bluuebunny/crossref_metadata_2025 huggingface dataset:
Direct Connection Between the Coronary Arteries in the Human Heart
Authors: Reig J. , Jornet A. , Petit M.
Published: July 2008

Seven cases of intercoronary arterial continuity are described, which were obtained from a study of 100 human hearts in individuals with an average age (±standard deviation) of 61.09 years (±21.96). The methods used in the study were postmortem coronary angiography and dissection. In those cases in which intercoronary continuity was found, a histologic study was performed on the connecting vessel, together with the distal portions of the interconnected arteries. Of the 7 cases observed, 5 showed continuity between the anterior and posterior interventricular arteries, in the distal portion of the posterior interventricular groove. The remaining 2 cases showed continuity between the distal portions of the right coronary artery and the circumflex artery, occurring in the posterior auriculoventricular groove. In all cases, continuity was by means of a single vessel in epicardial position, with a diameter similar to that of the terminal portions of the interconnected arteries. The histologic structure of the connecting vessel had the char acteristics of a normal arterial wall, so the authors conclude, therefore, that in these cases of intercoronary continuity reported in adult hearts, there is a persistence of the type of coronary circulation observed in the fetus.
Connective Tissue Accumulation in the Muscle Layer in Normal and Varicose Saphenous Veins
Authors: Cristóvão Porto Luis , da Silveira Paulo Roberto M. , de Carvalho Jorge José , Brandao Panico Marília Duarte
Published: July 2008

Varicose veins alternate areas of phlebosclerosis and hypertrophy of the vein wall. In this study, samples of long saphenous veins obtained from patients submitted for aortocoro nary saphenous vein graft or for surgical resection of varicose saphenous veins were examined. Histologic changes in the intima, muscle, and adventitial layers were quanti fied. Thicknesses of the venous wall layers were obtained by linear measurements, and the volumetric density of the connective tissue in the muscle layer was determined by point counting. The muscle layer thickness was 300 ±13 and 581 ±25 μm in normal and varicose veins, respectively A more severe connective tissue accumulation within the muscle bundles was found in the varicose condition. The volumetric density of the connective tissue in the circular muscle layer (CmC/MmC) showed also a marked differ ence between varicose (0.67 ±0.08) and normal veins (0.43 ±0.02), P < 0.05. The authors suggest that the varicose condition is associated with a connective tissue uniform accumulation among muscle cells in the circular muscle layer.
Transvenous Permanent Left Ventricular Pacing
Authors: Wen Lieng Lee  , Chi Woon Kong  , Lee Shing Chu  , Jer Young Liou  , Min Ren Lin  , Wan Leong Chan  , Mau Song Chang
Published: July 2008

This case report presents a patient who inadvertently received transvenous permanent left ventricular pacing through an unexpected atrial septal defect. This lead malpositioning was proved by two-dimensional and transesophageal echocardiography. The abnormal pattern of electric activation was demonstrated by radionuclide phase image analysis. He has been followed up for a total of forty-three months with antiplatelet therapy and has been free from systemic embolic phenomena. A simple and readily available method that could lead to early recognition of lead malpositioning is reiterated and the various causes, methods of detection, and prognosis of left ventricular pacing are discussed.
Successful Reduction of Endomyocardial Fibrosis in a Patient with Idiopathic Hypereosinophilic Syndrome
Authors: Lombardi Carlo , Rusconi Cesare , Faggiano Pompilio , Lanzani Giovanna , Campana Carlo , Arbustini Eloisa
Published: July 2008

A case of endomyocardial fibrosis in a patient with idiopathic hypereosinophilic syndrome is reported and discussed. The authors draw attention to the importance of both echocar diography (two-dimensional and Doppler) and nuclear magnetic resonance in the detection of cardiac involvement due to this rare pathology. Moreover, these imaging techniques appear to be valuable in the evaluation of effects of medical treatment. Therapy with corticosteroids alone has shown no reliable effectiveness in reducing the absolute eosinophil count. A combined immunosuppressive treatment with use of hydrox yurea is required.
Short-Term Evaluation of Plaque Area Measurement Reproducibility from Computer-Assisted Sonography
Authors: Massonneau M. , Caillard Ph. , de Chassey L. , Mouren X. , Thebault B. , Cloarec M.
Published: July 2008

One reason why quantifying plaque regression is difficult is the poor spatial control of the shooting angle whether in angiography or ultrasonography techniques. A computer-assisted technique has been developed to assess absolute carotid plaque dimensions from B-mode ultrasonography, with enhanced capability of comparative examinations at large time intervals. Plaque area is measured from arterial lumen to adventitia with a real-time tissular detection program. Further measurements on the same patient are made using an echo-specific mask automatically generated by the computer from the original section. For an average sonographer, the manipulation takes no more than ten minutes for each view. In order to determine the reproducibility of this technique, a repeated measurement study (TO, T1, T2) was carried out on 8 patients with moderate to severe atherosclerotic lesions at carotid localizations.

The plaque areas ranged from 52.7 to 202.3 mm2 (120.7 ±61). The coefficients of correlation between the measurements (T0-T1, T0-T2) were respectively 0.93 and 0.96 (P < 0.0001). The mean coefficient of variation (±SD) was 9.8% ±4.8.

