bluuebunny/crossref_metadata_2025 huggingface dataset:
Brain Infarction Caused by Syphilitic Aortic Aneurysm
Authors: Nakane Hiroshi , Okada Yasushi , Ibayashi Setsuro , Sadoshima Seizo , Fujishima Masatoshi
Published: July 2008

Neurosyphilis often develops brain infarction. Recently, the authors experienced a case of brain infarction caused by syphilitic aneurysm on the thoracic aorta, and its clinical signif icance is reported. A seventy-eight-year-old woman with strongly positive serologic tests for syphilis suddenly developed global aphasia and right hemiplegia. Brain computed tomography (CT) showed a large brain infarction in the left middle cerebral artery territory. A huge aneurysm of the ascending aorta eroded the sternum and the second and third ribs. The left common carotid artery was completely compressed by the aneurysm, and blood flow was not demonstrated on enhanced CT. A cerebrospinal fluid examination revealed normal cell counts, and the titer of a syphilis test was very low. She did not have any arrhythmia, ischemic heart disease, or valvular heart disease as an embolic source. Brain infarction may be developed by pressure of an aortic aneurysm on the left common carotid artery. They recommend consideration of syphilis as an etiology of brain infarction when luetic patients are seen in old age.
Pulmonary Pseudosequestration Receiving Arterial Supply from a Coronary Artery Fistula
Authors: Hung Kuo-Chun , Hsieh I-Chang , Chern Ming-Shyan , Lin Fun-Chung , Wu Delon
Published: July 2008

A forty-eight-year-old man with a history of pulmonary tuberculosis and scarring of both hila and upper lobes was noted to have bilateral pulmonary pseudosequestration, in which the blood supply originated from a coronary artery fistulous vessel arising from the left circumflex artery and draining into the pulmonary artery. This is the first reported patient with the source of blood supply to the pulmonary pseudosequestration arising from a coronary artery fistula.
Changes in Cardiac Autonomic Activities in Patients with Syndrome X
Authors: Wen Lieng Lee  , Chen Jaw-Wen , Chi Woon Kong  , Jiann Jong Wang  , Ting Chih-Tai , Wan Leong Chan  , Wang Shih-Pu , Chang Mau-Song
Published: July 2008

The present study was designed to assess cardiac autonomic activities, coronary microvas cular function, and their relationship in patients with syndrome X. Control of coronary blood flow is complex, and impaired coronary flow reserve has been attributed as the cause of myocardial ischemia in patients with syndrome X. It is unknown whether cardiac autonomic activities are altered in the presence of coronary microvascular dysfunction in patients with syndrome X. Eighteen patients with syndrome X were studied. Great cardiac vein flow was measured by the thermodilution method and the coronary flow reserve was determined by intravenous dipyridamole (0.56 mg/kg) infusion. Twenty-four-hour ambu latory electrocardiograms were obtained in a drug-free state. Another 14 age- and sex- matched normal subjects served as a control group. The amplitude (in ms) of ultralow (ULF), very-low (VLF), low (LF), and high (HF) frequency bands and total spectra of heart rate variability were measured for twenty-four-hour and every four-hour interval of the day.

The mean coronary flow reserve was 2.12 ±0.57 (range 1.33-2.94) in 15 syndrome X patients. Compared with those in control subjects, mean LF and HF oscillations were lower in patients with syndrome X, especially in the morning and evening hours and the twenty-four-hour analysis. Circadian HF and LF activities were blunted. The LF/HF ratio tended to be higher. Among patients with syndrome X, ULF, VLF, HF bands, and total spectra were significantly lower in the morning and/or evening hours in the subgroup presenting a higher mean daily heart rate (n = 9) than in the other subgroup with a lower rate (n=9). There was a positive correlation between coronary flow reserve and ULF activities in the morning ( r=0.47-0.48, P=0.07-0.08) and evening hours ( r=0.67, P=0.006). The LF/HF ratio negatively correlated with coronary flow reserve in hours 1200-1600 ( r=-0.55, P=0.03).

Coronary microvascular function and cardiac autonomic activities were impaired in patients with syndrome X. The predominant parasympathetic withdrawal suggests loss of cholinergic vasodilation in coronary microvasculatures, especially as sympathetic tone was activated. Abnormal cardiac autonomic activities could either play a role in the pathogenesis or just be a mark of coronary microvascular dysfunction in these patients.
Use of TPA-Induced Clot Lysis Time (TCLOT) to Diagnose Abnormal Clot Structure and Fibrinolysis in a Patient with Spontaneous Bleeding into His Leg
Authors: Carr Marcus E. , Carr Sheryl L. , McCardell Kathleen A.
Published: July 2008

Diagnosis and treatment of patients with bleeding due to enhanced fibrinolysis is hampered by the absence of a rapid screen of fibrinolytic potential. The authors have developed a simple assay to assess clot structure and fibrinolysis in patient samples exposed to tissue plasminogen activator (TPA). They present the case of a forty-one- year-old man who presented with spontaneous bleeding despite normal results from coagulation screening tests, platelet count, platelet aggregation studies, platelet force development, and bleeding time. Evaluation of the patient's clot structure revealed a very weak, low-modulus, clot that rapidly dissolved in the presence of TPA. Identification of the abnormality allowed treatment with ε-aminocaproic acid with prompt resolution of bleeding.
Ambulatory-Determined 24-Hour Blood Pressure in Mild Hypertensives and in Normotensives
Authors: Fariello Raffaele , Boni Enrico , Crippa Massimo , Damiani Gianpaolo , Corda Luciano , Valenti Luigi , De Tavonatti Fabrizio , Alicandri Carlo , Zaninelli Augusto
Published: July 2008

