bluuebunny/crossref_metadata_2025 huggingface dataset:
A Study of Disseminated Intravascular Coagulopathy in Hepatic Coma Complicating Acute Viral Hepatitis
Authors: Singh Ram , Singh M.M. , Hazra D.K. , Agarwal N. , Patney N.L. , Goyal S.P. , Bansal O.P. , Mehrotra M.P. , Sharma S.K.
Published: November 2007

Thirty cases of viral hepatitis with and without coma and 15 normal healthy age and sex matched controls were studied for disseminated intravascular coagulopathy (DIC).

Cases of viral hepatitis with coma showed strong evidence of DIC in the form of increased plasma FDP (240 ± 190.64 dilution), diminished fibrinogen half life (48.1 ± 15.3 hours) and increased fractional catabolic rate (46.13 ± 14.7% per day) with normal Euglobulin clot lysis time and reduced fibrinogen (147.33 ± 43.5%) and platelet count (1.27 ± 0.324 lakhs/cm.).

The possible role of heparin in the reversal of coagulation abnormalities have been discussed.
The Use of the Subclavian Vein for Temporary Transvenous Pacemaker Therapy
Authors: Papasteriadis E.G. , Afentoglou S.N. , Athanasopoulos C.B. , Aravanis C.H.
Published: November 2007

Temporary artificial pacing of the heart has been available clinically for the past twenty years. 1 It was introduced as a life saving procedure for the treatment of complete arterioventricular (A-V) block and other symptomatic bradyarrhythmias. Recent developments in the field of cardiac pacemakers have resulted in pacemaker application in a wide variety of patients and the technique chosen may vary considerably with the purpose. It is of value to separate the indications for temporary pacing into urgent, semi-urgent and elective.

Application of this mode of therapy requires access to the heart, a pulse generator capable of emitting a controlled electrical stimulus, and a conducting channel. In each of these areas a technology and body of knowledge has been developed.

Subclavian venipuncture with catheterization is a practical procedure for the prolonged or continuous intravenous administration of different kinds of fluids.

The technique of the insertion of temporary pacing lead and the point of entry vary with the indication for the procedure and the skill and experience of the operation. 2 For the insertion of a temporary pacing electrode, several veins can be utilized; femoral, anticubical, external and interval jugular, and subclavian. Successful electrode insertion can be accomplished with relative ease through each of these veins. Selection of a vein depends upon the clinical
Chronic Heart Failure in the Elderly: Vasodilator Therapy
Authors: Satinsky Jonathan D.
Published: November 2007

The clinical efficacy of vasodilator therapy in the treatment of chronic congestive heart failure specifically in the elderly population has not been previously reported. Fifteen patients age 72 to 91 years with symptomatic heart failure were given vasodilator in addition to a digitalis and diuretic regimen. Seven received hydralazine 100-400 mgms. per day plus nitrates and 8 were treated with prazosin 6-60 mgms. per day, 6 of whom received additional nitrates. Initial systolic blood pressure was 130-220 mm Hg (166±25.3). This gradually fell with recurrent failure and increasing doses of medications. Heart rate remained relatively unchanged. Side effects were similar to these reported in younger patients. The only serious incident occurred in the one patient receiving minoxidil when aggressive angina developed culminating in nonfatal myocardial infarction. Implications and possible precautions are discussed.

Duration of effectiveness was variable but a program of evaluation by nurses at home often allowed for early recognition of decompensation. Read justment of medication commonly alleviated symptoms, increased exercise tolerance and decreased the frequency of rehospitalization.
Treatment of Advanced Vascular Disease with Intra-Arterial Thrombolytic Therapy Followed by Arterial Dilatation
Authors: Troop Bryan , Peterson Gary J. , Pilla Thomas
Published: November 2007

A patient with severe arterial insufficiency was successfully treated with a combination of intra-arterial low-dose streptokinase and percutaneous trans luminal dilatation. The judicious use of a combination of these two techniques may extend the application of each technique and allow salvage of some severely ischemic extremities.
Unloading Effects of Molsidomine on Peripheral Circulation and Cardiac Hemodynamics in Patients with Acute Myocardial Infarction
Authors: Seino Yoshihiko , Vyden John K. , Rose Harold B. , Takano Teruo , Obayashi Kanji , Hayakawa Hirokazu , Kimura Eiichi
Published: November 2007

The unloading mechanisms and site of peripheral action of the new antian ginal drug molsidomine was compared with isosorbide dinitrate (ISDN) in 14 patients with acute myocardial infarction using a Swan-Ganz catheter and venous occlusion plethysmography. Sublingual molsidomine (2-4 mg) in creased calf venous capacitance (CVC) (0.42 ± 0.18 to 0.64 ± 0.09 ml/100 ml, p<0.05) from 30 to 240 minutes, while simultaneously lowering of PCWP (25.9 ± 4.9 to 15.8 ± 7.3 mmHg, p<0.05) and CVP (9.3 ± 3.7 to 5.8 ± 3.5 cmH2O, p<0.05). Calf blood flow (CBF), calf vascular resistance (CVR), CI, TSPR and SWI were not affected significantly. Molsidomine reduced preload more than 240 minutes after its administration. Sublingual ISDN increased CBF into the initial 15 minutes (1.19 ± 0.49 to 1.83 ± 0.98 ml/100ml/min, p<0.05) and CVC from 5 to 60 minutes (0.42 ± 0.19 to 0.68 ± 0.24 ml/100ml p<0.01) while simultaneously lowering PCWP (24.3 ± 2.2 to 14.6 ± 4.5 mmHg, p<0.01) and CVP (9.0 ± 2.8 to 5.5 ± 3.5 cmH2O, p<0.05). Neither drug affected cardiac index, blood pressure or systemic vascular resistance. These data suggest that molsidomine significantly lowered elevated preload (PCWP/CVP) by dilating venous capacitance vessels. Its length of action was 240 minutes compared with 60 minutes obtained with ISDN, which suggests this new agent may be of marked benefit in the AMI patients suffering from backward failure uncompli cated by forward failure in whom continued preload reduction is necessary. (Results are expressed as the mean ± standard deviation).
Comparison Between Segmental and Selective . Blood Flow Volume of the Lower Limbs: A Plethysmographic and Ultrasonic Study of Normal Subjects at Rest
Authors: Marquis C. , Meister J.J. , Mooser E. , Mosimann R.
Published: November 2007

