bluuebunny/crossref_metadata_2025 huggingface dataset:
A Missense Mutation of the Nitric Oxide Synthase (eNOS) Gene (Glu298Asp) in Five Patients with Coronary Artery Disease
Authors: Liao Yuan-Lan , Saku Keijiro , Ou Jiafu , Jimi Shiro , Zhang Bo , Shirai Kazuyuki , Arakawa Kikuo
Published: July 2008

The authors report five patients with a missense mutation of the endothelial nitric oxide synthase (eNOS) gene (Glu298Asp) who have angiographically proven coronary artery disease (CAD). They compare their clinical findings and coronary arteriographic charac teristics. They conclude that these case reports show that this mutation is not solely responsible for development of CAD. Diabetes mellitus, smoking, and hyperlipidemia are other risk factors.
Loculated Pericardial Effusion Due to Congestive Heart Failure: An Unusual Case of Vanishing Tumor
Authors: Sakamoto Hironosuke , Sakamaki Tetsuo , Kanda Tsugiyasu , Kurabayashi Masahiko , Nagai Ryozo , Fujii Jun
Published: July 2008

Loculation of a pleural effusion within an interlobar fissure as a result of congestive heart failure is a well-known entity. It has been termed "vanishing" or "phantom" tumor because its roentgenographic appearance simulates a pulmonary tumor and resolves with treatment of the congestive heart failure. The authors describe an 89-year-old man with a loculated pericardial effusion on the left cardiac border on chest roentgenogram. This was initially thought to represent an occult metastatic malignancy; however, its etiology became obvious when it disappeared with therapy of heart failure. Loculated pericardial effusion should be included in the differential diagnosis of roentgenographic densities in the chest when seen on the left cardiac border.
Rapid Changes in the Coagulant Proteins on Saphenous Vein Endothelium in Response to Arterial Flow
Authors: Turner Robert J. , Gosling Martin , Powell Janet T. , Golledge J.
Published: July 2008

Healthy endothelium provides a nonthrombogenic surface. In this study the authors investigated the effect of arterial flow on the saphenous vein endothelial expression of proteins controlling thrombosis. Human saphenous vein segments, freshly excised from patients, were placed in a validated in vitro circuit with flow conditions shown to simulate arterial or venous circulations. In separate experiments, placement of an external polytetrafluoroethylene (PTFE) stent was used to differentiate the effects of pulsatile wall deformation and shear stress, while addition of drugs to the vein perfusate allowed study of the role of ion channels in transducing the response of the vein to arterial flow. Endothelial concentrations of thrombomodulin, nitric oxide synthase, tissue factor, and tissue plasminogen activator were assessed by quantitative immunohisto chemistry and Western blotting of endothelial cell lysates, in paired vein samples, in comparison to control proteins.

Arterial flow conditions caused a rapid and significant reduction in the endothelial concentration of thrombomodulin: The immunostaining area decreased from 80.1 ± 7.0 to 48.3 ±5.0 and 32.9 ±3.0% at 45 and 90 minutes respectively, p = 0.01. These findings were confirmed by Western blotting. The reduction in thrombomodulin concentration was unaffected by eliminating vein wall deformation by placement of an external PTFE stent or by including the K+ channel blocker tetraethylammonium (TEA) in the vein perfusate. In contrast, thrombomodulin concentrations remained high when blockers of stretch-activated cation and calcium channels were included in the vein perfusate. The endothelial concentration of nitric oxide synthase increased after 90 minutes of arterial flow and this change was abolished when TEA was included in the vein perfusate.

Arterial flow induced rapid changes in saphenous vein antithrombotic proteins. Different cation channels mediated the flow-induced changes in thrombomodulin and nitric oxide synthase.
Diagnosis of Pulmonary Embolism by Use of Urinary TNFα and its Soluble TNF Receptor I
Authors: Shenoy Sadashiv , Murawski Sandra , Divan Kishore , Cullin Julia , Mousa Shaker , Taheri Syde A.
Published: July 2008

The purpose of this clinical study was to determine the concentration of soluble tumor necrosis factor in urine of patients with pulmonary embolism (PE), verses voluntary control individuals. Sixteen patients (ages 24 to 74 years) with diagnosis of PE, docu mented by ventilation perfusion scan or pulmonary angiogram, were the subjects of this study. Ten cc of urine was obtained from each patient and subjected to a solid-phase enzyme-linked immunosorbent assay thus determining the soluble tumor necrosis factor (TNF) receptor I (R I) and TNFα levels in these samples. In this pilot study of PE cases, a statistically significant elevation in urinary levels of TNFα and soluble TNF R I was demonstrated in PE patients. The average urinary soluble TNF R I in normal subjects was 1,029 pg/mL and in PE patients the average TNF R I was 3,734.4 pg/mL.

