bluuebunny/crossref_metadata_2025 huggingface dataset:
Clinical Features and Coronary Backgrounds of Coexistent Peripheral Vascular Disease in Japanese Coronary Artery Disease Patients
Authors: Seino Yoshihiko , Takita Takayuki , Tanaka Keiji , Takano Teruo , Hayakawa Hirokazu , Okumura Hidemasa
Published: November 2007

By use of noninvasive tests (Doppler segmental pressure study, supraorbital Doppler flow analysis, and segmental plethysmography), coexistent carotid (CTD) or lower extremity peripheral vascular disease (PVD) were diagnosed and cor related with subjective symptoms, coronary risk factors (CRFs), coronary ar teriograms (CAGs), cardiac hemodynamics. and infarct size in 121 consecutive patients with documented coronary artery disease (CAD). PVD was found in 16.5%, CTD in 33.1%, and both PVD and CTD in 9.9% of the patients studied; 20% of PVD patients and 47.5% of CTD patients were asymptomatic with respect to coexistent PVD or CTD. There were no significant differences between the presence or absence of PVD or CTD as regards number of CRFs, Killip classifi cation, cardiac hemodynamics, or number of stenotic coronary arteries. However, serum creatine kinase (CK) and CKMB release curves in the PVD group showed significantly higher peak CK and peak CKMB values than those in the PVD(-) group (4096 ± 5408/282 ± 263 vs 1706 ± 1715/179 ± 186, p < 0.05) because of the higher prevalence (100%) of multivessel disease on CAG. Investigation of the relationship of CRFs to coexistent PVD revealed that the smoking ratio in men (86.7%) and the hypertension ratio in women (80%) were extremely high in PVD patients, and statistically significant differences between PVD( +) patients and PVD(-) groups were found with respect to the obesity ratio (p<0.05) in men and the hyper cholesterolemia ratio (p < 0.05) and obesity ratio (60%, p < 0.05) in women. On the other hand, in CTD patients, the smoking ratio (84%) and hypertension ratio (64%) in men and the hypertension ratio (86.7%) in women were extremely high, and significant differ ences between CTD(+) patients and CTD(-) patients were found with respect to the smoking ratio (p < 0.05) and obesity ratio (p < 0.05) in men and the smoking ratio (p < 0.05) in women. For the entire group of patients, the ankle/brachial pressure index was signifi cantly lower (p<0.05) when CAD patients displayed four or more CRFs, suggesting the progression of PVD with increasing number of CRFs. The incidence and clinical features of coexistent PVD or CTD in Japanese CAD patients were documented in the present study.
Effect of Exercise Training on Multiple Respiratory Variables in Patients with Coronary Artery Disease: Correlation with Change in Exercise Capacity
Authors: Stratmann Henry
Published: November 2007

Multiple measurements of pulmonary function were performed during exer cise testing in 29 patients with coronary artery disease (CAD) before and after exercise training. Following training, significant increases in oxygen consump tion (VO 2), carbon dioxide production (VCO2), and peak flow at maximal exer cise were seen as compared with pretraining values (p < .01), but not in any other respiratory variables. Only the peak respiratory exchange ratio (RER) achieved during pretraining exercise testing and peak values of minute ventilation (VT), respiratory rate, and VCO2 during a posttraining exercise test showed signifi cant correlations with the change in maximum VO2 following exercise training (p<.05). Significant correlations were also found among VT, VCO2, and peak flow at peak exercise following exercise training and the change in exercise du ration between pretraining and posttraining stress tests. Of 22 patients evaluat ed with thallium 201 scintigraphy during their pretraining exercise test, 11 developed ischemic ST depression or a reversible perfusion defect. No signifi cant differences in pulmonary function measurements during exercise testing were seen between patients who developed ischemia and those who did not. However, the change in peak metabolic equivalents (METS) achieved between pretraining and posttraining exercise was significantly greater in patients who developed ische mia (.836±1.003 versus .091±.481, p<.05).

These results indicate that exercise training in patients with CAD is not as sociated with significant changes in most measurements of pulmonary function and, with the exception of RER at peak exercise, pretraining measurements do no show a significant correlation with changes in exercise capacity.
Internal Carotid Artery Occlusion: Diagnostic Inaccuracy of the Ocular Pneumoplethysmography
Authors: Smith S. Wayne , Angie Billie , Cheek Rosa , Stiglbauer Nancy
Published: November 2007

The diagnosis of internal carotid artery (ICA) occlusion has serious manage ment and prognostic consequences. The accuracy of noninvasive techniques in this setting remains questionable, with the result that contrast arteriography re mains the diagnostic method of choice in patients in whom ICA occlusion is suspected. Ocular pneuoplethysmography-Gee (OPG-Gee) is one of the nonin vasive methods that is still utilized extensively in the evaluation of carotid artery disease. In order to determine the real utility of OPG-Gee, the authors conduct ed a retrospective comparison of the results of OPG-Gee and arteriography in 26 patients (52 internal carotid arteries) who had undergone both examinations.

With the angiography results as the standard of comparison, 4 incorrect di agnoses were obtained by OPG-Gee, thus yielding an overall accuracy of 92 for this method. However, duplex ultrasonography, also performed in the same 26 patients, correctly identified the 2 ICA occlusions defined by angiography and further demonstrated patency in the 48 arteries so shown by angiography.

