bluuebunny/crossref_metadata_2025 huggingface dataset:
Incidence of Carotid Artery Atherosclerosis in Patients with Coronary Artery Disease
Authors: Sanguigni Valerio , Gallù Mariacarla , Strano Antonio
Published: July 2008

The natural history of coronary artery disease (CAD) is often complicated by cerebrovascular accidents. The real incidence of atherosclerotic lesions of carotid arteries in coronary patients is not well established. In order to detect a high-risk group for stroke development, 184 patients affected by CAD, either partially symptomatic or asymptomatic for carotid artery stenosis, underwent Echo-Doppler ultrasonography (duplex scanning) of supra-aortic branches. Significant carotid stenosis (>50%) was demonstrated in 51 subjects (27.7%); 21 subjects (41.2%) were partially symptomatic (dizziness, vertigo, lipothymia, etc), and 30 subjects (58.8%) were completely asymptomatic.

The authors' data suggest that carotid disease can develop concurrently with coronary disease in a significant proportion of patients, even though completely asymptomatic. In order to obtain optimal long-term results, both coronary and carotid artery disease require appropriate evaluation and either medical or surgical management. For these reasons they recommend duplex scanning as a routine screening procedure in patients affected by CAD.
The Damaging Potential of Leukocyte Activation in the Microcirculation
Authors: Schmid-Schönbein Geert W.
Published: July 2008

Traditionally leukocytes have been regarded as beneficial cells, owing to their immunologic and antimicrobial activity. Recent evidence suggests, however, an additional role of granulocytes and monocytes as mediators of cardiovascular complications, such as ischemia, reperfusion, diabetes, physiologic shock, venous ulceration, and other conditions. Granulocytes and monocytes have a large volume, and stiff cytoplasm; they have the ability to adhere to endothelium and to other substrates; and they exert several forms of cytotoxicity. Granulocytes and monocytes may be trapped in the microcirculation, may obstruct capillaries and thereby induce a no-reflow phenomenon, and may initiate organ dysfunction via oxygen free radical production and proteolytic cleavage. Few organs seem to be spared from the potential destructive actions of these cells, and novel approaches are required to interfere with leukocyte accumulation in local regions of the peripheral circulation.
Myocardial Infarction Complicating Postsplenectomy Thrombocytosis, with Early Left Ventricular Mural Thrombus Formation and Cerebral Embolism— A Case Report
Authors: Yau Ting Tai  , Yuk Ling Yu  , Chu Pak Lau  , Ping Ching Fong
Published: July 2008

Thrombocytosis is a rare cause of ischemic cardiovascular and cerebrovascular events in patients with intrinsically normal coronary and cerebral vasculature. This report details the occurrence of inferior wall myocardial infarction (MI) consequent upon postsplenectomy thrombocytosis in a thirty-four-year-old man with angiographically normal coronary arteries. The MI was complicated by early left ventricular mural thrombus formation and embolic cerebral infarction. Combined anticoagulant and antiplatelet therapy was required to prevent the recurrence of ischemic events.
The Risk of Emergency Intestinal Bleeding Among Users of Acenocoumarin: A Population-Based Cohort Study
Authors: Cleophas Ton J. M. , Tavenier Piet , Niemeyer Menco G.
Published: July 2008

In spite of a 10-13 fold increased risk of bleeding, standard doses of coumarin with a target prothrombin time of 2.7-4.5 INR (International Normalized Ratio) are chronically used in the Netherlands by 4-5% of the adult population forty to eighty years old, mainly for the secondary prevention of myocardial infarction. The Dutch Thrombosis Services, who monitor these patients, use less rigorous criteria than the standard studies do. It would not, therefore, be too much of a surprise if the numbers of bleeding complications in practice would be much higher than expected from the standard papers so far. To answer this question the authors studied emergency intestinal bleedings in a population-based cohort study of chronic acenocoumarin users (813 person years) and their age-matched and population-based controls (17,620 person years).

Of 142 first bleedings serious enough to require immediate sigmoidoscopy, 35 were connected with acenocoumarin (25%). The overall incidences in the acenocoumarin cohort and the age-matched controls were, respectively, 4.3 and 0.6 bleedings/100 person years, RR (relative risk) 7.09, p < 0.0001.

The acenocoumarin bleeders and their controls had symmetric clinical diagnoses and levels of hemoglobin. However, acenocoumarin bleeders were significantly older and more frequently males. The sex- and age-adjusted RRs were, however, only slightly different from the crude data, suggesting no major influence of these asymmetries on the overall results. Prothrombin times in the acenocoumarin bleeders were frequently higher than the target range. In the subjects initially excluded from the controls because they used alternative compounds that enhance bleedings, incidences of bleedings were calculated as well. The incidences were 0.6 bleeding/100 person years (RR 1.01, ns) for the patients receiving NSAIDS (nonsteroidal antiinflammatory drugs); 1.5 (RR 2.50, p < 0.05) for aspirin; and 1.6 (RR 2.67, 0.05 < p < 0.1) for dipyridamole.

