bluuebunny/crossref_metadata_2025 huggingface dataset:
Right Bundle Branch Block With Periods of Alternating Left Anterior and Left Posterior Hemiblock
Authors: Lichstein Edgar , Ribas-Meneclier Carlos , Gupta Prem K. , Chadda Kul D.
Published: November 2007

The case presented had an electrocardiographic pattern of complete right bundle branch block with alternating periods of left anterior hemiblock and left posterior hemiblock. During one of the periods of alternating hemiblock, an His bundle electrogram was recorded and the His Purkinje (H-V interval) conduction time was within normal limits. In a second episode of alternating hemiblock, periods of Mobitz type II second-degree A-V block were noted. It is postulated that this case provides clinical evidence that incomplete block of a fascicle may occur in spite of an electrocardiographic pattern of complete fascicular block. It is thought that the periods of alternating hemiblock result from a changing relationship between conduction velocity and refractory pe riod.
Angiotensin-Converting Enzyme Inhibitor (SQ 20881) in the Diagnosis of Renovascular Hypertension
Authors: Rosenthal T. , Kissin E. , Jacob E.T. , Stern N. , Levi Y. , Adar R.
Published: November 2007

SQ 20881, an angiotensin-converting enzyme inhibitor, was given to 12 patients with renovascular hypertension and to 1 patient with unilateral pa renchymatous renal disease in order to evaluate the role of renin-angiotensin systems in their hypertension. Plasma renin activity (PRA) and aldosterone were assayed in systemic blood before and after the injection of SQ 20881. In 5 patients PRA was also measured separately in each renal vein. Blood pressure decreased, PRA increased, and aldosterone level decreased in the 12 renin- dependant patients. When PRA was sampled separately from each renal vein, the increase was larger on the side of the affected kidney. Four patients with a positive test underwent corrective surgery, and in all blood pressure became normal. SQ 20881 is a useful agent in evaluating the contribution of renin in patients with hypertension.
Traumatic Aneurysm of Vertebral Artery
Authors: Case Mary E. S. , Archer Carol R. , Hsieh Victor , Codd John E.
Published: November 2007

A 64-year-old woman with a long-stand ing deformity of the neck presented with a rapidly enlarging neck mass following sud den turning of the head. Cervical radio graphs demonstrated a large erosion of the posterior elements of the cervical vertebra at the site of the deformity, and angiography revealed an aneurysmal sac of the left verte bral artery. The differential diagnoses of en larging neck masses associated with these ra diographic findings are discussed.
Specific Calcium Antagonists in the Treatment of Peripheral Vascular Disease
Authors: Emanuel M.B.
Published: November 2007

The antivasoconstrictor activity of the drugs cinnarizine and flunarizine is considered in relation to their inhibitory action on calcium ion flux mechanisms. Their clinical efficacy in peripheral vascular disease is reviewed, and the possible mode of action of the two drugs is discussed in relation to their described pharmacologic effects.
Experience With a Noninvasive Evaluation for Cerebral Vascular Disease
Authors: Raines Jeff , Schlaen Horatio , Brewster David C. , Abbott William M. , Darling R. Clement
Published: November 2007

This report describes a newly developed noninvasive method for extra cranial cerebrovascular evaluation. Two hundred consecutive cases were stud ied at the Massachusetts General Hospital and matched with clinical and angiographic findings. There were three false negative and five false positive results. Two ulcerated plaques without stenosis were not detected. Management routes for different groups of patients with central nervous system symptoms are outlined. We emphasize the usefulness of monitoring postoperative ophthal mic artery pressure to aid in the early detection of carotid occlusion in patients developing neurologic symptoms following carotid endarterectomy.
Plain Roentgenographic Estimation of Pulmonary Vascular Pressures
Authors: Rajaram P.C. , Razak Rahameth , Lakshmikanthan C.
Published: November 2007

Our improvement on Turner's technique enabled more accurate plain x-ray estima tion of pulmonary venous pressure (PVP) up to 60 mm and of systolic pulmonary arterial pressure (PAP) up to 150 mm in 215 patients catheterized for mitral valvular disease. Our improvement comprises (1) five main pul monary artery (MPA) grades 0 to IV accord ing to its area and volume; (2) modified pres sure values assigned for MPA and kinetic energy of the right ventricle (required to pump blood into the pulmonary arterial bed) according to MPA grades; and (3) nine PVP grades from 0 to 8 with corresponding assigned PVP values. These modifications have enhanced the accuracy of the technique up to 85 to 95%.
Exercise Tests in Patients With Severe Angina Pectoris: An Angiographic Correlation
Authors: Eshchar Y. , Yahini J.H. , Atlas P. , Kishon Y. , Deutsch V. , Neufeld H.N.
Published: November 2007

Graded submaximal ergometric tests were performed on 60 patients who suffered from clinically severe angina pectoris, and the results were correlated with their coronary angiograms. The test was positive in 44, negative in 9, and undetermined in 7 patients (defined as failure to reach the target heart rate without ischemic ST changes). Among patients with positive tests, 42 (95%) had obstruction of one to three coronary vessels. Among patients with negative tests, only 3 had significant coronary disease (sensitivity 93%).

While all patients suffered clinically from severe "angina pectoris," 8 (15%) had insignificant CAD, and among them 6 had a negative and 2 a false-positive exercise response (specificity 75%).