In order to find the correlations existing between segmental and selective arterial blood flow volume, 20 healthy subjects have been submitted to calf venous occlusion plethysmography and Multichannel Digital Pulsed Doppler examination of the common femoral and popliteal arteries at rest.

We found a linear correlation only between mean popliteal artery blood flow volume and plethysmographic calf blood flow volume (r=0,41; p<0,01).

We therefore suggest that venous occlusion plethysmography should not be used for the assessment of aorto-iliac and common femoral hemodynamics after direct arterial reconstructive surgery. Its use should be complementary to pulsed Doppler blood flow volume determination at the femoro-popliteal level, along with the usual pressure measurement.
Coronary Artery Disease in Aortic Stenosis: Importance of Coronary Arteriography and Surgical Implications
Authors: Bermudez G.A. , Abdelnur R. , Midell A. , DeMeester T.
Published: November 2007

In our report, the presence or absence of angina pectoris did not predict the presence of coronary artery disease. A significant number of patients with aortic stenosis and angina pectoris have coronary artery disease but coronary artery disease also exists in asymptomatic form in a significant number of patients with severe aortic stenosis that could not be detected clinically and therefore suggests that the routine use of selective coronary arteriography is indicated in patients over 40 years undergoing cardiac catheterization because of aortic stenosis. This is very important in the preoperative evaluation and in planning the technique of operation to employ during extracorporeal circula tion and in determining the necessity of combining aortic valve replacement and myocardial revascularization.
Ruptured Mycotic Salmonella Aortic Aneurysm Treated with Combined Cefotaxime Antibiotic and Staged Surgical Management
Authors: Humphrey Robert W. , Vercoutere Ann L. , Abu-Dalu Joseph
Published: November 2007

A case of salmonella infrarenal aortic aneurysm that ruptured and was treated with staged operative procedures and a highly effective antibiotic is reported and analyzed. An emergency situation with a ruptured abdominal aortic aneurysm required prompt surgical intervention with an aortobifemoral graft insertion. In the immediate postoperative period it was realized that a prosthetic graft was placed in the bed of a mycotic aneurysm. The patient had significant arteriosclerotic occlusive disease limiting the distal anastomotic site to the common femorals. Interoperatively the superficial femorals were noted to be occluded chronically. Consequently, revascularization via an extra- anatomical bypass after aortobifemoral graft removal was more complex. This was managed in a staged delayed fashion, while suppressing the infecting organism with Cefotaxime. The details of this complex situation are described within.
Improved Exercise Myocardial Perfusion During Lidoflazine Therapy
Authors: Shapiro William , Narahara Kenneth A. , Park Janet
Published: November 2007

Lidoflazine is a synthetic drug with calcium-channel blocking effects. In a study of 6 patients with severe classic angina pectoris, single-blind administra tion of lidoflazine was associated with improved myocardial perfusion during exercise as determined by thallium-201 stress scintigraphy. These studies demonstrate that lidoflazine therapy is associated with relief of angina, an increased physical work capacity, and improved regional myocardial perfusion during exercise.
The Atrio-Ventricular Node Artery in the Human Heart
Authors: Anderson Kenneth R. , Murphy John G.
Published: November 2007

The atrioventricular node artery is a major contributor to the arterial supply of the atrioventricular conducting pathway and is an important vessel in the pathogenesis of heart block. The terminal ramifications of this artery were studied in detail by serial sectioning techniques in 50 human infant hearts. The artery provided branches to the posterior interventricular septum in all hearts (100%) and to the interatrial septum in 22 hearts (44%). The vessel supplied the atrioventricular node in 45 hearts (90%) but it terminated before reaching the node in five (10%). It supplied the penetrating bundle in 32 hearts (64%). Alternative sources of arterial supply to the atrioventricular conducting path way include: the first septal branch of the left anterior descending coronary artery; the descending septal artery; and anterior atrial branches. Although the arterial supply to this region of the heart is variable, it is possible to make hypothetical predictions of conducting tissue involvement in myocardial in farction of various types.
Pulmonary Vascular Disease in Children with Congenital Cardiovascular Malformations
Authors: Folger Gordon M.
Published: November 2007