The authors conclude that in an adult population of 5% acenocoumarin users, about 25% of the emergency intestinal bleedings are connected with coumarin. The numbers of coumarin bleedings are 4-6 times higher than reported so far. They also demonstrate that the risk of bleeding from coumarin far exceeds the risks from alternative oral antithrombotic agents, such as aspirin and dipyridamole.
Effects of Aging and Hematocrit on Cerebral Blood Flow Velocity in Patients with Unilateral Cerebral Infarctions: A Doppler Ultrasound Evaluation
Authors: Titianova E.B. , Velcheva I.V. , Mateev P.S.
Published: July 2008

By means of conventional continuous-wave (CW) (4 MHz) and transcranial pulsed (2 MHz) Doppler sonography 50 patients (34 men and 16 women, mean age 58.6±7.6 years) who survived unilateral cerebral infarctions (UCI) in the middle cerebral artery (MCA) territory were investigated. The control group consisted of 30 presumed healthy age-matched persons. The main quantitative sonographic parameters of the major arteries of the head and the basal cerebral arteries were evaluated. On the day of the neurosonographic investigations, hematocrit (Hct) was determined.

Low-degree stenoses of the internal carotid arteries were found in 26 (52%) of the patients. Increased intracranial vessels' resistance in the MCA on the infarction side was usually obtained. Decreasing of Doppler shift frequency with advancing age and increasing of Hct was established in the controls. In patients with UCI the effects of aging and Hct on the sonographic parameters of the collateral arteries were more pronounced.

Obviously, in patients with UCI, the alterations of the sonographic parameters are caused by parallel influence of vessels' disease, age-defmed changes of vessels' walls, and viscosity variations.
Effects of Lovastatin on High-Density Lipoprotein Subfractions in Hypercholesterolemic Patients with Peripheral Vascular Disease
Authors: Tilly-Kiesi Marju , Mattila Severi P. , Tikkanen Matti J.
Published: July 2008

The effects of lovastatin treatment on high-density lipoprotein subfractions (HDL2 and HDL 3) were investigated in 34 patients with severe peripheral vascular disease and type IIa or type IIb hyperlipoproteinemia by use of a density gradient ultracentrifugation method.

Lovastatin therapy caused greater percentage changes in HDL2 than in HDL3. In HDL2 the increases of cholesterol, total lipid, apolipoprotein AI (apoAI) and apoliproprotein AII (apoAII) concentrations were 23% (p < 0.05), 28% (p < 0.01), 24% (p < 0.01) and 11 % (p < 0.01), respectively, in subjects with the type IIa phenotype. In patients with the type IIb phenotype the corresponding increases were 42% (p < 0.01), 44% (p < 0.01), 38% (p < 0.01) and 21% (p < 0.05), respectively. The apoAI/apoAII weight ratio in HDL2 rose by 11% and by 13% in type IIa and type IIb patients, respectively.

The present results suggest that during lovastatin treatment the slight increase in serum HDL-cholesterol concentration was due, not to cholesterol enrichment by high-density lipoproteins, but more probably to an increase of the number of HDL particles. The observed changes were more pronounced in type IIb than in type IIa patients.
Vasodilative Response to Hypoxia and Simulated Ischemia Is Mediated by ATP-Sensitive K + Channels in Guinea Pig Thoracic Aorta
Authors: Gasser Robert , Klein Werner , Kickenweiz Elisabeth
Published: July 2008

Local vasodilation in response to hypoxia or ischemia improves perfusion and O2 supply of the affected tissue. This local vasodilation thus constitutes the most important mechanism in the prevention of ischemic cell injury. The regula tion of vascular tone has mainly been attributed to changes of cytoplasmatic Ca2+ ((Ca2+)i) concentrations in vascular smooth muscle cells. The mechanism underlying these changes has not, however, been elucidated so far.

Using aortic strips of guinea pigs (transversally cut in spirals; normal Tyrode, in mM: NaCl 150, KCI 4.5, MgCl2 2, CaCl2 2.5, glucose 10; buffered with 10 mM HEPES at pH 7.4; equilibrated with 100% O2 at 31°C) the authors could show that metabolic blockade (glucose replaced by 10 mM 2-deoyglucose (DOG) led to a relaxation of the preparation.

Thus, in four experiments, resting tension decreased from 0.75 g by 27% ± 12% within two hours (% of maximal contractile force developed by each prepa ration when depolarized with 43 mM KCI and 101.5 mM NaCl). When the same experiment was carried out in the presence of 1 mM tolbutamide (a known blocker of ATP-dependent K+ channels) in vascular smooth muscle no such re laxation could be seen (n = 4).

Furthermore, in the same type of preparation, similar results have been obtained upon hypoxic relaxation (100% O2 replaced by 100% N2), where 1 mM tolbutamide also prevented vasodilation.

Thus, hypoxic/ischemic vasodilation in response to glycolytic inhibition (DOG) and hypoxia (N2) is based upon the opening of K+ATP channels and hence can be prevented by sulfonylureas (the opening of K+ATP channels would lead to hyperpolarization (increased K+ conductance, Goldmann equation), thus di minishing the open probability of voltage-gated Ca2+ channels with subsequent vasodilation).

This inhibition by sulfonylureas of vasodilative response to ischemia may also constitute the so far unknown cause of the increased cardiovascular mortal ity seen under sulfonylurea treatment.
Cardiac Depressant Effects of Oxygen Free Radicals
Authors: Prasad Kailash , Kalra Jawahar , Bharadwaj Lalita
Published: July 2008