The clinical diagnosis of PE is a challenging problem for the physician. Late diagnosis and delayed management of this condition could be associated with massive PE. Although pulmonary angiography is the gold standard for diagnosis of PE, it re quires expensive equipment, trained radiologists, and the patient could be at risk of sensitivity to contrast agents.
Shock Waves (SW) Noninvasive Extracorporeal Thrombolysis Treatment (NISWT)
Authors: Nicolaides A.N. , Cesarone M.R. , De Sanctis M.T. , Laurora G. , Incandela L. , Errichi B.M. , Marlinghaus E.H. , Pellegrini L. , Barsotti A. , Dugall M. , Belcaro G.
Published: July 2008

A group of 24 patients were considered for noninvasive shock waves thrombolysis (NISWT). Of these, 15 patients gave their informed consent. NISWT was attempted in eight patients (while seven patients were randomized for follow-up only). NISWT was possible in six of seven patients. In one patient randomized for NISWT, local inguinal scarring, due to previous surgery, made impossible the visualization of the femoral vein, and therefore focusing of shock waves (SWs). No side effects were reported in the days after SWs administration during the 4-month follow-up. In patients treated with NISWT it was possible to observe just after the SWs session the presence of echolucent "acoustic holes" and flow (by color and power Doppler) within the "holes." All "echolucent holes" produced at the first session were still present at 4 months, and color flow imaging also detected new flow channels in echogenic areas of thrombi previously not visible. In one patient thrombolysis was achieved after the first treatment, but at 3 and 4 months the thrombus was completely avascular. In conclusion, thrombolysis using SWs was obtained in selected cases and it was still persisting at 4 months in six of the seven treated patients. NISWT appears feasible and promising. These results should be confirmed by larger, prospective trials.
Management of Acute Nontraumatic Upper Limb Ischemia
Authors: Baguneid Mohamed , Dodd Dominic , Fulford Paul , Hadjilucas Yiannis , Bukhari Motassim , Griffiths Gareth , Chalmers Nicholas , Walker Michael , Walker M.G.
Published: July 2008

A retrospective review of all patients presenting to a tertiary referral center with acute nontraumatic upper limb ischemia between January 1992 and June 1997 was under taken to examine the role of intraarterial thrombolysis in the management of such cases. Twenty-one patients were identified in the radiology and vascular surgery departments' registers. Twenty (95%) underwent angiography, demonstrating subclavian artery occlusion in four, axillary in two, brachial in 13, and one at the digital level. Intraarterial thrombolysis was attempted in 12 patients. There were three technical failures, all requiring embolectomy. Six had complete lysis and resolution of their symptoms. One patient had partial lysis but experienced no further rest pain. Thrombolysis was unsuc cessful in two cases with one subsequently requiring embolectomy and the other surgical bypass. Three patients had surgical intervention as their primary procedure with two favorable outcomes and one ending in above-elbow amputation. Five patients were treated conservatively with heparin, resulting in three partial and two full recoveries. One patient experienced complete resolution of symptoms with an intravenous prosta cyclin infusion. Both electrocardiograms (ECG) and echocardiograms (ECHO) were of limited diagnostic aid, and long-term warfarin anticoagulation was prescribed to all patients. There was no recurrence of upper limb ischemia at a median follow up of 18 months. Intraarterial thrombolysis is an effective first line treatment for acute nontrau matic upper limb ischemia in selected cases.
Comparative Study of Different Venous Reflux Duplex Quantitation Parameters
Authors: Valentín Leonardo I. , Valentín Wilmer H. , Valentín Leonardo I.
Published: July 2008

The objective of this study was to compare different quantitation parameters of venous reflux by duplex scan in different venous disease manifestations. Duplex scan is a new modality to quantify venous reflux. Several studies propose different parameters. In addition, there is controversy about the importance of deep and superficial involvement in different disease manifestations. It is not clear whether there is an increased venous reflux associated with varied clinical stages. Venous conditions were classified in seven stages and their differences for several quantitation variables studied. Most quantitation variables, such as average and peak velocity, average and peak flow, and reflux volume disclosed significantly increased reflux from normal, pain only, and edema group to varicose vein, with or without edema, to lipodermatosclerosis and ulcer groups at every location in the lower extremity. Reflux time was not as consistent as other variables. Totalization of the results of every parameter for the whole extremity points to an increased reflux from pain only to edema and from lipodermatosclerosis to ulcer group. Chronic edema is not usually associated with increased venous reflux. The greater saphenous vein (superficial system) seems to be the main contributor to reflux in all stages of disease. Different quantitation methods of venous reflux are equivalent. Increased deep and superficial reflux and its totalization are associated with a more advanced disease stage. Reflux time may be the least useful variable. Chronic edema is frequently not associated with venous reflux. Greater saphenectomy may be the most useful intervention, even in the presence of deep vein reflux.
Catastrophic Arterial Reactivity During Primary Antiphospholipid Syndrome
Authors: Rey J. , Granel B. , Morange P. , Piquet P. , Serratrice J. , de Roux C. , Juhan-Vague I. , Weiller P.J. , Disdier Patrick
Published: July 2008

Arterial reactivity leading to acute thrombosis at the site of a needle stick injury has never been described during antiphospholipid syndrome. The authors report a case char acterized by a succession of thrombotic events occurring during or immediately after arterial angiographies or arterial surgery, in which catastrophic arterial reactivity can be strongly suspected. In this particular patient, it can be postulated that damage to the endothelial cells of the vessels injured during manipulation may have precipitated or aggravated the preexisting susceptibility to thrombosis.
Primary Cardiac Angiosarcoma with Right Coronary Artery-to-Pericardial Fistula
Authors: Reising Chris , Thieman Kent , Nuss Fredrick , Latcham Allan P. , Reising Christopher A.
Published: July 2008

Primary cardiac sarcoma is a rare tumor that is difficult to diagnose preoperatively. Hemopericardium and coronary artery fistula are rare complications of primary cardiac sarcoma. The authors report a case of primary cardiac angiosarcoma presenting with hemopericardium, secondary to right coronary artery-to-pericardial fistula, with a review of the literature.
Surgical Treatment of Interventional Coronary Angiographic Accidents
Authors: Morris Rohinton J. , Kuretu M.L.R. , Grunewald Karl E. , Samuels Louis E. , Strong Michael D. , Wechsler Andrew S. , Morris Rohinton J.
Published: July 2008