Noninvasive ambulatory twenty-four-hour blood pressure (BP) monitoring was carried out in 30 normotensive subjects (16 women, 14 men), aged twenty-five to sixty years (mean thirty-eight) and in 29 mild essential hypertensive patients without target organ damage (14 women, 15 men), aged twenty-three to sixty-one years (mean thirty-nine). Hypertensive patients were not treated, and they discontinued any antihypertensive treatment at least four weeks before the study. During the daytime period (6 AM-10 PM) BP was monitored every fifteen minutes, and during the night (10 PM-6 AM), every thirty minutes. Obviously, mean twenty-four-hour systolic blood pressure (SBP) and diastolic blood pressure (DBP) were higher in hypertensive patients (P < 0.001). There was a persistent correlation in the group of mild hypertensives between successive BP hourly mean readings (r ranged from 0.61 to 0.93 for SBP and from 0.45 to 0.82 for DBP). In normotensive subjects these correlations failed in particular periods: 8 AM-9 AM, r = 0.30 for SBP and 0.45 for DBP; 1 PM-3 PM, r = 0.17-0.49 for SBP and 0.28-0.37 for DBP; 9 PM to midnight, r = 0.21-0.57 for SBP and 0.23-0.38 for DBP.
Risk Factors That Predict Development of Microalbuminuria in Treated Hypertensive Men
Authors: Agewall Stefan , Fagerberg Björn
Published: July 2008

The aim of this prospective study was to investigate the risk factors for development of microalbuminuria in treated hypertensive men with and without diabetes mellitus. Two hundred and ninety-seven treated hypertensive men, aged fifty to seventy-two years, with at least one of the following: serum cholesterol ≥6.5 mmol/L, smoking, or diabetes mellitus, were included in the study. Patients with elevated overnight urinary albumin excretion (> 17 mg/12 hr) were excluded. Urinary albumin excretion (UAE), blood pressure, and various well-established risk factor levels were measured. Two hundred thirteen nondiabetic patients and 40 patients with diabetes mellitus completed the three- year follow-up. Development of microalbuminuria was more prevalent in those with diabetes mellitus at baseline compared with the group without diabetes mellitus, 25% and 10.3%, respectively (P = 0.02). Nondiabetic patients who developed microalbu minuria had higher UAE, 10.2 mg ±3.7 and 5.7 ±3.2, respectively (P < 0.0001), and higher systolic blood pressure 160 mm Hg ±27 and 152 ±17, respectively (P = 0.043), at baseline compared with whose who remained normoalbuminuric. In the group with diabetes mellitus, a higher UAE, 9.8 ±2.7 and 7.1 ±3.6, respectively (P = 0.036), at baseline was observed in whose who developed microalbuminuria compared with whose who remained normoalbuminuric.

In conclusion, concomitant diabetes mellitus significantly increased the risk for devel opment of microalbuminuria during the three-year follow-up in treated hypertensive men. Patients who progressed to microalbuminuria had higher UAE at baseline, but still within the normoalbuminuric range, compared with those who remained normoalbu minuric. Systolic blood pressure at baseline was higher in those who progressed to microalbuminuria, although reaching statistically significance only in the larger nondia betic group.
Ambulatory Blood Pressure and Echocardiographic Left Ventricular Dimensions in Elderly Hypertensive Subjects
Authors: Rizzo Vito , Piccirillo Gianfranco , Cicconetti Paolo , Bianchi Americo , Capponi Laura , Salza Maria Cristina , Cacciafesta Mauro , Marigliano Vincenzo
Published: July 2008

In a consecutive series of 62 hypertensive elderly subjects, the authors studied the relation of blood pressure circadian variations with echocardiographic parameters of left ventricular (LV) hypertrophy. All the subjects were submitted to an ambulatory blood pressure monitoring (ABPM) and to B- and M-mode echocardiography. In the elderly hypertensive group, LV mass index (LVMI) was more strongly related to twenty-four- hour, daytime and nighttime systolic ambulatory blood pressure (r = 0.52, r = 0.37, r = 0.51) than diastolic ambulatory blood pressures were ( r = 0.32, r = 0.18, r = 0.33). Casual systolic and diastolic blood pressure (CBP) was found more weakly related to LVMI than ambulatory blood pressures were (r = 0.35, r = 0.26). Elderly hypertensive subjects were divided into two subgroups in relation to the presence (group 1) or absence (group 2) of blood pressure nocturnal decline. No differences were found between these two subgroups in regard to: casual blood pressure values, ambulatory blood pressures in the diurnal period, sex, body surface area, height, weight, and age. LVMIs were computed in all three groups and showed the following results: 89.32 ±19.76 in elderly normoten sives, 91.21 ±31.32 in group 1, and 99.80 ±18.21 in group 2. Echocardiographic para meters of LV dimensions and LVMIs were different in group 1 and 2. An inverse correla tion, statistically significant, was observed between LVMIs and the nocturnal blood pressure reduction (systolic: r = -0.36, P < 0.05; diastolic: r = -0.29, P < 0.05). These results suggest an association between a smaller LV mass and nocturnal blood pressure decline in elderly hypertensive patients.
Postphlebitic Syndrome: Clinical Activity and Tolerability of Desmin, New LMW Dermatan Sulfate
Authors: Andreozzi Giuseppe Maria , Signorelli Salvatore , Di Pino Luigi , Allegra Claudio , Riccioni Camillo , Cucinotta Domenico , Manopulo Roberto , Dettori Anton Giulio , Megha Alessandro , Longo Franco Nicola , Urbano Oreste , Manganaro Agatino , Buda Domenico , Zamboni Villiam , Palazzini Ernesto
Published: July 2008

