bluuebunny/crossref_metadata_2025 huggingface dataset:
Advanced Glycation End Products and Antioxidant Status in Type 2 Diabetic Patients With and Without Peripheral Artery Disease
Authors: Lapolla Annunziata , Piarulli Francesco , Sartore Giovanni , Ceriello Antonio , Ragazzi Eugenio , Reitano Rachele , Baccarin Lorenzo , Laverda Barbara , Fedele Domenico
Published: February 2007

OBJECTIVE—Advanced glycation end products (AGEs), pentosidine and malondialdehyde (MDA), are elevated in type 2 diabetic subjects with coronary and carotid angiopathy. We investigated the relationship of AGEs, MDA, total reactive antioxidant potentials (TRAPs), and vitamin E in type 2 diabetic patients with and without peripheral artery disease (PAD).

RESEARCH DESIGN AND METHODS—AGEs, pentosidine, MDA, TRAP, vitamin E, and ankle-brachial index (ABI) were measured in 99 consecutive type 2 diabetic subjects and 20 control subjects.

RESULTS—AGEs, pentosidine, and MDA were higher and vitamin E and TRAP were lower in patients with PAD (ABI <0.9) than in patients without PAD (ABI >0.9) (P < 0.001). After multiple regression analysis, a correlation between AGEs and pentosidine, as independent variables, and ABI, as the dependent variable, was found in both patients with and without PAD (r = 0.9198, P < 0.001 and r = 0.5764, P < 0.001, respectively) but not in control subjects. When individual regression coefficients were evaluated, only that due to pentosidine was confirmed as significant. For patients with PAD, considering TRAP, vitamin E, and MDA as independent variables and ABI as the dependent variable produced an overall significant regression (r = 0.6913, P < 0.001). The regression coefficients for TRAP and vitamin E were not significant, indicating that the model is best explained by a single linear regression between MDA and ABI. These findings were also confirmed by principal component analysis.

CONCLUSIONS—Results show that pentosidine and MDA are strongly associated with PAD in type 2 diabetic patients.
Association Between Serum Concentrations of Persistent Organic Pollutants and Insulin Resistance Among Nondiabetic Adults
Authors: Lee Duk-Hee , Lee In-Kyu , Jin Soo-Hee , Steffes Michael , Jacobs David R.
Published: February 2007

OBJECTIVE—We reported strong relations between serum concentrations of persistent organic pollutants (POPs), especially organochlorine (OC) pesticides or nondioxin-like polychlorinated biphenyls (PCBs), and prevalence of diabetes in a U.S population with background exposure to POPs. Here, we investigated POPs and insulin resistance, a frequent pathogenic precursor of type 2 diabetes.

RESEARCH DESIGN AND METHODS—Serum POPs and homeostasis model assessment of insulin resistance (HOMA-IR) were investigated cross-sectionally in 749 nondiabetic participants aged ≥20 years. Nineteen POPs in five subclasses were selected, detectable in ≥60% of participants.

RESULTS—Among subclasses, OC pesticides were most strongly associated with HOMA-IR. Adjusted geometric means of HOMA were 3.27, 3.36, 3.48, and 3.85 (P for trend <0.01) across quartiles of OC pesticides. The relationship strengthened with increasing HOMA-IR percentile: adjusted odds ratios comparing the highest versus lowest POPs quartile were 1.8 for being ≥50th percentile of HOMA-IR, 4.4 for being ≥75th percentile, and 7.5 for being ≥90th percentile. Associations with elevated HOMA-IR appeared to be specific to oxychlordane and trans-nonachlor but also were found for two nondioxin-like PCBs. No HOMA-IR associations were seen in the other three POP subclasses. The association between OC pesticides and HOMA-IR tended to strengthen as waist circumference increased, with no apparent association in the lowest quartile of OC pesticide concentrations.

CONCLUSIONS—These findings, coupled with those concerning diabetes prevalence, suggest that OC pesticides and nondioxin-like PCBs may be associated with type 2 diabetes risk by increasing insulin resistance, and POPs may interact with obesity to increase the risk of type 2 diabetes.
Integrating Depression Care With Diabetes Care in Real-World Settings:Lessons From the Robert Wood Johnson Foundation Diabetes Initiative
Authors: Anderson Daren , Horton Claire , O'Toole Mary L. , Brownson Carol A. , Fazzone Patricia , Fisher Edwin B.
Published: February 2007

Depression is a common comorbidity in diabetic patients and poses challenges for health care providers, patients, and health care systems. This article describes the implementation of unique models of care geared toward treating patients with both illnesses in a coordinated manner in primary care and community settings serving disadvantaged and ethnic minority populations.

Nine community sites used the PHQ-9, a short version of the Patient Health Questionnaire, as a screening tool for depression in all diabetic patients enrolled in the Robert Wood Johnson Foundation Diabetes Initiative. The interventions and protocols developed independently at each Diabetes Initiative site are described. The authors then report aggregate screening data across the nine sites, describe models of treatment developed by the projects, and highlight key emergent themes.

The proportion of diabetic patients in this population with moderate to severe depression ranged from 30 to 70%. The interventions and treatment protocols that emerged included enhancements of primary care, integrated mental health services, group therapy, and approaches emphasizing cultural traditions and mind-body focus.