Although ST depression was a good indicator of CAD, its degree did not parallel the severity of the lesions. The peak heart rate on exercise of patients with ischemic ST changes was lower than their target heart rate, suggesting that the heart rate at which ST changes occur constitutes in itself a good indicator of severity.

Among the 7 patients with undetermined tests, CAD was found in 6. In these patients the absence of ST changes may be ascribed to extensive myocardial fibrosis, and the only clue to CAD resides in the negative chronotropic response to exercise. Although exercise testing does not always distinguish between normal and CAD patients, it nevertheless constitutes a valuable noninvasive technique for the detection of the high-risk patients.
Reactive Hyperemia in Patients With Intermittent Claudication, and Correlation With Other Diagnostic Methods
Authors: Clement Denis L. , Brugmans J.
Published: November 2007

The value of blood flow measurements was evaluated in 16 patients with in termittent claudication and in 17 healthy sex and age-matched volunteers. Limb volume was recorded with an ECG-triggered venous occlusion ple thysmograph (Periflow, Janssen), and the flow values were automatically plotted on a second channel. Resting blood flow was similar in both groups, but all the parameters from the reactive hyperemia curve in the claudication group were significantly different from those in the control group.6 The present data are preliminary in this respect.

In most patients visual inspection of the curve allows differentiation of nor mal and abnormal. Variability of the flow parameters is found to be small; the time-to-peak flow varies the most, but gives at the same time the largest differ ent results in both groups. Finally, there is a positive correlation between rest ing blood flow, peak blood flow, and walking distance. The present results sug gest that flow measurements provide valuable and objective information about the degree of functional distress caused by obliterative vascular diseases in the limbs.
Mitral Valve Prolapse: Whiplike Motion of the Posterior Mitral Leaflet Detected by Two-Dimensional Echocardiography
Authors: Kounis Nicholas G.
Published: November 2007

Thirty-four patients with symptoms suggesting mitral valve prolapse were evaluated by M-mode echocardiography, real time, two-dimensional, phased array echocardiography, and cardiac catheterization. Ten of these patients had unequivocal evidence of mitral valve prolapse during cardiac catheterization. This diagnosis was established initially by M-mode and two-dimensional echo cardiographic techniques.

A characteristic "whiplike" motion of the posterior mitral leaflet was seen in 7 patients. The posterior mitral leaflet was moving successively toward the left atrium and left ventricle during the cardiac cycle. Arching of one or both mitral leaflets was also seen in patients with mitral valve prolapse during two-dimen sional echocardiography. Two-dimensional echocardiography significantly en hances the mitral valve prolapse evaluation, but further experience and better techniques are necessary to explain many of the signs associated with this ab normality.
Blood Fluidity as a Consequence of Red Cell Fluidity: Flow Properties of Blood and Flow Behavior of Blood in Vascular Diseases
Authors: Schmid-Schönbein H. , Rieger H. , Fischer T.
Published: November 2007

Blood is known to be an extremely non-Newtonian material, the fluidity (or reciprocal of viscosity) of which can vary in vivo between that of plasma alone and zero, that is, the total lack of fluidity in the absence of coagulation. The fluidity of blood under high driving pressures and in small blood vessels is un usually high when compared to that of all other known suspensions or emul sions. The high fluidity of blood is caused by the fluidity of the red cells, which adapt to the forces of flow and participate in flow much like fluid droplets. When subjected to high forces the blood behaves dynamically like an emulsion of extremely low viscosity. In the absence of adequate flow forces, the erythro cytes are aggregated into rouleaux and rouleaux networks, which render to blood the properties of a reticulated suspension. Under these flow conditions, the fluidity of blood strongly decreases if the hematocrit value is normal or slightly elevated. If the flow forces fall below a critical level, the fluidity ap proaches zero, under which conditions the flow of blood ceases altogether (de spite the presence of residual driving pressures). The fluidity of blood is further jeopardized by an enhanced tendency to aggregation and biochemical erythro cyte rigidification, for example, by lactacidosis, hyperosmolarity, or loss of ATP. However, an actual loss of fluidity under these conditions occurs only if the biochemical changes are strictly associated with a drop in driving pressures (locally or generally).

Restitution of blood fluidity can be achieved most simply by isovolumic he modilution, by defibrinogating agents, or by drugs that protect against rigid ifying effects of acidosis or other biochemical sequelae of stagnation anoxia.
Thrombophlebitis: Diagnostic Techniques
Authors: Painter Thomas D.
Published: November 2007

A review of the extensive literature on the diagnosis of deep vein throm bophlebitis (DVT) is presented. DVT affects approximately 10% of all patients with superficial thrombophlebitis. Many authors have shown that the clinical findings of DVT are unreliable. Although pulmonary emboli are relatively fre quent in all patients with calf DVT, these emboli are generally not associated with clinical events. Venography is the "gold standard" of diagnostic tests, but it is too cumbersone to be practical as a screening procedure. Radioisotope-la beled fibrinogen is reasonably accurate in diagnosing calf DVT, but much less so in proximal lesions. The results of Doppler ultrasound and impedance pleth ysmography (IPG) agree with those of venography in 90% of the cases of proxi mal DVT.
Incidence of Thrombosis After Gynecologic Surgery Evaluated by an Improved 125 I-Fibrinogen Uptake Test
Authors: Bernstein Kurt , Ulmsten Ulf , Åstedt Birger , Jacobsson Lars , Mattsson Sören
Published: November 2007