This study shows the feasibility of an accurate follow-up for atherosclerotic patients, with a two-dimensional plaque quantification, closer to the reality of the evolution of the pathology than the usual scoring system.
Effects of Volume Loading on Pulmonary Venous Flow Pattern in Dogs with Normal Left Ventricular Function
Authors: Akita Sachie , Ohte Nobuyuki , Hashimoto Takeshi , Kobayashi Kenji , Narita Hitomi
Published: July 2008

The effects of altered loading conditions on the pattern of pulmonary venous flow are poorly understood. The authors investigated such effects, therefore, by using volume loading in 6 open-chest dogs. The pulmonary venous flow volume rate curve was obtained with a transit-time ultrasonic flowmeter at a fixed heart rate. Measurements were performed in the control and several states during the intravenous infusion of dextran. The influences of volume loading on hemodynamic and pulmonary venous flow variables were compared between the control state and three interventional states in which mean left atrial pressure was approximately 1, 2, and 3 mm Hg above the control value. The systolic flow volume (SI), which corresponds to left atrial reservoir volume, significantly increased, but the early diastolic flow volume (DI), which corresponds to left atrial conduit volume, did not show significant change with volume loading. The flow volume during left atrial contraction significantly increased with volume loading. The flow volume during one cardiac cycle (PVF) significantly increased with volume loading. Approximately 73% of increased PVF was distributed to the systolic flow. The rest was distributed to the early diastolic flow (14%) and to the flow during left atrial contraction (12%). The change in the ratio of SI/DI significantly and positively correlated with the change in mean left atrial pressure (r=0.87, P < 0.001). These findings indicate that increased pulmonary venous flow induced by volume loading in dogs with normal left ventricular function is mainly distributed to the left atrial reservoir volume.
Silent Giant Left Atrium
Authors: Badui Elias , Delgado Concepcion , Enciso Roberto , Graef Alicia , Solorio Sergio , Madrid Rosalba , Cruz Humberto
Published: July 2008

A sixty-two-year-old white woman with a 14.5 cm (145 mm) silent giant left atrial enlargement secondary probably to rheumatic heart disease is presented. Aside from mild progressive shortness of breath during the past year, the patient had been asymptomatic all her life. Her clinical picture was manifested for the first time by syncope secondary to slow atrial fibrillation, for which a permanent pacemaker was required. The correct diagnosis of the enlarged chamber was not possible through the routine chest roentgenogram. In this case, the echocardiogram, nuclear angiogram, and computed tomography were the pertinent studies needed to reach the diagnosis.
Jellyfish-Venom-Induced Deep Venous Thrombosis
Authors: Al-Ebrahim K. , Tahir M.Z. , Rustom M. , Shafei H.
Published: July 2008

The authors describe a case of jellyfish sting that resulted in deep venous thrombosis of the leg and thigh of a thirty-five-year-old healthy man. The authors found no mention of this complication from jellyfish sting in the literature. Successful treatment measures are described.
Combined Left Ventricular Wall Motion and Myocardial Perfusion Stress Imaging in the Initial Assessment of Patients with a Recent Uncomplicated Myocardial Infarction
Authors: Flamen Patrick , Dendale Paul , Bossuyt Axel , Franken Philippe R.
Published: July 2008

The aim of the study was to examine the ability to simultaneously assess left ventricular function and myocardial perfusion by using a single injection of technetium-99m Sestamibi at rest and during submaximal exercise to identify high-risk patients with left main, proximal left anterior descending (LAD), or three-vessel coronary artery disease (CAD) after an uncomplicated acute myocardial infarction (AMI). Multiple studies have evaluated the separate value of the exercise ECG, myocardial perfusion scintigraphy, and radionuclide angiocardiography (RNA) for identifying patients with severe CAD. The availability of technetium-99m (Tc99m)-labeled myocardial imaging agents offers the opportunity to evaluate simultaneously ventricular function and myocardial perfusion during a single exercise session. Only limited data are available about the value of this combined technique in the workout of patients early after an uncomplicated AMI.

Combined first-pass RNA and myocardial perfusion tomoscintigraphy (SPECT) at rest and during submaximal exercise were performed in 52 patients, less than six weeks after an uncomplicated AMI, with use of Tc99m Sestamibi. Patients were classified in two subgroups according to the presence of left main, proximal LAD, or three-vessel CAD. Stepwise logistic regression analysis was used to determine the independent predictors of severe CAD. All patients underwent the exercise testing without any medical complica tion. On univariate analysis, the global left ventricular ejection fraction (LVEF), wall motion score, and myocardial perfusion score, both at rest and at submaximal exercise, were significantly associated with the presence of severe CAD. The response of LVEF to exercise, and the presence of exercise-induced wall motion or myocardial perfusion abnormalities, were not associated with the severity of CAD.

On multivariant analysis only the wall motion score during exercise was an inde pendent predictor for the presence of severe CAD (P < 0.001, r=0.6). In analyzing patients with anterior AMI separately, LVEF at submaximal exercise was the most accurate predictive parameter. If a cutoff value of 40% was chosen, the LVEF at exercise had a sensitivity of 85% and a specificity of 78% for the detection of severe CAD. In patients with inferior AMI, neither LVEF nor wall motion or myocardial perfusion scores were useful for differentiating the two subgroups. In these patients the presence of an additional perfusion defect during exercise in one of the anterior wall segments yielded a sensitivity of 70% and a specificity of 75% for the presence of severe CAD.