Patients with diabetes from underserved and ethnic minority populations have high rates of comorbid depression, and this may affect their ability to self-manage diabetes. Addressing depression is an essential part of diabetes care and can be accomplished in a coordinated manner in real-world settings.
The Perils of Inpatient Hyperglycemia Management: How We Turned Apathy Into Action
Authors: Lubitz Carrie C. , Seley Jane Jeffrie , Rivera Cristina , Sinha Naina , Brillon David J.
Published: February 2007

As the number of Americans with prediabetes and diabetes continues to grow,so too will the number of patients who come into the hospital with hyperglycemia. Although tight glycemic control has been a well-established goal in the outpatient setting, it has only recently gained heightened interest in the inpatient arena. There is a growing body of knowledge supporting the benefits of strict glycemic control in hospitalized patients,yet there is little or no formal didactic training for health care professionals in inpatient management of patients with diabetes. Despite widespread inpatient hypoglycemic and hyperglycemic events, there are few systems in place for effective diabetes care and management.

In January 2006, the American Association of Clinical Endocrinologists, the American College of Endocrinology, and the American Diabetes Association convened a meeting titled “Improving Inpatient Diabetes Care: A Call to Action Consensus Development Conference,” which concluded that facilitating these changes required a paradigm shift that involves modifying both individual and institutional beliefs and practices that have been status quo for decades. One of the key consensus recommendations was the formation of an interdisciplinary steering committee to identify deficits, develop strategies, and facilitate the implementation of interventions to improve inpatient care. This article illustrates the planning and implementation of a systems-wide model to conquer inpatient hyperglycemia in an academic medical center.
Development and Implementation of Advanced Training Course for Diabetes Educators in Argentina
Authors: Gagliardino Juan José , Malbrán María del Carmen , Clark Charles
Published: February 2007

Purpose. Preliminary report on the development and evaluation of a university-based master's degree program in diabetes education in Latin America.

Methods. The program, based on reported international standards, was developed through the Department of Postgraduate Studies of the National University of La Plata, Argentina, with funds provided by the American Association of Diabetes Educators. This highly interactive program combines pedagogical, psychological, and communication-based education specifically related to diabetes. Consequently, its graduates will be prepared to communicate effectively with their patients about their self-care needs and work with them to overcome the day-to-day barriers that prevent them from integrating self-care effectively into their lives.

Results. The program was successfully implemented, and 20 students have completed their 1st year, including preparation of a formal master's thesis proposal. During the next year, they will establish and evaluate diabetes education programs in their own communities as part of their master's thesis requirement.

Conclusions. We have successfully implemented a master's degree program in diabetes education, based on reported international standards, that provides diabetes knowledge and educational/behavioral principles. Graduates will be able to help ensure patient participation in the control and treatment of their diabetes.
Food Practices and Preferences in Youth With Diabetes
Authors: Christensen Nedra K. , King Elaine Boswell , Hardy Sherrie , Pfister Roxane
Published: February 2007

Objectives. To determine where children with type 1 diabetes eat and with whom, how foods are prepared, their favorite foods, and food issues or conflicts regarding both portioning foods and types of food eaten and to examine the multiple factors that influence food intake in this population.

Methods. Parent-child pairs (n = 299) completed a questionnaire that focused on where and with whom children eat and how their food is prepared. χ2 tests and ANOVA were calculated to determine differences between child and parent responses.

Results. As reported by parents, children (78%) eat meals at home with the family 4–6 or more meals per week; 21% eat at home alone 4–6 or more meals per week; 27% eat at fastfood restaurants 2–3 or more meals per week, and 72% eat school lunch 2–3 or more times per week(58% almost every day). Confusion regarding portion skills was reported by 13%, 52% measure by “eye balling” only (estimating portions sizes), and 47% would like more information on portioning. Among parents, 37%reported disagreements with children over choices of food, and 28% reported disagreements over food portion sizes; 5% did not care about food portioning at all. Cooking from scratch was reported by 71% to occur ≥ 4 times per week (out of 21 meals per week), and 65% reported cooking prepackaged meals at least 2–3 times per week.

Conclusions. Suggestions for eating at fast-food restaurants and schools; food-portioning skills for home, school, restaurants, and homes of friends; cooking from scratch and from prepackaged foods; incorporating favorite foods; and reading labels on prepackaged foods should be addressed for effective educational sessions.
Development of thin‐walled halogen‐free cable insulation and halogen‐free fire‐resistant low‐smoke cable‐sheathing compounds based on polyolefin elastomer and ethylene vinyl acetate blends
Authors: Naskar K. , Mohanty S. , Nando G. B.
Published: February 2007

There is a growing interest in the use of polyolefins and their copolymer blends in cable industries. The present investigation deals with the development of thin‐walled halogen‐free cable insulation and thin‐walled halogen‐free fire‐resistant low‐smoke cable sheathing compounds based on polyolefin elastomer (Engage®) and ethylene vinyl acetate (EVA) blends. Blends of Engage (an ethylene octene copolymer) and EVA, varying in proportions, are prepared on a two‐roll mixing mill at an elevated temperature. Physicomechanical, electrical, and the most important flame‐retardant properties of the dicumyl peroxide/triallyl cyanurate cured blends have been basically studied. Properly compounded Engage‐EVA blends are found to be excellent materials in cable industry for insulation as well as for sheathing compounds. © 2007 Wiley Periodicals, Inc. J Appl Polym Sci 2007
Synthesis, mobility study and antimicrobial evaluation of novel self‐spreading ionic silicone oligomers
Authors: Pant Ramesh R. , Rasley Brian T. , Buckley Joseph P. , Lloyd Christopher T. , Cozzens Robert F. , Santangelo Patrick G. , Wynne James H.
Published: February 2007

