bluuebunny/crossref_metadata_2025 huggingface dataset:
Tissue Fibrinolytic Activity in Different Types of Varicose Veins
Authors: Hach Viola , Fink Monika , Blees Norbert , Scharrer Inge
Published: November 2007

The fibrinolytic activity of the venous wall was investigated by using Todd's technique 1 in 92 patients with different types of varicosis.

A control group consisted of 19 patients with apparently normal superficial veins who had had a saphenectomy prior to an aortocoronary bypass operation. Fibrinolytic activity was mainly localized in the adventitia of varicose and nor mal veins. It significantly decreased in the distal regions of all types of varicosis. The highest fibrinolytic activity was detected in the proximal part of the vari cose vena saphena magna and the lowest values were observed in the perforat ing and side branch veins of the calf. Fibrinolytic activity is higher (p < 0.077) in the normal vena saphena magna than in the varicose vena saphena of the calf. Older patients show a loss of fibrinolytic activity in their vena saphena magna. Obese patients have less fibrinolytic activity in varicose calf veins than patients with normal weight do.
Cerebral Hemorrhagic Infarction Associated with Anabolic Steroid Therapy for Hypoplastic Anemia
Authors: Shiozawa Zenji , Tsunoda Shinich , Noda Akitaka , Saito Masaru , Yamada Hideo
Published: November 2007

A twenty-two-year-old student with hypoplastic anemia was treated with large doses of anabolic steroid hormone preparations for two months. Cerebral hemorrhagic infarction shown by CAT scan developed when his hematologic conditions were improving. In treating hypoplastic anemia with anabolic steroid hormone preparations, one should be aware of the possible development of ce rebral hemorrhagic infarction at the time of hematologic improvement.
Recent Subsegmental Splenic Infarction: Hypervascular Appearance on Angiography
Authors: Rees Chet R. , Becker Gary J. , Roe Susan , Dalsing Michael
Published: November 2007

The authors describe a case of a focal splenic infarction with a hypervascular appearance on selective splenic arteriography. This appearance of splenic in farction has never before been reported. Angiographers should be aware of this unusual presentation of splenic infarction when they encounter an unexplained focal hypervascular area.
Theory and Methods of Local Tissue-pO2 Monitoring in Experimental Angiology
Authors: Spiegel H.U. , Hauss J. , Schönleben K. , Bünte H.
Published: November 2007

The platinum-multiwire-surface electrode after Kessler and Lübbers gives the opportunity of direct measuring of the local tissue-pO2-pressure; this 8-wire electrode with a Pt-wire-diameter of 15 μm operates on the polarographic principle. Each Pt-wire has a hemispheric collecting area of about 30 μm. Pressure ischemia by compression of capillaries is prevented by proportioning the weight (2.1 g) of the electrode.

Data output is done by 1) continuous pO2 measuring; 2) pO2 histograms.

During the continuous pO2 measurement the electrode stays on the tissue measuring point thus enabling the direct record of quickly proceeding reactions. The pO 2-histogram exhibits the statistical distribution of the local partial oxygen pressures in a studied organ, a quasi sample inquiry is performed in the tissue, based on minimum 100 single values that are obtained by repeated manual repositioning of the electrode.

By this, values are obtained on the level and distribution of local pO2 in the tissue so that condition and function of the microcirculation can be objectively assessed. Immediate alterations in the local tissue pO2 suggest regulatory adjustment after hemodynamic changes. Technical problems connected with pO2 measurement in clinical use (sterilization, data acquisition and presentation) are described. The presented technique gives the chance to exactly assess the effects of vasoactive drugs on the microcirculation and to quantify the results of operations, for example after bypass-surgery.
Platelet Function in Patients Admitted with a Diagnosis of Myocardial Infarction
Authors: Mikhailidis D.P. , Barradas M.A. , Mier A. , Boag F. , Jeremy J.Y. , Havard C.W.H. , Dandona P.
Published: November 2007

