bluuebunny/crossref_metadata_2025 huggingface dataset:
Minoxidil in the Treatment of Refractory Hypertension
Authors: Rosenthal Talma , Swartz Jacob , Teicher Avishai , Boichis Hayim
Published: November 2007

Minoxidil, a powerful vasodilator, is a very effective antihypertensive drug. Twenty-two patients, who were mostly refractory to conventional anti hypertensive medication, were treated with this drug. There was a swift and definite drop of blood pressure in all cases. In 7 patients with renal disease, renal function did not deteriorate during the administration of minoxidil, and it improved dramatically in the eighth patient. Side effects of the drug were hir sutism, fluid retention, and in 1 patient a pruritic bullous erruption which dis appeared when the drug was discontinued.
Effect of Intravenous Nitroglycerin on Hemodynamics of Congestive Heart Failure
Authors: Pitt William A. , Friedman Richard G. , Gross Steven A. , Glassman Jerrold , Keating Edward C. , Mazur John H.
Published: November 2007

Intravenous nitroglycerin (IV-NTG) has gained wide use in the manage ment of critically ill patients, yet little is known regarding dose-response hemodynamics in man. Therefore, we studied 10 patients, all Class III or IV New York Heart Association Classification with pulmonary artery wedge pressures of 15 torr or greater. A special delivery system designed to prevent drug absorption Nitrostat® IV Infusion Kit was used and assessed. Multiple hemodynamic values were recorded before, during, and after the infusion. Administration of IV-NTG was started at 0.125 mcg/kg/min and was doubled every 15 minutes to a maximum dose of 2.0 mcg/kg/min. The infusion was stopped if the pulmonary artery wedge pressure dropped below 10 torr, or arterial pressure dropped below 90/60 torr, or if the mean artery pressure fell more than 10 torr, or if significant side effects occurred. Samples for blood levels were collected. Only one patient noted any untoward effects and he recovered quickly upon cessation of infusion. The mean infusion rate was 0.6125 mcg/kg/min. A significant drop in mean arterial blood pressure, mean pulmonary artery pressure, mean pulmonary artery wedge pressure, heart rate, and arterial oxygenation was noted. Cardiac output did not change significantly. Pulmonary vascular resistance index, as well as several other indices, decreased significantly in all patients.

Nitrostat IV® appears to be very safe and to work by dilating preload capacitance vessels, followed by a drop in arterial pressure without an adverse lowering of cardiac output.
Gray Hair in Black Males A Possible Risk Factor in Coronary Artery Disease
Authors: Eisenstein Isaac , Edelstein Joseph
Published: November 2007

Premature gray hair has been reported to be associated with coronary artery disease (CAD) in white males. Premature gray hair also occurs in black males despite a reported lower incidence of coronary artery disease in this group. In order to determine if premature gray hair is associated with coronary artery disease in a black male population, we prospectively studied 120 pa tients. Forty black males with proven CAD had gray hair in 100 percent of the cases as compared to 55 percent in a control series of 80 black males. The appearance of gray hair occurred at an earlier age in the black patients wtih CAD. The appearance of gray hair occurred at an earlier age in the black patients with CAD. The interrelating mechanism between premature gray hair and CAD in black males is not clearly understood at this time, but we think it represents a clinically significant observation.
Persistent Eustachian Valve Causing Severe Cyanosis in Atrial Septal Defect with Normal Right Heart Pressures
Authors: Bashour Tali , Kabbani Sami , Saalouke Michel , Cheng Tsung O.
Published: November 2007

A 22-year-old female with cyanotic congenital heart disease was found to have veno-arterial shunting via a large secundum atrial septal defect despite normal pulmonary arterial and right ventricular pressures. Persistence of the Eustachian valve of the inferior vena cava was suspected preoperatively and confirmed at operation. This valve caused a large right-to-left shunt by favoring the flow of inferior vena caval blood into the left atrium via the defect. Surgical excision of the abnormal valve and closure of the atrial septal defect resulted in complete physiological and clinical cure.
Takayasu's Arteritis: A Hospital-Region Based Study on Occurrence, Treatment and Prognosis
Authors: Urban Waern A. , Andersson P. , Hemmingsson A.
Published: November 2007

Occurrence of Takayasu's arteritis (TA) is described in this work in a defined area of Sweden, namely the Uppsala Hospital region (1.3 million inhabitants). During the eight year period 1969-1976 there were 15 cases of TA discharged from the hospitals in this region. The estimated yearly prevalence was 0.64 per 100,000 inhabitants. All subjects underwent angiography of the aorta and the main vessels.

The authors point to the necessity of performing a total aortography. The most common lesions in this study were confined to the subclavian arteries in contrast to the commonly reported lesions of the aortic arch. Six of the fifteen subjects died during the study period. Those who died more often had hyper tension hypercholesterolemia and were smokers to a greater extent than those who survived. Treatment with corticosteroids and azathioprin seemed to im prove the prognosis. At present a total aortography and/or biopsy of the vessel at autopsy or operation is the most accurate way of establishing the diagnosis.
A Randomized, Double-Blind, Parallel Group Comparison of Disopyramide Phosphate* and Quinidine in Patients with Cardiac Arrhythmias
Authors: Arif Mohammed , Laidlaw James C. , Oshrain Carl , Willis Park W. , Nissen Catherine H. , McDermott Daniel J. , Smith W. Scott , Karim Aziz , Wilson Richard R.
Published: November 2007

This report summarizes the results of a randomized, double-blind, parallel group, multicenter study which compared the antiarrhythmic activity and safety of oral disopyramide phosphate and oral quinidine sulfate. A total of 124 outpatients, whose pretreatment rates of ventricular and/or supraventricular arrhythmias were documented by ambulatory ECG recordings, were randomly assigned to receive either oral disopyramide or oral quinidine for the eight- week course of the study. Every two weeks, ten-hour ambulatory ECG record ings were obtained from each patient and blood was drawn to determine serum concentrations of assigned drug.