One hundred patients suffering from postphlebitic syndrome of the lower limbs were enrolled in an open, randomized, and multicenter (six centers) trial for a period of eighteen months. Patients were randomly assigned to three treatment groups to receive (for ninety consecutive days) Desmin, a new low-molecular-weight dermatan sulfate, at the dose, respectively, of 100 mg once daily by subcutaneous (SC) route (36 patients), 100 mg twice a day by SC route (33 patients), and 200 mg once daily by intramuscular (IM) route (31 patients). The general and local tolerability and the clinical efficacy of the drug were evaluated by means of clinical, instrumental, and laboratory parameters. Desmin is effective in the decompensation stage of postphlebitic syndrome; this was demonstrated by a significant reduction in the severity of a number of typical symptoms as well as by the drug's positive effect on venous tone as confirmed by phlebotensio metric examination. The daily dose of 200 mg (either SC or IM) was more effective than the 100 mg dose. The results obtained at the end of the trial (ninety days) were statisti cally better than those obtained after thirty days of treatment.

This trial demonstrated that both the systemic and the local (at the site of injection) tolerability of the drug, administered for three months, were good and without significant variations in the laboratory parameters monitored.
Hemitruncus Presenting in an Adult
Authors: Edasery B. , Sharma M. , Vaddigiri V. , Santucci T.
Published: July 2008

Hemitruncus is a rare congenital anomaly in which one pulmonary artery branch, usually the right, arises from the ascending aorta just above the aortic sinuses, whereas the main pulmonary artery and the other pulmonary branch arise in their normal position. The authors present a case in which the patient was diagnosed as having hemitruncus as an adult, and to the best of their knowledge only 7 similar cases have been reported in the medical literature.
In Situ Endothelin in Coronary Artery Disease
Authors: Brody Jerome I. , Capuzzi David M. , Fink Gordon B.
Published: July 2008

Despite the significant advances made in the understanding and treatment of coronary artery disease much remains unclear about the pathogenesis of this complex atherothrombotic process. Atherogenesis may reflect a combination of multiple factors interacting with one another leading to coronary artery occlusion. One potential partic ipant may be endothelin-1 (ET-1), a potent mitogenic vasoconstrictor. The presence of endothelin within saphenous veins before insertion and after removal during coronary artery bypass grafting (CABG) because of bypass closure, within internal mammary arteries before and after surgical intervention, and within native coronary artery segments resected during CABG was demonstrated immunocytochemically with an antiendothelin antibody and aminoethyl carbazole as the indicator chromogen. Increased amounts of ET-1 were observed in failed venous grafts, in damaged internal mammary artery grafts, and in vessels of the myocardium. These results suggest that ET-1 may play a significant pathophysiologic role in the evolution of coronary heart disease.
Plasma Endothelin-1 Concentrations During Cold Exposure in Essential Acrocyanosis
Authors: Mangiafico Roberto Antonio , Malatino Lorenzo Salvatore , Santonocito Maurizio , Spada Rosario Sebastiano , Tamburino Giacomo
Published: July 2008

To assess endothelin-1 (ET-1) response to cold stimulation in essential acrocyanosis (EA), the authors measured ET-1 plasma concentrations in 6 patients with EA (6 women, age range seventeen to thirty-seven years) and in 6 controls (5 women, 1 man, age range twenty-one to thirty-seven years) before and after cold challenge by unilateral hand immersion in water bath at 13°C for five minutes. The contralateral upper limb was considered as control. Blood samples were simultaneously drawn from an antecubital vein in the cooled side and in the contralateral upper limb at baseline, at the end of cooling, and at ten and ninety minutes after cooling was begun. Plasma ET-1 was deter mined by a radioimmunoassay system. Results are mean ±SD. Baseline ET-1 was higher in patients with EA (5.1 ±0.3 pmol/L) than in controls (1.9 ± 0.1 pmol/L, P < 0.001). After hand cooling, ET-1 in the cold-exposed upper limb rose in patients with EA to a peak value of 7.2 ±0.7 pmol/L, which was greater than that observed in healthy subjects (2.7 ±0.4 pmol/L, P < 0.001). The absolute increase in ET-1 plasma concentrations from baseline to peak value was significantly higher in patients with EA than in controls (2.1 ±0.3 vs 0.8 ± 0.2 pmol/L, respectively, P < 0.001). In patients with EA, but not in controls, the rise in ET-1 plasma concentrations was still detected ninety minutes after cooling. The same time course of the plasma ET-1 concentrations was observed in the noncooled upper limb, but the increases in ET-1 at different times after cold stimulus were smaller than in the cold-challenged upper limb in both groups (P < 0.001). In conclusion, the results demonstrate that in patients with EA, baseline plasma levels of ET-1 are enhanced and are further increased by cooling until ninety minutes after cold challenge. This rise in plasma ET-1 could contribute to potentiating and prolonging cold-induced vasoconstric tion/vasospasm and/or could be a marker for endothelial damage in EA.
Comparison of Factor VIII-Related Antigen and Erythrocyte Sedimentation Rate in Outpatient Management of Vasculitis
Authors: Roberts W. Neal , Brodeur James P. , DeWitt John , Carr Sheryl Z. , Wise Christopher M. , Carr Marcus E.
Published: July 2008

Electroimmunodiffusion (Laurell rocket) determinations of factor VIII-related antigen in plasma were ordered to determine the cost/benefit ratio for factor VIII-related antigen as a putative test for endothelial damage in suspected vasculitis.