Polydimethylsiloxanes (PDMS) have been extensively utilized for their ability to spread and lubricate surfaces. This ability can be mostly attributed to their low surface energy and extremely flexible backbone. This study examines their unique ability through a comparative analysis of the rates of spread of numerous commercially available oils and lubricants, including a series of methyl‐terminated PDMS. The analysis facilitated the design and synthesis of two homologous series of PDMS, in which the terminal ends were functionalized as quaternary ammonium salts. The two new series of compounds were examined for their ability to spread both as neat liquids and as formulated blends. Additionally, these hybrid ionic oligomers were screened for biological activity against Staphylococcus aureus. All of the new oligomers exhibited antimicrobial properties in preliminary testing. © 2007 Wiley Periodicals, Inc. J Appl Polym Sci 2007
Hybrid model for the diffusion of simple and complex penetrants in polymers
Authors: Dimos V. , Kanellopoulos N.
Published: February 2007

A hybrid model, which combines the characteristic features of the Pace–Datyner molecular model with those of the Kulkarni–Stern free‐volume model, was developed to assess the effect of temperature, penetrant concentration, and polymer crystallinity on penetrant diffusivity. The predictive capabilities of the proposed model were tested by a direct comparison with experimental data. The diffusivity of ethylene and propylene vapors in semicrystalline polyethylene and isotactic polypropylene was experimentally measured using a magnetic suspension microbalance. Sorption kinetic measurements were carried out at temperatures up to 80°C and pressures up to 80 atm. The diffusivity was found to increase with temperature and penetrant concentration. Apparently, there was a very good agreement between the theoretical values predicted by the new hybrid diffusion model and the experimentally determined diffusivities. © 2007 Wiley Periodicals, Inc. J Appl Polym Sci 2007
2‐oxo‐tetrahydrofuran‐3‐yl 9H‐carbazole‐9‐carbodithioate mediated reversible addition‐fragmentation chain transfer (RAFT) polymerization
Authors: Zhou Di , Zhu Xiulin , Zhu Jian , Hu Lihua , Cheng Zhenping
Published: February 2007

The 2‐oxo‐tetrahydrofuran‐3‐yl 9H‐carbazole‐9‐carbodithioate (OTCC) mediated reversible addition‐fragmentation chain transfer (RAFT) polymerizations of styrene and methyl acrylate were investigated. The results showed that OTCC was an effective RAFT agent for the polymerizations of styrene and methyl acrylate. The polymerizations exhibited “living”/controlled characters. The resulting carbazole and 2‐oxo‐tetrahydrofuran‐3‐yl groups end‐labeled polymer exhibited stronger fluorescence in N, N‐dimethyl formamide, compared with those of OTCC under the same conditions. © 2007 Wiley Periodicals, Inc. J Appl Polym Sci 2007
A splice site mutation confirms the role of LPIN2 in Majeed syndrome
Authors: Al‐Mosawi Zakiya S. , Al‐Saad Khulood K. , Ijadi‐Maghsoodi Roya , El‐Shanti Hatem I. , Ferguson Polly J.
Published: February 2007

Majeed syndrome is an autoinflammatory disorder consisting of chronic recurrent multifocal osteomyelitis, congenital dyserythropoietic anemia, and neutrophilic dermatosis. To date, 2 unrelated families with Majeed syndrome have been reported. Mutations in LPIN2 have been found in both families. Here we report a third consanguineous family with Majeed syndrome with a novel mutation. The patient, a 3‐year‐old Arabic girl, had hepatosplenomegaly and anemia as a neonate. At age 15 months, she developed recurrent episodes of fever and multifocal osteomyelitis. In addition, bone marrow aspiration demonstrated significant dyserythropoiesis, suggesting Majeed syndrome. Coding sequences and splice sites of LPIN2 were sequenced in the patient and her mother. A homozygous single‐basepair change was detected in the donor splice site of exon 17 (c.2327+1G>C) in the patient; her mother was heterozygous at this site. These data confirm the role of LPIN2 mutations in the etiology of Majeed syndrome.
Calcified cyst of the pericardium
Authors: Wright A Dickson
Published: February 2007

Calcified cysts of the pericardium are of sufficient rarity to warrant presentation of the following case.
A retroperitoneal enterogenous cyst
Authors: Horn Louis J
Published: February 2007

Enterogenous cysts, though not extremely rare, are sufficiently so to be worth recording. The following case showed some unusual features as regards form and position of the cyst.
A carcinoid tumour of the lower ileum
Authors: Wood W Quarry
Published: February 2007

Carcinoid tumours of the gastro-intestinal tract have excited a great deal of interest among pathologists during the past twenty years, an interest which is perhaps out of proportion to their clinical importance. They are rare tumours, but in their origin, structure, and method of spread they present peculiarities which are responsible for the amount of attention they have attracted. They are most common in the appendix, but have been recorded as occurring in all parts of the abdominal alimentary canal. The cases recorded in the small intestine up to the latter part of 1934 numbered 152; since then a few additional cases have appeared in the literature. The comparative rarity of the tumour and the fact that it is now being recognized that a rather characteristic group of symptoms are frequently associated with the condition may justify the publication of another case.
On chronic inflammatory ‘tumours’ of the gastro-intestinal tract
Authors: Ralphs F G
Published: February 2007

