bluuebunny/crossref_metadata_2025 huggingface dataset:
Comparison of Left Ventricular Ejection Fraction by Cine Computed Tomography and Single Plane Right Anterior Oblique Ventriculography
Authors: MacMillan Robert M. , Rees Michael R. , Maranhao Vladir , Clark Donald L.
Published: November 2007

Cine Computed Tomography (CCT) is a minimally invasive technique which offers high temporal (50 msec scan time) and spatial (2 line pairs) resolution. Left ventricular ejection fraction (LVEF) has been determined by this technique in dogs and normal subjects but no comparison has been made with contrast left ventriculography by cardiac catheterization. Ten patients, 9 male and 1 female, mean age 61 (range 46-70) had LVEF determined by both single plane RAO left ventriculography and CCT. Patients were studied in the fasting state, on differ ent days without change in medication. LVEF by CCT was determined in the long axis, a new view which has been developed for CCT to be comparable to the RAO view of contrast left ventriculography by catheterization. This view is obtained by positioning the patient head first into the scanner, supine, with a counterclockwise table slew (20°) without table tilt. Contrast is introduced via a median antecubital vein, and injected in a prolonged bolus of 7-13 seconds de pendent on arm to heart circulation time. Scans are performed in the cine mode (17 frames/sec) timed during maximal opacification of the right and left ventri cles. Four or six contiguous levels are imaged as required to slice the entire left ventricular cavity. End-systolic and end-diastolic frames are identified. Left ventricular cavity areas are determined by computerized planimetry after the Hounsfield level number is set at half the difference between the contrast in the cavity and the myocardium and setting the window width at one giving a black and white image. Left ventricular end-diastolic volume (LVEDV) and end-sys tolic volume (LVESV) per slice are summated to obtain LVEDV and LVESV from which LVEF is desired. LVEF was also determined in the same patients using single plane RAO contrast ventriculography at cardiac catheterization employing the area-length method. The LVEF was the average of two sinus beats not preceded by an extrasystole. Mean LVEF for CCT was 0.61 (range 0.38-0.80) versus catheterization LVEF of 0.56 (range 0.42-0.80). Comparing both methods we found a significant correlation (r = .92). We conclude that CCT determination of LVEF using the long axis view is a reliable method.
Failure of a Pure Anti-Platelet Drug to Decrease the Number of Attacks More Than Placebo in Patients With Raynaud's Phenomenon
Authors: Destors J.M. , Gauthier E. , Lelong S. , Boissel J.P.
Published: November 2007

Fifty-eight patients with Raynaud's phenomenon were randomly allocated in a six week double-blind clinical trial in parallel groups to compare the efficacy of a pure antiplatelet agent, ticlopidine (250 mg b.i.d.) with that of a placebo. There was no significant difference between the two treatments in percent re duction of weekly number of attacks and in subjective improvement assessed by both patient and investigator. It is unlikely that platelets are involved in the mechanisms of Raynaud's crisis.
Reduced Activity of Serum β-Glucuronidase in Marfan Syndrome
Authors: Nakashima Yasuhide
Published: November 2007

Reduced activity of serum β-glucuronidase (EC 3.2.1.31) was found in three patients with Marfan syndrome, two of whom were siblings. The serum β-glu curonidase levels in the patients ranged from 294 to 439 μg (360.7±73.2, mean±SD) of the released P-nitrophenol/100 ml of serum/hour, whereas those of 7 healthy subjects ranged from 564 to 1445 μg (836.4±287.3). This difference was statistically significant (p < 0.01).

Plasma glycosaminoglycan levels in the patients were lower than those in the healthy subjects, owing mainly to the differences in plasma high-sulfated glyco saminoglycan. The correlation coefficients of serum β-glucuronidase activity with high-sulfated and total plasma glycosaminoglycans were 0.794 and 0.809, respectively (p<0.01 and p < 0.005, respectively).

The results suggest that the decreased plasma high-sulfated glycosaminogly can levels in Marfan syndrome are due to the reduction of serum β-glucuroni dase, which leads to the decreased degradation of macromolecules and, subsequently, the accumulation of the glycosaminoglycans in the tissues.
Replacement of Ruptured Aneurysm of Arteriovenous Fistula by Segmental Frozen Venous Allograft: A Case Report
Authors: Halevy Ariel , Weissgarten Joshua , Modai David , Averbukh Zhan , Orda Ruben
Published: November 2007

A ruptured aneurysm of an arteriovenous fistula created for chronic hemodialysis was replaced by a segment of frozen saphenous vein allograft. Fifteen months following the procedure the graft is patent. Frozen vein allografts should be considered as an appropriate option for the reconstruction of disrupted A-V fistulae.
Autopsy Incidence of Pulmonary Vascular Episodes. A Study of 218 Cases
Authors: Datta B.N. , Ramesh K. , Bhusnurmath Bharti
Published: November 2007

Pulmonary thromboembolism is a rarity in India. This common clinical im pression has so far not been tested. Among 7000 autopsies between 1964 and 1980, a total of 218 cases (126 males and 92 females) were recorded to have thrombosis and/or embolism and/or infarction in the lungs. This incidence of 3.1% is far lower than that reported in the West and similar to the low incidence in Africa. Of the 218 cases, 42.6% had a cardiac disease, 18.3% had systemic septicemia, 13% had a malignancy, 12.8% had pulmonary disease, and the re maining suffered from diseases of liver, kidney, CNS, etc.