In conclusion: simultaneous evaluation of LV function and myocardial perfusion at submaximal exercise, using a single injection of Tc99m-Sestamibi, is a safe and accurate technique for selecting patients with severe CAD after an uncomplicated AMI.
Brain Infarction Developed in Hypertensive and Normotensive Patients During Hospitalization—Hemodynamic Factors
Authors: Sugimori Hiroshi , Ibayashi Setsuro , Fujii Kenichiro , Yao Hiroshi , Sadoshima Seizo , Fujishima Masatoshi
Published: July 2008

To determine the effects of changes in blood pressure (BP) on the development of ischemic stroke, 17 patients who developed acute brain infarction during hospitalization were analyzed in relation to the vascular risk factors such as hypertension, previous stroke, diabetes mellitus, and hyperlipidemia. Their BPs were retrospectively referred to the onset of stroke. The average values of mean arterial blood pressure (MABP) on admission were 137 mmHg in hypertensive patients (HT; n=9) and 101 mmHg in normotensives (NT; n=8). HT patients received antihypertensive treatment after admission and MABP decreased by 22 mmHg (14%) prior to the ictus (three to sixty-five days after admission). MABP in NT patients remained constant before the attack (-1.4 mmHg, four to one hundred ten days after admission). Similarly, MABP decreased by 17 mmHg (four to ninety-three days) before the ictus in patients with previous stroke (n=9), whereas it changed only a little in patients without history of stroke (n=8). BP in each group elevated immediately after the stroke and gradually decreased to 90% of the resting level after two weeks. An excessive reduction of BP may induce brain infarction in HT or chronic stroke patients or cause it to recur.
Unstable Angina of Crescendo Pattern vs New Onset: A Clinical, Coronary Arteriographic and Hemodynamic Study
Authors: Hussain K.M.A. , Gould L. , Bharathan T. , Abdelsayed G. , Karpov Yu.
Published: July 2008

Unstable angina includes a variety of clinical presentations with a different level of risk for an unfavorable outcome. In this study the authors investigated the prognostic signif icance of crescendo angina and new-onset angina to discuss management strategies, paying attention to the relevance of baseline clinical characteristics, coronary artery lesions, and left ventricular function, as well as their alterations during atrial pacing. Accordingly coronary arteriographic anatomy and changes in left ventricular volumes and ejection fraction before and during atrial pacing were studied by means of digital subtraction ventriculography in 18 patients with crescendo angina and in 18 patients with new-onset angina. Triple-vessel disease was more frequently observed in crescendo angina (56%; P < 0.05) as compared with the patients with new-onset angina (11%). Complex coronary morphology was statistically more likely to be found in crescendo angina. The angiographic evidence of intracoronary thrombi was found in 33% (P < 0.05) patients with crescendo angina and in 4% patients with new-onset angina. Compared with the patients with new-onset angina, patients with crescendo angina had higher end-diastolic and end-systolic volumes and lower ejection fraction at rest. At peak pacing, ejection fraction was significantly (P < 0.05) lower in crescendo angina (0.48 ±0.06) than in new-onset angina (0.66 ±0.04). In crescendo angina, during pacing, the magnitude of velocity of circumferential fiber shortening was significantly decreased as compared with new-onset angina.

Thus, our findings document more extensive coronary atherosclerosis and more severe left ventricular dysfunction in patients with crescendo angina than in patients with new-onset angina, which may explain the poorer outcome in the former subgroup of patients.
Refractory Cardiogenic Shock and Complete Heart Block After Verapamil SR and Metoprolol Treatment
Authors: Lee Don W. , Cohan Barry
Published: July 2008

A seventy-eight-year-old woman presented with complete heart block and refractory hypotension two days after a therapeutic dose of sustained-release verapamil with concomitant use of metoprolol. The patient continued to remain hypotensive with complete heart block, even with multiple uses of intravenous atropine as well as high doses of pressor agents such as dopamine and dobutamine. However, shortly after the use of intravenous calcium chloride, the refractory hypotension and complete heart block resolved.
Transesophageal Echocardiography Combined with Magnetic Resonance Imaging for Detecting Venous Anomalies in Dextrocardia
Authors: Nakagawa Takahiko , Tanouchi Jun , Nishino Masami , Ito Tatsuo , Ohnishi Shusaku , Tanahashi Hideo , Yamada Yoshio , Abe Hiroshi
Published: July 2008

A fifty-six-year-old woman was admitted to Osaka Rosai hospital because of dyspnea, chills, and fatigue. The patient was diagnosed by transthoracic echocardiography as having congestive heart failure due to severe biatrioventricular valve regurgitation, and cardiac surgery was proposed. Preoperative transesophageal echocardiography (TEE) revealed a dilatation of the coronary sinus (CS), a right-sided hemiazygos vein (R-AZ), and another great vessel lying between the CS and the R-AZ. Magnetic resonance imaging (MRI) was also performed, and this showed a persistent right superior vena cava (PRSVC) entering the left atrium via the dilatated CS. However, the site of connec tion between the R-AZ and the PRSVC could not be detected by MRI because of inade quate slice acquisition. Each method has its limitations, particularly with regard to visu alizing the extracardiac vascular system. Therefore, the authors demonstrated that the combination of TEE and MRI might be more useful than each alone, and the combina tion is as a valuable method as digital subtraction angiography for the diagnosis of extracardiac venous anomalies.
Heart Block in Dextrocardia with Situs Inversus
Authors: Badui Elias , Lepe Luis , Solorio Sergio , Sanchez Hector , Enciso Roberto , Garcia Paula
Published: July 2008

