bluuebunny/crossref_metadata_2025 huggingface dataset:
The Echocardiographic Features of an Aneurysm of the Inter-Atrial Septum
Authors: Kong Chi-Woon , Chan William
Published: November 2007

The echocardiographic features of a surgically confirmed case of an aneurysm of the inter-atrial septum presenting as a persistent right atrial lesion were described. The lesion appeared cystic and could be differentiated from solid tumours. In contrast to other reported cases of smaller aneurysms, the lesion in this patient remained in the right atrium and did not show any phasic variation during the respiratory cycle because of its larger size. A review of the reported echocardiographic features of intra-cavitary right atrial tumours and pseudotumours was made. This highlighted distinguishing features that could be used in the differential diagnosis of space-occupying lesion within the right atrium.
Effects of Flunarizine and Pentoxifylline on Walking Distance and Blood Rheology in Claudication
Authors: Perhoniemi Vesa , Salmenkivi Kari , Sundberg Stig , Johnsson Riitta , Gordin Ariel
Published: November 2007

Thirty-one patients, mean age 60 years (range 45-80 years), with a typical history and objective symptoms of intermittent claudication with a reported maximal walking dis tance less than 500 m, were included in a cross-over study. After a one month's run-in period on placebo, the patients were randomized into two groups: one group started with flunarizine (5 mg t.i.d.) and the other with pentoxifylline (400 mg t.i.d.). The treatment lasted 3 months, whereafter the medications were changed. The trial followed a double-blind design.

The median of the maximal walking distance was 255 m after the placebo period, increasing significantly (p<0.01) during both medication periods: by 43% and 18% during flunarizine and pentoxifylline, respectively. No changes were recorded in the ankle systolic blood pressure ratio (ASBP-ratio) after placebo or either medication period. Red cell rigidity (Pmax), which was initially elevated, decreased significantly (p<0.05) during both medication periods, but there were no significant differences between the two drugs. No changes were found in whole blood or plasma viscosity.

We conclude that the decrease in red cell rigidity may have contributed to the increased walking distance.
High Out-Put Congestive Heart Failure as First Manifestation of Osler-Weber-Rendu Disease M. Montejo Baranda, M.D., F.I.C.a., M. Perez, M.D.,* J. De Andres, M.D.,* C. De La Hoz, M.D., J. Merino, M.D., and C. Aguirre, M.D. Bilbao, Spain
Authors: Montejo Baranda M.
Published: November 2007

We present two cases of hemorrhagic he reditary telangiectasia (HHT) or Osler-We ber-Rendu disease which debuted as heart failure. Both had multiple arteriovenous fis tulas, one of them in a rare localization in this disease, a lower extremity. We conclude stressing the importance of thinking of HHT in the presence of obscure heart failure or ar teriovenous fistulas and of looking for inter nal fistulas when faced by a HHT.
Ineffectiveness of Ca2+-Antagonists Nicardipine and Diltiazem on Experimental Atherosclerosis in Cholesterol-fed Rabbits
Authors: Naito Michitaka , Kuzuya Fumio , Asai Kan-ichi , Shibata Kazuaki , Yoshimine Noboru
Published: November 2007

There is accumulating evidence that calcium metabolism plays an important role in the pathogenesis of atherosclerosis. The inhibitory effect of nifedipine, a Ca2-antagonist, on experimental atherosclerosis in cholesterol-fed rabbits has been reported, and we examined the anti-atherosclerotic action of nicardipine and diltiazem, similar Ca2+-antagonists, but no inhibitory action was observed.

It is necessary to recognize the fact that the sensitivity of rabbits to an antiatherogenic diet shows great individual differences. For the purpose of preventing atherosclerosis due to the abnormality of lipid metabolism the use of Ca2+-antagonist is not warranted at the present stage.
Hand Exercise Effect in Maturation and Blood Flow of Dialysis Arteriovenous Fistulas Ultrasound Study
Authors: Rodriguez Moran Manuel , Almazan Enriquez Arturo , Ramos Boyero Manuel , Rodriguez Rodriguez Jose M. , Gomez Alonso Alberto
Published: November 2007

With the help of the Doppler Ultrasound we have measured the radial artery blood flow of 20 healthy volunteers and the fistula flow of 40 uraemic patients. The measurements were made at rest and repeated one, three and five minutes after initiation of hand exercise, and one minute after the exercise had finished.

Radial artery mean flow increased significantly with the exercise (p < 0.001); radial arteries with greater baseline flow had less flow increase (p < 0.002). However, we were not able to demonstrate any fistula flow increase with the hand exercise.

Therefore, we conclude that there is no benefit in advising uraemic patients to squeeze a rubber ball which, otherwise, supposes an unnecessary preoccupation for these patients.
Prevalence of Angiographically Recognizable Atherosclerosis in Non-Dominant Right Coronary Arteries
Authors: Moreyra Abel E. , Sclar Craig , Burns John J. , Kostis John B.
Published: November 2007

Among 1,000 consecutive patients referred for coronary arteriography be cause of chest pain, 89 patients were found to have a non-dominant right coro nary artery (NDRCA). These patients were compared to 89 consecutive patients with dominant right coronary artery (DRCA) matched for age, sex, smoking and serum cholesterol. There was a lower incidence of obstructive disease in NDRCA (23 of 89 patients, 26%) than in DRCA (55 of 89 patients, 62%), χ2=23.368, p < 0.001. The incidence of coronary disease was also lower in the NDRCA group, 50 of 89 patients (56%), than in the DRCA group, 68 of 89 patients (76%), χ2=8.146, p<0.01.