Twenty-seven consecutive patients referred for vasculitis or suspected vasculitis were identified and followed up for an average of 9.1 ±months (range: one to thirty-three months) in a prospective, unblinded study performed in a clinic, associated with a 1054- bed inner-city university hospital. There was no difference in Westergren erythrocyte sedimentation rate (WESR) in patients with final diagnosis of systemic vasculitis (SV) (38 ± 12 mm/hour) compared to those without vasculitis (NV) (27 ± 7) as the final diagnosis. The mean plasma concentration of factor VIII-related antigen was significantly elevated in SV (344 ±100%) when compared with NV (147 ±39%) (P < 0.016). The factor VIII- related antigen test in this study was 2.56 times more likely (crude odds ratio) than the WESR to contribute to a change in diagnosis or therapy (P=0.016). Positive and negative predictive values (PPV and NPV) for factor VIII-related antigen (abnormal at greater than 220% of the normal value) were both 70%. PPV and NPV for WESR were 56% and 86%, respectively.

The factor VIII-related test was less cost-effective than the WESR in the follow-up period unless it was important to define complete remission or differentiate vasculitis flare from infection. The authors conclude that factor VIII-related antigen is a useful test in the initial diagnosis of vasculitis.
Hypothenar Hammer Syndrome Successfully Managed with Intravenous Prostaglandin E1 and Heparin and with Correction of the Thrombogenic Risk Profile
Authors: Wieczorek Iwona , Farber Alexander , Alexander Klaus
Published: July 2008

A fifty-one-year-old man presented with a history, symptoms, and clinical findings typical of a hypothenar hammer syndrome in his dominant hand. A thrombotic obstruction in the distal section of the ulnar artery with multiple downstream occlusions of proper digital arteries were documented angiographically. Coexistence of additional cardiovascular risk factors (smoking-induced polycythemia, obesity, hypercholesterolemia, and hyperten sion) was identified. Conservative management with intravenous heparin and prostaglandin E1 together with measures directed at controlling the additional risk factors (repeated venesection, immediate smoking cessation, and low-lipid diet) resulted in a striking clinical and angiographic improvement of the digital perfusion, without resort to interventional measures or thrombolysis.
Digital Ventriculography: Valid On-Line Calculation of Cardiac Volumes by Corrected Computer Densitometry in Coronary Artery Disease
Authors: Lehmkuhl Hans , Blunck Birgit , Altstidl Robert , Barth Karl , Bachmann Kurt
Published: July 2008

Cardiac catheterization facilitates the assessment of left ventricular function in coronary artery disease (CAD). Digital left ventriculography offers the potential for an on-line quantitative determination of left ventricular end-diastolic volume (LVEDV) and left ventricular end-systolic volume (LVESV). These are routinely evaluated by the area- length method (ALM), which is considered as a standard. Densitometry (DENS) is an alternative method but may lead to calculated underestimations.

The purpose of this study was to investigate the accuracy of corrected DENS for LVEDV and LVESV in comparison with ALM in single-plane 30° right anterior oblique (RAO) projection. The computer densitometric correction equation was adapted from the linear regression analysis (y=0.86x+2.73) in cardiac models and applied to the analysis of digital left ventriculograms in patients suffering from CAD.

The study of cardiac models yielded highly significant correlations ( r≥ 0.9; P≤ 0.001) between true volumes and both DENS and ALM. DENS and ALM correlated highly signif icantly ( r≥ 0.9; P ≤ 0.001) with a low standard error of estimate (SEE) of ±9.5 mL.

The comparison of DENS and ALM in 44 patients' digital ventriculograms exhibited highly significant (r=0.74; P ≤ 0.001) correlations for noncorrected and corrected LVEDV. Systematic underestimation by DENS of LVEDV disappeared after correction and SEE decreased from ±23.7 to ±19.2 mL. DENS and ALM correlated highly significantly for LVESV (r=0.78; P ≤ 0.001; SEE ± 15.6 mL ± 13.5 mL, respectively) after correction. Following correction, mean values for DENS increased from 116 ±32 to 132 ±37 mL (LVEDV) and 50 ±22 to 55 ±25 mL (LVESV). For ALM, mean values decreased from 159 ±35 to 127 ±28 mL (LVEDV) and 55 ±25 to 46 ±21 mL (LVESV).

This study shows that LVEDV and LVESV can be reliably analyzed on-line by corrected computer densitometry. Method-related errors of both DENS and ALM are present and account for minor volume deviations.
Clinical, Electrocardiographic, and Echocardiographic Features in Patients with Asymptomatic Aortic Abdominal Aneurysm
Authors: Bolognesi Roberto , Tiberti Gianluca , Azzarone Matteo , Tecchio Tiziano , Pellegrino Felice , Manca Carlo
Published: July 2008

Cardiac involvement in peripheral vascular diseases can present interesting patho physiological aspects and can influence the prognosis. The authors evaluated the cardiac condition of patients with asymptomatic aortic abdominal aneurysm (AAAA) by using clinical, electrocardiographic, and echocardiographic techniques. Seventy-eight patients were studied, 74 men and 4 women, with ages ranging from fifty-five to eighty-one years (mean 69.5 ± 6.4). All patients were submitted to a complete clinical examination, usual blood tests, a 12-lead resting electrocardiogram, and an echo- Doppler evaluation. Forty-eight subjects (61.5%) were affected by hypertension, 53 (67.9%) were smokers, 25 (32.1%) were alcohol abusers, 39 (50%) had a history of angina pectoris, 20 (25.6%) had had previous myocardial infarction, and 30 (38.5%) were receiving active cardiovascular treatment.