Ninety-six patients, 56 of 62 subjects randomized to disopyramide and 40 of 62 subjects randomized to quinidine, were able to complete the eight-week trial. Disopyramide and quinidine were found to be similar and highly effective in reducing ectopic activity. However, disopyramide was better tolerated. Twenty-two of the 62 patients randomized to quinidine discontinued therapy due to side effects, while only six of 62 randomized to disopyramide discon tinued therapy. The mean blood levels observed were 2.9 mcg/ml for diso pyramide and 2.5 mcg/ml for quinidine.
Venous Capacity, Venous Refill Time and the Effectiveness of the Calf Muscle Pump in Normal Subjects
Authors: Barendsen G.J. , van den Berg Jw.
Published: November 2007

With strain gauge plethysmography various procedures to assess the competence of the venous system in the lower leg were compared in 10 normal subjects. The reproducibility and ease of use were established, and normal values were obtained. It is concluded, that measurements in the sitting position are preferable to those in the standing position. To measure the venous capacity, the dependency test is the method of choice. Rhythmic exercise to assess the effectiveness of the calf muscle pump can be restricted to five successive contractions. The refill time after exercise is not a suitable parameter to assess the competence of the venous valves.
Double-Blind, Crossover Study of the Clinical Efficacy and the Hemorheological Effects of Pentoxifylline in Patients With Occlusive Arterial Disease of the Lower Limbs
Authors: Strano A. , Davi G. , Avellone G. , Novo S. , Pinto A.
Published: November 2007

The effect of a 3 month daily administration of 800 mg pentoxifylline (Trental 400 bds) or placebo was assessed under double blind crossover design in 18 patients (12 males and 6 females) with peripheral occlusive arterial disease in respect of painfree walking distance and various hemorheological and hemostasiological variables, platelet aggregation, serum cholesterol and triglycerides. In first treatment period walking distance significantly increased with pentoxifylline by 46% from baseline 121 ± 15 m and by 4% with placebo from baseline 134 ± 18 m. Pentoxifylline administration furthermore yielded significant decrease in whole blood and plasma viscosity and significant increase in erythrocyte deformability. This was paralleled by distinct reduction of fibrinogen, platelet aggregation and euglobuline lysis time, also plethysmographic variables showed positive changes pointing to improvement of limb perfusion. The results of the study suggest that treatment of peripheral occlusive vascular disease by a drug improving blood fluidity through correction of hemorheological and hemostasiological factors turns especially promising and beneficial since the action centers finally on the languishing microcirculation in the ischemic tissue.
Shallow Left Anterior Oblique Right Coronary Angiography: Technique and Applications
Authors: Filiberti Allen W. , Mills Roger M.
Published: November 2007

A "new" shallow left anterior oblique view of the right coronary artery allows better vi sualization of the distal vessel in selected pa tients. This paper describes the angiographic technique; retrospective data suggest that the view is useful in approximately 20% of pa tients. An illustrative case is presented.
The "Blue Toe" Syndrome with Renal Atheroembolism and Failure
Authors: Zatuchni Jacob , Patel Harshad K. , Chiemchanya Surtrong
Published: November 2007

The occurrence of atheromatous embolization following cardiac catheteriza tion and coronary artery bypass surgery is described. It was manifested initially by bluish discolored toes inciting suspicion of vasospasm and then by progres sive renal failure. The diagnosis was confirmed by renal biopsy. The syndrome of multiple atheromatous or cholesterol emboli is probably more common than previously reported because of its masquerade of other illnesses and failure of consideration of diagnosis.
Somatostatin and Peripheral Blood Flow in Man
Authors: Savi Luigi , Cardillo Carmine , Bombardieri Giuseppe
Published: November 2007

Somatostatin (SS), a physiological substance which inhibits secretion of GH, TSH, glucagon and insulin, was evaluated as a vasoactive agent.

In normal and arteriopatic subjects SS was administered intravenously by bolus for 3 minutes and by infusion for 30 minutes.

Rheography and plethysmography of lower limbs were performed before, during and after somatostatin administration.

A marked improvement of blood flow, provoked by somatostatin, was ob served. A reduction of heart rate was also observed.

Some hypotheses about the mechanism with which SS acts upon peripheral circulation are discussed.
Uncommon Presentation of Pheochromocytoma: Case Studies
Authors: Grossman Ehud , Knecht Aron , Holtzman Eliezer , Nussinovich Naomi , Rosenthal Talma
Published: November 2007

Twelve patients with pheochromocytoma have shown unusual clinical and laboratory presentation. These include three patients with cardiac manifesta tions (sick sinus syndrome, obstructive cardiomyopathy and ischemic ECG changes). Two patients with gastrointestinal problems (acute abdomen due to ischemic bowel and constipation). One child with sudden blindness and one, non diabetic patient with polyuria. Laboratory findings included four patients with diabetes mellitus, four patients with hypercalcemia two of them with concomi tant hyperreninemia and one patient with hypokalemia. Awareness of the illness leads to the discovery of unusual cases and even a most severely sick patient can make a complete recovery.
A Case Report of Anomalous Branching of the Popliteal Artery
Authors: Fikry Abdelwahab I. , Zwass Alicia
Published: November 2007