The authors conclude from this experience that OPG-Gee is less reliable than duplex ultrasonography in the diagnosis of ICA occlusion. Furthermore, despite the 92% overall accuracy of their results with OPG-Gee, the occurrence of both false-positive and false-negative results renders this examination modality sus pect in the diagnosis of ICA occlusion.
Peripheral and Renal Vein Renin Activity in Patients with Renovascular Hypertension Due to Nonspecific Aortoarteritis
Authors: Lall S.B. , Dave V. , Dash S.C. , Bhargava S.
Published: November 2007

The diagnostic utility of peripheral and renal vein renin estimations in rela tion to angiographic findings was evaluated in 13 patients with renovascular hyper tension and non-specific aortoarteritis (NSAA, Gr I), in comparison with 10 patients with renal artery stenosis due to other causes (Gr II). Plasma renin ac tivity (PRA) was measured by radioimmunoassay. Blood samples were collect ed after angiography from the femoral vein and renal vein on the affected side followed by sampling from the less affected or unaffected side. Renal vein renin ratio (RVRR) was calculated from renal vein renin values. The effect of cap topril (25 mg oral) on blood pressure, PRA, and RVRR was examined in 8 pa tients from each group. Normotensive volunteers (8) with moderately low salt intake were also included in the study for comparison of twenty-four-hour uri nary sodium output, peripheral PRA, and response to captopril.

The mean peripheral PRA was high in both groups as compared with normo tensive controls; however, the values were lower in patients with NSAA. The rise in PRA in response to captopril was insignificant in Gr I (p >0.05) and RVRR > 1.5 was observed in 5 of 13 patients in contrast to 9 of 10 in Gr II (p < 0.05). A paradoxical ratio, ie, (high renal vein renin levels on the less stenotic side) was noticed in 3 patients of Gr I, whereas none of the patients of GR II showed such a ratio. An improvement in RVRR after captopril was observed in 50% of patients of Gr I as compared with a marked response in all patients of Gr II.

The predictive value of RVRR for positive outcome of surgery or angioplasty could be assessed in only 5 patients owing to extensive bilateral involvement and poor general condition of patients with NSAA. Two patients with RVRR > 1.5 and 1 with a false-negative ratio were cured after unilateral nephrectomy/ angioplasty, whereas 2 with RVRR < 1.5 did not show any improvement; prob ably bilateral intervention in these was required. On the other hand, all the 8 patients of Gr II were benefited after unilateral intervention. It is concluded that peripheral PRA and RVRR are useful indices in patients with NSAA for diag nosis and planning surgery/angioplasty and also in avoiding unnecessary surgi cal intervention in patients with paradoxical ratio.
Influence of Deproteinized Hemodialysate on Rest Pain and Walking Distance in the Presence of Peripheral Chronic Arterial Occlusive Disease
Authors: Angelkort Bernhard , Rühlmann Kurt-Ulrich , de la Haye Rainer , Kuntz Günter
Published: November 2007

In a controlled and randomized single-blind study (blind observer) the clinical efficacy of intra-arterial therapy with a metabolically active deproteinized dialysate from calf blood has been tested against a vasodilating and hemorheologically active reference substance (bencyclan). Over a period of four weeks 28 patients each received 20 intra-arterial infusions of the deproteinized hemodialysate 20% for infusion. The reference group with 30 patients was treated with 250 mg bencyclan in 250 mL saline 0.9%. As for the target criteria, rest pain and consumption of analgesics, the hemodialysate treatment proved superior to the therapy with the reference substance. Both preparations induced to a small extent pain-free walking distances: hemodialysate group, 29.2 ±14.6 m; reference group, 25.8±18.7 m (group difference not significant).
Interaction between Histidine-Rich Glycoprotein and Platelet Factor 4 with Dermatan Sulfate and Low-Molecular-Weight Dermatan Sulfate
Authors: Cella Giuseppe , Boeri Giuseppe , Saggiorato Graziella , Paolini Rossella , Luzzatto Guido , Terribile Vittorio Ilario
Published: November 2007

There is a controversy about whether or not histidine-rich glycoprotein (HRG), the most abundant plasma protein with glycosaminoglycans-neutralizing capacity, is able to prevent the inhibition of human thrombin by heparin cofactor II (HC II) in the presence of dermatan sulfate (DS). The authors studied the interaction of DS and low molecular weight DS, in a purified system with HRG, platelet factor 4 (PF 4), and with HC II.

Their results show that HRG, like PF 4, has an affinity, not only for heparin, but also for DS. However, this affinity seems very weak. In fact, HRG is 10 times less effective than PF 4 in neutralizing the 50% antithrombin activity of HC II in the presence of DS.
Effect of Intensive Walking Exercise on Skeletal Muscle Blood Flow in Intermittent Claudication
Authors: Weiss Th. , Fujita Y. , Kreimeier U. , Messmer K.
Published: November 2007

Walking exercise is generally accepted as a valid therapeutic regimen in the treatment of peripheral arterial occlusive disease (PAOD) of Fontaine stage II. In order to quantify the effect of walking exercise and/or drug therapy on regional muscular blood flow, PAOD Fontaine stage II was induced by multiple ligations of the femoral artery and of all side branches in one hindlimb of mongrel dogs; the contralateral extremity served as control.

The animals underwent walking exercise with increasing intensities on a treadmill five days per week over one year; one group received 600 mg buflomedil (BF) per day orally in addition. At the end of the training period, the regional blood flow in all skeletal muscles of both hindlimbs was quantified by means of 15 μm radioactively labeled microspheres at resting conditions, after treadmill exercise (ten minutes) with or without preinjection of BF (3 mg/kg body weight) into the abdominal aorta.

At resting condition and at the end of treadmill exercise the regional muscular blood flow did not differ significantly between the diseased and control extremity. Supplementary oral treatment with BF over one year had no significant effect; the increase in muscular blood flow during treadmill exercise was not enhanced after intra-aortic injection of BF.

