bluuebunny/crossref_metadata_2025 huggingface dataset:
Bivalvular Endocarditis Complicating Pregnancy
Authors: Felice Philip V. , Salom Ira L. , Levine Raymond
Published: July 2008

A twenty-nine-year old woman with a history of rheumatic fever and both mitral and tricuspid valve prolapse (without cardiac effects on the echocardiogram) presented with Streptococcus viridans infective endocarditis of both the tricuspid and mitral valves at seventeen weeks' gestation. Twelve weeks before admission she underwent a dental curettage and received presumably adequate antibiotic prophylaxis. The present case was successfully managed by means of aggressive antibiotic therapy appropriate for endocarditis, with adequate and appropriate monitoring of minimal inhibitory concentration and peak and trough levels. This case exhibits the appropriate management in the three phases of therapy for valvular disease, ie prevention, treatment, and subsequent prevention of sequelae, prior to vaginal delivery in a patient with endocarditis. The pregnancy resulted in a term vaginal delivery, without maternal or fetal morbidity.
In Vivo Measurement of Regional Large Artery Compliance by Intravascular Ultrasound Under Pentobarbital Anesthesia
Authors: Wilson Richard A. , Di Mario Carlo , Krams Rob , Loe Kie Soei  , Wenguang Li , Laird Anne C. , The Salem H. K. , Gussenhoven Elma , Verdouw Pieter , Roelandt Jos R. T. C.
Published: July 2008

Background: The presence of smooth muscle fibers on the wall of large arteries would suggest that arterial compliance might change in response to vasoactive substances. The purpose of this study is to determine the basal level of vasomotor tone in these arteries in a commonly used animal preparation and to learn whether the compliance of large conductance arteries can be altered in vivo by vasoactive agents.

Methods: Proximal iliac arterial compliance was measured in 7 pentobarbital-anes thetized pigs, before and during local infusions of adenosine and norepinephrine. Luminal area was measured every forty milliseconds by means of a 30 MHz intravas cular ultrasound catheter and an automatic edge detection program. Simultaneous high- fidelity pressure measurements were obtained by means of a catheter-tipped pressure microtransducer positioned at the origin of the iliac artery. Linear regression analysis of the area/pressure relationship in two consecutive cardiac cycles (systolic phase only) was performed before and during adenosine and norepinephrine infusions. The slope of the area/pressure regression line was defined as an index of arterial compliance. Measurements after three minutes of infusions of adenosine (5-5000 μg/minute) and norepinephrine (0.001-10 μg/minute) were compared with the control measurements.

Results: Even at the highest infusion rate, adenosine did not significantly increase arterial compliance as compared with baseline (25 ± 7 vs 19 ±4 mm2/mmHg x 10-3, respectively, P = ns). In contrast, norepinephrine decreased arterial compliance as compared with the second baseline control (13 ±3 vs 20 ±3 mm2/mmHg x 10-3, respectively, P < 0.01).

Conclusions: In this animal model with pentobarbital anesthesia, arterial compliance may be modified more by the acute infusion of norepinephrine than by adenosine in large conductance arteries such as the proximal iliac. Thus, in this preparation, smooth muscle tone tends to be minimal and arterial compliance near maximal (ie, mostly a passive phenomenon). However, in response to norepinephrine, arterial compliance can decrease significantly as smooth muscle tone increases. Intravascular ultrasound allows continuous and accurate monitoring of these changes of arterial dimensions, suggesting that this technique may be useful in the evaluation of pharmacologically induced changes in the compliance of large arteries by vasoactive agents.
Relation Between Postpacing T Wave Changes and Myocardial Scintigraphic Characteristics in Patients with Ventricular Demand Pacemaker
Authors: Abe Mitsunori , Hamada Mareomi , Matsuoka Hiroshi , Shigematsu Yuji , Sumimoto Takumi , Okayama Hideki , Kawakami Hideo , Nakata Shigeru , Hiwada Kunio
Published: July 2008

The aim of this study was to elucidate the cause of T wave changes after ventricular pacing using thallium 201 single photon emission computed tomography (T1-SPECT). T1-SPECT was performed in 20 patients with sick sinus syndrome who had negative T wave after ventricular pacing and had had a ventricular demand pacemaker (WI) implanted. Patients who have stenotic coronary arteries were excluded from the study. From the analysis of Tl-SPECT, extent score was calculated as the ischemic region. Data in patients with SSS were compared with those in 20 normal controls (NC).

Thallium perfusion defects in patients with VVI were observed and distributed mainly in apex and inferior regions on the polar map. The extent score in patients with VVI was significantly higher than that in NC (56.4 ±21.6% vs 3.2 ±6.4%, P < 0.01). The washout rate of thallium 201 in the defect area was significantly lower in patients with VVI than in NC (27.4 ±10.2% vs 46.8 ±12.3%, P<0.01).

These results suggest that T wave changes after ventricular pacing are closely related to myocardial ischemia.
Atrial Natriuretic Peptide and Antihypertensive Action Due to β-Blockade in Essential Hypertensive Patients
Authors: Hama Junkichi , Nagata Shuzou , Takenaka Tosihiko , Kino Hirofumi , Kamoi Kouji , Shimada Seijirou , Horiuchi Masatsugu , Katori Ryo
Published: July 2008