Of the 218 cases, 141 (64.6%) showed only infarcts, 40 (18.3%) had only thromboemboli, and 37 (16.9%) showed both events.

In view of the overlap among these three conditions and their essential pathophysiologic identity (thrombus/embolism/infarction), it is suggested that these be grouped under the name "pulmonary vascular episode."
A New Method for the Quantitative Assessment of Arterial Insufficiency of the Limbs: Cutaneous Postischemic Hyperemia Test by Laser Doppler
Authors: Leonardo Giuseppe , Arpaia Maria Rosaria , Del Guercio Raffaele
Published: November 2007

The cutaneous postischemic hyperemia test, by means of laser Doppler flowmetry, was carried out on 71 normal, healthy lower extremities and 138 lower limbs suffering from peripheral occlusive arterial disease. The test, a new technique for evaluating the hemodynamics of limbs, permitted a clear distinction between normal, healthy subjects and patients suffering from arterial disorders. It was also seen that the degree of deterioration in the quantitative parameters was quite obviously related to the seriousness of the clinical picture. A comparison of the more severely and less severely affected limbs of each patient and the values taken bilaterally gave a correspondence of 98.6%. A therapeutic cycle consisting of the intraarterial administration of naftidrofuryl in 20 limbs achieved a statistically significant improvement in two parameters (tL and tR). Four limbs were treated with percutaneous transluminal angioplasty. After treatment the values obtained with the test were found to be absolutely normal. It is therefore suggested that this test be widely adopted in vascular diagnostic laboratories.
Aneurysms of the Pulmonary Arteries—A Case Report
Authors: Gould Lawrence , Yang David C. , Patel C. , Patel D. , Lee J. , Judge D. , Taddeo M.
Published: November 2007

A fifty-five-year-old male demonstrated over a three-year period marked enlargement of pulmonary aneurysms. This can be a fatal condition owing to rupture of the aneurysms.
Effects of Pentoxifylline on Severe Intermittent Claudication
Authors: Reich Theobald , Gillings Dennis
Published: November 2007

Pentoxifylline has been shown to improve treadmill walking distances under blinded, controlled conditions in patients with intermittent claudication. From the pooled data of a blinded, controlled, randomized, multicenter trial, the data from all enrolled patients with severe claudication ( < 70 m on treadmill at base line) were evaluated. The treadmill data from these more severely ill patients were analyzed separately as a "severe subset" (placebo n = 17; pentoxifylline n=21). No differences between the two treatment groups were observed in de mography, history, or baseline treadmill walking distances. The initial claudica tion distance (ICD) improved 68% over baseline with pentoxifylline and 12% with placebo (p=.012) after twenty-four weeks of treatment. A new, derived efficacy variable was developed, "minimum distance walked," which tended to minimize psychological effects on treadmill performance. Over sixteen to twenty-four weeks of treatment, the pentoxifylline group improved 49% over baseline and the placebo group 3% (p=.019), when the "minimum distance walked" measurement was used. In this controlled trial the subset of patients with severe intermittent claudication benefited from pentoxifylline therapy.
Circulating Dopamine in Raynaud's Phenomenon
Authors: Marasini Bianca , Biondi Maria Luisa , Agostoni Angelo
Published: November 2007

Plasma free and conjugated and intraplatelet free dopamine, norep inephrine, and epinephrine levels were determined by high-performance liquid chromatography coupled with electrochemical detection for 20 subjects with Raynaud's phenomenon of various etiologies.

Circulating free dopamine and epinephrine were significantly lower in Ray naud's patients than in controls (dopamine 26.0±13.6 vs 56.3+39.6 pg/ml, p<0.005; epinephrine 25.8±16.9 vs 56.9±40.9 pg/ml, p < 0.005), while the corresponding conjugated forms in plasma and the intraplatelet contents were within normal limits. There were no abnormalities in plasma free, conjugated, or intraplatelet free norepinephrine. All of the levels were independent of the etiology, the duration, and the severity of the disease.

The reduced plasma levels of free dopamine and epinephrine might be due to impaired adrenal release in response to some kinds of sympathetic stimulation or to rapid tissue uptake and peripheral metabolism. A possible role for a post- ischemic dopaminergic vasodilating system is discussed.
Intermittent Claudication: Predictors and Outcome
Authors: Naschitz Johanan E. , Ambrosio Deborah Ann , Chang John B.
Published: November 2007

The authors reviewed 460 patients with intermittent claudication. With primarily conservative management, these patients were followed for an average of 4.1 years (one to ten years). The mean age was 71.7 years, ranging from thirty-six to eighty-four years; 55.9% were males. The subsequent follow-up study revealed that the status of 44.1% of the patients with underlying arterial insufficiency deteriorated. Eventually, they underwent vascular surgery for limb-threatening ischemia. From this study, the analysis of the parameters could predict the clinical outcome of intermittent claudication at the time of initial and follow-up evaluation. During initial evaluation, when the ankle brachial index (ABI) was higher than 0.7 or when follow-up evaluation did not show a decrease of ABI by 0.15, the chance of favorable outcome was increased by 2.4 and 1.6 times respectively. When the ABI was less than 0.5 at the initial evaluation and decreased 0.15 or more during follow-up studies, the risk of requiring vascular surgery for limb salvage increased by 3.8 and 1.9 times, respectively. The onset of major vascular events in other areas appeared to influence the time of significant deterioration in the lower limb arterial disease, indicating multifactorial and systemic contribution in the natural history of intermittent claudication. In this homogeneous patient population with arterial insufficiency referred to the vascular surgeon, conservative management with strong supervision for smoking cessation, exercise, diet control, body weight reduction, and medical regimen can modify the natural course of intermittent claudication and associated vascular problems.
Hemorheologic Factors in the Postacute Phase of Ischemic Stroke
Authors: Ciuffetti Giovanni , Mercuri Michele , Parnetti Lucilla , Lupattelli Graziana , Senin Umberto
Published: November 2007