When only patients with coronary artery disease (CAD) were included in the analysis: 23 of 50 (46%) patients with CAD and NDRCA had obstructive disease in the right coronary artery (RCA) while 55 of 68 (80%) patients with DRCA and CAD had obstructive disease in the RCA, χ2=15.646, p < 0.001. The lower incidence of disease in NDRCA persisted even when only the proximal one-third of the DRCA was considered: 41 of 89 (46%) patients with DRCA had proximal lesions compared to the total length of NDRCA, 23 of 89 patients (26%), χ2=7.940, p<0.01.

We conclude that (1) obstructive atherosclerotic lesions are less frequent in NDRCA than in comparable populations; (2) the length (extension) of the artery does not appear to explain this fact, since the lesser degree of disease persists even when only the proximal segment of dominant right coronary artery was considered; (3) an intriguing observation is that the incidence of obstructive atherosclerotic lesions was lower in NDRCA than in a matched DRCA popula tion.
Value of Radionuclide Angiogram for the Diagnosis of Ebstein's Anomaly
Authors: Gould Lawrence , Gopalaswamy C. , Yang David , Patel D.M. , Kim B.S. , Patel C.
Published: November 2007

A radionuclide angiogram in a patient with Ebstein's anomaly showed a very dilated right atrium with a minimally enlarged right ventricle and a normal sized left ventricle. This study led to the establishment of a definitive diagnosis by means of an echocardiogram. Late close of the tricuspid valve was demon strated. In addition prolapse of the tricuspid and mitral valves was docu mented. A tricuspid valve prolapse has never been reported in this condition.
Fibromuscular Hyperplasia of the Brachial Artery—Failure of Calcium Antagonist Therapy
Authors: Olson Leatrice A. , Faber D. Bruce , LeMar Jerold V. , Routman Burton N. , Hoff Gary L.
Published: November 2007

Fibromuscular dysplasia (FMD) of the arteries of the extremities has been reported few times in the literature. The clinical significance of FMD relates to the consequences of interruption of arterial blood to the tissues. We report here the second case of FMD of the brachial artery and discuss the failure of the calcium channel blocker, nifedipine, in the therapy of this disorder. A review of the pertinent literature is included.
Infectious Endocarditis Caused By Actinobacillus Actinomycetemcomitans
Authors: Gould Lawrence , Gopalaswamy C. , Kim B.S. , Patel C. , Freiberg K.
Published: November 2007

Actinobacillus actinomycetemcomitans is a very uncommon cause of infectious endocarditis. The organism was first described in 1912.1 Thjotta and Sydnes2 reported its isolation in pure culture from a long standing abscess which had developed after tooth extraction. Subsequently this organism was found to be part of the normal flora, and the organism was defined as a slow growing, fastidious gram negative bacillus.3 Carbon dioxide is essential for the growth of A. actinomycetemcomitans. Approximately 50 cases of endocartitis due to A. actinomycetemcomitans have been reported4 since the first case reported in 1964.5

The purpose of this report is to document a case of endocarditis due to A. actinomycetemcomitans and to stress the value of the echocardiogram in the assessment of patients with endocarditis.
PISA - A New Noninvasive Method for Early Detection and Quantification of Ischemia in Hypertensive Patients
Authors: Prasad Kailash , Gupta Madan M. , Nikiforuk P.N. , Ezenwa Bertram N. , Ito Koji , Sterns Craig , Rebenal Perlita , Singh Bramah N. , Shah Pravin M.
Published: November 2007

Hypertension if untreated, is known to produce cardiac damage. Cardiac complications result from the effects of hypertension on the myocardium and/or to accelerated atherosclerotic changes in the coronary arteries. Presently availa ble diagnostic tools are able to detect cardiac complications only when they are relatively at an advanced stage. Early detection of cardiac complications would have the advantage of early treatment, with potential for reversal. PISA (Phase- Invariant Signature Algorithm) - a new noninvasive method has been shown by us to have high sensitivity and specificity for diagnosis of ischemic heart disease. This method was therefore used in 25 healthy individuals, 20 patients with doc umented ischemic heart disease and 50 hypertensive patients (duration 1-6 years) with no end-organ disease in order to determine if these patients have myocardial ischemia and/or infarction. These patients were on antihypertensive medication. Healthy individuals as expected, had phase-invariant PISA signa ture and low PISA index. All 20 patients with documented ischemic heart dis ease had phase variant signature and had high PISA index in two or more leads. The sensitivity of this method for detection of ischemic heart disease was found to be 100%. Twenty-nine of the 50 hypertensive patients were found to have phase-variant (abnormal) PISA signatures and their PISA index was beyond the upper limit of normal PISA range (mean + 3S.D. of healthy individual). This study suggests that these 29 hypertensive patients possibly have ischemic heart disease. This PISA study indicates that 8 patients have anterior wall, 10 inferior wall, and 11 both anterior and inferior wall ischemia and/or infarction. These twenty-nine patients have varying degree of ischemia and/or infarction.
Non Invasive Study of Carotid Arteries by Echo-Doppler and Metabolic Abnormalities in Patients With Dementia
Authors: Postiglione A. , Grossi D. , Faccenda F. , Cicerano U. , Chiacchio L. , Rubba P. , Campanella G.
Published: November 2007