Two cases are recorded of chronic inflammatory ‘tumour’ of the colon.
Precocious puberty in a boy of one year
Authors: Fraser Ian
Published: February 2007

Judging by the small number of published cases, precocious puberty is a rare condition. As the disease is an interesting one, it is probable that most of the cases have been recorded. It seems to be found three or four times more frequently in girls than in boys; Kepler (Mayo Clinic) was able to collect from the literature only 37 cases in children, and of these 12 were in boys. Broster, in what is probably the most exhaustive survey of the subject, mentions only one case in a boy, so perhaps I may be excused if I give the details of what was to me a very interesting case of virilism—pubertas præcox, or precocious puberty—in a baby of twelve months.
Prospective randomized trial comparing postoperative pain and return to physical activity after transabdominal preperitoneal, total preperitoneal or Shouldice technique for inguinal hernia repair
Authors: Schrenk P , Woisetschläger R , Rieger R , Wayand W
Published: February 2007

In a prospective randomized study postoperative pain, analgesic consumption, return to physical activity and work, cosmetic result and experience with the type of operation were assessed in 86 patients undergoing inguinal hernia repair by means of either the Shouldice technique (n = 34), the laparoscopic transabdominal preperitoneal (TAPP) (n = 28) or total preperitoneal (TPP) (n = 24) repair. Patients having TAPP repair had decreased visual analogue scale scores for pain on the day of operation compared with those undergoing TPP and Shouldice repair (4·8 versus 6·5 and 6·2 respectively, P = 0·02) and on the first postoperative day compared with TPP (4·0 versus 6·0, P = 0·01). There was no difference between the three groups for days 2, 3, 4, 5 and 30 after operation. Patient satisfaction with the operation, analgesic consumption, return to physical activity such as walking, driving, climbing stairs, running, bicycling and sexual intercourse, as well as return to work, was comparable in the three groups. There was a better cosmetic result after TAPP and TPP repair. This study failed to demonstrate significant benefits from laparoscopic hernia repair over the Shouldice technique.
Prognostic value of negative intraoperative ultrasonography in primary colorectal cancer
Authors: Paul M A , Blomjous J G M , Cuesta M A , Meijer S
Published: February 2007

The risk of developing recurrent tumour was assessed in a group of 85 patients with primary colorectal cancer who had a negative intraoperative ultrasonographic examination at the time of primary tumour resection. At a median follow-up of 40 months liver metastases had developed in 14 patients (16 per cent). Dukes classification of the primary tumours was stage A, B and C in one, three and ten patients respectively. The interval between primary tumour resection and detection of metastases varied from 6 to 24 months but all became evident within 2years. Sixteen patients (19 per cent) presented with extrahepatic recurrence, one of whom also developed liver metastases. A negative intraoperative ultrasonographic examination did not prove to be a favourable prognostic factor which allowed exclusion from follow-up or adjuvant chemotherapy.
Effect of blood transfusion on outcome after pancreaticoduodenectomy for exocrine tumour of the pancreas
Authors: Yeh J J , Gonen M , Tomlinson J S , Idrees K , Brennan M F , Fong Y
Published: February 2007

Background

Blood transfusion is thought to have an immunosuppressive effect. The aims of this study were to examine survival in patients with pancreatic cancer receiving blood transfusion in association with pancreaticoduodenectomy, and to define preoperative risk factors for subsequent transfusion.

Methods

A retrospective review was performed of a prospective database of patients with exocrine tumours of the head of the pancreas who had undergone pancreaticoduodenectomy between 1998 and 2003. Clinical data, transfusion records and preoperative laboratory values were recorded.

Results

A total of 294 patients underwent pancreaticoduodenectomy for exocrine tumours in the pancreatic head. Of these, 140 (47·6 per cent) received a blood transfusion. Their median survival was 18 months, compared with 24 months for those who did not have a transfusion (P = 0·036). Postoperative transfusion, margin status and node stage were independent predictors of survival. Age and preoperative total bilirubin and haemoglobin levels were the only preoperative factors that correlated with transfusion.

Conclusion

In patients with exocrine tumours of the pancreas, blood transfusion should be avoided when possible. Preoperative risk factors can identify patients who are likely to require transfusion and would therefore benefit most from blood conservation methods.
Comparison of Indices of Muscle and Pump Performance in Patients with Coronary Artery Disease
Authors: Rogers William J. , Russell Richard O. , Moraski Roger E. , Coghlan H. Cecil , Zisserman Dimitry , Rackley Charles E.
Published: February 2007

During diagnostic cardiac catheterization of 20 patients, 19 of whom had coronary artery disease (CAD), left ventricular (LV) performance was assessed by both muscle function indices and pump function indices. Muscle function indices included max dP/dt, Vpm, Vce5, and Vmax, the latter derived from both total pressure (TP) and developed pressure (DP) using catheter‐tip manometry. Pump function indices included LV ejection fraction (EF) and percent abnormally contracting segment (ACS), determined from biplane LV angiography. Muscle and pump function indices were also compared to the presence of the S3 (ventricular diastolic) gallop. Correlations existed between EF and Vmax (TP), EF and Vpm, percent‐ACS and Vmax(TP), and percent‐ACS and Vpm, with r values of 0.760, 0.777, −0.884, and −0.841, respectively. Vmax(TP) and Vpm also correlated quantitatively with the presence of the S3 gallop (p < 0.0005). Total pressure‐derived muscle function indices appear to adequately describe mean LV performance in patients with CAD and ACS, but these muscle function indices are probably highly dependent upon the size of the myocardial scar.
Cardiac Catheterization and Selective Angiography in Infants with a New Flow‐Directed Catheter
Authors: Schwartz David C. , Kaplan Samuel
Published: February 2007