Clinical and hemorheologic data were recorded in a homogeneous group of 72 patients (age range sixty-one to seventy years), suffering from ischemic stroke with an onset of less than eight hours, confirmed clinically and by com puterized tomography. A quantitative neurologic analysis and the following he morheologic parameters were monitored for twenty weeks following the acute episode: fibrinogen, total proteins, albumin, hematocrit, leukocyte and platelet counts, whole blood filterability (WBF), red blood cell deformability (RBCD), and blood plasma, and serum viscosity. The results show a significant decrease in hematocrit values parallel to the clinical neurologic improvement and a sig nificant increase in RBCD in the patients with the better clinical recovery. These data confirm the role of hemorheologic parameters in the clinical follow-up of cerebrovascular disorders.
Morphodynamic Interpretation of Acute Coronary Thrombosis, with Special Reference to Volcano-Like Eruption of Atheromatous Plaque Caused by Coronary Artery Spasm
Authors: Penha Pedro D. , Zak Frederick G. , Lin Judith C. , Lin Ching-Shen
Published: November 2007

Routine autopsy studies of hearts with coronary thrombosis, collected over a period of eleven years, showed unique morphologic features of rup ture of soft atheromatous plaques. These features include: (1) irregular luminar outline: angulation, invagi nation, upheaval, and/or wrinkles, (2) wavy outline of atheromatous cav ity, (3) volcano-like rupture with seepage or gushing of semiliquid ath eromatous contents into lumen, (4) cholesterol crystals arranged in rheo logic vector direction, (5) rupture of deeper intimal fibrous tissue, (6) one or multiple intimal upheavals, (7) fo cal thickening of contracted media, (8) vestige of volcano-like eruption with organized thrombus, and (9) old thrombotic occlusion with wavy ap pearance of thick intimal fibrous tis sue.

The authors present a dynamic model of vasoconstriction or artery spasm that accounts for these fea tures and the rupture of soft ather omatous plaques.
Localization of Experimental Calcification in Rabbit Blood Vessels with Particular Reference to Hemodynamics
Authors: Stehbens William E.
Published: November 2007

An observational study was made of the localization of experimental calcification of blood vessels induced by hypervitaminosis D in 15 stock rabbits, in 10 rabbits with arteriovenous fistulae, and in 6 rabbits with experimental saccular aneurysms. An arteriotomy and a phlebotomy were performed on several animals from each group. The pulmonary trunk, aorta, common carotid arteries, and external jugular veins were dissected and stained with silver nitrate to demonstrate calcification macroscopically. The first major bifurcation from 37 renal arteries from these animals was examined by the serial section technique to localize calcification about the arterial forks histologically. There was evidence that early calcification was flow related with a predilection for sites where atrophic lesions occur. Proliferative lesions in which matrix vesicles are abundant exhibited no such predisposition. It was concluded that matrix vesicles do not appear to be susceptible to vitamin D calcification. The topography of the experimental calcification differed from that of diet-induced lipid deposition.
Recurrent Giant Hypogastric Artery Aneurysms — A Case Report
Authors: Golden Richard L. , Bauman Judah , Johnstone Margaret , Pindyck Frank
Published: November 2007

Aneurysms of the hypogastric artery are rare occurrences that are frequently asymptomatic until the time of rupture. When signs and symptoms are present, a pulsatile pelvic mass, frequently detected by rectal or vaginal examination, may produce compression symptoms with urologic, gastrointestinal, and neurologic manifestations. In addition to classical invasive methods of detection such as angiography, newer noninvasive imaging techniques, including ultrasonography, computerized tomography, and magnetic resonance imaging, may be employed to establish the diagnosis. Proximal ligation of the hypogastric artery is the usual method of treatment. A case of bilateral, giant hypogastric artery aneurysms with successful surgical management is reported.
Value and Limits of "Critical Auscultation" of Neck Bruits
Authors: Floriani M. , Giulini S.M. , Bonardelli S. , Portolani N. , Benvenuti M. , Pouchè A. , Tiberio G.
Published: November 2007

Within a group of 2,000 patients evaluated, most of them with symptoms of cerebrovascular insufficiency, 441 had a monolateral or bilateral cervical bruit. The 627 sides with an audible bruit were divided into main groups (A) sympto matic (TIA and/or stroke homolateral to the bruit), (B) possibly symptomatic (non-side-related symptoms), (C) asymptomatic (Cl, in totally asymptomatic patients; C2, in patients with symptoms dependent on the hemisphere contralat eral to the cervical bruit). Each patient was studied by means of clinical (history, blood pressure in both upper limbs, phonoendoscopic auscultation at various levels) and noninvasive instrumental examinations (CW Doppler spectrum anal ysis). An apparently primitive cervical bruit corresponded to a lesion of the carotid bifurcation in 61% of the cases (positive predictive value) whereas a normal bifurcation was detected in 70% of the cases in which the cervical bruit was considered as secondary (negative predictive value); the diagnostic accu racy of the "critical auscultation" has a value therefore of 63%, with a sensitiv ity of 84% and a specificity of 40%. The results obtained in the different groups of patients (symptomatic or asymptomatic) were not significantly different (chi square). Even though maintaining the value of a cervical bruit as a sign of carotid stenosis or occlusion and consequently confirming the importance of neck auscultation, the authors conclude that the critical auscultation as com monly performed is not capable of excluding the presence of a carotid lesion with sufficient reliability, even in totally asymptomatic patients.
Intralobar Sequestration of Upper Lobe of Right Lung — Case Reports
Authors: Gupta Shri Krishna , Abraham Abraham K. , Mani Ganesh K.
Published: November 2007