In many clinical situations, including cardiac ischemia/reperfusion, elective cardiac arrest, and renal dialysis, the chances of increased production of oxygen free radicals (OFR) exist. OFR have been implicated as a causative factor of cell damage in several pathologic conditions. The effects of exogenous OFR, gener ated by xanthine plus xanthine oxidase, in the absence and in the presence of OFR scavenger (superoxide dismutase [SOD]) on the contractility of isolated perfused heart of rabbit were studied. OFR produced concentration-dependent decreases in the contractility of perfused heart. SOD prevented the OFR-in duced decreases in the left ventricular contractility. Xanthine produced an in crease in the contractility of isolated perfused rabbit's heart. Xanthine oxidase produced a marked decrease in the left ventricular contractility. Repeated ad ministration of xanthine oxidase produced accelerated and greater decreases in the contractility of perfused heart when compared with that of the initial admin istration of the drug. Effects of xanthine or xanthine oxidase on the cardiac function and contractility were also studied in anesthetized dogs. Xanthine alone had no significant effect on the cardiac function and indices of myocardial contractility. However, xanthine oxidase produced a marked decrease in the mean aortic pressure, left ventricular work index, heart rate, cardiac index, left ventricular systolic pressure, left ventricular end-diastolic pressure, (+) and ( — ) dp/dt of left ventricular pressure, and other indices of myocardial contrac tility [(dp/dt)/PAW (pulmonary arterial wedge pressure)]; and an increase in the total systemic and pulmonary vascular resistance. Repeated administration of xanthine oxidase in anesthetized dogs had lesser effects on the cardiovascular system when compared with those from the initial dose of the drug.

These results suggest that OFR are cardiac depressant. Clinical situations wherein there is an increased production of OFR or increased formation of xanthine and xanthine oxidase may be associated with decreased cardiac func tion and contractility. Scavengers of OFR may protect the heart from the delete rious effects of OFR in such clinical conditions.
Therapeutic Embolization of Bronchial Artery: A Successful Treatment in 209 Cases of Relapse Hemoptysis
Authors: Cremaschi P. , Nascimbene C. , Vitulo P. , Catanese C. , Rota L. , Barazzoni G.C. , Cornalba G.P.
Published: July 2008

Still today bronchial artery embolization (BAE) is an important procedure in the management of hemoptysis, as an alternative to, or in association with, surgical or medical therapy. From 1974 to 1990, BAE was performed in 209 patients who suffered from hemoptysis with different etiopathogeneses and se verity. Bronchiectasias were the most frequent indication (46%) followed by tuberculosis (31%), cystic fibrosis (16%), lung cancer (4%), and aspergillosis (3%). BAEs were performed by means of polyvinyl alcohol particles and ab sorbable gelatin sponge. In a few cases complete occlusion of the main truncus of particularly large bronchial arteries was obtained by use of Gianturco steel coin (5 mm o) technique. In the last seven years, together with the traditional angiographic techniques, selective digital angiography (SDA) was performed, above all in preliminary control phases, to evaluate occlusion during emboliza tion. SDA reduced catheterization time and the mean quantity of contrast ad ministered, decreasing side effects; 98% of hemoptysis was controlled in the first twenty-four hours, the other 2% in the following forty eight hours; 16% relapses occurred within the first year; 27 patients needed reembolization (15 patients twice, 11 patients three times, 1 patient five times). No complications were seen. If diagnosis, therapeutic indications, operative technique, and equip ment selection are adequate, BAE has a high reliability in patients affected by relapsing hemoptysis, which is difficult to resolve.
Blood Viscosity During Long-Term Treatment with Ticlopidine in Patients with Intermittent Claudication. A Double-Blind Study
Authors: Fagher Birger , Persson Sylvi , Persson Gunnar , Larsson Hans
Published: July 2008

The aim was to test within a randomized, double-blind trial whether the antiaggregant drug ticlopidine might reduce blood viscosity as has been claimed. Sixteen patients with intermittent claudication were studied before and after three years of treatment with ticlopidine, 500 mg/day, or placebo. At base line, the viscosity values were significantly higher as compared with a reference group of healthy subjects. Whole-blood viscosity, measured at four different shear rates at hematocrit adjusted to a standard 40%, decreased significantly at follow-up, with no difference between ticlopidine treatment and placebo. Hema tocrit showed a slight increase in the placebo group. The viscosity parameters were unrelated to lower limb blood flow variables, ankle/brachial index, and walking distances. The mechanism behind the overall decrease in whole-blood viscosity is obscure but could possibly be explained by lifestyle changes. Smok ing habits were, however, unaltered. Since plasma viscosity remained increased, it might indicate that some erythrocyte factor, notably red cell aggregability and deformability, had improved. It is concluded that ticlopidine had no long-term effect on blood viscosity.
Measurement of Cardiac Chamber Volumes by Cine Magnetic Resonance Imaging
Authors: Matsuoka Hiroshi , Hamada Mareomi , Honda Toshio , Kobayashi Takamasa , Suzuki Makoto , Ohtani Takashi , Takezaki Masayuki , Abe Mitsunori , Fujiwara Yasushi , Sumimoto Takumi , Sekiya Michihito , Hiwada Kunio
Published: July 2008

Cardiac chamber volumes (both atria and ventricles) in 19 healthy volun teers were measured noninvasively by cine magnetic resonance imaging (MRI). First, cardiac localization was determined from the coronal image by 0.5-T superconducting magnetic imager. Then, transaxial ECG gated multislice spin echo images were obtained from the bottom to the top of the heart. In the last step, cine MRI was performed at each level of all these transaxial spin echo MR images involving the heart. Each cardiac chamber volume at the same phase was calculated by adding chamber areas in each anatomic section multiplied by slice thickness. Left ventricular (LV) end-diastolic volume (EDV) (132.0±26.9 mL) and LV end-systolic volume (ESV) (47.8 ±13.9 mL) were smaller than right ventricular (RV) EDV (141.1 ±24.8 mL) and RVESV (57.0± 12.6 mL), respec tively (p < 0.01). LV stroke volume (84.3±17.9 mL) was equivalent to RV stroke volume (84.2±17.6 mL) (r=0.91, p < 0.01). Left atrial (LA) and right atrial (RA) maximal volumes were 75.8 ±15.4 mL and 84.4±18.7 mL, respectively. LA minimal volume (37.5 ± 10.7 mL) was smaller than RA minimal volume (47.8 ± 12.2 mL). These values measured by cine MRI are satisfactory and cine MRI will be a useful method of determining cardiac chamber volumes, espe cially atrial volumes.
Serum Magnesium and Potassium in Acute Myocardial Infarction: Relationship to Existing β-Blockade and Infarct Size
Authors: Landmark Knud , Urdal Petter , Landmark Knud
Published: July 2008

