bluuebunny/crossref_metadata_2025 huggingface dataset:
Angiotensin-Converting-Enzyme Inhibitor Administration Must Be Monitored for Serum Amylase and Lipase in order to Prevent an Acute Pancreatitis
Authors: Borgia Maria Clotilde , Celestini Andrea , Caravella Patrizia , Catalano Carlo
Published: July 2008

Some clinical cases published in literature show that angiotensin-converting enzyme (ACE)- inhibitor administration may cause acute pancreatitis. In this work, the authors report a case of a patient affected by hypertension. Upon admission, the authors started antihypertensive therapy using captopril, which caused an important amylase and lipase rise within 13 days. When the ACE-inhibitor therapy was stopped, a rapid decrease of the serum enzyme was observed within 3 days. The high levels of serum amylase and lipase were linked to neutrophilia but were not associated with relevant symptomatic findings or features of pancreatopathy. The absence of the usual conditions that may cause pancreatitis, such as biliary stasis, hyper calcemia, or alcohol abuse, and the rapid decrease of serum enzyme levels after drug suspen sion suggested an ACE-inhibitor-induced pancreatitis. This is the first clinical report of an ACE- inhibitor-induced pancreatitis in which captopril administration was found after hospitalization. The drug suspension probably prevented other complications. This case report suggests that, when ACE-inhibitor administration is started, serum amylase and lipase should be monitored in order to prevent acute pancreatitis without waiting for clinical evidence of a pancreatopathy.
Peripartum Cardiomyopathy: Clinical and Therapeutic Aspects
Authors: Mehta Nirav J. , Mehta Rajal N. , Khan Ijaz A.
Published: July 2008

Peripartum cardiomyopathy is an under-recognized form of dilated cardiomyopathy of unknown cause and is associated with excess morbidity and mortality in women of childbearing age. Incidence of peripartum cardiomyopathy ranges from 1 in 1,300 to 1 in 15,000 pregnancies. The diagnostic criteria are onset of heart failure in the last month of pregnancy or in first 5 months postpartum, absence of determinable cause for cardiac failure, and absence of a demonstrable heart disease before the last month of pregnancy. Multiparity, twin births, advanced maternal age, preeclampsia, gestational hypertension, and black race are known risk factors. The exact cause of peripartum cardiomyopathy is unclear. The clinical presentation of patients with peri partum cardiomyopathy is similar to that of patients with systolic congestive heart failure. Little is known about the therapy of this disease, and the medical treatment is limited to the use of drugs for symptomatic control. Prospective, randomized, double-blind studies are needed to define the role of immunosuppressive treatment and to evaluate the role of conventional treatment of dilated cardiomyopathy in reducing the mortality rate of peripartum cardiomy opathy. About half the patients of peripartum cardiomyopathy recover without any complica tions. The prognosis is poor in patients with persistent cardiomyopathy. Persistence of disease after 6 months indicates irreversible cardiomyopathy and portends worse survival. The risk of developing peripartum cardiomyopathy in subsequent pregnancies remains high. The clinical and therapeutic aspects of the peripartum cardiomyopathy are discussed.
Effects of Beraprost Sodium (Dorner®) in Patients with Diabetes Mellitus Complicated by Chronic Arterial Obstruction
Authors: Toyota Takayoshi , Oikawa Shinichi
Published: July 2008

The effects of the prostaglandin I2 derivative beraprost sodium (Dorner®) on ankle pressure index (API; ankle joint-to-upper extremity systolic pressure ratio), subjective symptoms, and intermittent claudication were investigated in diabetic patients with arteriosclerosis obliterans (ASO). Forty patients (25 men and 15 women), mean age 63.9 years, were enrolled in this study. ASO was grade I in 30 patients, grade II in seven, grade III in one, and grade IV in two according to the Fontaine classification. They were administered six tablets (20 μg/tablet) of beraprost sodium daily for 6 months. At 3 and 6 months, API had significantly increased and symptoms such as coldness, numbness, and lack of feeling in the lower extremities were significantly improved. Ten evaluable patients increased ambulatory distance by approximately threefold, suggesting an improvement in intermittent claudication. Adverse reactions were experienced by five (12.5%) of the 40 patients (one case each of headache, dull headache, pain in the posterior region of the neck, heartburn, stomach discomfort, and anemia), but all were mild and resolved without treatment. Beraprost sodium was shown to improve API and symptoms in the lower extremities in diabetic patients with ASO, suggesting that it is useful in treating peripheral circulatory disorders in such patients.
Cardiovascular Risk Factors Do Not Predict Clinically Defined Restenosis After Percutaneous Transluminal Angioplasty for Lower Limb Ischemia
Authors: Alfke Heiko , Froelich Jens J. , Nowak Severin , Wagner Hans-Joachim
Published: July 2008