Two cases of intralobar sequestration of the right upper lobe, which is sup plied by a major anomalous collateral artery from the descending thoracic aorta and also by the upper lobe branch of the right pulmonary artery, are presented. Both cases underwent surgical correction. The plexus of abnormal vessels in the right upper lobe of the lung communicating to the anomalous collateral artery was unexpected. The return pathway into the right pulmonary artery was most unusual.

The embryologic explanation of the anomaly and the surgical implications are discussed. The return pathway of the left-to-right shunt by a branch of the pulmonary artery is most unusual and has hitherto not been reported in English literature to the best of the authors' knowledge.
Restrictive Cardiomyopathy Following Acute Myocarditis—A Case Report
Authors: Katayama Tomoyuki , Iwamoto Keiji , Ochi Shizuka , Honda Yukiharu , Shigematsu Kazuto
Published: November 2007

A fifty-five-year-old man developed intractable heart failure four weeks after upper respiratory infection. His central venous pressure was as high as 300 mmH2O. Two-dimensional echocardiogram revealed no muscular hypertrophy of the ventricles, no pericardial thickness, and no pericardial effusion. On catheterization, hemodynamic data were compatible with restrictive cardiomyopathy. Transvenous endomyocardial biopsy of the left ventricle was performed. Histologic examination strongly suggested that cardiomyopathy developed after acute myocarditis.
Lower Extremity Amputation: Open Versus Closed
Authors: Senkowsky Jon , Money Matthew K. , Kerstein Morris D.
Published: November 2007

Wound breakdown was assessed in 117 amputations for nonhealing lesions and peripheral vascular closure (χ2 10.34). Nonhealing occurred in 10/63 amputations with primary skin closure when compared with those not closed (p < .01). All 54 amputation sites treated by the open technique healed without revision. Of 22 toe amputations, the open technique performed in 14 patients required a mean of nine postoperative days; the closed-toe amputation technique performed in 8 patients needed a mean of 5.8 days; the closed-toe amputation requiring revision needed a mean of 36.3 days. Healing rates were significantly different when the wound was left open versus primarily closed (χ2 8.56 p < .01). Nineteen transmetatarsal amputations (TMA) were completed; 10 open TMAs required a mean of twenty-four days; 9 closed TMAs required a mean of fifteen days; and revision a mean of eighteen days. Of 51 below-the-knee amputations (BKA), 20 open BKAs required a mean of thirteen days; 3 closed BKAs required a mean of 18.5 days; and 1 revision required two hundred fifty-eight days postoperatively. Twenty-five above-the-knee amputations (AKA) were performed; the 10 open AKAs required a mean of sixteen days; the 15 closed AKAs required a mean of eleven days. There was no significant difference in healing rates of TMA, BKA, or AKA. Healing rates of toe amputations and amputation overall are, however, significantly different. Closed lower extremity amputation wounds require fewer hospital days than open, except if problems in wound healing require revision.
Reocclusion Prophylaxis with Dipyridamole Combined with Acetylsalicylic Acid Following PTA
Authors: Heiss H.W. , Just H. , Middleton D. , Deichsel G.
Published: November 2007

After primary successful PTA, 199 patients were randomized into one of three treatment groups, namely, placebo or a combination of 75 mg dipyridamole with either 330 mg (high dose) or 100 mg (low dose) acetylsalicylic acid (ASA) tid. The duration of treatment was six months. Of the 199 patients admitted to the study, 156 completed the six-month trial period. Not all patients had a second angiogram, and in these cases clinical findings were used in the evaluation.

Evaluation of the combined angiographic and clinical results showed improvement or no deterioration in 37% of patients in the placebo group compared with 49% in the low-dose and 61% in the high-dose ASA groups respectively. The only statistically significant difference observed was between the placebo group and the group treated with dipyridamole and high-dose ASA (p = 0.01). This difference remained statistically significant at p = 0.039 if only the angiographic findings were considered for group comparison. It cannot, however, be concluded from this study that 75 mg dipyridamole in combination with 100 mg ASA tid is more effective in preventing reocclusion after PTA than in combination with 330 mg ASA tid.
Pulmonary Tuberculosis with Multiple Saccular Aneurysms of the Aorta — A Case Report
Authors: Mally Ashith , D'Souza Charles , Dwivedi Shridhar , Shatapathi Pitambar
Published: November 2007

A forty-eight-year-old man presented with cavitary pulmonary tuberculosis and widening of the mediastinum. Mediastinal widening was due to multiple saccular aneurysms of the ascending aorta and the arch of the aorta. The various presentations of tubercular aortitis and the reasons for considering alternative etiology for the thoracic aneurysms in this case are discussed. The authors report this interesting association of pulmonary tuberculosis with luetic aortic aneurysm.
Effect of Captopril on Plasma Prolactin in Patients with Essential Hypertension
Authors: Saito Ikuo , Takeshita Eiko , Hayashi Satomi , Takenaka Tuneo , Murakami Marohito , Saruta Takao , Nagano Shiro , Sekihara Toshio
Published: November 2007

