bluuebunny/crossref_metadata_2025 huggingface dataset:
Coronary Artery Disease Obscuring Giant Cell Myocarditis
Authors: Kwok On-Hing , Chau Elaine M. C. , Wang Elaine P. , Chow Wing-Hing
Published: July 2008

A case in which the diagnosis of idiopathic giant cell myocarditis was obscured by the presence of severe coronary artery disease is described. A 47-year-old man presented with recurrent inferior myocardial infarction and complete heart block. Cardiac catheterization confirmed severe 2-vessel disease and left ventricular dysfunction. Incessant ventricular arrhythmia rapidly ensued, which did not respond to anti-arrhythmic therapy and overdrive pacing despite complete surgical revascularization. He eventually died. Autopsy revealed giant cell myocarditis superimposed on coronary artery disease. Acute myocarditis masquerading as myocardial infarction has been well known, but virtually all reported cases had normal coronary arteries. This case illustrated the fact that even in the presence of obvious coronary artery disease the remote possibility of myocarditis should not be entirely disregarded. Although giant cell myocarditis is a rare and frequently fatal disorder, recent studies suggest that combined immunosuppressive therapy may improve the prognosis.
Coronary-Pulmonary Artery Fistula Associated with Right Heart Failure: Successful Closure of Fistula with a Graft Stent
Authors: Atmaca Yusuf , Altin Timuçin , Özdöl Çağdaş , Pamir Gülgün , Çağlar Nail , Oral Derviş
Published: July 2008

Coronary artery fistula constitutes a rare congenital anomaly. The reported incidence of this anomaly ranges from 0.1% to 0.2% of the population undergoing coronary angiography. Coronary-pulmonary artery fistula is an extremely rare congenital anomaly of the coronary artery. Its real incidence is unknown. The authors report a case of coronary-pulmonary artery fistula that caused right heart failure in a 77-year-old woman. The fistula, arising from a proximal portion of the circumflex artery to the pulmonary artery, was sealed successfully using a Jostent (polytetrafluoroethylene-covered graft stent).
Pharmacotherapy for Peripheral Arterial Disease: Emerging Therapeutic Options
Authors: Jaff Michael R.
Published: July 2008

Although endovascular therapy has revolutionized the management of patients with peripheral arterial disease (PAD), noninterventional regimens, such as structured exercise therapy, ath erosclerotic risk factor modification, and pharmacotherapy, are effective in patients suffering from mild-to-moderate PAD and intermittent claudication (IC). For more than a decade, the only pharmacologic therapy for IC available in the United States was pentoxifylline, which had demonstrated superiority in improving walking distances but offered minimal clinical benefit. Recently, basic research into the pathophysiology of IC has led to the development of cilostazol, a new pharmacologic agent approved for treatment of this condition in 1999. Ongoing research in the use of angiogenic growth factors has further broadened the range of potential alternatives to treatment in patients with PAD. Revascularization procedures, including nonsurgical and surgical techniques, can thus be reserved to improve patency and reduce the risk of limb loss in patients with PAD and IC with more severe impairment.
Superficial Thrombophlebitis and Low-Molecular-Weight Heparins
Authors: Kalodiki Evi , Nicolaides Andrew N.
Published: July 2008

The current status of superficial thrombophlebitis, including incidence, diagnosis, and manage ment, are reviewed. Treatment options are assessed in the light of data from the main studies reported in the literature. These include compression, ambulation, and nonsteroidal antiin flammatory agents and surgical management with high saphenous ligation (with or without saphenous vein stripping) with or without anticoagulants, ranging from aspirin, unfractionated heparin, warfarin, and low-molecular-weight heparin (LMWH). The advantage of the surgical approach is that by ligation with or without stripping of the superficial veins the underlying pathesis (i.e., varicose veins) is also eradicated. In the presence of deep venous thrombosis (DVT), surgery could be combined with anticoagulants. The extensive current literature for DVT treatment shows that the LMWHs are at least as effective and safe as the unfractionated heparins. On this basis, one could reasonably recommend LMWH for the treatment of superfi cial thrombophlebitis with involvement of the deep veins. Pentasaccharide, a drug that has been recently explored for the prophylaxis and treatment of DVT could be another option. However, there are as yet no data for recommended dosages or duration of treatment for the latter two options.
Determinants of Progression of Coronary Artery Calcifications in Asymptomatic Men at High Cardiovascular Risk
Authors: Chironi Gilles , Simon Alain , Denarié Nicolas , Védie Benoit , Séné Valérie , Mégnien Jean-louis , Levenson Jaime
Published: July 2008

Extended coronary artery calcifications (CAC) are predictive for cardiovascular complications but little is known about factors likely to influence CAC deposit. An analysis was undertaken to assess the cardiovascular risk factors that are capable of predicting CAC change over time. A retrospective analysis of CAC change was carried out in 55 asymptomatic men who underwent sequential electron beam computed tomographic measurement of CAC score a mean of 3.3 years apart. To ensure maximal accuracy in CAC change analysis, patients were included who had an initial CAC score of 10 or greater and with difference between both scores of 20% or greater of the initial score. The annual change rate in CAC score was calculated by dividing the change in CAC score by the interval between scores. Subjects' risk factors were analyzed and included body mass index, blood pressure, blood lipids and glucose, plasma lipoprotein(a) and fibrinogen, smoking status, and family history of coronary heart disease. The annual change rate in CAC score correlated positively with lipoprotein(a) (r = 0.42, p < 0.01 ) and with initial CAC score (r = 0.46, p < 0.001) and these associations persisted in multivariate analysis (p = 0.01, p = 0.001 respectively, R2 = 0.31). In contrast, no association existed between annual CAC change and baseline values and follow-up changes of other risk factors. The asso ciation of lipoprotein(a) with CAC progression in symptom-free patients with preexisting coronary calcifications provides new insights into the progression of coronary artery disease and may be useful for planning therapy and follow-up.
Comparison of Two Different Methods for the Evaluation of Left Ventricular Ejection Fraction in Patients with Coronary Artery Disease
Authors: Pontillo Daniele , Patruno Nicolino , Capezzuto Aldo , Serra Francesco , Sassara Massimo , Scabbia Enrico Vittorio
Published: July 2008