Two hundred and seventy-six women over 50 years of age who had gyneco logic surgery were followed postoperatively with the 125I-fibrinogen uptake test (125I-FUT) to detect deep venous thrombosis (DVT). By using a newly devised technique based on conventional 125I-FUT, the exact depth of thrombi could be determined. The correlation between the results with our new technique and those from phlebography was almost 100%. Forty-seven (17%) of the women developed DVT postoperatively, 60% of them occurring in the calf muscle veins. Patients subjected to abdominal hysterectomies for malignant diseases had the highest incidence of DVT (36%), whereas those operated on for benign diseases with the same technique had the lowest (11%). Patients operated on for uterine prolapse had an intermediate DVT frequency of 15% but advanced age and estrogens given preoperatively increased the frequency. Neither the type of anesthesia (epidural or general), nor the duration of the operation, significantly influence the incidence of DVT in this study.
Determination of Systolic Time Intervals from the First Derivative of the Indirect Brachial Arterial Pulse
Authors: Stefadouros Miltiadis A. , Kavouras Theodoros
Published: November 2007

Technical difficulties occasionally preclude adequate recording of the indirect carotid pulsations needed for measuring the systolic time intervals by the conventional method. Accordingly, in 81 subjects with a wide spectrum of heart diseases, an alternative method was tested based on substituting the first time derivative of the indirect brachial arterial pulse for the carotid pulse. The observed differences between systolic time intervals measured by the two methods were small enough, and their correlation coefficients high enough, to inspire confidence in the use of the proposed method as an alternative way for determining systolic time intervals.
The Thoracic Outlet Syndrome: An Assessment of 20 Cases with Regard to New Clinical and Electromyographic Findings
Authors: Glassenberg Myron
Published: November 2007

Twenty patients with a clinically documented thoracic outlet syndrome were studied with regard to their clinical and electromyographic findings. Certain vascular as well as neurologic signs were noted to be prominent, particularly the presence of a supraclavicular bruit as well as reproduction of the patient's symptomatology while doing the thoracic outlet stress test. Other findings such as interossei weakness, ulnar nerve hypalgesia, supracla vicular tenderness to deep palpation, and reproduction of the patient's symptomatology via bilateral shoulder opposition were noted to be present. Classical maneuvers used to diagnose the thoracic outlet syndrome were compared and the thoracic outlet stress test was shown to be the best clinical test available at the present time. In addition, electromyographic studies were done which showed abnormalities in only 55% of the cases when using multiple parameters that have been described in the literature recently.

A new nerve conduction procedure was described here in which nerve conductions over the ulnar nerves were obtained in the thoracic outlet stress position and found, in a few cases, to show a reduction in amplitude of the evoked potential obtained at the hypothenar eminence. In addition, some findings suggestive of cervical radiculopathy were noted in the cases studied and several possible explanations for this were discussed.
All in the Family: Matrimonial Mitral Valve Clicks
Authors: Desser Kenneth B. , Bokhari S. Ismail , Benchimol Alberto , Romney David
Published: November 2007

Mitral valve clicks with or without late systolic murmurs were detected in genetically unrelated marital partners of 5 families. The first family repre sented 2 successive nonconsanguineous marital unions with 3 generations of mitral valve clicks. The second family included 1 natural and 2 adopted children with clinical and echographic evidence of mitral valve prolapse. The third family was comprised of asymptomatic parents, both with nonejection clicks and mitral valve prolapse, whose daughter presented 3 years previously with syncope, palpitations, and combined mitral and tricuspid valve prolapse. The fourth family had 3 members with auscultatory and ultrasonic manifes tations of billowing mitral valve, whereas the fourth member had "silent mitral valve prolapse." The fifth family represented a mother with auscul tatory and echographic evidence of mitral valve prolapse; her 14-year-old daughter had both mitral and tricuspid valve prolapse, whereas the son had a bicuspid aortic valve. Both children were products of a prior marriage, and her husband has symptomatic mitral valve prolapse. We conclude that matrimonial mitral valve prolapse probably reflects the purported (6-10%) prevalence of this disorder in the general population. The consequences of such marital union on progeny is currently unclear and warrants future investigation.
Arterial Blood Pressure and the Flow in the Calf at Rest and During Reactive Hyperemia
Authors: Barendsen G.J. , van den Berg Jw.
Published: November 2007

The influence of a handgrip-induced rise in arterial blood pressure on the blood flow in the calf at rest and on the maximal flow during reactive hyperemia after 5-minute arterial occlusion was studied in 7 healthy subjects. Isometric contractions of the forearm muscles (handgrip) with 20% of the maximal voluntary contraction during 3 minutes caused a significant increase in mean blood pressure of 19% (SEM 3%; p < 0.05). No significant increase in the mean blood flow at rest was found. The maximal blood flow during reactive hyperemia was increased by 42% (SEM, 5%; p < 0.05). The lowest peripheral resistance during reactive hyperemia was decreased by 15% (SEM 6%; p < 0.05).
Therapeutic Scope of Intravenous Nitroglycerin
Authors: Flaherty John T.
Published: November 2007