Patients (n = 314) with acute myocardial infarction (AMI) were divided into three groups according to the time elapsed from onset of chest pain to when the first sample for determination of magnesium (s-Mg1) and potassium (s-K1) was drawn (A: hours 0-6; B: hours 6-10, and C: hours 10-24). Potassium and Mg were also measured in a second sample drawn three to twelve days (mean 6.3 days) later (s-Mg2, s-K2). Whereas s-Mg1 was lower than s-Mg2 in all three groups, s-K1 was reduced only in group A. Ten patients in group A receiving nonselective β-blockers had an attenuated drop in s-Mg1, whereas the drop in s-K1 was completely inhibited. The differences between s-Mg2 and s-Mg1 (Δ s-Mg) in all groups, and between s-K2 and s-K1 (Δ s-K) in group A, increased with increasing mean peak creatine kinase (CKmax) levels to approximately 1300-1800 U/L.

In conclusion, these observations suggest that the initial drop in s-Mg and s-K in the early phase of AMI is due to increased stimulation of β2-adrenergic receptors; these changes can be prevented partly or completely by the use of nonselective β-blockers.
Clinical and Angiographic Features of Patients with an Occluded Versus a Patent Infarct Vessel After Intravenous Streptokinase for Acute Myocardial Infarction
Authors: Chouhan Lalit , Hajar Hajar A. , George Thomas , Pomposiello Juan Carlos
Published: July 2008

Despite early treatment with thrombolytic agents for acute myocardial in farction, a significant portion of patients fail to achieve a patent infarct artery. To study the various factors related to achieving patency in the infarct vessel, 201 patients who received streptokinase within six hours of symptoms were studied. All patients underwent cardiac catheterization during the same hospi talization at 5.40±3.26 days after admission. Forty five (22.4%) patients were found to have an occluded infarct artery (group 1) and 156 (77.6%) had a patent infarct vessel (group 2). There was no difference in the time from onset of symp toms to receiving streptokinase between the two groups. The two groups were to each other with regard to age, gender, history of myocardial infarc tion or angina, and major risk factors for coronary disease. Coagulation pa rameters before and after streptokinase therapy, reflecting the lytic state, were similar in both groups. The left ventricular end diastolic pressure was signifi cantly higher and the left ventricular ejection fraction was significantly lower in group 1 than in group 2.

These observations suggest that despite early initiation of thrombolytic ther apy in patients with acute myocardial infarction, a significant portion of pa tients fail to achieve a patent infarct artery. This failure cannot be explained by the observed clinical parameters or the lytic state after streptokinase.
Bleeding Angiodysplasia of Stomach Associated with Severe Ischemic Congestive Cardiomyopathy—A Case History
Authors: Schwartz J. , Rozenfeld V. , Stelian J. , Leibovitz A. , Rabinovitz H. , Habot B.
Published: July 2008

The authors present a case of gastric angiodysplasia with upper gastrointes tinal bleeding, associated with severe ischemic congestive cardiomyopathy.
Renin Responses in Patients with Orthostatic Hypotension: Case Reports
Authors: Asato Chifumi , Muratani Hiromi , Touma Taskashi , Kawazoe Nobuyuki , Kimura Yorio , Takishita Shuichi , Fukiyama Koshiro
Published: July 2008

In orthostatic hypotensive patients renin is reported to increase in response to head-up tilt unless the lesion involves postganglionic sympathetic efferent nerves. The authors examined responses of plasma renin activity (PRA) to acute blood pressure reduction in 4 patients with orthostatic hypotension. When the coexistence of normal plasma norepinephrine (PNE) and normal or high-nor mal pressor response to alpha stimulant is considered to be a sign of preserved function of postganglionic fibers, 2 of the patients had sympathetic lesions mainly confined to central and/or preganglionic fibers. They were diagnosed as having multiple system atrophy (MSA). The other 2 were diagnosed as having idiopathic orthostatic hypotension with possible postganglionic lesions. Al though 1 MSA patient showed an increase in PRA from 2.0 to 4.7 ng/mL/hr in response to the tilt, the other MSA patient showed no PRA response to the tilt. The head-up tilt did not provoke an apparent PRA response in patients with idiopathic orthostatic hypotension. The authors infused sodium nitroprusside (SNP) in the 3 patients whose PRA did not respond to the head-up tilt. The infusion decreased blood pressure by 40 mmHg or more, but PRA responses were inappropriately small or suppressed. In all cases, PNE did not respond at all to the head-up tilt and to the infusion of SNP. These findings suggest that possible preservation of postganglionic fibers does not necessarily indicate an intact responsiveness of PRA. The PRA profiling may not be an accurate pre dictor for the site of the fiber degeneration in orthostatic hypotension.
Effect of Ticlopidine on the Cutaneous Circulation in Peripheral Vascular Disease
Authors: Shuixian Qian  , Iwai Takehisa
Published: July 2008

