHA lesion type and residual percent diameter stenosis greater than 20% after stenting were the significant explanatory factors of adverse cardiac events. Long-term clinical outcome in patients with coronary artery disease treated with successful coronary stenting was influenced by the ACC/AHA lesion type of stented lesion and residual percent diameter stenosis after stent implantation.
Haziness on Coronary Angiogram After Percutaneous Transluminal Coronary Angioplasty Evaluated with Angioscopy
Authors: Kanamasa Ken , Ishikawa Kinji
Published: July 2008

Coronary angiograms obtained after percutaneous transluminal coronary angioplasty are often hazy due to uneven distribution of contrast medium at the angioplasty site. In this study, structural changes resulting in haziness after percutaneous transluminal coronary angioplasty were identified angioscopically. The affected coronary arteries of 35 patients who underwent successful percutaneous transluminal coronary angioplasty were examined with angioscopy. Coronary angioscopic examination of the sites subjected to percutaneous transluminal coronary angioplasty revealed large surface disruptions in 17 cases, small surface disruptions in four cases, and thrombi in 24 cases. Angiographic haziness was recognized in 24 of 35 patients after percutaneous transluminal coronary angioplasty. Haziness on angiography was more significant in patients who exhibited large surface disruption (88% vs 50%, p < 0.05), and was significantly greater in patients who exhibited white thrombus (100% vs 56%, p < 0.05). Moreover, it appears that percutaneous transluminal coronary angioplasty-induced large surface disruption and white thrombus likely play an important role in increasing haziness.
Diffuse Neonatal Hemangiomatosis Without Cutaneous Lesions in an Adult
Authors: Ohnishi Shunsuke , Miyagishima Takuto , Nakagawa Masao , Kamata Takahiro , Kishimoto Atsuhito , Choi Gong Heun , Kudo Mineo , Okabe Mihiro
Published: July 2008

Diffuse neonatal hemangiomatosis (DNH) is a rare disorder that first presents with multiple cutaneous and visceral hemangiomas during the neonatal period and has a high mortality rate. The authors report a long-term survivor of DNH who presented with multiple visceral heman giomas without cutaneous lesions. Vascular endothelial growth factor (VEGF) may play an important role in tumor progression.
Treatment of Buerger's Disease with Electrical Spinal Cord Stimulation
Authors: Chierichetti F. , Mambrini S. , Bagliani A. , Odero A.
Published: July 2008

Buerger's disease or obliterating thromboangiitis is an inflammatory pathologic condition affecting the distal vascular segments; it strikes young adults, especially males and heavy smokers. Medical and surgical treatment often fail to heal these patients, especially considering the frequent relapse of this disease linked with tobacco abuse—definitive healing often involves limb amputation. Electrical spinal cord stimulation is evaluated in this study with an analgesic aim and for improvement in skin microcirculation, with the goal of long-term healing of diseased limbs.
Progression of Atherosclerosis in Patients with Peripheral Arterial Disease as a Function of Angiotensin-Converting Enzyme Gene Insertion/Deletion Polymorphism
Authors: Taute Bettina-Maria , Gläser Christiane , Taute Ralf , Podhaisky Hubert
Published: July 2008

Angiotensin-converting enzyme insertion/deletion (I/D) gene polymorphism plays a role in deter mining the inter-individual variability of circulating angiotensin-converting enzyme activity and intracellular angiotensin-converting enzyme levels. Angiotensin-converting enzyme, as a key enzyme in the renin-angiotensin system, catalyzes the activation of the vasoconstricting and proliferation-stimulating angiotensin II and breaks down the vasodilatory peptide bradykinin. It is assumed that the excess supply of angiotensin II (due to the deletion polymorphism of the angiotensin-converting enzyme gene) contributes to endothelial dysfunction and in this way promotes the onset and progression of atherosclerosis. The aim of this study was to test whether the presence of the deletion allele of the angiotensin-converting enzyme gene predis poses a more rapid systemic progression of a preexisting peripheral arterial disease. To this end, the course of disease was surveyed for an average of 5 years in 97 patients who were angiotensin-converting enzyme gene-typed and suffered from a stable stage II peripheral arterial disease according to Fontaine. These patients did not suffer from an additional coronary artery disease, a cerebrovascular disease, or other serious illness. A local progression in the periphery or a systemic progression in the coronary or cerebrovascular areas was regarded as study endpoints. Of the patients, 49.5% showed an atherosclerosis progression during the surveillance period. With II-carriers, a progression was registered in 42.1 % and with DD carriers, progression was seen in 59.4%. D/I allele frequencies were seen in patients with progression at a level of 0.60/0.40 vs 0.55/0.45 for patients without progression. The average duration of disease in stable stage II (before progression appeared) amounted to 108 ± 14 months for II carriers, 88 ±8 months for ID carriers, and 92 ±11 months for DD carriers (p=0.21). Based on these findings, the deletion polymorphism of the angiotensin-converting enzyme gene is not an independent risk factor for progression of atherosclerosis in patients with peripheral arterial disease.
Circadian Variation in Ischemic Threshold in Patients with Stable Angina: Relation to Plasma Endothelin-1
Authors: Li Jian-Jun , Huang Cong-Xin , Fang Chun-Hong , Fang Chen  , Hong Jiang  , Tang Qi-Zhu , Li Geng-Shan
Published: July 2008