All patients except 2, who had chronic atrial fibrillation, manifested sinus rhythm. Electrocardiographic signs of left ventricular (LV) hypertrophy were present in 20 cases (25.6%), intraventricular conduction disturbances in 19 (24.4%), pathological Q waves in 20 (25.6%), and primary repolarization abnormalities in 25 (32.1%).

Echocardiography showed a slight increase in left atrial diameter and intraventric ular septum thickness (41.5 ± 4.3 and 12.3 ± 2 mm respectively). A clearer increase was found in LV mass index (159 ± 44 g/m2). In 31 patients one or more LV asynergic segments were found.

In our patients with AAAA the prevalence of major risk factors for atherosclerosis and ischemic heart disease including previous myocardial infarction was high. Echo-derived LV myocardial mass index was higher than normal even though electrocardiographic criteria for LV hypertrophy did not match echocardiographic data in all subjects. Finally a moderate prevalence of intraventricular conduction disturbances was recorded.
Thoracoabdominal Aortic Aneurysm in an Infant Treated by Thromboexclusion with Thoracoabdominal Aortic Bypass
Authors: Hashimoto Ryoichi , Hada Masao , Kamiya Kihachiro , Tada Yusuke , Ueno Akira , Yanai Jun , Komai Takayuki
Published: July 2008

A case of a huge thoracoabdominal aortic aneurysm in an eighteen-month-old boy is reported. Surgical treatment was successfully performed by thromboexclusion of the aneurysm with thoracoabdominal aortic bypass using a low-porosity woven Dacron graft 10 mm in diameter and of sufficient surplus length. During the early postoperative period, he developed moderate hydronephrosis, owing to compression of the left ureter by the graft, but no further deterioration was seen. Follow-up angiographies performed four and six years after surgery revealed straightening of the graft and slight stretching of the aorta at the distal anastomosis, but no stenosis was found. Now, seven and a half years after surgery, he has no pressure gradient between upper and lower extremities.
A Case of Behçet's Disease with an Abdominal Aortic Aneurysm and Two Aneurysms in the Common Carotid Artery
Authors: Tuzuner Altan , Uncu Hakan
Published: July 2008

A sixteen-year-old boy presented with varied symptoms to the hospital. After he had been diagnosed as having Behçet's disease, investigations revealed two carotid aneurysms in the right common carotid artery and one abdominal aortic aneurysm. The aneurysms were resected, medical therapy was started, and the patient recovered well. Although multiple aneurysms have been reported previously, the authors believe this is the first reported case involving both the carotid and the aorta.
Local Venous Thrombosis After Cardiac Catheterization
Authors: Zahn Ralf , Fromm Elke , Thoma Sylvia , Lotter Raimond , Zander Matthias , Wagner Stefan , Seidl Karlheinz , Senges Jochen
Published: July 2008

Pulmonary embolism is a rare but life-threatening complication of cardiac catheterization. Underlying deep venous thrombosis (DVT) is often not detectable clinically. To determine the true incidence of DVT the authors prospectively studied 450 consecutive patients (29% women, 71% men, mean age: fifty-eight years) undergoing a diagnostic cardiac catheterization. Patients were examined clinically and by duplex sonography with a high- resolution (5 or 7.5 MHz) transducer before and twenty-four hours after catheterization before mobilization. Duplex sonography excluded complete proximal DVT in all patients. Only partial occluding thrombi (pDVT) were detected in 11 (2.4%) patients. The thrombi were always localized at the puncture site. In 2 patients a difference was found in the circumferences of the legs, but no other clinical signs of DVT were seen. With use of continuous wave (cw) Doppler sonography, only 3 of these 11 patients (27%) showed a spontaneous (s) sound. Phlebography was performed in 4/11 patients (36%). In 2 patients the diagnosis was confirmed; in 1 patient extravenous compression was assumed, and the other demonstrated a normal-appearing phlebography at the time of investigation. Logistic regression analysis yielded a 3.5 times higher risk for developing a pDVT if a venous puncture was performed in addition to arterial puncture. Furthermore a 9.8 times higher risk was found if more than one venous puncture was necessary. During the follow-up no patient developed clinical signs of pulmonary embolism. The results of this study demonstrate that DVT is a rare complication of cardiac catheteriza tion (0/450 patients), but pDVT occurred in 2.4%. Risk factors for pDVT are the venous puncture itself and multiple puncture attempts. Clinical relevance of pDVT remains to be determined.
Comparative Ultrasonographic and Angiographic Study of Carotid Arterial Lesions in Takayasu's Arteritis
Authors: Taniguchi Nobuyuki , Itoh Kouichi , Honda Masanori , Obayashi Taminori , Nakamura Michiru , Kawai Fukiko , Irie Takasuke
Published: July 2008

The purpose of this study was to compare the usefulness of ultrasonography to that of angiography for studying arterial lesions in Takayasu's arteritis.

Ultrasonographic and angiographic findings from 44 carotid arteries of 22 patients with Takayasu's arteritis (2 men and 20 women; mean age, 41.2 years) were compared. Angiography was used to classify the patency of the carotid arteries into three groups: nonstenotic, stenotic, and occlusive. Ultrasonography was also used to classify the same arteries into four groups: nonstenotic, mildly stenotic, moderately stenotic, and occlusive. Thickness of the wall (intima-media complex) of the carotid artery was measured with high-frequency transducers.