In order to evaluate the prevalence of common and/or internal carotid stenoses together with metabolic abnormalities in dementia nineteen patients were investigated. Dementia and differential diagnosis between Alzheimer type (DAT) and multi-infartual (MID) dementia were performed on the basis of Computerized Tomography scan, behavioural anamnesis, neurological and neu ropsychological examinations. Eight patients were diagnosed as MID and 11 as DAT. Noninvasive study of neck arteries was performed in supine position by a Duplex Scanner, able of detecting a wide range of stenosis, even when very mild. Arterial hypertension, hyperlipidemia, diabetes and high hematocrit level were present in both groups, although to a higher extent in MID (p 0.05). Results from Duplex Scanner demonstrate 12 vascular stenoses 16-49% and one be tween 50-99% (13/76), being vascular abnormalities equally distributed among DAT and MID patients. These data suggest that patients with metabolic abnor malities and arteriosclerosis can develop dementia not necessarily of vascular type. On the other hand, MID patients do not present higher number of stenosis as compared to DAT, indicating that vascular disease of carotid arteries is not prominent in the clinical context of dementia.
Therapy for Late Post Infarction Ventricular Tachycardia
Authors: Somberg John C. , Butler Brenda , Torres Vilma , Tepper David , Keren Gad , Siegel Louis , Jentzer John , Miura Dennis S.
Published: November 2007

Non-sustained ventricular tachycardia (VT) in the late post myocardial in farction (MI) period (7-21 days) has been reported to be a predictor of sudden death. We suspected that patients with 3 beat VT on Holter monitoring in the late infarction period would demonstrate electrical instability at electrophysio logic studies. Forty-seven patients were identified as having at least 3 beat VT on Holter monitoring. Eighteen patients refused electrophysiologic studies or were not referred by their attending physician. The mean ejection fraction of this group was 43 ± 16%. Eight patients have died, 3 sudden deaths in 13 ± 5 months, a 17% incidence of sudden death. Twenty-nine patients underwent in vasive electrophysiologic studies. Their mean ejection fraction was 37 ±7%, and 28 had inducible, 18 sustained ventricular tachycardia and 10 non-sus tained VT. No complications were noted with electrophysiological testing in the post infarction patients. Using programmed electrical stimulation studies an effective antiarrhythmic agent preventing VT induction (usually experimental) could be found for each patient. After a mean follow-up of 12.5 ± 4 months, the patient without inducible VT is alive and 26 of the 28 "inducible" patients are alive and well. Two patients died, one of stroke and one due to pump failure following a second MI. No sudden deaths were observed in this group. Two patients had breakthrough arrhythmias and were treated by alternative antiar rhythmic therapy that was also effective at the initial electrophysiologic studies.

Thus, PES studies post MI are safe and may be an effective way to assess therapy for patients in the early post MI period, indentified at high risk for sudden death.
Alpha and Beta-Blockade and Beta-Stimulation in Raynaud's Syndrome: A Double-Blind, Placebo Controlled, Single Dose Study
Authors: Cleophas Ton J.M. , Fennis Jan F.M. , van 't Laar Albert
Published: November 2007

We examined in a double blind fashion and placebo controlled the effects of some alpha and beta adrenergic receptor agonists and antagonists on the recov ery of finger skin temperature 12 min after finger cooling (5 min waterbath for both hands) in twelve patients with Raynaud's syndrome. A favourable effect was established on phenoxybenzamine 20 mg as compared to placebo. A signifi cant but rather small effect on orciprenaline 10 mg. The beta-agonists pre nalterol (10 mg) and terbutaline (5 mg) did not influence the recovery of finger skin temperature. The beneficial effect of phenoxybenzamine 20 mg was not influenced by the addition of beta-agonists (prenalterol 10 mg or terbutaline 5 mg) or a beta-blocker (propranolol 40 mg).

The beta-agonists terbutaline and orciprenaline caused a fall in diastolic pressure and an increase in heart rate. These effects presumably were con nected with one collaps and three near-collapses. On alpha- and beta-blocker (phenoxybenzamine and propranolol) a decrease in systolic pressure appeared, whereas diastolic pressure did not significantly differ from the placebo value. While physical exercise is considered to exacerbate the hypotensive effect of alpha-blockers, a fall in blood pressure during physical exercise could not be established in our experiments after the addition of propranolol to the alpha- blocker phenoxybenzamine. Our results suggest that an alpha-blocker is a good choice in Raynaud's syndrome, whereas the addition of a beta-blocker may have some advantages.
Thrombocytopenia and Lupus-Like Anticoagulant in a Patient with Peripheral Vascular Disease: Response to Infusion of Prostacyclin
Authors: Fonseca V. , Mikhailidis D.P. , Boag F. , Barradas M.A. , Jeremy J.Y. , Gracey L. , Dandona P.
Published: November 2007

A 46 year old man with intermittent claudication due to severe peripheral vascular disease had a circulating lupus like anticoagulant (LLAC), thrombocy topenia (79 x 109/1), markedly reduced platelet survival and a normal bone mar row. He was treated with intravenous prostacyclin (PGI 2) infusions which resulted in improvement of the patient's exercise tolerance and normalisation of his platelet count (300 x 109/ 1) and platelet aggregation could then be assessed. The platelets were markedly hyperaggregable and generated supranormal quantities of thromboxane A2. A diagnosis of consumptive thrombocytopenia secondary to peripheral vascular disease and platelet hyperaggregability was made. Despite therapy with aspirin and dipyridamole, gradual and progressive reduction in platelet count followed and his exercise tolerance declined over the next three months. Immunoglobulin prepared from the patient's serum did not inhibit vascular PGI2 synthesis in vitro.