Consequently walking exercise has the potential to increase the functional capacity of collaterals in intermittent claudication and to restore blood supply to skeletal muscle.
Bilateral Coronary-Artery-to-Pulmonary-Artery Fistula Coexistent with Apical Hypertrophic Cardiomyopathy— A Case Report
Authors: Tai Yau-Ting , Fong Ping-Ching , Chow Wing-Hing
Published: November 2007

A sixty-four-year-old man presented with repolarization abnormalities on the electrocardiogram. Echocardiography and cardiac catheterization revealed that he had the rare combination of apical hypertrophic cardiomyopathy with bilateral coronary-artery-to-pulmonary-artery fistula. An exercise thallium scan was negative, suggesting that the marked electrocardiographic changes were most likely secondary to the apical myocardial hypertrophy, instead of to coronary-steal-induced ischemia.
Blood Flow Asymmetry in Carotid Occlusive Disease
Authors: Levine Ross L. , Rozental Jack M. , Nickles Robert J.
Published: November 2007

Patterns of anterior border zone (ABZ) and middle cerebral artery (MCA) cerebral blood flow (CBF) asymmetry were readily seen during both normocap nic room air (RA) and induced hypercapnic (CO2) inhalation using fluoromethane and a multislice, high-resolution positron scanner. Wilcoxon two-sample rank testing showed symptomatic-over-nonsymptomatic CBF ratios for unilateral greater than 75 % carotid stenosis patients (n = 8) to be 1.05 ± 0.07 (p < 0.008 as compared with control of 0.97 ± 0.02) ABZ RA, 0.98 ± 0.11 ABZ Co2, 0.98 ± 0.04 MCA RA, and 0.98 ± 0.06 MCA CO2. Unilateral carotid occlusion pa tients (n = 8) had ratios of 0.90 ± 0.16 ABZ RA, 0.81 ± 0.19 (p < 0. 002) ABZ CO2, 0.90 ± 0.12 and 0.89 ± 0.13 for MCA RA and CO2, respectively (both p < 0.008 as compared with control 0.99).

These preliminary results suggest an upgrade of autoregulation (ie, very high ratio) in the ABZ of high-grade stenosis patients during normocapnia. CBF was preferentially higher on the symptomatic side and then either did not increase or paradoxically fell in response to hypercapnia. In comparison, carotid occlu sion patients had low ABZ and MCA ratios during normocapnia, also unable to increase with hypercapnia. The fall in ratios from normocapnia to hypercap nia indicates that these areas, already subject to maximal vasodilation, fail to increase CBF or actually become hypoperfused following induced hypercapnia. These results aid in understanding the concept of "hemodynamic significance."
Evaluation of the Metabolic Compensation After Treadmill Test in Patients with Peripheral Occlusive Arterial Disease
Authors: Duprez Daniel , De Buyzere Marc , Van Wassenhove Annie , Clement Denis
Published: November 2007

Patterns of release of lactate, hypoxanthine, and arginine into the bloodstream after a standardized treadmill test (twelve minutes, 1.6-2.8 mph, inclination 0,5,10,15%) were recorded in 21 consecutive patients with stage II peripheral arterial occlusive disease. Heart rate, systolic blood pressure, ankle blood pres sure, and ankle/brachial systolic blood pressure ratio (A/B ratio), as well as plas ma lactate, plasma hypoxanthine and serum arginine were recorded before and at fifteen to thirty-minute intervals for up to two hours after the treadmill test.

Immediately after the treadmill test, lactate levels (36.6 ± 3.7 mg/L) and hypoxanthine levels (2.73 ± 0.19 mmol/L) were significantly (p < 0.001) increased but returned to preexercise levels after thirty and sixty minutes, respectively. Ar ginine levels did not change significantly. Ankle blood pressure (57 ± 5 mm Hg) and A/B ratio (0.40 ± 0.04) were significantly (p < 0.001) decreased after exercise, while heart rate and systolic blood pressure were increased. These parameters returned to normal as well within a half hour after exercise. Abso lute walking distance correlated significantly (p < 0.01) with the postexercise sys tolic blood pressure (r = - 0.62), ankle pressure (r = 0.63) and A/B ratio (r = 0.72). Induced hypoxanthine and lactate production intercorrelated signifi cantly positively (r = 0.57, p = 0.007) but were independent of the absolute walking distance. In contrast with lactate, hypoxanthine production correlated significantly with postexercise ankle pressure (r = 0.49, p = 0.02) and exercise- induced fall in A/B ratio (r = 0.66, p = 0.001). Initial preexercise venous hypox anthine, but not lactate levels were correlated with postexercise A/B ratio (r = - 0.49, p = 0.02) but not with the patients' walking distance.

These results indicate that hypoxanthine determination may reflect more close ly than lactate the degree of metabolic compensation after exercise in peripheral arterial occlusive disease.
Digital Blood Flow in Cooled and Contralateral Finger in Patients with Raynaud's Phenomenon. Comparative Measurements Between Photoelectrical Plethysmography and Laser Doppler Flowmetry
Authors: Suichies H.E. , Aarnoudse J.G. , Wouda A.A. , Jentink H.W. , de Mul F.F.M. , Greve J.
Published: November 2007