To investigate circadian variation in ischemic threshold in chronic coronary heart disease (CHD) and its relation to plasma endothelin-1 (ET-1), 21 patients with stable angina underwent treadmill exercise tests twice within a day, performed at 8-9 AM for the first test and at 3-4 PM for the second one. Ischemic threshold was defined as the heart rate at the onset of 1 mm ST segment depression during exercise tests. Blood samples were taken at 5 minutes before each exercise test, and plasma ET-1 was measured for determining the possible relation to ischemic threshold in patients with CHD. The results showed that the heart rate-ischemic threshold in individual patients varied by 10 ± 1% (range, 2-15%) in the morning and 9 ± 1% (range, 2-14%) in the afternoon, while there was a mean (11.2%) reduction in the ischemic threshold between 2 time points, with the ischemic threshold being significantly lower in the morning compared with that in the afternoon (115 ±22 bpm vs 128 ±31 bpm p<0.04). ET-1 values were 6.20 ±2.44 ng/L in the morning hours and 4.02 ±1.61 ng/L in the afternoon hours, with a statistical significant difference (p<0.01). In conclusion, the present study indicated that circadian variation of plasma levels of ET-1 was likely to be one of the most likely mech anisms involved in reduction in the ischemic threshold in the morning hours.
Venous Aneurysms of the Upper Extremity
Authors: Tahata Takafumi , Kusuhara Kenji , Johno Hiroyuki , Okamoto Ken
Published: July 2008

Venous aneurysms are a rare clinical entity, especially in upper extremities. A 35-year-old Japanese woman was diagnosed as having venous aneurysms in her left arm. The lesions were excised, and microscopic examination revealed a lack of smooth muscle, media, and elastic fibers in the aneurysmal wall, with partial hyperplasia of smooth muscle.
Statins and Renal Function
Authors: Elisaf Moses , Mikhailidis Dimitri P.
Published: July 2008

Renal disease is often associated with an increased risk of vascular events. Moreover, an accelerated form of atherosclerosis commonly occurs in these patients. The reasons for these associations are not clearly defined but include the widespread presence of several estab lished risk factors (eg, dyslipidemia, hypertension, and diabetes). Other predictors of athero sclerotic disease may also be abnormally elevated (eg, homocysteine, fibrinogen, and lipopro tein a). In addition, there is evidence that impaired renal function per se predicts vascular risk. Despite this high-risk background, the potential benefit of treatment with statins has not been widely investigated in these patients. The present review considers the evidence (exper imental and clinical) that statins exert beneficial effects in patients with different types of renal disease. This includes improved renal function, decreased microalbuminuria, and a fall in blood pressure. Statins may also improve renal allograft survival. The potential mechanisms mediating these effects are considered. The interactions between statins and several risk factors that may be present in patients with impaired renal function are also considered. There is an urgent need to define the role of statins in these high-risk patients. Which is the statin of choice? This question is relevant because impaired renal function can interfere with statin pharmacokinetics. Furthermore, other drugs administered to these patients may cause serious interactions with statins.
Mechanical Factors in the Production of Coronary Atheromata
Authors: RuDusky Basil M.
Published: July 2008