Newer methodologies have increased the incidence of coronary interventions. At the authors' institution, 5,614 coronary interventional procedures (28% of all catheteriza tions) were performed over a 3-year period, from 1995 to 1997. Eighty-one patients (1.4%) suffered angiographic accidents, including coronary artery dissection, free rupture, tamponade, foreign body embolism, and wire entrapment, and were retrospec tively reviewed. All patients were taken for emergency surgery in less than 4 hours. The mean age was 61.2 years, 44 (54%) were men, and 37 (46%) were in cardiogenic shock at the time of surgery. Fifty-seven patients (70%) had intraaortic balloon counterpulsa tion. The number of previous cardiac interventions ranged from one to four with a mean of 1.9. One to five bypass grafts (mean, 2.2) were performed, and three patients required temporary ventricular assist devices. There were six deaths for a 30-day mortality rate of 7.4%. Thirty-two patients (39.5%) suffered significant morbidity, including cerebrovas cular accidents, and renal and respiratory failure. Perioperative myocardial infarctions were diagnosed in 39 (48%) patients. Average length of stay was 12.1 days. One-year survival was satisfactory at 90% (73/81), with 56 survivors (77%) regaining normal everyday activity. Early surgical intervention, rapid revascularization, and temporary mechanical support are keys to low mortality in this high-risk group. Identification of high-risk interventions and significant comorbid conditions, with concomitant surgical consultation, need to be pursued to reduce the high morbidity rate.
Daytime-Selective Antihypertensive Activity of Celiprolol
Authors: Cleophas Ton J. , van der Meulen Jan , van de Luit Leonie , Zwinderman Aeilko H. , Cleophas Ton J.
Published: July 2008

Day-activity rhythms of heart rate and blood pressure are thought to be mediated mainly through the sympathetic nervous system and may have greater amplitudes in patients with hypertension owing to increased daytime and largely normal nighttime values. Drug- induced nighttime hypotension in patients with chronic hypertension has been associated with the precipitation of cardiac failure and a fall in cerebral flow. The authors examined the effects of a single dose and of a 4-week treatment with different classes of antihy pertensive drugs on ambulatory blood pressure (ABP) in 10 patients with mild hyper tension. Data were assessed by polynomial analysis (Harvard Graphics 3). A single oral dose of enalapril 10 mg, amlodipine 5 mg, carvedilol 25 mg, and celiprolol 200 mg produced a mean reduction of 24-hour ABP compared to placebo of, respectively, 24/11, 11/5, 13/6, and 12/5 mm Hg (p values between < 0.02 and < 0.001). With enalapril, amlodipine, and carvedilol, between-subject variability contributed significantly to the overall variability in the measurements (p values between 0.05 and 0.01 versus zero), whereas with celiprolol this was not so. Although the beta blockers reduced daytime blood pressures similarly to the ACE inhibitor or the calcium channel blocker, they did not reduce nighttime blood pressures. These results were confirmed by an 8-week crossover trial comparing enalapril 10 mg daily with celiprolol 200 mg daily in the same group of patients. The authors conclude (1) that beta blockers produce a more stable reduction of blood pressure in patients with mild hypertension less affected by pressor effects through the sympathetic nervous system; (2) that beta blockers, unlike ACE inhibitors and calcium channel blockers, do not give rise to nighttime hypotension in this category of patients; and (3) that the selective beta blocker celiprolol may even perform better in these respects than the nonselective beta blocker carvedilol.
Doppler Echocardiographic Study of Right Ventricular Systolic Performance in Inferior Myocardial Infarction
Authors: Özgül Sami
Published: July 2008

Twenty-four male patients with myocardial infarction (MI) without clinical and electro cardiographic signs of right ventricular (RV) involvement were selected to enter the study. All the patients were divided into two groups: Group I consisted of 12 patients with anterior MI and infarct-related left anterior descending artery and Group II included 12 patients with inferior MI and infarct-related right coronary artery. Patients of Group II had higher right atrial pressure and right atrial pressure/pulmonary capillary wedge pressure ratio (p < 0.01, p < 0.01) and lower values of pulmonary flow velocity, mean acceleration, and pulmonary flow velocity 2/acceleration time ratio than patients of Group I (p < 0.01, p < 0.01, p < 0.01, respectively). Pulmonary flow indices correlated inversely and significantly with hemodynamic dysfunction in patients with inferior myocardial infarction and right coronary proximal lesions (p < 0.01).
Pharmacogenetic Analysis of the Effect of Angiotensin-Converting Enzyme Inhibitor on Restenosis After Percutaneous Transluminal Coronary Angioplasty
Authors: Okamura Atsunori , Ohishi Mitsuru , Rakugi Hiromi , Katsuya Tomohiro , Yanagitani Yoshihiro , Takiuchi Shin , Taniyama Yoshiaki , Moriguchi Koichi , Ito Hiroshi , Higashino Yorihiko , Fujii Kenshi , Higaki Jitsuo , Ogihara Toshio , Higaki Jitsuo
Published: July 2008