Sublingual nitroglycerin has been the time-honored therapy for angina pectoris for nearly a century. Sustained-action oral forms and cutaneous ointment have been used for perhaps ten years for prophylactic treatment of angina and even more recently have been recommended for use in congestive failure. For the past six years investigators at Johns Hopkins Hospital have been administering intravenous nitroglycerin to patients with acute myocardial infarction with and without left ventricular failure. More recently, we have employed intravenous nitroglycerin to manage acute hypertension developing in patients before and after coronary artery bypass graft surgery. I would like to review with you the current indications for intravenous nitroglycerin and the beneficial effects that would be expected in each clinical situation. I will draw on our own clinical experience obtained in nearly 200 patients1-6 and, when necessary, on the recent medical literature.
Measurement of Blood Pressure in All Toes in Arterial Occlusive Disease of the Leg
Authors: Hirai Masafumi , Kawai Seiichi , Ohta Takashi , Seko Toshiyuki , Shionoya Shigehiko
Published: November 2007

In the present study, systolic blood pressure in all toes was measured by using a bladder-free cuff in 20 normal limbs and 106 limbs with arterial occlusive disease, and the clinical significance of blood pressure measurement in all toes was studied.

In 97 of 106 limbs with arterial occlusion, all 5 toes showed a significantly decreased blood pressure, indicating that any toe can be used for the purpose of diagnosis of arterial occlusions. However, 41% of cases showed the differ ence in blood pressure of more than 15 mm Hg between any 2 toes. Great variations of blood pressure among 5 toes were observed especially in limbs with gangrene or with other skin ischemic symptoms such as cold sensitivity, numbness, or history of gangrene in the toes. In these cases, evaluation of hemodynamics in each toe is considered to be of use for prognostic study of gangrene, selection and evaluation of treatments, and follow-up study. In limbs with intermittent claudication, however, blood pressure measurement in all toes may have little value in clinical practice because of small variation among blood pressure values of 5 toes.

In comparison of blood pressure values in each toe from limbs with gangrene, toes with gangrene showed a significantly lower blood pressure than toes without gangrene. However, even in these toes without gangrene, a significantly lower blood pressure was observed than in toes from limbs without gangrene. These findings indicate that severe damage to digital circulation due to an occlusive process proximal to the toes is a primarily indispensable condition for development of gangrene in arterial occlusive disease.
Calcium Antagonists in the Treatment of Individuals with Ischemic Heart Disease
Authors: Winniford Michael D. , Willerson James T. , Hillis L. David
Published: November 2007

The so-called calcium antagonists—verapamil, nifedipine, diltiazem, and perhexiline—are pharmacologic agents that will have a dramatic impact on the medical therapy of individuals with ischemic heart disease. They have been used extensively in Europe and Japan for over 15 years, and more recent studies from this country have demonstrated their efficacy in the treatment of patients with Prinzmetal's "variant" angina pectoris, stable (exertional) an gina pectoris, and unstable angina pectoris. In addition, they appear effective in protecting ischemic myocardium both in patients with acute myocardial infarction as well as in those undergoing cardiopulmonary bypass. The purpose of this review is twofold: (a) to describe the mechanism of action and phar macology of these agents and (b) to delineate their role in the treatment of individuals with ischemic heart disease.
Effect of Gemfibrozil on Serum Lipids in Man
Authors: Fenderson Ralph W. , Deutsch Stanley , Menachemi Eli , Chin Bruce , Samuel Paul
Published: November 2007

The effect of gemfibrozil, a new lipid-lowering agent, was studied in 22 patients. Each patient served as his own control in a double blind study. The administration of gemfibrozil, for a period of 24 months, 1200 mg daily, reduced mean serum triglyceride levels by 45.6% (p<0.001) and mean serum cholesterol levels by 8.3% (p<0.001). Mean serum HDL cholesterol was increased by 32.3% (p<.0001) and mean serum LDL cholesterol levels were decreased by 11.4% (p<0.01). Mean serum VLDL cholesterol was decreased by 45.9% (p<0.001). A 3-hour glucose-tolerance test was done in each patient during a placebo-control period and during the administration of gemfibrozil. Mean plasma glucose was moderately increased during the administration of gemfibrozil at all points on the glucose tolerance curve, and to levels of significance at one (p<0.05) and two hours (p<0.02). There was no effect of the drug on serum immunoreactive insulin. No subjective side effects were apparent.
Extra-Anatomic Bypass Operation for Aorto-Iliac Disease in Poor Risk Cardio-Pulmonary Patients
Authors: Vijayanagar R. , Bognolo Diego A. , Eckstein Paul F.
Published: November 2007

Three years experience with subcutaneous axillo-femoral and bifemoral bypass surgical procedures has been outlined in patients with poor cardio- pulmonary and other risk related factors. Special emphasis has been made regarding technical consideration; advantages and disadvantages have been discussed. There were 49 limbs at risk in this group of 27 patients requiring axillo-bifemoral in 22, and axillo-unifemoral in 5. Sixty-three percent of pa tients had associated arteriosclerotic heart disease and 48% had severe em physema. There were 3 peri-operative deaths for 11% hospital mortality and 3 late deaths (12.5%). Six of the remaining patients for whom long term follow-up is available, acute graft thrombosis occurred in 3 patients salvaged by graft thrombectomy and 4 patients had late thrombosis resulting in 3 permanent graft failures. Two patients required above the knee amputation. Limb salvage and relief of lower extremity ischemic pains has been gratifying. During the limited follow-up period from 1-36 months (Mean 18) there is 87% patency rate for 43 grafts to 43 limbs.
Upper Extremity Thrombosis: Etiology and Prognosis
Authors: Demeter Stephen L. , Pritchard James Scott , Piedad Oscar H. , Cordasco Edward M. , Taherj Syde
Published: November 2007