The effects of β-blocker treatment on hemodynamics were studied in relation to plasma atrial natriuretic peptide (ANP) levels in 17 outpatients with essential hypertension. Administration of propranolol for twelve weeks to untreated subjects resulted in a signif icant (P < 0.001) rise in plasma ANP levels (from 37.9 ±21.2 to 66.7 ±46.2 pg/mL, mean ±SD). Systolic and diastolic blood pressures were significantly decreased (P < 0.05 and P < 0.01, respectively). Heart rate was also significantly decreased (P < 0.001). On the other hand, a significant reduction of cardiac index was detected (from 4.12 ±1.34 to 2.96 ±0.75 L/min/m2, P < 0.01) with chronic administration of propranolol, suggesting a reflection of decreased cardiac function. A significant negative correlation was observed between %changes in systolic blood pressure and %changes in plasma ANP ( r=-0.594, P < 0.05). These results suggest that the increased plasma ANP levels may contribute to the antihypertensive effect with propranolol.
Comparing a High-Dose Dipyridamole SPECT Imaging Protocol with Dobutamine and Exercise Stress Testing Protocols
Authors: Fleming Richard M. , Rose Charles H. , Feldmann Kristine M.
Published: July 2008

Objective. To determine the safety, sensitivity, specificity, and accuracy of high-dose dipyridamole compared with treadmill and dobutamine stress imaging protocols.

Background. Nuclear imaging studies using standard dose dipyridamole provide similar results to those obtained when treadmill stress is used. Recently dobutamine tomography and planar imaging with high-dose dipyridamole have been shown to improve nuclear imaging results.

Methods. One hundred fifty-nine patients were imaged with thallium, teboroxime, or sestamibi per standard single photon emission computed tomography (SPECT) protocols. Pharmacologic stress was performed in 85 people with the remainder under going exercise testing by Bruce protocol. In this study, 0.852 mg dipyridamole was used per kilogram body weight and was infused over a four-minute period. Results from nuclear imaging were compared with those from coronary arteriograms.

Results. The sensitivity and specificity of high-dose dipyridamole was 100% and 88.9%, respectively, which is statistically greater (P < 0.005) than that achieved when patients were stressed by treadmill. Side effects with the higher dose of dipyridamole were easily reversed with aminophylline. The sensitivity and specificity of intravenous dobutamine was 100%, but it was used in a limited number of subjects. When patients were stressed by Bruce protocol the sensitivity was 92.5% and specificity was 42.8%. The differences were not attributable to inadequate exercise duration.

Conclusions. High-dose dipyridamole is safe and easily reversed with intravenous aminophylline. The sensitivity and specificity of dipyridamole and dobutamine stress testing were statistically more accurate than results obtained with treadmill protocols when SPECT is used to image the heart.

High-dose dipyridamole resulted in greater changes in heart rate and blood pressure response than seen with standard-dose dipyridamole. Associated side effects can be easily reversed with the administration of intravenous aminophylline without significant complications. The sensitivity, specificity, and accuracy of single photon emission computed tomography using high-dose dipyridamole are 100%, 88.9%, and 97.9%, respectively, for the overall presence or absence of disease when compared with coronary arteriography. This is significantly (P < 0.005) greater than that obtained by treadmill nuclear imaging protocols, independent of imaging agent.
Nuclear Cardiology, Current Applications in Clinical Practice
Authors: Niemeyer M.G. , van der Wall E.E. , Kuijper A.F.M. , Cleophas A.T. , Pauwels E.K.J.
Published: July 2008

The clinical applications of nuclear cardiology have rapidly expanded since the introduc tion of suitable imaging cameras and readily applicable isotopes. The currently available methods can provide useful data on estimates of ventricular function and detection of myocardial ischemia for adequate patient management. Two standard procedures are routinely used: (1) myocardial perfusion scintigraphy, eg, with thallium 201; and (2) radionuclide angiocardiography by using technetium 99m-labeled red blood cells.

Myocardial perfusion scintigraphy provides information on regional viability and estimates regional myocardial perfusion by measuring regional tracer activity. Thallium 201 is the agent used for noninvasive assessment of myocardial perfusion and for improving the results of exercise electrocardiography. Alternative tests, such as pharmacologic stress testing with dipyridamole, have been proposed as a reliable substitute for exercise testing. Additional quantitative analysis and computed tomography have increased the sensi tivity and specificity of thallium scintigraphy.

Radionuclide angiography techniques are used for the noninvasive evaluation of cardiac function, right and left ventricular function, and wall motion abnormalities. As in perfusion scintigraphy, radionuclide angiography has proven its value for the detection of coronary artery disease (CAD). Abnormal regional wall motion abnormalities are specific for CAD.
Henoch-Schönlein Syndrome Associated with Breast Cancer
Authors: Maestri Antonio , Malacarne Paolo , Santini Alessandra
Published: July 2008

The association of the Henoch-Schönlein syndrome with leukemias and lymphomas, though rare, is well known, but this type of pathology appears to be exceptional in the case of solid tumors. The authors report a case of malignant breast tumor wherein cutaneous vasculitis appeared at the moment of the disease's progression.
A Role for Platelet-Derived Growth Factor in Drug-Induced Chronic Ergotism?
Authors: Pietrogrande Francesco , Caenazzo Andrea , Dazzi Francesco , Polato Giuliana , Girolami Antonio
Published: July 2008

Generalized vasoconstriction in chronic ergot poisoning is attributed both to the ergota mine activity on α-adrenergic receptors and to its direct action on vascular smooth muscle cells. The authors propose that endothelial wall, chronically damaged by ergot alkaloids, releases platelet-derived growth factor (PDGF), which contributes to vasoconstriction and promotes further arterial obstruction. Their hypothesis is supported by the increased PDGF activity found in plasma of a patient suffering from chronic ergotism.
Angiotensin II Pressor Activity Depends on Medial and Lateral Anterior Hypothalamic Pathways
Authors: Kawabe Hiroshi , Lopes Oswaldo U. , Brosnihan Karen B. , Saruta Takao , Ferrario Carlos M.
Published: July 2008