Platelet function and thromboxane A2 release were measured in 71 patients admitted to a coronary care unit with a provisional diagnosis of acute myocardial infarction (AMI). All measurements were carried out within twenty-four hours of admission. Of these, 35 patients had the diagnosis of AMI confirmed. The remainder (n=36), who did not have AMI (NMI), were divided into two groups: (a) those (n = 18) with an unequivocal history of previous vascular disease and (b) those without vascular disease (n=18). Platelet aggregation and thromboxane A2 (TXA2) release were significantly increased in the AMI group when compared with those in the NMI without vascular disease group or a healthy control group with similar age and sex distribution. Aggregation and TXA 2 release in the NMI patients with vascular disease were greater than those in controls and did not differ significantly from those in the AMI group. Patients in the AMI or NMI with vascular disease groups who were taking β-blockers or calcium channel antagonists at the time of admission showed significantly less platelet aggregation than those who were not taking these drugs. Heparin, added in vitro at therapeutic concentrations, induced significantly more aggregation in patients in the AMI and NMI with vascular disease groups than in the NMI without vascular disease group. We conclude that: (1) platelets obtained from patients with AMI are hyperaggregable and release more TXA2; (2) platelets from patients with significant vascular disease are hyperaggregable, even in the absence of AMI, although they are not as hyperaggregable as those from AMI; (3) treatment with nifedipine and β-blockers protects these patients from platelet hyperaggregability; (4) heparin induces significant aggregation of platelets from patients with AMI and NMI with vascular disease. These observations are of importance in considering the pathogenesis and treatment of AMI and ischemic heart disease.
Effects of Intracellular and Extracellular Calcium Blockers on the Pulmonary Vascular Responses to PGF2α and U46619
Authors: Santoian Edward C. , Angerio Allan D. , Fitzpatrick Thomas M. , Rose John C. , Ramwell Peter W. , Kot Peter A.
Published: November 2007

In this study, TMB-8, an intracellular calcium antagonist, and verapamil, an extracellular calcium antagonist, were used simultaneously to elucidate the role of calcium in the pulmonary vasopressor response induced by PGF2α and U46619. The pulmonary vasoconstrictor action of these two agonists was evaluated in the canine isolated lung lobe preparation. Lobar arterial pressure was constantly monitored and changes in arterial pressure were recorded as a percentage from baseline. Control responses to PGF2α (42.0±8.2%) and U46619 (47.2±7.0%) were obtained prior to the administration of TMB-8 and verapamil. After administration of TMB-8 and verapamil, the PGF2α (7.4±3.1%) and U46619 (28.8±6.2%) responses were significantly attenutated. We conclude that the PGF2α pressor response is dependent on a TMB-8-sensitive intracellular calcium pool and a verapamil-sensitive slow-channel calcium influx. In contrast, the degree of attenuation of the U46619 response was similar to the vasopressor response in the presence of verapamil alone, as described previously. This indicates a direct dependence on extracellular calcium. An additional source of calcium insensitive to verapamil and TMB-8 may also be activated and contribute to the pulmonary vasoconstrictor action. These results suggest that each agonist possesses a mechanism of action distinctly different from the other.
Early Disappearance of Lymphatics Draining Ischemic Myocardium in the Dog
Authors: Szlavy Laszlo , Koster Kenneth , de Courten Alfred , Hollenberg Norman K.
Published: November 2007

To assess myocardial lymphatics during the evolution of myocardial infarction we performed lymphangiographic studies thirty and three hundred sixty minutes after occlusion of the left anterior descending coronary artery in 92 dogs. A morphometric index was employed on a coded basis to assess the lymphangiograms. Well before myocardial necrosis was evident, at thirty minutes, a striking reduction was evident in lymphatic filling in the ischemic zone: similar changes were seen three hundred sixty minutes after occlusion. Heparin in doses that rendered blood incoagulable did not prevent the lymphatic occlusion or collapse, but they were prevented by two agents that act as cardiac lymphagogues, hyaluronidase and CLS 2210. Lymph flow from the heart was assessed in another 23 dogs. Lymph flow fell sharply after coronary artery occlusion in placebo-treated dogs but was well maintained in dogs treated with hyaluronidase and with CLS 2210. The reduction in cardiac lymphatic filling and lymph flow occurred too early to be a consequence of myocardial necrosis. To the extent that reduced lymphatic drainage allows the local accumulation of potentially toxic products, it could contribute to the local damage. Treatment with the lymphagogues not only maintained lymphatic patency but also reduced evidence of myocardial damage evident on examination by light and electron microscopy. These studies provide an alternative to commonly held concepts on how hyaluronidase reduces myocardial infarction after coronary artery occlusion and support the concept that lymphatic occlusion or collapse plays a role in myocardial infarction.
Salvage of Ischemic Myocardium by CLS 2210 in the Dog: A Preliminary Double-Blind Study
Authors: Szlavy L. , Repa I. , Szabo Z. , de Courten A. , Hachen H.J.
Published: November 2007