The purpose of this study was to evaluate risk factors predicting restenosis and primary patency after percutaneous transluminal angioplasty. Follow-up data (including cardiovascular risk factor scores according to SCVIR criteria, preinterventional and postinterventional clinical data and patient history) of all patients who underwent successful percutaneous transluminal angioplasty for lower limb ischemia were analyzed retrospectively and patients, relatives, or referring physicians underwent a telephone interview. Patients with incomplete follow-up data were examined by means of a clinical examination, including Doppler measurements and treadmill test. Additionally all angiograms were evaluated to calculate lesion length, number of treated lesions, lesion type (SCVIR score), and runoff. The outcome was categorized into four groups: early recurrence (< 1 month, group I), mean recurrence (1-6 months, group II), late recurrence (> 6 months, group III), and no recurrence (group IV). According to common concepts group I was defined as early (thrombotic) reocclusion, group II as clinically defined restenosis, and group III as progression of atherosclerosis. One hundred thirty-seven patients underwent percutaneous transluminal angioplasty of 148 extremities. The groups differ signif icantly only with respect to a higher diabetes score for group I in comparison to group IV (p = 0.002, Kruskal-Wallis test), and a worse runoff of group I compared with group IV (p = 0.008). There was a trend toward a higher diabetes score for group II in comparison to group IV (p = 0.014). There were no differences with regard to hyperlipemia, hypertension, and tobacco use between patient groups. Mean primary patency was 436 days. Predictors for lower patency rates were diabetes mellitus (p < 0.001), runoff (p = 0.005), and number of treated lesions (p=0.007) in a stepwise, multiple regression analysis. Patients with clinically defined restenosis showed no specific risk factor profile in this study. Predictors for lower primary patency were diabetes mellitus, number of treated lesions, and runoff.
Spontaneous Coronary Artery Dissection: The Clinical Spectrum
Authors: Dhawan Rajiv , Singh Gurdev , Fesniak Henry
Published: July 2008

Spontaneous coronary artery dissection is a rare but increasingly reported cause of myocar dial ischemia and sudden death. It is more commonly seen in younger age groups and has a predilection for postpartum women. The clinical spectrum of its presentation includes angina, myocardial infarction, cardiogenic shock, and death. No specific cardiac risk factors have been associated with its occurrence. In postpartum patients, it is presumed that dissection results from pregnancy-induced degeneration of collagen and the additional stresses of parturition. The sporadic nature of spontaneous coronary artery dissection has precluded the develop ment of any consensus for a medical approach, and treatment is usually tailored to individual patient needs. A case of postpartum spiral dissection of the left anterior descending coronary artery with successful medical management is reported.
Coronary Artery Disease and Periodontal Disease: Is There a Link?
Authors: Abou-Raya Suzan , Naeem Amr , Kheir Hassan Abou-El , El Beltagy Sheriff
Published: July 2008

Background: Cardiovascular disease is the number one killer worldwide. The so-called classic risk factors of coronary heart disease do not account for all of its clinical and epidemiological features. Recent evidence suggests that certain infections, among them dental infections and in particular periodontal disease, are involved in the pathogenesis of coronary artery disease. Aim: To evaluate the association between periodontal disease and coronary artery disease.

Patients and Methods: Fifty patients referred for diagnostic coronary angiography were assessed for periodontal disease. All patients underwent a thorough physical examination, routine laboratory testing, cardiac evaluation and dental examination which included panto mography x-ray evaluation.

Results: Pantomography x-rays and coronary angiograms of the participants were scored blindly by a dentist and cardiologists respectively. The association between periodontal disease and coronary atheromatosis remained significant after adjustment for age, smoking, blood lipids, body mass index, hypertension and the presence of diabetes.

Implications: Periodontal disease was still significantly associated after all the known risk factors were accounted for. The implication here is that periodontal disease could be a potential risk factor for heart disease by predisposing the individual to chronic low-grade infec tions. If so, then dental health becomes an important parameter for medical health.
Association of Carotid Artery Intima-Media Thickness with Complex Aortic Atherosclerosis in Patients with Recent Stroke
Authors: Fasseas Panayotis , Brilakis Emmanouil S. , Leybishkis Biana , Cohen Marc , Sokil Alexis B. , Wolf Nelson , Dorn Rose Lee , Roberts Andrew , VanDecker William
Published: July 2008

This study was undertaken to determine whether carotid intima-media thickness can predict complex aortic atherosclerosis. A retrospective review was conducted of 64 consecutive patients who underwent transesophageal echocardiography and carotid ultrasonography for evaluation of recent ischemic stroke at MCP Hahnemann University, Medical College of Pennsylvania Hospital between January 1, 1999, and December 31, 1999. The mean age was 65 ± 14 years and 59% of the patients were women. Thirty-nine patients (61 %) had carotid atherosclerosis (defined as an intima-media thickness ≥ 1 mm) and seven patients (11%) had complex aortic atherosclerosis (defined as the presence of protruding atheroma ≥4 mm thick, mobile atherosclerotic debris, or plaque ulceration in any aortic segment by transesophageal echocardiography). Compared to patients without complex aortic atherosclerosis, patients with complex aortic atherosclerosis were more likely to have hypercholesterolemia (19% vs 57%, p = 0.05) and a carotid intima-media thickness of 2 mm or greater (35% vs 86%, p = 0.02). A carotid intima-media thickness of 2 mm or more had 86% sensitivity, 65% specificity, 23% positive predictive value, 97% negative predictive value, 2.5 positive likelihood ratio, and 0.22 negative likelihood ratio for the diagnosis of complex aortic atherosclerosis. Carotid intima- media thickness measurement can be used to noninvasively estimate the probability of complex aortic atherosclerosis. A carotid intima-media thickness less than 2 mm makes complex aortic atherosclerosis very unlikely.
Carotid Atherosclerosis in Type 2 Diabetes Mellitus: Potential Role of Endothelin-1, Lipoperoxides, and Prostacyclin
Authors: Kalogeropoulou K. , Mortzos G. , Migdalis I. , Velentzas C. , Mikhailidis D.P. , Georgiadis E. , Cordopatis P.
Published: July 2008