The effects of the angiotensin-converting enzyme inhibitor captopril on blood pressure, heart rate, plasma prolactin, and renin activity were examined in a single-blind, placebo-controlled trial on 30 patients with essential hypertension (15 given drug, 15 placebo). Captopril, 25 mg administered orally, reduced the blood pressure and increased the plasma renin activity. Captopril decreased mean plasma prolactin from 17.5±1.4 ng/mL to 9.1±1.0 ng/mL (p<0.001). Significant correlation was found between captopril-induced change from control values of plasma prolactin (Δplasma prolactin) vs Δplasma renin activity (r = -0.688, p<0.001). These results suggest that acute administration of captopril was accompanied by a reduction in plasma prolactin and that this reduction may be of clinical significance during therapy of hypertension.
Transvenous Sclerotherapy of the Gonadal Veins for Treatment of Varicocele: Long-Term Results
Authors: Salgarello Giovanni , Cagossi Marco , Salgarello Tommaso L. A. , Cotroneo Antonio R. , De Cinque Massimo , Patane Domenico , Falappa Piergiorgio
Published: November 2007

Percutaneous occlusion of the spermatic vein has been performed on 136 consecutive patients with varicocele scroti during the last six years. The authors report their long-term results on the first 119 cases to have a follow-up of at least six months. Occlusion of the insufficient gonadal vein is induced by the selective transcatheter injection of sclerosing agent with local anesthesia. Their patients are always evaluated before and after the procedure by Doppler examination. A spermiogram is done before the procedure and after six months. In this series they registered only 4 recurrences with no major complications.
Transcutaneous Measurement of Oxygen and Carbon Dioxide Tension (TcPO2 and TcPCO 2) during Treadmill Exercise in Patients with Arterial Occlusive Disease (AOD)—Stages I and II
Authors: Schmidt Jan André , Bracht Christiane , Leyhe Achim , von Wichert Peter
Published: November 2007

Transcutaneous oxygen and carbon dioxide tensions were measured during treadmill exercise in 30 patients with stages I and II arterial occlusive disease and 28 normal controls. Measuring sites were the dorsum of the foot and the frontal thorax. The calculated oxygen index at maximum exercise/rest (foot/ thorax) differentiated with 100% sensitivity and specifity between the two groups. The oxygen index was the only parameter with a significant positive correlation with the pain-free walking distance, whereas, eg, oscillography and Doppler analysis did not correlate. Carbon dioxide tensions showed significant differences only in the recovery time between patients and normal controls.
Syndrome of Diminished Vasodilator Reserve of the Coronary Microcirculation (Microvascular Angina or Syndrome X): Diagnosis by Combined Atrial Pacing and Thallium 201 Imaging—A Case Report
Authors: Magarian Gregory J. , Palac Robert , Reinhart Steven
Published: November 2007

Patients with angina-like chest pain without evidence of epicardial coronary artery disease or coronary arterial vasospasm are becoming increasingly recognized. These are often related to noncardiac causes including esophageal, musculoskeletal, and hyperventilatory or panic states. However, recently a subgroup of such patients are being recognized as having true myocardial ischemia and chest pain on the basis of diminished coronary microvascular vasodilatory reserve (microvascular ischemia or Syndrome X). The authors describe such a patient who was found to have replication of anginal pain associated with a reversible ischemic defect on thallium 201 imaging during atrial pacing, suggesting ischemia in this myocardial segment. Resolution of angina and ST segment electrocardiographic changes of ischemia occurred with cessation of pacing. We believe this is the first report of a patient with this form of myocardial ischemia diagnosed by this method and should be considered in patients with anginal chest pain after significant coronary artery disease and coronary vasospasm have been excluded.
The Effect of Dopexamine HCl Upon Collateral Perfusion of the Acutely Ischemic Myocardium in Anesthetized Dogs
Authors: Gosselin Anne-Marie , Biro G.P.
Published: November 2007

The effects of low-dose (10-9 and 3x10-9 mole/kg/min) infusions of dopexamine HCl, a new synthetic catecholamine with β2-adrenergic and DA 1-dopaminergic agonostic actions, was tested in anesthetized dogs, with and without acute ligation of the left anterior descending coronary artery. The infusions caused diastolic arterial blood pressure to fall by 12±4 and 23±5 mmHg, respectively. Microsphere-estimated collateral blood flow to the ischemic myocardium did not change significantly during the drug infusions. The findings suggest that low doses of dopexamine HCl do not cause coronary "steal" from acutely ischemic myo cardium.
Mucoid Vasculopathy of Unknown Etiology
Authors: Sandhyamani S.
Published: November 2007

A new vascular disorder with generalized deposition of abnormal amounts of acid mucopolysaccharide (AMPS) material in arteries, veins, and vasanervorum has been observed in a large number of autopsies at the author's institution. It is unlike any of the known vascular diseases and has emerged as a distinct disorder of vascular connective tissue. This has been named "mucoid vasculopathy of unknown etiology." This hitherto unreported entity is described here.
Serum-Erythropoietin Concentration During Acute Cardiogenic Pulmonary Edema
Authors: Kurz Robert W. , Stockenhuber Felix , Jahn Christian , Wurnig Christian , Balcke Peter
Published: November 2007

Reduced oxygen tension is regarded as the primary physiologic signal for the production of erythropoietin (EPO). There is little information available about early changes of EPO production in man due to severe hypoxia. The purpose of the present study was to examine the time course of EPO in serum of patients with acute cardiogenic pumonary edema (ACPE).