To our knowledge this is the first reported case of consumptive thrombocyto penia due to severe peripheral vascular disease and platelet hyperaggregability. PGI2 administration caused a transient resolution of these features which was not sustained by aspirin and dipyridamole.
Mortality and Morbidity in Patients with Intermittent Claudication in Relation to the Location of the Occlusive Atherosclerosis in the Leg
Authors: Jonason Tommy , Ringqvist Ivar
Published: November 2007

Mortality and morbidity from cerebrovascular and coronary arterial disease over a period of six years were studied in 224 non-diabetic patients with inter mittent claudication. Patients with multiple arterial stenoses in the leg had a lower six-year survival than patients with single stenoses (55% versus 77%), with a higher mortality from cardiac deaths. These differences were still signifi cant after adjustment for differences in clinical characteristics at the initial ex amination. This might indicate that patients with multiple arterial stenoses in the legs have a more widespread and more progressive atherosclerotic disease.
Lightning-Induced Myocardial Injury. A Case Report with Management
Authors: Amarendra Kumar Sinha
Published: November 2007

A young patient of lightning induced myocardial injury with chest pain is described. Electro-cardiogram mimicked true myocardial infarction (due to coronary artery disease). Practical aspects of case management is discussed. Use of short course of steroid helped in early recovery.
Superior Vena Caval Obstruction: An Analysis of Seventy-Six Cases, with Comments on the Safety of Venography
Authors: Davies P.F. , Shevland J.E.
Published: November 2007

Seventy-six cases of superior vena caval obstruction (SVCO) were docu mented in the period 1970-1980. There were 53 males and 23 females, with a mean age of 61.7 years. The underlying causes were:

a) Lung cancer 64/76 84.2%

b) Metastatic disease 4/76 5.3%

c) Lymphoma 4/76 5.3%

d) Benign aetiology 2/76 2.6%

e) Undiagnosed 2/76 2.6%

97.4% of the cases were due to malignancy.

Of 61 patients on whom follow-up is available, only one is alive. Eighty-two percent of this group died within one year following the onset of SVCO. Autop sies were performed on 17 patients. Nine of these (52.9%) showed invasion of the superior vena cava, 6 (35.3%) showed compression without invasion, and 2 (11.8%) showed neither compression nor invasion following Radiotherapy. Venography was performed on all patients with only one minor complication being recorded.
Laboratory Control of Continuous Intravenous Heparin Therapy with Howel Time and Activated Partial Thromboplastin Time A Prospective, Randomized and Blind Study
Authors: Almazan Arturo , Lozano Francisco , Ramos Manuel , Rodriguez-Moran Manuel , Gomez-Alonso Alberto
Published: November 2007

Although heparin has been used extensively to treat Deep Venous Thrombo sis (DVT) and arterial ischemia (AI), controversy still exists regarding optimal dosage and the need for monitoring.

Different authors have employed various test with variable results. Others, however, persist in giving heparin without laboratory control.

This study was made in order to compare, in a prospective, randomized and blind manner, two coagulation tests, namely: Howel Time (HT) and Activated Partial Thromboplastin Time (APTT), in controlling the dose of heparin given by continuous intravenous infusion in DVT and AI. Our results show no signifi cant difference in complications and failures of the therapy with either test, although significantly higher doses of heparin were needed to maintain APTT within therapeutic range than those needed to keep HT within a similar range.
Prevention of Atheromatous Heart Disease
Authors: Agarwal O.P.
Published: November 2007

Five thousand patients of atheromatous heart disease, presented as angina pectoris, were studied over a period of five years. After adding the 'Husk of Isabgol' and 'aloe vera' (an indigenous plant known as ghee-guar-ka-paththa) to the diet, a marked reduction in total serum cholesterol, serum triglycerides, fasting and post parandial blood sugar level in diabetic patients, total lipids and also increase in HDL were noted. Simultaneously the clinical profile of these patients showed reduction in the frequency of anginal attacks and gradually, the drugs, like verapamil, nifedipine, beta-blockers and nitrates, were tapered. The patients, most benefitted, were diabetics (without adding any antidiabetic drug). The exact mechanism of the action of the above two substances is not known, but it appears, that probably they act by their high fibre contents. Both these substances need further evaluation. The most interesting aspect of the study was that no untoward side effect was noted and all the five thousand patients are surviving till date.
Viscerally Induced Cutaneous Vasospasm
Authors: Kushner Michael , Alavi Abass
Published: November 2007

Superficial vasomotor tone in the forearm has been thought to be dependent mostly on vasodilatation rather than vasoconstriction. Despite this view we re port now that a mechanism for profound vasoconstriction exists in the forearm surface. This phenomenon was observed in normal subjects undergoing elective radial artery catheterization and the stimulus for the vasoconstriction consisted of the intra-arterial infusion of normal saline (rate of 0.5 - 6.0 ml/min). Two components to this reaction were observed. A stable pericatheter zone of pallor varied in extent proportional to the rate of infusion. The second component consisted of distal patches of vasoconstriction over the whole anterior forearm surface which first appeared 5 to 10 seconds after the infusion rate was in creased. These satellite areas tended to coalesce with sustained infusion but they were unstable over time. Local changes in vascular intrinsic regulation can ac count for the pericatheter vasoconstriction but this does not readily explain the observed distal changes. The time latency, distribution and evolution of the dis tal vasoconstriction suggests the operation of an autonomic vasomotor reflex arc.
The Assessment of Cutaneous Blood Flow with Transoxode Probe
Authors: Al-Fallouji M.A.R. , Al-Quisi N.K.S. , Kurdy N.M.G.
Published: November 2007