The evaluation of left ventricular ejection fraction (LVEF) may be troublesome in difficult clinical settings in patients with coronary artery disease (CAD). The aim of this study was to compare 2 simple geometrical and nongeometrical methods of LVEF evaluation that could overcome the typical technical limitations of ultrasound examination. The authors studied 26 patients with proven CAD (63 ± 10 years) who underwent left ventricular (LV) catheterization and coronary angiography during the hospital stay. A complete 2D-Doppler echocardiography was performed and LVEF was evaluated with the formula by Wyatt (W-LVEF), which relates the left ventricle to a biplane ellipsoidal figure, and by the myocardial performance index (MPI) formula (MPI-LVEF), MPI being an index of systodiastolic function. Mean MPI-LVEF was 41 ±8% and was significantly lower with respect to contrast angiography (52 ± 14%, p = 0.0003) and to W-LVEF (49 ± 13%, p = 0.0009). There was no statistically significant correlation between MPI-LVEF and geometric (either angiographic or ultrasound) LVEF. Bland-Altman analysis showed lack of agreement between MPI-LVEF and any other method evaluated in the study. MPI-LVEF may not be reliable and accurate for the evaluation of systolic function in patients with CAD. Nonetheless, the evaluation of global LV function by means of MPI may represent a valuable and affordable alternative to expensive and time-consuming methods, especially in the presence of difficult technical settings.
Cardiac Papillary Fibroelastoma Originating from Pulmonary Vein
Authors: Gowda Ramesh M. , Khan Ijaz A. , Mehta Nirav J. , Gowda Mamatha R. , Gropen Toby I. , Dogan Ozgen M. , Vasavada Balendu C. , Sacchi Terrence J.
Published: July 2008

Cardiac papillary fibroelastoma is a primary cardiac neoplasm that typically affects the cardiac valves, mainly the aortic and mitral valves, and very rarely the endocardium of cardiac chambers. Cardiac papillary fibroelastoma is rarely diagnosed during life, as the majority are incidental findings at autopsy, but with the advent of echocardiography, it is being increasingly recognized. Although the tumor is usually small and histologically benign, it may have a malignant propensity for life-threatening complications, such as a cerebrovascular accident, myocardial ischemia or infarction, or sudden death. The patient reported here presented with an embolic stroke from a thrombus on the surface of a left atrial papillary fibroelastoma. The papillary fibroelastoma was originating from the lower portion of the left inferior pulmonary vein and was protruding into the left atrial cavity. Papillary fibroelastoma originating from the pulmonary veins has not been reported before. The tumor was successfully removed by intra operative transesophageal echocardiography-guided cardiac surgery. Grossly, the surface of the tumor was smooth and translucent. The gelatinous membrane on the surface tore easily, and soft papillary tumor with multiple fronds was visible. Histology confirmed the mass was a papillary fibroelastoma. Postoperative recovery was uneventful. Follow-up transthoracic echocardiogram revealed no residual or recurrence of tumor. The patient was in excellent health at 2-year follow-up. The case is described and the clinical characteristics of cardiac papillary fibroelastoma are reviewed.
The LONFLIT4-Concorde - Sigvaris Traveno Stockings in Long Flights (EcoTraS) Study
Authors: Cesarone Maria Rosaria , Belcaro Gianni , Nicolaides Andrew N. , Geroulakos George , Lennox Andrew , Myers Kenneth A. , Moia Marco , Ricci Andrea , Brandolini Rosella , Ramaswami G. , Bavera Peter , Dugall Mark , Ippolito Edmondo , Winford Michelle
Published: July 2008

The LONFLIT1/2 studies have established that in high-risk subjects after long (> 10 hours) flights the incidence of deep venous thrombosis (DVT) may be between 4% and 6%. The LONFLIT4 study was aimed at evaluating the control of edema and DVT prevention in low- medium-risk subjects. In this study prophylaxis of edema with specific travel stockings was evaluated in 2 separate studies involving flights lasting 7 hours and 10-12 hours. Part I. Sub jects at low-medium risk for DVT were contacted; 55 subjects were excluded for several nonmedical, travel-related problems or inconvenient evaluation time; the remaining 211 were randomized into 2 groups to evaluate prophylaxis with elastic stockings in 7-8-hour, long- haul flights. The control group had no prophylaxis; the treatment group used below-knee, Sigvaris Traveno elastic stockings (Ganzoni, Switzerland, producing 12-18 mm Hg of pressure at the ankle). Color duplex scanning was used to evaluate the possible presence of DVT; edema/swelling were evaluated with a composite score including the presence of edema (with an edema tester), variations in ankle circumference and leg volumetry, subjective swelling, and discomfort (scale ranging from 0 to 10). Results: Of the 103 included subjects in the stockings group and 108 in the control group (total 211), 195 subjects completed the study. Dropouts (16) were due to low compliance or traveling and connection problems. Age, sex distribution, and risk factors distributions were comparable in the 2 groups. Stockings Group: Of 97 subjects none had DVT or superficial thromboses. Control Group: Of 98 subjects none had thrombosis. The level of edema at inclusion was comparable in the 2 groups of subjects. After flights there was an average score of 6.4 (1.3) in the control group, while in the stockings group the score was on average 2.4 (SD 1), 2.6 times lower than in the control group (p < 0.05). In the control group 83% of the subjects had an evident increase in ankle circumference and volume that was visible at inspection and associated with discomfort. The control of edema with stockings was clear, considering both parametric data (circumference and volume) and
The Assessment of Deep Vein Thromboses for Therapeutic Trials
Authors: Leizorovicz Alain , Kassai Behrouz , Becker François , Cucherat Michel
Published: July 2008