In 29 patients (seventy-five ± six years, mean age ± SEM) who were hospital ized within two hours after onset of symptoms of ACPE, serum EPO concentra tions were monitored for up to seventy-two hours. At the moment of admission all patients showed significantly increased EPO concentrations of 121 ± 64 mU/mL (mean ±SEM) compared with a healthy population (15-35 mU/mL). Twenty- three patients who recovered within thirty minutes (group A) exhibited a quick return of their EPO serum levels to normal. The remaining 6 patients (group B) had a protracted clinical course and their EPO concentration showed a further increase up to the end of the observation period.

The comparative monitoring of concentrations of alpha-1-proteinase inhibi tor, antithrombin III, C-reactive protein, fibronectin, hapotoglobin, and trans errin in serum and plasma revealed no significant changes. Thus a major contribution of fluid shifts into or from the intravascular compartment to the observed changes in EPO concentration seems to be unlikely.

The data suggest that the production and release of EPO in the kidneys due to altered oxygen delivery is a fast-responding mechanism.
Coronary Artery Aneurysms—A Case Study and Literature Review
Authors: Wright William P. , Alpert Martin A. , Mukerji Vaskar , Santolin Craig J.
Published: November 2007

Coronary artery aneurysms are detected with increasing frequency owing to the advent of coronary angiographies. Although most patients with coronary artery aneurysms are asymptomatic, manifestations of myocardial ischemia may occur. The case described herein serves as a basis for a discussion of the pathogenesis, clinical manifestations, detection, and treatment of coronary artery aneurysms.
Nuclear Magnetic Resonance Microscopy of Atheroma in Human Coronary Arteries
Authors: Pearlman Justin D. , Southern James F. , Ackerman Jerome L.
Published: November 2007

The purpose of this study was to use direct nuclear magnetic resonance (NMR) microscopy to quantitate and image accumulations of atheroma lipids in human coronary arteries and to validate the results by comparison with histologic preparations. NMR microscopy was performed on a superconducting experimental NMR imaging system operating at 2 Tesla with a probe designed for short echo time (TE), strong B 1 field strength, and small samples. Data acquisition used multiple-offset chemical encoding with offsets based on the thermotropic spectral signature of atheroma lipids within the human arterial vessel wall. Three separate channels of image data yielded color axis display of atheroma within the vessel walls. Atheroma location by histology was identified by rarefaction of stroma, as the lipids are extracted in the process of embedding in paraffin. Perimeters, areas, and a shape index (perimeter2:4πarea) of lumen, atheroma, and outer wall were determined and compared for NMR vs histology. There was no significant difference in the measurements with the exception of luminal shape indices, which were uniformly larger by histology, attributable to flattening of the vessels during histologic preparation. NMR measurement of atheroma content of coronary artery walls agreed well with histology (r = 0.996). NMR microscopy with color axis display proved able to quantitate and image atheroma in coronary arteries, obviating the distortions and lipid removal associated with fixation, embedding, and sectioning for histology.
A Pressor Effect of Noncardioselective Beta Blockers in Mildly Hypertensive Patients During Surgery Under Anesthesia
Authors: Cleophas Ton J.M. , Asselt Lies M. V. , Oudshoorn Nelly H. , Quadir Sajid U.
Published: November 2007

Sixty-two patients with mild hypertension were randomly assigned to receive no treatment, or 160 mg propranolol, or 200 mg metoprolol daily starting one week before elective surgery under anesthesia. The last dose was given two hours before anesthesia. Anesthesia consisted of induction with midazolam (2.5-5 mg) followed by thiopental (250-500 mg) and was maintained with 60% inspired N2O in oxygen and 0.4% enflurane inspired. Airway carbon dioxide was monitored continuously by a CO2 analyzer. Preoperative blood pressures were equally reduced by the two beta blockers. During anesthesia, however, blood pressure further decreased in the metoprolol group but not in the propranolol group.

The authors conclude that propranolol is less effective than metoprolol in mildly hypertensive patients during surgery under anesthesia, owing probably to a pressor response from propranolol during the stress of surgery. They also conclude, however, that the amount of blood pressure reduction by cardioselec tive beta blockade (metoprolol) may not be needed and that anesthesia itself is an effective means of reducing the blood pressure.
Studies on Blood Rheology in Patients with Primary Pulmonary Hypertension
Authors: Persson Sylvi Ulrika , Gustavsson Carl Gunner , Larsson Hans , Persson Stig
Published: November 2007

The rheologic properties of blood were studied in 6 patients with primary pulmonary hypertension (PPH) and compared with those of a control group of 10 healthy subjects. Blood viscosity was studied with a rotational viscometer and blood cell deformability with a filtrometer giving values for clogging particles (CP) and red cell transit time (RCTT). Blood viscosity at varying shear rates was found to be increased both at natural (p < 0.025-0.005) and standardized hematocrit, 45% (p < 0.05 at 40 s-1) in patients with PPH. Red cell deformabil ity was reduced as indicated by a significant increase of RCTT (p<0.01). In creased values for hematocrit (p < 0.001), hemoglobin concentration (p < 0.001), and erythrocyte count (p < 0.005) were found and decreased values for mean cor puscular hemoglobin concentration (MCHC) (p< 0.025) and HDL cholesterol (p < 0.005). Plasma viscosity, white cell deformability, white cell count, mean corpuscular volume (MCV), and plasma fibrinogen concentration did not sig nificantly differ from the values found in the control group. It is concluded that patients with PPH have impaired blood rheology. The hemorheologic abnor malities in these patients may be of hemodynamic significance.
Plasticity of Intercellular Junctions of Rat Liver Lymph Capillaries in Relation to Functional Conditions
Authors: Weber Elisabetta , Sacchi Giovanni , Comparini Leonetto
Published: November 2007