Upper extremity thrombosis is responsible for 1-2% of all cases of deep venous thrombophlebitis (DVT). Little has changed concerning the clinical presentation, diagnostic investigation, or treatment of the disorder over the last forty years. However, a changing pattern in the natural history of the disease seems to be emerging with the advent of more invasive procedures and prolonged medical care of critically-ill individuals. Case histories of sixteen (16) patients with seventeen (17) episodes of upper extremity thrombosis are reviewed. Fewer cases of "primary" thrombosis, and fewer acute or chronic sequelae were noted in the present study than would be implied in previous reviews of the subject. It is our opinion that DVT of the upper extremity, especially when due to "secondary" thrombosis, is a more benign and self- limiting disease than has been traditionally reported.
Systemic Arterial Compliance in Patients with Non Obstructive Cardiomyopathy (NOCM), and Coronary Artery Disease (CAD)
Authors: Levy Bernard I. , Babalis Dimitri , Masquet Christianne , Slama Robert
Published: November 2007

Arterial compliance had been estimated in three groups of patients: control, NOCM, and CAD, from analysis of the arterial pressure curve. In the three groups, a simple first order Winkessel model had been validated during normal and post extrasystolic beats. The measured arterial compliance depends mainly on i the diastolic pressure, ii, the mechanical properties of the aorta and major arteries.

For the same range of age and diastolic pressure, the arterial compliance was not significantly different in the three groups of patients. Because of the significant variations of the arterial compliance during slight modifications of the diastolic pressure, the lack of difference in the compliance of control, NOCM, and CAD patients may be attributed to similar arterial mechanical properties.
Type D Double Aortic Arch
Authors: Rajaram P.C. , Hussain A.T. , Lakshmikanthan C. , Vaidyanathan D. , Subramanian N. , Vasudevan S.
Published: November 2007

Type D double aortic arch in a five year old boy (with interruption of left arch proximal to left common carotid artery)—with persistent ductus ar teriosus and stenosis of right and left pulmonary arteries diagnosed during life is reported. At surgery for P.D.A., the anatomy was confirmed. There was no vascular ring. Types A, B and C double aortic arches with interruption of left arch respectively distal to P.D.A., proximal to P.D.A. and proximal to left subclavian artery have already been reported. Ours happens to be the first case of type D double aortic arch diagnosed ante-mortem and confirmed at surgery.
Toe Pulse Wave Analysis in Obliterating Atherosclerosis
Authors: Oliva I. , Roztocil K.
Published: November 2007

Photoplethysmographic measurements were carried out in 61 limbs with angiographically documented obliterating atherosclerosis (OA) and in 72 limbs without OA. The distance P was measured between the ascending and de scending limbs of the pulse wave at the border of the upper and middle thirds of the amplitude. To standardize the measurements the P value was divided by the length L of the pulse wave (P/L ratio). Using 95% confidence limit in the group of healthy young individuals, 80.8% of the lower limbs with obliterating atherosclerosis without occlusion (OAWO) and 100% of those with complete occlusion (OAWCO) were revealed. In the group of healthy individuals (aver age age 50 years), 69.8% of lower limbs with OAWO and 100% of those with OAWCO were found. This method showed the higher number of detected OAWO when compared with peripheral systolic pressure measurements.
Nifedipine in Ulnar Artery Occlusion
Authors: Fisher Martin M. , Snart Alan G.
Published: November 2007

With the introduction of the calcium channel blocker, Nifedipine, potent peripheral vasodilatation has been demonstrated. 1-22 Its main action is on the peripheral arterioles and venules with decreased peripheral resistance. Calcium affects most smooth muscle cells of the peripheral arteries and arterioles. Any small increase in the radius of a peripheral vessel or collateral increases the blood flow by an increment of four square. It is not surprising, therefore, that the calcium entry blocker exerts a vasodilatory effect. That effect varies with the intensity of the disease in the vascular bed in the different patients.
Indirect Blood Pressure Measurement at the Common Femoral Artery
Authors: Hirai Masafumi , Seko Toshiyuki , Ohta Takashi , Matsubara Junichi , Ban Ichiro , Shionoya Shigehiko
Published: November 2007

In the present study the technique and the reliability of indirect blood pres sure measurement at the common femoral level was described. The blood pres sure was measured by using a long cuff, which encircled the hips at the level of the groin, and determining the flow signals by Doppler technique applied at the ankle. In order to transmit the cuff pressure to the artery, a slender bag with air, which was a blood pressure cuff used in children, was placed over the common femoral artery under the cuff. A 14 cm. wide cuff-bladder was usually used, but in obese subjects with the size of hips more than 90 cm, a 16 cm. wide cuff-bladder was applied. In patients with collateral vessels around the groin due to the iliac disease, the blood pressure could be measured by placing the Doppler flat probe over the common femoral artery or the collateral vessel. In observation of 24 subjects, a close correlation was obtained between the femoral cuff pressures and common femoral intra-arterial pressures. Furthermore, blood pressure values at the common femoral level measured indirectly showed similar reproducibility as those at the ankle and toe levels.
Polymyalgia Rheumatica and Systemic Giant Cell Arteritis. Bioptic Findings of the Subclavian Arteries in a Case of Aortic Arch Syndrome
Authors: Di Giacomo V. , Fraioli A. , Carmenini G. , Schietroma M. , Meloni F. , Grossi F.
Published: November 2007