The role of mechanical factors and hemodynamic shear stress in the production of coronary atheromatous disease appears certain. Its propagation is influenced by a variety of genetic transformations, disease states, and biofunctional and extraneous factors. Recent research attests to the high degree of complexity of the biochemical and physiologic processes involved. It is hoped that continued research will produce results that will allow the clinician to halt or reverse the process.
The Hybrid Approach to Coronary Artery Revascularization: Minimally Invasive Direct Coronary Artery Bypass with Percutaneous Coronary Intervention
Authors: Amodeo Victoria J. , Donias Harry W. , D'Ancona Guiseppe , Hoover Eddie L. , Karamanoukian Hratch L.
Published: July 2008

In the past decade, new developments in cardiology and cardiac surgery have begun to offer patients a variety of new, less invasive options for the treatment of coronary artery disease. One such option is the hybrid approach to coronary artery revascularization. This combines minimally invasive direct coronary artery bypass surgery (MIDCAB) of the left anterior descending artery (LAD) with percutaneous coronary intervention (PCI) of the remaining diseased coronary arteries. This approach, as an alternative to conventional coronary artery bypass surgery, retains the benefit of internal mammary artery bypass to the LAD, accom plished with a minimally invasive technique, substitutes PCI for saphenous vein grafts as treatment for low-grade lesions of other coronary arteries, and may provide a maximally bene ficial outcome for many patients. Preliminary outcomes of patients receiving the hybrid approach have been strikingly positive. This report highlights the rationale for the development of this procedure, patient selection, results, and future applications of this emerging method of treating coronary artery disease.
Beta-Blocker-Induced Psoriasis: A Rare Side Effect
Authors: Birhan Yilmaz Mehmet , Turhan Hasan , Akin Yesim , Kisacik Halil L. , Korkmaz Sule
Published: July 2008

Beta blockers are one of the oral agents shown to decrease cardiovascular morbidity and mortality rates in randomized, controlled trials, and hence, they are widely used for the management of many cardiovascular situations. In terms of side effects there are 3 major modes of action: (1) contraction of smooth muscles, particularly of bronchi with nonselective agents; (2) exaggerated cardiac effects; and (3) central nervous system effects. There are also some rare side effects of beta blockers, some of which are unpredictable, but the others are related to mode of action at the cellular level. Beta-blocking agents may cause psoriaform eruptions and worsen existing psoriasis. Psoriasis may be an inconvenient side effect of beta blockade. Herein, we report a case of beta-blocker-induced psoriasis.
Increased Immunoglobulin E Response in Acute Coronary Syndromes
Authors: Erdogan Okan , Gul Cetin , Altun Armagan , Ozbay Gultac
Published: July 2008

The role of inflammation and mast cell activation has been implicated in atherosclerotic plaque destabilization and rupture. To investigate the role of immunoglobulin E (IgE) in acute coronary syndrome, a prospective clinical study was conducted in patients with acute myocardial infarc tion (AMI), unstable angina pectoris (UAP), stable angina pectoris (SAP), and healthy controls. IgE levels were serially measured and compared in consecutive patients with AMI (n = 16) and UAP (n=14) on days 1, 3, 7, 21 after admission and 3 months later and only once in stable angina pectoris (n = 15) and healthy controls (n = 14). In addition, blood eosinophil and basophil levels on admission were measured in all groups and compared. Initial IgE levels determined at admission in patients with AMI, UAP, and SAP were significantly higher than levels in the control group (p = 0.002). Initial high IgE level in AMI on day 1 increased to a peak by day 7 (p = 0.024), then gradually decreased by day 21 and at 3 months (p = 0.052). High IgE level in UAP persisted by day 7 and gradually decreased by day 21 and 3 months (p = 0.037 and p=0.018, respectively). Blood eosinophil count on admission was significantly higher in UAP than in the control group (p = 0.005). Basophil levels of both AMI and UAP groups on admission were found to be elevated as opposed to control group (p = 0.02 and p = 0.012, respectively). This study demonstrates that the level of IgE significantly increased during the acute phase of acute coronary syndromes and gradually decreased, supporting the role of acute inflammatory response and mast cell involvement in plaque rupture.
Delayed Embolization of Amplatzer Septal Occluder Device: An Unknown Entity
Authors: Verma Puneet K. , Thingnam Shyam K. S. , Sharma Anurag , Taneja Jasbir S. , Varma Jagmohan S. , Grover Anil
Published: July 2008