Factors were studied that may initiate macroangiopathy or enhance or aggravate its patho genesis in patients with type 2 diabetes mellitus. A total of 151 diabetics were compared with healthy controls (n = 50); all patients and subjects were normotensive and without renal failure. Plasma endothelin-1 and free radical levels were measured. In addition, plasma prosta cyclin levels were assessed by assaying its stable, spontaneous, breakdown product 6-keto prostaglandin-F1a. Diabetics were divided into three groups: those with clinically evident macroangiopathy and those with early or without atherosclerosis (as determined by the carotid intima-media thickness. Plasma endothelin-1 levels were increased in all diabetics with atherosclerosis. Plasma free radical levels were increased in diabetics with macroan giopathy when compared with control subjects. The plasma levels of 6-keto-prostaglandin-F 1a were slightly, but significantly, decreased in the diabetics with macroangiopathy when compared with control subjects. The carotid intima-media thickness was significantly greater in diabetics without macroangiopathy when compared with the controls. Furthermore, the intima-media thickness increased significantly in this group of diabetics but not in the controls over a 30-month follow-up period. Several factors may contribute to atherogenesis in diabetics. These include increased plasma endothelin-1 and free radical levels as well as a defi ciency of prostacyclin. These factors may become targets for intervention as well as markers of disease progression.
Unilateral Stent Implantation for Renal Function in Bilateral Atherosclerotic Renovascular Hypertension
Authors: Takakuwa Hiroshi , Shimizu Kazuaki , Izumiya Yoshiaki , Kato Tamayo , Yokoyama Hitoshi , Kobayashi Ken-ichi , Matsui Osamu , Ise Takuyuki
Published: July 2008

Renal artery stenting improves or preserves renal function in patients with bilateral renovas cular disease and chronic renal insufficiency. An 80-year-old male was admitted to the hospital for elevated blood pressure accompanied by congestive heart failure. He had renal insufficiency and severe hypertension secondary to bilateral atherosclerotic renal artery stenosis. Unilateral renal artery stenting in the left kidney resulted in the recovery of renal function, whereas renal artery stenting in the right kidney was technically difficult due to a tortuous aorta. After the left unilateral stent implantation, the serum creatinine concentration decreased from 2.0 to 1.3 mg/dL, and control of his blood pressure required fewer antihypertensive drugs, namely a calcium antagonist, an angiotensin-converting enzyme inhibitor, and diuretics. Fifteen months after stenting, renal scintigraphy demonstrated improved function of the right kidney, despite severe renal artery stenosis, as well as improved function of the left kidney. Renal angioplasty or stenting should be attempted in bilateral atherosclerotic renovascular hypertension with renal insufficiency, even though it may only be successful unilaterally.
Long-term, Continuous Treatment with Both Oral and Transdermal Nitrates Increases Cardiac Events in Healed Myocardial Infarction Patients
Authors: Kanamasa Ken , Hayashi Takahiro , Kimura Akio , Ikeda Akiko , Ishikawa Kinji , secondary prevention group
Published: July 2008

This study was performed to investigate the effects of continuous dosing of oral, trans dermal (patch), and a combination of the two with nitrate treatments on cardiac events in patients with healed myocardial infarction. In total, 1,291 patients with healed myocardial infarction were assigned 2 groups: treatment with nitrates (n = 713) or nontreatment (n = 578). Nitrate treatment was subdivided into 3 groups: patch group (n =149), oral group (n = 504), and combination group (n = 60). The mean observation period was 17.4 ±21.1 months. Primary end points were nonfatal and fatal recurrent myocardial infarction, death from congestive heart failure, and sudden death. Baseline characteristics were also compared among the 4 groups to determine any effects on outcome. Among the patients with patch, oral, and combination groups, cardiac events occurred 3.4%, 6.7%, 10.0%, respectively, whereas only 2.9% of the patients treated without nitrates had cardiac events. The incidence of cardiac events was significantly greater in patients with oral nitrates and combination groups compared to patients without nitrates (p<0.01, respectively). Continuous dosing of long-term treatment with both oral and transdermal nitrates increased cardiac events in healed myocardial infarction patients.
Acute Coronary Syndrome in Patients with Human Immunodeficiency Virus Disease
Authors: Mehta Nirav J. , Khan Ijaz A. , Mehta Rajal N. , Gowda Ramesh M.
Published: July 2008

With more effective prophylactic treatment and an increased time of survival, noninfectious conditions associated with human immunodeficiency virus (HIV) disease are being recognized with increasing frequency in HIV patients. Cardiac involvement in HIV-infected patients varies from clinically silent to a fatal disease with a direct cardiac cause of mortality estimated at 1% to 6%. Pericardial effusion, pericarditis, myocarditis, cardiomyopathy, endocarditis, and pulmonary hypertension are known cardiac manifestations associated with HIV infection. Coronary artery disease (CAD) has not been a recognized complication of HIV disease, although some recent case reports have suggested occurrence of premature CAD and accel erated atherogenesis in HIV-infected patients. The role of protease inhibitors have been suggested in the development of this complication. After reviewing records of the last 7 years, the authors found 10 cases of acute coronary syndrome in HIV-infected patients who had no other risk factor for CAD except smoking. The presence of CAD was confirmed by angiog raphy or autopsy. The mean CD4 count was 380 cells/mm3, and the mean duration between the diagnosis of HIV infection and CAD was 7.5 years. Four patients had single-vessel disease, 1 patient had 2-vessel disease, and 5 patients had 3-vessel disease. Three patients underwent coronary bypass surgery and 1 patient died of cardiogenic shock. CAD may be associated with HIV disease.
Effects of Anticoagulation on Infarct Size and Clinical Outcome in Acute Cardioembolic Stroke
Authors: Wakita Masayuki , Yasaka Masahiro , Minematsu Kazuo , Yamaguchi Takenori
Published: July 2008