To assess the effect of ticlopidine on the cutaneous circulation, 25 patients with lower limb ischemia were investigated just before and at two hours after being given a 200 mg oral dose of ticlopidine. The transcutaneous partial pres sure of oxygen (PtcO2) and the skin temperature were determined at 35 limb sites and 9 chest walls sites. Both the PtcO 2 and the skin temperature were significantly increased at two hours after the administration of ticlopidine (p < 0.01). The findings suggest that ticlopidine can improve the cutaneous mi crocirculation in patients with peripheral vascular disease.
Circulating Platelet Aggregates Indicative of in Vivo Platelet Activation in Pulmonary Hypertension
Authors: Lopes Antonio Augusto , Maeda Nair Yukie , Almeida Ana , Jaeger Rui , Ebaid Munir , Fischer Chamone Dalton
Published: July 2008

The authors investigated the existence of circulating cellular aggregates in 12 patients with moderate to severe pulmonary hypertension, using scanning elec tron microscopy. Peripheral venous blood was collected in the presence of 11.5 mM buffered ethylenediaminetetraacetic acid, in order to disperse freshly formed disaggregable aggregates. Irreversible aggregates represented by plate let clusters and/or platelet attachment to either leukocytes or red cells were identified in 7 patients with pulmonary hypertension. Endogenous platelet acti vation was further confirmed by a significant increase in plasma levels of beta- thromboglobulin in comparison with controls (33.8 ± 14.1 vs 22.7 ± 11.5 ng/mL respectively, p < 0.025). The presence of irreversible aggregates in the blood stream strongly suggests that cell-cell interactions actually occur in vivo in these patients. If so, therapeutic measures aimed at preventing in situ thrombosis and its consequences may be beneficial in this disorder.
A Botanical Compound, Padma 28, Increases Walking Distance in Stable Intermittent Claudication
Authors: Drabaek Hans , Mehlsen Jesper , Himmelstrup Holger , Winther Kaj
Published: July 2008

Thirty-six patients with a median age of sixty-seven years and a median duration of intermittent claudication of five years were randomized to either active treatment with Padma 28 or placebo. The effect of treatment was quanti fied by measurements of systemic and peripheral systolic blood pressures and by measurements of the pain-free and the maximal walking distance on a tread mill. The ankle pressure index (ankle systolic pressure/arm systolic pressure) was calculated.

The group randomized to active treatment received two tablets bid contain ing 340 mg of a dried herbal mixture composed according to an ancient lamais tic preparation (Padma 28). After active treatments, administered over a period of four months in a double-blinded, randomized design, the patients allocated to this group attained a significant increase in the pain-free walking distance from 52 m (20-106) to 86 m (24-164; P < 0.05) and in the maximal walking distance from 115 m (72-218) to 227 m (73- > 1,000; P < 0.05). The patient-group receiv ing placebo treatments did not show any significant changes in either the pain- free or the maximal walking distance. The authors could not demonstrate any significant changes in the ankle pressure index either during active or during placebo treatment.

In conclusion, this study has shown that treatment with Padma 28 over a period of four months significantly increased the walking distance in patients with stable, intermittent claudication of long duration.
Coronary Angioplasty in the Elderly: Immediate and Long-Term Results
Authors: Voudris Vasilis , Antonellis John , Salachas Anastasios , Ifantis George , Sionis Dimitris , Margaris Nikolaos , Koroxenidis Gabriel
Published: July 2008

Coronary angioplasty was performed in 37 elderly patients ( > sixty-eight years) with unstable or stable angina, refractory to medical treatment. History of myocardial infarction was present in 38% and of previous bypass surgery in 5% of patients. Coronary angiography revealed single-vessel disease in 22 (59%) and multivessel disease in 15 (41%) of patients. The mean left ventricular ejec tion fraction was 53 ± 17 % . Percutaneous transluminal coronary angioplasty (PTCA) was successful in 92% of patients; there were two angioplasty failures and 1 acute occlusion leading to Q wave myocardial infarction. In patients with multivessel disease complete revascularization was achieved in 33%. Follow-up data (21.29 ± 9.23 months) are available in all patients with primary angio graphic success. There was 1 death. Seventy-nine percent of patients had an improved anginal status, and repeat PTCA was performed in 2 patients because of clinical recurrence. Thus, coronary angioplasty is a safe and efficacious method of revascularization in symptomatic patients over the age of sixty-eight years.
Precise Assessment of Myocardial Damage Associated with Secondary Cardiomyopathies by Use of Gd-DTPA-Enhanced Magnetic Resonance Imaging
Authors: Matsuoka Hiroshi , Hamada Mareomi , Honda Toshio , Kawakami Hideo , Okayama Hideki , Abe Mitsunori , Shigematsu Yuji , Sumimoto Takumi , Hiwada Kunio
Published: July 2008

To evaluate the myocardial damage in patients with secondary cardiomy opathies, the authors examined gadolinium-diethylenetriaminepentaacetic acid (Gd-DTPA)-enhanced magnetic resonance imaging (MRI) in 5 patients (2 with cardiac amyloidosis, 2 with acute myocarditis, 1 with cardiac thyrotoxicosis). MR images were performed at 1.5-T by using a spin echo pulse sequence before and after intravenous administration of Gd-DTPA (0.2 mmol/kg). All patients revealed distinct high-intensity areas on postcontrast images. Moreover, MRI with Gd-DTPA could determine the severity and precise regions of myocardial damage associated with secondary cardiomyopathies.