A rare developmental anomaly of absent posterior tibial artery and hypo- plastic anterior tibial artery is presented. In this case, marked hypertrophy of the peroneal artery compensated for the absent arteries. The peroneal artery also gave collaterals to form the dorsalis pedis and the plantar arteries.
A Quantitative Test for Measuring Reactivity to Cold by the Digital Plethysmograph Technique
Authors: de Faucal Ph. , Essboui S. , Grolleau J.Y. , Planchon B.
Published: November 2007

The authors have developed a vascular reactivity test to cold using the digital plethysmograph technique with a mercury strain gauge. Three types of arterial reactivity were determined: local reactivity after immersion of the hand in 11°C water, general reactivity after thorax ventilation, and cumulative reactivity as sociating both of these cooling modes. The method is based on measurement of the digital plethysmographic signal expressed as a ratio of a reference warm amplitude obtained after immersion of the hand in 45°C water for 3 min. The method was tested and perfected in 66 control subjects before being applied to 65 patients with Raynaud's disease. Significant differences were noted between these 2 groups, especially in cumulative reactivity (p < 10-9), which led to nu merical expression of results in 5 types of increasingly important reactivity. It would appear that the test has diagnostic and prognostic value in the explora tion of vascular acrosyndromes and their therapeutic follow-up.
Pulmonary Edema of Environmental Origin — Newer Concepts
Authors: Demeter Stephen R. , Kester Lucy , Cordasco Martha A. , Lammert Gary , Beerel Fred , Cordasco Edward M.
Published: November 2007

Pulmonary edema of non-cardiac origin is usually an urgent clinical prob lem, which has recently increased in frequency throughout the world in the past few years. This is partly due to sociological factors and to pre-eminent advances in industrial technology. Recent severe massive toxic gas explosions have had national and worldwide implications. Therefore, urgent and appropriate ther apy is of utmost importance in most of these patients. The use of high flow oxygen with Constant Positive Pressure Breathing are the main inhalational therapeutic approaches. Newer modalities of treatment include: (1) earlier Fi beropticbronchoscopy in those individuals afflicted with aspiration problems and (2) certain specific chemical blocking agents for the management of phos gene intoxication and hydrogen sulfide toxicity. Preventive environmental mea sures are also important.
Investigation of the Venous Hemodynamics of the Lower Limb by Venous Pressure Models
Authors: Psathakis Nikolaos D. , Psathakis Dimitrios N.
Published: November 2007

The conversion of the measured ambulatory venous pressure (AVP) to a value resulting from a resting venous pressure of 100 mmHg is significant for a standardized evaluation of the venous dynamics in different patients. By apply ing the formulas derived from the measured ambulatory and resting venous pressures, the venous insufficiency and the functional reserves can be calculated in percent. By combining the refilling time (RT) with the venous pressure index (VPI), the venous pressure hemodynamic index (VPHI) results, which is a very sensitive parameter also for minimal changes in the venous hemodynamic.

Thus, the venous dynamics can be compared before and after a treatment in the same or in different persons.
Mossy Leg — An Unusual Therapeutic Success
Authors: Beninson Joseph , Redmond Michael J.
Published: November 2007

Elephantiasis verrucosa nostrum occurs when lymphatic obstruction of sufficient magnitude causes back pressure in the lymphatic channels forceful enough to produce superficial vessel dilation which has a "pebbly" or cobble-stone appearance. Unchecked this can progress to a marked verrucous or mossy appearance, frequently complicated by infection, with swelling and gross deformity.

The patient presented here was both post-phlebitic and post-lymphatic with significant deformity. He showed dramatic improvement on a regimen of antibiotics and elevation followed by decompression and routine use of pressure-gradient support garments. This has not recurred and he has remained under control since 1979.
Contrast Echocardiography in the Evaluation of Interatrial Septal Defect
Authors: Hajar Rachel , Hajar Hajar A. , Folger Gordon M.
Published: November 2007

One hundred twenty-four adult patients consecutively referred for suspected interatrial septal defect (IASD) were studied with contrast echocardiography. In 58 the study eliminated altogether the diagnosis of any significant cardiac defect. Fifteen patients had other forms of cardiac abnormalities with no shunting of blood, and 51 patients had echocontrast study positive for interatrial shunting ; 48 of these were subsequently proven by cardiac catheterization to have IASD. Echocontrast provided a highly sensitive and specific means of both diagnosing IASD and eliminating this diagnosis.
Effects of Mesoglycan Sulfate on the Arterial Elastic Module
Authors: Andreozzi Guiseppe Maria , Signorelli Salvatore , Duca Salvatrice Lo , Minacapelli Concetta , Amico-Roxas Maria T. , Minardo Giovanna , Cacciaguerra Giuseppe
Published: November 2007

Ten patients with peripheral obstructive arterial disease (POAD) in stages I and II according to Leriche-Fontaine, were subjected to therapy with mesogly can sulfate (60 mg/day for twenty days), to evaluate the effect of the drug on the elastic module of the arterial wall. The wall elasticity was deduced from some Doppler velocitographic indices (arterial dynamics index, resistance index, per fusion pressure index, tibial distensibility index); from the analysis of systolic, protodiastolic, and end diastolic velocity variations; and from computerized analysis of the Doppler sound spectrum.