A 64 year old woman complained of aches and stiffness of the neck and the shoulders with fever and E.S.R. increase. A nonsteroid anti-inflammatory treatment was unsuccessful. A clinical examination revealed absence of both radial pulses and presence of murmurs at level of the carotids. The angio graphic findings confirmed an aortic arch syndrome with severe stenosis of the subclavian and axillary arteries. The diagnostic approach, in spite of a negativ ity of the temporal artery biopsy, was for systemic giant cell arteritis with gen eral manifestations of polymyalgia rheumatica. The biopsies of both subclavian arteries, performed during a surgery revascularization, showed a typical giant cell arteritis in acute stage. The histopathological pattern of extratemporal giant cell arteritis obtained by means of a surgical biopsy is really uncommon, being the previous reports performed on necroscopic findings only. In addition this case confirms that polymyalgia rheumatica implies a systemic arteritis even if the clinical and histopathological signs of temporal arteritis are lacking. There fore the temporal artery should be only considered as a particular and incon stant localization of this vasculitis.
Paroxysmal Ventricular Tachy Cardia Associated With Bell's Palsy in a Teenager At Late Preg Nancy
Authors: Menon K.P.S. , Mahapatra Rajat K.
Published: November 2007

Several attacks of ventricular tachycardia (VT) were observed in a fifteen-year-old girl at late pregnancy. Left sided Bell's Palsy was the accompanying presentation. The symp tom started with a viral-like illness. The VT could be effectively controlled with IV Lido caine therapy. Labor was induced and the de livery was uneventful. To the best of the au thors' knowledge, this syndrome was not pre viously described.
Noninvasive Quantification of Ambulatory Venous Hemodynamics During Elastic Compressive Therapy
Authors: Norris C. Scott , Turley Glenn , Barnes Robert W.
Published: November 2007

Quantifying the hemodynamic results of elastic compression requires inva sive and cumbersome techniques. Twenty lower extremities (normal, primary, acute and chronic post-thrombotic varicosities) were evaluated with quantita tive photoplethysmography (PPG) prior and subsequent to initiating graded compression. The PPG transducer is placed against the stockings and the in vivo method of calibration is used to predict the results of compressive therapy on ambulatory venous pressure (AVP).

Noninvasive evaluation of patients with quantitative PPG techniques follow ing compressive therapy may provide a better understanding of venous hemo dynamics and a rational approach to selection of therapy.
Angiographic and Pathologic Evidence of Hemorrhage Into the Myocardium After Coronary Reperfusion
Authors: Yasuno Masao , Endo Shigeki , Takahashi Masaaki , Ishida Moriharu , Saito Yoshihiko , Suzuki Katsuhiro , Fujiwara Hisayoshi
Published: November 2007

Severe myocardial hemorrhage can occur as a potential adverse effect of reperfusion therapy in evolving myocardial infarction. This report describes a 83-year-old man, who showed angiographic evidence of extravasation of con trast medium from the reperfused right coronary artery into the inferoposterior left ventricular wall. At autopsy, severe hemorrhage was transmurally observed in the inferoposterior wall of the left ventricle. The finding of extravasation is a useful angiographic sign of the production of hemorrhage during coronary re perfusion therapy, and great attention should be focused to the existence of this sign to prevent further hemorrhage.
Photoplethysmography of the Distal Pulp in the Assessment of the Vasospastic Hand
Authors: Cooke Ernest Davidson , Bowcock Sally Ann , Trevor Smith Albert
Published: November 2007

A procedure for assessing the peripheral vasculature and a new technique for determining the characteristics of the a.c. (arterial) photoplethysmographic (PPG) waveform are described. Comparing 12 normal female volunteers and 12 female patients with Raynaud's phenomenon, PPG amplitude is as good as the results of a standard thermographic test in distinguishing between the groups. The limb arterial flow measured by strain gauge plethysmography (SPG) and the timing of features in the PPG waveform showed differences between the groups, which did not reach statistical significance. The rise time of the PPG waveform, however, was found to be correlated with age independently of vasospasticity.
Influence of Intravenous Infusions of Hydroxyethylstarch (HES) (MW 40,000 and 450,000) on the Blood Flow Properties of Healthy Volunteers
Authors: Ehrly Albrecht M. , Landgraf Helmut
Published: November 2007

Infusions of hydroxyethylstarch (HES) solutions as plasma substitutes and flow improvers play an increasing role in the treatment of various diseases. Little is known about the effect of HES solutions of different molecular weights on the flow properties of blood i. e. blood viscosity, plasma viscosity, erythrocyte aggregation and erythrocyte deformability (filtrability). In the present study the influence of 500 ml-infusions of a 6% solution of HES (MW 450,000) has been compared to that of 6% solutions of HES 40,000.

Infusions of 500 ml of HES 450,000 into healthy persons induced a hemodilution with a subsequent decrease in whole blood viscosity whereas the plasma viscosity increased. Red cell aggregation increased as well, red cell deformability was slightly impaired.