In the current paper, we provide recommendations for the assessment of deep vein throm boses for the purpose of therapeutic trials evaluating antithrombotic drugs in the prevention of deep venous thrombosis. We have reviewed recently published articles on diagnostic and therapeutic studies, and we have evaluated methods of assessments. Ascending venography has been considered as the reference test for the confirmation of DVT. A roentgenographic image is subsequently available for review and allows classification by blinded, objective observers. However, venography poses substantial clinical and methodological limitations, particularly in the setting of systematic screening for all patients enrolled in a randomized clinical trial. Compression ultrasonography may replace venography for systematic screening of DVT in clinical trials, provided that specific methodological details are specified in the protocol and are fulfilled to ensure high and comparable sensitivity and specificity from all participating centers. This non-invasive technique has virtually no contraindications, and therefore more patients can be enrolled and evaluated. Furthermore, the compression ultra sonograph can be videotaped for central reading. Compression ultrasonography has already been adopted as the principal method for evaluating DVT in several ongoing large scale preven tion trials with the approval of major drug agencies.
The Epsilon 2 and 4 Alleles of Apolipoprotein E and Ischemic Vascular Events in the Greek Population — Implications for the Interpretation of Similar Studies
Authors: Kolovou Genovefa D. , Daskalova Deliana Ch. , Hatzivassiliou Marilena , Yiannakouris Nikos , Pilatis Nektarios D. , Elisaf Moses , Mikhailidis Dimitri P. , Cariolou Marios A. , Cokkinos Dennis V.
Published: July 2008

The authors investigated whether apolipoprotein (apo) E polymorphism has an allelic and/or genotypic impact on the risk of an ischemic vascular event (IVE) in Greek patients with cardio vascular diseases (CVD). They compared apo E polymorphisms in 1) a group of 165 patients with IVE [IVE(+)], of whom 107 had survived a myocardial infarction and 58 an ischemic stroke; 2) a group of 165 patients, matched with the first group for age and gender, with angio graphically confirmed coronary artery disease but without IVE [IVE(-)]; 3) a group of 240 healthy younger individuals with no family history of CVD. The apo ε2 allele was 5.2-fold less frequent in the IVE(+) group compared to the IVE(-) group (1.2% vs 6.2%, p= 0.001). The frequency of the ε2 allele in healthy subjects was 8.1 %, which is 6.7-fold higher than in the IVE(+) group (p < 0.001), and more than twice as high compared to all CVD patients (p = 0.001). No significant differences in ε4 allele frequencies were observed between IVE(+) and IVE(-) patients (9.8% vs 8.4%) or between patients with CVD and healthy subjects (9.1% vs 10.2%). The ε4 allele was not associated with an increased risk for CVD or IVE. In contrast, an inverse and beneficial association of the ε2 allele with IVE was observed among Greek patients with CVD. These results suggest that the ε4 and ε2 alleles have a variable significance in terms of predicting the risk of vascular events in different populations. Therefore, it is important to carry out "local" studies.
Apolipoprotein E Polymorphism and Atherosclerosis
Authors: Kolovou Genovefa , Daskalova Deliana , Mikhailidis Dimitri P.
Published: July 2008

The relationship between apolipoprotein (apo) E and vascular disease has been the subject of a considerable amount of research. However, this relationship is far from clearly defined. This deficiency appears to be due to a multitude of factors. Among these are differences in ethnicity, age (and possibly gender), diagnostic criteria, and environmental factors (eg, diet and smoking) that have contributed to the contradictory findings. Several diseases and their treatment may also influence this relationship. There are also documented interactions between apo E genotypes and other genes or vascular risk factors. One possible clinically relevant application of identifying the apo E genotype could be to assess the response to a particular drug treatment. It may also be that apo E polymorphism will become a good predictor of vascular death (eg, from myocardial infarction or stroke) rather than an indicator of the risk of developing vascular disease but without an acute ischemic event. More research is required to define the place of apo E genotyping in the management of vascular disease in its various forms. Whatever the future brings, the evaluation of apo E genotypes will need to be rapid, cheap, and technically undemanding before this investigation becomes widely available and clinically relevant.
Apoptosis and Histopathologic Changes in Diffuse Coronary Atherosclerosis
Authors: Zorc Marjeta , Zorc-Pleskovič Ruda , Vraspir-Porenta Olga , Legan Mateja , Petrovič Daniel
Published: July 2008