An experimental study on 12 healthy individuals was conducted over a per iod of six months, using the transoxode probe to assess cutaneous blood flow via measurements of transcutaneous oxygen tension (TcpO2) and relative heat power input (R.H.P.). The possible clinical use of the probe in peripheral vascular ischaemia was re-evaluated. The results were controlled with those of venous occlusion plethysmography, being a reliable means of assessing peripheral blood flow. The study revealed that changes in TcpO2 did not correlate significantly with alterations in skin perfusion mainly due to the lack of probe sensitivity. The clinical implications of such methods are discussed.
A Comparative Study of Conventional vs Rapid Speed of Blood Transfusion in Cases of Chronic Severe Anemia
Authors: Nand Nitya , Gupta M.S. , Bhutani J.C. , Gupta S.P. , Sharma M.
Published: November 2007

Pulmonary capillary 'wedge' pressure (PCWP) was studied in 20 cases of chronic severe anemia before and after transfusing one unit of blood. They were divided into 2 groups of 10 age and sex matched cases. Blood was transfused at a speed of 2 ml/min in group A and 5 ml/min in group B. Pretransfusion PCWP was normal in all the cases. Following blood transfusion (BT) 'wedge' pressure increased significantly (p < 0.001) in both the groups being 17.2% and 29.2% in group A and B respectively. The difference in the rise of PCWP between the two groups was not statistically significant (p > 0.05). All the cases tolerated BT very well.

It is therefore, concluded that transfusion of one unit of blood at a speed of 5 ml/min is nearly as safe as when it is transfused at a rate of 2 ml/min (conven tional speed) so far as the cardiopulmonary haemodynamics are concerned.
Solitary Hypoplasia of the Right Ventricle: A Case Report
Authors: Folger Gordon M.
Published: November 2007

Hypoplasia of the right ventricle occurring as an isolated abnormality is an uncommon cause of cyanotic congenital heart disease. Its presentation in the newborn may mimic the ductus dependent and less stable right ventricular hy poplasias such as tricuspid atresia and pulmonary atresia. However, the natural history of this abnormality contrasts with those ductus dependent lesions by the rather benign course it presents. A patient with only marked reduction in right ventricular size and commensurate reduction in size of the tricuspid and pulmo nary valves is described. Although cyanotic this child has shown none of the critical problems frequently encountered with the more severe forms of the right ventricular hypoplasias.
The Clinical Spectrum of Tricuspid Regurgitation Detected by Pulsed Doppler Echocardiography
Authors: Missri J. , Agnarsson Uggi , Sverrisson Jon
Published: November 2007

The clinical diagnosis of tricuspid regurgitation (TR) is often difficult. Two- dimensional pulsed Doppler echocardiography offers a sensitive and specific method for detecting and semi-quantitating tricuspid regurgitation. The clini cal, radiographic, radionuclide, echocardiographic, and when available, the right cardiac catheterization findings were evaluated in 36 patients with a diag nosis of tricuspid regurgitation by pulsed Doppler. Ten healthy subjects served as controls. The underlying cardiac cause was rheumatic heart disease in 7 (20%), ischemic heart disease in 12 (33%), dilated cardiomyopathy in 5 (14%), hypertensive heart disease in 2 (5%), aortic valve stenosis and/or regurgitation in 3 (8%), mitral valve prolapse with mitral regurgitation in 1 (3%), and con genital heart disease in 6 (17%). Seven patients (19%) had a temporary or per manent transvenous right ventricular pacing wire. A systolic murmur was heard in 29 patients (81%) with 16 (46%) having an elevated jugular venous pressure. Tricuspid regurgitation was clinically suspected in only 2 patients (6%). Isolated tricuspid regurgitation was uncommon, seen in 6 patients (17%), and usually secondary to congenital heart disease, ischemic heart disease, with the use of a transvenous pacing wire and following mitral valve replacement. Right cardiac catheterization was performed in 10 patients, of which 7 demon strated elevated right atrial and pulmonary artery pressure.

Pulsed Doppler echocardiography offers a practical and accurate method of detecting and evaluating the severity of tricuspid regurgitation. Tricuspid re gurgitation is generally a functional disorder, and frequently occurs in associa tion with left sided valvular heart disease, cardiomyopathy or congenital heart disease.
Carotid Artery Assessment with Continuous Wave Doppler Ultrasound, Comparison of Two Methods with Angiography
Authors: Hutchison Kenneth J. , Potemkowski Antoni P.
Published: November 2007

A comparison of two non-invasive techniques of evaluation of the internal carotid artery in the neck with the results of angiography was carried out in 31 patients. The techniques were, spectral analysis of the doppler signals obtained from the common, internal and external arteries and, velocity waveform analy sis of the common carotid analogue signal, in both methods a continuous wave doppler ultrasound velocimeter was used.

With the spectral analysis technique sensitivity was 80% and specificity was 78% for a diagnosis of internal carotid stenosis of greater than 50% diameter reduction. For a diagnosis of 20% or greater, sensitivity was 82% and specificity 85%. Sensitivity may have been underestimated in this study because the angio graphic technique used in 22 of the 31 patients was the intravenous digital sub traction method.