It is suggested that gated cardiac MRI with Gd-DTPA enhancement is useful for detecting the myocardial damage in secondary cardiomyopathies.
Hormonal and Hemodynamic Changes Following Single-Dose Felodipine Treatment During Mental Stress
Authors: Hædersdal Carsten , Petersen Claus Leth , Lund Jens Otto , Trap-Jensen Jens
Published: July 2008

Mental stress induces changes in hemodynamic variables and in the plasma level of many hormones and plasma peptides. These changes can be modulated by various drugs, eg, β-blockers. In a double-blind, placebo-controlled cross over study, the authors evaluated the hormonal and hemodynamic changes dur ing psychological stress and the effect of felodipine 10 mg (plain tablet). Eight male volunteers participated. Heart rate, blood pressures, and stroke volume were measured by ECG, mercury sphygmomanometer, and impedance cardiog raphy. Catecholamines and atrial natriuretic factor in plasma were measured by electrochemical and radioimmunoassay techniques. A single dose of felodi pine, 10 mg, exaggerates the heart rate decreases the left ventricular ejection time and augments the plasma level increment of noradrenaline. The stress- induced changes in other variables were not influenced by felodipine treatment. In conclusion, acute felodipine treatment influences the reflex activation of the sympathetic nervous system during psychological stress. In the treatment of patients, especially patients with heart disease, these findings could be impor tant but further investigations in patients need to be done.
99Tcm-Sestamibi Uptake in the Leg Muscles and in the Myocardium in Patients with Intermittent Claudication
Authors: Boström Per-Ake , Diemer Henrik , Leide Sigrid , Lilja Bo , Bergqvist David
Published: July 2008

99Tcm -Sestamibi has now replaced 201Tl as a cardiac imaging agent. In addi tion to the myocardial uptake there is also a considerable uptake in the striated muscle, which may be used for analyzing the muscular perfusion. Sixteen pa tients with intermittent claudication were investigated with 99Tcm -Sestamibi- SPECT (single photon emission computerized tomography) in order to visualize coronary ischemic disease. After the registration of the myocardial perfusion they were also studied regarding their leg muscle perfusion. This was done at rest and during standardized stress test using a bicycle ergometer.

In 10 of the patients there was an increase in the isotope uptake in the myocardium from work to rest > 10% reflecting pronounced myocardial ische mia, which, however, was symptomatic in only 4 of the patients.

The muscular uptake in the myocardium of 99Tcm -Sestamibi in the thigh in creased significantly from rest to exercise (P < 0.01), while it remained un changed in the calf muscle.

There were no significant correlations at rest between the ratio of the right and left systolic blood pressure in the ankles and the ratio between the right and left isotope uptake in the calves, but the increase in the isotope uptake from rest to work correlated with the blood pressure ratio at r = 0.79, P< 0.01 (anterior projection) and r = 0.71, P< 0.01 (posterior projection).

This study demonstrates the possibility of using 99Tcm -Sestamibi to analyze myocardial and muscular perfusion impairment in intermittent claudication.
Doxazosin Withdrawal and Ambulatory Blood Pressure Monitoring in Normotensive Subjects
Authors: Takata Yutaka , Yoshizumi Takayuki , Ito Yasuo , Hirota Yasuo , Fujishima Masatoshi
Published: July 2008

The effect of doxazosin withdrawal on normotensive subjects was examined by ambulatory blood pressure monitoring (ABPM) during twenty-four hours. Eight normotensive volunteers were treated with doxazosin for four weeks. ABPM was done the day before withdrawal and on the second and seventh days after withdrawal. The average systolic and diastolic BP were not altered by doxazosin withdrawal either on day 2 or day 7, but pulse rate (PR) decreased on day 2 and day 7. Daytime PR decreased on day 2, but both daytime and night time PR decreased on day 7. On withdrawal of doxazosin, the plasma nore pinephrine concentration decreased and the plasma renin activity tended to decrease. Neither overshooting hypertension nor cardiovascular event was re lated to doxazosin withdrawal was observed. It is concluded that, in normoten sive subjects, discontinuation of doxazosin may result in bradycardia without hypotension or signs of withdrawal syndrome.
Fibrinogen: Its Emerging Role as a Cardiovascular Risk Factor
Authors: Ernst E.
Published: July 2008

Several epidemiologic studies have produced longitudinal data identifying fibrinogen as a major cardiovascular risk factor. Cross-sectional results show strong associations between fibrinogen and cardiovascular risk factors or dis eases. Clinical cohort studies demonstrate that fibrinogen might also be a risk factor for the sequelae of cardiovascular disease. At present, knowledge about the determinants of the plasma level of fibrinogen in health and disease is in complete. Understanding of the mechanisms that might be involved in the atherogenic action of fibrinogen is also fragmentary. Fibrinogen strongly affects blood coagulation, blood rheology, and platelet aggregation, and in addition it has direct effects on the vascular wall and is a prominent acute-phase reactant. All of these phenomena might provide some insight into the pathophysiologic mechanisms involved in the association between fibrinogen and cardiovascular events. Even though many crucial questions await answers, it is concluded that fibrinogen represents a major, independent risk factor that should be consid ered for screening programs aimed at identifying individuals at high risk for cardiovascular disease.
Role of Transesophageal Pacing in Recurrent Atrial Fibrillation. Experience with Propafenone
Authors: Turco Pietro , Guarino Pietro , Parente Antonella , Viola Vincenzo , Candelmo Fiore , Bellizzi Gennaro , Foffa Antonio , Morella Alessandro , Martino Domenico F.
Published: July 2008

To assess the role of transesophageal pacing (TP) at very high rates in the follow-up of patients with recurrent and sustained paroxysmal atrial fibrillation (AF) on therapy, the authors studied 15 patients (10 women, 5 men; aged forty- four to seventy-seven years old). Of them only 1 had a mild mitral regurgita tion; none had hyperthyroidism or acute ischemic heart disease. They tested propafenone (P) at a dose of 1.4-2 mg/kg over ten minutes as an intravenous bolus and 0.5 mg/minute as intravenous maintenance for two hours and then 300 mg twice daily orally and chronically. Serial TPs at very rapid rates (up to 600 bpm) were performed to test the long-term efficacy of P to prevent paroxys mal AF. The mean follow-up was fifteen months (nine to twenty-four months).