Angiotensin-converting enzyme (ACE) inhibitors are reported to prevent neointimal formation after balloon injury in animal models, but in most prospective studies in humans, ACE inhibitors failed to prevent restenosis after percutaneous transluminal coronary angioplasty (PTCA). The ACE genotype assigned by an insertion/deletion ( I/D) polymorphism is known to affect the potency of ACE inhibitors in several renal diseases. The authors attempted to clarify whether the effect of ACE inhibitors on restenosis might be modified by the ACE genotype. A total of 126 patients was randomly and prospectively assigned to the control group and the imidapril group. In the imidapril group, patients received 5 mg imidapril daily, starting 1 day before PTCA and continuing for 3 to 6 months. Forty-six control (65 vessels) and 32 imidapril patients (43 vessels) completed the study. The minimal lumen diameter before and after the procedure did not differ significantly among the groups with the three genotypes ( II, ID, and DD) in both the control and imidapril groups. Late luminal loss during the follow-up period was not related to the ACE genotype in the control group but was significantly related in the imidapril group ( II, 0.63 ±0.19 mm; ID + DD, 1.12 ±0.14 mm, p<0.05). Furthermore, in the II genotype, imidapril significantly reduced late loss and restenosis rate as defined by most of the frequently used definitions. In conclusion the ACE I/D polymorphism may influence the effect of ACE inhibitors in preventing restenosis after PTCA.
Air Plethysmography in Chronic Venous Insufficiency: Clinical Diagnosis and Quantitative Assessment
Authors: Ting Albert C. W. , Cheng Stephen W. K. , Wu Lisa L. H. , Cheung Grace C. Y. , Cheng Stephen W. K.
Published: July 2008

To define the role of air plethysmography (APG) in the clinical diagnosis and quantita tive assessment of chronic venous insufficiency (CVI), APG studies were performed on 582 limbs in 291 patients with signs and symptoms of CVI. One hundred and thirty- one limbs were classified into group I (no evidence of CVI), 291 into group II (mild CVI), and 160 into group III (advanced CVI). On APG, the mean venous filling index (VFI) was 1.45 mL/s, 3.90 mL/s, and 5.25 mL/s in groups I, II, and III respectively (p < 0.05). The mean ejection fraction (EF) and mean residual volume fraction (RVF) also showed significant differences between the limbs with CVI and the contralateral normal limbs, but the values were similar for the different severities of CVI limbs. The amount of overlap in VFI, EF, and RVF values among the clinical groups was consider able. Discrimination analysis derived a VFI value of 2.67 mL/s as a cutoff point between normal limbs and limbs with CVI, with a positive predictive value of 96%. In conclusion, APG is a simple and noninvasive test for quantitative assessment of the different compo nents of CVI, valvular reflux, and calf muscle pump function. However, only VFI corre lated significantly with the severity of CVI. VFI, with its high positive predictive value, may be useful in diagnosis of CVI, and it may serve as an objective quantitative measure ment for monitoring the effect of treatment.
An Unusual Case of Multiple Right Atrial Thrombi in a Patient with a Dual-Chamber Pacemaker
Authors: Schifter David R. , Kozer Leonid M. , Saul Barry I. , Reddy C.V.R.
Published: July 2008

The authors present an unusual case of multiple large atrial thrombi attached to perma nent pacemaker leads identified by transesophageal echocardiography. Pathogenesis, clinical implications, and therapeutic options of pacemaker thrombi are discussed.
Results of Saphenous Vein Graft Stent Implantation: Single Center Results from Use of Oversized Balloon Catheters
Authors: Scavetta Karen , Oh Christopher , Caldron Randall , Abdel-Dayem Tarek , Al-Zaibag Muayed , Jutzy Kenneth R. , Marsa Robert J. , Sjolander Matts , Ribeiro Paulo A.
Published: July 2008

The results and complications of a single-center experience of stent implantation in old saphenous vein grafts (SVGs) need to be defined. The authors studied their initial consec utive 92 patients (125 stents, 1.4 stents/per patient) with a mean age of 67 ±9 years. The patients' mean saphenous vein graft (SVG) age was 10 ±4 years, and the mean left ventricular ejection fraction was 46% ± 15. Patient population included unstable angina (65%), stable angina (10%), myocardial infarction (21%), and silent ischemia (4%). The authors implanted 122 Palmaz-Schatz/biliary and three Gianturco-Roubin stents. They aimed at a balloon-artery ratio of 1.1/1.0. Procedural success, defined as stent deployment with <50% stenosis without death/Q-wave myocardial infarction/coronary artery bypass grafting (MI/CABG) was 95%. The mean luminal diameter (MLD) increased from 0.6 ±0.5 to 3.3 ±0.8 mm (p<0.001) and mean SVG stenosis diameter was decreased from 80% ± 14 to -10% ±11 (p<0.001). Angiographic SVG lesions exhibited thrombus (17%), ulceration (38%), and plaque rupture (28%). Sixty-two patients were treated with warfarin and aspirin and 30 with ticlid and aspirin. Complications included death in three patients (3.3%) who sustained subacute stent thrombosis, and two of three had Q- wave MI. Distal embolization occurred in seven patients (8%); six of seven sustained a non Q-wave acute myocardial infarction (AMI); and one of seven a Q-wave MI. Eight (9%) patients had major groin hematoma, two had pseudoaneurysm (2.2%), one had arteriovenous (A-V) fistula (1.1%), two had vascular surgery (2.2%), nine had blood transfusion (9.8%), and three had stent migration (3.3%). Single-center experience with stents in SVGs indicates a highly successful procedural and angiographic immediate result. However, it was complicated by significant risk of non Q-wave MI due to distal coronary embolization which may affect prognosis.
Ultrasonic Evaluation of Congestive Liver After Tricuspid Annuloplasty
Authors: Koga Masaaki , Taira Akira , Toyohira Hitoshi , Shimokawa Shinji , Moriyama Yukinori , Watanabe Shunichi
Published: July 2008