Effects of anticoagulation on infarct size and outcome have not been fully elucidated in patients with acute cardioembolic stroke, although the anticoagulation therapy reduces both occurrence and recurrence of ischemic stroke greatly. The authors retrospectively investi gated the relationship of anticoagulation intensity to infarct size and outcome. In 104 consec utive patients (mean age 70.8 ±10.0 years) who had suffered acute supratentorial cardioem bolic infarction or transient ischemic attacks, they analyzed risk factors for atherosclerosis, underlying heart diseases, the infarct size (maximal area) on brain computed tomography, and modified Rankin scale score upon discharge. They compared these clinical data between patients who had received warfarin before the ictus and those who had not. In addition, they investigated the effects of the international normalized ratio (INR) on infarct size and outcome in 19 patients who had been receiving anticoagulant therapy and had measurement of INR within 24 hours after stroke onset. There were 25 patients who had received anticoagulation before the stroke (A/C group) and 79 patients who had not (non-A/C group). The infarct size in the A/C group tended to be smaller than that in the non-A/C group (p = 0.081, Mann-Whitney U test). In the 19 patients who had prior anticoagulation and measurement of INR within 24 hours of stroke onset, large infarcts were seen in 6 of 13 patients with INR < 1.6 and in none of 6 patients with INR ≥ 1.6. Poor clinical outcome was observed in 5 patients with INR < 1.6, but in none with INR ≥ 1.6. In conclusion, anticoagulant therapy with INR ≥ 1.6 appears to effec tively prevent a large infarct and poor outcome, even when ischemic stroke dose occurs in patients with an emboligenic heart disease.
Risk Factors for the First-Time Development of Venous Ulcers of the Lower Limbs: The Influence of Heredity and Physical Activity
Authors: Bérard Anick , Abenhaim Lucien , Platt Robert , Kahn Susan R. , Steinmetz Oren
Published: July 2008

The objective of this prospective case-control study was to identify and quantify demographic and clinical risk factors for venous ulcer disease, with special emphasis on heredity and physical activity. Patients presenting to a participating vascular surgery department between January and December 1997 with a first open venous ulcer served as cases. Controls were sampled among patients with subacute conditions such as skin problems, back pain, cold, headache/migraine, sore throat, and mild ear infections and were matched on referral physician, age (±5 years), and gender. Subjects were eligible if they were 18 years or older and were excluded if they had nonpalpable pedal pulse or any chronic active diseases such as cancer or AIDS. Cases' and controls' statuses were ascertained by the participating physi cians. Data on risk factors were collected with an interviewer-administered questionnaire and were self-reported by patients. The mean age of participants was 61 years for cases (n = 102) and 59 years for controls (n = 200). Family history of maternal venous insufficiency (odds ratio (OR) = 6.8, 95% confidence interval (Cl) = [1.9, 24.3]95%), vigorous exercise (OR = 8.9, Cl = [1.1, 72.0]95%), and history of deep vein thrombosis (DVT) (OR = 17.6, Cl = [2.9, 106.8]95%) were found to be significant predictors of venous ulcers in matched multivariate logistic regression analysis; number of pregnancies was also a significant risk factor in women (OR = 1.2, Cl = [1.0, 1.5]95%). Our study suggests that knowledge of family history of venous insufficiency and monitoring of physical activity will lead to ulcer prevention. Although physical activity is recommended for patients with venous insufficiency, vigorous exercise increases the likelihood of ulcerations.
Rubella-Associated Perimyocarditis
Authors: Harada Tomohiro , Ohtaki Eiji , Tobaru Tetsuya , Kitahara Koichi , Sumiyoshi Tetsuya , Hosoda Saichi
Published: July 2008

Perimyocarditis represents an inflammation of both the myocardium and pericardium. Although several causative agents have been recognized, pericarditis or myocarditis associated with rubella is an unusual complication. In a 29-year-old woman, left ventricular function transiently deteriorated accompanied by ongoing cardiac inflammation a few days after illness. The titer of rubella virus increased from seronegative to more than 32-fold during the admission, and a rise in specific antirubella virus antibody was present. The patient was suspected of having perimyocarditis associated with the rubella infection. The authors also present clinical features of rubella-associated perimyocarditis and myocarditis in the literature.
Direct Stenting in Single Coronary Artery Arising from the Left Sinus of Valsalva
Authors: Tejada Julio G. , Albarran Agustín , Velazquez Maria T. , Sanz Javier , Pindado Carlos , Tascon Juan C.
Published: July 2008

A patient with postinfarction angina was referred for coronary angiography. In addition to severe atherosclerotic coronary disease, which was responsible for clinical presentation, a single coronary artery arising from the left sinus of Valsalva was found. The authors report the use of direct coronary stent deployment without predilation to treat disease in this rare anomaly.
Ischemic Preconditioning Detected by Treadmill Exercise Tests in Patients with Stable Angina
Authors: Li Jian-Jun , Huang Cong-Xin , Hong Jiang  , Fang Chun-Hong , Fang Cheng  , Tang Qi-Zhu , Li Geng-Shan
Published: July 2008