A case of delayed embolization of Amplatzer septal occluder, occurring at 2 weeks postim plantation in a 10-year-old girl with an oval-shaped secundum atrial septal defect is reported. The structurally intact device dislodged into the left atrium owing to reversal of transatrial pressure gradients and embolized to the left ventricular outflow tract from where it was retrieved surgically.
Arterial Embolism to the Upper Extremity in a Patient with Factor V Leiden Mutation (APC Resistance)
Authors: Dorweiler B. , Neufang A. , Kasper-Koenig W. , Schinzel H. , Schmiedt W. , Oelert H.
Published: July 2008

Factor V Leiden mutation has emerged as one of the leading abnormalities in inherited blood coagulation disorders, resulting in a markedly increased risk for deep leg vein thrombosis. A 24- year-old woman presented with acute onset of critical ischemia of her left thumb and index finger. Intraarterial angiography revealed an embolus in the distal radial artery and a thrombotic occlusion of the digital artery of the thumb and index finger. Immediate therapy encompassed a selective surgical embolectomy of the distal radial artery followed by a local intraarterial lysis that was continued for 3 days. Additionally, therapeutic anticoagulation and vasodilating drugs (prostaglandin E) were administered. Within 2 days, capillary refill reappeared and the initial loss of sensory function at the tip of the thumb and index finger diminished. A screening test for thrombophilic disorders led to the diagnosis of a heterozygous mutation of factor V (Leiden mutation). Arterial thromboembolic events of factor V Leiden mutation are rare and have to date been described only in the supraaortic and coronary circulation. Therefore, the arterial embolism to the left hand presented in this report constitutes a rarity that could be successfully salvaged by the combined use of a vascular surgical procedure and intensified medical management.
Cold Exposure and Left Ventricular Diastolic Performance In Coronary Artery Disease
Authors: Kudaiberdieva Gulmira , Timuralp Bilgin , Ata Necmi , Unalir Ahmet , Gorenek Bulent , Cavusoglu Yuksel , Goktekin Ömer , Birdane Alpaslan
Published: July 2008

It is known that cold exposure is accompanied by coronary artery vasoconstriction and ischemia in patients with coronary artery disease (CAD). The aim of the present study was to evaluate the response of left ventricular (LV) diastolic and systolic functions, estimated by means of Doppler echocardiography, to cold pressor test (CPT) in patients with CAD. Twenty- five male patients (mean age 50.8 ±8.1 years) with documented CAD underwent CPT with Doppler echocardiographic assessment of LV diastolic and systolic functions. According to the development of ischemic response to CPT, all patients were divided into 2 groups: group 1,10 patients with ischemia and group 2, 15 patients without ischemia during CPT. Cold exposure caused significant increase in blood pressure with no changes in heart rate in all CAD patients. Patients with signs of ischemia during cold exposure had lower transmitral flow velocity during early filling (p < 0.001), prolonged isovolumic relaxation time (p < 0.04), shortened deceleration time of early transmitral flow velocity (p < 0.001), and higher values of Doppler-derived index of myocardial performance (p< 0.0001) than those without ischemic response to CPT. Cold exposure in CAD patients through stimulating of vasoconstriction and ischemia was associated with derangements in LV myocardial performance, manifested by delayed relaxation, impaired stiffness, and reduced contractility.
Left Cervical Aortic Arch Associated with Aortic Aneurysm, Aortic Coarctation, and Branch Artery Aneurysm
Authors: Tsukamoto Osamu , Seto Shinji , Moriya Manabu , Yano Katsusuke
Published: July 2008

Cervical aortic arch (CAA) is a rare congenital aortic anomaly. Although, in CAA, other cardio vascular abnormalities including aortic aneurysm and aortic coarctation are occasionally accom panied, coexistence of those 2 aortic abnormalities on the same patient is rare, and moreover, association of the aneurysm of branching artery has not been reported. The authors present here the first patient with CAA who had both an aneurysm and a coarctation in the aortic arch, and further, another aneurysm in the left subclavian artery. Clinical characteristics of CAA with either aortic aneurysm or aortic coarctation are reviewed.
HIV-Associated Coronary Artery Disease
Authors: Mehta Nirav J. , Khan Ijaz A.
Published: July 2008