To assess the effect of tricuspid annuloplasty (TAP), the authors measured the size of the liver by using echography in the patients undergoing tricuspid annuloplasty. From April 1989 to August 1996, 18 patients underwent TAP. The authors measured preoperatively and postoperatively the hepatic index (HI) by echography, defined as follows: HI=L x D/ BSA (L: the top-to-bottom length of the left hepatic lobe; D: the front-to-back length of the left hepatic lobe; BSA: body surface area). They also calculated the reducing rate (RR) of HI. The mean HI decreased after TAP; preoperative HI: 39.7 ±11.8 vs postoper ative HI: 33.8 ±10.5 (p=0.0069). The RR of the patients with postoperatively residual tricuspid regurgitation (TR) over 2 degrees (n=4) was significantly lower than that of the other patients (n=14): -11.0 ±6.0% vs 20.2 ±3.2% (p=0.0003). They conclude that the use of echography to measure the HI is a good method of assessing congestion after TAP.
Chronic/Subacute Total Occlusion of the Left Main Coronary Artery
Authors: Kanjwal Mohammed Y. , Carlson David E. , Schwartz Jeffrey S.
Published: July 2008

Total occlusion of the left main coronary artery is rare. Acute occlusion is invariably fatal; however, survival is possible if the patient reaches the hospital in time. Patients usually present with acute myocardial infarction, cardiogenic shock, and sudden cardiac death. Chronic total occlusion presents with angina, myocardial infarction, or congestive heart failure. The authors describe complete occlusion of the left main coronary artery in a patient who presented with recent-onset angina. They review the clinical and angio graphic features of 60 cases described in the literature.
Comparison of 50-mg and 100-mg Sustained-Release Isosorbide Mononitrate in the Treatment of Stable Angina Pectoris: Effects on Quality-of-Life Indices
Authors: Zwinderman Aeilko H. , Cleophas Ton J. , van der Sluijs Hans , Niemeyer Menco G. , Buunk Bram P. , van der Wall Ernst E. , Cleophas Ton J. ,   Dutch Mononitrate Quality of Life Study Group
Published: July 2008

High-dosage nitrates are more effective for the management of anginal symptoms but produce more adverse effects, including development of tolerance and the zero-hour effect (rebound angina at the end of the dosing interval). Such effects may reduce the beneficial effect of treatment on quality of life. In a self-controlled, 6-month study, the effects on symptoms and quality of life of 50 mg and 100 mg sustained-release isosorbide mononitrate (SR ISMN), administered once daily, on anginal symptoms and quality of life (QOL) were assessed in 453 patients with stable angina pectoris. QOL was assessed by means of a test battery based on the Medical Outcomes Short-Form 36 Health Survey and the Angina Pectoris Quality of Life Questionnaire. The internal consistency and reliability of the multiitem scales were estimated by use of Cronbach's alpha coefficient. Based on their improvements in New York Heart Association (NYHA) angina classification, patients who received 100 mg daily showed greater improvement than those who received 50 mg daily; the mean difference between treatments was consistent with a significantly greater improvement of mobility and angina indices. Adverse effects, as estimated by side-effect index, including rebound angina at times of rest, and by patient compliance rating, differed slightly between the two treatment regimens and were even less problematic with the higher dosage than with the lower dosage. Psychological distress index and life satisfaction scores also were significantly higher with 100 mg than with 50 mg daily. The results of this study suggest that SR ISMN 100 mg once daily provided a better NYHA angina classification than SR ISMN 50 mg did and did not produce further adverse effects. In addition SR ISMN 100 mg improved various QOL indices more than SR ISMN 50 mg did, particularly the mobility index and certain life satisfaction scores, which are the most important indicators of QOL in this category of patients.
Lymphoscintigraphic Manifestations of Hennekam Syndrome
Authors: Rockson Stanley G. , de los Santos Maribeth , Szuba Andrzej , Rockson Stanley G.
Published: July 2008

Hennekam syndrome is a rare, recently described genetic disorder in which facial anomalies and mental retardation accompany congenital lymphedema and intestinal lymphangiectasia. Several other somatic abnormalities have variously been described, as have milder degrees of lymphatic dysfunction. The authors herein describe a case of Hennekam syndrome in which the diagnostic difficulties were partially overcome by the judicious use of radionuclide scintigraphy to verify the lymphedematous component of the patient's presentation.
Acute Myocardial Infarction Following Gemcitabine Therapy
Authors: Kalapura Thomachan , Krishnamurthy Muthuswamy , Reddy C.V. , Reddy C.V.
Published: July 2008

The authors report a case of acute myocardial infarction following gemcitabine infusion and electrocardiographic abnormalities suggestive of ischemia on rechallenge of the drug. The possible underlying mechanisms of ischemia and/or infarction and the strate gies for prevention are discussed.
Clinical Review : Conjunctivitis in Children
Authors: Moore Roger A. , Schmitt Barton D.
Published: July 2008

The management of acute conjunctivitis need not be confusing. In the newborn period the common etiologic agents are chemical, TRIC, and bacterial. The latter two causes are effectively treated with sulfacetamide ophthalmic preparations. Dacryostenosis should be suspected in any child with recurrent conjunctivitis in the first six months of life. With older children the major causes can be classified as viral, allergic, foreign bodies, and bacterial. Bacterial conjunctivitis almost always responds to sulfacetamide ophthalmic preparations.
Poliomyelitis in the Fetus and the Newborn
Authors: Wyatt H.V.
Published: July 2008