A detailed clinical analysis of 16 patients with various forms of congenital cardiac malformations with the potential for large left-to-right shunts who developed extreme pulmonary hypertension in infancy and early childhood has been carried out. The study plan was to include only patients with sufficiently long follow up to allow analysis of their course in both the prepubescent and postpubescent periods. In early life these patients were all characterized by lack of evidence for significant development of the expected left-to-right shunt indicating inappropriate maturation of their pulmonary vascular circulation. Throughout all phases of their life, they were significantly polycythemic in comparison with a control group but this polycythemia, representative of peripheral systemic hypoxemia, increased markedly with the acquisition of puberty in all patients. These two findings indicate both an early abnormality, suggestively primary, of the pulmonary vasculature and a late progression of the disease associated with pubertal maturation.
Phonomechanocardiographic Findings in Endomyocardial Fibrosis
Authors: Carvalho Fernando R. , Matos Sandra , Victor Edgar G. , Saraiva Lurildo , Brindeiro Filho Djair , Maranhao Efren , Moraes Carlos R.
Published: November 2007

Endomyocardial fibrosis (EMF) is a severe restrictive cardiomyopathy charac terized by the formation of fibrous tissue on the endocardium and to a lesser extent in the myocardium of one or both ventricles. The disease results in endocardial rigidity, atrioventricular valve dysfunction and progressive obliteration of the ventricular cavity.

The clinical and pathological findings of EMF have been well established and definitive diagnosis can be made by selective cineangiocardiography.1-5 However, there are few reports concerning the phonomechanocardiographic (PMCG) patterns in this condition. In this paper we describe the PMCG findings in 12 patients with EMF which is now recognized with increasing frequency in the Northeast of Brazil.
Intracavernous Injection of Papaverine as a Diagnostic and Therapeutic Method in Erectile Failure
Authors: Virag R. , Frydman D. , Legman M. , Virag H.
Published: November 2007

The effect of intracavernous injection of papaverine (ICIP) has been investigated in 45 men: 6 normally potent volunteers, 10 psychogenic, and 29 organic impotent males. The first two groups obtained erections within 10 minutes, lasting from 1 to 4 hours, after injection of 80 mg of papaverine. Those belonging to the organic group experienced delayed, weaker and shorter erections, related to various degrees of arterial and/or veinous and neurologic lesions.

Haemodynamic and radiologic studies done concomitantly, showed a strong vasodi lation in the penile arteries (even when pathologic) and a diminished outflow from the cavernous bodies. Subsequently, a pilot study was performed in a series of 63 patients suffering from various degrees of angiogenic impotence, in order to study the therapeu tic effect of repeated intracavernous injections of papaverine completed by intracavern ous infusion of heparinized saline. Erections improved significantly in 66% of the patients with a mean follow up of one year.
Pulsus Alternans Its Response to Amyl Nitrite Inhalation
Authors: Cheng Tsung O. , Leet Christopher J.
Published: November 2007

Marked pulsus alternans was observed in a patient with primary congestive car diomyopathy. Afterload reduction with amyl nitrite caused the disappearance of the pulsus alternans. Investigation by phonocardiography, echocardiography, systolic time interval measurement and cardiac catheterization disclosed that during pulsus alternans the weak beat originated following a short diastolic filling period and generated much lower contractile force. This report may be relevant to the currently accepted concepts of afterload reduction in the treatment of chronic congestive heart failure.
The Role of the Oculopneumoplethysmography in Detecting Postendarterectomy Carotid Stenosis or Thrombosis
Authors: AbuRahma A.F. , Osbornet Linda
Published: November 2007

The oculopneumoplethysmography has been a well established tool in the diagnosis of significant carotid artery stenosis; however, very few articles have studied the role of the OPG/Gee in detecting the postendarterectomy stenosis or thrombosis. The purpose of this article is to study that role.

Eighty-two patients who had carotid endarterectomy and postoperative OPG/Gee were reviewed and compared with carotid arteriograms. Sixteen of these had bilateral and 66 had unilateral carotid endarterectomy. Seventy-nine of these patients had angiograms and three were explored. The total arteries studied were 98. Thirteen of these oculopneumoplethysmograms were done in the recovery room and the rest a few days to three years later. A carotid stenosis of 50% or more in diameter was considered significant. There were 10 positive oculopneumoplethysmograms, nine of which were confirmed by angiograms; i.e., 10.0% false positive rate. There were also three positive oculopneumoplethysmograms which were explored in surgery and found to be thrombosed ; i.e., a total of 13 positive oculopneumoplethysmograms, 12 of which were confirmed which made the real false positive rate 7.7%. Eleven patients had positive arteriograms, nine of which had positive oculopneumoplethysmograms; i.e., 81.8% diagnostic sensitivity (9/11). Eighty-four arteries were considered normal by arteriogram (11 of which had insignificant stenosis), 83 of these had negative oculopneumoplethysmograms; i.e., 98.8% diagnostic specificity (83/84). The false negative rate was 2.4% (2/85). The overall accuracy rate was 96.8% (92/95). If the three explored arteries were added, the overall accuracy rate would be 96.9% (95/98).

To conclude, the OPG/Gee is a valuable tool in detecting immediate postendarterectomy thrombosis or recurrent stenosis.

The oculopneumoplethysmography has been well established as a tool in detecting significant carotid artery stenosis. However, very few articles studied the value of the oculopneumoplethysmography in detecting the postendarterectomy stenosis, whether immediate postoperative occlusion or recurrent carotid artery stenosis.