The aims of the study were to investigate the histopathologic characteristics of atherosclerotic lesions and to evaluate the role of apoptosis or programmed cell death in diffuse coronary atherosclerosis. The study included 59 patients who underwent coronary artery bypass grafting coupled with coronary endarterectomy because of diffuse coronary atherosclerosis. Histopathologic analysis of endarterectomy sequesters showed atheroma with confluent extracellular lipid core—type IV lesions in 13 cases (22%); atheroma with lipid core and a cap of fibromuscular layers—type V lesions in 9 cases (15.3%); predominantly calcified fibrous tissue—type VII lesions in 13 cases (22%); and predominantly fibrous tissue—type VIII lesions in 24 cases (40.7%). TUNEL-positive cells were observed in 4 endarterectomy sequesters (6.8%) of subjects with diffuse coronary atherosclerosis. TUNEL-positive cells were demon strated in the area of mononuclear infiltrates as well as in the vessel wall. The percentage of TUNEL-positive cells in mononuclear infiltrates was 0.5%. Intense mononuclear infiltrates in tunica intima were found in 50% of sequesters, and they consisted of macrophages (40%), T-lymphocytes (17%), and B-lymphocytes (14%). In the area of infiltrates the proportion of MIB-1-positive cells was 2.7%, which was higher than in the intima outside the area of infil trates (0.5%). In conclusion, apoptosis, which is confined to mononuclear infiltrates, is most likely involved in the development of diffuse coronary atherosclerosis; however, the percentage of apoptotic cells was low (0.5%). A higher proportion of apoptotic cells in the area of infiltrates compared to the rest of the intima was associated with a higher proportion of MIB-1-positive cells. Atherosclerotic lesions in diffuse coronary atherosclerosis were advanced, with a predom inance of type VII to VIII lesions.
Minimally Invasive Mitral Valve Surgery: From Port Access to Fully Robotic-Assisted Surgery
Authors: Donias Harry W. , Karamanoukian Hratch L. , D'Ancona Giuseppe , Hoover Eddie L.
Published: July 2008

Currently, there is a growing interest in minimally invasive cardiac surgery, and despite early criticisms, it has become the preferred method of mitral valve repair and replacement in many institutions worldwide with excellent results. The interest in performing cardiac valve opera tions through minimal incisions was stimulated by Port Access technology and has evolved to include robotically assisted video-enhanced valve surgery. Robotic assistance has led to shorter operating times and represents an ideal tool to prepare for fully robotic-assisted cardiac procedures. This report will highlight minimally invasive mitral valve surgery with its evolution from Port Access techniques to fully robotic-assisted surgery. The nuances, strengths, and shortcomings, as well as the potential to enhance the valvular procedure, the promise to reduce hospital stay, earlier return to normal activity, less pain, better cosmesis, and the rethinking of surgical dogma that wide surgical exposure is essential for such complex intracardiac surgery are discussed.
Acute Myocardial Infarction in a 16-Year-Old Male
Authors: RuDusky Basil M. , Lohin David L.
Published: July 2008

Acute myocardial infarction in the teenage years of life is a rare phenomenon. It is more rare in patients who have no risk factors or comorbid conditions and normal coronary arteries. Evaluation requires extensive investigation into the various risk factors that may be involved as well as the performance of invasive and noninvasive cardiovascular studies. A case of acute myocardial infarction in a teenage boy without familial, inherent, or extraneous risk factors is presented.
Unusual Electrocardiographic Presentation of an Isolated Right Ventricular Myocardial Infarction Secondary to Thrombotic Occlusion of a Non-dominant Right Coronary Artery
Authors: Carroll R. , Sharma N. , Butt A. , Hussain K.M.A.
Published: July 2008

Isolated right ventricular infarction is an extremely rare phenomenon. Its electrocardiographic (ECG) features may be misinterpreted or even missed if not suspected. A case of an isolated right ventricular myocardial infarction is presented, recognized by ST-segment elevation in a single precordial lead, such as V1, aided thereafter by right precordial ECG changes. Immediate coronary angiography revealed proximal occlusion of a small non-dominant right coronary artery. Coronary intervention as well as infusion of intravenous normal saline solution and pressor agent for hypotension provided symptomatic relief, and subsequent recovery from this potentially life-threatening, but rare condition. Routine 12-lead ECG done approximately 12 hours after the admission showed extension of ST segment elevation from V1 trough V3 without any ST-segment elevation in inferior leads. This case demonstrates that there might be a very unusual ECG appearance in the setting of an isolated right ventricular myocardial infarction and can be missed if not immediately suspected. Isolated right ventricular myocar dial infarction may be difficult to recognize, requiring both a high index of clinical suspicion for its presence, as well as careful evaluation of unusual ECG features of the disease entity.
A Family with Abdominal Aortic Aneurysms
Authors: Karlsson Lars , Gnarpe Judy , Olsson Gunnar , Gnarpe Hakan
Published: July 2008

This investigation focused on 7 siblings to 2 brothers with abdominal aortic aneurysm (AAA), with respect to AAA, Chlamydia pneumoniae (CP) serology, serum cholesterol, and smoking habits. Five male and 4 female siblings were included. All siblings underwent ultrasonography, and surgical specimens from the aorta were prepared for immunohistochemical (IHC) analysis. Blood was obtained from all living siblings and serum cholesterol level was analyzed. Serologic analysis was done by microimmunofluorescence (MIF). Smoking habits were recorded. In addition to the 2 known siblings with AAA, 2 other brothers with AAA were found. Four of 8 siblings had IgG 1/512 or greater and 7 of 8 had IgA 1/64 or greater. Two of 3 were positive for CP in IHC obtained from aortic specimens. Two of 8 had hypercholesterolemia; 7 of 9 were smokers. C. pneumoniae as well as smoking seems to be important in the pathogenesis of AAA in this small cohort; however, larger patient cohorts are needed.
Identifying Risk Factors in a Mostly Overweight Patient Population with Coronary Artery Disease
Authors: Yologlu Saim , Sezgin Alpay Turan , Ozdemir Ramazan , Sezgin Nurzen , Colak Cemil , Topal Ergül , Barutcu Irfan
Published: July 2008