To assess whether a cardiac lymphagogue, CLS 2210, would reduce myocardial infarct size after coronary artery ligation, studies were performed in 14 dogs. The left anterior descending coronary artery was ligated in each dog, and the dogs were randomized to either placebo or CLS 2210 treatment, which was carried on for seven days. After seven days the animals were sacrificed and the volume of infarcted myocardium was determined macroscopically on a double-blind basis, supported by histologic examination. CLS 2210 treatment resulted in a highly significant reduction in the volume of infarcted myocardium (p < 0.001). Since CLS 2210 is chemically and pharmacologically unrelated to hyaluronidase but shares an action with hyaluronidase as a cardiac lymphagogue, the results offer further support for a role of myocardial lymphatics in the evolution of myocardial necrosis following coronary artery occlusion and provide an explanation for the mechanism by which these agents reduce myocardial infarction size.
Anomalous Origin of the Right Coronary Artery From the Left Sinus of Valsalva: Echocardiographic Diagnosis— A Case Report
Authors: Erol Cetin , Candan Isfendiyar , Sonel Ahmet , glu Celal Kervancio , glu Murat Kiniko
Published: November 2007

Anomalous origin of the right coronary artery from the left sinus of Valsalva is a rare congenital abnormality diagnosed by coronary angiography. This is the first report of an echocardiographic diagnosis of a patient with this anomaly, as far as is known.
Clinical Experience With a Transdermal Nitroglycerin System
Authors: Mahapatra Rajat K. , Mahapatra Dipta , Yaden Senka
Published: November 2007

Forty-seven patients with chronic stable angina pectoris entered a thirteen-week open-label study with a transdermal therapeutic system of nitroglycerin in order to evaluate its clinical efficacy, safety, and patient acceptance.

In 19 patients, a beta-blocker and in 17 patients a calcium-channel blocker were continued throughout the study period without alteration of their doses. The study consisted of a two-week run-in period and an eleven-week active drug period. Acute titration was done with nitroglycerin patches on the basis of weekly patient diaries on frequency of angina and sublingual nitroglycerin consumption. Overall, reductions in frequency of angina and in nitroglycerin consumption were statistically significant (p < 0.05). Adverse reactions were common but tolerable. The reported side effects were headache in 32, skin rash in 18, dizziness in 10, palpitation and itching in 9 each, nausea in 7, flushing in 3, and vomiting in 1 patient. In conclusion, the present study demonstrates that individual dose titration with nitroglycerin patches for obtaining significant antianginal effect is essential. The present therapeutic system is convenient to use and well tolerated and had acceptable side effects in our study population.
Nicardipine in the Treatment of Raynaud's Phenomenon: A Randomized Double-Blind Trial
Authors: Kahan André , Amor Bernard , Menkès Charles J. , Weber Simon , Guérin Francois , Degeorges Michel
Published: November 2007

The efficacy of the calcium-channel blocker nicardipine in the treatment of Raynaud's phenomenon was assessed in a prospective, double-blind, randomized, crossover trial in 20 patients. Each patient received nicardipine 20 mg or placebo three times a day for two weeks and then was crossed over for two weeks. Nicardipine significantly decreased the frequency and severity of Raynaud's phenomenon as compared with placebo. The authors conclude that nicardipine is effective in the treatment of Raynaud's phenomenon.
Immature Angiomas: The Importance of the Doppler Exam in Diagnosis and Prognosis
Authors: Salgarello G. , Rosselli D. , Salgarello M. , Pola P. , Serricchio M. , Naegeli C.D.
Published: November 2007

Immature angiomas are vascular hamartomatous malformations but clearly different from all other vascular, capillary, venous, arteriovenous, and lymphatic malformations, which, normally present at birth and established from a cellular viewpoint, grow because of the effect of hemodynamic stimuli and present no tendency toward spontaneous regression. The difference between immature angiomas and other hemangiomas has been demonstrated by investigations into cell dynamics. To facilitate a differentiated diagnosis and prognosis, the hemodynamics of the angiomas were studied with the Doppler flowmeter.