Infusions of 500 ml of HES 40,000 into healthy persons were followed by a hemodilution with a decrease in blood and plasma viscosity, a decrease in erythrocyte aggregation and a slight improvement of red cell deformability. The reason for this difference in behaviour and its therapeutical consequences are discussed.
What is the Optimum A-V Interval in D.D.D. Pacing?
Authors: Rao Gopal , Winzelberg Gary , Flaherty Patrick
Published: November 2007

One of the programmable parameters in recent pacemakers is atrio-ventric ular interval. To find out the optimum A-V interval studies were done in 14 patients. Multigated radionuclide scans were used to measure the left ventricu lar function, at a resting heart rate of 70/minute. Seven patients had poor left ventricles (ejection fraction < 50%). Left ventricular ejection fraction, relative cardiac output and end diastolic counts were highest at 250 M. Sec. interval compared to 150. Ejection rates and end systolic counts were not related to A-V interval. Relative cardiac output was 27% higher in poor ventricles at 250 delay than 150. This observation was not significant in normal hearts. Optimum P-R interval is 250 M. Sec. for maximum left ventricular function.
Biochemical Analysis of Dermal Connective Tissue in Subjects Affected by Primary Uncomplicated Varicose Veins
Authors: Andreotti Lupo , Cammelli Daniele , Sampognaro Salvatore , Allori Andrea , Baldoni Daniele , Bussotti Alessandro , Cortini Paolo , Di Giovine Francesco , Sterrantino Gaetana
Published: November 2007

Biochemical analysis of dermal connective tissue was carried out in 14 sub jects affected by primary uncomplicated varicose veins and 14 controls. Skin samples were taken, according to fixed criteria, from operation pieces of total mastectomy for breast cancer.

The results suggest that the dermal tissue in these subjects is just thinner than that of controls, confirming previous similar clinical findings.

The elective reduction of the collagen content observed, unassociated with changes of other components of the dermal connective tissue, brings evidence for a systemic biochemical defect of the extracellular matrix i.e. a collagen de fect affecting the entire body structure and not only the varicose or pre-varicose veins of the lower limbs.
Delayed Fatal Pulmonary Hemorrhage Complicating Use of a Balloon Flotation Catheter
Authors: Klibaner Michael I. , Hayes John A. , Dobnick Dusan , McCormick John R.
Published: November 2007

A case of delayed fatal pulmonary hemorrhage caused by a balloon flotation catheter is described. The catheter was inserted preoperatively. The patient died on the 14th postoperative day from massive hemorrhage in the right pleural space after 12 days without any clinical symptoms. Pulmonary artery rupture is documented by the autopsy findings.
Antithrombotic Potential of Pentoxifylline A Hemorheologically Active Drug
Authors: Schröer Reiner H.
Published: November 2007

An up-dated synopsis is given on the antithrombotic potential of pentoxifyl line. Pentoxifylline enhances the PGI2 release from the vascular wall and causes increasing platelet sensitivity to antiaggregating prostaglandins. By its PDE in hibiting effect pentoxifylline in high doses can also enhance PGI2-stimulated cAMP synthesis. These platelet aggregation inhibiting effects in combination with increases in fibrinolytic activity under pentoxifylline administration are suggested to be the main determinants of the compound's antithrombotic prop erties as evident from investigations in different animal models of thrombosis: Intravascular thrombus formation upon stimulation by both iontophoretically introduced ADP or laser injury of endothelium in the hamster cheek pouch and in the rat mesentery, respectively, was significantly reduced under pentoxifyl line. Clinically these findings are corroborated by the regress of platelet aggre gability, reduction in fibrinogen, increase in AT III and decrease in antiplasmin activity under treatment with pentoxifylline.
Gangrene of the Foot: A Complication of Phlebography
Authors: LePage James R.
Published: November 2007

One believes there is a necessity to bring to widespread attention a most serious complication of what is often considered a mundane radiological exami nation - lower extremity contrast venography. So mundane is it considered in fact, that outside of resident teaching programs, an informal telephone survey of 15 hospitals from 240 beds to 780 beds revealed that a number of injections and examinations: (a) were conducted entirely by technologists without any pre tense of radiologist supervision; (b) that the radiologist "supervised" the injec tion (i.e. was in the "immediate vicinity") or; (c) injection was preferentially done by the radiologist, but no reason was seen why a skilled non-physician could not conduct the examination.1
A Non-Invasive Index of Leg Arterial Perfusion Pressure During Walking, Derived From Cutaneous Toe Temperature
Authors: Baccelli Giorgio , Corbellini Ezio , Walsh J Timothy , Busca Stefano , Boccaccini Ugo , Zanchetti Alberto
Published: November 2007

This article describes and evaluates a non-invasive technique for continuous monitoring of hemodynamic changes in the legs during walking. The method involves monitoring of cutaneous toe temperature. In six normal subjects we have shown that, during exercise under carefully controlled conditions, a unique steady-state toe temperature exists for any given leg arterial perfusion pressure, when perfusion pressure is varied by means of an external occluding ankle cuff. Further, we have demonstrated a strong correlation between this external ankle cuff pressure and the time rate of changes of toe temperature during the test-period following occlusion. Correlation coefficients, r1, were be tween -1 and -0.88 (mean -0.95; standard deviation±0.03) for big toe and between -1 and -0.87 (mean -0.94; standard deviation ±0.03) for third toe.