The authors report a case of a forty-one-year-old white woman with dextrocardia with situs inversus who presented episodes of prolonged sinus arrest and syncopal episodes secondary to possible idiopathic degeneration of the conduction system, managed successfully with a permanent bicameral pacemaker. In their literature review they found that this case represents a very rare association.
Cerebral Dural Sinus Thrombosis
Authors: Budak Faik , Bölükbaşi Okan , Demirci Ali , Özmenoğlu Mehmet , Komsuoglu Baki
Published: July 2008

Cerebral dural sinus thrombosis is an uncommon syndrome that a patient presents with severe headache, which may be associated with complex physical and neurologic findings. The authors present a thirty-two-year-old woman with severe headache, focal motor seizures, and subsequent hemiparesis when she was ten weeks pregnant, diagnosed as having a dural sinus thrombosis by magnetic resonance imaging and magnetic resonance angiography. In this report, the application of magnetic resonance techniques, including angiography to diagnose and monitor therapy for dural sinus thrombosis, is presented.
Origin and Pathophysiological Role of Increased Plasma Endothelin-1 in Patients with Acute Myocardial Infarction
Authors: Setsuta Koichi , Seino Yoshihiko , Tomita Yoshifumi , Nejima Jun , Takano Teruo , Hayakawa Hirokazu
Published: July 2008

To investigate the origin and pathophysiological role of increased plasma endothelin-1 (endothelin-1) concentration in patients with acute myocardial infarction (AMI), the authors measured plasma endothelin-1 sequentially after the onset of AMI and analyzed the origin by the simultaneously obtained blood samples from the radial artery, right atrium, and pulmonary artery in 28 patients with AMI. The data were correlated with cardiovascular hemodynamics, infarct size, and coronary arteriographic findings.

Arterial endothelin-1 at twenty-four and seventy-two hours significantly correlated with mean pulmonary arterial pressure (r=0.48, r=0.46, P < 0.05, respectively), central venous pressure (r=0.42 and 0.51, P < 0.05, respectively), and pulmonary vascular resis tance (r=0.42, r=0.42, P < 0.05), and endothelin-1 at one hundred twenty hours signif icantly correlated with peak creatine kinase (r=0.53, P < 0.05) and creatine kinase isozyme MB (r=0.58, P < 0.01).

Simultaneous blood samples showed no significant difference in endothelin-1 concen trations among them. However, a subgroup of patients with endothelin-1 concentration higher in the radial artery than that in the right atrium showed a significantly higher mean pulmonary arterial pressure (25.2 ±6.5 vs 17.0 ±1.6 mmHg, P < 0.05), peak creatine kinase (3594 ±1597 vs 865 ±495 IU/L, P < 0.05), and peak creatine kinase MB (214 ±91 vs 69 ±22 IU/L, P < 0.05) as compared with those in patients in whom endothelin-1 was higher in the right atrium than in the radial artery.

Increased plasma endothelin-1 concentration in the early stage of AMI reflects higher pulmonary artery pressure and elevated pulmonary vascular resistance, while that in the later stage is related to the infarct size.

The production of endothelin-1 in patients with severe pump failure may be accere lated in the pulmonary vascular bed, left ventricle, or systemic arterial trees, and the main origin in the later stage is possibly coronary vasculature in the infarcted area.
Pacing-Induced ST Segment Deviation in Patients with Unstable Angina: Clinical, Angiographic, and Hemodynamic Correlation
Authors: Hussain K.M.A. , Gould L. , Pomerantsev E.V. , Angirekula M. , Bharathan T.
Published: July 2008

To assess the clinical, coronary arteriographic, and hemodynamic differences between the unstable angina patients manifesting ST segment depression and those showing ST segment elevation as well as those demonstrating chest pain only without ST segment deviation during pacing, low-dose digital subtraction ventriculography was performed in 33 patients before and after abrupt cessation of atrial pacing during selective coronary arteriography. Transient ST segment depression during pacing was observed in 17 patients (52%), whereas 6 patients (18%) showed ST segment elevation; however, 10 patients (30%) did not manifest any ST segment deviation in spite of typical chest pain. Hypertension and a history of myocardial infarction were observed in a significantly higher (P < 0.05) proportion of patients with ST segment depression than in those with ST elevation. Patients who manifested ST segment depression during pacing had a higher incidence of triple-vessel disease (65 vs 17%; P < 0.05) as compared with the patients with ST segment elevation. Indirect evidence of intracoronary thrombi (complicated lesion, abrupt occlusion, and intraluminal filling defect) was noticed in a higher frequency (P < 0.05) in the group of patients with ST elevation during pacing. In patients with ST segment depression, no significant changes of global left ventricular (LV) func tional parameters were observed. However, the length of the LV severe hypokinetic region was increased significantly (6.2 ±3.1 vs 23.5 ±6.2%; P < 0.05) during pacing in this group of patients. The shortening of the affected segments of the left ventricle was decreased significantly (52.3 ±3.6 vs 38.3 ±4.9%; P < 0.05) in these patients during pacing. In the group of patients with ST segment elevation during pacing, decrease in ejection fraction was associated with significant (P < 0.01) increase in midwall equato rial diastolic stress as compared with the patients with pacing-induced ST segment depression as well as patients without ST segment deviation. In the group of patients without ST segment deviation during pacing there was no considerable aggravation of LV global or regional function. This distinction should be taken into consideration in evalu ating patients with unstable angina for diagnostic and therapeutic intervention.
Significant Differences Between Side-Mounted and End-Mounted Intracoronary Doppler Flow Probes for the Measurement of Blood Flow Velocity
Authors: Holdright Diana R. , Clarke Debbie , Ford David W. , Fox Kim M. , Poole-Wilson Philip A. , Collins Peter
Published: July 2008

Use of the intracoronary Doppler flow probe is an established method for the assessment of coronary blood flow velocity. The aim of this study was to perform an in vitro compar ison of two commonly used Doppler probes, which differ in the location of the piezo electric crystal (end-mounted vs side-mounted).