Overweight/obesity is a complex multifactorial chronic disorder, and the American Heart Association (AHA) has recently classified as a modifiable risk factor for coronary heart disease (CAD). This study (1) evaluates the association between CAD in a patient population mostly overweight (MOP) and conventional and novel coronary risk factors by using univariate and multivariate logistic regression analysis and (2) seeks to find the best model by comparing univariate and multivariate logistic regression analysis algorithms, which were systematically applied to risk factors by using Hosmer-Lemeshow statistic test. In univariate analysis, there were significant associations between CAD in MOP and conventional and novel risk factors. However, the model's sensitivity, specificity, and accuracy levels were weak. In multivariate analysis, although some risk factors were not found as predictors of coronary artery disease, the model showed good fit to data and had high sensitivity, specificity, and accuracy levels. This was also confirmed by using the Hosmer-Lemeshow goodness of fit test, more specifically.
Amiodarone-Induced Torsade de Pointes During Bladder Irrigation: An Unusual Presentation
Authors: Voigt Louis , Coromilas James , Saul Barry I. , Kassotis John
Published: July 2008

The authors present a case of early (within 4 days) development of torsade de pointes (TdP) associated with oral amiodarone therapy. Consistent with other reports this case of TdP occurred in the context of multiple exacerbating factors including hypokalemia and digoxin excess. Transient prolongation of the QT during bladder irrigation prompted the episode of TdP. It is well known that bradycardia exacerbates acquired TdP. The authors speculate that the increased vagal tone during bladder irrigation, a vagal maneuver, in the context of amiodarone therapy resulted in amiodarone-induced proarrhythmia. In the absence of amiodarone therapy, a second bladder irrigation did not induce TdP despite hypokalemia and hypomagnesemia.
Unilateral Necrobiosis Lipoidica of the Ischemic Limb
Authors: Naschitz Jochanan E. , Fields Madeline , Isseroff Hillel , Wolffson Vladimir , Yeshurun Daniel
Published: July 2008

A 63-year-old diabetic woman presented with new-onset intermittent claudication of the right calf accompanied by ipsilateral necrobiosis lipoidica (NL). The latter presented the typical appearance of oval, indurated plaques, with brownish-red margins and central atrophy, scattered over the right thigh and calf. Arteriography demonstrated severe obstructive lesions on the right femoral artery. NL and claudication spared the left leg. A possible ischemic pathogenesis of NL emerges from this observation and is supported by recent studies in the literature.
Isolated Noncompaction Cardiomyopathy Presenting with Paroxysmal Supraventricular Tachycardia
Authors: Khan Ijaz A. , Biddle William P. , Najeed Syed A. , Abdul-Aziz Syed , Mehta Nirav J. , Salaria Vikrant , Murcek Annette L. , Harris David M.
Published: July 2008

Isolated noncompaction cardiomyopathy is an exceedingly rare congenital cardiomyopathy. A case of isolated noncompaction cardiomyopathy is reported and the literature on the subject collected through a comprehensive literature search is reviewed. Fewer than 100 cases of this condition have been reported. Isolated noncompaction cardiomyopathy is caused by a defect in cardiac morphogenesis resulting in an arrest of compaction of loose interwoven meshwork of myocardial fibers during intrauterine life, which results in severe systolic dysfunction as well as undue hypertrophy of the involved walls of the ventricles. Although the most frequent sites involved are left ventricular apex and inferior wall, involvement of other left ventricular walls and right ventricle has also been reported. Etiology of the isolated noncompaction of myocardium is not clear. Familial cases have been reported and the mode of inheritance is heterogeneous. In X-linked form of the disease, a locus has been found on Xq28, and mutations have been reported in G4.5 gene. The age of onset of symptoms ranges from infancy to the geriatric age. Patients with isolated noncompaction cardiomyopathy have a high incidence of heart failure, arrhythmias, and thromboembolism. The most common presentation is conges tive heart failure. Arrhythmias include atrial arrhythmias, ventricular tachycardia, and sudden cardiac death. The patient reported in this article presented with paroxysmal supraventric ular tachycardia. Echocardiography is the procedure of choice to establish diagnosis. Due to the lack of associated cardiac anomalies, antenatal detection is difficult. The treatment is that for congestive heart failure, arrhythmias, and thromboembolism. The end-stage congestive heart failure is managed with heart transplantation and potential life-threatening ventricular tachy arrhythmias with an implantable cardioverter defibrillator. Prognosis is poor and the common causes of death are intractable heart failure and sudden cardiac death.
Penetrating Atherosclerotic Ulcer of the Ascending Aorta: A Delayed Complication of Coronary Artery Bypass Surgery
Authors: Jain Deepak , Gehl Hans B. , Katus Hugo A. , Richardt Gert
Published: July 2008

A 71-year-old woman, undergoing coronary angiography during preoperative evaluation for a major noncardiac surgery, was fortuitously detected as having penetrating atherosclerotic ulcer of the ascending aorta 5 years after coronary artery bypass surgery. While acute aortic dissections have been described after coronary bypass grafting, penetrating atherosclerotic ulcer of the ascending aorta as a delayed complication of bypass surgery has never been reported. The patient was treated conservatively and closely observed. A brief review of liter ature is also presented.
The Importance of von Willebrand Factor Level and Heart Rate Changes in Acute Coronary Syndromes: A Comparison with Chronic Ischemic Conditions
Authors: Heper Gülümser , Bayraktaroglu Mehmet
Published: July 2008