The results show a significant improvement of arterial wall elasticity, which suggests a rational use for the drug in the initial stages of peripheral obstructive arterial disease.
Changes in Systemic and Pulmonary Vascular Reactivity in Hypertension Following Nifedipine and Verapamil
Authors: Bailo Mariangela , Fiorentini Cesare , Folli Andreina , Galli Claudia , Loaldi Alessandro , Maltagliati Anna , Tosi Elena , Tamborini Gloria , Guazzi Maurizio D.
Published: November 2007

Excessive vascular tone and overresponsiveness to adrenergic stimuli char acterize the hemodynamics of the greater and the lesser circulation in hyperten sion. We tested whether calcium entry blockade with verapamil (11 cases) or nifedipine (11 cases) may improve the vascular regulation in high blood pres sure. Mental arithmetic and cold were used as adrenergic activators. The former stimulus produced obvious elevation of epinephrine plasma concentra tion, increase of cardiac output (CO), slight systemic vasodilatation, pulmonary vasoconstriction, and rise of blood pressure in both circuits. After calcium an tagonists, the epinephrine reaction to the arithmetic test was significantly attenuated, variations in CO and systemic blood pressure were unchanged, pul monary vasoconstriction was abolished, and the pressure rise in the lesser cir cuit was halved. The cold pressor test increased norepinephrine plasma concen tration (NE pc), systemic and pulmonary blood pressure, and vascular resist ance and did not alter CO. The attained NE pc during cold was unvaried after verapamil and significantly enhanced after nifedipine; pressure and resistance responses of the two circuits were almost unchanged after the former, whereas systemic and pulmonary vascular resistance rises were importantly attenuated after the latter compound, resulting in much lower pressure reactivity.

A modulation of the sympathoadrenal reaction, per se, can explain changes in the systemic and in the pulmonary vasomotion with calcium blockade during arithmetic. It would seem that after verapamil the sympathetic system was still activated during cold to such an extent as to maintain the same vasoconstrictor potency. NE pc suggests that the sympathetic discharge was not reduced by nifedipine. The impressive attenuation of the constrictor reaction in the two circuits would imply the existence of a shared vascular disorder in which cal cium ions are involved, which is more sensitive to nifedipine.
Cholesterol Crystal Embolization: A Review of 221 Cases in the English Literature
Authors: Fine Michael J. , Kapoor Wishwa , Falanga Vincent
Published: November 2007

Cholesterol crystal embolization (CCE) frequently presents with nonspecific manifestations that mimic other systemic diseases. The authors reviewed 221 cases of histologically proven CCE in the English literature to define the clinical, laboratory, and pathologic characteristics of this disorder. CCE affected predominantly elderly males (mean age sixty-six) with a frequent history of hypertension (61%), atherosclerotic cardiovascular disease (44%), renal failure (34%), and aortic aneurysms (25%) at presentation. At least one possible predisposing factor was present in 31 % and included operative and radiological vascular procedures and the use of anticoagulants. Cutaneous findings (34%) and renal failure (50%) were two of the most common clinical findings throughout the course of CCE. The nonspecific signs and symptoms included: fever (7%), weight loss (7%), myalgias (4%), and headache (3%). Premortem diagnoses were established in 31 % of patients most commonly by biopsy of the muscle, skin, and kidney. Mortality was high (81 %) and was most commonly due to multifactorial, cardiac, and renal etiologies. The authors conclude that CCE should be strongly considered in elderly patients with atherosclerotic vascular disease who have the onset of renal insufficiency and cutaneous manifestations. CCE may be confirmed by a skin or muscle biopsy.
Blood Pressure Response to a Calcium Entry Blocker in Normotensive Subjects With or Without a Family History of Hypertension
Authors: Saito Ikuo , Takeshita Eiko , Saruta Takao , Nagano Shiro , Sekihara Toshio
Published: November 2007

The possibility that a familial background of hypertension might influence the blood pressure response to a calcium entry blocker was evaluated in 15 normotensive relatives of patients with essential hypertension and 18 normoten sive subjects with no family history of hypertension. Under control conditions, blood pressure, heart rate, plasma noradrenaline, adrenaline, and renin activ ity did not differ between the two groups. Nifedipine, at a dose of 10 mg admin istered sublingually, lowered the blood pressure and increased the heart rate, plasma noradrenaline, and renin activity. The normotensive relatives of patients with essential hypertension did not differ in their responses from the normoten sive subjects with no family history of hypertension, with the exception of plasma noradrenaline thirty minutes after nifedipine. These results provide evi dence to suggest that there is no functional abnormality with increased depen dency of vascular smooth muscle tone on calcium influx in the prehypertensive state.
Transient Left Atrial Mobile Thrombus in Acute Myocardial Infarction—A Case Report
Authors: Matsuyama Koshi , Misumi Ikuo , Horio Yutaka , Yasue Hirofumi
Published: November 2007

The authors report a fifty-year-old woman with acute inferior myocardial infarction in whom left atrial mobile thrombus was found by echocardiography. They believe this to be the first echocardiographic documentation of such a thrombus after acute myocardial infarction. The combination of the stagnant flow in the left atrium due to atrial ischemia, the low output state due to left ventricular dysfunction, and the hemoconcentric tendency from use of diuretics might have played a role in the present thrombus formation. The thrombus was safely lysed without complication after intravenous urokinase.
Hemorheologic Treatment of Cerebral Reversible Ischemic Episodes with Pentoxifylline — A Prospective Study
Authors: Ott E. , Körner E. , Lechner H.
Published: November 2007

