bluuebunny/crossref_metadata_2025 huggingface dataset:
Management of the prolonged QT syndrome and recurrent ventricular fibrillation with an implantable automatic cardioverter‐defibrillator
Authors: Platia E. V. , Griffith L. S. C. , Watkins L. , Mirowski M. , Mower M. M. , Reid P. R.
Published: July 2009

Two patients with the prolonged QT syndrome and recurrent ventricular tachyarrhythmias are presented, one of them refractory to combination antiarrhythmic drug therapy and bilateral stellate ganglion blockade. We implanted and tested in vivo an automatic cardioverter‐defibrillator to provide a cardiac monitoring system with the capability of delivering a 25 J electrical discharge to the heart if rapid ventricular tachycardia or ventricular fibrillation is detected. Arrhythmia induction in the electrophysiology laboratory confirmed the appropriate recognition of the arrhythmias in each patient, with prompt discharge of the device and resultant termination of the tachycardias. We suggest that implantation of such a device may provide an effective adjunct to antiarrhythmic drug therapy in the management of infrequent, but potentially lethal, ventricular arrhythmias occurring in patients with the prolonged QT syndrome.
Prediction of rupture in acute myocardial infarction
Authors: Herlitz J. , Samuelsson S. O. , Richter A. , Hjalmarson Å
Published: July 2009

In two patient series including 809 and 327 patients, respectively, with acute myocardial infarction we have compared those who died in myocardial rupture (verified at autopsy, Group A) with those who died without rupture (autopsied, Group B), and those who survived hospitalization (Group C) with regard to previous history and clinical course in hospital. Rupture among autopsied patients was observed in 45% and 40% of the cases in the respective studies. Previous infarction was observed in each study as 0% and 0% in Group A compared with 25% and 31% in Group B, and 20% and 34% in Group C. Previous angina pectoris was observed in 26% and 22% in Group A compared with 50% and 54% in Group B and 52% and 54% in Group C. Maximum serum enzyme activity in Group A did not differ from Group B, but was higher than in Group C (p>0.001). Group A patients tended to have a higher initial pain score and a higher requirement of analgesics compared with other groups, whereas initial heart rate or systolic blood pressure did not differ in these patients compared to others. We thus conclude that patients with myocardial rupture have a very low occurrence of previous myocardial infarction and angina pectoris, and that their pain course appears to be particularly severe in the acute phase.
QT intervals as an index of high serum calcium in hypercalcemia
Authors: Saikawa T. , Tsumabuki S. , Nakagawa M. , Takakura T. , Tamura M. , Maeda T. , Ito S. , Ito M.
Published: July 2009

The relationship between QT interval and serum calcium concentration (s‐Ca) was examined in 9 hypercalcemic (s‐Ca > 11 mg/dl) patients. Three QT intervals corrected by Bazett's formula were used for the analysis: the intervals from the beginning of the QRS to the onset (QoTc), the apex (QaTc), and the end of T wave (QeTc). The measurements of s‐Ca and other electrolytes were made on the blood sample taken on the same day of the electrocardiogram (ECG) recordings. The normal range of s‐Ca and three QTc intervals was determined in 50 outpatients with no cardiac disease. Three QT intervals in the hypercalcemic patients were significantly shortened with a diminution in the s‐Ca. The QTc intervals showed significant negative correlation with s‐Ca. Sensitivity of QoTc, QaTc, and QeTc in predicting high s‐Ca was 83%, 57%, and 39%, respectively, and specificity was 100%, 100%, and 89%. The PQ interval tended to be prolonged in the case of hypercalcemia, but the change was statistically insignificant. These observations suggest that QT intervals can serve as an indicator of high s‐Ca and that the QoTc seems to be a good indicator of the three QTc's.
Iatrogenic cardiac tamponade after central venous catheter
Authors: Chabanier A. , Dany F. , Brutus P. , Vergnoux H.
Published: July 2009

Myocardial perforations with a central venous catheter are rare in adults (67 cases published since 1968). These accidents are fatal in more than two‐thirds of the cases owing to confusion caused by misleading symptoms which suggest pulmonary embolism. The perforation is generally localized in the right atrium (29 cases), less frequently in the right ventricle (18 cases). The superior vena cava is rarely affected (3 cases). The site of the perforation was not found in the other published cases. Clinical symptoms are signs of tamponade with disorders of cardiac rhythm. An enlargement of the cardiac shadow and an abnormal position of the catheter, buckled or openly intrapericardial, make the diagnosis radiologically. Echocardiography provides some information, but this is often too late for practical application. The diagnosis is made with right catheterization when it shows an equalization of the diastolic pressures. This allows the patient to be watched closely following the pericardial tap, after which a surgical approach may be indicated and performed. Prevention of these iatrogenic accidents must be systematic and strictly controlled for.
Incidence of exertional right ventricular wall motion abnormalities in patients with coronary artery disease
Authors: Ratner S. J. , Friedman M. I. , Pierson R. N. , Baum M. S. , Wolinsky D. G.
Published: July 2009