The effects of cooling of a hand on lateral and contralateral digital skin blood flow were investigated in 18 patients with primary or secondary Raynaud's phenomenon. The aim of the study was to compare photoelectrical plethsmog raphy (PhEP) and laser Doppler flowmetry (LDF). PhEP and LDF were used simultaneously for skin blood flow measurements of the third finger of both hands. One hand was cooled in water from 33 ° to 3 ° C in steps of 3 ° C, each step lasting four minutes. It was followed by a recovery period of ten minutes in room air of 24 ° C. During stepwise cooling from 33 ° to 9 ° C the relative PhEP and LDF values, measured on the cooled hand, decreased to 6.2% ± 3.2% and 10% ± 12% respectively. The correlation coefficients between LDF and PhEP varied between 0.79 and 0.99. In the contralateral hand the relative PhEP and LDF values decreased to 38% ± 30.% and 64% ± 7.9% respec tively. The correlation coefficients between LDF and PhEP values were lower on the contralateral hand and ranged from 0.26 to 0.95. By calculating the LDF/PhEP ratios during cooling and recovery, more specific changes in red blood cell velocities during cooling were studied. Increasing LDF/PhEP ratios suggest increasing red blood cell velocities during cooling at 9 ° C and a difference in the measuring methods. For testing the severity of Raynaud's phenomenon and the effect of treatment the results of both methods show consistent and quite comparable results when measured on the cooled hand. The effect of indirect cooling on the contralateral hand is, however, less consistent.
Exercise Strain-Gauge Venous Plethysmography: Evaluation of a "New" Device for Assessing Lower Limb Venous Incompetence
Authors: Rooke Thom W. , Heser J.L. , Osmundson P.J.
Published: November 2007

Plethysmography can be used to detect and assess venous incompetence in the lower extremities. The authors recently evaluated a new device designed for this purpose that uses strain gauges to determine changes in lower extremity cir cumference occurring with (and immediately after) exercise. The device plots a curve of volume against time for each limb and automatically calculates key values such as the volume of blood expelled from the lower limb veins during exercise and the time required for the veins to refill following exercise. The ap paratus was incorporated into their noninvasive vascular laboratory and used (along with other standard tests) to study patients referred for suspected venous incompetence.

They observed the following: (1) A shortened postexercise refilling time ac curately identified limbs with venous incompetence. (2) The clinical severity of venous incompetence was inversely related to the refilling time. (3) Exercise- induced changes in lower extremity volume correlated well with simultaneously determined changes in venous pressure. (4) Valvular incompetence could be local ized to the deep or superficial veins based upon the improvement in refilling times seen following placement of elastic tourniquets around the lower limb. (5) The type of exercise performed (knee bends while the patient was standing versus ankle reflexes while sitting) had little effect on results. The authors conclude that exercise venous plethysmography is a useful noninvasive tool for assessing low er limb venous incompetence.
Cessation of Recurrent Bleeding from Gastrointestinal Angiodysplasia, After Beta Blocker Treatment in a Patient with Hypertrophic Subaortic Stenosis—A Case History
Authors: Schwartz J. , Rozenfeld V. , Habot B.
Published: November 2007

The authors present the case of an elderly patient suffering from obstructive cardiomyopathy and bleeding colonic angiodysplasia. After treatment with propranolol, the bleeding stopped without recurrence.
Expansion of Contracted Visual Fields Following Treatment with Pentoxifylline in Two Patients with Coexistent Peripheral Vascular Disease—Case Reports
Authors: Elliot Eric C. , Kollarits Carol R.
Published: November 2007

Pentoxifylline, a hemorheologic drug reputed to reduce blood viscosity, can be used to improve the microcirculation in peripheral vascular disease. The authors report on 2 patients who were being followed up for possible glaucoma and whose visual field constriction became worse at about the same time as their peripheral vascular symptoms began to increase in severity. Following initiation of treatment with oral pentoxifylline, their peripheral vascular complaints de creased and their visual fields gradually expanded over the next several months. This dual effect seemed more than a coincidence. It may in fact indicate that the same mechanism said to aggravate the peripheral ischemia (ie, increased blood viscosity) in patients with peripheral vascular disease may also have been the basis for the visual field contraction in these 2 patients, possibly by producing retinal ischemia. The reversal of the contracted visual fields would then seem to be due to the ameliorative effect of the pentoxifylline treatment on the blood viscosity.
Value of Clinical Screening for Detection of Asymptomatic Hemodialysis Vascular Access Stenoses
Authors: Levy Scott S. , Sherman Richard A. , Nosher John L.
Published: November 2007

Measurement of recirculation and intradialytic venous line pressures may aid in the detection of hemodialysis vascular access stenoses. The authors screened 29 consecutive asymptomatic patients for recirculation values exceed ing 15% or venous pressures greater than 150 mmHg. All 13 patients requiring and agreeing to angiography on the basis of the screening protocol proved to have high-grade stenoses of their vascular access outflow or inflow. Asympto matic vascular access pathology is common. High-risk asymptomatic popula tions may be detected by simple screening procedures.
Right Atrial Thrombus as a Complication of Subclavian Vein Catheterization—A Case Report
Authors: Huraib Sameer
Published: November 2007

The author reports a case of right atrial ball thrombus in a patient with Behçet's disease who was receiving plasmaphoresis through a subclavian cathe ter and who had resolution of the thrombus while receiving heparin therapy.
Is Sublingual Nifedipine Administration Superior to Oral Administration in the Active Treatment of Hypertension?
Authors: Diker Erdem , Ertürk Sehsuvar , Akgün Günes
Published: November 2007