The aim of this study was to explore the ischemic preconditioning (IP) phenomenon in patients with chronic stable angina (SA) by using treadmill exercise tests (TETs). Twenty-nine patients with SA were divided into 2 groups: group A (n =15) and group B (n =14). There was no differ ence between the 2 groups in both clinical characteristics and extent of coronary stenosis. Group A was subjected to 2 TETs at a 10-minute interval, but group B had a 60-minute interval according to Bruce protocol. The occurrence and time of chest pain, maximal value, duration of ST segment depression, and arrhythmias that occurred during TETs were analyzed for differ ences in the 2 tests in the 2 groups. In group A, 9 patients (60.0%) complained of chest pain in the first test, whereas only 4 (26.7%) did in the second test (p<0.01); The time of occur rence of chest pain during exercise was 1.88 ±0.2 min in the first test, 2.3 ±0.4 min in the second test (p < 0.05); The maximal value of ST segment depression decreased from 0.21 ±0.09 mV in the first test to 0.14 ±0.05 mV in the second (p<0.01); the duration of ST segment depression decreased from 7.12 ±0.9 min in the first test to 4.42 ±0.3 min in the second (p<0.01). The incidence of arrhythmia decreased from 40.0% in the first test to 13.3% in the second (p < 0.05). However, no significant difference was observed in the multiple parameters, mentioned above, in group B. In conclusion, the first ischemic event could induce the IP phenomenon and protect the heart from more serious damage at a 10-minute interval. However, this effect disappeared when the second test was done at a 60-minute interval.
Coronary Stent Implantation in Patients with a Single Coronary Artery
Authors: Sasao Hisataka , Hasegawa Tohru , Endo Akita , Fujiwara Tadashi , Kikuchi Yuka , Oimatsu Hiroshi , Takada Takehito
Published: July 2008

An isolated single coronary artery is a rare congenital anomaly and a cause of cardiac ischemia, congestive heart failure, and sudden cardiac death. Reported here are 3 cases of single coronary artery with acute myocardial infarction in which coronary stenting was performed. Also reported are the coronary blood flow patterns of the right coronary artery arising from the single left coronary artery.
Use of Abciximab and Tirofiban in Patients with Peripheral Arterial Occlusive Disease and Arterial Thrombosis
Authors: Schweizer Johannes , Kirch Wilhelm , Koch Reiner , Müller Axel , Hellner Grit , Forkmann Lutz
Published: July 2008

Acute peripheral arterial occlusive disease is an important factor affecting the mobility and mortality rate of elderly patients. Catheter-guided arterial thrombolysis in these patients has its limitations: long lysis times, early occlusions, and high restenosis rates. The study investi gated whether the use of tirofiban has the same favorable effect as the glycoprotein (GP) IIb/IIIa receptor antagonist abciximab and whether lysis times can be shortened and the disease course positively influenced by these substances. Sixty patients were randomly assigned to 2 groups. Each group received 5 mg recombinant tissue-type (rt-PA) plasminogen activator by slow intra-arterial injection for 10 minutes followed by 5 mg rt-PA per hour and 500 IU heparin per hour IV. After randomization 1 group received a bolus of 0.25 mg abciximab per kg body weight followed by 10 mg per minute IV for 12 hours (heparin was reduced to 250 IU/hr). The other group received a bolus of 0.4 μg tirofiban per kg body weight as well as postinterventional medication with 0.1 μg tirofiban per minute and kg body weight for 24 hours. During medication with GP IIb/IIIa inhibitor, the patients received a reduced heparin dosage for 24 hours. After 24 hours both groups received 200 mg aspirin orally and full heparinization controlled on the basis of the partial thromboplastin time. The following efficacy criteria were analyzed: rehospitalization events, reintervention events, and amputations within 6 months. Secondary endpoints were changes in the Fontaine stage, the crurobrachial index, the distance to claudication, and the duration of local arterial lysis. No significant differences were found between the abciximab and tirofiban groups in terms of the rehospitalization, rein tervention, or amputation rates, nor were there any group differences in the total number of events. The secondary parameters, such as the crurobrachial index, distance to claudication, and Fontaine stage, also showed no significant differences between the 2 groups within 6 months. The duration of lysis was significantly shorter in the abciximab group. Major bleeding events did not occur in either group. With regard to the adverse effect rate, there were no significant differences between the 2 groups. Both abciximab and tirofiban can be used successfully in patients with peripheral arterial occlusive disease and arterial thrombosis.
Gadolinium Magnetic Angioresonance in the Study of Aortoiliac Disease
Authors: Wolosker Nelson , Nakano Livio , D'Hippolito Giuseppe , Rosoky Ruben Ayzin , Borri Maria Lucia , Wolosker Angela Maria Borri
Published: July 2008

There is a need for noninvasive methods for the early identification of patients with intermit tent claudication who need surgical treatment. Newer magnetic resonance angiography (MRA)- techniques allow detailed study of the arterial tree with image quality similar to that of conven tional arteriography. From April 1997 to January 2001, 30 patients with intermittent claudica tion of the lower limbs were studied with both imaging methods. In each case, the MRA images were examined first and the arteriographic images were examined 15 days later. Examiners interpreting the arteriographic images were blinded to the results of the corresponding MRA images. After each examination (MRA and arteriography), a vascular surgeon suggested a surgical plan. MRA showed results similar to those of arteriography, although with inferior image quality. No patient had an allergic reaction or side effects due to administration of contrast material. There was total agreement between MRA and arteriography in regard to the morphologic analysis and proposed surgical plans in every case. In conclusion, MRA is a feasible, useful, and less invasive alternative for the morphologic evaluation of the aortofemoral area in patients with intermittent claudication of lower limbs.
A Young Girl with Vasospastic Angina Associated with Mutation in Endothelial Nitric Oxide Synthase Gene
Authors: Fukuda Naoto , Kurokawa Singo , Maeda Kayo , Iseki Sae , Takahasi Motoi , Niwano Hiroe , Nakazato Kazumi , Niwano Shinichi , Kurosawa Toshiro , Izumi Tohru
Published: July 2008