To evaluate the role of analysis of right ventricular function with exercise in patients with presumed coronary artery disease referred for radionuclide ventriculography, the records of 55 patients referred to our laboratory over a 19‐month period were reviewed. All underwent rest and exercise first‐pass radionuclide stress testing and cardiac catheterization within a period of four months. Three groups were identified: (1) patients with normal exercise right ventricular function (n = 24); (2) patients with exercise‐induced right ventricular regional wall motion abnormalities (n = 15); and, (3) patients with abnormal resting right ventricular function without new exercise abnormalities (n = 16). Patients in each group were similar in age, sex, baseline left ventricular function, medication usage, and indication for study. The incidence of right coronary artery disease was identical in the three groups, as was the incidence of left ventricular functional abnormalities with exercise. Patients with proximal right coronary artery disease were more likely to have reduced left ventricular ejection fraction and more extensive coronary artery disease than those without disease at this site. We conclude that: (1) analysis of rest and exercise right ventricular function does not allow prediction of coronary anatomy in an unselected group of patients; (2) normal right ventricular function with exercise is compatible with extensive coronary artery disease, including proximal right coronary artery disease; and (3) abnormal exercise right ventricular function may be due to exertional left ventricular dysfunction in the absence of proximal right coronary artery disease.
Ergometric evaluation of the effects of enalapril maleate in normotensive patients with stable angina
Authors: Portaluppi F. , Cocco G. , Urso L.
Published: July 2009

The anti‐ischemic effect of a single oral dose of 10 mg of enalapril maleate (E) was investigated in 14 normotensive patients with coronary artery disease (CAD) and stable effort‐induced angina pectoris. An exercise stress test was performed three times in each patient at the same clock hour on three successive days: with no treatment (baseline), 6 h after administration of placebo (P), and 6 h after oral administration of a single 10 mg dose of E. The multistage nonstop effort tests were performed in the sitting position. Workload started at 25 W and was increased by 25 W every 2 min until an ischemic ST depression of more than 1.5 mm was observed. The following parameters were measured: heart rate (HR), systolic blood pressure (BP), rate‐pressure product (RPP), workload sustained (WS), elapsed time of effort (ET), and millimeters of ischemic ST depression. The values of the parameters observed with baseline, P, and E were compared at the moment of appearance of chest pain or ischemic ST depression, at the moment of maximal effort, maximal common WS (MCWS), and maximal common RPP (MCRPP). Enalapril delayed the appearance of the ischemic ST depression. At the MCWS, the RPP was significantly lower under E and the ST depression was less marked; this effect was the result of a lower BP level, in the absence of any significant change in HR response. The acute effects of E observed in normotensive patients with effort‐induced angina pectoris seems to be related to the inhibition of angiotensin at the coronary level and to its antiadrenergic action.
Cardiovascular effects of berberine in patients with severe congestive heart failure
Authors: Marin ‐ NETO J. A. , Maciel B. C. , Secches A. L. , Gallo L.
Published: July 2009

Berberine, an alkaloid of the protoberberine family, has been shown to have strong positive inotropic and peripheral resistance‐lowering effects in dogs with and without heart failure. To determine the acute cardiovascular effects of berberine in humans, 12 patients with refractory congestive heart failure were studied before and during berberine intravenous infusion at rates of 0.02 and 0.2 mg/kg per min for 30 minutes. The lower infusion dose produced no significant circulatory changes, apart from a reduction in heart rate (14%). The 0.2 mg/kg per min dose elicited several significant changes: (a) Decreases in systemic (48%, p>0.01) and pulmonary vascular resistance (41%, p>0.01), and in right atrium (28%, p>0.05) and left ventricular end‐diastolic pressures (32%, p>0.01). (b) Increases in cardiac index (45%, p>0.01), stroke index (45%, p>0.01), and LV ejection fraction measured by contrast angiography (56%, p>0.01). (c) Increases in hemodynamic and echocardiographic indices of LV performance: peak measured velocity of shorten: ing (45%, p>0.01), peak shortening velocity at zero load (41%, p>0.01), rate of development of pressure at developed isovolumic pressure of 40 mmHg (20%, p>0.01), percent fractional shortening (50%, p>0.01), and the mean velocity of circumferential fiber shortening (54%, p>0.01). (d) Decrease of arteriovenous oxygen difference (28%, p>0.05) with no changes in total body oxygen uptake, arterial oxygen tension, or hemoglobin dissociation properties. These salutary acute effects show that berberine markedly improved cardiac performance in patients with heart failure refractory to conventional medical therapy with digitalis and diuretics. The improvement is probably subsequent to peripheral vasodilatation and to inotropic stimulation. Significant untoward effects appear to be the development of ventricular tachycardia with “torsades de pointes” morphology, detected in 4 patients 1‐20 h after the infusion of berberine. This possible association requires further elucidation before the administration of berberine may be extended to other patients in heart failure.
Pathophysiological aspects of predominant preload lowering on pulmonary circulation, gas exchange, and the biventricular function in patients with chronic obstructive lung disease
Authors: Seibold H. , Bunjes D. , Schmidt A. , Hombach V.
Published: July 2009