The purpose of this paper is to study the value of the OPG/Gee in detecting the postoperative carotid stenosis or occlusion.
Microvascular Alterations in Thrombin-Induced Experimental Disseminated Intravascular Coagulation in the Dog
Authors: Vignolo-Scalone Washington H. , Vignolo-Puglia Washington H. , Kitchens Craig S.
Published: November 2007

Disseminated intravascular coagulation is often characterized by organ failure and bleeding. By use of light microscopy, previous studies have shown extensive fibrin deposition in vessels. However, quantification of fibrin deposition using ultrastructural methods has not been reported. In this study dogs were infused with thrombin, and disseminated intravascular coagulation developed. Using a blinded morphometric analysis method, we observed deposition of fibrin in nearly half of the microvascular vessels. Such deposition probably accounts at least for part of the organ dysfunction. Almost half the vessels also had altered endothelial structure including thinning of the endothelial membrane, formation of extremely thin spots, fenestrations, and even a few ruptured areas. These findings at least in part explain the extravasation of blood in disseminated intravascular coagulation.
Mitral Valve Prolapse and Spasm of Normal Coronary Arteries: Report of Four Cases and Review of the Literature
Authors: Rippe James M. , Singh Jang B. , Jarvais Nancy , Adams Eileen , Erkkila Kevin
Published: November 2007

The association between mitral valve prolapse (MVP) and atypical chest pain has been well-described. Numerous theories have been proposed to explain this association. A number of lines of evidence suggest that underlying ischemia may cause chest pain in some patients with MVP. We have recently evaluated 4 patients with chest pain syndromes who had angiographic evidence of MVP and spasm of angiographically normal coronary arteries. The possibility that coro nary spasm is the underlying etiology of chest pain in some patients with mitral valve prolapse raises a theoretical argument against β-blockade in these patients. Three of our patients were successfully treated with calcium channel blockers.
The Management of Valvular Heart Disease in Children
Authors: Folger Gordon M.
Published: November 2007

The child with significant valvular heart disease may present in any single instance both the most difficult of management decisions or a surprisingly simple one. Thus, if a direct surgical approach on the valve is feasible, the problems may very well be quite simple and straightforward; conversely, if valve replacement is indicated such may not be the case.

We have recently reported our experience with one type of valvular heart condition, congenital aortic stenosis, in respect to determination of surgical approach based upon the ability to predict the orifice area and valvular anatomy.1,2 This report reviews our current experience with this technique. As well, the experience concerning the approach to each of the valvular conditions will also be reviewed with emphasis in respect to the left heart valves and particularly their long term postoperative management.
Pentoxifylline in the Treatment of Intermittent Claudication of the Lower Limbs
Authors: Reich Theobald , Cutler Bruce C. , Lee Bok Y. , Porter John M. , Reichle Frederick A. , Scogin John T. , Strandness D. Eugene
Published: November 2007

Pentoxifylline, a methyl xanthine analogue was evaluated for treatment of intermittent claudication in a double-blind placebo controlled parallel group study in seven centers in the United States. Tests were performed on 128 cases, including 42 who took pentoxifylline (600 mg by mouth daily, increased stepwise to 1200 mg daily at the end of one month) and 40 who took placebo for 24 weeks. Twenty-five patients on pentoxifylline and 21 on placebo were dropped from the study for reasons unrelated to the drug. Walking ability on a treadmill was increased significantly after 2 weeks and remained so throughout the study in the pentoxifylline vs. the placebo group. Ability to walk until first experiencing intermittent claudication was a more sensitive index than the maximum ability to walk. The drug did not cause changes in blood pressure or in heart rate. Other than mild nausea, there were no significant side effects.
Trental® 400 in the Treatment of Intermittent Claudication: Results of Long-Term, Placebo-Controlled Administration
Authors: Roekaerts F. , Deleers L.
Published: November 2007

A double-blind, randomized, placebo-controlled long-term clinical study of Trental® 400 was carried out, partly under cross-over design, partly as a parallel-group study, in 36 patients suffering from chronic arterial obstructive disorders in the lower limbs, associated with intermittent claudication, in order to evaluate the effectiveness and the safety of this drug administered t.i.d. over a period of 6 months. This controlled period was preceded by a placebo run-in period of 3 months. The clinical results under Trental 400 showed a statistically significant within group improvement of painfree and maximum walking parameters (p < 0.05) corresponding to an increase to baseline by + 96% to + 139% respectively and also in comparison to placebo (p < 0.05). The alterations of walking parameters within the placebo groups, ranging between -25% and +28% were not significant.

The subjective parameters (rest pain, paraesthesias, muscular cramps and sensation of heaviness in the legs) paralleled the course of the walking parameters. Under Trental 400, 24 out of 36 patients reported an improvement of these symptoms compared to 7 under placebo. Trental 400 was well tolerated. Minor side effects were mentioned by 7 out of 36 patients. One patient had to stop the drug treatment because of persisting prickling sensation and subsequent insomnia. Drug-related changes in the laboratory findings could not be detected; vital signs varied in function of age, concomitant drug treatments and seasonal factors. The results obtained in these studies suggest Trental 400 as a drug of choice for treating patients with intermittent claudication due to peripheral arterial obstruction according to stage II or III after Fontaine.
Studies of the Clinical Pharmacology and Therapeutic Efficacy of Pentoxifylline in Peripheral Obstructive Arterial Disease
Authors: Di Perri Tullio , Carandente Orazio , Vittoria Aurelio , Guerrini Maurizio , Messa Gian Luca
Published: November 2007