Angiography showed 23 carotid arteries to be nonstenotic; 12, stenotic; and 9, occlusive; whereas ultrasonography showed 16 to be nonstenotic; 18, mildly stenotic; 7, moderately stenotic; and 3, occlusive. Results of the two diagnostic modalities correlated closely (P < 0.0001). Ultrasonography, aided by color flow imaging, detected six instances of a marginal but definite blood flow that angiography had failed to reveal. Arterial wall thickness correlated closely with the severity of ultrasonographic stenosis (P < 0.005). This thickness was 1.3 ±0.4 mm in the nonstenotic group, 1.6 ± 0.5 mm in the mildly stenotic group, 2.2 ±0.8 mm in the moderately stenotic group, and 1.9 ±0.2 mm in the occlusive group. Even the walls of the nonstenotic arteries were significantly thicker than those of the normal carotid arteries (0.7 ±0.1 mm, P < 0.01).

Ultrasonography appeared to be more useful than angiography in estimating stenotic severity of the carotid artery in Takayasu's arteritis. Characteristic ultrasonic findings included luminal stenosis or occlusion on two-dimensional ultrasonograms, decrease in or lack of flow shown by color Doppler flow imaging, and concentric thickening of the carotid arterial walls. Ultrasonographic mural thickness was the most sensitive indicator of early, latent inflammation.
Microvascular Reactivity After Ischemia/Reperfusion in the Hamster Cheek Pouch: Beneficial Effects of Different Oral Doses of S-5682 (Daflon 500 mg)
Authors: Bouskela Eliete , Cyrino Fatima Z. G. A. , Lerond Laurence
Published: July 2008

Daflon 500 mg (S-5682) is a purified, micronized flavonoid fraction containing 90% diosmin and 10% hesperidin that is currently used to treat chronic venous insufficiency and hemorrhoidal disease. Thus, it seemed of interest to evaluate the effects of S-5682 on ischemia/reperfusion, ie, the changes in mean internal diameter and blood flow of arte rioles and venules and the functional capillary density (FCD) during reperfusion after ninety minutes of total ischemia in the hamster cheek pouch microvasculature. Different doses of S-5682 (5, 20, 80, and 160 mg/kg body weight/day), suspended in 10% lactose solution or vehicle (10% lactose) were administered orally to male hamsters for ten days twice a day. The cheek pouch preparation was placed under an intravital microscope coupled to a closed-circuit TV system. A ninety-minute local ischemia was obtained by a cuff mounted around the neck of the everted pouch where it left the mouth of the hamster. Mean arteriolar and venular internal diameters were determined by means of an image-shearing device, IPM model 907; red blood cell (RBC) velocity was measured by the dual-slit photometric technique; microvessel volume flow was calculated from diameters and RBC velocities; and FCD was defined as the number of red-cell-perfused capillaries per observation field. During reperfusion, placebo-treated animals showed significant vasodilatation concomitant with a decrease in blood flow and FCD compared with preischemic values and an impairment of the myogenic response. In S-5682-treated animals, there was a significant dose-dependent improvement in all these parameters including the myogenic tonus. These results clearly demonstrated that oral administration of different doses of S-5682 for ten days improved the microvascular reactivity and FCD after ischemia/reperfusion in a dose-dependent fashion in the hamster cheek pouch microvasculature.
Antioxidant Effect of Flavonoids
Authors: Catapano Alberico L.
Published: July 2008

Our body generates hydroxyl radicals under a number of conditions. This radical is very unstable and, therefore, very reactive. After attack of radicals on membranes and lipopro teins, lipid peroxidation starts, and may lead to the development of vascular lesions. The human body has developed antioxidant defenses to protect against free radicals such as superoxide dismutases, glutathione peroxidases, plasma iron binding proteins, or α toco pherol. Oxidized LDL are believed to play a key role in vascular damage and can modulate several endothelial properties including NO production and expression of adhesion molecules. Antioxidants, such as flavonoids, inhibit "in vitro" oxidation of LDL and their cytotoxicity; in humans consumption of flavonoids appears to be related to a reduction of the risk of cardiovascular diseases. The biochemical mechanisms respon sible for this effect remain to be addressed.
Pathophysiology of Venous Leg Ulceration—An Update
Authors: Dormandy John A.
Published: July 2008

The microcirculatory component of the pathophysiology of venous ulceration is now attracting considerable research interests, but is still far from fully elucidated. Currently, the central role is filled by the inappropriately activated white cell and its interaction with the endothelium. Interstitial oedema, pericapillary fibrin cuff and capillary microthromboses could all fit in with this hypothesis. However, there are other demon strated changes, for instance in lymphatic drainage, intrinsic fibrinolysis and hemorheo logical changes which also need to be taken into account. The interaction between the microcirculatory changes is an obvious target for the systemic pharmacotherapy of venous ulceration.
Efficacy of Daflon 500 mg in Venous Leg Ulcer Healing: A Double-Blind, Randomized, Controlled Versus Placebo Trial in 107 Patients
Authors: Guilhou Jean-Jacques , Dereure Olivier , Marzin Loïc , Ouvry Pierre , Zuccarelli François , Debure Clélia , Van Landuyt Hervé , Gillet-Terver Marie-Noëlle , Guillot Bernard , Levesque Hervé , Mignot Jean , Pillion Gérard , Février Benoit , Dubeaux Dominique
Published: July 2008

The objective of this study was to evaluate the efficacy of Daflon® 500 mg (Dios)* in venous ulcers. A multicenter, double-blind, randomized, controlled versus placebo (Plac) trial was conducted, with stratification according to the size of ulcer (≤ 10 cm and > 10 cm). The protocol called for a two-month treatment with Dios (one tablet = 450 mg micronized purified Diosmin) or a placebo, two tablets/day, in addition to compression therapy.