A group of 21 patients with various degrees of chronic obstructive pulmonary disease underwent radionuclide ventriculography with hemodynamic monitoring to assess the extent to which pulmonary artery pressures and pulmonary vascular resistance can be lowered by the vasodilator molsidomine. Molsidomine (N‐carboxy‐3‐morpholino‐sydnonimin‐ethylester) is similar to nitroglycerin in its mode of action. After hemodynamic and radionuclide data acquisition, at rest and during sub‐maximal exercise in the steady state, 2 mg molsidomine was injected intravenously. Rest and exercise measurements were repeated 45 min after molsidomine injection. in patients with mild to moderate disease (group 1), pulmonary artery resting pressures decreased by 12% (p<0.05) at rest and by 22% (p<0.01) during exercise after the administration of the drug. Total pulmonary resistance during exercise decreased significantly (p <0.01) as a result of a marked decrease of pulmonary artery pressure (PAP) compared with a minimal decrease in cardiac index (CI). in patients with severe disease (group 2), only the resting values of PAP decreased while the relationship between pressure and flow was unchanged. During the exercise period, the preload parameters of the right and left ventricles decreased by an average of 30%. With regard to gas exchange, only the arterial PO2 at rest decreased slightly but significantly (p<0.05) after molsidomine, while the coefficient of oxygen delivery was not affected by the drug. However, in four patients arterial PO2 was markedly reduced by the drug. Right ventricular ejection fraction increased significantly (p<0.01) both at rest and during exercise in group 1 and during exercise in group 2 after administration of molsidomine. The left ventricular ejection fraction increased at rest (p<0.05) and during exercise (p<0.01) only in group 1. in conclusion, our results show that only a few patients with advanced lung disease and hypoxia benefit from this vasodilator with predominant preload lowering effect. The lowering of total pulmonary vascular resistance in the exercise state and the marked lowering of preload and afterload of the right ventricle in patients with mild to moderate lung disease after administration of molsidomine might be relevant to patients during surgical stress. in these patients, the net effect of the drug may be beneficial despite a slight reduction of cardiac output in most patients.
Pericardial effusion early in acute myocardial infarction
Authors: Charlap S. , Greenberg S. , Greengart A. , Budzilowicz L. , Gelbfish J. , Hollander G. , Shani J. , Lichstein E.
Published: July 2009

The incidence and significance of pericardial effusions early in acute myocardial infarction remain unclear. Using two‐dimensional echocardiography, 172 patients with an acute myocardial infarction were evaluated within 72 h of presentation. Thirty patients (17%) had a pericardial effusion (29 small, 1 moderate) while 142 (83%) did not. No patient developed cardiac tamponade or required pericardiocentesis. Patients with pericardial effusions had higher peak creatine kinase as compared to patients without effusions (2036 ± 1466 vs. 1483 ± 1241, p>0.05) and a greater number of aneurysms (20% vs. 6%, p>0.05). In‐hospital mortality was higher in the patients with pericardial effusions (10% vs. 2%, p > 0.05). In conclusion, pericardial effusions are common in the early AMI period but are generally small and hemodynamically insignificant. They are associated with larger infarcts and greater mortality.
Awareness, treatment, and control of hypertension in the elderly in a general practice experience
Authors: Pirone F. , Radice M. , Avanzini F. , Alli C , Bettelli G. , Colombo F. , Conforti L. , Devoto M. A. , Di TULLIO M. , Marchioli R. , Mariotti G. , Spagnoli A. , Taioli E. , Tognoni G. , Villella M. , Zussino A. ,   and the participating physicians of the Study Group on Hypertension in the Elderly
Published: July 2009

In 3858 ambulatory elderly people (age >65 years) prevalence of hypertension was 67.8%. The hypertensive status was unknown to both the doctor and the patient in 21.4 % of cases. More than 90 % of known hypertensives were treated, but hypertension could be considered as controlled in less than 30% of them.
Pathophysiology and management of unstable angina
Authors: Von Dohlen T. W. , Rogers W. B. , Frank M. J.
Published: July 2009

Significant progress has been made in recent years in unraveling the dynamic mechanisms involved in the production of unstable angina. This knowledge, and advances in medical and interventional therapy allow the formulation of treatment strategies aimed at specific pathogenic mechanisms and promise to reduce mortality and morbidity. This review covers the diagnosis, pathogenesis, risk stratification, and therapy of unstable angina.
Outpatient cardiac catheterizations: Analysis of patients requiring admission
Authors: Pink S. , Fiutowski L. , Gianelly R. E.
Published: July 2009

The purpose of this study was to review the results of the first 1,000 outpatient cardiac catheterizations performed at our hospital with special emphasis on patients who were hospitalized. Nearly all patients had percutaneous femoral artery catheterization using #8F catheters. There were no deaths. The major complications included two myocardial infarctions and four cerebral emboli. Surgery on the femoral artery was required in 2 patients (1 occlusion and 1 pseudoaneurysm), 7 patients developed unstable angina without subsequent infarction, and 4 patients had ventricular tachycardia or fibrillation. Complications requiring admission were found in 39 patients. Another 59 were admitted, 51 for revascularization procedures. Of the latter 51 patients, 27 had main left coronary stenosis of 50% of greater. We have found outpatient catheterization to be a safe procedure. Complications requiring admission occurred in 3.9% of the patients. The most common reason for admission was to perform urgent bypass surgery in patients with main left coronary stenosis in excess of 50%.
Leaflet entrapment causing acute severe aortic insufficiency during balloon aortic valvuloplasty
Authors: Treasure C. B. , Schoen F. J. , Treseler P. A. , Bittl J. A.
Published: July 2009