Preliminary experience with a new flow‐directed pediatric anglography catheter in 35 infants indicates that catheterization of all cardiac chambers and both great vessels can be accomplished without risk of perforation or major arrhythmia. Antegrade access to the aorta from the left ventricle via the foramen ovale reduced the need for retrograde arterial catheterization. The maneuverability of this balloon‐tipped catheter coupled with the ability to perform safely selective anglography at any site entered establishes a unique advantage over standard cardiac catheters now in use. The success with this catheter in performing right and left heart studies and the safety in its use promise to significantly reduce the risk of mechanical and angiographic accidents during the intracardiac investigation of critically ill Infants with congenital heart disease.
Thromboembolism Associated with Pigtail Catheters
Authors: Rashid Ahmad , Hildner Frank J. , Fester Arieh , Javier Roger P. , Samet Philip
Published: February 2007

Three incidents of asymptomatic arterial thromboembolism associated with polyurethane pigtail catheters occurred during 1,417 cases of left ventricular angiocardiography. No similar incident occurred with polyethylene pigtail or (dacron) Eppendorf and Gensini (style) catheters. In vitro comparison of hydraulic characteristics of polyurethane (Cordis) and polyethylene (Cook) pigtail catheters showed higher flow‐pressure transmission through the tip of the Cordis polyurethane catheter favoring dislodgment of any existing clot. The problem of thrombogencity of polyethylene compared with polyurethane remains unsettled. Our experience with polyurethane pigtail catheters has resulted in limitation of their use in our laboratory.
A New Atrial Septostomy Technique
Authors: Park Sang C. , Zuberbuhler J. R. , Neches William H. , Lenox Cora C. , Zoltun Richard A.
Published: February 2007

Balloon atrial septostomy is usually ineffective if the atrial septum is thickened. A technique for incising the atrial septum is described. A no. 6 French catheter was modified to enclose a tiny surgical blade. The distal end of the blade was pivoted to the catheter tip, and the proximal end was attached to a guide wire in the catheter lumen. Advancing the guide wire protruded the blade through a slit in the long axis of the tip of the catheter. Atrial septostomy was performed in five newborn lambs in vivo and in adult dog hearts and human hearts in vitro by advancing the catheter tip across the atrial septum with the blade retracted and withdrawing it to the right atrium with the blade extended. Eight to 12 mm lacerations of the atrial septum were produced and could be extended by subsequent balloon septostomy. The technique may be useful when balloon septostomy has been ineffective.
Dosimetry of Portable Image Intensifiers in Pacemaker Insertions
Authors: Hayt David B. , Malsky Stanley J. , Blatt Charles J. , Greenberg Elliott I. , Pochaczevsky Rubem , Simon Donald F. , Perez Louis A.
Published: February 2007

With the increased utilization of portable image intensifiers for pacemaker insertions, an investigation of the radiation hazards to operative personnel was undertaken. The personnel were tested first utilizing a Rando phantom and later during actual pacemaker insertions. Studies of medical personnel show the critical organs to be the thyroid (approximately 15mR per procedure) and the lens of the eye (approximately 13mR per procedure). While the MPD/week was not exceeded, the radiation dosage was substantial and could increase under operating conditions other than those measured. Recommendations to insure safer operation of this equipment are presented.
Experience with Preformed Catheters for Coronary Angiography by the Brachial Approach
Authors: Zir Leonard M. , Dinsmore Robert E. , Goss Cynthia , Harthorne J. Warren
Published: February 2007

Experience with a simplified technique for selective coronary angiography by the brachial cutdown approach using preformed coronary catheters in over 500 cases is described. This technique has facilitated selective catheterization of the coronary arteries in patients where use of the Sones catheter has proven difficult or impossible. Particularly, coronary arteries in patients with a dilated aortic root, high‐rising left coronary artery or tortuous subclavian artery are easily catheterized with the preformed catheters described in this report. Shortened procedure time, an acceptable morbidity (1.4%) and mortality (0.2%), and improved coronary opacification by virtue of the ease in selectively entering the coronary ostia make these preformed catheters a useful modification to coronary angiography by the transbrachial approach.
Preoperative Coronary Angiographic Prediction of Bypass Flow and Short‐Term Patency
Authors: Mehta Jawahar , Hamby Robert I. , Aintablian Agop , Hoffman Irwin , Hartstein Marvin L. , Wisoff B. George , Smedresman P.
Published: February 2007