A survey of the literature shows that although poliovirus may be recovered from fetuses whose mothers have paralytic poliomyelitis, there is no evidence that the fetuses themselves are affected. It is suggested that if postnatal poliomy elitis results from an autoallergic response not developed in the fetus, then poliovirus cannot enter the CNS of the fetus. When a mother has paralytic poliomyelitis at delivery the neonate has a 40 per cent chance of poliomyelitis, with a case fatality rate of about 50 per cent. It is suggested that most of these neonates become infected by virus entry into the exposed olfactory and nasal nerve endings after the membranes have burst. This would explain the very short incubation period and the high case and case fatality rates.
Reye Syndrome Associated with Vaccination with Live Virus Vaccines
Authors: Morens David M. , Halsey Neal A. , Schonberger Lawrence B. , Baublis Joseph V.
Published: July 2008

To determine whether vaccination with live virus vaccines may be etiologi cally related to Reye syndrome, we examined 404 cases reported to the Center for Disease Control. Fifteen of 269 children with Reye syndrome had been inoculated with live virus vaccines within 30 days before onset of illness. Although this temporal relationship may have occurred by chance, seasonal distribution and clustering of incubation periods suggests that live virus vaccines may occasionally serve as cofactors in the etiology of Reye syndrome through undefined mechanisms.
Clinical Review : Measles in Africa: A Deadly Disease
Authors: Guillozet Noël
Published: July 2008

Measles dominate childhood illnesses in tropical Africa with a variety and severity of complications virtually unknown in the West. There is no apparent continental variation in measles virus but environmental factors vary widely. The frequent association of severe measles with malnutrition and recent studies indicating impaired humoral, cellular, and mucocutaneous immunologic function in the malnourished may explain this perplexing disease. Prevention of early malnutrition combined with lasting and economic early immunization with heat-stable vaccine, currently unavailable, are needed to halt this fre quent, costly, and often fatal African scourge.
Hearing Loss in Down's Syndrome
Authors: Balkany Thomas J. , Downs Marion P. , Jafek Bruce W. , Krajicek Marilyn J.
Published: July 2008

Significant hearing loss was found in about two-thirds of a series of 107 individuals with Down's syndrome. Hearing loss of that degree causes retarda tion of speech, language and intellectual development in normal children. Down's children are presumably affected even more by this sensory depriva tion and without correction are prevented from reaching their full potential.
Acute Disseminated Aspergillosis During the Neonatal Period
Authors: Gonzalez-Crussi F. , Mirkin L. David , Wyllie Robert M. , Escobedo Marilyn
Published: July 2008

We describe an infant who died with extensive lesions of disseminated aspergillosis on the 18th day of postnatal life. Aspergillus fumigatus was re covered from blood cultures. Initial clinical manifestations were suggestive of hepatitis, and steroids and antibiotics were used in the treatment. This therapy may have fostered the onset of an opportunistic mycosis. Advanced multi- systemic aspergillotic lesions were seen at autopsy, especially prominent in lungs and gastrointestinal tract. The extent and magnitude of the lesions observed suggest inception of the disease very early in life, although no case of human aspergillosis has been known to be congenital. Neonatal aspergillosis is poorly characterized. Only four previously reported cases came to our notice in which the disease could be diagnosed in the first month of life. The ubiquitous nature of pathogenic Aspergillus, joined to aggressive treatments designed to achieve increased survivals in neonatology, could potentially result in greater numbers of cases of this and other uncommon mycoses.
Clinical Review : Measles Vaccine Failure
Authors: Hayden Gregory F.
Published: July 2008

Measles in the United States has declined dramatically since the introduction of measles vaccine in 1963, but still remains an important pediatric problem. When given at age 15 months or later, the live, further attenuated virus vaccine provides durable immunity in over 90 per cent of vaccinees. Measles vaccine failure has been associated with the use of inactivated measles vaccine, vaccination before 1 year of age, and errors in vaccine handling. To minimize measles vaccine failure, health professionals should re-vaccinate children whose initial vaccination is likely to have been ineffective, and pay meticulous attention to vaccine handling.
Bacterial Endocarditis due to Penicillin-Resistant Streptococcus viridans
Authors: McCarthy V.P. , Cho C.T. , Diehl A.M. , Ramsey B.W.
Published: July 2008

Bacterial endocarditis remains a formidable diagnostic and therapeutic problem for clinicians. Streptococcus viridans still accounts for 45 to 50 per cent of all cases and between 5 to 10 per cent of all clinical isolates of Strepto coccus viridans from patients with bacterial endocarditis may be relatively resistant to penicillin. The case of a 9-year-old child with Tetralogy of Fallot and a Waterston shunt who subsequently developed bacterial endocarditis due to penicillin-resistant Streptococcus viridans following failure of oral peni cillin dental prophylaxis is presented. In the face of penicillin resistance, additional considerations for workup, including microbiological assays for antimicrobial synergism become necessary in the selection of a therapeutic regimen.
Editorial
Authors: Cornfeld David
Published: July 2008

In his editorial for the first issue of Clinical Pediatrics, Irving J. Wolman, M.D. wrote "Clinical Pediatrics, here presented in its first issue, aims to bring to its readers, with promptness, accuracy and efficiency, knowledge concerning the care of infants and children." A contributor to that first issue with an article on bacterial upper respiratory infection in children, today takes on this challenge as Editor-in-Chief of Clinical Pediatrics. We take great pleasure in introducing the new Editor-in-Chief, David Cornfeld, M.D.