Cusp entrapment is a previously unreported mechanism of aortic insufficiency after balloon aortic valvuloplasty. In a patient who developed severe acute aortic insufficiency and expired after balloon aortic valvuloplasty, pathologic evaluation revealed a large, solitary, fractured, calcific nodule in the noncoronary cusp in which the malaligned, irregular fracture surfaces of the nodule had entrapped the leaflet in an open position. The ease with which the entrapped leaflet was reduced by manipulation on postmortem examination suggests that further manipulation of the cusp might restore valve competence in some cases when aortic insufficiency occurs after balloon valvuloplasty in calcific aortic stenosis.
Hypertrophic cardiomyopathy: Two‐dimensional echocardiographic score versus clinical and electrocardiographic findings
Authors: Melacini P. , Fasoli G. , Canciani B. , Buja G. , Mammola C. , Dalla Volta S.
Published: July 2009

The severity and site of hypertrophy is important in determining the clinical picture and the natural history of hypertrophic cardiomyopathy (HCM). We evaluated left ventricular hypertrophy by means of two‐dimensional echocardiographic score and score index, and correlated these findings with symptoms, electrovector‐cardiographic data, and ventricular arrhythmias. A total of 42 patients with HCM were studied by clinical examination, ECG, VCG, M‐mode and 2D echocardiography, and 24‐h Holter monitoring. The extent and severity of the hypertrophic process were calculated by a score system. The left ventricle was divided into 11 segments and a hypertrophic score (HS) was given to each segment. A hypertrophy score index (HSI) was also calculated by dividing the number of hypertrophied segments by 13. No correlation was found between symptoms and HS and HSI, nor ECG‐VCG abnormalities and HS and HSI. A statistically significant relationship between the severity of ventricular arrhythmias and HS and HSI was found (p<0.01). The mechanism responsible for ventricular tachyarrhythmias in severe and diffuse hypertrophy might reside in the high intraventricular pressures which produce or worsen areas of myocardial ischemia.
Letters to the editor
Authors: Lindsey Douglas
Published: July 2009

Nicolai S. Korotkoff (1874–1920) J. D. Cantwell: Clin Cardiol 12, 233 (1989)
Current concepts of left ventricular pseudoaneurysm: Pathophysiology, therapy, and diagnostic imaging methods
Authors: March K. L. , Sawada S. G. , Tarver R. D. , Kesler K. A. , Armstrong W. F.
Published: July 2009

Left ventricular pseudoaneurysm represents a cardiac rupture which is temporarily confined by pericardium and is amenable to curative surgical treatment. The case described illustrates several atypical features of its presentation and diagnosis, highlighting the importance of maintaining a sufficient clinical index of suspicion for this relatively uncommon, but potentially lethal entity. The use of various diagnostic imaging methods is described, including the first description of magnetic resonance imaging of ventricular pseudoaneurysm. The prospect of medical therapies directed toward the prevention of cardiac rupture, and thus pseudoaneurysm, is discussed in the context of its pathophysiology which involves alterations in the cardiac fibroskeletal support.
Left ventricular diastolic function in normotensive adolescents with different genetic risk of hypertension
Authors: Alli C. , Avanzini F. , Ditullio M. , Mariotti G. , Salmoirago E. , Taioli E. , Radice M.
Published: July 2009

Abnormalities of the diastolic function of the left ventricle are the first sign of cardiac involvement in arterial hypertension. We have studied the diastolic function in a group of normotensive adolescents with confirmed family history of hypertension. M‐mode echocardiography was performed in 86 normotensive males aged 14‐19 years: 41 sons of at least one hypertensive parent (SHT) and 45 sons of normotensive parents (SNT). Cross‐sectional area of the left ventricle and left ventricular (LV) mass index were significantly greater in the SHT than in the SNT group (10.05 ± 1.84 vs. 8.9 ± 1.56 cm/m2, p < 0.01 and 129.3 < 29.3 vs. 109.23 ± 25.7 g/m2, p < 0.002, respectively). No significant difference between the two groups was observed in the indices of left ventricular diastolic function, except for mitral valve opening rate (463.51 ± 90.45 in SHT vs. 416.71 ± 78.84 mm/s in SNT; p ± 0.02). From the analysis of the subgroup of adolescents having left ventricular mass greater than the upper normal value, we observed that they showed mean time of rapid filling significantly longer than SNT: this could represent an early marker of the pathological character of such hypertrophy. Our results suggest that the higher LV mass observed in the SHT is not associated with chamber and myocardial stiffness abnormalities.
Giant P wave in a patient with right ventricular cardiomyopathy
Authors: Martini B. , Nava A. , Buja G. F. , Canciani B. , Bigolin E. , Dalla Volta S.
Published: July 2009

A P wave of 7.5 mm in lead I and 12.5 in V, was detected in a 28‐year‐old man, with a progressive cardiomegaly since the age of 14 years. At last admission he had minor symptoms, and a systolic murmur consistent with tricuspid regurgitation. The electrocardiogram showed an extremely tall P wave and a QRS of a very low amplitude; T waves were inverted on the precordial leads. These ECG features, and subsequent investigations, were consistent with right ventricular cardiomyopathy with massive tricuspid regurgitation, and right atrial abnormality.
Radionuclide assessment of left ventricular function during dobutamine infusion in patients with coronary artery disease: Comparison with ergometer exercise
Authors: Konishi T. , Koyama T. , Aoki T. , Yada T. , Futagami Y. , Nakano T. , Yamamuro M. , Watanabe K.
Published: July 2009