A quantitative preoperative coronary angiographic index was defined in 148 patients undergoing coronary revascularization. Each diseased vessel was scored 0–3, for both diameter and quality of run‐off. The sum of the scores for diameter and run‐off constituted the numerical index for the diseased vessel. Correlations between the index and graft flow measured by electromagnetic flow meter at surgery were established in 259 bypassed vessels. The highest scores (5–6) were associated with higher flows, and the lower scores (0–4) with the lower flows (P < 0.005). Repeat angiography performed 2 wk postoperatively in 110 patients demonstrated 174 graft patencies and 15 graft closures. Mean flow in open grafts was 82 ± 41 ml/min vs. 60 ± 23 ml/min in closed grafts (P < 0.005). It is concluded that graft flow is predictable from preoperative Coronary Angiographic Index and that higher flow and index scores are more likely to be associated with graft patency than low flows and index scores.
105 mm Photofluorography: An Adjunct to the Study of Coronary Arterial and Vascular Disease
Authors: Grollman J. H. , Gray Robert K. , Po Jonathan , Macalpin Rex N. , Eber Leslie M.
Published: February 2007

Obtaining high resolution static films through an image intensifier has been made possible by recent developments in radiographic equipment. Serial photofluorography 105 mm spot filming has been used successfully to complement cine coronary arteriography in approximately 700 patients. Many patients with coronary heart disease have diffuse peripheral atheromatous changes which are also suitable to study by serial 105 mm photofluorography. Aortic arch, abdominal aortography, and peripheral studies are easily and quickly performed in conjunction with coronary arteriography.

Satisfactory results still depend upon skillful application by the angiographer of this imaging mode and proper processing of the film. Advantages of photofluorographic filming over conventional large film techniques include lower radiation exposure, reduction of costs, and easier film handling and storage. Most important is the facilitation of the performance of angiographic studies since constant television monitoring of the catheter and the contrast injections is possible. Disadvantages include restricted area of coverage and slight decrease in resolution. Our experience indicates that photofluorography may be relied upon in the study of vascular disease eliminating the need for large film changers in a laboratory used primarily for cardiac diagnosis.
Angiographic assessment of right ventricular volumes and ejection fraction
Authors: Ferlinz Jack
Published: February 2007

Since the advent of cardiovascular angiography only a few decades ago (1), a massive number of data related to the ventricular function have been accumulated. Specifically, left ventricular (LV) geometry, volumes, and patterns of contractility have been extensively investigated (2–7), especially in patients with coronary artery disease (8–11). In contrast, much less attention has been given to the characteristics of the right ventricle (RV). This has been due partially to the fact that the LV was always considered to be the more important chamber of the heart. The relative neglect of RV performance has been further compounded by difficulties in analyzing the geometry of the RV chamber: while the LV configuration approximately resembles an ellipsoid of revolution (and therefore lends itself to relatively simple mathematical analysis), the RV has always been considered a somewhat amorphous structure that does not yield to simple geometric manipulation.

In this review, recent approaches to the angiographic measurements of RV volumes and ejection fraction are examined.
Percutaneous catheter emboli: Sources and prevention
Authors: Page Harry L.
Published: February 2007

Percutaneous coronary arteriography has been associated with numerous reports of embolic complications. Efforts to minimize such complications have focused upon normal hemostatic functions and the possible preventative role of systemic heparin. In considering the source and prevention of catheter emboli it is useful to review the mechanisms by which particulate matter may be introduced into the aortic root and to recognize that foreign material unaffected by anticoagulation may constitute a significant source of emboli. A simple technical protocol described in this communication has been followed during 3,500 percutaneous transfemoral coronary arteriograms using the Judkins approach. During this experience no embolic complications have been observed.
Aortic stenosis, angina pectoris, coronary artery disease
Authors: Moraski Roger E. , Russell Richard O. , Mantle John A. , Rackley Charles E.
Published: February 2007

The data from 88 patients (pts) with aortic stenosis (AS) were reviewed to determine relationships between angina pectoris (AP) and coronary artery disease (CAD). Results of surgery performed in 81 of these pts was analyzed. All pts had coronary arterlograms, and lesions ≥ 50% were considered significant. Fifty‐nine pts had an aortic valve gradient measured at catheterization ≥ 40 mmHg, and in 29 pts, AS was confirmed at operation.

Sixty‐eight pts (77%) experienced AP, and 32 had coexisting CAD (47%); 9 of 20 pts without AP had CAD (45%). There were no significant differences in the incidence of AP in pts divided into subgroups by the aortic valve gradient (40–50, 51–100, 101–200 mmHg) or age (40–59, 60–81 years. Also, no significant differences were found in the incidence or extent of CAD between the two age groups; the extent of CAD was similar regardless of the presence or absence of AP. In pts with AP (1) CAD was more likely in pts ≥ 60 years of age; (2) CAD was less likely when the aortic valve gradient was > 100 mmHg, suggesting that AP in these pts was due to hemodynamically severe AS. All pts with 3‐vessel CAD experienced AP, and the aortic valve gradient was less in these pts than in those with no CAD or less extensive CAD. In 19 pts with combined AS and CAD who had both the aortic valve replaced and a revascularization operation only 1 of pts died in the hospital, while 3 of 19 pts with combined AS and CAD who had aortic valve replacement alone died.