The preoptic region of hypothalamus was disconnected from caudal structures with two different-size knife cuts in rats to investigate the pathway responsible for the effects of intracerebroventricular (ICV) and intravenous (IV) angiotensin II (ang II) on blood pressure and arginine vasopressin (AVP) release. Seven days after surgery ICV ang II (125 ng) in sham-operated (sham) rats increased mean arterial pressure (MAP) (+23 ±3 mmHg) and decreased heart rate (HR) (-58 ± 5 beats/minute). However, ICV ang II had no effect on MAP or HR of rats with a large (preoptic-hypothalamic disconnection) cut. Both the pressor response (+12 ±2 mmHg) and the bradycardia (-39 ±6 beats/minute) were significantly reduced by a small (medial preoptic-hypothalamic disconnection) cut. The increased plasma AVP to ICV ang II in sham rats (9.8 ±3.6 pg/mL) was abolished in large-cut rats and attenuated in small-cut rats (3.2 ±0.7 pg/mL). IV bolus injection of ang II (125 ng) in sham rats increased MAP by 43 mmHg, whereas large-cut rats showed a blunted (25%) pressor response. The pressor response to IV infusion of ang II (8 ng/20 μL/minute for 15 minutes) was diminished in large-cut rats (+4 ±1 mmHg) as compared with that in sham rats (+ 19 ± 2 mmHg).

Both cuts transected the projection between the periventricular tissue surrounding the anteroventral third ventricle and supraoptic nucleus, but the supraoptic-neurohy pophyseal pathway was severed only by the large cut. By examining the location of microknife cuts, the authors conclude that the connectivity of the preoptic region with more caudal sites is necessary for the expression of the central and peripheral pressor activity of ang II, probably involving a key role of supraoptic nucleus and its connections.
Transcutaneous Oxygen Tension and Doppler Ankle Pressure During Upper and Lower Body Exercise in Patients with Peripheral Arterial Occlusive Disease
Authors: Liu Yuefei , Steinacker Jürgen M. , Stauch Martin
Published: July 2008

The effects of upper and lower body exercise on blood supply to the lower extremi ties were investigated in patients with peripheral arterial occlusive disease (PAOD) by measurements of transcutaneous oxygen tension (tcPO2) and Doppler ankle pressure (DAP).

Twenty patients with PAOD (PAOD group) and 10 subjects without PAOD (control group) performed treadmill test (TT), recumbent cycle ergometry (CE), and rowing ergometry (RE) with a fixed seat. The tcPO2 was registered on the calf and DAP was measured at the end of each step of CE and RE.

The walking distance in TT of the control group was not limited (> 1000 m), whereas that of the PAOD group was 161 m in median. In the control group there was no significant difference of performance between CE (125 ±33 W) and RE (111 ±24 W), whereas in the PAOD group, performance was lower in CE (72 ±31 W) than in RE (102 ±28 W) (P <0.01). DAP of controls increased during both CE (136 to 165 mmHg) and RE (170 to 213 mmHg), whereas the DAP of the PAOD group decreased during CE (from 85 to 44 mmHg) and remained relatively constant during RE (113 to 101 mmHg). In controls, tcPO2 did not distinctly change during TT (70 to 66 mmHg) and increased during CE (58 to 73 mmHg) and RE (69 to 82 mmHg), whereas in the PAOD group, tcPO2 decreased during TT (66 to 33 mmHg) and CE (50 to 22 mmHg) and remained almost unchanged in RE (64 to 60 mmHg). A hyperbolic relationship was found between tcPO 2 and DAP.

In conclusion, during upper body exercise, blood supply to the lower extremities in patients with PAOD was not affected, whereas lower body exercise led to exhaustion of the functional reserve of blood supply. Because of a hyperbolic relationship between tcPO 2 and DAP, tcPO2 remained relatively constant if blood supply was sufficient, but in disturbed blood supply a small change of DAP was accompanied by a great change of tcPO2. Therefore, in critical ischemia the change of tcPO2 was more sensitive than that of DAP.
L-Propionylcarnitine Effect on Postexercise and Postischemic Hyperemia in Patients Affected by Peripheral Vascular Disease
Authors: Corsi Carlo , Pollastri Maurizio , Marrapodi Ernesto , Leanza Donatella , Giordano Stefania , D'Iddio Stefania
Published: July 2008

The hemodynamic effect of L-propionylcarnitine (LPC) administered intravenously was evaluated in a double-blind, randomized, three-period crossover study in 12 men (aged sixty to seventy-five years) with Leriche-Fontaine stage II peripheral arterial disease of lower limbs. At baseline, maximum working capacity of each patient was determined by a standardized ergometric test. This test was repeated at 80% of each patient's maximum working capacity before and after intravenous administration of LPC. Each patient received three single doses of 300 mg, 600 mg, and 1200 mg of LPC with a two-day rest period between them.

Hemodynamic variables measured by strain-gauge plethysmography were: peak blood flow, peak flow time, and halftime and total time of hyperemia both after exercise and after induction of ischemia (with an occlusion cuff).

LPC administration significantly shortened the halftime as well as the total time of hyperemia after exercise and after ischemia. With the two highest doses, LPC shortened the peak flow time after exercise. The peak blood flow after exercise and after ischemia increased, but this increase did not reach statistical significance.

The results obtained indicate that LPC improves circulatory reserve of the ischemic limb and has no effect on heart rate and arterial blood pressure. No adverse events were reported.