The pathogenesis of acute coronary syndrome (ACS) and transient myocardial ischemia (TMI) is not completely understood. Therefore, the authors studied the biological indicators of throm bogenesis and sympathetic activity. The study was conducted on 50 patients with acute coronary syndrome and 30 patients with stable angina pectoris. Treatment was standardized with low-molecular-weight heparin and 300 mg aspirin/day but with no IIb/IIIa inhibitors, an oral β-blocker, diltiazem 60 mg tid, glyceryl trinitrate IV in patients with ACS but with monon itrates orally and low-molecular-weight heparin in patients with stable angina. Twenty-four- hour continuous ECG monitoring and ST segment analysis were performed on day 2 of admission and heart rate analysis was performed 10, 5, and 1 minute before and during the myocardial ischemia periods. Blood sampling for von Willebrand factor (vWf) determination was performed through a peripheral vein at 8 AM, noon, 6 PM and 10 PM and half an hour after the description of angina. The patients with ACS were grouped as transient myocardial ischemia positive (n = 20) and negative (n = 30). The patients with stable angina were desig nated as the control group (n = 30). The detected vWf levels at 4 different daytime periods in patients with ACS were significantly higher than those in patients with stable angina. At the 6 PM to 10 PM period, the vWf level increase was significantly higher in patients with TMI than in the patients without TMI. At the 8 AM to noon period, the detected vWf levels decreased significantly in both TMI groups. During the nocturnal ischemia periods, the increase in vWf levels immediately after angina was significantly more apparent than the detected changes during daytime ischemia. Analysis showed that heart rates before the ischemia during stable angina episodes were significantly higher than those in TMI (-) (silent) angina. The heart rate difference between 10 minutes before and during the ischemia in the angina group was signif icantly different from that during TMI (-) (silent) ischemia. The heart rates at the times related to ischemia in the nocturnal period were significantly lower than those in the daytime period. The heart rate differences between the ischemia-related times and during the ischemia were significantly higher in daytime ischemic attacks than in nocturnal ischemic attacks. The study confirms that the vWf level, which is an indicator of thrombogenesis, was significantly increased in patients with ACS. Nocturnal ischemia is associated with thrombogenesis. Daytime ischemia is associated with increased sympathetic activity, and symptomatic ischemia is usually associated with increased sympathetic activity.
A Review of the Concept of Circulatory Bioassist Focused on the "New" Demand Dynamic Cardiomyoplasty: The Renewal of Dynamic Cardiomyoplasty?
Authors: Rigatelli Gianluca , Carraro Ugo , Barbiero Mario , Riccardi Roberto , Cobelli Franco , Gemelli Marzio , Rigatelli Giorgio
Published: July 2008

After the initial enthusiasm, the dynamic cardiomyoplasty lost its reputation owing to the poor long-term results, caused by the muscular degeneration subsequent to chronic continuous electrical stimulation of the latissimus dorsi. An activity-rest stimulation protocol that avoids full transformation of the skeletal muscle, maintaining muscular properties over time, has been successfully tried. This "demand" stimulation protocol showed in humans good results improving NYHA class, ejection fraction value, and survival. The discussion about the capa bility of this and a unique kind of cardiocirculatory bioassist is due to be reopened. In fact, heart transplant, percutaneous circulatory-supporting device, multisites stimulation therapy, and total artificial heart have some drawbacks, one of which is the economic cost. In developing countries the more economic demand dynamic cardiomyoplasty may still play a role.
Foam-Sclerotherapy, Surgery, Sclerotherapy, and Combined Treatment for Varicose Veins: A 10-Year, Prospective, Randomized, Controlled, Trial (VEDICO Trial)
Authors: Belcaro G. , Cesarone M.R. , di Renzo A. , Brandolini R. , Coen L. , Acerbi G. , Marelli C. , Errichi B.M. , Malouf M. , Myers K. , Christopoulos D. , Nicolaides A. , Geroulakos G. , Vasdekis S. , Simeone E. , Ricci A. , Ruffini I. , Stuard S. , Ippolito E. , Bavera P. , Georgiev M. , Corsi M. , Scoccianti M. , Cornelli U. , Caizzi N. , Dugall M. , Christopoulos D. , Veller M. , Venniker R. , Cazaubon M. , Griffin M.
Published: July 2008

The study compared, by a prospective, randomized method, 6 treatment options: A: Sclero therapy ; B: High-dose sclerotherapy; C: Multiple ligations; D: Stab avulsion; E: Foam-sclero therapy ; F: Surgery (ligation) followed by sclerotherapy. Results were analyzed 10 years after inclusion and initial treatment. Endpoints of the study were variations in ambulatory venous pressure (AVP), refilling time (RT), presence of duplex-reflux, and number of recurrent or new incompetent venous sites. The number of patients, limbs, and treated venous segments were comparable in the 6 treatment groups, also comparable for age and sex distribution. The occur rence of new varicose veins at 5 years varied from 34% for group F (surgery + sclero) and ligation (C) to 44% for the foam + sclero group (E) and 48% for group A (dose 1 sclero). At 10 years the occurrence of new veins varied from 37% in F to 56% in A. At inclusion AVP was comparable in the different groups. At 10 years the decrease in AVP and the increase in RT (indicating decrease in reflux), was generally comparable in the different groups. Also at 10 years the number of new points of major incompetence was comparable in all treatment groups. These results indicate that, when correctly performed, all treatments may be similarly effective. "Standard," low-dose sclerotherapy appears to be less effective than high-dose sclero and foam-sclerotherapy which may obtain, in selected subjects, results comparable to surgery.
Improvement of Microcirculation and Healing of Venous Hypertension and Ulcers with Crystacide. Evaluation of Free Radicals, Laser Doppler Flux and PO2. A Prospective- Randomized-Controlled Study
Authors: Belcaro G. , Cesarone M.R. , Nicolaides A.N. , Geroulakos G. , Di Renzo A. , Milani M. , Ricci A. , Brandolini R. , Dugall M. , Ruffini I. , Cornelli U. , Griffin M.
Published: July 2008