Studies were carried out to investigate the effects of pentoxifylline on various hemorheological (whole blood, plasma and serum viscosity, erythrocyte filtrability, hematocrit), hemostasiological (blood coagulation and fibrinolysis: euglobulin lysis time, fibrinogen, plasminogen, alpha-2-macroglobulin, alpha-1-antitrypsin, antiplasmin; platelet function: β-thromboglobulin), and hemodynamic factors (limb perfusion: rest and peak flow, time to peak flow; systemic blood pressure, heart rate). In addition, clinical efficacy was monitored in claudicants by assessing walking capacity under placebo controlled double blind cross over conditions. The investigations disclosed the positive influence of acute and chronic pentoxifylline administration on hemorheological, hemostasiological and perfusion parameters, most of the changes recorded being statistically significant. The clinical benefit of pentoxifylline (Trental 400) treatment was demonstrated by the significantly superior increase in walking capacity in comparison to placebo in the controlled study.
Non-Invasive Predictors of Short and Long-Term Survival in Dilated Cardiomyopathy
Authors: Missri Jose C.
Published: November 2007

Dilated cardiomyopathy (DCM) carries a poor prognosis. This study exam ined the non-invasive parameters that may be predictive of survival in two groups of patients, short-term survivors who died within one year of onset of symptoms (Group I, 6 patients) and long-term survivors who survived greater than one year of presentation (Group II, 16 patients). The M-mode echocardio gram (E), resting radionuclide ventricular function study (RNA) and electro cardiogram (ECG) were reviewed for factors that would differentiate between Group I and II. The E mean ventricular wall thickness in Group I was 0.6 cm and Group II 0.9 cm (p < 0.05), a hypertrophy-dilation index (mean thick ness/LVDd) was 0.09 for Group I and 0.12 for Group II (p < 0.05). There was no significant difference between Groups I and II in LVDd by E, RNA, LV ejection fraction, ECG (LVH, ventricular ectopy, conduction abnormalities).

Thus, the finding of a mean ventricular wall thickness of 0.9 cm and a hyper trophy-dilation index of greater than 0.10 by E was predictive of survival longer than one year. The ECG and RNA LV ejection fraction did not predict outcome.
Lipedema — The Non-Lymphatic Masquerader
Authors: Beninson Joseph , Edelglass John W.
Published: November 2007

Two cases of lipedema are presented. They illustrate this clinical syndrome which occurs almost exclusively in women and presents as grossly enlarged legs, thighs and buttocks. The etiology remains uncertain. Although infrequently di agnosed, lipedema is not rare. We report success treating such patients with properly measured and fitted compression garments.
Angiodysplasia of the Colon in Patients with Hemostatic Defects: Risk of Secondary Hemorrhage After Electrocoagulation Treatment
Authors: Bell A.J. , Mufti G.J. , Oscier D.G. , Hamblin T.J. , Shepherd D.F.C.
Published: November 2007

Angiodysplasia of the colon is a relatively common cause of blood loss in the elderly. Electrocoagulation through a colonscope is a common mode of treat ment for this condition. Three patients are presented who had associated hemo static defects and electrocoagulation resulted in life threatening secondary hemorrhage. In two of these patients a right hemicolectomy was performed. On the basis of these findings we suggest that patients with angiodysplasia and asso ciated hemostatic disorders have a greatly increased risk of secondary hemor rhage following electrocoagulation treatment. These patients should be followed closely for two-three weeks following this treatment.
Longterm Complications of Beall Prosthetic Valve: A Case Report
Authors: Gaw Johnny , Samant Dinesh R. , Dietrick William R. , Venkataraman Kalyanasundaram
Published: November 2007

A case of malfunctioning Beall prosthetic mitral valve causing severe heart failure is presented. The unusual aspect of this malfunction was the finding of disc dislodgment despite the absence of pathology in the disc itself. The dislodg ment was caused by excessive tissue ingrowth around the suture ring. The need for close clinical follow-up of this type of prosthetic valve is emphasized.
Enlargement of the Superior Thyroid Artery: an Unusual Cause for a Cervical Bruit
Authors: Healy John F. , Brault Thomas
Published: November 2007

An enlarged superior thyroid artery with increased blood flow to a large benign ade nomatous goiter was found to be the cause of a bruit in the region of the right carotid bifur cation. We have not been able to find mention of this cause for a cervical bruit in the litera ture.
Acute Myocardial Infarction in a Thirty-Six Year Old Postpartum Female
Authors: Bornstein Abraham , Dalal Prakash , Tischler James , Novack Stuart , Michaelson Stephen
Published: November 2007

A thirty-six year old woman who had an acute myocardial infarction during the early postpartum period is described. Review of lit erature on the incidence of postpartum myocardial infarction, the possible mecha nisms and its clinical implications are summa rized.
Age-Dependent Changes of Collagen and Elastin Content in Human Aorta and Pulmonary Artery
Authors: Hosoda Yasuhiro , Kawano Koichi , Yamasawa Fumihiro , Ishii Toshiharu , Shibata Tetsuichi , Inayama Seiichi
Published: November 2007

Collagen and elastin in the arterial wall are thought to show some age-dependent changes, and to relate with development of the arteriosclerotic lesion.

Both aortas and the pulmonary trunks were collected from 137 autopsy cases. Biochemical determination of collagen and elastin content was carried out. Collagen and elastin of the aorta and the pulmonary artery showed no significant age-dependent changes. Elastin content of the pulmonary artery increases with age in the adult.