The effect of LPC on the hyperemic response to stress, mainly on halftime of hyperemia, is possibly due to a drug-induced increase of adenosine triphosphate utiliza tion by the ischemic tissues.
Coronary Artery Disease in Dermatomyositis
Authors: Nagayama Yoichi , Takahashi Mamoru , Shigematsu Michio , Nagai Sonoko
Published: July 2008

A sixty-two-year-old woman with chronic dermatomyositis (DM) receiving steroid monotherapy developed coronary artery stenosis. She had lung fibrosis and complained of dyspnea, but no ischemia was suggested by electrocardiogram. Arteriographic findings and clinical symptoms of coronary artery disease in DM have not been previously reported.
Nonocclusive Ischemic Colitis Following Glycerin Enema in a Patient with Coronary Artery Disease
Authors: Chang Rei-Yeuh , Tsai Cheng-Ho , Chou Y u-San , Wu Tsai-Cheng
Published: July 2008

Acute colonic ischemia is the most common form of intestinal ischemia. Nonocclusive ischemic colitis contributes to some of these disorders. Heart disease, such as congestive heart failure, myocardial infarction, arrhythmias, aortic valve disease, and atheroscle rotic cardiovascular disease, account for many of its risk factors. The majority of cases are associated with severe congestive heart failure with low cardiac output, or disease states resulting in dehydration, or the splanchnic vasoconstrictive effect of some medications. Reactive splanchnic vasoconstriction is responsible for nonocclusive ischemic colitis. Ischemic colitis induced by a cleansing enema has been reported once before. The authors present a case of coronary artery disease complicated by colonic ischemia following glycerin enema in preparation for coronary bypass surgery. Reactive inferior mesenteric artery spasm in response to the enema was noted in this case, rather than diffuse mesen teric artery spasm in response to low cardiac output state and vasoconstrictive drugs.
Noncardiac Pulmonary Edema, Newer Environmental Aspects
Authors: Cordasco E.M. , Burns Donald E. , Beerel Fred , Vance J.W. , Demeter Steven , Cordasco Martha A. , Lubs Peter , Piedad Oscar , Popovici M. , Piech Kenneth , Zenz Carl
Published: July 2008

Accidental spread of potentially toxic gases, fumes, and particulate chemicals has been reported recently in various cities throughout the country and appears to be on the increase throughout the world in the past few years. Moreover, cerebral trauma, septic shock (ARDS), and environmental pulmonary edema from drug intoxication have been commonly encountered. Newer modalities of treatment include earlier fiber optic bron choscopy, constant positive airway pressure mask, administration of surfactant, pentox ifylline, and use of newer experimental agents such as nitrous oxide, antitumor necrosis factor (ATNF), and extracorporeal carbon dioxide with low-frequency positive pressure (ECC02R-LFPPV). The future holds promise for probable reductions in both morbidity and mortality rates of this ubiquitous occupational and environmental health problem, which is of global importance.
Basal Release of Endothelium-Derived Nitric Oxide Plays an Important Role in the Prevention of Afterload Mismatch in Acute Left Ventricular Dysfunction
Authors: Yamamoto Kazuhiro , Masuyama Tohru , Mano Toshiaki , Naito Johji , Kondo Hiroya , Nagano Reiko , Tanouchi Jun , Hori Masatsugu , Kamada Takenobu
Published: July 2008

The basal release of endothelium-derived nitric oxide (EDNO) is considered to play an important role in regulating the vascular tone in normal subjects; however, its role in the presence of acute heart failure is unknown. This study was designed to clarify the role of a basal release of EDNO in the presence of acute heart failure. Acute ischemic left ventric ular (LV) dysfunction was produced in 22 dogs by coronary microembolization. After the embolization, only saline solution was intravenously infused for sixty minutes in 10 dogs. In another 12 dogs, NG-monomethyl-L-arginine (L-NMMA), which is known to inhibit the formation of EDNO in the vascular endothelium, was intravenously infused at a rate of 20 μg/kg/minute for sixty minutes. Infusion of saline solution did not produce any changes in hemodynamic variables. Infusion of L-NMMA caused increases in mean aortic pressure, systemic vascular resistance, and LV end-diastolic pressure without changes in the LV peak + and - dP/dt (time constant) of LV pressure fall, and these changes were associated with a giant "v" wave in the tracing of left atrial pressure and a decrease in cardiac output. The basal release of EDNO may play an important role in the prevention of afterload elevation, subsequent cardiac output reduction, and afterload mismatch in the presence of acute heart failure.
Multiple Cholesterol Emboli Syndrome—Six Cases Identified Through the Spontaneous Reporting System
Authors: Hauben Manfred , Norwich Judith , Shapiro Elizabeth , Reich Lester , Petchel Kasia Šuljaga , Goldsmith David
Published: July 2008

Six cases of suspected multiple cholesterol emboli syndrome were identified by a review of reports contained in the company's records of adverse event reports. Antecedent risk factors in these reports included cardiac catheterization, thrombolytic therapy, translumbar aortography, renal arteriography, subclavian arteriography, abdominal aortography, and heparinization. Unlike the commonly reported subacute presentation, onset occurred during or immediately after catheterization in 5 of the 6 patients reported. Acute renal failure; hypertension; back, leg, and/or abdominal pain; and livedo reticularis were the events most frequently reported. Angiographers should consider multiple choles terol embolization when multiple organ system dysfunction occurs during or immedi ately after intraarterial catheterization.
Cerebral Blood Flow and Metabolism in Hypertensive Patients with Cerebral Infarction
Authors: Nakane Hiroshi , Ibayashi Setsuro , Fujii Kenichiro , Irie Katsumi , Sadoshima Seizo , Fujishima Masatoshi
Published: July 2008