In our hands velocity waveform analysis of the common carotid analogue signal while showing a similar sensitivity to the spectral analysis method had an unacceptably low specificity.
Aortic Connective Tissue in Ageing—A Biochemical Study
Authors: Andreotti Lupo , Bussotti Alessandro , Cammelli Daniele , di Giovine Francesco , Sampognaro Salvatore , Sterrantino Gaetana , Varcasia Giuseppe , Arcangeli Paolo
Published: November 2007

The biochemical analysis of samples of aortic connective tissue was carried out in 22 subjects from 9 to 84 years old.

Aortic samples were taken at necropsy performed after sudden or, more often, traumatic death. The results suggest that aging of the aorta is accompanied by an increase both in collagen content and in total sugar content when expressed as mg/cm2 while the elastin content, when expressed in the same way, does not undergo any variation.
Felodipine-Induced Dilatation of Epicardial Coronary Arteries A Randomized, Double-Blind Study
Authors: Emanuelsson Hakan , Ekström Lars , Hjalmarson Ake , Jonsteg Christina , Schlossman David
Published: November 2007

Dilatation of large coronary arteries is of potential value in the treatment of angina pectoris. In this double-blind study, the acute effect of felodipine or placebo on coronary artery dilatation was studied in patients with severe angina pectoris with the aid of coronary arteriography. There were two parallel groups, one with 9 patients who received felodipine, the other with 12 patients who received placebo. Measurements of vessel diameters were performed at a proximal position of the affected artery, at the site of the stenosis, and distal to the lesion. The mean plasma felodipine concentration was 17+/-6 nmol/l. The systolic blood pressure was reduced from 156 + / -15 to 145 + / -13 mm Hg after felodipine (p < 0.05), but was unaffected by placebo. The heart rate and arterial catecholamine levels were basically unchanged in both groups of patients. The proximal arterial segment was dilated 7% after felodipine (p=0.05), the stenosis area 9% (N.S.) and the distal part of the vessel 7% (p < 0.05). There were no changes in coronary diameters in the placebo group. In conclusion, felodipine dilates large coronary arteries, and this mode of action may be valuable in the treatment of patients with coronary artery disease, especially in cases where coronary spasm is a prominent feature.
Continuous Measurement of Transcutaneous Oxygen Tension on Stress Test in Claudicants and Normals
Authors: Ohgi Shigetsugu , Ito Katsuaki , Hara Hiroshi , Mori Tohru
Published: November 2007

Subjective evaluation of hemodynamics by stress tests in claudicants should be made to establish severity of functional ischemia. As an indispensable examination of vascular laboratory, non-invasive, simple methods can only satisfy methodological conditions.

The aim of this study was to apply the transcutaneous oxygen tension measurement for a non-invasive, continuous detector of hemodynamic responses in skin circulation by stress tests and to elucidate the clinical usefulness of this technique.

Investigated were 20 legs in patients with intermittent claudication and 9 legs in healthy persons as controls. Ten legs with ischemic pain during exercise loading revealed abnormal transcutaneous oxygen tension (tcPO2) curves in comparison with those with in normal legs. Over the continuous tcP02 curve, the minimum tcPO2 at the reverse postural change after exercise loading was the most reliable indicator for evaluating induced ischemia.

We conclude that hemodynamic responses on stress tests should be analyzed both during and after exercise loading, and that the continuous tcP02 curve constitutes a useful method for evaluating and following up the claudicants.
Demonstration of Mitral Valve Function by Cine Computed Tomography Using a New Long Axis View
Authors: Rees Michael R. , MacMillan Robert M. , Lopez Mario , Rodriguez Enrique , Sing San Yang  , Maranhao Vladir , Clark Donald L. , Fender Barbara
Published: November 2007

Comparison was made between contrast enhanced cine computed tomo graphy (Cine/CT) and echocardiography in the imaging of the mitral valve in 14 patients. The mitral valve was seen in all 14 patients by Cine/CT using a new long axis view. There was agreement with echocardiography in 12 patients. Abnormalities in mitral valve movement were detected by Cine/CT. Left atrial size and contraction was measured by Cine/CT with a difference in left atrial ejection fraction observed between 13 patients with no evidence of mitral dis ease and 3 patients with mitral disease.
A New, Ideal Technique to Monitor Thrombolytic Therapy
Authors: Görög Peter
Published: November 2007

In an earlier article we have reported a technique which allows the measure ment of haemostasis from whole blood by the "tube bleeding" principle. The technique is now progressed by using non-anticoagulated blood and therefore clotting-time is also measured. We report here that the technique allows a sim ple thrombolytic assay to perform from the same blood sample used for haemo stasis measurement by detecting the length of time until the haemostatic plugs crack or are expelled. Evidence is presented that this "spontaneous" expulsion is mainly due to thrombolysis. Generation of thrombin during haemostasis is indicated by the inhibitory effect of hirudin. 125I-fibrinogen accumulates (28- fold) in the haemostatic plugs. Plasminogen activators (streptokinase and uro kinase) reduce while inactivation of plasminogen by specific antibody greatly prolongs the expulsion-time. The effect of cytochalasin B shows that the retrac tion of the haemostatic plug is not a decisive factor of the expulsion. As the technique allows the simultaneous measurement of haemostasis, thrombolysis and clotting, it seems ideal for monitoring thrombolytic therapy.
Digital Blood Pressure and Flow Measurements in Patients with Primary Raynaud's Phenomenon
Authors: van de Wal Henry J.C.M. , Wijn Pieter F.F. , Hoppenbrouwers Marc W.J.M. , Skotnicki Stefan H.
Published: November 2007

The value of digital systolic blood pressure (DBP) and flow (DBF) measure ments for a quantitative diagnosis of Primary Raynaud's Phenomenon (PRP) was evaluated by comparing the results obtained in 10 patients and 20 normals.