Nifedipine, a calcium-channel-blocking agent, was administered orally to 44 untreated patients (Group A) and sublingually to 51 untreated patients (Group B) who had a diastolic blood pressure more than 90 mm Hg and systolic blood pressure more than 140 mm Hg. The mean pretreatment systolic and diastolic blood pressure values were 185.3 ± 26.0 and 115.1 ± 13.4 mm Hg in Group A patients and 193.6 ± 23.1 and 118.1 ± 14.1 mm Hg in Group B patients respectively (p >0.05). The hypotensive activity of nifedipine was observed at the tenth minute in both groups. Mean systolic and diastolic pressures were 168.9 ± 23.7 and 101.9 ± 14.2 mm Hg in Group A and 170.6 ± 26.2 and 103.0 ± 15.8 mm Hg in Group B, (p < 0.001) Diastolic blood pressures dropped under 100 mm Hg at the twentieth minute in both groups. Maximal reduction of blood pressure was observed at the fortieth minute in both groups and the degree of reduction in blood pressure was also the same (mean systolic and diastolic blood pressures: 143.7 ± 22.1 and 86.9 ± 11.7 in Group A and 148.7 ± 21.4 and 91.7 ± 17.0 in Group B (p >0.05)

The authors conclude that sublingual nifedipine administration is not supe rior to oral nifedipine administration (in capsular form) in the acute treatment of hypertension.
Successful Dissolution of Massive Left Atrial Thrombus After the Use of Warfarin—A Case Report
Authors: Cohen Alberto , Larkins Cynthia K.
Published: November 2007

A case of rheumatic heart disease, mitral stenosis, large left atrium, and chronic atrial fibrillation is reported and discussed. This patient was shown, by means of two-dimensional echocardiography, to have a massive left atrial thrombus, and after the initiation of anticoagulation with warfarin, complete resolution of the clot was seen in less than two months. The use of two-dimen sional echocardiography was valuable in the follow-up of this patient, and it is suggested that further prospective studies are necessary for better understand ing the natural history of left atrial thrombus.
Total Pulmonary Torsion Without Vascular Compromise—
Authors: Callol L. , Navarro V. , Galvez A. , Boned J. , Sevillano C. , Gayan R. , Rada I. , Gomez-Terreros J.
Published: November 2007

A new case of pulmonary torsion is reported. Only 15 cases of this rare entity have been published in the literature, all of them either surgically treated short term or resulting in death. Small right-side pneumothorax following diagnostic transthoracic puncture seemed to be the mechanism of production. Because of the absence of acute clinical manifestations, fibroscopy, isotopic perfusion scan ning, and hemodynamic and pulmonary angiographic studies were done. The lack of compromise in the pulmonary flow and venous pulmonary return ex plains the surprisingly good progress (ten months, at present) of the patient.
Measurement of Lymphatic Flow Variation by Noninvasive Method Cases of Lymphedema
Authors: Thibaut G. , Durand A. , Follignoni P. , Bertrand A.
Published: November 2007

The purpose of this study was to measure the variations of lymphatic flow. A noninvasive isotopic method was used to achieve a functional exploration of lymphatic circulation.

Fifteen subjects were used in the study: 10 healthy subjects and 5 patients with lower extremity lymphedema.

A first subcutaneous injection of technetium 99m rhenium sulfate (99mTc) was performed in the first interdigital space of both feet. The radioactivity was re corded in two places: the first one on the inguinal site by a gamma camera; the second, below the first, on the precordial site by a multichannel analyzer. With the two types of recording procedures, it was possible to obtain a curve that showed the amount of radioactivity in relation to time. In order to obtain a muscular activity fifty-five minutes after the injection, each subject or patient spent ten minutes on an ergometric bike.

A second subcutaneous injection was performed one week later, but prior to the injection, the subject or patient took orally 1800 mg of heptaminol adeno sine phosphate (HAP) per day for three days. The radioactivity recording was made under the same conditions as with the muscular activity.

The statistical results of the experiment without treatment on the two types of recording show that in the healthy subjects the amount of radioactivity in creased during muscular activity. Moreover, the treatment indicated higher ra dioactivity values, which remained at a higher level. However, the muscular activity performed by a patient was unable to increase the radioactivity.

On the other hand, the drug gave radioactivity values that were higher than the previous values of the first curve. Then, because of the increase of the pre cordial recording in all cases, it is possible to say that the lymphatic flow rose; the drug was able in each case to obtain an increase in the lymphatic flow.

This method permits recognition of an increase in the lymphatic flow; more over, it shows that muscular activity improved the flow only in healthy subjects, whereas HAP in all cases constantly gave a higher flow.
Blood Rheology After LDL Apheresis Using Dextran Sulfate Cellulose Absorption—A Case Report
Authors: Koenig Wolfgang , Ditschuneit Herwig H. M. , Hehr Reinhard , Grunewald R. Willi , Ernst Edzard , Hombach Vinzenz
Published: November 2007

The authors describe a thirty-eight-year-old woman with familial hyper cholesterolemia treated by dextran sulfate cellulose adsorption apheresis. This technique and the selective extracorporeal LDL cholesterol elimination by im munoabsorption or heparin-induced precipitation not only dramatically decrease blood lipids but also result in a marked improvement in the rheologic profile. It is suggested that the amelioration of blood rheology by LDL apheresis may represent the cause for the early clinical improvement felt by most patients with severe coronary heart disease and hypercholesterolemia.
TIAs in a Spontaneously Dissecting Aneurysm of the Internal Carotid Artery—A Case Report
Authors: Shintani Shuzo , Shiigai Tatsuo , Tsuruoka Shin , Tsukagoshi Hiroshi
Published: November 2007

A spontaneous internal carotid artery dissection of an aneurysmal form is reported. The patient, a fifty-eight-year-old man, had manifested recurrent transient left hemiparesis, dysesthesia of the left upper limb, and dysarthria for three months. After administration of ticlopidine, the transient ischemic attacks completely disappeared. Three months later, the follow-up angiographic study revealed the same form of dissection in the same portion as compared with the initial study. Conservative therapy was successful.
Differential Exercise Effects of Captopril and Nadolol in Patients with Essential Hypertension
Authors: Kostis John B. , Shindler Daniel M. , Moreyra Abel E. , Ruddy Michael C. , Schneider Stephen , Cosgrove Nora
Published: November 2007