The authors investigated, by positron emission tomography, the effect of long-standing hypertension on cerebral blood flow (CBF) and oxygen metabolism in patients with chronic atherothrombotic brain infarction. In the nonbrain infarct (non-BI) group (n=13, mean age: sixty-two years), the regional CBF (rCBF) was decreased significantly with a rise in the mean arterial blood pressure (MABP) in the cerebral cortexes ( r=-0.575) and the deep gray matter ( r=-0.451), whereas the regional cerebral metabolic rate for oxygen (rCMRO2) remained unchanged. In the brain infarct (BI) group (n=22, mean age: fifty-eight years), however, the rCBF as well as the rCMRO2 were reduced even in the normotensive patients and thus did not correlate with the MABP. These results suggest that long-standing hypertension per se causes a reduction in the rCBF but not in the oxygen metabolism with a compensatory increase in the oxygen extraction fraction. On the other hand, patients with brain infarction, even normotensives, show a diffuse decrease in cerebral circulation and metabolism, which is probably due to the more severe sclerotic changes that take place in the cerebral vessels.
A Comparative Study of Captopril and Enalapril on Endothelial Cell Function in Congestive Heart Failure Patients
Authors: Bridges A.B. , McLaren M. , Belch J.J.F.
Published: July 2008

Angiotensin-converting enzyme (ACE) inhibitors have been shown to reduce the incidence of future coronary artery thromboses in postmyocardial infarction patients. A possible prothrombotic role for the angiotensin system has been postulated, and support for this has been provided by a recent study that demonstrated that an infusion of angiotensin increases levels of the prothrombotic plasminogen activator inhibitor (PAI).

In the current study the authors have investigated the effect of two ACE inhibitors, captopril and enalapril, on tissue plasminogen activator (tPA) and PAI in 33 congestive heart failure (CHF) patients. Blood samples were obtained pretreatment and then at weeks 1, 12, and 24 after initiation of ACE inhibitor therapy for measurement of tPA antigen and PAI activity levels.

The results of the study indicated that the initiation of ACE inhibitors had no signif icant effects on tPA antigen or PAI activity levels at the time points studied, and no signif icant differences were demonstrated between captopril and enalapril. The results suggest, therefore, that ACE inhibitors do not affect tPA antigen or PAI activity in CHF patients, and thus another mechanism is probably responsible for the observed decrease in coronary artery thromboses in post-MI patients treated with ACE inhibitors.
Spontaneous Coronary Artery Dissection in an Elderly Woman with Acute Inferior Myocardial Infarction
Authors: Lee Tsung-Ming , Liau Chiau-Suong
Published: July 2008

Spontaneous coronary artery dissection is a rare cause of acute myocardial infarction. It usually occurs in relatively young patients and is frequently found at autopsy. Because of the low incidence, the treatment of choice for spontaneous coronary artery dissection is still not settled. Here the authors report a sixty-six-year-old woman with coronary lesions judged as spontaneous coronary artery dissection. She presented with chest pain. Under diagnosis of acute inferior myocardial infarction, she was treated with recombinant tissue-type plasminogen activator. Coronary arteriography performed two weeks later revealed a dissection involving a long segment of right coronary artery. The left coronary arteries and uninvolved portion of right coronary artery were smooth and patent. She suffered no hypertension and gave no definite history of trauma. This patient was treated medically with aspirin, isosorbide dinitrate, and metoprolol and remained in stable condition after a follow-up period of six months.
Massive Lower Extremity Arterial Thrombosis and Acute Hepatic Insufficiency in a Young Adult with Premature Atherosclerosis Associated with Hyperlipoprotein(a)emia and Antiphospholipid Syndrome
Authors: Levy Pavel J. , Cooper Christian F. , Gonzalez M. Francisco
Published: July 2008

The authors describe a healthy young male smoker with familial history of recurrent thromboembolism who presented with severe, rapidly progressive lower limb ischemia and abnormal results from liver function tests. An arteriogram of the lower extremities showed bilateral infrainguinal atherosclerotic arterial occlusions. The laboratory findings, in addition to abnormal liver function findings, included moderately elevated antiphos pholipid antibodies and hemostatic abnormalities involving elevated fibrinogen, lipopro tein (a) levels, and deficient fibrinolysis. He underwent bilateral femoral thrombectomy, which was followed by a meticulous anticoagulation, and had gradual improvement of ischemic symptoms and liver functions. This is, to their knowledge, the first reported case in the English literature of premature lower extremity atherosclerosis and antiphos pholipid syndrome associated with elevated lipoprotein (a) levels and documented complex hemostatic abnormalities contributing to systemic thrombosis.
Color Doppler Imaging of Basal Cerebral Arteries: Normal Reference Values and Clinical Applications
Authors: Bartels Eva , Fuchs H.-H. , Flügel K.A.
Published: July 2008

Transcranial color-coded duplex ultrasonography is a new diagnostic procedure allowing the visualization of major intracranial vessels. The purpose of this report is to describe this method and to evaluate its practical potential in the routine examination of basal cerebral arteries. The results from the examination of 96 patients are presented. By means of color coding of Doppler frequencies, the major intracranial vessels were identified by nature of their anatomic location with respect to the echogenic brainstem structures in all subjects. The average maximal systolic velocity was, in the middle cerebral artery, 108 ± 15 cm/s; in the anterior cerebral artery, 96 ±15; in the posterior cerebral artery, 76 ±16 ; and in the basilar artery, 59 ± 17 cm/s. The determination of the angle between the ultrasonic beam and the examined vessel improved the accuracy of flow velocity measure ments in comparison with conventional transcranial Doppler ultrasonography. The exact measurement of blood flow velocity in several segments of the visualized vessel proved helpful in the assessment of pathologic findings, especially in differentiation between a stenosis of the intracranial vessel and a vasospasm.
Electrocardiographic Diagnosis of the Responsible Coronary Artery in Acute Inferior Myocardial Infarction Through Right Chest Leads V3R-V8R
Authors: Prieto-Solis J.A. , Domenech J. , San Jose J.M. , Villalobos M.A. , Jimeno F.
Published: July 2008

In order to identify the electrocardiographic changes that occur in right-chest leads V3R-V 8R for the most significant diagnosis of the responsible coronary artery of acute myocardial infarction, the authors performed a prospective study on 66 patients in whom coronary arteriography was done between the first and twelfth weeks after suffering the infarction. Electrocardiograms were done within the first six hours after the onset of symptoms.