Evaluations were performed every fifteen days, from DO to D60. The primary endpoint, in accordance with Alexander House group requirements were: percentage of patients with complete ulcer healing, ie, comparison between Dios and Plac group at D60, and comparison of survival curves in each group between DO and D60 (log rank test). Secondary endpoints included ulcer surface area assessed by computerized plani metric measurements, qualitative evaluation of ulcers, and symptoms.

The patients were 105 men and women ranging in age from eighteen to eighty-five years, with standard compression stocking, who were undergoing standardized local care of ulcer and had no significant arterial disease (ankle/arm systolic pressure index > 0.8). Fifty-three patients received Dios, and 52 received Plac. The 2 groups were well matched for age (m ±1 SD = seventy-one ±eleven years), gender, ulcer size, and associated disorders.

Among patients with ulcer size ≤ 10 cm (Dios = 44, Plac = 47) a significantly larger number of patients had a complete ulcer healing at two months in the Dios group (n = 14) in comparison with the Plac group (n = 6) (32% vs 13%, P = 0.028) with a signifi cantly shorter time duration of healing (P = 0.037). No difference was shown for the secondary criteria, except for sensation of heavy legs (P = 0.039) and a less atonic aspect of ulcer (P = 0.030) in favor of Dios. Among the 14 patients with ulcer size > 10 cm (Dios = 9, Plac = 5), subjected to a descriptive analysis only, no ulcer healed.

This study showed that a two-month course of Daflon 500 mg at a daily dose of two tablets, in addition to conventional treatment, is of benefit in patients with venous ulcer ≤ 10 cm by accelerating complete healing.
Synergism of Hemopoietic Growth Factors on Endothelial Cell Proliferation
Authors: Sigounas George , Steiner Manfred , Anagnostou Athanasius , Sigounas George
Published: July 2008

Endothelial cells, which are nonhemopoietic cells, express and/or produce most of the known hemopoietic receptors and cytokines. The biological role of these factors, and their respective receptors, on endothelial cells is still unknown. In this study, the authors assessed the effect of different hemopoietic growth factors, ie, interleukin-3 (IL-3), erythropoietin (EPO), macrophage-colony stimulating factor (M-CSF), granulocyte-colony stimulating factor (G-CSF), granulocyte macrophage-colony stimulating factor (GM-CSF), singly or in conjunction with others, on proliferation and chemotaxis of human umbilical vein endothelial cells (HUVECs). They found growth stimulatory activity with IL-3, EPO, and GM-CSF and potent synergism between EPO and IL-3, less with IL-3 and GM-CSF, and none with EPO and either GM-CSF or G-CSF. All the singly tested hemopoietic growth factors stimulated the migration of HUVECs, but in conjunction with other factors, they did not show any additive or synergistic effect.
A Comparison Between Aspirin and Pentoxifylline in Relieving Claudication Due to Peripheral Vascular Disease in the Elderly
Authors: Ciocon Jerry O. , Galindo-Ciocon Daisy , Galindo Diana J. , Ciocon Jerry O.
Published: July 2008

Peripheral vascular disease (PVD) commonly presents with leg claudication during walking and eventually limits the walking distance and daily activities. Aspirin or pentox ifylline are commonly prescribed to improve blood flow. Aspirin works through its antiplatelet aggregation mechanism, and pentoxifylline increases the red blood cell flex ibility, which leads to increased tissue perfusion. Data on comparative studies of these drugs for improving claudication in the elderly are limited. The objective of this study was to compare pain relief offered by either aspirin or pentoxifylline for walking leg pain in the elderly with PVD.

Patients sixty-five years or older with claudication were randomly assigned to receive aspirin or pentoxifylline. Their reported level of walking claudication pain with use of the visual analogue scale (0-5) and the distance walked during exercises were recorded. Six weeks later the same parameters were recorded and results were compared with Student's t test, and a P value less than 0.05 was considered a statistically significant difference. Of the 90 patients who participated, 45 received aspirin (325 mg daily) and 45 were prescribed pentoxifylline (400 mg tid) for six weeks. Both the aspirin and the pentoxifylline groups reported a moderate level of pain (2/5) and remained about the same (2/5 for aspirin and 1/5 for pentoxifylline, P = 0.9, NS) after six weeks. However, the pentoxifylline group reported a farther walking distance of 2 miles compared with the aspirin group of 1.2 miles (P < 0.05). The level of pain did not change significantly with either aspirin or pentoxifylline, but the walking distance was farther with the pentoxi fylline group.
Carotid Floating Plaques Associated with Multiple Cerebral Embolic Strokes
Authors: Ko Pin-Tang , Lin Shinn-Kuang , Chang Yeu-Jhy , Ryu Shan-Jin , Chu Chun-Che , Lin Shinn-Kuang
Published: July 2008

The authors describe 2 patients with multiple cerebral infarcts and hemorrhagic trans formation caused by artery-to-artery emboli. Ulcerated plaques with free-floating thrombus adherent to the plaque were detected at the carotid bifurcation by duplex sonography. No other embolic source could be found. One patient developed an occipital infarction due to carotid emboli passing through a fetal-type posterior communicating artery. Both patients recovered well without recurrence of stroke or transient ischemic attack with antiplatelet treatment only. Follow-up carotid duplex sonography showed disappearance of floating thrombus in 1 patient and consolidation of the lesion in the other.
Racial Differences in Risk Factors for Atherosclerosis
Authors: Hutchinson Richard G. , Watson Robert L. , Davis C. Edward , Barnes Ralph , Brown Spencer , Romm Fredric , Spencer Jessie M. , Tyroler H.A. , Wu Kenneth , Hutchinson Richard G. , ARIC Study Group
Published: July 2008