In a crossover study, 12 patients with mild to moderate hypertension were given placebo, captopril (12.5 to 50 mg three times a day), and nadolol (20 to 160 mg once a day) to control the resting diastolic blood pressure to a nearly identical degree (p < 0.0001) (106.1 ±4 placebo, 89.6 ±8 captopril, 89.8 ±7 nadolol). Both drugs lowered (p < 0.0004) systolic and diastolic blood pressure at rest and during exercise. However, systolic blood pressure lowering during exercise was more pronounced (p < 0.05) with nadolol than with captopril (difference of 6 mmHg, 16 mmHg, and 21 mmHg at 5.0, 7.0, and 9.0 metabolic equivalents (METS) respectively). Heart rate was lower (p < 0.05) at rest and during exercise with nadolol as compared with placebo and with captopril. These data imply different mechanisms of action of the two drugs at rest and during exercise and may help in selection of drug therapy in special patient subsets.
Comparison of Three Progressive Exercise Protocols in Peripheral Vascular Occlusive Disease
Authors: Gardner Andrew W. , Skinner James S. , Vaughan Natalie R. , Bryant Cedric X. , Smith L. Kent
Published: November 2007

Although claudication pain and hemodynamic responses to exercise are usually clinically assessed via graded treadmill walking, measuring these responses to other commonly performed tasks may yield a more nearly complete evaluation of peripheral vascular occlusive disease. Thus, the purpose of this study was twofold: (1) to determine the reliability of claudication and hemodynamic responses to level walking and stairclimbing and (2) to compare these responses with those obtained with graded walking at similar oxygen consumption.

Ten patients with stable claudication symptoms performed graded walking, level walking, and stairclimbing progressive protocols with respective increases in grade, walking speed, and stepping rate on a modified stairclimbing device every two minutes. Similar peak oxygen consumption (13.60 to 14.18 mL/kg/min) was attained with the three protocols (P = NS). Reliability coefficients for the times to onset and to maximal claudication pain during level walking (R = 0.95 and 0.95, respectively) and during stairclimbing (R = 0.92 and 0.82, respectively) were similar to those previously obtained during graded walking. Reliability coefficients for foot transcutaneous oxygen tension during and following level walking (R = 0.78 to 0.96) and stairclimbing (R = 0.65 to 0.98) and for ankle systolic blood pressure following level walking (R = 0.95 to 0.97) and stairclimbing (R = 0.90 to 0.98) were also similar to those previously found with graded walking. Additionally, claudication and hemodynamic measurements were similar among the three exercise protocols. Thus, because graded walking, level walking, and stairclimbing progressive exercise protocols yield reliable and similar information about the hemodynamic severity of peripheral vascular occlusive disease, only one is needed for evaluation.
Evaluation of a New Systolic Time Interval, the Q-V Peak: Effects of Heart Rate, Contractile State, and Loading Conditions in Dogs
Authors: Hashimoto Takeshi , Ohte Nobuyuki , Narita Hitomi , Kobayashi Kenji , Fujinami Takao
Published: November 2007

The authors investigated the effects of alterations in heart rate, contractility, and loading conditions on a newly defined systolic time interval, the Q-V peak, in 46 anesthetized dogs. The Q-V peak was measured as the time from the beginning of the electrocardiographic Q wave to the moment at which the blood flow rate reached its peak in the ascending aorta as determined with an electromagnetic flowmeter. The Q-V peak did not change significantly as the heart rate was varied by atrial pacing between 70 and 110 beats/minute. The Q-V peak shortened when the contractility was augmented with dobutamine (p=0.0001) and was prolonged when it was depressed with propranolol (p=0.0001). However, the Q-V peak did not change significantly when the left ventricular end-diastolic pressure or the mean aortic blood pressure was increased to 130% or decreased to 70% of the baseline values. These findings suggest that one may also evaluate left ventricular performance by measuring the time to systole, which the authors define as the Q-V peak.
Double-Blind Comparison of the Clinical, Hemodynamic, and Electrocardiographic Effects of Sodium Meglumine Ioxaglate or Iohexol During Diagnostic Cardiac Catheterization
Authors: Petersen Ronald , McKay Charles R. , Kawanishi David T. , Kotlewski Adam , Parise Karen , Niland Joyce C.
Published: November 2007

The clinical effects and the maximal hemodynamic and electrocardiographic effects of two low-osmolality radiographic contrast media (ioxaglate and iohex ol) were directly compared during diagnostic cardiac catheterization in a double- blind, randomized study in 80 patients. Because small changes were expected after injection of both of these agents, sensitive ECG and intracardiac-pressure- monitoring methods were used, and maximal changes, as well as mean changes in variables, were analyzed.

Symptoms were absent, mild, or moderate in 67-77% of patients after left ventriculography and in 97-100% of patients after coronary arteriography. Af ter left ventriculography, maximum and minimum left ventricular systolic pres sure and end-diastolic pressure, the first derivative of left ventricular pressure (dp/dt), heart rate, were significantly altered over the two-minute observation period but were not different from the preinjection values at two minutes after both agents. Small but significant increases in mean aortic pressure, cardiac out put, and pulmonary arterial wedge pressures were seen at two minutes after both agents.