Results: Intravenous P converted AF in five to ninety minutes (mean twenty- one minutes) in 9/15 patients (conversion rate of 60%); in an additional 4 pa tients oral P converted AF in two to fifteen hours. In the other 2 patients P failed to convert AF. Three patients experienced recurrence of AF in the early follow- up. Of the 10 patients who completed the entire protocol, only 1, who had mild mitral prolapse regurgitation and AF induction by TP, experienced new epi sodes of AF during follow-up. No significant side effects were noted during P therapy.

Conclusions: Propafenone appears safe and effective for controlling and pre venting recurrent and sustained AF. Transesophageal pacing is a valid tool for predicting the efficacy of long-term therapy in the follow-up of patients with paroxysmal atrial fibrillation.
Arterial Compliance and Its Pressure Dependence in Hypertension and Vasodilation
Authors: Li John K-J. , Zhu Ying
Published: July 2008

Arterial compliance has been recognized to be pressure-dependent. Its varia tion due to changing systolic and diastolic blood pressures in hypertension and subsequent vasodilation has not been investigated. The authors examined this aspect by combining an animal experiment and a recently established nonlinear windkessel model of the arterial system that incorporates a pressure-dependent arterial compliance, C(P). Aortic pressure and flow were simultaneously mea sured in experimental dogs during control and during methoxamine-induced hypertension and nitroprusside-induced vasodilation. A numerical procedure was implemented to compute the nonlinear compliance and account for the pressure dependence. Results show that within the cardiac cycle, C(P) reached its maximum at end-systole and increased in diastole when diastolic aortic pres sure decayed. The magnitude of C(P) and its variation within the cardiac cycle was larger at low pressures, while the reverse was found when blood pressure was high. C(P) decreased significantly in hypertension and increased during subsequent vasodilation.
Noninvasive Testing of Dynamic Component of Internal Carotid Artery Stenosis in Patients with Chronic Cerebrovascular Disease
Authors: Akopov Sergey , Grigorian George , Gabrielian Emil
Published: July 2008

By means of Doppler spectral analysis it was shown that internal carotid artery stenosis has a dynamic component that determines the possibility of changes in the area of stenosis under various influences. It was found that the cold pressor test may increase the area of stenosis in some patients for up to three to five hours. In such cases reduction of blood flow volume in the common carotid artery and decrease of cerebral blood flow in the ipsilateral hemisphere of the stenosis are observed. Such a response was effectively removed by nifedi pine. At the same time nifedipine itself is capable of changing the area of steno sis, either enlarging or reducing it. In the first case enhancement of brain blood supply is observed, and in the second case, its decrease. The data obtained disclose one of the reasons for the variability in therapeutic effects of vasodila tors in patients with cerebrovascular disorders.
Alcohol and Coronary Spasm
Authors: Oda Hiroyuki , Suzuki Makoto , Oniki Toshiyuki , Kishi Yukio , Numano Fujio
Published: July 2008

Alcohol is known to sometimes cause coronary spasm, the mechanism of which is still unknown. The authors monitored changes in plasma levels of prostanoids (thromboxane [TX B 2], 6-keto prostaglandin F1α [PGF1α]), catecholamines (CA), serotonin (5-HT), cyclic nucleotides (cyclic adenosine monophosphate—cAMP, cyclic guanosine monophosphate— cGMP), and platelet aggregation after alcohol ingestion (Japanese rice wine 400 mL) in 8 patients with alcohol-induced variant angina and 8 healthy men as controls. Coronary spasm was confirmed to have been induced in 4 patients nine hours after alcohol challenge (VA[+]), when their plasma ethanol levels had already returned to a null level. Neither CA nor 5-HT levels showed any change after alcohol ingestion either in patients or controls, though controls showed high levels of CA during alcohol ingestion. TX B2 in VA (+) patients increased gradually after alcohol ingestion to reach up to a statistically signifi cantly high level just before attack, as compared with those of controls and VA(-) patients, who, on the contrary, did not show such changes. The levels of 6-keto PGF1α, however, which were significantly lower in patients than in controls before the test, exhibited a gradual increase in VA (+) patients in parallel with the increase in TX B2.

No significant changes in cAMP levels between either controls or patients were present.

On the contrary, cGMP levels had a gradual decrease in patients after alcohol ingestion. Especially six hours after alcohol ingestion, cGMP levels in VA (+) patients decreased so much as to make a statistically significant difference, as compared with the level in controls.

Platelet aggregability in controls showed a decrease after alcohol ingestion, in spite of no change or even increase in patients.