Digital skin temperature (DST), DBP and brachial systolic blood pressure (BBP) and DBF were measured at room temperature, at maximal vasodilatation and during cold provocation. At room temperature DST discriminates between normals and patients with an accuracy of 77%. On maximum vasodilatation no significant differences can be found in DBP and DBF between normals and patients. However, DBF was significantly different between male and females both in normals and in patients. During gradual cooling a decrease in DBF (a closing phenomenon) was observed both in normals and patients. In contrast DBP did not show a substantial pressure drop. Calculating digit to brachial systolic pressure indexes (DBI) a slight significant increase can be found during cold provocation both in normals and in patients.

Only the DBI of digit IV during cold provocation showed a significant differ ence between normals and patients which resulted in an accuracy of 83%.
Cardiorespiratory and Metabolic Effects of Buflomedil: Case Reports
Authors: Giovannini Ivo , Boldrini Giuseppe , Chiarla Carlo
Published: November 2007

An extensive study has been performed of the cardiovascular, respiratory and metabolic effects of buflomedil. The results indicate that the drug, at the administered dose, does not alter the patient physiological stability.

An improved perfusion regimen in peripheral tissues and an optimization of cardiac energetics are also directly or indirectly implied in the results.
Future/Novel Uses of Beta Blockers in Clinical Therapeutics
Authors: Maclean Derek
Published: November 2007

Beta-blocker usage in the United Kingdom centers around propranolol and oxprenolol as noncardioselective drugs, atenolol and metoprolol as cardioselec tive agents, and pindolol or oxprenolol when partial agonist activity is desired. Any meaningful comparison of a novel beta blocker against the established drugs must be a variable-dose trial, for the optimum dose of any beta blocker that can be tolerated varies widely. Effective beta blockade is considered to have been achieved when the standing heart rate has been lowered to about 55 beats- /minute.
Clinical Pharmacokinetics and Metabolism of Bevantolol
Authors: Latts Jeffrey R.
Published: November 2007

Bevantolol (the hydrochloride salt) has pharmacokinetic properties that are clinically advantageous. Bevantolol is well absorbed orally (> 70%); and the systemic bioavailability is 60%. Peak plasma concentrations are achieved 1 to 2 hours following an oral dose. Elimination is first-order with an average elimina tion half-life of 1.5 hours. Bevantolol exhibits linear pharmacokinetics within the therapeutic range (100 to 400 mg) with no change in half-life with chronic dosing. These properties result in predictable plasma levels and predictable drug response.
Dose Response Studies of Bevantolol in Hypertensive Patients
Authors: Okawa K. Kay
Published: November 2007

This multicenter study, conducted to determine the antihypertensive efficacy of bevantolol at different fixed doses compared with placebo was carried out at four separate institutions using a common protocol. One hundred thirty-nine patients with mild to moderate essential hypertension were enrolled. At doses of 200 to 400 mg/day bevantolol was clearly effective in lowering diastolic blood pressure and in maintaining this effect over the eight weeks of this double-blind study. Twice a day dosing is indicated since efficacy was evident 12 hours post- dosing. Bevantolol was well tolerated.
Safety Profile of Bevantolol
Authors: Bray John S.
Published: November 2007

Double-blind and long-term open-label studies have demonstrated a remark ably favorable safety profile for bevantolol. The drug was associated with a low incidence of adverse experiences similar to that observed with placebo. The adverse experiences were mostly mild to moderate and of the types found previ ously for other beta-blocking drugs. Very few patients withdrew from clinical studies because of adverse effects. Some patients continued on study for over four years. Bevantolol offers safe beta-blocking activity for the long-term treat ment of angina and hypertension.
Role of "Wave Line" (Doerr; Wellenlinie) of Aorta in Atherosclerosis
Authors: Tanimura Akira , Cho Takanori , Saito Yasuyuki , Nakashima Teruyuki
Published: November 2007

Some aortas of neonates and of children have intimal wrinkles (wave line) which run closely pucked and horizontally across the longitudinal axis. Fre quently the wave line corresponded with arteriosclerotic lesion.

The purpose of this study is about the distribution of this structure and its relation to arteriosclerosis.

180 aortas ranging from neonates to 82 year olds were examined.

The frequency of the wave line was 133 of 180 aortas (74%). The wave line already were visible in new born babies and were frequently found in the second and third decades. However, in cases over 30 years old its frequency decreased. It was suggested that this was due to increasing thickness of the intima and development of arteriosclerosis, which tend to obscure the wave line.

The wave line could be classified into three patterns of distribution; (A) be ginning from under the closure of the ductus arteriosus of the aorta, (B) begin ning from the posterior wall of the celiac artery in the vicinity of the dia phragma and (C) beginning in the vicinity of the outside of lumbar artery run ning along the outside of each lumbar artery.

These three distribution patterns were found in neonates and arteriosclerosis was — with advancing age — apt to correspond to the (C) pattern of wave lines.

The histogenesis of the wave line was not clarified. It was apparent that these structures were closely related to arterial branching.