Persistent prolongation of QTc interval over two minutes after ioxaglate injec tion was not associated with ectopy or clinical events. After coronary arteriog raphy maximum and minimum aortic pressures, ST and T wave segment displacements, and QTc intervals were significantly altered after both agents, but all variables had returned to preinjection values by two minutes. Compari son of the mean changes over time showed that only QTc intervals were altered after left ventriculography. Direct comparison of the maximum changes between the two agents showed that both contrast agents caused similar hemodynamic and electrocardiographic changes except for small but significantly greater decreases in heart rate with iohexol after left ventriculography and after right coronary arteriography.

These contrast agents have small differences in osmolality and significant differences in sodium content. Clinical events of nausea and heat sensation were noted more often in the ioxaglate group, but the frequency did not reach statistical significance. Analyses of maximal changes using sensitive monitoring devices showed that the two agents have substantially similar hemodynamic and elec trocardiographic effects. Analysis of mean changes over time was less sensitive in identifying small, transient changes and differences between the two agents.
Protection from Cold Injury by Deferoxamine, an Iron Chelator
Authors: Maity Swapna , Dan Lu  , Russel John C. , Lyengar Jaisimha , Das Dipak K.
Published: November 2007

The presence of hydroxl radical (OH-) has been implicated in the pathogen esis of cold injury. Since iron is known to catalyze the OH- formation respon sible for cellular injury, this study was designed to examine whether an iron chelator such as deferoxamine can salvage a tissue from cold injury. Cold inju ry was induced in the hind limbs of rabbits. The experimental group received 0.6 mM of deferoxamine through the femoral vein prior to cooling of the limbs. Deferoxamine reduced the tissue injury, as evidenced by the decreased release of lactate dehydrogenase, a nonspecific marker for cellular injury. In addition, this drug inhibited OH - formation and lipid peroxidation when examined by monitoring the formation of conjugated dienes and malonaldehyde, presump tive markers for lipid peroxidation. Rewarming of the cooled limbs was also as sociated with the loss of membrane phospholipids, with the corresponding accumulation of lysopho-sphoglycerides and free fatty acids, especially linoleic and arachidonic acids. Deferoxamine prevented the loss of phospholipids and inhibited the accumulation of amphipathic lipid products. These results indi cates that deferoxamine salvaged the tissue from cold injury, possibly by prevent ing the formation of OH- presumably by chelating iron, thus protecting the phospholipids from free radical attack.
Fibrinolytic Enhancement in Diabetic Microangiopathy with Defibrotide
Authors: Belcaro G. , Marelli C. , Pomante P. , Laurora G. , Cesarone M.R. , Ricci A. , Girardello R. , Barsotti A.
Published: November 2007

Skin microcirculation was evaluated in 117 patients with diabetic microan giopathy over a period of six months. They were divided into two groups. Group 1 (64 patients) was treated with oral defibrotide, a new profibrinolytic drug, in association with diet and oral antidiabetic drugs. Group 2 (53 patients) was treated only with diet and antidiabetic agents.

The microcirculation was studied by means of laser-Doppler flowmetry trans cutaneous partial pressure of oxygen and carbon dioxide pressure measurements, and evaluation of capillary filtration.

After six months, patients in group 1 improved their microcirculatory parameters in association with an improvement in signs and symptoms.

Moreover, 30 patients in group 1 and 36 in group 2 were followed up for eighteen months, and the authors observed that the deterioration of the microcir culatory parameters was significantly slowed in diabetics treated with defibrotide.

A decrease in plasma fibrinogen during defibrotide treatment was observed in all treated patients in association with an increased fibrinolytic activity.

In conclusion, it appears that defibrotide, enhancing fibrinolysis, improved the microcirculation in diabetics, preventing further, progressive deterioration.
Procion Yellow Fluorescent Microscopy: A New Method of Studying Arterial and Venous Pathology
Authors: Berlin Richard B. , Farnsworth Patricia , Groth-Vasselli Barbara , Kuo June Azu
Published: November 2007

A new means of studying vessel wall pathology is presented. This technique utilizes Procion yellow, a vital fluorescent dye, to stain and delineate the connective elements, matrix, and elastic tissue within the arterial wall. In addition, penetration of the dye into cells provides evidence of membrane pathology. A canine model was used, and clamped segments of femoral artery were stained and examined. The appreciation of this approach for the examination of the vessel wall shows alterations in tissue elements that have not been reported previously. This technique makes possible a unique means of studying connective tissue elements as well as membrane integrity.
Local Thrombolysis and Percutaneous Transluminal Venoplasty for the Venous Complications of Thoracic Outlet Syndrome: Case Report
Authors: Baron Bruce , Kiproff Paul M. , Khoury Maroon B.
Published: November 2007

The authors report successful treatment of a case proven to result from the thoracic outlet syndrome by local fibrinolytic therapy with urokinase followed by percutaneous transluminal venoplasty.
Capillary Blood Flow to the Skin of Forearm in Cirrhosis
Authors: Carrella Massimino , Hunter John O. , Fazio Serafino , Del Piano Concetta , Cannada Bartoli Giuseppe
Published: November 2007

In liver cirrhosis a hyperkinetic circulatory state is frequently observed as a consequence of an arterial or even a venous peripheral vasodilatation with sec ondary increase in cardiac output. Indirect evidence suggests that, in liver dis ease, the manifestation of warm hands, capillary pulsation, or palmar erythema may also relate to such a state by way of an increased skin blood flow.

The purpose of the present study has been to directly assess capillary skin blood flow in liver disease through the clearance of a locally injected radioactive substance.