These data suggest that low levels of PGF1α and the decrease of cGMP levels from alcohol ingestion play important roles in the mechanism of coronary spasm induced by alcohol ingestion.
Development of a New Laser-Doppler Microvelocimetering and Its Application in Patients with Coronary Artery Stenosis
Authors: Shisen Jiang , Gorai Yu , Xu Shun-zhao
Published: July 2008

A new Laser-Doppler microvelocimetering (LDMV) was developed to study blood flow in individual vessels in patients with coronary artery stenosis. The LDMV measures steady blood flow velocity, diameter of vessels and pulsation flow. In addition, the effects of China's traditional herbs—Salvia Mitiorrhyza and other drugs—on the blood flow in the patients were investigated. LDMV constitutes a new quantitative procedure and is a promising tool for rapid monitoring of tissue perfusion in cardiovascular disease and estimating the action of drugs on microcirculation.
Anomalous Origin of the Right Coronary Artery from the Main Pulmonary Artery. A Case Report
Authors: Dahlström Carl Gustav , Hellekant Christer , Johansson Bengt W. , Nyman Ulf
Published: July 2008

A fifty-nine-year-old, asymptomatic woman with anomalous origin of the right coronary artery from the main pulmonary artery is presented. The diagnosis was established by catheterization and angiocardiography. The indications for surgery in this condition are discussed, with special reference to asymptomatic patients. In this patient, surgery was not undertaken, because of the absence of signs of impairment of left ventricular perfusion and function. The patient remains asymptomatic after eight years of observation.
A Case of Acute Myocardial Infarction
Authors: Nakagawa Takahiko , Yasuno Masao , Tanahashi Hideo , Ohnishi Shusaku , Nishino Masami , Yamada Yoshio , Abe Hiroshi
Published: July 2008

A fifty-four-year-old woman was admitted to the hospital for a sensation of tightness in the chest of one hour's duration. She had undergone surgery for breast cancer two years previously and had been taking 30 mg of tamoxifen and 1200 mg of medroxyproges terone daily after surgery. Emergency coronary angiography on admission revealed thrombi in both the right coronary artery and the left anterior descending coronary artery. Tissue-type plasminogen activator was injected into both coronary arteries, resulting in diminution of thrombus size. Repeat coronary angiography on the next day disclosed no thrombus in either artery and no significant stenosis. Electrocardiographic and laboratory data indicated myocardial infarction. These findings strongly suggest that the combination hormone therapy altered the patient's blood coagulability and played an important role in the formation of the intracoronary thrombi and subsequent acute myocardial infarction.
Changing Features of Proximal Vein Thrombosis Over Time
Authors: Cogo Alberto , Prandoni Paolo , Villalta Sabina , Polistena Paola , Bernardi Enrico , Simioni Paolo , Vigo Mario , Benedetti Lino , Girolami Antonio
Published: July 2008

Recently, the sensitivity of impedance plethysmography (IPG) for the diagnosis of acute deep-vein thrombosis (DVT) in symptomatic outpatients has been questioned. In order to verify whether a change in the venographic pattern of DVT has occurred over years, accounting for the decreased sensitivity of IPG, the authors compared two series of consecutive venograms demonstrating proximal DVT, performed between 1984-1988 (166 patients) and 1990-1992 (140 patients). They evaluated both the extension and the occlusiveness of deep-vein thrombi in the two series. Moreover, changes in the referral characteristics of patients were investigated. In the second series of venograms a signif icant decrease in thrombi extension, expressed by a lower prevalence of iliac vein throm bosis (29% versus 43%; P = 0.0074) was observed; moreover, a significant increase in the prevalence of nonocclusive thrombi (22% versus 8%; P = 0.0004) was also recorded in the second series when compared with the first. During the study period, among the referral characteristics of patients, the authors observed both a significant decrease in the prevalence of proximal DVT (from 31% to 24%; P < 0.01) and a slight and not statistically significant decrease in the median time elapsed between onset of symptoms and referral for objective testing (from eight and a half to seven days). In conclusion, proximal deep- vein thrombi are currently less extensive and occlusive than observed in the past. These results might depend on earlier referral of less symptomatic patients and might explain the recently reported decrease in IPG sensitivity for proximal DVT.
Transcutaneous Oxygen Tension Measurement in Patients with Chronic Arterial Obstructive Disease: Reliability and Long-Term variability of the Method
Authors: Melillo Elio , Catapano Giosue' , Ferrari Mauro , Pedrinelli Roberto
Published: July 2008

Although transcutaneous oxygen tension (TcpO2) measurement may be useful for assessing changes in regional perfusion induced over time by drug or surgical treatment in patients with chronic arterial obstructive disease (CAOD), the reliability of the method over a long-term period is not know To approach this problem, the authors evaluated retrospectively the behavior of TcpO2 measurement over time in patients with CAOD. To eliminate confounding influences due to the concomitant vascular disease at the limb level, data analysis was performed on TcpO2 measured at the right infraclavicular position. The median length of follow-up ranged from twenty days in 34 patients to 832 days in 3 patients (n=2 and n=10 individual sequential replications respectively).

Initial and final TcpO 2 values did not differ significantly even at the longest follow-up term, which indicates that the parameter is constant over time. The intrapatient variation coefficient of TcpO2 (calculated over at least three individual replications) ranged between an average of 11% to 16.2%. The corresponding interpatient variation fluctuated between 15.5% and 33.4%, a variability explained to some extent by sex-related influ ences, but, at least in the range of this sample, not by age, arterial oxygen levels, or disease status. Thus TcpO2 levels per se are stable, implying that TcpO2 measurement has the potential to record consistent changes caused by specific therapeutic interventions or the clinical evolution of patients with CAOD. However, the intrapatient and interpa tient variability of the method has to be taken into account when TcpO2 is used for the follow-up and the physiopathologic study of patients with CAOD.