One hundred patients (49 males, 51 females) with reversible neurologic defi cit due to cerebral ischemia of vascular origin in the carotid artery territory were recruited for a long-term observation to follow up recurrence of ischemic events. Fifty-eight patients (mean age sixty-four years) were treated daily with 1200 mg oral pentoxifylline in addition to basic therapy (antihypertensives, antidiabetic drugs, etc), and 42 matching patients (mean age sixty-two years) of a control group had no pentoxifylline or other hemorheologic medication. The mean observation period was fifty-six months (range thirty-six to sixty). On admission patients presented with increased platelet aggregation and/or im paired red cell filterability and with enhanced red cell aggregation. Five pa tients in the pentoxifylline group (8.6%) and 16 control patients (38%) suffered a relapse of an ischemic episode. These data support previous reports of a bene ficial effect of pentoxifylline in the prevention of cerebral ischemic events.
Are Strokes More Likely to Result from Severe Carotid Atherosclerotic Stenoses? If Not, Why Not?
Authors: Schoenfeld Myron R. , Aronow Wilbert S. , Paul Patti
Published: November 2007

The authors studied by carotid duplex ultrasonography 478 unselected el derly patients (age sixty to one hundred one years, mean 82±8), in their long- term health care facility. Of these, 108 had previously experienced strokes owing to atherothrombotic brain infarcts, documented by a neurologist, and 370 had not. The degree of extracranial internal or common carotid narrowing in these patients was classified by standard Vmax Doppler criteria as 0-40%, 40- 80%, and 80-100% luminal diameter reduction.

The authors found that 87% of the patients had little or no carotid stenosis (0-40% luminal diameter reduction). Nevertheless, 79% of the previous strokes had occurred in these patients, and the incidence of strokes in this group was 21%. Severe, but not mild or moderate, degrees of carotid obstruction (80- 100% luminal diameter reduction) were associated with a 100% stroke inci dence.

The authors conclude that strokes most commonly result from causes other than ischemia due to in situ severe extracranial internal or common carotid stenosis or occlusion.
Electrocardiographic and Hemodynamic Correlations in Primary Pulmonary Hypertension
Authors: Kanemoto Nariaki
Published: November 2007

In order to evaluate the pulmonary hemodynamics in primary pulmonary hypertension, the relation between the standard 12-lead electrocardiogram (ECG) and pulmonary hemodynamics as determined by right-heart catheteriza tion was analyzed. Significant positive correlations were noted between ampli tude of the R in V1, the R/S ratio in V1, and the pulmonary artery systolic pressure (r=0.46 and 0.50, respectively, p < 0.01). An amplitude of the R in V1 of more than 1.2 mV indicated a pulmonary artery systolic pressure of more than 90 mmHg with a sensitivity of 94% and a specificity of 47%. The cardiac index showed a significant positive relationship with amplitude of the R in V5 and V6 and the R/S ratio in Vs and V6 (r = 0.46, 0.46, 0.39, and 0.48, respec tively ; each with a p < 0.01). Moreover, an ÂQRS ≥ 100°, and either an SV6 ≥ 0.7 mV, or R/SV 6 ≤ 2 indicated a cardiac index of < 2.8L/min/m2 with a sensitivity of 82% and 84% and a specificity of 86% and 100% respectively. This study suggests, therefore, that the 12-lead ECG is useful for the evalua tion of the severity of pulmonary hypertension by its ability to predict pulmo nary artery systolic pressure and cardiac index with clinically useful accuracy.
Percutaneous Angioplasty of Totally Occluded Coronary Vein Bypass Grafts: Case Histories
Authors: Mosseri Morris , Admon Dan , Hasin Yonathan , Kriwitzki Michael , Rosenheck Shimon , Gotsman Mervyn S.
Published: November 2007

Seven patients with totally occluded coronary artery bypass vein grafts underwent percutaneous transluminal angioplasty. All patients had either acute or recent occlusion of the graft itself. In 2 patients the proximal and in 3 the distal anastomosis were also narrowed. The vein graft was successfully dilated in all the patients. Six patients also received direct intragraft thrombolytic therapy during the procedure. Five uncomplicated patients improved clinically. One patient was studied routinely as part of a myocardial infarction-streptokinase protocol and had no symptoms. This patient had a no-reflow phenomenon. One patient did not receive intragraft thrombolytic therapy and the procedure was complicated by embolization with myocardial infarction and a cerebral embolus. In 2 patients, a routine angiogram was performed two to six months after graft dilatation and in both the grafts were patent. Another patient, initially successfully dilated, had recurrent angina and restenosis of the proximal anastomosis ten months after angioplasty; this was successfully redilated.

Angioplasty of acutely or recently totally occluded coronary vein grafts is feasible and improves angina when present. Additional thrombolytic therapy prevents embolization.
Effects of Pentoxifylline and Metabolite on Red Blood Cell Deformability as Measured by Ektacytometry
Authors: Cummings Doyle M. , Ballas Samir K.
Published: November 2007

The present investigation sought to evaluate the effects of pentoxifylline and its major hydroxyhexyl metabolite on red blood cell (RBC) deformability using the technique of ektacytometry. Red blood cells were harvested from normal volunteers (normal RBCs) and patients with sickle cell disease (abnormal RBCs) and incubated with varying concentrations of pentoxifylline and its major metabolite for varying time periods. The deformability of both treated and untreated RBCs from both patient groups was assessed by ektacytometric analysis. In contrast to the in vitro effects of pentoxifylline on whole-blood filterability, the present results demonstrated no effect of pentoxifylline or metabolite on RBC deformability at any concentration or incubation time period.