We conclude that during walking the time profile of toe temperature changes is a useful index of changes in leg perfusion pressure. Therefore, toe tempera ture may be used to study the dynamics of leg arterial circulation in atheroscler otic occlusive diseases.
The Accuracy of "Pull-Through" Pressure Measurements and Papaverine Testing
Authors: Baker A.R. , Evans D.H. , Taylor J.D. , James D.C. , Bell P.R.F.
Published: November 2007

Intra-arterial pressure measurements have been made in a group of vascular patients using two different methods. The pull-through method, without sys temic pressure monitoring, is compared with a technique employing simultane ous radial and femoral arterial puncture. In both techniques, pressures are measured at resting flow and during papaverine induced hyperaemia.
Instrumental Evaluation of the Venous Circulation in the Arteriopathic Subjects
Authors: Bartolo M. , Antignani P.L. , Pittorino L. , Todini A.R. , DiFolca A.
Published: November 2007

In peripheric arteriopathies, alterations occur to the venous system with a particular swelling of the veins of the foot-top, in the subjects (sclerotic or dia betic) at the 2nd and 3rd Fontaine stage, which gradually decreases until the collapse in the most advanced levels of the arterious affection (4th stage).

In order to verify all that, we examined 40 artheriopathic subjects at the different Fontaine stages through a c.w. doppler apparatus and an impedence plethysmograph.

Together with the modification of the arterious doppler velocitogram and the reduction of the Winsor index, we noticed that the velocity of the venous flow increases together with a venous hypertension that reaching the highest values at the 3rd stage, while at the 4th stage they are reduced because of the progress of the sclerosis. The impedence plethysmogram shows a reduction of the systo diastolic sphygmic excursion with a variation of the basic line, depending on the respiration, proportional at the clinic stage.

In diabetic subjects the progress of the disease is more precocious because of the quicker implication of the microcirculation.
Necrobiosis Lipoidica: Treatment with Porcine Dressings, Split-thickness Skin Grafts and Pressure Garments
Authors: Youshock Eva , Beninson Joseph
Published: November 2007

A 39-year old nondiabetic female had severely ulcerated necrobiosis li poidica of the legs which was refractory to medical management for 2½ years. Surgical management with porcine grafting followed by autologous split-thick ness skin grafts successfully healed these ulcerations. With the use of custom- fitted contoured pads and pressure gradient stockings, the grafts have remained intact for 21/2 years, and there has been significant improvement of the nonul cerated plaques.
Surgical Approach and Review of Literature on Gastroduodenal Aneurysm: A Case Report
Authors: Taheri Syde A. , Mueller George
Published: November 2007

Splanchnic artery aneurysms are relatively uncommon occurrences. The splenic artery aneurysm is the most common, making up 58% of the abdominal visceral vessel aneurysms. This is followed by hepatic artery aneurysm and those of the gastroduodenal (GDA) and pancreaticoduodenal arteries. The GDA artery aneurysm is quite rare. Only 29 had been reported by 1980. We are reporting here a case of GDA aneurysm diagnosed pre-operatively as an aortic aneurysm. We will also review the literature and make note of the changes in pathophysiologic concepts and the diagnosis of GDA aneurysms.
Evaluation of the Effects of Vasoactive Drugs on Cutaneous Microcirculation by Laser Doppler Velocimetry
Authors: Leonardo Giuseppe , Arpaia Maria Rosaria , Del Guercio Raffaele
Published: November 2007

The effects provoked in different points of skin circulation by a vasoactive drug injected in the femoral artery of patients affected by chronic obliterative arterial disease at clinical stage 2, were evaluated using the laser Doppler velocimeter. At the same time, by means of strain gauge plethysmography, measurements were taken of the relative variations of volume and amplitude of the pulse waves in the hallux and of blood flow in the calf.

After administration of the drug, a number of phenomena were observed, the most notable of which was a rapid and intense shift of blood from skin to muscle, followed by an increase in the global perfusion of the limb.

Considering the physio-pathological importance of regional blood redistribution between skin and muscle and the high frequency rate of skin lesions in vascular diseases of the limbs, the possibility of evaluating, with a practical, non-invasive technique, the effects of drugs at the skin level is of great interest.
An Uncommon Systemic Arteritis — A Case Report
Authors: Di Giacomo V. , Meloni F. , Transi M.G. , Mastroberardino G. , Iannucci G. , Sciacca V.
Published: November 2007

A 26-year-old male shortly after an acute respiratory disease was affected by a thrombophlebitis of the left leg. After a few days he had two syncopal attacks. Later on, a myocardial ischemia was diagnosed. Subsequently the patient began to complain of a bilateral claudication of the calves; after an attack of fever, the ischemia of the lower limbs worsened with recurring pain at rest.

At the same time, in absence of any symptom, a myocardial ischemia occurred again and the presence of a thrombus was observed in the right atrium. After surgical removal of it, the ischemic troubles of the lower limbs once again began to worsen with the occurrence of bilateral gangrene of the feet. An amputation of both the legs was promptly performed at the level of the thighs. The histological examination of the arteries of the amputated legs showed segmental arteritis with partially recanalized thrombi of the popliteal, left femoral and tibioperoneal arteries. In the meantime, the titres for Coxsackie virus B2 and B6 were found slightly increased.

One month later, the left radial pulse disappeared for a few days. The histopathological findings may relate this arteritis to a form of Buerger's disease even if a systemic thromboangioitis obliterans is not commonly accepted.

In case that the acute respiratory infection represented the true onset of the sickness, it seems conceivable that the hypothesis of a viral infection gave raise to arteritis with morphological features recalling those of Buerger's disease.