This paper describes black/white differences in risk factors for atherosclerosis in the large multicenter Atherosclerosis Risk in Communities (ARIC) Project sponsored by the National Heart, Lung, and Blood Institute. It is based on data collected at baseline in ARIC's four geographically distinct clinical centers. Participants were randomly selected (4264 black and 11,479 white men and women, ages forty-five to sixty-four years at entry). There were striking differences in obesity between black and white women, higher fasting glucose and greater prevalence of diabetes in blacks, and lower high-density lipoprotein values in white men. Not unexpectedly, blood pressure in black participants exceeded that in whites. Clustering of multiple risk factors was more common in the black population. Conversely, prevalence of no risk factors was greatest among whites. In conclusion, while African-Americans and Caucasians share much the same group of risk factors for atherosclerosis, there are clinically important racial differences in emphasis.
Hemodynamic, Electrocardiographic, Metabolic, and Hematologic Abnormalities Resulting from Lithium Intoxication
Authors: Hussain K.M.A. , Kostandy G. , Kurz L. , Pachter B.R. , Hussain K.M.A.
Published: July 2008

The authors report a unique case that presented with hemodynamic abnormalities and severe bradycardia, necessitating the insertion of a temporary pacemaker, as well as metabolic disturbances, hematologic changes, and hepatic and renal dysfunction in an elderly individual owing to lithium intoxication. This case also demonstrates that these various serious side effects of lithium resolved with prompt recognition and discontinu ation of lithium. Lithium should be used with extreme caution and frequent monitoring especially in the elderly.
Serial Assessments of Middle Cerebral Artery Flow Velocity with Transcranial Doppler Sonography in the Recovery Stage of Eclampsia
Authors: Hashimoto H. , Kuriyama Y. , Naritomi H. , Sawada T. , Hashimoto Hiroyuki
Published: July 2008

The pathophysiologic changes of eclampsia and/or hypertensive encephalopathy are unclear. Changes of middle cerebral artery flow velocity during the recovery stage in a case of eclampsia are reported. After the disappearance of signs and symptoms, the flow velocity began to increase, owing probably to delayed vasospasm, which was confirmed by magnetic resonance angiography.The vasospasm may be a consequence of eclampsia and may be of small significance in the pathogenesis.
Clinical Manifestations of Takayasu Arteritis in India and Japan— New Classification of Angiographic Findings
Authors: Moriwaki Ryutaro , Noda Makoto , Yajima Michiyoshi , Sharma B.K. , Numano Fujio
Published: July 2008

In this retrospective review 102 Indian and 80 Japanese patients with Takayasu arteritis were compared in regard to their clinical manifestations and angiographic findings. Regardless of nationality, most patients were initially affected in their teens or twenties. Japanese patients were female in a larger ratio compared with the ratio in India. Clinically, the two groups exhibited several different features. More Japanese patients were found to be pulseless (P<0.01) whereas many Indian patients were hypertensive (P<0.01). Inflammatory conditions in Japanese patients were more severe (P<0.01) and tended to be more prolonged than those in the Indians. More Japanese patients suffered from aortic regurgitation (P<0.01), but Indians suffered from hypertension (P<0.01). Angiographic findings revealed that the aortic arch and its branches were mainly involved in Japanese patients (type I, IIa) whereas the abdominal aorta and its branches were mainly involved in Indian patients (type IV). However, the diffusely involved type (type V) was the one most commonly found in both countries. From the analyses of vascular lesions in both Indian and Japanese patients, 510 and 396, respectively, different progressions of vasculitis are speculated. In Japanese patients, vasculitis generally occurs in the ascending aorta, the aortic arch, and/or its branches and extends into the thoracic and abdominal aorta, subsequently forming various complicated lesions with prolonged inflammatory activity. On the other hand, in Indian patients, vasculitis generally occurs in the abdominal aorta involving renal arteries, subsequently extending into the thoracic aorta within one or two decades, simple vascular lesions being formed. Data analysis suggests that this morbid condition progresses differently in India and Japan, in spite of some common etiologic factor(s).
Immunohistochemical and Ultrastructural Examination of Smooth Muscle Cells in Aortocoronary Saphenous Vein Grafts
Authors: Yamada Takahiro , Shiraishi Ryo , Taki Kenji , Nakano Shigeo , Tokunaga Osamu , Itoh Tsuyoshi
Published: July 2008

In this study, phenotypic modulation and remodulation of smooth muscle cells and associated intermediate filament expression were demonstrated by means of immunohistochemistry and ultrastructure to understand the development of intimal hyperplasia in aortocoronary saphenous vein grafts. In nongrafted saphenous veins, all smooth muscle cells expressed vimentin and desmin and were of a contractile form. In saphenous vein grafts showing stenotic intimal hyperplasia (luminal stenosis < 75%), expression of desmin was notably lower, whereas that of vimentin was higher. The cells were shown to be of a synthetic phenotype, suggesting modulation from the original contractile form. In saphenous vein grafts showing occlusive intimal hyperplasia (luminal stenosis >76%), desmin expression in smooth muscle cells was increased again, and such cells were of a contractile form, suggesting remodulation from the synthetic phenotype. Some of the smooth muscle cells of the synthetic phenotype were positive for an antibody against proliferation cell nuclear antigen. Smooth muscle cells of the contractile form were negative for this antibody.

The study suggests that smooth muscle cells of synthetic phenotype are highly respon sible for "growing" intimal hyperplasia of aortocoronary saphenous vein grafts.