The effects of dobutamine on left ventricular function were assessed employing radionuclide ventriculography (RNV) in 7 normal subjects (Group 1) and 21 patients with coronary artery disease (Group 2). After routine bicycle ergometer exercise RNV, dobutamine infusion was started at 5 μg/kg/min and the dosage was increased by 5 μg/kg/min every 4 minutes to a total of 15 μg/kg/min. In Group 1, left ventricular ejection fraction (LVEF) increased by both ergometer exercise and dobutamine infusion. In Group 2, LVEF did not increase during exercise, but increased during dobutamine infusion without evidence of significant myocardial ischemia. Only 2 patients in Group 2 had new regional wall motion abnormality. Left ventricular end‐diastolic volume (LVEDV) in Group 2 increased from 191 ± 19 to 210 ± 18 ml during ergometer exercise, but decreased from 193 ± 18 to 153 ± 19 ml during dobutamine infusion. Short‐term low‐dose infusion of dobutamine may be used in patients without evidence of significant myocardial ischemia, but probably cannot be substituted for exercise testing in patients with mild to moderate coronary artery disease.
Clinical approach to paroxysmal atrial fibrillation
Authors: Coumel P.
Published: July 2009

In addition to the role of the electrophysiological substrate, paroxysmal atrial fibrillation depends on the modulation of the atrial tissues by the autonomic nervous system. Experimentally, models of atrial fibrillation can be based on either adrenergic or vagal stimulations that provoke the arrhythmia by disturbing in a different way conduction and refractory periods of the atrium. Clinically, the role of the autonomic nervous system can be suspected from the clinical history, and paroxysmal attacks can typically be observed either at daytime or at night, at exercise or at rest. Careful attention should be paid to the changes of heart rate that occur in the minutes or tens of minutes prior to the attacks, and the trend of acceleration or slowing of cardiac frequency observed in Holter tracings provides reliable indications of the state of the vago‐sympathetic balance in these patients. During the attacks, the electrocardiographic aspect of atrial flutter alternating with a pattern of atrial fibrillation is typical of vagally dependent arrhythmias, whereas atrial tachycardia is more frequently observed at the onset of adrenergic atrial fibrillation. When the paroxysmal forms of arrhythmia are resistant to usual pure antiarrhythmic therapy including type IA agents and flecainide or en‐cainide, one should take into account the role of the autonomic nervous system. Propafenone, or beta‐blockers combined with type I drugs, are very effective every time an adrenergic factor is involved, but prevent the beneficial role of other agents if a vagal mechanism is predominant. Amiodarone, a complex drug with multiple facets, can be active in many different situations but its use should be reserved to definitely resistant cases, in combination with other agents, in order to limit its potential long‐term side effects. Digitalis and verapamil mainly address the tolerance to arrhythmias, rather than their prevention.
Diurnal change of giant negative T wave in patients with hypertrophic cardiomyopathy
Authors: Iida K. , Sugishita Y. , Yukisada K. , Ito I.
Published: July 2009

To examine the diurnal change of negative T wave (deeper than 10 mm in precordial leads) in apical hypertrophic cardiomyopathy and the mechanism of giant negative T wave, 24‐h ambulatory electrocardiographic monitoring was performed in 8 patients with apical hypertrophic cardiomyopathy, and effect of atropine on electrocardiogram was studied. The mean depth of negative T wave at 1, 2, and 3 P. M. was 9.3±3.0 mm, and that at 1, 2, and 3 A. M. was 12.6 ± 4.8 mm. The mean R‐R interval at 1, 2, and 3 P. M. was 792 ± 113 ms and that at 1, 2, and 3 A. M. was 1055 ± 94 ms. In seven patients (88%), negative T wave was deeper during the night than during the daytime. There was a positive correlation between R‐R interval and depth of negative T wave in 6 patients (75%). Despite significant shortening of R‐R interval (879 ± 116 to 804 ± 110 ms, p < 0.05), atropine did not significantly change the depth of negative T wave (14 ± 5 to 14 ± 5 mm). In conclusion, negative T wave is not fixed, but is variable, diumally, probably due to the change of sympathetic tone.
Electrophysiologic effects of bepridil in patients with refractory ventricular tachycardia assessed by programmed electrical stimulation
Authors: Schmitt C. , Brachmannm J. , Hölzel C. , Waldecker B. , Schöls W. , Beyer T. , Kübler W.
Published: July 2009

The effect of intravenous bepridil, a new calcium antagonist with class I and III properties, was tested in 21 patients with sustained ventricular tachyarrhythmias refractory to a mean of five antiarrhythmic agents as assessed by programmed right ventricular stimulation. At control electrophysiologic study without antiarrhythmic agents, sustained monomorphic ventricular tachycardia (VT) was initiated in 20 patients and ventricular fibrillation (VF) was initiated in one patient. After 3 mg/kg of bepridil was administered, VT was still inducible in 19 patients (3 patients had self‐terminating VT); the other 2 patients had no inducible VT after bepridil. Bepridil prolonged significantly the QTc interval, the effective refractory period, and the cycle length of induced ventricular tachycardia. Two patients with no inducible VT after intravenous bepridil were placed on oral bepridil (300 mg/day). One patient died suddenly and one patient died of progressive heart failure. The results seem to indicate that the efficacy of bepridil in patients with refractory ventricular tachycardia is limited.
On the segmentation of vascular geometries from medical images
Authors: Radaelli A. G. , Peiró J.
Published: July 2009