Blood flow velocity was measured over a wide range of flow rates in a flow simulator using heparinized whole blood. Measurements were made with both Doppler probes assessed in two positions (supported and unsupported) within the tubing. The results were compared with estimated true velocities. Further measurements were made with six side-mounted probes, correcting for the assumed crystal mounting angle and for the angle calculated from magnified images of the individual crystals.

Mean velocities for end- and side-mounted probes correlated highly with predicted velocities (all r ≥ 0.99), but the side-mounted probes significantly overestimated velocity by >100%. Estimation of the true crystal mounting angle of the side-mounted probe revealed considerable variability (range 30-42°) and was lower than the recommended angle correction factor of 60 ° . Velocities corrected for the individual crystal mounting angles agreed more closely with predicted mean velocities.

Although both probes are adequate for the assessment of relative changes in flow, the side-mounted probe considerably overestimates mean velocity, which is partly explained by the variable mounting angle of the crystal. The demonstrated limitations of the side- mounted Doppler flow probe in vitro should be considered in undertaking measurement of intracoronary blood flow velocity.
Percutaneous Transluminal Coronary Angioplasty of an Anomalous Right Coronary Artery Arising from a Separate Ostium in the Left Sinus of Valsalva
Authors: Chakraborty Barendra , Chan Charles N. S. , Tan Arthur
Published: July 2008

The authors describe a case of angioplasty in an anomalous right coronary artery arising from an aberrant ostium in the left sinus of Valsalva anterior and slightly superior to the ostium of the left main coronary artery. The patient also had associated bicuspid aortic valve. To the best of their knowledge, this is the first case of angioplasty in an aberrant right coronary artery originating from an ectopic ostium. The choice of guiding catheter and balloon angioplasty catheter is discussed.
Risk Factor Profile of Nonsmokers with Peripheral Arterial Disease
Authors: Fowkes F.G.R. , Dunbar J.T. , Lee A.J.
Published: July 2008

Cigarette smoking is a very common and important risk factor for peripheral arterial disease (PAD) such that a history of never having smoked is unusual in diseased subjects. The aim of this study was to determine whether never smokers with PAD had a unique risk factor profile that put them at particularly high risk of disease. The study population was derived from the Edinburgh Artery Study, which is a cross-sectional random sample survey of 1592 men and women aged fifty-five to seventy-four years. PAD was measured by means of the WHO questionnaire on intermittent claudication, the ankle brachial pressure index, and a reactive hyperemia test. Cigarette smoking was measured by use of a standardized questionnaire. In the 561 subjects who had never smoked, 32 (5.7%) had PAD as compared with 12.3% in ex-smokers and 17.8% in current smokers. The never smokers with disease were slightly older and were more likely to be female than the current smokers. They had a higher body mass index, serum cholesterol (non-HDL), HDL cholesterol, systolic and diastolic blood pressure, and glucose intolerance, although a statistically significant difference (P < 0.01) between never and current smokers was found only for body mass index. The risks of disease associated with each risk factor were not significantly different. The authors conclude that a unique risk factor profile for disease was not apparent among subjects who had never smoked, although never smokers were more likely to be women and to have higher levels of other risk factors.
Heart Rate-Corrected Ankle-to-Arm Index in the Diagnosis of Moderate Lower Extremity Arterial Disease
Authors: Abraham Pierre , Desvaux Benedicte , Colin Denis , Leftheriotis Georges , Saumet Jean-Louis
Published: July 2008

Although the ratio of ankle-to-arm systolic pressures (AAI) at rest is widely used in the clinical diagnosis of peripheral arterial disease, the heart rate (HR) at which the measure ments are performed is rarely reported.

The relation of ankle-to-arm index (AAI) to HR was studied in a normal population (n=65) and in a population of patients (n=101) suspected of moderate lower extremity arterial disease (LEAD). In the normal population, a significant inverse correlation was found between AAI and HR at rest: AAI=-0.277 x HR/100 + 1.303; r=-0.52, P < 0.001. In the second population suspected of LEAD, the authors recorded AAI and HR at rest on both legs: 80 normal legs, 110 diseased legs. Thereafter, with normal limits as superior to 0.8, 0.9, and 0.95, sensitivity was respectively 16, 39, and 46%, and specificity was 100, 100, and 98%. In defining normal limit as superior to -2 standard deviations of the AAI-HR relation found in the normal population, sensitivity and specificity were 57 and 100%, respectively.