In this study a significant number of pts with AS experienced AP, and the presence or absence of AP did not predict coexisting CAD. Coronary arteriography is recommended in the evaluation of pts ≥ 40 years of age with AS. The operative mortality appears to be decreased in pts with AS and CAD who have combined surgery.
Ejection time — Heart rate relationship during exercise
Authors: Lance Veronica Q. , Spodick David H.
Published: February 2007

The slope of the regression equation for left ventricular ejection time (LVET) vs heart rate (HR) is the appropriate factor for correcting LVET for HR. Because the regression relationship varies under different conditions, we determined the LVET‐HR equations for subjects (1) seated at rest on a bicycle ergometer, and (2) during uninterrupted bicycle exercise. In 18 normally active male volunteers, ages 22 − 37, HR and LVET were measured under the two conditions and the regression relationship for LVET on HR determined for each. Regression equations are as follows: (1) LVET = 379 − 1.8 HR ± 11.0 for subjects seated at rest on a bicycle ergometer, and (2) LVET = 371 − 1.2 HR ± 13.9 for subjects performing upright bicycle exercise. The slope factors (1.8 and 1.2) differed significantly (p<0.01). The data indicate that considerable error can result from arbitrarily applying to exercising or resting subjects a correction factor which does not fit the conditions of the data to be corrected.
A semiautomated technique for the rapid evaluation of left ventricular regional wall motion
Authors: Cole James S. , Holland Patricia A. , Glaeser Donald H.
Published: February 2007

A semiautomated system for the rapid evaluation of left ventricular regional wall motion is described. The system includes direct projection of the cineangiogram film on an X‐Y digitizer which is interfaced with a PDP‐9 computer. The ventricular model used to evaluate regional wall motion and the methods of data analysis are described. Validation of the accuracy of the technique and specific clinical applications are presented. It is concluded that this technique provides a rapid means of evaluating left ventricular regional wall motion and that the accuracy of the technique is acceptable for clinical application.
Congenital obstructive lesions involving the major pulmonary veins, left atrium, or mitral valve: A clinical, laboratory, and morphologic survey
Authors: Luke Glancy D. , Roberts William C.
Published: February 2007

The clinical, laboratory, and morphologic features of congenitally obstructive lesions causing pulmonary venous hypertension are reviewed. These lesions are responsible for considerable infant mortality and morbidity, especially in the first weeks of life, are not infrequently encountered in older children, and are occasionally seen in adults. The presence of a malformation causing pulmonary venous hypertension often can be detected clinically, but precise anatomical and physiological diagnoses, usually necessary for optimal patient management, often can be made only by detailed laboratory study. Cardiac catheterization and angiocardiography remain the prime modes of accurate diagnosis in such patients, many of whom have other significant cardiovascular malformations, and echocardiography is an extremely useful adjunct, especially in patients with mitral valvular stenosis, hypoplasia, or atresia. The only definitive treatment in any of these patients is operative relief of the obstruction, and the chances of success depend not only on the skill of the surgeon, but also on the nature of the obstructing lesion, the types of associated malformations, and the precision with which these are defined preoperatively.
Pulmonary arteriography in congenital heart disease
Authors: Freedom Robert M. , Olley Peter M.
Published: February 2007

Pulmonary outflow tract obstruction may occur at subvalve, valve, or pulmonary artery level. Selective ventriculography will usually define the intracardiac obstruction (whether valve, subvalve, or both) and may define pulmonary arterial abnormalities. Increasing experience in the surgical management of patients with tetralogy of Fallot and other conotruncal abnormalities characterized by significant pulmonary outflow tract obstruction suggests that preoperative recognition of pulmonary arterial stenosis is essential to the successful operative management of these patients (1‐4).
Coronary artery spasm: The effect of cardiovascular laboratory premedication practice
Authors: Bennett Kenneth R.
Published: February 2007

Eighty‐four university cardiovascular laboratories responded to a questionnaire concerning premedication practice and observation of noncatheter‐induced coronary artery spasm during routine coronary angiography. Half of the laboratories stated that they had not observed the phenomenon. The data suggest that premedication practice may account in part for the relative rarity of this phenomenon.
The significance of early changes of positive and negative dp/dt following contrast ventriculography
Authors: Crelinsten Gordon , Fallen Ernest , Fenton Richard , Marpole Derek , Sniderman Allan
Published: February 2007

The contrast agents used for cardiac angiography have pharmacologic effects on the myocardium and on peripheral and coronary circulations. These effects are a stress to the left ventricle. We have studied the sequential changes in heart rate, LVEDP, positive and negative dP/dt in 34 patients following left ventriculography. These patients were divided into three groups: nine normal patients, 14 patients with valvular or coronary artery disease and abnormal left ventricular function at rest, and 11 patients with significant coronary artery stenosis but normal left ventricular function at rest. Changes in dP/dt most clearly defined the normal and abnormal response. In the normal group the mean positive dP/dt rose abruptly at 30 sec after the ventriculogram, whereas the abnormal group showed a mean decrease. The extent of change varied, however, for patients within each group. Negative dP/dt decreased in both groups but more so in the abnormal group. As did the other groups, patients with coronary artery disease but with normal ventricular function showed individual variation in response. Their mean changes in positive and negative dP/dt were intermediate. Positive dP/dt decreased at 30 sec (similar to, but less than, the group with abnormal ventricular function) and negative dP/dt also diminished at 30 sec with a mean value between the normal and abnormal groups. The results of this study support the concept that left ventricular dysfunction may be elicited by the stress of contrast injection. More importantly, such dysfunction seen both with abnormal and normal left ventricles at rest, may be reflected by the relatively simple measurement of positive dP/dt after ventriculography.
Anomalous origin of the right coronary artery from the left sinus of valsalva with associated chest pain: Report of two cases
Authors: Thompson LCdr Stanley I. , Vieweg Cdr W. V. R. , Alpert LCdr Joseph S. , Hagan Capt A. D.
Published: February 2007