A 13-year-old girl was successfully recuperated from cardiopulmonary arrest shortly after running 80 m in a competition. The electrocardiogram, echocardiogram and 123 I-MIBG myocar dial scintigraphic imaging indicated myocardial ischemia in the anteroseptal wall of the left ventricle. Coronary angiography during the recovery phase revealed no stenotic lesions, and spasms of the left anterior descending artery and the left circumflex artery could be provoked by acetylcholine. The endothelial nitric oxide synthase gene abnormality associated with coronary spasms was examined. The patient had the T-786→C, A-922→G, and T-1468 →A mutations in the 5'-flanking region on one allele of the endothelial nitric oxide synthase gene. To the authors' knowledge, she represents the first case of life-threatening coronary spasms in childhood associated with mutations in the endothelial nitric oxide synthase gene.
Diabetes Mellitus Adversely Affects the Outcomes of Thrombolytic Therapy in Patients with Acute Myocardial Infarction
Authors: Tikiz Hakan , Tezcan Ugur , Ileri Mehmet , Balbay Yücel , Atak Ramazan , Kütük Emine
Published: July 2008

This study was performed to evaluate whether coexistent diabetes mellitus has any adverse effect on the outcomes of thrombolytic therapy in patients with acute myocardial infarction. Although the early reperfusion rates were similar between the two groups of patients who had acute myocardial infarction with and without diabetes mellitus (42% vs 45.4%, p > 0.05), the results of late angiographic examination showed a significantly lower rate of patency in infarct- related coronary artery (defined as TIMI 3 flow) in diabetics compared to nondiabetics (28.9% vs 41.3%, p< 0.001). The global left ventricular function was also poorer in diabetics (left ventricular wall motion score was 18.6 ±7.3 in diabetics and 14.1 ±4.6 in nondiabetics, p < 0.01 1).
Superior Vena Cava Thrombosis in Chronic Lead Exposure
Authors: Köklü Seyfettin , Aksoy Duygu Yazgan , Altundag Kadri , Usalan Celalettin
Published: July 2008

Thrombosis is a rare cause of superior vena cava syndrome (SVCS). A 43-year-old male patient with SVCS due to thrombosis underwent investigation for the etiology of thrombus formation. He had been hospitalized several times because of lead intoxication in the past. Lead has a known thrombogenetic effect experimentally. This patient with superior vena cava thrombosis had thrombophilia that was probably due to lead intoxication. The etiologies of venous throm bosis and thrombogenetic effect of chronic lead exposure are discussed.
Left Ventricular Mass in Dippers and Nondippers with Newly Diagnosed Hypertension
Authors: Cicconetti Paolo , Morelli Sergio , De Serra Caterina , Ciotti Veronica , Chiarotti Flavia , de Marle Manfredi Giusti , Ottaviani Luigi , Riolo Noemi , Marigliano Vincenzo
Published: July 2008

Hypertensive subjects can be subdivided into 2 groups, dippers and nondippers, according to the presence or the lack of a nocturnal fall of blood pressure of more than 10%. Several studies have investigated cardiac organ damage in the 2 groups with discordant results, but they included subjects with different onset, severity, and treatment of hypertension. The authors selected 23 dippers and 17 nondippers affected by newly (< 1 year) diagnosed grades 1 and 2 hypertension, never treated, who underwent 24-hour ambulatory blood pressure monitoring and M-mode echocardiography. They did not find significant differences between the 2 groups as regards the echocardiographic left ventricular and atrial dimensions or regarding the left ventricular mass, left ventricular mass index, or relative wall thickness. Also no significant differences were found in the rate of either left ventricular remodeling or left ventricular hyper trophy. These data suggest that nondipping status is not associated with a higher level of cardiac involvement in the early phases of hypertension compared to dipping status.
The Effect of Short-Term Treatment with Simvastatin on Renal Function in Patients with Peripheral Arterial Disease
Authors: Youssef Fahed , Gupta Prakash , Seifalian Alexander M. , Myint Fiona , Mikhailidis Dimitri P. , Hamilton George
Published: July 2008

The objective of this study was to investigate the effects of lipid-lowering treatment on renal function in patients with peripheral arterial disease (PAD). This was a retrospective study of hyperlipidemic claudicants referred to a vascular surgery and risk modification clinic. Serum creatinine and urate concentrations and the fasting lipid profile were measured pretreatment and after 3-4 months of treatment with 20 mg/day simvastatin. In 103 consecutive patients with PAD (57 men; 46 women), median age 67 years (range: 51 to 83) there was a significant decrease in serum creatinine from a mean (SD) of 87 (12) μmol/L pretreatment to 84 (12) μmol/L post-treatment (p<0.0001). This difference was more marked in the tertile of patients with the highest baseline creatinine levels. There was also a significant reduction in serum urate from 0.37 (0.07) mmol/L to 0.35 (0.07) mmol/L (p<0.0001). Both these effects were independent of the degree of total cholesterol (TC) or low-density lipoprotein (LDL) cholesterol reduction. There was a significant reduction in TC from 6.6 (1.0) to 5.2 (0.8) mmol/L and LDL cholesterol from 4.3 (1.0) to 2.8 (0.7) mmol/L; both p<0.0001. Significant improvement also occurred in the high-density lipoprotein cholesterol and triglyceride levels. Cholesterol lowering with simvas tatin 20 mg/day improved indices of renal function after 3-4 months of treatment in hyper lipidemic patients with PAD. Further studies are needed to establish and define the clinical relevance of these findings, especially in patients with different degrees of renal failure.
Congenital Familial Vascular Anomalies: A Study of Patients with an Anomalous Inferior Vena Cava, and of Their First-Degree Relatives
Authors: Obernosterer Andrea , Aschauer Manuela , Mitterhammer Heike , Lipp Rainer W.
Published: July 2008