A comprehensive analysis of vascular morphology and the application of generic models of vascular biomechanics to specific patients require the ability of extracting a geometrical representation of the vascular anatomy from medical images. Owing to the wide range of clinical manifestations of vascular disease and associated imaging modalities and protocols, several segmentation methods have been proposed over the last 20 years and are available in the literature. In this paper, we review the methods of segmentation of angiographic medical images and identify major advantages and disadvantages of state‐of‐the‐art techniques. We further discuss the performance of some of the most popular intensity‐based and gradient‐based methods using a set of images of peripheral by‐pass grafts acquired with magnetic resonance angiography (MRA). We then propose a threshold front method for the segmentation of MRA images and assess its performance using two anatomic scale replica models, reproducing a normal and a stenotic peripheral artery. The threshold front algorithm is a simple, fast and parameter‐free (still adaptive) method achieving segmentation errors below pixel resolution. Copyright © 2009 John Wiley & Sons, Ltd.
An optimizing finite difference scheme based on proper orthogonal decomposition for CVD equations
Authors: Du Juan , Zhu Jiang , Luo Zhendong , Navon I. M.
Published: July 2009

In this article, an optimizing reduced finite difference scheme (FDS) based on singular value decomposition (SVD) and proper orthogonal decomposition (POD) for the chemical vapor deposit (CVD) equations is presented. And the error estimates between the usual finite difference solution and the reduced POD solution of optimizing FDS are derived. At last, some examples of numerical simulation are given to demonstrate the consistency of the numerical and theoretical results. It is shown that the optimizing reduced FDS based on POD method is of great feasibility and efficiency. Copyright © 2009 John Wiley & Sons, Ltd.
Stability‐indicating chemometric methods for the determination of pyritinol dihydrochloride
Authors: El‐Sayed Mohammad A. , Abdul‐Azim Mohammad Mohammad
Published: July 2009

Three multivariate calibration methods, including classical least square with nonzero intercept (CLS), principal component regression (PCR) and partial least square (PLS), have been used for the determination of pyritinol dihydrochloride in the presence of its degradation product. The CLS, PCR and PLS techniques are useful in spectral analysis because the simultaneous inclusion of many spectral wavelengths instead of the single wavelength used in derivative spectrophotometry has greatly improved the precision and predictive abilities of these multivariate calibrations. A training set was constructed for the mixture and the best model was used for the prediction of the concentration of the selected drug. The proposed procedures were applied successfully in the determination of pyritinol dihydrochloride in laboratory‐prepared mixtures and in commercial preparations. Pyritinol dihydrochloride was analysed with mean accuracies 99.99 ± 0.905, 99.91 ± 0.966 and 99.92 ± 0.962 using the CLS, PCR and PLS methods respectively. The validity of the proposed methods was assessed using the standard addition technique. The proposed procedures were found to be rapid and simple and required no preliminary separation. They can therefore be used for the routine analysis of pyritinol dihydrochloride in quality‐control laboratories. Copyright © 2009 John Wiley & Sons, Ltd.
Localization of winding radial deformation and determination of deformation extent using vector fitting‐based estimated transfer function
Authors: Karimifard P. , Gharehpetian G. B. , Tenbohlen S.
Published: July 2009

This paper suggests a new method to detect the location and the extent of the winding buckling which is based on the transfer function (TF) estimation using the vector fitting (VF) method. To study the proposed method, the verified detailed model of the transformer winding in the frequency range of kHz < f < MHz has been developed. The simulation results indicate the capability of the proposed method to localize the deformed section in the transformer winding. In addition, the proposed method presents an index for the determination of the deformation extent. Copyright © 2008 John Wiley & Sons, Ltd.
A randomized controlled trial to examine the effectiveness of case management model for community dwelling older persons with mild dementia in Hong Kong
Authors: Lam Linda C. W. , Lee Jenny S. W. , Chung Jenny C. C. , Lau Anna , Woo Jean , Kwok Timothy C. Y.
Published: July 2009

Objective

To evaluate a case management (CM) model for people with mild dementia, whereby resources within the family and in the community were mobilized and optimally used.

Method

Community dwelling psychiatric and geriatrics outpatients with mild dementia were randomized to receive CM by a trained occupational therapist for 4 months (CM group, N = 59) or usual care only (control group, N = 43). Primary outcome indicators included the Zarit Burden Scale (ZBI), General Health Questionnaire (GHQ), and Personal Well‐Being Index for Adult (PWI‐A) of the family caregivers. Secondary outcome indicators included the Mini‐Mental State Examination (MMSE), Neuropsychiatric Inventory (NPI), Cornell Scale for Depression in Dementia (CSDD), and Personal Well‐Being Index for Intellectually Disabled (PWI‐ID) of the demented subjects as measured at fourth and twelfth months.

Result

CSDDis reduced in the CM group at fourth month, but not at twelfth month. The changes in outcome variables of persons with dementia did not differ between the groups (Mann–Whitney U‐test, p > 0.05). At follow‐up, CM group used more day care and domestic helpers than control group (χ 2, p > 0.05).