Ectopic origin of the right coronary artery from the left sinus of Valsalva is an infrequent coronary anomaly. The right coronary artery then passes between the aorta and pulmonary artery. We report two such cases with chest pain suggestive of angina pectoris in the absence of atherosclerosis, as demonstrated by selective coronary arteriography. A technique for selectively catheterizing the ectopic right coronary artery is described.
Error in thermodilution cardiac output measurement caused by variation in syringe volume
Authors: Reininger Edward J. , Troy Bart L.
Published: February 2007

It is important to measure the exact volume of 5% dextrose injected when thermodilution cardiac output determinations are made. The marked volume on plastic syringes and their variability may contribute to a small but significant error in the results.
Coronary arteriography by the percutaneous transfemoral technique in patients on intraaortic counterpulsation
Authors: Fernandez Jose J. , Feldman Mark J. , Schocket Lee , Carroll John F. , DeSando C. James , Bast Gary
Published: February 2007

Presented are the results of the use of the transfemoral approach for coronary arteriography, as a safe alternative to the brachial approach, in evaluating patients in cardiogenic shock. Five patients, each with an intraaortic balloon pump device in operation, were evaluated. No complications were encountered using the transfemoral approach.
A quantitative method for determining angiographic jet energy forces and their dissipation: Theoretic and practical implications
Authors: Abbott Joseph A. , Lipton Martin J. , Hayashi Thomas , Lee Francis C. S.
Published: February 2007

Jets emanating from the exit holes of cardiac catheters during angiographic injections are theoretically capable of producing severe localized cardiovascular trauma. We adopted a fluid mechanical model of an axially symmetric jet to define these energy forces quantitatively, especially as they would occur in the clinical setting. During angiographic injection at all catheter flow rates used clinically, the jet emanating from the exit hole was always turbulent. The physical characteristics of the turbulent jet penetration into the intravascular blood fell upon a universal curve independent of the jet Reynolds number. This curve, never previously described, allows ready calculation of hydraulic energy dissipation for any catheter of known length and lumen size. The diameter of the catheter exit orifice has a greater effect than injection flow rate on decreasing jet penetration. These results provide useful guidelines for reducing trauma during routine angiography.
Comparison between regional myocardial blood flow measurements and results of exercise tests
Authors: Roberts Barbara H. , Cohn Peter F. , Holman B. Leonard , Adams Douglass F. , See Jackie R.
Published: February 2007

The relationship between regional myocardial blood flow and the results of exercise tests were evaluated in 54 patients, 40 of whom had angiographically demonstrated coronary artery disease (CAD) and 14 had normal angiograms. After 20 patients had 2‐step tests, 20 had bicycle ergometry, and 14 had treadmill tests, regional myocardial specific blood flow (RMBF) at rest was determined by selective injections of xenon‐133 into the left coronary artery and quadrantic washout measured with an Anger camera. RMBF (ml/min/100 gm, mean ± S.E.) was significantly lower in patients with coronary artery disease (72 ± 3) than in normals (91 ± 7, p<.05) but RMBF in 12 CAD patients with negative exercise tests (75 ± 6) was similar to regional myocardial blood flow in 28 coronary artery disease patients with positive exercise tests (71 ± 4). Degree of ST depression did not influence results. Although measurement of RMBF and exercise testing are both useful procedures in the evaluation of patients with CAD, the data in the present study indicate the RMBF measurements at rest cannot predict the result of the postexercise ECG and vice versa.
Assessing the Blalock‐Hanlon atrioseptectomy at cardiac catheterization
Authors: Clark Edward B. , Rosenquist Glenn C.
Published: February 2007

Blalock‐Hanlon atrial septectomy (BH) is performed to increase systemic and pulmonary venous mixing at the atrial level. Failure of clinical improvement may be related to inadequate intraatrial communication. A simple catheterization technique employing a balloon catheter is used to assess the presence or absence of the limbus of the foramen ovale following BH, since persistence of the limbus of the fossa ovalis after BH is associated with significantly smaller percentage of communication (atrial communication area/total atrial area).
Microreactor Processing for the Aqueous Kolbe‐Schmitt Synthesis of Hydroquinone and Phloroglucinol
Authors: Hessel V. , Hofmann C. , Löb P. , Löwe H. , Parals M.
Published: February 2007

Hydroquinone and phloroglucinol were used as substrates for the aqueous Kolbe‐Schmitt synthesis, using a novel processing methodology, termed high‐p,T processing, recently demonstrated for the carboxylation of resorcinol. By the high‐p,T approach, the temperature limitations of classical batch synthesis, e.g., set by reflux conditions (solvent boiling point), can be overcome by simple technical expenditure, e.g., the use of a few microstructured components, a capillary, and a needle valve at very low internal holdup. In this way, favorable speed‐up of chemical reaction is achieved at temperatures normally outside the useful range for organic synthesis. While the hydroquinone synthesis gave only very low yields, phloroglucinol was converted to the corresponding carboxylic acid at a high yield of 50 %, which is about 20 % higher than for a laboratory batch synthesis. Process intensification was achieved by reducing the reaction time from 2 h for the batch synthesis to 50 s for the micro processing. However, the most favorable temperature is limited to ca. 130 °C, since at higher temperatures, decarboxylation of the product back to phloroglucinol outpaces the speed‐up of the reaction, while at lower temperatures, the reaction rate and conversion are insufficient.