This paper seems to be the first report of simultaneous estimation of collagen and elastin content of both the aorta and the pulmonary artery.
Fascial Pathways of Extravasation of Blood in Lower Abdomen Following Angiography-Anatomic and Clinical Correlation
Authors: Ali Khan S. , Desai P.G. , Jayachandran Sundarajan , Smith Noel
Published: November 2007

The extravasation of urine following traumatic rupture of the urethra or periurethral abscess is well known to clinicians. The extravasation of blood following angiography, in the same anatomical space, is rare. Extravasation of fluids in the lower abdomen, groin and external genitalia follows distinct anatomical pathways. This case illustrates the anatomical pathways and emphasizes their clinical importance.
The Effectiveness of Isoxsuprine in Patients With Intermittent Claudication
Authors: Skotnicki S.H. , van Gaal G. , Wijn P.F.F.
Published: November 2007

Sixty male patients with intermittent claudication were investigated in a ran domized, double-blind, placebo-controlled study in order to determine the ef fectiveness of Isoxsuprine.

The analysis of the results was made on the basis of subjective assessment of symptoms by the patients themselves and also on the results of segmental blood- pressure measurements and ankle/arm indices at rest and after standardised exercise.

Significant differences were demonstrated between the active and placebo groups as regards pain-free walking distance although arterial pressure mea surements did not show statistically significant differences between the two groups.

Isoxsuprine appears to be significantly beneficial only for patients with ob structions at the femoro-popliteal level.
Leg Blood Flow in Intermittent Claudication — A Comparison Between Non Insulin Dependent Diabetics and Non Diabetics
Authors: Janzon Lars , Bergentz Sven-Erik , Ericsson Björn F. , Hanson Martin , Lindell Sven-Eric
Published: November 2007

The influence of diabetes on leg blood flow in intermittent claudication has been assessed by comparing the systolic arm-ankle pressure gradient at rest and resistance to blood flow during reactive hyperemia in patients with non-insulin dependent diabetes and non-diabetic controls. Cases and controls were matched for age and sex. Smoking habits, blood pressure, and blood lipids didn't differ in the two groups. Diabetes was associated with a higher resistance to blood flow during reactive hyperemia and a greater arm-ankle pressure gradient at rest. Resistance to blood flow during reactive hyperemia was in the non-diabetics strongly correlated to the arm-ankle pressure gradient at rest (r=0.84). Corres ponding correlation coefficient was in diabetics 0.04. In one of four diabetic legs a high resistance to blood flow during reactive hyperemia didn't correspond to a big arm-ankle pressure gradient. The results in this study support the concept of both macro- and microvascular disease in diabetes.
Pseudoaneurysm of the Left Ventricle: Diagnosis by Gated Radioisotope Imaging
Authors: Mendelsohn Steven
Published: November 2007

Because pseudoaneurysms of the left ventricle, although rare, can rupture, their differentiation from true aneurysm is desirable. A case is described in which a pseudoaneurysm was diagnosed noninvasively by means of a gated ra dioisotope ventriculogram. The diagnosis was made by noting a narrow neck leading to a large chamber. The pseudoaneurysm was successfully excised at surgery.
Treatment of Hypertension in Mild Asthmatic Patients With Atenolol
Authors: Krauss Shimon , Spitz Edward , Krauss Agota , Grizotzki Bronja , Clement Sinai
Published: November 2007

Fourteen patients with uncomplicated essential hypertension and mild asthma were treated with Atenolol 50-125 mg/day for up to 8 months. Heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), rate pressure index (RPI), stress testing time (STT) and peak expiratory flow rate (PEFR) were measured before, during and after stress testing (ST) before and during treatment. Atenolol significantly lowered HR, SBP, DBP and RPI. It prolonged STT and had no effect on PEFR. Furthermore, Atenolol did not worsen the patient's asthma except for one patient. The drug did not interfere with the bronchodilatation effect of salbutamol.

Atenolol can be used cautiously to treat hypertension in asthmatic patients under certain conditions.
Hemodynamic Factors Changing Blood Flow Velocity Waveform and Profile in Normal Human Brachial Artery
Authors: Baccelli Giorgio , Pignoli Paolo , Corbellini Ezio , Pizzolati Pier Luigi , Bassini Mario , Longo Tito , Zanchetti Alberto
Published: November 2007

We have investigated the influence of changes of perfusion pressure and local peripheral resistance on blood flow velocity waveform and profile in normal human peripheral arteries. Blood flow velocity and profile were recorded from the distal end of the left brachial artery in ten normal subjects by means of an ultrasonic device. The records were obtained in basal conditions and after blood pressure in the brachial artery and local peripheral vascular resistance were changed, separately or together, by progressive inflation of two arm cuffs, one encircling the proximal half of the left arm and the other the middle part of the left forearm.