A native of Philadelphia and a graduate of the University of Pennsylvania School of Medicine, Dr. Cornfeld comes to the journal with a distinguished career in pediatric medicine. He is presently Professor and Associate Chairman of the Department of Pediatrics at the University of Pennsylvania School of Medicine. He is certified by the American Board of Pediatrics and the American Board of Pediatric Nephrology and is a Fellow in the College of Physicians of Philadelphia and the American Academy of Pediatrics. His many other accomplishments, too numerous to mention here, all testify to his dedication to the practice of medicine and more particularly pediatric medicine. We at the publishing offices know Dr. Cornfeld as an editor who has brought with him a sense of vitality that we know will reflect in the journal. We know him, too, as an editor with whom we will work to publish a journal which we will be proud of.

As did Janus, we look backward and forward at the same time. Backward to many productive years under the stewardship of Irving Wolman and forward to many more productive years being guided by David Cornfeld. To Dr. Cornfeld, we say we are happy you have joined us.

The Publisher
Children's Conceptions of Illness and Cognitive Development
Authors: Whitt J. Kenneth , Dykstra Weiss , Taylor Catherine A.
Published: July 2008

Editor's Note: "Information in this article will give the clinician an understanding of the stages of cognitive de velopment and the ways of utilizing this knowledge. It affords an explanation of what most good practitioners do as the result of intuition founded on experience."
Review of Intensive Care Unit Admissions for Asthma
Authors: Richards Warren , Lew Cheryl , Carney Jean , Platzker Arnold , Church Joseph A.
Published: July 2008

A review of ICU admissions for asthma to the Childrens Hospital of Los Angeles was conducted for the period January 1969 through July 1977. The admission rate remained relatively constant during this period. Patients requiring ICU admission tended to be young, intractable severe asthmatics whose asthma started at a very young age. There were three patients who had no previous history of asthma. The incidence of pneumomitis/atelectasis was somewhat greater than has been reported for patients hospitalized for status asthmaticus. A significant number of children received neither intravenous corticosteroids, sympathomimetics nor oxygen therapy while hospitalized prior to transfer to the ICU. Those children receiving mechanical ventilation or intravenous isoproterenol tended to be somewhat younger and had a higher incidence of pneumonitis/atelectasis and more abnormal blood gas determina tions than their counterparts who were not similarly treated. Mechanical ventilation was administered to 15 patients and 19 patients received intra venous isoproterenol. Intravenous isoproterenol resulted in prompt improve ment in most patients; except for one patient who experienced cardiac arrhyth mia (reversed when the dosage was decreased), this medication was well-tolerated.
Sodium Valproate in the Prophylaxis of Simple Febroile Convulsions
Authors: Williams A.J. , Evans-Jones L.G. , Kindley A.D. , Groom P.J.
Published: July 2008

Thirty children with simple febrile convulsions were treated with sodium valproate following their second convulsion. Twenty-two of the 30 (73%) had no further convulsions during the one-year period of observation compared with 17 of 28 in the control group (61%). This was not a statistically signif icant difference. Side effects attributed to sodium valproate treatment were noted in 7 patients (23%), although 4 of these showed only mild transient gastrointestinal symptoms at high dosage. The study did not confirm any advantage in the use of sodium valproate as a prophylaxis for febrile con vulsions, although compliance was good and significant side effects infrequent.
Sickling Crises and Altitude
Authors: Mahony Barry S. , Githens John H.
Published: July 2008

Seventy-five black patients with sickle hemoglobinopathies who are fol lowed by the Colorado Sickle Cell Treatment and Research Center, and 172 of their family members were evaluated by retrospective interview for the occurrence of sickling crises when traveling in the Rocky Mountains or by aircraft. Twenty per cent of 39 patients with sickle cell anemia (Hgb SS) and 28.6 per cent of 21 with sickle/hemoglobih C disease or sickle/thalassemia (Hgbs S/C and S/T) have developed crises when traveling in the mountains above 2000 m. Vaso-occlusive crises predominated in the SS group and splenic crises occurred primarily in those with Hgbs S/C and S/T. Approximately 20 per cent of those with S/C and S/T, but none with SS, had crises when flying in pressurized aircraft. Among 103 family members with sickle cell trait (Hgb AS), no significant risk of developing crises could be identified with either mountain or pressurized aircraft travel.
Behavior Modification Therapy in Hyperactive Children
Authors: Wolraich Mark L.
Published: July 2008

One hundred fifty-seven studies employing behavior modification in the management of hyperactive and disruptive children were reviewed. The studies were analyzed against standards of scientific validity. The review found: (1) behavior modification was effective in alleviating problem behaviors; (2) token programs were the most commonly used; (3) both positive reinforce ment and punishment were effective; positive reinforcement, however, had the advantage of improving self-esteem; (4) behavioral problems occurring in the home most likely require a home-based program; (5) behavior modification and stimulant medication can be used simultaneously, often with additive effects; and (6) long-term benefits beyond one year have not been assessed.
Iron Poisoning
Authors: Ng Raymond C. W. , Perry Kitty , Martin David J.
Published: July 2008

Severe acute iron poisoning developed in a 1½-year-old child who had eaten an iron preparation that resembles a popular chocolate candy. Tablets con taining iron, with and without vitamins, and the sugar-coated candy of similar appearance, were radiographed with human gastric juice in vitro. Times of dissolution of the radiopaque tablets were noted, to assess the value of ab dominal radiographs in the diagnosis and management of acute iron poisoning.
Extrahepatic Portal Hypertension Due to Congenital Obstruction of the Portal Vein and Associated Gross Hepatic Lobulation
Authors: Johnson Abiodun O. , Obisesan Akinsanya O. , Olufemi Williams A.
Published: July 2008