The junctions between endothelial cells in lymph capillaries may have differ ent degrees of complexity and have been classified as three types: "end to end" (EE), "overlapping" (OVL), and "interdigitating" (ID). Under normal condi tions, the more complex junction types (ID and OVL) are more frequent than the simple type (EE). The authors' hypothesis was that not only the folds and digitations of the endothelial profile but also the prevalence of the more com plex junction types under normal conditions impart plasticity and distensibility to the endothelial wall. To verify this hypothesis they performed a transmission electron microscope study of lymph capillaries of rat liver under normal condi tions and after treatment with histamine, which induces natural filling of lymph vessels. In lymph capillaries of histamine-treated animals they found a signifi cant prevalence of the simplest (EE) junctions (50 ±5% versus 20±4% in con trols, p < 0.001) over the more complex OVL (28 ± 4% versus 57 ± 4% in controls, p < 0.001) and ID junctions (12± 3% versus 19± 4% in controls, NS). The over all trend in junction types showed a highly significant shift toward the simpler types after histamine treatment (p < .0001). There was also a significant reduc tion in the mean length of adjoining cell borders from 1.5 ± 0.1 m in histamine- treated animals (p < 0.001). These findings indicate the participation of the junc tions in variations in capacity of lymph vessels in rat liver. This mobilization of cell junctions may also favor the drainage of interstitial fluids into the ab sorbing lymph vessels.
Does Pentoxifylline Prolong the Walking Distance in Exercised Claudicants? A Placebo-Controlled Double-Blind Trial
Authors: Ernst E. , Kollár L. , Resch K.L.
Published: November 2007

The aim of this study was to test whether in claudicants oral pentoxifylline, given for twelve weeks in addition to physical exercise, prolongs the walking distance more than placebo plus exercise. Forty outpatients were randomized into group A (2 x 600 mg oral pentoxifylline per day) or group B (placebo). Both groups received the same exercise program in addition. The maximal and painfree walking distances and blood viscosity were measured. Intergroup dif ferences in terms of blood viscosity reached the level of significance only after twelve weeks (p=0.006 at shear rate of 94.5 s-1), but values of group A continu ously decreased and those of group B continuously increased. After one and eight weeks, but not after twelve weeks, the maximal walking distances were significantly longer in group A than in group B. At no point were there signifi cant intergroup differences in terms of painfree walking distance. The data suggest that pentoxifylline is clinically effective in claudicants even when given in addition to exercise. The benefit of drug plus physical therapy compared with exercise alone could be observed mainly in the first weeks of treatment and may wear off during long-term therapy.
A Comparison of Dipyridamole Thallium 201 Scintigraphy and Clinical Examination in the Determination of Cardiac Risk Before Arterial Reconstruction
Authors: Vasehus Madsen Poul , Vissing Michael , Munck Ole , Kelbaek Henning
Published: November 2007

Preoperative clinical examination, including a 12-lead resting ECG, and pla nar dipyridamole thallium imaging (DTI) were compared in a prospective study of 65 vascular surgical patients in regard to their value for predicting postopera tive cardiac complications. Fifty-three patients underwent abdominal vascular procedures and 12 were operated on for peripheral artery disease.

Thirty-six patients had ischemic heart disease (IHD) and/or abnormal find ings from 12-lead resting ECG. Of these 36 patients, 11 had nonfatal cardiac complications. The remaining 29 patients were free of IHD and had normal results from ECG. No complications occurred among these 29 patients. There was no postoperative death.

Thallium imaging results were abnormal in 45 patients, showing either redis tribution and/or scar tissue or low washout. In 18 of these patients major changes with redistribution were present in all projections. Among these patients, 9 had a nonfatal cardiac complication. In the 27 patients with abnormalities in only one or two projections, only 2 had a cardiac event postoperatively. No cardiac complications occurred in patients with normal thallium scintigraphy findings.

The patients were operated on irrespective of the results of the scans, and all recovered from any cardiac complications that occurred.

In vascular surgical patients with previous IHD and/or abnormal findings from resting ECGs further risk stratification is achieved with DTI.
The Effect of Enalapril Maleate on Cerebral Blood Flow in Chronic Cerebral Infarction
Authors: Kobayashi Shotai , Yamaguchi Shuhei , Okada Kazunori , Suyama Nobuo , Bokura Kazunori , Murao Mituyoshi
Published: November 2007

The influence of long-term oral administration of enalapril maleate (an an giotensin II-converting enzyme inhibitor) on regional cerebral blood flow (rCBF) was studied in 10 patients with chronic cerebral infarction. The rCBF was meas ured by a 133Xe inhalation method before and after a mean of sixty-five days' administration of 5 mg of enalapril.