In conclusion: In screening for LEAD in the general population with the use of AAI at rest, the authors suggest that the heart rate at which arterial pressure measurements are performed should be reported.
Efficacy of Ibudilast on Lower Limb Circulation of Diabetic Patients with Minimally Impaired Baseline Flow
Authors: Sone Hirohito , Okuda Yukichi , Asakura Yukari , Asano Michiko , Mizutani Masakazu , Bannai Chieko , Yamashita Kamejiro
Published: July 2008

Ibudilast is a prostacyclin-mediated vasodilator and antiplatelet agent. The hemodynamic effects of ibudilast were evaluated in 41 patients with non-insulin-dependent diabetes mellitus by means of two-dimensional Doppler ultrasonography and laser Doppler blood flowmetry. Before and one hour after oral administration of ibudilast (10 mg), or elastase (1800 U) as a control, the cross-sectional area (CSA) of the dorsal pedis artery, its blood flow index (BFI), and dermal microcirculatory blood volume (MBV) were measured. In the ibudilast group, all of the parameters (CSA, BFI, and MBV) significantly increased as compared with the elastase group. These data suggest that ibudilast is effective in amelio rating diabetic macroangiopathy and microangiopathy of the lower limbs.
The Effect of Ageing on Platelet Function and Fibrinolytic Activity
Authors: Gleerup G. , Winther K.
Published: July 2008

Twelve healthy young male volunteers, mean age twenty-five, range twenty-one to thirty years, and 12 healthy middle-aged male volunteers mean age fifty-eight, range forty- four to seventy-two years, were tested regarding platelet aggregation induced by adenosine diphosphate and fibrinolytic activity, estimated as euglobulin clot lysis time (ECLT), tissue plasminogen activator (t-PA), and the fast-acting inhibitor against t-PA normally referred to as (PAI-1).

Platelet aggregation increased significantly in the middle-aged group as compared with the young, as shown by a decrease in ADP thresholds for irreversible aggregation (P < 0.01). In healthy young volunteers, vigorous cycling exercise by itself caused platelet aggregability to decrease (P < 0.05). Such changes were not observed in the elderly. Fibrinolytic activity decreased significantly in the middle-aged group as shown by a prolongation of the ECLT (P < 0.01) and PAI-1, although not significantly, increased by approximately 100%, whereas t-PA significantly increased in the middle-aged group (P < 0.01).

The present results suggest that increasing age is associated with not only increased platelet aggregability but also decreased fibrinolytic activity.
Dynamic Exercise Induces Elevation of Plasma Levels of Endothelin-1 in Patients with Coronary Artery Disease
Authors: Letizia C. , Barillà F. , Cerci S. , D'Ambrosio C. , Coassin S. , De Ciocchis A. , Mastroianni M.A. , Campa P.P. , Scavo D.
Published: July 2008

In this investigation the response of endothelin-1 plasma levels to dynamic exercise in patients with coronary artery disease (CAD) was studied. The study population consisted of 20 patients with CAD, 16 men and 4 women (mean age 53 ±8.6 years). Seven normal volunteers all men (mean age 53.4 ±4.4 years) were studied as a control group. Seven patients had prior myocardial infarction. All patients and controls exercised on a multi stage bicycle ergometer; plasma endothelin-1 levels and hemodynamic indices were measured at rest, at peak exercise, and at two and six minutes after exercise. Of the 20 patients examined, 7 (35%) showed electrocardiographic (ECG) signs of myocardial ischemia during the stress test. The mean plasma endothelin-1 concentration increased significantly from 7.8 ±3.0 to 13.6 ±3.5 pg/mL at exercise peak (P < 0.05) only in patients who did not show ECG signs of myocardial ischemia and returned to baseline values during recovery (six minutes) (9.4 ±2.1 pg/mL). In normal subjects baseline endothelin-1 levels (9.4 ±4.2 pg/mL) were not significantly altered at peak exercise (10.8 ±4.7 pg/mL) and at recovery (11.3 ±3.6 pg/mL). The hemodynamic parameters were not correlated with the plasma endothelin-1 levels before, during, and after exercise in all groups.

The present study demonstrated that the plasma levels of endothelin-1 in patients with CAD increased significantly during stress testing.
Correlation of Clinical and Electrocardiographic Variables with Coronary Lesions in Unstable Angina Pectoris
Authors: Salahas Anastasios , Kranidis Athanasios , Kostopoulos Konstantinos , Antonelis Ioannis , Kolettis Miltiadis
Published: July 2008

The relation of clinical and electrocardiographic variables to the severity of coronary lesions in unstable angina was studied in 84 men and 8 women, aged thirty-nine to seventy-five, who were subjected to coronary arteriography within two weeks. Eighty- seven patients (94.6%) had significant stenosis (50% of the diameter) of at least one vessel, whereas 5 (5.4%) had normal coronary arteries. Eleven (12%) had one-vessel disease, 13 (14%) had two-vessel, and 63 (68.5%) had three-vessel disease. Twelve (13%) had also significant left main stem stenosis. Except for 1 patient with artificial pacemaker, three-vessel and/or left main stem disease was present in 20 (100%) patients with ST segment deviation ≥ 0.2mV as compared with 20 of 36 patients (55.5%) with ST segment deviation of 0.1-0.19 mV and 24 of the 35 (68.6%) with no additional ECG changes or with T wave inversion only (P < 0.005). The direction of ST segment deviation (elevation or depression) made no difference. Preexisting angina or infarction was associated with three-vessel disease and/or left main stem disease in 74.1% and 81.4%, respectively, as compared with 45.5% (P=0.05) of the patients with angina of recent onset. Pain at rest persisting for more than forty-eight hours was associated with three-vessel and/or main stem disease in 93.1% of the patients as compared with 60.3% of patients in whom rest angina subsided within forty-eight hours (P < 0.01) . In the multivariable analysis the duration of unstable angina (P=0.010), the degree of the ST segment deviation (P=0.006), age (P=0.011), and possibly preexisting myocardial infarction (P=0.076) were associated with the number of the diseased vessels. In contrast, sex (P=0.370), blood pressure ≥ 160/90 mmHg (P=0.619), smoking (P=0.249), diabetes mellitus (P=0.797), and preexisting ischemic heart disease (P=0.509) were not significant factors in the extent of the coronary lesions.
Subclavian Steal Phenomenon Associated with Stress Polycythemia
Authors: Kato Hiroyuki , Morita Hidesuke , Takashima Toshinobu , Ohmori Keizo , Sunaga Toshiaki
Published: July 2008