In 20 patients with chronic venous insufficiency and venous hypertension associated with ulcerations, the effects of a new compound, applied onto the skin (Crystacide) were assessed in a randomized, controlled study. Duplex scanning was used to assess the presence of venous obstruction and incompetence, and microcirculatory methods were used to assess and quantify venous microangiopathy and to follow up subjects after local treatment with Crystacide. Laser Doppler flowmetry (LDF) was used to assess skin perfusion in association with transcutaneous (tc) partial pressure of oxygen (PO2) measurements. Local plasma free radicals (PFR) were evaluated in the area surrounding the venous ulcer, with the D-Rom test. Crystacide was applied around and on the ulcer for 10 days. Crystacide was more effective than the control treatment: PO2 was increased, PFR and LDF were decreased (flux increase is associated with venous hypertension), and the ulcer area was significantly smaller at 10 days in the Crystacide group in comparison with the placebo group (p < 0.05). In conclusion, in venous ulcerations, local treatment with Crystacide (10 days) improves the microcirculation and decreases skin free radicals improving healing.
Prevalence and Risk Factors of Peripheral Arterial Obstructive Disease in Taiwanese Type 2 Diabetic Patients
Authors: Tseng Chin-Hsiao
Published: July 2008

The aim of this study was to evaluate the prevalence and risk factors of peripheral arterial obstructive disease (PAD) in Taiwanese type 2 diabetic patients. A total of 610 patients (268 men and 342 women), aged 63.3 ± 10.8 years, were recruited from a diabetic clinic in a teaching hospital. PAD was diagnosed by an ankle-brachial index (ABI) < 0.9 on either leg. Risk factors studied were age, sex, body mass index (BMI), smoking, diabetes duration, hypertension, insulin therapy, systolic blood pressure (SBP), diastolic blood pressure (DBP), fasting plasma glucose (FPG), serum total cholesterol (TC), and triglyceride (TG). Overall prevalence of PAD was 10.0% without significant sexual difference. Univariate analyses disclosed age, BMI (inverse associa tion), diabetes duration, hypertension, insulin therapy, and SBP as significant risk factors. In stepwise logistic regression, age, SBP, BMI, and insulin therapy were independent risk factors with respective odds ratios (95% confidence intervals, CI) of 1.09 (1.05-1.13), 1.02 (1.01-1.04), 0.88 (0.80-0.96), and 3.37 (1.83-6.19). In conclusion, prevalence of PAD in Taiwanese type 2 diabetic patients was 10.0% and the major risk factors were older age, lower BMI, higher SBP, and insulin therapy. The inverse association between PAD and BMI is contradictory to the general impression that obesity is a risk factor for PAD.
Myocardial Contusion Culminating in a Ruptured Pseudoaneurysm of the Left Ventricle
Authors: RuDusky Basil M.
Published: July 2008

Blunt chest trauma continues to be one of the most common injuries at all ages. Trauma in general is the leading cause of death in the young to middle-aged segment of our population. Blunt chest injury is said to occur in more than one third of all motor vehicle accidents. Myocardial contusion is the most frequent cardiac injury resulting from blunt chest trauma. Autopsy studies indicate that cardiac trauma was directly associated with death in approxi mately 10% of cases suffering blunt chest injury. Aneurysm formation as a sequela of blunt cardiac trauma is a rare entity and pseudoaneurysm formation is considerably more rare. A case of myocardial contusion resulting in myocardial necrosis, rupture of the ventricle, and pseudoaneurysm formation with subsequent rupture and sudden death is presented.
Adenosine-Sensitive Wide-Complex Tachycardia: An Uncommon Variant of Idiopathic Fascicular Ventricular Tachycardia
Authors: Kassotis John , Slesinger Todd , Festic Emir , Voigt Louis , Reddy C.V.R.
Published: July 2008

Most wide-complex tachycardias encountered in the emergency department (ED) are ventric ular in origin, most commonly associated with structural heart disease. Ventricular tach yarrhythmias range in severity from life-threatening rhythms (eg, ventricular fibrillation and hemodynamically compromising ventricular tachycardia [VT]) to idiopathic forms of VT, which have a benign clinical course and a more favorable prognosis. The authors present the case of a 34-year-old woman who presented to the ED, with a wide-complex tachycardia with a right- bundle-branch block (RBBB) morphology and a right inferior axis, which was terminated with adenosine. The patient was previously misdiagnosed as suffering from a paroxysmal supraven tricular tachycardia (SVT), which was unresponsive to beta-blocker therapy. Although the tachycardia responded to adenosine, suggestive of an SVT, the patient was referred to the arrhythmia service, where further work-up revealed an uncommon form of an idiopathic VT, originating from the left anterior fascicle. The authors discuss the unique electrocardiographic and electrophysiologic properties and useful diagnostic maneuvers required to properly identify this form of VT.
Risk of Myocardial Infarction in Relation to Plasma Levels of Homocysteine and Inflammation-Sensitive Proteins: A Long-Term Nested Case-Control Study
Authors: Lind Peter , Hedblad Bo , Hultberg Björn , Stavenow Lars , Janzon Lars , Lindgärde Folke
Published: July 2008