Pentoxifylline does not enhance RBC deformability following acute in vitro incubation, and this suggests the need for further evaluation of the mechanism of action of this drug.
The Role of Leukocyte Depletion by in Vivo Use of Leukocyte Filter in Lung Preservation After Warm Ischemia
Authors: Ide Hirofumi , Ino Takashi , Hasegawa Tsuguo , Matsumoto Hiroshi
Published: November 2007

The oxygen metabolites of leukocytes have been implicated as playing the central role in reperfusion injury of preserved lung for transplantation. Furthermore, it is still unknown how leukotrienes take part in this process. Twelve mongrel dogs were used, divided into two groups. In group A, left thoracotomy and hilar stripping of the left lung was performed under anesthesia. During warm ischemia (two hours) and reperfusion (two hours), a filter was used three times between the femoral artery and vein, and quantitative in vivo blood filtration was performed. In group B, warm ischemia and reperfusion was done in the same fashion without filtration. As for tissue free radical assay, lipid peroxidation products were measured by means of thiobarbituric acid. Tissue leukotriene B4 and C4 levels were measured by radio immunoassay. In addition, peripheral blood count and tissue wet/dry ratio were analyzed.

Significant leukocyte depletion of peripheral blood with leukocyte efflux from reperfused lung was observed in group A. Significant increase of tissue malondialdehyde (MDA) titers after reperfusion was observed in group B, whereas no significant fluctuation of tissue MDA titers was noted in group A. Concerning leukotriene B4 and C4, no significant increase was observed in either group. Tissue damage estimated by lung wet/dry ratio was considered to be controlled in group A compared with group B.

Thus, the authors conclude that in vivo use of a leukocyte filter is efficient in removal of peripheral blood leukocytes and in preservation of reperfused lung after warm ischemia and that oxygen metabolities of leukocytes are considered to play a role in tissue damage in this process.
Experimental Analysis of Sapphire Contact Probes for ND-YAG Laser Angioplasty
Authors: Ashley Simon , Brooks Stephen G. , Gehani Abdurrazzak A. , Kester Ralph C. , Rees Michael R.
Published: November 2007

Laser angioplasty may offer percutaneous recanalization of occluded vessels where conventional guidewire and balloon techniques fail. Metal laser thermal angioplasty probes may, however, cause excessive thermal damage due to high tip temperatures (>400.C). Therefore, contact probes made from artificial sapphire crystal designed for general laser surgery are currently being evaluated for use in laser angioplasty with continuous wave Nd-YAG energy. The sapphire modifies the laser energy in various ways, and this paper examines the physical characteristics of five types of rounded sapphire probe (SMTR, MTR, MTRL, OS, LT) and how these properties are affected by clinical usage.

The laser beam profile emitted by these probes demonstrates a focal spot 1-2 mm in front of the tip. However, the forward transmission of Nd-YAG energy through the sapphires varied (SMTR, 85%; MTR, 83%; MTRL, 75%; OS, 54%; LT, 69%). Probe heating occurs owing to energy absorption within the sapphire. The surface temperature of the sapphires was measured in air by infrared thermography and the hottest region within the probes localized by an isothermographic technique. At energy settings used clinically (20 J, 10 watts for 2 s) the SMTR, MTR, and MTRL probes exhibited higher temperature rises (94-112.C) than the OS and LT probes (30.C), and heating was localized to the front surface of the former probes. Peak sapphire temperatures remained lower than those of metal probes even at higher energies. After clinical use, the MTR probe demonstrated reduced transmission, beam defocusing, and increased heating, due to surface pitting. Thus, recanalization with sapphire probes occurs by a combination of photothermal and contact thermal effects that are localized to the probe tip and may reduce the degree of thermal injury associated with metal probes. Understanding these basic properties is important to the application and development of contact probes for laser recanalization.
Primary Intraventricular Hemorrhage Imaged by High-Field Magnetic Resonance Imaging—A Case Report
Authors: Ooboshi Hiroaki , Sadoshima Seizo , Yoshida Fujio , Hasuo Kanehiro , Fujishima Masatoshi
Published: November 2007

Primary intraventricular hemorrhage (PIVH) imaged by magnetic resonance imaging (MRI) is reported. A fifty-seven-year-old man with long-standing hypertension suddenly developed severe headache, vomiting, and retrograde amnesia. A computed tomography scan on the same day revealed hematoma in the right posterior horn of the lateral ventricle and in the 4th ventricle. Angiography of the neck and head failed to demonstrate any vascular abnormalities. On the second day his neurological symptoms almost recovered except for the loss of the memory of the ictal day. High-field MRI on the sixteenth day demonstrated an isointense lesion surrounded by a hypointense area in the T1 weighted image or a hyperintense lesion in the T2 weighted image, suggesting subacute hematoma consistent with hypertension, just anterior to the right tri-gone of the lateral ventricle.
Electrocardiographic Abnormalities in Cerebrovascular Accidents
Authors: Ramani Ananthakrishnan , Shetty Uday , Kundaje G.N.
Published: November 2007

The electrocardiographic abnormalities found in 100 patients with acute cerebrovascular disease and previously normal hearts are described. The ab normalities were more often seen in patients with intracerebral and subarach noid hemorrhages. The most common changes were Q-Tc Prolongation and ST segment and T wave abnormalities. The mechanisms of these electrocardio graphic abnormalities appear to be multiple.
Significance of U Wave Polarity in Patients with a Prior Inferior Myocardial Infarction
Authors: Kanemoto Nariaki , Hosokawa Joji , Chino Masao , Takahashi Tetsuo
Published: November 2007

Sixty consecutive patients who underwent coronary angiography and left ventriculography from six to eight weeks after the onset of definite inferior myocardial infarction were divided into three groups according to the polarity of U waves in (1) leads II, III, aVF and (2) in leads V4 to V6 (positive = Group P, flat or isoelectric = Group F, and negative = Group N). The following parame ters were analyzed: (1) ECG score; (2) global ejection fraction: (3) regional area change: (4) number of asynergic, and akinetic segmental radii; (5) number of asynergic and akinetic areas: and (6) number of diseased coronary arteries and the incidence of left anterior descending artery (LAD) disease.