A case of stress polycythemia without symptoms of cerebral ischemia is presented. The patient demonstrated a blood flow reversal through the right vertebral artery that was caused by a complete obstruction of the right subclavian artery at its origin. This obstruc tion may have been due to thrombosis associated with stress polycythemia. This is a rare example of a case in which thrombotic complications of stress polycythemia occurred in a larger caliber vessel such as the subclavian artery.
Transient Cortical Blindness Following Bypass Graft Angiography
Authors: Kamata Junya , Fukami Kenichi , Yoshida Hiroaki , Mizunuma Yoshimi , Moriai Naoki , Takino Toshitake , Hosokawa Shunichi , Hashimoto Koya , Nakai Kenji , Kawazoe Kohei , Hiramori Katsuhiko
Published: July 2008

Transient cortical blindness, an uncommonly recognized complication of cerebral angiog raphy, is an exceedingly rare event after cardiac catheterization and angiography. This report describes a sixty-two-year-old patient who had transient cortical blindness following bypass graft angiography. In this case, the authors showed that cortical blindness was associated with the breakage of the blood-brain barrier (BBB) and an increase in vascular permeability rather than with primary cerebral circulatory insuffi ciency. When the possibility exists that an excess volume of contrast medium may enter the cerebral circulation as in this case, that is, following a coronary artery bypass graft (CABG) using the internal mammary artery (IMA), precautionary measures may be necessary such as changing the type of contrast medium to be used or decreasing the volume injected. When cortical blindness occurs, it is a serious clinical problem whether transient or permanent. Therefore, the circumstances leading to this complication should be understood to determine suitable treatment and management.
Unusual Coronary Collateral Circulation: Filling of a Totally Occluded Left Anterior Descending Artery by Direct Continuity from a Left Posterior Descending Artery
Authors: Abu-Ful Akram , Margulis Giora , Ilia Reuben
Published: July 2008

A patient with an unusual coronary collateral circulation is presented. The left anterior descending artery, which was totally occluded proximally, was filled directly by a contin uation of the left posterior descending artery. A thallium stress test revealed normal perfusion in the territory of the left anterior descending artery.
Severe Acute Hand Ischemia Following an Accidental Intraarterial Drug Injection, Successfully Treated with Thrombolysis and Intraarterial Iloprost Infusion
Authors: Andreev Andreia , Kavrakov Tanyo , Petkov Dimitar , Penkov Petar
Published: July 2008

A young woman with acute upper extremity edema and ischemia after intraarterial drug injection is presented. Unsatisfactory results from standard treatment were the reason for changing the therapy to temporary thrombolysis, which led to significant improvement. Some days later severe impairment forced another attempt at applying standard therapy, again unsuccessful. Only after continuous intraarterial infusion of Iloprost®, a new improvement occurred and saving of the hand was possible. It became obvious that more effective therapeutic measures ought to be applied when severe hand ischemia following intraarterial drug injection is present.
Migration Behavior of Human Smooth Muscle Cells Cultivated from Restenotic and Primary Lesions
Authors: Brandl Richard , Maurer Peter Carl , Höfling Berthold , Bauriedel Gerhard
Published: July 2008

Subintimal smooth muscle cell (SMC) migration is considered an essential determinant of arteriosclerosis and neointimal formation. In this study, a cell culture model was estab lished to characterize migration activity of SMCs originating from restenotic and primary lesions. Plaques from symptomatic stenoses of 32 patients (19 men, 13 women; 4 carotid, 17 peripheral, 11 coronary lesions) were removed by percutaneous atherectomy or direct operative approach. Ten patients suffered from recurrent stenosis. Cell cultures were established by explantation of tissue samples. By indirect immunofluorescence microscopy, SMCs were shown to be the predominant cell type of all advanced lesions irrespective of their origin. The spontaneous cellular motility of SMCs was analyzed in vitro by means of a computer-assisted observation system. Cells of all groups exhibited random motility. SMC migratory velocity was found to be significantly (P < 0.001) greater in cells from restenotic lesions than in those from primary plaques. In conclusion, migration behavior of human SMCs originating from arteriosclerotic lesions may be quan tified in vitro as a functional determinant characterizing restenotic versus primary lesions.
Reduction of Left Ventricular Hypertrophy with St. Jude Medical 19 mm Valve Prosthesis
Authors: Ota Toshiaki , Iwahashi Kazuhiko , Matsuda Hitoshi , Tsukube Takuro , Ataka Keiji , Okada Masayoshi
Published: July 2008

To determine the permissible range of the St. Jude Medical 19 mm valve (SJM19) as an aortic prosthesis, transvalvular maximal pressure gradient (maxPG) and postoperative reduction of left ventricular (LV) hypertrophy were examined in 21 patients (body surface area [BSA] 1.28-1.56 m2, mean 1.42 m2). Doppler echocardiographically measured maxPG at rest was 31 ±16 mmHg, which showed no significant difference from the differences in patients' diseases (aortic regurgitation=AR or stenosis=AS), or BSA. The maxPG, also measured during dobutamine administration when they were less than 40 mmHg at rest, increased significantly from 21 ± 11 mmHg to 32.1 ± 15 mmHg, having no differences from the differences in diseases or BSA. Reduction of LV hypertrophy was achieved postoperatively (mean postoperative period of ten months), with the reduction rates of 26 ± 19% in LV mass and 21 ± 15% in LV cross-sectional area. No significant differences were found between the reduction rates and the differences in the patients' diseases or BSA. These results indicate that, following the implantation of SJM19, LV hypertrophy was reduced in patients with AR as well as with AS, when their BSA values were less than 1.6 m2. However, limited use is recommended because the increase in pressure gradient during exercise cannot be ignored.
Diagnosis of Lymphangitic Carcinoma to Lung by Sputum Cytology: Case Report
Authors: Shanies Harvey M. , Mehta Dhiren C. , Robert Thomas L.
Published: July 2008