A 10-week old girl presented with splenomegaly and recurrent hematemesis from esophageal varices. Splenoportography revealed a dilated extrahepatic portion of the portal vein with nonvisualization of its intrahepatic tributaries. The child died following an episode of hematemesis and was found to have a dilated portal vein which ended blindly. In addition, there was abnormal lobulation of the inferior surface of the liver which was not cirrhotic. The portal vascular anomaly, which presumably was responsible for the portal hypertension, was probably due to failure of communication between the em bryonic vitelline veins or to atresia of the portal vein secondary to pressure from the abnormal hepatic lobulation in utero. It would appear that congenital factors may be significant in the etiology and pathogenesis of some cases of extrahepatic portal hypertension in early life and recognition of such develop mental anomalies is of importance in management.
Safety of Intravenous Diazoxide in Children with Severe Hypertension
Authors: McCrory Wallace W. , Kohaut Edward C. , Lewy John E. , Lieberman Ellin , Travis Luther B.
Published: July 2008

The safety and efficacy of diazoxide administered intravenously in the treat ment of children with acute severe hypertension have been evaluated by a col laborative study. Observations of the response of blood pressure in 36 patients, ranging in age from two months to 18 years, during the initial episode of hos pitalization reveal diazoxide treatment to be effective in lowering blood pres sure in 94 per cent of the cases. No serious adverse circulatory, fluid and electrolyte, metabolic or hematologic effects were observed. Symptomatic and subjective reactions observed with diazoxide administered intravenously to children were identical with those described in adults. Reinstitution of other means of antihypertensive therapy is safe and effective when delayed until the transiently induced period of hypotension has passed. Repeated use of diaz oxide for subsequent recurrence of severe hypertension was equally effective and safe in 93 per cent of the instances. The results lead us to recommend the use of intravenous diazoxide for treatment of children with severe symptomatic hypertension especially when it is refractory to control by other hyper tensive agents.
The Mean Corpuscular Volume (MCV) in Children With Acute Lymphoblastic Leukemia
Authors: Small Trudy , Oski Frank A.
Published: July 2008

Although most children with acute lymphoblastic leukemia (ALL) are anemic at the time of diagnosis, the cause of this anemia remains obscure. In an effort to characterize the anemia, we analyzed the mean corpuscular volume (MCV) at the time of diagnosis. The MCV was selected because of the observation that older erythrocytes have a reduced MCV and an anemia presumably related to decreased red blood cell production should be reflected by a reduced MCV. A total of 54 patients fulfilled the criteria for analysis. Of this group, 33 per cent had an increased MCV, 61 per cent had a normal MCV, and 6 per cent had a decreased MCV for age. Patients with an increased MCV were found to have a significantly lower hemoglobin and platelet count. The number of females in the group with the increased MCV was 83 per cent as contrasted with 43 percent in the group with a normal MCV. At relapse, 71 per cent of patients with an initially increased MCV had an elevated MCV as contrasted with only 23 per cent in the group with an initially normal MCV. These observations suggest that in patients with ALL and an increased MCV, a maturation defect may be present that affects all cell lines and may be the result of a diffusible substance released from the leukemic cells. The MCV cannot be used as a reflection of mean cell age in patients with ALL and does not support the belief that the anemia in ALL is merely the result of a "crowding-out" process.
Acute Triclofos Poisoning in a Preterm Infant
Authors: Shahar Eli , Shnaps Yitzchak , Frand Mira
Published: July 2008

A preterm infant with accidental triclofos sodium poisoning is described. He developed deep coma, severe hypothermia, mild hypotension and lack of the primitive and deep tendon reflexes. During recovery, the primitive reflexes were the last to appear. The natural course of triclofos poisoning, and its influence on the immature central nervous system of the preterm infant are discussed.
A Clinical Score for Predicting The Level of Respiratory Care in Infants With Respiratory Distress Syndrome
Authors: Peckham George J. , Schulman Joseph , Pereira Gilberto R. , Shutack John G.
Published: July 2008

A scoring system was developed to predict the need for transferring infants with respiratory distress syndrome (RDS) from community hospitals to spe cialized respiratory care centers. five clinical and laboratory determinations (birthweight, clinical RDS score, FIO2, PCO2 and pH) recorded from 100 infants with RDS during one year were utilized in a score with values ranging from 0 to 10. Application of the score to 159 with RDS during the following year showed that: (1) 73 per cent of infants scoring ≤3 received only oxygen by hood; (2) 75 per cent of infants scoring 4-5 required continuous positive air way (CPAP); and (3) 87 per cent of scoring ≥6 needed me chanical ventilation (MV). Mean scores were significantly different (p < 0.02) for each type of respiratory therapy employed: oxygen by hood (2.30 ± 0.19 S.E.M.); CPAP (4.27 ± 0.16 S.EIM.); MV (6.72 ± 0.25 S.E.M.).

The accuracy and simplicity of the score make it valuable for the physician in the community hospital to assist in deciding when to transfer a neonate with RDS for more intensive respiratory therapy.
Auditory Brain-stem Response Audiometry in Children
Authors: Weber Bruce A.
Published: July 2008

Auditory Brain-stem Response (ABR) Audiometry, also called Brain-stem Evoked Response Audiometry, is an effective procedure for assessing the hear ing of children who cannot or will not perform satisfactorily on behavioral audiotnetric tests. Although ABR audiometry has limitations, it does permit an estimate of hearing status in nearly all children regardless of their age or developmental level.