Several studies have found that the homocysteine plasma level is associated with cardiovas cular disease. The authors previously described a relationship between concentrations of fibrinogen and other inflammation-sensitive plasma proteins, namely, α1-antitrypsin, cerulo plasmin, haptoglobin, and orosomucoid (α 1-acid glucoprotein) and the incidence of myocardial infarction (MI). Whether levels of these proteins are related to homocysteine has not been clarified. The aim of this study was to investigate whether a supposed relationship between homocysteine in plasma and the occurrence of MI is modified by these inflammation-sensitive proteins. A nested case-control study was designed, comprising 241 cases of MI, with a mean age of 48 years at baseline, and 241 controls matched for age, month of examination, and duration of follow-up. The mean homocysteine concentration did not differ between cases and controls and there was no association between the baseline homocysteine level and the time lapse before the occurrence of the MI. For the cases, there was no correlation between homo cysteine and any of the measured proteins, but for the controls, homocysteine was weakly but significantly negatively correlated to haptoglobin and ceruloplasmin and slightly positively correlated to albumin. For the separated groups of cases and controls there was no associa tion between the number of inflammation-sensitive proteins in the top quartiles and homo cysteine concentration. In this population-based, prospective cohort study the occurrence of MI had no relationship to homocysteine baseline plasma level. Furthermore, there was no strong association between homocysteine and the concentrations of any of these inflamma tion-sensitive proteins.
Evaluation of the Local Effects of Vitamin E ( E-Mousse®) on Free Radicals in Diabetic Microangiopathy: A Randomized, Controlled Trial
Authors: Ruffini I. , Belcaro G. , Cesarone M.R. , Geroulakos G. , Di Renzo A. , Milani M. , Coen L. , Ricci A. , Brandolini R. , Dugall M. , Pomante P. , Cornelli U. , Acerbi G. , Corsi M. , Griffin M. , Ippolito E. , Bavera P.
Published: July 2008

The aims of the study were to evaluate the short-term effects of a new thermosensitive, vitamin E (V-E) mousse on local free radicals (FR) and skin flux in diabetic microangiopathy. A group of 40 patients with diabetic microangiopathy was included. The variation in measure ments of skin FR was evaluated by the D-Rom test. Subjects were between 45 and 65 years with type II diabetes and good metabolic control. E-mousse®, a thermoactive preparation of acetate vitamin E (20%), was applied twice daily on the whole surface of the leg (below knee) and foot for 3 weeks. The contralateral leg was untreated acting as control. Subjects with age between 45 and 65 years with type II diabetes (diagnosed at least 5 years before) and good metabolic control (blood sugar < 180 mg/dL) were included after informed consent. Patients with uncontrolled diabetes, peripheral vascular disease, and severe lower limbs infec tions were excluded. Local free radicals (FR) and laser Doppler flux including the venoarteriolar response (VAR) were evaluated. The tolerability was evaluated by a semiquantitative score. Of the 40 included patients 34 completed the study. The 2 groups were comparable. At 3 weeks there was no decrease in FR in controls; the decrease in the treatment group was 45.3% (p < 0.05). Also in the treatment group RF decreased (p < 0.05) and the VARveno improved from an average of 21% to an average of 38% (p < 0.05). No significant variations were observed in the control group. The variation in symptomatic score was from a total value of 8 to 5 in the control group and from 8 to 1 in the treatment group (p < 0.02). Their tolerability was good. In conclusion local treatment with E-mousse for 3 weeks in diabetic microangiopathy improves skin microcirculation and the metabolic condition as shown by the decrease in FR.
Coronary Stenting After Rotational Atherectomy in Diffuse Lesions of the Small Coronary Artery: Comparison with Balloon Angioplasty Before Stenting
Authors: Kwon Kihwan , Choi Donghoon , Choi Seung-Hyuck , Bon Kwon Koo  , Jang Yangsoo , Shim Won-Heum , Cho Seung-Yun
Published: July 2008

The purpose of this randomized trial was to evaluate the role of debulking and balloon predi lation on acute and long-term results of stent implantation in diffuse stenosis of small vessels. Patients with symptomatic diffuse stenosis of the native left anterior descending coronary artery between 2 and 2.9 mm in size were randomly assigned to rotational atherec tomy (group I, n = 21 ) or balloon dilation (group II, n = 20) before stenting. The primary end point of the study was the incidence of angiographic restenosis at follow-up; adverse clinical events, such as death, myocardial infarction, stroke, or target vessel revascularization, were assessed as secondary end points. Acute gain was significantly greater in group I than in group II (p = 0.038), but net gain at follow-up was similar in both groups (p = 0.24). There was no significant difference in angiographic restenosis rate (33.3% vs 31.3%, p = 0.80), target vessel revascularization (23.8% vs 15%, p=0.21) or 1-year event-free survival rate (72.8% vs 84.6%, p = 0.28). In conclusion, rotational atherectomy before stenting showed no additional benefit over balloon dilation with stenting in the management of diffuse lesions in small coronary vessels.