Documenting lymphangitic metastases to the lungs may be therapeutically important. Several techniques have been described to this end. Sputum cytology, the least invasive and expensive, is the most available. It has a role that may be overlooked but that should be emphasized, since abundant malignant cells in sputum may be associated with this pattern of tumor spread. This case is the first, to the authors' knowledge, in which the pathologic findings associated with malignant cells in lymphangitic carcinomatosis were demonstrated in sputum in the absence of tumor mass invasion of large airways.
Flow Pattern of Four Pulmonary Veins in a Case with Prolapsing Left Atrial Myxoma
Authors: Ho Yi-Lwun , Wu Chau-Chung , Chen Wen-Jone , Chu Shu-Hsun , Lee Yuan-Teh
Published: July 2008

The authors report the flow pattern of the four pulmonary veins in a case with prolapsing left atrial myxoma. The early systolic flow was reversed, midsystolic forward flow was diminished, and diastolic forward flow was augmented and decelerated rapidly in all four pulmonary veins. This phenomenon is attributed to the dynamic movement of the myxoma.
Diagnostic Dilemma of an Intramedullary Vascular Malformation
Authors: Dinakar I. , Gupta P.K. , Ratnakar K.S.
Published: July 2008

A young man was seen at a neurologic center for a slowly progressive myelopathy involving the lower limbs in 1983. After examination and investigations, a diagnosis of chronic tuberculous spinal arachnoiditis was made and the patient was administered antituberculous treatment. However, his condition continued to deteriorate. He was reviewed at another center in 1985, where a diagnosis of demyelinating disorder was made, for which he was treated. However, this also did not help, and he was diagnosed as having a nonspecific spinal arachnoiditis at yet another center in 1988. His condition continued to worsen, and after ten years of symptoms, when magnetic resonance imaging (MRI) was done, an intramedullary cystic lesion opposite D-12 vertebrae was seen, which on histopathology was proved to be a vascular malformation. After excision of the lesion his neurologic status has been slowly improving. The conditions that a malformation could mimic, misleading a clinician, and the role of MRI in clinching the diagnosis are highlighted.
Treating Hyperlipidemia in the Elderly
Authors: Fleming Richard M. , Ketchum Kristy , Fleming Diane M. , Gaede Ruth
Published: July 2008

Background: Determination of the effects of dietary modification and hyperlipidemic medications in the elderly (> sixty-five years of age) patient has not been significantly investigated to date despite knowledge that elevated cholesterol (TC) and triglyceride (TG) levels increase the risk of coronary artery disease (CAD).

Methods: Twenty-seven individuals were placed into one of three treatment groups and longitudinally followed up to examine the effects of diet and hyperlipidemic medications on TC and TG levels. Group 1 (n = 14) received neither dietary nor drug therapy. Group 2 (n = 9) received dietary counseling without concomitant hyperlipidemic medications. Subjects in group 3 (n = 4) underwent dietary instruction for six months and hyperlipi demic medication(s) for eighteen months.

Results: Subjects in group 1 demonstrated a statistical increase in TC (P ≤ 0.001) during the study. Patients in groups 2 (P ≤ 0.001) and 3 (P ≤ 0.05) demonstrated statistical improvement in TC reduction during dietary counseling. The effect on TC was blunted in group 3 after dietary counseling was discontinued. Reductions in TG levels were signifi cant (P ≤ 0.001) only for patients in group 2.

Conclusion: Elderly individuals were able to significantly reduce both TC and TG levels by dietary modification alone. Minimal improvement was seen with the addition of hyper lipidemic medications.
Efficacy and Issues of Emergent Percutaneous Transluminal Coronary Angioplasty
Authors: Yabe Yoshimasa , Muramatsu Toshiya , Nakano Hajime , Wagatsuma Kenji
Published: July 2008

The authors investigated the efficacy and prognosis of emergency percutaneous trans luminal coronary angioplasty (PTCA) in elderly patients. A study was conducted on the early and late prognosis of the study group composed of 66 younger patients < sixty-five years in Group A and 46 elderly patients ≥ seventy years in Group B who underwent reperfusion therapy, including PTCA, for acute myocardial infarction (AMI). No difference was seen in the initial success rate of 82% for Group A and 85% for Group B, or in the vessel patency in the predischarge coronary arteriogram (CAG) with 84% for Group A and 87% for Group B. However, in-hospital mortality was 3% for Group A and 11% for Group B.

The patient restenosis rate in the 4.2 months follow-up CAG was 28% for Group A and 50% for Group B. The lesion restenosis rate was 30% for Group A and 53% for Group B (P < 0.05), and the late period mortality rate was 3% for Group A and 11% for Group B. Although there was no difference in the initial success rate of reperfusion through PTCA for AMI in the elderly as compared with the younger patient group, poorer results were seen in the restenosis rate and mortality rate.