Judging from these studies, there seemed to be some relation between the branching and the torsion resulting from the growth of the aorta
Efficacy and Safety of Oral Tocainide in Refractory Ventricular Arrhythmia: A Preliminary Report on an Open Label Study
Authors: Mahapatra Rajat K. , Mahapatra Dipta
Published: November 2007

The preliminary data on efficacy and safety of oral tocainide in refractory ventricular dysrhythmia in 8 patients is described. Two patients died; one within 15 days and the other after 1750 days of continuous tocainide therapy. The cause of death in both patients was unclear. During initial administration and acute titration, oral tocainide was extremely effective in lidocaine-sensitive ventricular dysrhythmia and in patients with Q-T prolongation syndrome. Four out of 8 patients received tocainide in presence of left ventricular dysfunction and 2 out of 4 such patients died suddenly. Minor central nervous system side effects were seen in 2 patients and dermatologic adverse reaction was seen in one patient only.
Aortocaval Fistula: Diagnosis and Treatment: Case Studies
Authors: Taheri Syde A. , Plonka Andrzej J.
Published: November 2007

Two cases of aortocaval fistula were treated successfully with prompt surgi cal repair and dacron graft insertion in place of the abdominal aortic aneurysm. The first case presented here displayed signs and symptoms characteristic of aortocaval fistula, the second case displayed signs and symptoms characteristic of a ruptured abdominal aortic aneurysm. The lack of symptoms of arterioven ous fistula in the second case was due to occlusion of the fistula by laminated clots. The post-operative course of the second case was complicated by an acute renal failure which improved after medical treatment.
Effects of Ethaverine Hydrochloride on the Walking Tolerance of Patients with Intermittent Claudication
Authors: Trainor Frieda S. , Phillips Raymond E. , Michie David D. , Zellner Stephen R. , Hogan Leo , Chubb James M.
Published: November 2007

The effect of ethaverine hydrochloride on excercise tolerance of patients with intermittent claudication was evaluated in a double-blind, placebo-con trolled study conducted at three sites. Forty-five patients with symptoms of oc clusive arterial insufficiency of the lower extremities were randomly assigned to receive ethaverine 200 mg or placebo four times daily. The patients were evalu ated biweekly for 12 weeks with treadmill claudication tests, patient and investi gator assessments of symptom severity, and reports of adverse reactions. Doppler ankle/brachial pressure ratios were recorded for 26 patients.

Walking tolerance improved for patients in both groups during the course of the study. Increases in distance-to-claudication were significantly greater for patients receiving ethaverine after 6, 8, 10, and 12 weeks of therapy. Ankle/ brachial pressure index after exercise was unchanged in both groups. Incidence of adverse reactions was similar for the two groups. Although patients were generally unaware of any improvement in symptoms, the investigators judged significant relief of claudication among those receiving ethaverine compared to those receiving placebo. It was concluded that ethaverine safely increased dis tance-to-claudication in patients with intermittent claudication.
Hemiazygous Vein Thrombosis As A Cause of Unexplained Left-Sited Pleural Effusion. A New Syndrome?
Authors: Moulopoulos Spyridon D. , Kelekis Dimitrios , Diamantopoulos Emmanuel J. , Toumanidis Savas
Published: November 2007

In seven cases with pleural effusion transosseal azygography has been per formed, in order to specify any cause for the fluid accumulation that could be related to the azygous system. In 4 cases azygography appeared normal and further laboratory work-up revealed collagen disease, heart failure and lung cancer. In the remaining 3 cases (2 with recent myocardial infarction and 1 with unstable angina) azygography discerned thrombosis of the hemiazygous vein. It is suggested that in cases with an otherwise unexplained left-sited thoracic tran sudate a thrombosis of the hemiazygous vein may be visualized by transosseal azygography.
T.I.A. Revisited: New Wine—Old Bottle
Authors: Slade Walter R. , Raguthu S. , Borras R. , Chen J.R. , Alperovich A.
Published: November 2007

TIA has been accepted as a concept of transient cerebral ischemia. There is an ever enlarging body of literature sparking controversies considering its natu ral history, prognosis, outcomes of clinical trials and usefulness of the concept. Much of the controversy is related to the diverse pathophysiology of TIAs, the selection of patients for clinical trials and the associated risk factor in the stud ied population.

The advantages of the concept are (1) a warning of the possibility of future irreversible pathology (2) an opportunity to treat and/or remove risk factors (3) an opportunity to establish a basis for monitoring the patient and making in terim decisions concerning intervention.

The risks of the concept are: (1) administering a specific therapy to all pa tients (2 failure to fully evaluate the patient once the diagnosis is made (3) ten dency to rely on "experts" for guidance.

TIA is a useful concept if one recognizes:

(1) the pathophysiology is polymorphous and multiplex,

(2) the concept is a signal for diligent search for the underlying cause or causes,

(3) it is more important to treat the risk factors than to give a specific ther apy.
Diffuse Intravascular Coagulation Complicating Thrombosis of a Popliteal Aneurysm: A Case Report
Authors: Mahler Charles , Parizel Gaston , Hautekeete Marc L. , Nagler Jan M. , Van Goethem Jozef K. , Hermans Colette
Published: November 2007

Several reports have described the association between diffuse intravascular coagulation (DIC) and arterial aneurysmal disease. We report a patient with extensive arterial aneurysmal disease who developed transient severe DIC dur ing thrombosis of a popliteal aneurysm; following surgical removal of the thrombosed aneurysm, he was found to have chronic subclinical DIC. We be lieve thrombosis should be added to the complications of aneurysms which can cause DIC, next to dissection and rupture. The chronic DIC occurring after removal of the thrombosed aneurysm was characterized by an abnormal pro- thrombin time (PTT), low fibrinogen levels and elevated fibrin split products (FDP's); this pattern may be characteristic of the DIC complicating arterial aneurysms.