Lesions of the right coronary artery were found in 46 patients—27 at a proximal level and 19 at a distal one—and in 20 patients the circumflex coronary artery was injured.

The electrocardiographic findings were studied in 2 groups of leads: V3R-V4R and V5R-V8R.

An ST elevation equal to or higher than 0.5 mm and the presence of Q waves in V3R-V 4R are specific markers of lesions of the right coronary artery (P < 0.001). Lowering of the ST segment in V3R-V4R is a specific marker of a circumflex artery lesion (P < 0.001).

An ST elevation equal to or higher than 1 mm in V3R-V4R is specific for a proximal lesion of the right coronary artery (P < 0.001). No specific marker for a lesion of the distal right coronary artery was identified, its more significant characteristic being an "isoelectrical" ST segment (between 0 and 0.4 mm), an rS morphology and positive T waves in V3R-V4R.
A Randomized Trial of E5510 versus Aspirin in Patients with Transient Ischemic Attacks
Authors: Maruyama Shoichi , Uchiyama Shinichiro , Tohgi Hideo , Hirai Shunsaku , Ikeda Yasuo , Shinohara Yukito , Matsuda Tamotsu , Fujishima Masatoshi , Kameyama Masakuni
Published: July 2008

In a randomized double-blind trial, the Study Group compared the efficacy of E5510, a novel antiplatelet agent, and aspirin in preventing the recurrence of transient ischemic attacks (TIA). In total, 227 patients who suffered from TIA in the twelve weeks prior to the study were enrolled. They were randomly allocated to three treatment groups, ie, 71 patients in the E5510 4 mg group, 77 patients in the E5510 2 mg group, and 79 patients in the aspirin 324 mg group, and were treated for twelve to twenty-four weeks. The incidence of recurrent TIA or stroke was 21.5% in the aspirin group and was significantly lower in the E5510 groups, being 8.5% in the 4 mg group (P < 0.05) and 11.7% in the 2 mg group (P < 0.05). Adverse events were observed in 5 cases in the 4 mg group, in 8 cases in the 2 mg group, and in 10 cases in the aspirin group, but none of them were serious. Since safety was judged to be comparable among the three groups, E5510 appears to be an antiplatelet agent for the treatment of TIA with a clinical benefit over aspirin.
Increased Lung Uptake During Myocardial Scintigraphy Improves the Detection and Localization of Coronary Artery Disease
Authors: Papadopoulos Constantine L. , Doumas Argyrios S. , Koliakos George , Gitsios Constantine , Sakadamis George
Published: July 2008

Increased lung uptake during exercise thallium 201 scanning denotes severe ventricular hypofunction. To assess whether there is any relationship between this finding and the stenosis of a single coronary artery, the authors studied 140 patients (age 57.5 ±12 years) with both exercise thallium and coronary angiography within three months. A planar view was acquired for two hundred forty seconds immediately postexercise and prior to the single photon emission computed tomography acquisition. Two identical regions of interest outlining the left ventricle and the right lung in the planar view were used for calculation of the lung uptake, expressed as a lung-to-heart counts ratio. The patients were divided into four angiographic groups: (I) lesions at the left anterior descending (LAD), n=35; (II) stenosis at the circumflex (CRX), n=35; (III) stenosis at the right coronary artery (RCA), n=35; and (IV) another group of 35 normal subjects serving as controls. No patient had a previous myocardial infraction (MI) or any cardiac operation. Patients in groups I (0.53 ±0.094) and II (0.44 ±0.072) had higher lung uptake than those in groups III (0.43 ±0.061) or IV (0.42 ± 0.050) . There was no differ ence between groups III and IV, or II and IV, but the difference between I and IV was of statistical significance (P < 0.001). Hence, the authors conclude that reversible defects consisting of ischemia at the LAD territory induce more severe left ventricular dysfunction during peak exercise and this is demonstrated as an increase in the thallium lung uptake, whereas the RCA or CRX single lesions have to have other additional factors (MI or hyper tension) in order to produce the same phenomenon.
Improved Skin Blood Flow and Cutaneous Temperature in the Foot of a Patient with Arteriosclerosis Obliterans by Vasopressin V1 Antagonist (OPC21268)
Authors: Toba Kenji , Ouchi Yasuyoshi , Akishita Masahiro , Kozaki Koichi , Ishikawa Michiro , Nagano Koichiro , Etoh Masato , Hashimoto Masayoshi , Jing Liang  , Ueda Namiki , Orimo Hajime
Published: July 2008

A seventy-four-year-old woman with arteriosclerosis obliterans, diabetes mellitus, and hypertension was admitted for the treatment of intermittent claudication and coldness and pain in the right lower extremity. After the administration of a vasopressin V1 antag onist, OPC21268, the symptoms were markedly improved. Furthermore, blood flow in the dorsalis pedis artery and the cutaneous temperature in the right foot increased in response to acute and chronic administration of OPC21268. OPC21268 may be a new useful therapeutic tool for the treatment of arteriosclerosis obliterans.
F. P. Weber Syrldrome Associated with a Brachial Artery Aneurysm
Authors: Bartels Claus , Claeys Luc , Ktenidis Kiriakos , Horsch Svante
Published: July 2008

Klippel-Trenaunay syndrome is characterized by the triad of unilateral port-wine heman giomas, varicose veins, and hypertrophy of bone and soft tissue affecting one or more limbs. The rare F. P. Weber syndrome describes the mentioned entity and additional arteriovenous malformations.