Results: Mean arterial blood pressure (MABP) was mildly decreased in 6 pa tients, but the average change in MABP was not significant (Endtidal partial pressure of carbon dioxide (PeCO2) was not changed significantly. The mean rCBF was increased by 8% after administration of enalapril (0.05 < p<0.1) There was no significant correlation between percent change in MABP and the percent change in rCBF. These results indicate that enalapril has not only antihyperten sive action but also a beneficial effect on the cerebral circulation in patients with chronic cerebral infarction.
Favorable Clinical Effects of Iloprost Infusion in 4 Uremic Patients with Critical Limb Ischemia
Authors: Bedani Pier Luigi , Perini Leonella , Farinelli Roberto , Fabbian Fabio , Fiocchi Orazio , Guerra Severino , Vanini Antonietta , Gilli Paolo
Published: November 2007

Four uremic patients with advanced peripheral arterial occlusive disease (PAOD) of lower limbs causing rest pain and ischemic-necrotic lesions were treated with a four-hour intravenous infusion of Iloprost at doses of 0.75-2.5 ng/kg/min for twenty-eight days. After a week of the therapy all patients experi enced disappearance of rest pain and prolonged walking distance. At the end of the trial a diabetic patient showed a complete regression of the necrotic areas of two toes while the other patients still showed ischemic-necrotic foot lesions that were well demarcated.

Iloprost therapy can be effective in uremic patients with severe PAOD.
Hemodynamic Characteristics of Patients with Coronary Artery Disease Presenting False-Negative Exercise Stress Test
Authors: Sekiya Michihito , Suzuki Makoto , Fujiwara Yasushi , Sumimoto Takumi , Hamada Mareomi , Hiwada Kunio
Published: November 2007

The present study was designed to clarify the characteristics of left ventricu lar hemodynamics and coronary arteries in patients with coronary artery dis ease presenting false-negative response to the Master's two-step stress test.

Eighty-eight consecutive patients performed the Master's two-step stress test and had coronary angiography for evaluation of suspected or known coronary artery disease. The frequency of false-negative and true-positive responses in the Master's two-step stress test was 20% and 45%, respectively. Elevated left ventricular end-diastolic pressure, reduced ejection fraction, and low cardiac output characterized the left ventricular hemodynamics in patients with false- negative responses, as compared with those with true-positive response. The severity and extent of coronary artery disease, as well as prior myocardial in farction, did not affect the frequency of false-negative response.

This study indicates that the false-negative response to the Master's two-step test is unexpectedly frequent in coronary artery disease with severe left ventric ular dysfunction. Thus, one should be careful in judging the results of the Mas ter's two-step test in symptomatic patients with severe left ventricular dysfunction.
Distinct Responses of Interleukin-6 and Other Laboratory Parameters to Treatment in a Patient with Polyarteritis Nodosa—A Case Report
Authors: Nakahama Hajime , Okada Mitsunori , Miyazaki Mutsuo , Imai Nobuyuki , Yokokawa Tomoko , Kubori Shujiro
Published: November 2007

The authors describe a patient in whom the serum levels of interleukin-6 (IL-6) and other laboratory parameters were monitored. The IL-6 and C-reac tive protein (CRP) levels, which were extremely high before treatment, declined rapidly with administration of prednisolone. Rheumatoid factor, IgG, and platelets count declined more gradually. Thus, determination of the serum IL-6 level might be useful in diagnosing and monitoring polyarteritis nodosa.
Effect of Pentoxifylline on Treatment of Lower Limb Ulcers in Patients with Thalassemia Major
Authors: Angelides N.S. , Angastiniotis Ch. , Pavlides N.
Published: November 2007

The possible healing effect of deferoxamine and pentoxifylline on persisting lower limb ulcers was studied in 51 patients with thalassemia major.

The results indicated that the regular use of deferoxamine at an intravenous dose of 20 mg/kg did not affect the healing progress and the recurrence rate of these ulcers significantly. On the contrary, the oral administration of pentoxifyl line at a dose of 1,200 mg daily during the ulcer's healing time and at a low long- term maintenance dose of 400 mg daily during the ulcer-free intervals improved their healing ability impressively and diminished their recurrence rate signifi cantly.
Ventricular Arrhythmias Induced by Programmed Ventricular Stimulation After Uncomplicated Myocardial Infarction
Authors: Hueb Whady , Bellotti Giovanni , Sosa Eduardo , Ramires José Antonio , da Luz Protasio Lemos , Pileggi Fulvio
Published: November 2007

The aim of this study was to correlate the occurrence of ventricular dys rhythmias induced by programmed ventricular stimulation and sudden cardiac death (SCD) after a first episode of acute myocardial infarction (AMI).

Twenty-seven consecutive male patients aged fifty-four ± six (forty-seven to seventy) years were studied prospectively. Thirty days after AMI, patients were submitted to coronary arteriography and programmed ventricular stimulation with the S2-S3-S4 protocol. Noninvasive assessments, including Holter monitor ing, ECG stress test, and radionuclide ejection fraction, were also repeated six and twelve months after AMI.

Ventricular dysrhythmias were induced in all patients. According to such response, patients were divided into three groups: (1) repetitive ventricular re sponse (n = 9); (2) nonsustained ventricular tachycardia (n=8); and (3) sus tained ventricular tachycardia (n=10). All patients consistently developed complex ventricular dysrhythmias at Holter monitoring and ECG stress test. One patient from group 2 suffered SCD and another presented a syncope. Simi larly, in group 3, 2 patients suffered SCD, 1 during a documented episode of recurrent AMI. Except for 1 patient, radionuclide ejection fraction remained unchanged throughout the study in all cases. SCD was also unrelated to the presence and type of dysrhythmias at noninvasive evaluation.

Therefore, the type of ventricular dysrhythmia induced by the S2-S3-S4 pro tocol has no correlation with late SCD in patients with a first AMI and pre served ejection fraction.