There were no significant differences among the three groups according to the polarity of U waves in two subgroups by the site of U waves in age, gender, systemic blood pressure, and ECG scores. The polarity of U waves in leads II•III•aVF (subgroupl) correlated with the size of myocardial infarction; regional area changes in inferior segment (Area 2) were 64.1±8.2 in group P1, 31.8±14.7 in group F1, and 21.0±15.8 in group N1 (p<0.01, F = 32.8). The polarity of U waves in leads V 4-6 (subgroup2) correlated with anterolateral wall motion; re gional area changes in anterolateral segments (Area 5) were 76.8± 11.6 in group P, 66.5±18.5 in group F, and 48.9±17.1 in group N (p<0.01, F = 18.6). The incidence of multivessel disease increased from group P2 (36.4%), to group F2 (54.5%), to group N2 (75.0%), and the incidence of LAD disease increased from 27.3%, to 45.5%, to 68.8%, respectively. A negative U wave in either location suggested severely decreased apical wall motion, and there was a tendency for global ejection fractions to decrease in the following order: group P, group F, and group N.

From these results, the authors conclude that the polarity of U waves may be one of the parameters correlating with the wall motion and left ventricular function in prior inferior myocardial infarction.
Hemorheologic and Coagulative Pattern in Hypercholesterolemic Subjects Treated with Lipid-Lowering Drugs
Authors: Bo M. , Bonino F. , Neirotti M. , Gottero M. , Pernigotti L. , Molaschi M. , Fabris F.
Published: November 2007

The effects on the coagulative and rheologic pattern of two lipid-lowering drugs, bezafibrate and simvastatin, were studied in 36 hypercholesterolemic subjects. Patients were randomly divided into two groups (18 subjects each) and received bezafibrate R 400 mg/day or simvastatin 10-40 mg/day over a twelve week period. Besides a decrease in plasma fibrinogen and fibrinopeptide A (p<0.001 both), bezafibrate induced a reduction of factor VIIc and VIIIc activity (p<0.001 both), while antithrombin 3 activity was increased (p<0.001) and the hemorheologic pattern was greatly improved (p<0.001). Simvastatin caused a slight decrease in factor VIIIc activity and a moderate reduction of beta thromboglobulin. The efficacy of bezafibrate in reducing the activation of the coagulative cascade and improving the hemorheologic pattern has been con firmed; the peculiar triglycerides- and fibrinogen-lowering effect of the drug, not observed with simvastatin, could be responsible for these modifications.
EPA in the Prevention of Restenosis Post PTCA
Authors: Bowles Mark Howard , Klonis Demo , Plavac Thomas G. , Gonzales Brenda , Francisco Dan A. , Roberts Roger W. , Boxberger Gregory R. , Poliner Larry R. , Galichia Joseph P.
Published: November 2007

The effect of fish oil on restenosis was evaluated in patients undergoing coronary balloon angioplasty. In addition to routine pharmacotherapy, subjects were given 2.8 g of eicosapentanoic acid (EPA) daily. Treatment was started within twenty-four hours after successful percutaneous transluminal coronary angioplasty (PTCA). After six months of therapy, participants were subjected to coronary arteriography, exercise scintigraphy, exercise electrocardiography, or clinical evaluation.

Follow-up evaluation involved 97 coronary lesions in 85 patients. Partial or significant restenosis occurred in 36.5% of patients and 33 % of vessels. The presence of severe stenosis before PTCA, dissection, thrombus, multilesion PTCA, and template bleeding time values were not correlated with restenosis. Dilation of the left anterior descending (LAD) and a residual stenosis≥ 35 % were associated with restenosis.

Approximately 20% of the patients related difficulty in taking the fish oil. Furthermore, these results show no advantage over expected restenosis rates.
Mortality in Acute Cerebral Infarction in Young Adults—A Ten-Year Experience
Authors: Biller José , Adams Harold P. , Bruno Askiel , Love Betsy B. , Marsh E. Eugene
Published: November 2007

We reviewed the one-month mortality among 213 patients aged fifteen to forty-five years (mean thirty-five) with acute cerebral infarction (CI) evaluated during the period July 1, 1977, to February 1, 1988. Atherosclerotic cerebral infarction (ACI) was diagnosed in 59 (27.7% ) patients, 53 (24.9%) had non- atherosclerotic vasculopathies (NAV); 46 (21.6%) had cardioembolic infarcts (CEI). Hematologically related disorders were diagnosed in 30 (14.1%) patients; the cause of CI could not be established in 25 (11.7%) patients. Fourteen patients (9 men, 5 women, mean age 34.8 years), (6.6%) died within thirty days of their CI: 7 had CEI (7/46, 15.2%); 4 had ACI (4/59, 6.7%); and 3 had NAV (3/53, 5.6%). Our data suggest that young patients with acute CI have a thirty-day mortality rate lower than older patients. Deaths were most common in patients with CEI. Brain edema and herniation accounted for 6 (43 % ) of the deaths.
t-PA, PAI, and Protein C Before and After Vascular Occlusion of the Upper Limb in Patients with Raynaud's Phenomenon
Authors: Cimminiello Claudio , Milani Massimo , Uberti Tiziano , Arpaia Guido , Motta Adele , Bonfardeci Giuseppe
Published: November 2007