The association of an arterial aneurysm with the F. P. Weber syndrome has never been described in the current literature. A case of a brachial artery aneurysm in a patient with F. P. Weber syndrome is presented and the etiology of arterial aneurysm combined with congenital vascular abnormalities is discussed.
Transcutaneous PCO2 Level as an Index of Tissue Resistance to Ischemia
Authors: Andreozzi Giuseppe Maria , Riggio Francesco , Butto Giuseppe , Barresi Mario , Leone Alfredo , Pennisi Giuseppe , Martini Romeo , Signorelli Salvatore S.
Published: July 2008

The authors performed a retrospective study on a data base of 525 patients with periph eral arterial disease, to analyze the pathophysiologic meaning of resting transcutaneous pressure of carbon dioxide (PCO2) and of CO2 production during three minutes of local ischemia. The resting and postischemic PCO2 and its maximum increase related to rest (PCO2 production) were measured with Kontron 7640 equipment.

The results show a significant increase of PCO2 production in the Fontaine stage 2A (183 patients, 4.61 mmHg, P < 0.0001), in stage 2B (194 patients, 5.22 mmHg, P < 0.0001), in the third stage (83 patients, 6.10 mmHg, P < 0.0001), and in the fourth stage (53 patients, 8.66 mmHg, P < 0.0001). Only the patients at the first stage showed an insignificant increase, perhaps because of the small number (12) in this group.

The authors feel that the measurement of tcPCO2 production during local ischemic stress can be a very important parameter for evaluating peripheral arterial disease as an expression of metabolic tissue performance and, overall, of the tissue resistance to ischemia.
Hydrogen Sulfide Poisoning: Management and Complications
Authors: Gregorakos L. , Dimopoulos G. , Liberi S. , Antipas G.
Published: July 2008

Hydrogen sulfide poisoning is a rare but devastating injury. Four of 8 cases of toxic inhalation of hydrogen sulfide are presented with special attention to the life-threatening complications. Four patients died at the scene of the accident and the remaining 4 had been hospitalized in the Intensive Care Unit (ICU). One patient died in the hospital from cardiogenic pulmonary edema and circulatory failure (pulmonary wedge pressure > 30 mmHg) and 3 patients left the hospital in good health although they presented serious complications. One of them left the hospital with a temporary pacemaker, and 1 of the 2 others died after two months owing to myocardial infarction. The authors discuss in detail the clinical features of this condition and emphasize the need for urgent and appro priate therapy as well as the need for safe environmental conditions.
Cor Triatriatum: Report of an Unusual Variant—Triatrial Heart
Authors: Öztürk Omer Y. , Cicek Sertac , Demirkilic Ufuk , Kuralay Erkan , Tatar Harun , Dündar Narbay R.
Published: July 2008

Cor triatriatum is a rare cardiac malformation presenting with symptoms and signs of pulmonary venous obstruction. Although diagnosis of this defect has been facilitated by diagnostic procedures such as echocardiography and angiocardiography, it could be missed preoperatively. The authors report a case of cor triatriatum that is unique in having two separate atrial septal defects in each side of the fibromuscular membrane and that was undiagnosed preoperatively with transthoracic echocardiography and cardiac catheterization.
Synergistic Inhibitory Effect of Angiotensin-Converting Enzyme Inhibitor and Heparin on Intimal Hyperplasia After Rat Aorta Injury
Authors: Sang Park Jang , Seung Nam Kim  , Jong Man Won  , Yong Bok Koh  , In Chul Kim
Published: July 2008

The respective efficacies of angiotensin-converting enzyme (ACE) inhibitor and standard heparin were investigated with respect to their inhibitory effects on intimal hyperplasia after balloon denudation of rat aorta. Local angiotensin II effects in the artery wall may participate in regulation of the vascular response to arterial injury, apparently independent of the plasma renin and angiotensin system. ACE inhibitors have been shown to block intimal hyperplasia after arterial injury in rats. Increasing evidence points toward an inhibitory effect of heparin on intimal hyperplasia independent of anticoagulation.

Balloon catheter aortic denudation was performed in 25 rats pharmacologically treated from six days or one day before to fourteen days after surgery and split into four groups: group A (control group), normal feeding; group B (ramipril group), ramipril 10 mg/kg/day orally; group C (heparin group), heparin 1200 IU/kg/day subcutaneously; group D (combined group), both ramipril and heparin. Animals were killed and aortas were perfused and fixed at physiologic pressure fourteen days after denudation. Cross-sectional intima-to-media area ratios (I-M ratio) were calculated by an image analyzer system. (continued on next page)

Morphometric analysis of cross sections showed marked intimal thickening in the control group with a mean I-M ratio of 95.1 ±2.76%. In contrast, the I-M ratios in the ramipril group were significantly reduced by 37.3 ±2.06% (P = 0.0001) and in the heparin group by 29.7 ± 1.58%. The I-M ratio of animals treated with both ramipril and heparin was 16.6 ±1.3% (P=0.0001) (Figs. 1-7). Blood pressure in the ramipril group decreased from 111.7 ±5.16 mmHg and 91.7 ±2.58 mmHg (P = 0.0001) and in the combined group from 111.7 ± 6.06 mmHg to 92.5 ± 5.24 mmHg and 85.0 ±3.16 mmHg (P=0.0001) after seven days and fourteen days, respectively, whereas heparin had no effect on blood pressure (114.2 ±8.61 mmHg to 111.7 ±6.06 mmHg and 111.7 ±4.08 mmHg) (Fig. 8).