The study was performed in 24 patients with different liver diseases, includ ing 14 Child class II cirrhotics, and in 9 control subjects. A small volume of Na131I solution was injected at the volar surface of the forearm, and radioactive counts were recorded continuously for ten seconds every minute for up to twenty minutes. The best fit line of the disappearance rate was determined by the least square method, and both its T/2 and an estimated blood flow parame ter were calculated. The T/2 of isotope disappearance rate was 4.54±0.71 and 4.38±0.68 minutes in cirrhotics and controls, respectively. Similarly, estimates of skin blood flow (mL/min/100 g tissue) were 7.82±1.28 in the cirrhotic pa tients, not significantly different from those in both patients with mixed liver diseases (7.6±2.86) and control subjects (8.06 ± 1.04). Parameters of skin blood flow were also invariant in respect to the various etiologies of liver disease.

Thus, the present findings indicate that capillary skin blood flow is not af fected by the hyperdynamic circulatory changes occurring in liver cirrhosis. Likely, such changes mostly relate to more proximal circulatory variations oc curring at the level of arteriovenous anastomoses.
Automated Blood Pressure Determination During Exercise Test. Clinical Evaluation of a New Automated Device
Authors: Modesti Pietro Amedeo , Carrabba Nazario , Gensini Gian Franco , Bonechi Francesco , Taddei Tamara , Malfanti Pier Luigi
Published: November 2007

The accuracy and reproducibility of a new automatic device (P) specially designed for noninvasive blood pressure monitoring during the exercise stress test were evaluated in 50 consecutive subjects (34 normotensives and 16 hyper tensives). Automatic measurements were compared with those taken by a sphygmomanometer (RR). A good agreement between systolic pressure values obtained by the two methods was found (RR 159±30 mmHg, P 158 ± 28 mmHg, mean difference = -1.53 ± 13 mmHg, p = 0. 166, ns). On the contrary the new device significantly underestimated diastolic pressure values (RR 89.3 ± 13 mmHg; P 84±13 mmHg, mean difference -5.37±9.3, p < 0.001).

In conclusion the new device seems able to measure systolic but underesti mates diastolic blood pressure both in hypertensives and in normotensives dur ing the effort test.
Post-Infectious Acute Cerebellar Ataxia in Children
Authors: Nussinovitch Moshe , Prais Dario , Volovitz Benjamin , Shapiro Rivka , Amir Jacob
Published: November 2007

Acute cerebellar ataxia is a relatively common neurologic disorder among children. Our aim was to characterize the clinical picture, etiology, and prognosis of acute cerebellar ataxia. The medical records of all children with a diagnosis of acute cerebellar ataxia hospitalized in our center and Hasharon Medical Center from 1990 to 2001 were reviewed. The diagnosis of acute cerebellar ataxia was based on the following criteria: acute onset of ataxia with or without nystagmus; absence of known genetic predisposing factors, such as familial degenerative disorders; and absence of drug intoxication, bacterial meningitis, and metabolic disorders. Thirty-nine children were identified; 54% were male; mean age at presentation was 4.8±3.8 years. All patients were observed for at least 1 year. A prodromal febrile illness was noted in 74.4%: varicella, 31%; mumps, 20%; nonspecific viral infection, 15.4%; mycoplasma, 5%; Epstein Barr virus, 3%. Latency from the prodromal illness to the onset of ataxia was 8.8±7.4 days. The most common associated neurologic findings were nystagmus and dysmetria. Full gait recovery took less than 2 weeks on average, and the longest duration of neurologic signs was 24 days (mumps-related). Acute cerebellar ataxia in childhood is a self-limited disease. The recovery was faster than that reported in previous publications and was complete in all children without any neurologic sequelae. Imaging studies are needed only in atypical presentation or if there is no spontaneous improvement after 1 to 2 weeks.
Identifying Risk Factors for the Development of Diabetic Ketoacidosis in New Onset Type 1 Diabetes Mellitus
Authors: Mallare Johanna T. , Cordice Candida C. , Ryan Barbara A. , Carey Dennis E. , Kreitzer Paula M. , Frank Graeme R.
Published: November 2007

To identify risk factors associated with the development of diabetic ketoacidosis (DKA) in new-onset type 1 diabetes mellitus, a retrospective chart review of 139 new onset type 1 diabetes patients from 1995 to 1998 was conducted. Categorical data were examined with contingency table analysis. Age range was 0.5 to 18 years. Overall, 38% of the patients presented in DKA. Sixty-two percent of the patients with either Medicaid or no insurance presented in DKA compared to 34% of the patients with private insurance, odds ratio 3.17 (92% CI 1.2-8.3) p=0.03. Sixty-eight percent of patients in whom the diagnosis was missed (n=25) presented in DKA (mean age, 5.4 ± 4.4 years) compared to 32% in whom the diagnosis was not missed (mean age, 8.8 ± 4.0 years) odds ratio 4.6 (95% CI 1.9-11.7), p=0.0012; age p=0.00019. Lack of private insurance, although a risk factor for the development of DKA, did not increase the likelihood of a missed diagnosis. Lack of private insurance (a proxy for socioeconomic status) and young age are apparent risk factors for the development of ketoacidosis. Misdiagnosis by the physician at initial patient encounter is especially prevalent in the young child but not related to insurance. Both increased public awareness and greater medical alertness are necessary to reduce the high rates of DKA in new-onset type 1 diabetic children. Clin Pediatr. 2003;42:591-597
The Child with School Problems
Authors: Blanche Bourne I.
Published: November 2007

Failure in school affects about 20 per cent of school children, and is an important problem for medical consideration in that the reason for failure is often a diagnostic challenge.

In large metropolitan areas many of the school problems en countered are the result of the emotional condition, which fre quently has a direct relationship to the socia-economic or socio- cultural background or both. These are most often problems related to mental health rather than deviations from physical health. Much more knowledge is needed in this area of mental health.