Tissue plasminogen activator (t-PA) and its inhibitor (PAI) were assessed in venous blood drawn before and after venous occlusion (bvo, avo) for 33 patients with Raynaud's phenomenon (RP), 14 with primary RP (PRP), 9 with suspected secondary RP (SSRP), and 10 with definite collagen disease and secondary RP (SRP). There were significant differences in PAI values avo between PRP (and controls), SSRP, and SRP. PAI activity decreased significantly avo only in controls and in PRP, and there was significant t-PA antigen elevation avo in the same groups. In addition, since PAI is neutralized by activated protein C (PC), both PC antigen and PC activity were assessed avo and bvo. PC Ag remained unchanged in all groups, with PC activity significantly lower than controls in SRP and SSRP. Finally the authors looked for interference of anticardiolipin antibod ies (ACA) and lupus-like anticoagulant (LAC) with the PC system in collagen disease-associated RP. Specific IgG ACA were found in only 1 patient with SRP. In conclusion, there is an endothelial derangement, involving t-PA release and PAI, in SSRP and SRP patients. The reduced PC activity in these latter groups appears to be due to increased PAI influence rather than to ACA/LAC.
Higher Recurrence Rate After Coronary Angioplasty in Unstable Angina Pectoris
Authors: Johansson Sten R. , Ekström Lars , Emanuelsson Håkan
Published: November 2007

Purpose: Recurrent stenosis after percutaneous transluminal coronary an gioplasty (PTCA) is a significant problem, requiring repeat dilation in about one-third of all treated patients. Various clinical and procedure-related predic tors have been proposed. Between 1983 and 1987, 257 patients underwent 322 procedures, where 380 stenoses were attempted. Indications were: stable angina pectoris 73 %, unstable angina pectoris 22 %, other indication 5%. The primary success rate was defined as a <50% remaining postprocedure stenosis.

Findings: Repeat angiograms were done for 88 % of the initially successful cases, either six months after PTCA or if there was a clinical recurrence. Restenosis was defined as a recurrence of a more than 50% diameter stenosis. The restenosis rate was 33 % and was significantly higher (p<0.05) for unstable (46 % ) than for stable angina pectoris (29%). There was a nonsignificant tendency to a higher restenosis rate in the left anterior descending artery than in the other coronary vessels.

Implications: The increased restenosis rate seen after PTCA for unstable angina pectoris could be caused by a higher activity in systems affecting the proliferative processes in the smooth muscle cells of the arterial wall, which is thought to form the pathophysiologic basis for restenosis after PTCA.
Transcutaneous Electrical Nerve Stimulation (TENS) in Raynaud's Phenomenon
Authors: Mulder Peter , Dompeling Ellen C. , van Slochteren-van der Boor Janny C. , Kuipers Wietze D. , Smit Andries J.
Published: November 2007

Transcutaneous nerve stimulation (TENS) has been described as resulting in vasodilatation. The effect of 2 Hz TENS of the right hand during forty-five minutes on skin temperature and plethysmography of the third digit of both hands and feet and on transcutaneous oxygen tension (Tcp02) of the right hand was compared with that of a control study using indifferent stimulation of the iliopsoas region in 8 patients with primary Raynaud's phenomenon. After TENS a slight increase in skin temperature of both hands was found, while plethysmographic amplitude was increased in the contralateral hand only. No changes in TcpO2 occurred. The authors conclude that the observed small effects of TENS are of no clinical value in primary Raynaud's phenomenon.
Usefulness of Leg-Crossing for Maintaining Blood Pressure in a Sitting Position in Patients with Orthostatic Hypotension—Case Reports
Authors: Takishita Shuichi , Touma Takashi , Kawazoe Nobuyuki , Muratani Hiromi , Fukiyama Koshiro
Published: November 2007

The authors report a case with idiopathic orthostatic hypotension in which the patient prevents his blood pressure from fatting to a symptomatic level by leg-crossing in a sitting position. Including 4 other patients with orthostatic hypotension and 5 normal subjects, their study found that the changes in blood pressure with leg-crossing inversely correlated with those induced by assuming seated posture from a supine position. Leg-crossing may, therefore, be one of the useful nonpharmacologic measures for maintaining blood pressure in a sitting position in patients with orthostatic hypotension.
Prediction of Postoperative Pulmonary Function Following Thoracic Surgery for Bronchial Carcinoma
Authors: Cordiner A. , De Carlo F. , De Gennaro R. , Pau F. , Flore F.
Published: November 2007

At present surgery is accepted as the most effective mode of therapy for car cinoma of the lung. Because the lack of respiratory reserve is the major deter minant of postoperative function, it is useful to identify the patient, who is at significant risk.

Eighteen patients with lung cancer (mean age = 56 ± 6.5 years) were studied preoperatively (preop) and postoperative (postop) (three to four months after lung resection) by spirometry, measurement of arterial blood gases, and quan titative lung scanning (99mTc). A predicted postoperative value of some variables was calculated by the formula: postop value = preop value x % function of regions of lung not resected. The correlation coefficient between the predicted (pred) and postoperatively observed (observ) values VC = vital capacity, FEV1 = forced expiratory volume in 1 second) is: VC pred/VC observ r = 0.83 p<0.001 FEV1 pred/FEV 1 observ r = 0.82 p < 0.001

The authors' results agree with earlier reports and show that the method used can accurately predict the postoperative respiratory function in patients under going lung resection (pneumonectomy or lobectomy). A predicted FEV1 of 0.8 L does not permit a surgical program, because, below this level, carbon dioxide retention becomes more frequent and exercise intolerance is increasingly severe (poor quality of life). The method proposed to predict the postoperative respira tory function is simple and routinely useful. The authors choose a perfusion in stead of ventilation scan, because the former provides similar predicted postoperative data, and can be done routinely.