Both blood flow velocity waveform and profile were shown to be markedly modified by changes in perfusion pressure and local peripheral vascular resistance. Reduction of perfusion pressure decreased both forward and reverse peak velocities, but had the largest effect upon reverse velocity. The upslope and the downslope of the forward velocity wave were left unchanged. Increase in local peripheral vascular resistance markedly augmented reverse peak velocity, whether perfusion pressure was normal or reduced. Increased resistance only slightly influenced peak forward velocity.
Problems and Prospect of Internal Arterio-Venous Fistula for Hemodialysis
Authors: Lala M.S.A.
Published: November 2007

Vascular access for dialysis in patients with terminal renal failure has assumed increasing importance on surgical services as more and more facilities are developing to support such patients for longer period. Logevity of such vascular access is aimed for, meticulous care is needed in its creation. Direct arterio-venous fistula is best method available, but in case of its failure, fistula formation using graft is useful alternative. Complications associated with vascular access still represent one of the most frequent and significant problems encountered in a hemodialysis center. Measures to overcome such problems are discussed. Historical background and literature are reviewed. Seven patients treated with maintenance hemodialysis are presented. One of them had severe haemorrhage from the fistula, an unusual complication of internal arterio-venous fistula.
Clinical-Instrumental Relationships in Post-Phlebitic Syndrome
Authors: Bartolo M. , Antignani P.L. , Nicosia P.M. , Raffi S.
Published: November 2007

981 lower limbs belonging to 829 subjects, 67.6% of which were females, have been examined. The average venous pressure at the tibial posterior vein was 101 ± 12 mmHg and 102 ± 13 mmHg on the internal saphenous vein. In 311 lower limbs with femoro-iliac thrombosis, venous pressures are slightly higher than in 670 lower limbs with calf veins occlusion.

In the 44.4% of cases the phlebothrombosis was clearly dependent on traumas, deliveries, surgical operations or other conditions. The relationships between the supposed aetiopathogenesis of the affection and the pressure values have been examined. The 6.7% refers to phlebitis, which caused pulmonary embolism during their acute phase.

The different objective and subjective symptoms have, furthermore, been taken into consideration. It has been noticed by the analysis of the diagrams of the pressure values in the time that the same values which are considerably high at the initial phase of the iliac postphlebitic syndrome, are always high in the following years. On the other hand, in postphlebitic syndrome of the leg those pressures whose value are not remarkably high in the initial phase, increase from the second to the fourth year after the arising of phlebitis and, finally become stable at fairly high values, but still lower than those of iliac syndrome.

The venous orthostatic pressure of internal saphenous vein in the iliac postphlebitic syndrome was also found to exceed the deep pressures, likely because of the altered saphenous discharge at the cross level.
Influence of the Menstrual Cycle on Raynaud's Phenomenon and on Cold Tolerance in Normal Women
Authors: Terregino Carol A. , Seibold James R.
Published: November 2007

Digital strain gauge plethysmography during a controlled cycle of hand warming and cooling was performed at weekly intervals through a single men strual cycle in 10 normal women and 6 patients with idiopathic Raynaud's phe nomenon (RP). Results were compared to those in 16 additional RP patients and 5 normal males. Maximum digital arterial flow at finger temperature 38 ° C and reactive hyperemia following three minute arterial occlusion at 30° C was com parable for all groups and did not vary with menstrual status. During cooling, normal women manifested plethysmographic loss of digital arterial flow at fin ger temperatures (18.1°C±7.9) intermediate between those of normal men (13.7°C±4.3, P < 0.05) and RP patients (26.0°C±6.1, P < 0.001). RP patients showed no change in cold tolerance in relation to menstrual status. However, normal women had variable responses to cooling and were found least cold tolerant at the time of menstruation with RP-like responses in all 10 cases al though digital color changes were absent. These data support the hypothesis that RP in the premenopausal woman is physiologic and thus, in the majority of cases, not likely to evolve into a definable connective tissue disease.
The Size of Kidney with Renovascular Hypertension in Patients with Aortitis Syndrome
Authors: Morooka Shigenori , Kimura Yoshio , Sumino Seiichi , Takabatake Yutaka , Sugimoto Tsuneaki
Published: November 2007

Renal atrophy due to the renal artery stenosis associated with aortitis syn drome was studied in seven patients. Severe hypertension, high plasma renin activity and normal overall renal functions were present in all. The luminal diameter of the stenosed renal artery seen on the angiogram was less than 1.5 mm at the maximum area of stenosis in all patients. The size of the kidney with renal artery stenosis was diminished, ranging from 8.0 to 14.0 cm in longitudi nal diameter on the nephrogram. Histological findings of the small kidney re vealed ischemic atrophy. Although the rate of progression of the arterial stenosis was uncertain, the collateral circulation was found to be rich. Renal atrophy was not frequent and not marked even in the presence of high grade renal stenosis or obstruction in case of renovascular hypertension secondary to the arteritis.
Peripheral Circulatory Effects of Insulin in Diabetes
Authors: Takata Shigeo , Yamamoto Masakazu , Yagi Shinji , Noto Yutaka , Ikeda Takayuki , Hattori Nobu
Published: November 2007

Peripheral circulatory effects of insulin were studied in the diabetic patients with and without autonomic neuropathy. Forearm blood flow, calf venous vol ume and calf venous distensibility were measured by strain gauge plethysmo graphy. In the diabetic patients with autonomic neuropathy, mean blood pres sure fell from 96±5 to 88±5 mmHg after an intravenous injection of 4 U of monocomponent insulin (p < 0.001). Forearm vascular resistance decreased from 53.99±8.29 to 45.88±7.76 mmHg•ml -1•100ml-1•min-1 after insulin (p < 0.01). Insulin increased calf venous volume from 1.20±0.19 to 2.23±0.44 ml/100ml (p < 0.05) and calf venous distensibility from 0.039±0.004 to 0.082±0.016 ml/mmHg (p < 0.05). In contrast, in the diabetic patients without autonomic neuropathy, there were no significant changes in the mean blood pressure, forearm vascular resistance, calf venous volume and calf venous dis tensibility. Symptoms of hypoglycaemia did not occur in any patient.