Conclusion

Case management for Chinese persons with mild dementia outpatients did not show significant effects in reducing caregiver burden, but encouraged family caregivers to seek external support. Copyright © 2009 John Wiley & Sons, Ltd.
High specific activity (+)‐amphetamine and (+)‐methamphetamine
Authors: Lamb Pamela B. , McElhinny Charles J. , Sninski Todd , Purdom Hunter , Carroll F. Ivy , Lewin Anita H.
Published: July 2009

High specific activity (+)‐amphetamine and (+)‐methamphetamine were prepared by reductive dechlorination of (S)‐(3′,5′‐dichlorophenyl)‐2‐propylazide and (S)‐2′6′‐dichloromethamphetamine, respectively. While the latter was readily obtained by resolution of racemic 2′6′‐dichloromethamphetamine using (+)‐dibenzoyltartaric acid, the analogous amphetamine resisted all efforts to resolve it. Hence, the required chiral precursor was prepared by stereospecific total synthesis following methodology that had been previously developed in our Laboratories. The tritium labeled compounds had specific activity 30.1 Ci/mmol and 38.3 Ci/mmol, respectively. Copyright © 2009 John Wiley & Sons, Ltd.
Factors associated with cognition in adults: The Seattle Longitudinal Study
Authors: Yu Fang , Ryan Lindsay H. , Schaie K. Warner , Willis Sherry L. , Kolanowski Ann
Published: July 2009

A better understanding of factors that affect cognition could lead to improved health and greater independence for older adults. We examined the association of four modifiable factors (leisure‐time physical activity, leisure‐time cognitive activity, self‐directed work, and hypertension) with changes in two aspects of fluid intelligence (verbal memory and inductive reasoning). Data for 626 adults collected over 14 years (three time points) were analyzed by multi‐level modeling. A component of self‐directed work, higher work control, was associated with better verbal memory (p < .05) and inductive reasoning (p < .01). There were no significant interactions among these factors. The findings suggest that a strong sense of control at work may be protective for fluid intelligence in adults. © 2009 Wiley Periodicals, Inc. Res Nurs Health 32:540–550, 2009
Effect of organoclay on thermal and dynamic mechanical properties of novel thermoplastic polyurethane nanocomposites prepared by melt intercalation technique
Authors: Barick Aruna Kumar , Tripathy Deba Kumar
Published: July 2009

Polymer nanocomposites based on thermoplastic polyurethane (TPU) containing organophilic montmorillonite (OMMT) were prepared by melt compounding method followed by compression molding. Different percentage of organically modified nanoclays (1, 3, 5, 7, and 9 wt%) was incorporated into the TPU matrix in order to examine the influence of the nanofillers on nanophase morphology and materials' properties. The microstructure morphology of the nanocomposites was examined by transmission electron microscopy (TEM), energy dispersion X‐ray analysis (EDX), wide angle X‐ray diffraction (WAXD), and atomic force microscope (AFM). The observation established that the organoclay is homogeneously dispersed and preferentially embedded in the TPU soft segment phase. Significant enhancement in the thermal stability of the nanocomposites was observed with the addition of the OMMT under thermogravimetric analysis (TGA). Dynamic mechanical properties of the TPU nanocomposites were analyzed using a dynamic mechanical thermal analyzer (DMTA), which confirms that the addition of OMMT has a strong influence on the storage and loss modulus of the TPU matrix. Copyright © 2009 John Wiley & Sons, Ltd.
Novel polymer nanocomposites based on polystyrene and Ti‐functionalized polyhedral silsesquioxanes
Authors: Monticelli Orietta , Zunino Ennio , Carniato Fabio , Boccaleri Enrico , Marchese Leonardo , Chincarini Andrea
Published: July 2009

Ti‐based polyhedral silsesquioxanes (Ti‐POSSs) have been prepared and dispersed in polystyrene (PS), by in situ polymerization, and the resulting materials have been characterized by several experimental techniques including both scanning (SEM) and transmission (TEM) electron microscopy, wide angle X‐ray diffraction (WAXD), X‐ray photospectroscopy (XPS), and thermogravimetric analysis (TGA/DTG). TEM and SEM analyses proved that PS nanocomposites of the samples based on heptaisobutyl‐Ti‐POSS (HEI‐Ti‐POSS) are formed, where HEI‐Ti‐POSS cages are directly linked to the macromolecules via Ti‐C bonds. The presence of HEI‐Ti‐POSS enhances the thermo‐oxidative stability of PS‐based nanocomposites and does not significantly affect the polymer molecular mass. Copyright © 2009 John Wiley & Sons, Ltd.
Use of ultrasound biomicroscopy to image human ovaries in vitro
Authors: Baerwald A. , Dauk S. , Kanthan R. , Singh J.
Published: July 2009

Objectives

To test the hypothesis that ultrasound biomicroscopy is an effective tool for imaging human ovaries in vitro.

Methods

This was a prospective, observational study of 11 women (mean age, 48.9 ± 2.3 years; range, 40–65 years) undergoing unilateral or bilateral oophorectomy. Ovaries were obtained in the operating room and imaged in a cooled saline bath using conventional two‐dimensional (2D) ultrasound. Follicles identified using conventional 2D ultrasound were then imaged in a cooled saline bath using ultrasound biomicroscopy. Ovaries were then placed in 10% neutral‐buffered formaldehyde and transported to the Pathology Department for histological evaluation. Digital images of individually identified ovarian follicles using conventional ultrasound, ultrasound biomicroscopy and histology were obtained (n = 22). Thicknesses of the follicle wall, granulosa layer and theca interna layer were measured using standardized techniques.