With magnetic resonance angiography and computed tomography, congenital anomalies of the inferior vena cava are diagnosed more frequently than they used to be. Accessory renal arteries identified by magnetic resonance angiography in a patient with an anomalous inferior vena cava indicated a combination of arterial and venous abnormalities. The study was initiated to screen consecutive patients with an anomalous inferior vena cava for concomitant abdominal and pelvic arterial abnormalities, and their first-degree relatives for congenital vascular anomalies. Magnetic resonance angiography identified in 2 of 5 patients with an anomalous inferior vena cava concomitant accessory renal arteries and in 5 of 11 first-degree relatives major abdominal vascular anomalies including accessory renal arteries, accessory renal veins, and anomalies of the hepatic artery. None of the relatives showed abnormalities of the inferior vena cava. The familial occurrence of vascular anomalies strongly suggests an underlying pathogenetic component in affected family members. In patients with a congenital anomaly of the inferior vena cava, concomitant arterial abnormalities should be considered. First-degree relatives may be at risk for congenital vascular anomalies.
New-Onset Congestive Heart Failure Secondary to a "Huge" Right Atrial Mass
Authors: Kassotis John , Riboti Zakhariy , Saul Barry I. , Tan Jian-You , Gopa Chitra , Reddy Chatla V. R. , Makan Majesh
Published: July 2008

Transesophageal echocardiography is a useful adjunct to other diagnostic modalities in uncov ering the etiology of congestive heart failure. The authors describe the case of a 75-year-old woman with a 4-week history of progressive congestive heart failure, in whom trans esophageal echocardiography played a critical role in the diagnosis of a right atrial mass, accounting for this patient's constellation of symptoms.
Capecitabine-Induced Coronary Vasospasm
Authors: Rizvi Asad A. , Schauer Peter , Owlia Dariush , Kallal James E.
Published: July 2008

The authors report the case of a 70-year-old man with metastatic colon cancer and no known history of coronary disease or major risk factors who developed coronary vasospasm after the initiation of capecitabine (Xeloda®). Although coronary vasospasm has been associated with another older fluoropyrimidine compound, 5-fluorouracil, this is the first reported occurrence with this relatively newer cancer drug.
Risk Factors for Coronary Atherosclerosis in the Elderly
Authors: Mukerji Vaskar , Holman Andrew J. , Artis André K. , Alpert Martin A. , Hewett John E.
Published: July 2008

To determine the importance of traditional risk factors for coronary artery disease (CAD) in the elderly, the authors studied 64 consecutive patients with angiographically nor mal or near-normal coronary arteries and 64 patients with CAD. All pa tients were ≥ sixty years old. The risk factors studied were male sex, hypertension, diabetes mellitus, hy percholesterolemia, cigarette smok ing, sedentary life-style, and family history. The prevalence of these risk factors in the two groups of patients was compared. The results suggest that in persons ≥ 60 years old, male sex and cigarette smoking continue to remain risk factors for CAD. Since most of the patients with diabetes and hypertension were on medical man agement for their condition, the au thors' findings also suggest that diabetes mellitus, even under treat ment, remains an important risk fac tor for CAD in the elderly but controlled hypertension does not. Other traditional risk factors (hyper cholesterolemia, sedentary life-style, and family history) do not discrimi nate individuals with moderate to se vere CAD from those with normal or near-normal coronary arteries in persons ≥ sixty years old.
Controlled Comparison of Ketanserin and Nifedipine in Raynaud's Phenomenon
Authors: Codella O. , Caramaschi P. , Olivieri O. , Perbellini L. , Perbellini A. , Bambara L.M. , Corrocher R. , De Sandre G.
Published: July 2008

Twenty-eight patients suffering from either primary or secondary Ray naud's phenomenon were treated with nifedipine and ketanserin. Each patient was treated with one of the two drugs administered after an adequate washout period. Furthermore each patient was submitted before and after treatment with each drug to computerized digital thermometry to evaluate the therapeutic response. The data obtained during the intake of the two drugs at zero, five, and twenty-three minutes were compared with thermometry-relevant baseline data at the same periods. Ketanserin proved to be useful in the treatment of Raynaud's phenomenon and statistically significantly superior (a < 0.05) with respect to nifedipine in the thermometric controls and also in the subjective evaluation of the patients (p < 0.02). In this study nifedipine did not show par ticular efficacy. Furthermore only 2 patients had to discontinue treatment with ketanserin, whereas 8 had to discontinue treatment with nifedipine (p < 0.001).
Brachial Artery Catheterization Via Cutdown and A Direct Needle Puncture
Authors: Vaghei Reza , Terrell Ernest B. , Kunyosying Udom
Published: July 2008

Brachial artery catheterization via cutdown and a direct needle puncture was evaluated in 369 patients undergoing arteriography at the authors' medical center from January, 1970, to March, 1988. The indications for retrograde brachial arteriography were absence of palpable femoral pulses, failure of a femoral approach, previous aortic bypass surgery, and/or aneurysms of the ab dominal aorta. The technique and results are described. Two patients lost their radial pulse; 1 of them had thrombectomy and, one year later, developed an aneurysm at the site of the needle puncture. The authors conclude that catheter ization of the brachial artery through direct needle puncture is a safe procedure with good results.
Exercise First-Pass Radionuclide Assessment of Left and Right Ventricular Function and Valvular Regurgitation in Symptomatic Mitral Valve Prolapse
Authors: Lumia Frank J. , LaManna Margaret M. , Atfeh Mowaffak , Maranhao Vladir
Published: July 2008

The changes in right ventricular (RV) and left ventricular (LV) function and in regurgitant fractions on first-pass exercise radionuclide angiography (RNA) were assessed in 29 consecutive patients with symptomatic mitral valve prolapse (MVP).