Both the ACE inhibitor ramipril and heparin significantly reduced intimal hyperplasia. More significant reduction of intimal hyperplasia was obtained when these two drugs were given together. These data have led the authors to conclude that ACE inhibitors and heparin together inhibit intimal thickening after injury, and an apparently synergistic effect of these two drugs may be obtained. These results may be useful for clinical application to prevent the proliferation that occur after endarterectomy or bypass surgery.
Intimal Medial Thickening of Common Carotid Artery as Indicator of Coronary Artery Disease
Authors: Visonà Adriana , Pesavento Raffaele , Lusiani Luigi , Bonanome Andrea , Cernetti Carlo , Rossi Maurizio , Maiolino Pietro , Pagnan Antonio
Published: July 2008

The authors investigated the relation between coronary atherosclerosis, angiographically detected, and intimal-medial (I-M) thickening of the common carotid artery (CCA), as measured by high-resolution B-mode ultrasound system. They studied 31 patients with coronary artery disease (CAD) and 23 healthy control subjects. I-M thickening of CCAs and atheromatous plaques at the carotid bifurcation were evaluated. A score system was defined (range 0-20) based on the absence or presence of atherosclerotic lesions at common and internal carotid arteries. A coronary angiography score was defined based on the presence of atherosclerotic lesions at nine coronary arterial segments (range 0-36) .

The thickness of CCAs (M ±SD) in CAD patients was significantly higher (1.45 ±0.95 mm) than in controls (0.87 ±0.10 mm, P < 0.005), and an I-M thickening of 1.1 mm or more was specific and positively predictive of CAD. A significant positive correlation between coronary and carotid score was observed (P < 0.028, r=0.373).

The study suggests that I-M thickening could be helpful for the identification of patients at risk for CAD.
Stroke-A Rare Presentation of Eales' Disease A Case Report
Authors: Misra U.K. , Jha S. , Kalita J. , Sharma K.
Published: July 2008

Eales' disease is common in India and the Middle East, but its neurologic manifestations are rare. The authors report a young man with recurrent vitreous hemorrhage and acute amnestic confusional state who subsequently developed myelopathy. Eales' disease should be considered in the differential diagnosis of stroke in a young patient.
Percutaneous Transluminal Coronary Angioplasty of Anomalous Coronary Arteries Case Reports
Authors: Oral Dervis , Dagalp Zehra , Pamir Gülgün , Alpman Ahmet , Ömürlü Kenan , Erol Çetin , Kervancloglu Celal , Hüseyin Telli H.
Published: July 2008

To date, technical experience reported in the literature is very limited on angioplasty in patients with anomalous coronary arteries. Balloon angioplasty may be a more favorable approach for revascularization in these vessels. A major factor is selection of the guiding catheter. The authors report 4 patients with severe atherosclerotic lesions of anomalous coronary arteries who underwent coronary angioplasty of the anomalous vessel. Three patients had an anomalous circumflex artery and 1 had an anomalous right coronary artery. Angiographic and clinical success were achieved in 3 patients.
Hyperventilation Test in Syndrome X
Authors: Alexopoulos Dimitrios , Olympios Christoforos , Christodoulou John , Fakiolas Constantinos , Foussas Stefanos , Cokkinos Dennis V.
Published: July 2008

The hyperventilation (HV) test has been extensively used in different forms of coronary artery disease. The purpose of this work was to investigate the response to HV in patients with syndrome X and compare HV with exercise (EX) test. The authors studied 20 patients with syndrome X (angina, a positive EX test, and normal coronary angiogram) and 20 healthy subjects who underwent HV and EX tests. In 7 patients, all women, angina and electrocardiographic (ECG) changes occurred during HV but in none of the controls. Patients with syndrome X and controls had a similar rate-pressure product (RPP) at rest and achieved a similar RPP with HV. The RPP achieved with HV in patients with syndrome X without ECG changes was significantly lower, 121.8 ±29.1 (mean ±SD), than what was achieved by those with changes, 167.9 ±42.9, P < 0.01. In patients with an abnormal response to HV the RPP at which angina and ECG changes occurred was similar to that where similar changes were observed during EX. There was a significant correlation of the RPPs between the two tests, r=0.82, P < 0.02. In contrast, in patients in whom no angina or ECG changes occurred, the RPP they achieved with HV was significantly lower than the anginal threshold during EX 204 ±47.4, P < 0.0001. In conclusion, a significant proportion of patients with syndrome X, mainly women, who achieve a high RPP with HV, develop angina and ECG changes during overbreathing. The close relation between EX and HV RPPs where these changes occur suggests an increased myocardial oxygen demand as the most likely underlying mechanism for this behavior.
Evaluation of Aortic Distensibility in Patients with Coronary Artery Disease by Use of Cine Magnetic Resonance
Authors: Matsumoto Yuji , Honda Toshio , Hamada Mareomi , Matsuoka Hiroshi , Hiwada Kunio
Published: July 2008

To evaluate the aortic wall sclerosis in patients with coronary artery disease (CAD), the authors measured the aortic distensibility (AD) at the ascending and descending aorta by using cine magnetic resonance (MR).

Cine MR was performed in 15 patients with CAD and 15 normal controls (NCs). Patients with CAD had angiographically significant coronary arterial stenosis and almost normal left ventricular function. Age and sex were matched in the patients with CAD and the NCs. Ascending and descending aortic areas of transverse image were measured in the maximum and minimum frames. AD was calculated from the following formula: (max area - min area) / (min area x pulse pressure).

Although systolic and diastolic blood pressures showed no significant differences between patients with CAD and NC, AD was significantly lower in patients with CAD than in the NCs in each transverse section (P < 0.05).

In conclusion, it is indicated that aortic wall sclerosis is advanced in patients with CAD.