Results

The imaging sensitivity, defined as the smallest follicle visualized, was greater using ultrasound biomicroscopy (0.33 ± 0.07 mm) than it was using conventional ultrasound (1.5 ± 0.21 mm; P < 0.0001). The mean follicle wall thickness was greater using conventional ultrasound (0.675 ± 0.039 mm) compared with ultrasound biomicroscopy (0.254 ± 0.017 mm), which in turn, was greater than that measured by histology (0.160 ± 0.009 mm) (P < 0.0001). The mean granulosa and theca layer thickness measurements, respectively, were greater using ultrasound biomicroscopy (0.067 ± 0.004 mm; 0.186 ± 0.014 mm) compared with histology (0.034 ± 0.002 mm; 0.126 ± 0.008 mm) (P ≤ 0.001). Protrusions from the follicle wall into the antrum, believed to represent cumulus–oocyte complexes, were visualized in five of 22 follicles using ultrasound biomicroscopy.

Conclusions

The ultrasound biomicroscope was an effective tool to image human ovaries in vitro. Ultrasound biomicroscopy provided greater sensitivity and resolution for imaging ovarian follicles compared with conventional 2D ultrasonographic techniques. Copyright © 2009 ISUOG. Published by John Wiley & Sons, Ltd.
Gender dimorphism in siblings with schizophrenia‐like psychosis due to Niemann‐Pick disease type C
Authors: Walterfang M. , Fietz M. , Abel L. , Bowman E. , Mocellin R. , Velakoulis D.
Published: July 2009

We describe the differential presentation of schizophrenia‐like psychosis in two siblings with the ‘variant’ biochemical presentation of adult Niemann‐Pick disease type C. The male sibling presented with psychosis at age 16 years and cognitive and motor disturbance at age 25 years, whereas his elder sister, sharing the same mutation but showing less severe biochemical, neuroimaging and ocular motor parameters, presented with a similar schizophrenia‐like illness with associated cognitive and motor disturbance at age 31 years. Their illness onset, course and response to treatment mirrors the sex dimorphism seen in schizophrenia, and is suggestive of an interaction between the neurobiology of their metabolic disorder and sex differences in neurodevelopment.
An easy way to reduce PIT‐tag loss in rodents
Authors: Lebl Karin , Ruf Thomas
Published: July 2009

Passive integrated transponders (PIT‐tags) have been shown to be a reliable method for individually marking rodents in field studies. The loss rates of PIT‐tags vary, depending on the species, from 3.6 to 7.2%. We used PIT‐tags to individually mark a population of edible dormice. Due to a relatively high loss rate of transponders in the first year (7.4%) we used a tissue adhesive to seal the punctuation wound in the second year. With this method we could reduce the tag‐loss rate to 2.2%. We therefore recommend using a tissue adhesive, which is easy and fast to apply, after injecting a transponder.
Gas exchange of juvenile and mature trees of Alnus jorullensis (Betulaceae) at sites with contrasting humidity in the Venezuelan Andes
Authors: Piper Frida I. , Cavieres Lohengrin A.
Published: July 2009

The reduction of photosynthetic rates with tree age has been proposed as a major driver of the productivity declination along ontogeny. It is not clear, however, how environmental humidity affects stomatal conductance and biochemical potential of photosynthesis in trees belonging to different age‐classes. We assessed daily cycles of gas exchange on leaves of juvenile and mature individuals of the tropical high‐elevation tree Alnus jorullensis Kunth (Betulaceae), at two sites with contrasting precipitation in the Venezuelan Andes. Photosynthesis and stomatal conductance were higher in juvenile trees during the morning and at noon in the mesic site, and were in general similar between age‐classes in the wet site. Under light‐saturating conditions, the net photosynthetic rate was similar between the age‐classes at the wet site and higher for juvenile trees at the mesic site, whereas stomatal conductance did not differ between age‐classes and was higher at the wet site. Daily cycles of gas exchange and a type II regression model between photosynthesis and intercellular CO2 concentration indicated that the better performance of juvenile trees at the mesic site was due to lower non‐stomatal limitations. These results support the proposal that non‐stomatal limitations—rather than stomatal ones—are involved in the decay of photosynthesis in mature trees, and suggest that such limitations may be evident only under drier conditions.
Polymeric Nanocapsule from Silica Nanoparticle@Cross-linked Polymer Nanoparticles via One-Pot Approach
Authors: Shen Ruoping , Mu Bin , Du Pengcheng , Liu Peng
Published: July 2009

A facile strategy was developed here to prepare cross-linked polymeric nanocapsules (CP nanocapsules) with silica nanoparticles as templates. The silica nanoparticle@cross-linked polymer nanoparticles were prepared by the encapsulation of the silica nanoparticles by the one-pot approach via surface-initiated atom transfer radical polymerization of hydroxyethyl acrylate in the presence ofN,N′-methylenebisacrylamide as a cross-linker from the initiator-modified silica nanoparticles. After the silica nanoparticle templates were etched with hydrofluoric acid, the CP nanocapsules with particle size of about 100 nm were obtained. The strategy developed was confirmed with Fourier transform infrared, thermogravimetric analysis and transmission electron microscopy.