The mean right ventricular ejection fraction (RVEF) was 35±8% at rest and 46±15% after exercise (p < 0.001). The mean left ventricular ejection fraction (LVEF) was 62 ± 11 % at rest and 74±13% after exercise (p < 0.001) . Seven of 29 patients had an abnormal RV response and 6 had an abnormal LV response. Eight had abnormal wall motion after exercise. A total of 12/29 patients (41 %) had one or more abnormalities.

The mean left-sided regurgitant fraction before exercise was 27±17% in 21/29 patients (72%) and 31±21% after exercise (p=ns) . An additional 5 pa tients (17%) developed left-sided regurgitation after exercise.

These fmdings indicate that wall motion abnormalities and abnormal RVEF and LVEF responses to exercise occur in symptomatic MVP patients. In addi tion, 26/29 (89.6%) had left-sided regurgitation after exercise.

Since the presence of a murmur did not correlate with the presence of mitral regurgitation by RNA, then symptomatic patients with MVP should have first- pass exercise RNA to assess the presence of regurgitation at rest and after exer cise. Antibiotic prophylaxis is recommended in MVP patients with systolic mur murs or with regurgitation. Since patients without murmurs can have regurgi tation, further study is necessary to determine the need for endocarditis pro phylaxis in these patients.
Effect of Nifedipine on the Sick Sinus Syndrome
Authors: Kouvaras George , Chronopoulos George , Nikolaou Periklis , Sofronas George , Cokkinos Dennis
Published: July 2008

The effect of nifedipine (N) on sinus node (SN) function was studied in 15 patients (9 males, 6 females) sixty-two to seventy-six (mean 68.1 ±11) years old, with sick sinus syndrome (SSS). SSS was characterized electrophysiologically by a prolonged corrected sinus node recovery time (CSNRT > 535 msec) and/or prolonged sinoatrial conduction time (SACT > 125 msec), assessed by applying premature atrial stimulation. Ten mg N was given sublingually, and CSNRT and SACT were again evaluated sixty minutes after N administration, and again ten minutes after 1.5 mg atropine (A) was given IV. Heart rate increased significantly after N (p < 0.005), systolic blood pressure (SBP) diminished sig nificantly (p < 0.005), and CSNRT and SACT shortened significantly (p < 0.005, p < 0.005) and became normal in 7 and 5 patients respectively. After A administration, a further significant increase of heart rate (p < 0.005) and decrease of CSNRT (p < 0.005) and SACT (p < 0.005) were observed. CSNRT and SACT became normal in 8 and 7 patients respectively. SBP remained sta ble.
An Improved Noninvasive Method for Measurement of Cardiac Output and Evaluation of Left-Sided Cardiac Valve Incompetence
Authors: Kelbaek Henning
Published: July 2008

A time-saving method was devel oped to label red blood cells in vitro with 99mTc while avoiding centrifuga tion. After tin incubation, extracellu lar tin was oxidized by sodium hypochlorite, and EDTA was added for stabilizing the complex prior to 99mTc incubation. Labeling yields were 95%, and in vivo decay showed a high stability with a mean biologic half-life of eleven hours.

The first-passage radionuclide technique for determination of car diac output using the above-men tioned tracer was evaluated by using the left ventricle as area-of-interest with individual background correc tion after complete mixing of the tracer. This technique showed a high level of agreement with invasive methods.

By combining this method for measurement of the forward stroke volume with the multigated equilib rium principle for determination of the total left ventricular stroke vol ume using similar background cor rections, an exact evaluation of re gurgitation fractions was obtained. In patients with aortic and mitral valve disease the noninvasive radio nuclide technique gave similar but probably more accurate results as compared with contrast aortography and ventriculography. The radionu clide technique may be suitable for monitoring and selecting patients for surgical treatment.
Real-Time Ultrasound for Diagnosis of Symptomatic Venous Thrombosis and for Screening of Patients at Risk: Correlation with Ascending Conventional Venography
Authors: Monreal Manuel , Montserrat Enric , Salvador Rafael , Bechini Jordi , Donoso Lluis , MaCallejas Jose , Foz Marius
Published: July 2008

This is a prospective study of 108 patients in two distinct groups undergoing real-time ultrasonography (US) and ascending conventional venography within the same day. The two patient groups consisted of the following: Those patients evaluated because of suspicion of deep venous thrombosis of lower limbs (69 patients) and those at high risk for venous thrombosis (19 patients with a recent hip fracture, 20 with a suspected pulmonary embolism). In the diagnosis group 48 patients had venographic evidence of thrombosis. The predictive value of abnormal findings from real-time US was 97%, and that of a negative study was 75%. Thus, real-time US may have a role as a diagnostic procedure, to be fol lowed by x-ray venography in patients with negative US results.

By contrast, real-time US is far less sensitive as a screening test in patients without clinical evidence of thrombosis. Only 3 of 9 patients with thrombosis were detected, with a 50% sensitivity for proximal vein thrombosis. Therefore, the use of real-time US for screening high-risk patients must be limited to very high risk patients in whom other tests are ineffective (as in hip surgery).