Cases, case series, and related articles on coronary artery disease in patients with human immunodeficiency virus (HIV) infection and acquired immunodeficiency syndrome (AIDS) iden tified through a comprehensive literature search were examined for clinical characteristics and angiographic findings of HIV-associated coronary artery disease. Among 129 identified cases, 91 % were males. The mean age was 42.3 ± 10.2 (SD) years (range, 23 to 77 years). The interval between the diagnosis of HIV infection and the diagnosis of coronary artery disease was 72 ±60 (SD) months. Degree of immunosuppression was variable (CD4 mean, 313 ±209 cells/mm3; range, 6-1070 cells/mm 3). There was no correlation between the CD4 cell count and the development and progression of coronary artery disease. Similarly, the development and progression of coronary artery disease was independent of the presence of HIV-related opportunistic infections. Acute myocardial infarction was the initial presentation in 77% of patients. In 76 patients, information on diseased vessels was available: 36 (47%) patients had 3-vessel disease, 14 (18%) patients had 2-vessel disease, and 26 patients (35%) had 1-vessel disease. The left anterior descending artery was involved in 47 (62%) patients while the left circumflex and right coronary arteries were involved in 34 (45%) and 38 (50%) patients, respectively. Thirty-two (25%) patients underwent catheter-based or surgical revascularization. Data were not adequate to assess the prognosis following the acute coronary events or revas cularization. The histologic characteristics unique to HIV-associated coronary arteriopathy were diffuse circumferential involvement of the vessel with an unusual proliferation of smooth muscle cells, mixed with abundant elastic fibers, resulting in endoluminal protrusions. Coronary artery disease was a late complication of AIDS.
Inflammatory Diseases Associated with Takayasu's Arteritis
Authors: Ohta Yuko , Ohya Yusuke , Fujii Koji , Tsuchihashi Takuya , Sato Kaori , Abe Isao , Iida Mitsuo
Published: July 2008

The etiology of Takayasu's arteritis is unknown; however, abnormality of the immune system plays an important role. To clarify a possible association between inflammatory diseases and Takayasu's arteritis, the authors retrospectively reviewed the medical records of 36 patients (2 men and 34 women), admitted to their department with this diagnosis. They found that 11 of the 36 patients had at least 1 other chronic or subacute inflammatory disease: Chronic tonsillitis, tuberculous lymphadenitis of the neck, chronic hepatitis B (infectious diseases); pyoderma gangrenosum, erythema nodosum (skin lesions); subacute thyroiditis, chronic thyroiditis (autoimmune diseases); Crohn disease, and ulcerative colitis (inflammatory diseases with unknown etiology). The present observation revealed a high prevalence of other inflam matory diseases in patients with Takayasu's arteritis and raises the possibility that Takayasu's arteritis may be associated with abnormality of the immune system activated by other inflam matory diseases, such as infection, autoimmune diseases, or inflammatory diseases of unknown origin.
Evaluation of Regional Aortic Distensibility Using Color Kinesis
Authors: Kato Yoshimasa , Kotoh Keiju , Yamashita Akio , Furuta Hidetoshi , Shimazu Chikasi , Misaki Takurou
Published: July 2008

Regional aortic stiffness cannot be evaluated by conventional methods. Regional aortic wall velocity during systole in the descending aorta was evaluated by using transesophageal echocardiography with color kinesis. The authors defined regional aortic distensibility (RAD) by considering pulse pressure, with RAD (μm/s/mm Hg) = (regional aortic wall velocity)/(pulse pressure). RAD was evaluated in 38 patients who had coronary artery disease (CAD) and 10 who did not. RAD decreased depending on aging (partial regression coefficient was -5.39 x 10-1, p < 0.001), and RAD was lower in the CAD group than that in the no-CAD group (p < 0.05). In the CAD group, 19 patients had a single fixed plaque (4 calcified and 15 noncalcified plaques). RAD in the calcified plaque was lower than that in the noncalcified plaque (p<0.01), and RAD was lower in the noncalcified plaque than that in the no-plaque region (p < 0.05). In noncalcified plaques, the relation between RAD and maximum intimal thickness had a signifi cant correlation, r = 0.7, p<0.001. The residual of RAD from the regression line was signifi cantly larger in the calcified plaque than that in the noncalcified plaque (p< 0.001). In conclu sion, RAD can express increasing regional aortic wall stiffness brought about by arteriosclerosis quantitatively. Color kinesis provides information on characteristic difference between calcified and noncalcified plaque.