These results suggest that insulin has a vasodilator action on both resistance and capacitance vessels, which may be one of the main factors in insulin-in duced hypotension.
Myocarditis and Hepatitis B Virus
Authors: Mahapatra Rajat K. , Ellis Gregory H.
Published: November 2007

Two patients with hepatitis B virus infection and myocarditis are reported. The implicated pathogenesis was an immune complex mechanism in one pa tient. Both patients presented with heart failure and arrythmia which were con trolled with conventional medical therapy. Echocardiography played an important role for early detection of left ventricular dysfunction. The efficacy and safety of corticosteroid therapy is still conjectural. Acute hepatitis B infec tion should be a differential diagnostic consideration in the etiology of acute myocarditis.
The Osborn Wave in Hypothermia
Authors: Gould Lawrence , Gopalaswamy C. , Kim B.S. , Patel C.
Published: November 2007

A patient is reported who presented with fatal hypothermia. The electrocar diographic changes of a sinus bradycardia, prolonged QT interval and Osborn waves were documented and correlated with body temperature. The possible genesis of these electrocardiographic changes is reviewed in this article.
Subacute Left Main Coronary Stenosis: An Unusual but Serious Complication of Percutaneous Transluminal Coronary Angioplasty
Authors: Slack John D. , Pinkerton Cass A.
Published: November 2007

Percutaneous transluminal coronary angioplasty (PTCA) is a proven non- operative method of direct myocardial revascularization. Acute complications occurring during PTCA center primarily around acute disruption at the site of dilatation, arrhythmias, or vascular problems at the site of guide catheter ac cess. Late complications include restenosis or aneurysm formation at the site of dilatation. Subacute stenosis of the left main coronary artery occurred in three of 440 patients who had PTCA performed between September 1980 and Decem ber 1983 and may be an infrequent but potentially critical complication of PTCA. The serious clinical course of patients with left main coronary stenosis requires prompt recognition and intervention.
Methysergide (Sansert) Treatment in Acute Stroke Community Pilot Study
Authors: Weintraub Michael I.
Published: November 2007

Since its first discovery in 1948,1 serotonin (5-HT) has been the subject of considerable interest. Its potent vasoactivity led to the hypothesis that altered serotonin metabolism was responsible for the pathophysiology of cerebrovascu lar disease (infarction & hemorrhage) with documentation of elevated levels of serotonin in CSF.2 If (5-HT) serotonin-mediated release is ultimately responsible for cerebral edema, vasospasm and infarction in experimental and human stroke, then an opportunity exists to pharmacologically block these effects with serotonin-antagonizing agents. This hypothesis has been tested in the laboratory with several agents that inhibit biogenic amines3-6 resulting in promising data suggesting a reduction in damage and disability. Since the "natural history of human stroke" results in a 30-40% mortality within the first three weeks,7,8 an aggresive new attempt should be directed to increasing the number of survivors in this initial period of high risk. In this regard Sansert (methysergide) was considered worthy of clinical trials.
Conservative Treatment of Lymphoedema of the Limbs
Authors: Földi Ethel , Földi M. , Weissleder H.
Published: November 2007

Management of Lymphoedema is extremely variable in the medical profes sion, ranging from aggressive diagnostic procedures, which may aggravate the disease (lymphography by oily contrast mediums) in combination with thera peutic nihilism to precipitous operations. Scattered between these two con traversial extreme positions are quite a number of various conservative methods - some of which being in conflict with the anatomy and physiology of the lymph vascular system and the pathology of Lymphoedema.

Lymphoedema, if left untreated, or is treated inadequately, may lead to in- validity and to death if Stewart - Treves Syndrome develops. Unnecessary sur gery may have disastrous consequences. The paper describes how Lymphoedema can be treated with success, free of any side effects, by complex physiotherapy.
Prevalence of Atherosclerotic Lesions at the Carotid Bifurcation in Patients with Asymptomatic Bruits: An Echo-Doppler (Duplex) Study
Authors: Lusiani L. , Visona A. , Castellani V. , Ronsisvalle G. , Bonanome A. , Pagnan A.
Published: November 2007

The prevalence of atherosclerotic lesions at the carotid bifurcation with asymptomatic Meck bruits has been evaluated in 71 patients, 42 males, ages ranging from 19 to 84 yrs, referred to our non-invasive vascular laboratory for an echo-doppler (duplex) scan, associated with spectral analysis (Mark V ATL with Flow analyzer 459). Fifty-nine patients had mid-neck or high-neck bruits (30 bilateral), 12 had low-neck bruits (4 bilateral). The internal carotid arteries were classified as normal, minimal stenosis (diameter reduction 20%), moder ate stenosis (20-49%), severe stenosis ≥50%), total occlusion. Twenty-four of the internal carotid arteries homolateral to a mid- or high-neck bruit were nor mal, 84% had stenosis of various degree (16% severe), 2% were occluded. Stenoses of various degree were also present on the contralateral side of the bruit. No lesions above a diameter reduction of 20% were present in the internal carotid arteries corresponding to a low-neck bruit.

The echo-doppler (duplex) system, being capable of spanning the whole spectrum of the internal carotid occlusive disease, allows us to limit the number of the invasive diagnostic procedures in asymptomatic patients.