The use of noninvasive techniques, such as those introduced by the Doppler flowmeter, permit a technical alternative and/or integration, giving results of equal relevance and importance, as well as the advantages of a more accessible and less expensive methodology.
Recurrent Aneurysms of the Upper Arteries of the Lower Limb: An Atypical Manifestation of Fibromuscular Dysplasia—A Case Report
Authors: Herpels Vincent , Van de Voorde Wim , Wilms Guy , Verbeken Eric , Baert Albert , Lauweryns Jozef , Nevelsteen André
Published: November 2007

Fibromuscular dysplasia (syn. arterial dysplasia, fibromuscular hyperplasia, medial fibroplasia) is an arteriopathy of unknown etiology, most frequently involving the renal arteries.

The string-of-beads appearance of these lesions seems to be a characteristic angiographic finding. We report atypical angiographic findings at an unusual site, which proved to correspond to fibromuscular dysplasia at histological examination.
The Oral Glucose Tolerance Test in Men Under 55 Years of Age With Intermittent Claudication
Authors: Hanson Martin , Bergentz Sven-Erik , Ericsson Björn F. , Janzon Lars , Lindell Sven-Eric
Published: November 2007

Blood glucose at sixty, ninety, and one hundred twenty minutes after a stand ardized oral glucose load was compared in healthy middle-aged men and pa tients with intermittent claudication. No difference was found when the authors compared blood glucose at zero and sixty minutes. At both ninety and one hun dred twenty minutes, however, they found a relative hypoglycemia in patients with peripheral arteriosclerotic disease in an early stage.
Validity of Continuous-Wave Doppler Sonography of the Vertebrobasilar System
Authors: Karnik Ronald , Stöllberger Claudia , Ammerer Hans-Peter , Perneczky Gedeon , Slany Jörg , Brenner Heinz
Published: November 2007

To assess the value of continuous-wave Doppler sonography for detection and exclusion of lesions in the vertebrobasilar system, the ultrasonic and angiographic findings were compared in a prospective study. Altogether, 200 vertebral arteries in 176 patients were evaluated by both methods. Insonation of the vertebral arteries was performed at the mastoid slope and at the origin of the vessel. Of 62 angiographically proven lesions, 45 were detected by ultrasound. Of 138 normal vertebral arteries, 129 were correctly diagnosed.

Sensitivity for all lesions was 72.5%, and for hemodynamically relevant lesions it was 91%. Overall specificity was 93.5%. A positive predictive value of 83.3% and a negative predictive value of 88.4% for all lesions shown by angiography demonstrate the high reliability and accuracy of doppler ultrasound of the vertebrobasilar system.
Impact of Thromboischemic Reentry Mechanism on Coronary Thrombosis and Microembolism in Acute Myocardial Infarction1
Authors: Gasser Robert N. A. , Dienstl Franz , Henn Rainer
Published: November 2007

It has been suggested that the thromboischemic reentry mechanism (TRM) is responsible for washing platelet aggregates out of the coronary vessels during the early phase of acute myocardial infarction (AMI). This might account for the observation of Schwartz, who reported the presence of multiple microthrombi in the subendocardial blood vessels following AMI but found only a few thrombotic occlusions in the main coronary arteries. This washing-out of the vessel (due to reperfusion waves) intermittently releases myoglobin into the serum and is responsible for the "staccato phenomenon."

We examined a group of 177 patients with a mean age of 66.1 years, whose sudden death was definitely of cardiac origin. Infarction was confirmed in 84.7% of the subjects (fresh infarct: 23.7%; fresh infarct with scarring: 25.9%; scarring alone: 35.0%; no change in myocardium: 15.2%). In other words, 49.7% of all postmortem subjects (88 cases) showed fresh infarction. Opening the coronary arteries longitudinally revealed only 7 thrombi in these 88 cases, i.e., 7.9% of all fresh infarcts. These observations confirm those of Roberts (8.5%) and Friedmann (4%).
Evaluation of the Vasodilator vs Inotropic Effect of Milrinone Using an Animal Model of Left Ventricular Failure: Reversal of Disopyramide Depression of the Myocardium with Milrinone
Authors: Goldberg Emanuel , Berdoff Russell , Spivack George , Haimowitz Azriel , Tay Steven
Published: November 2007

Milrinone (M) has been shown to improve left ventricular (LV) performance in animal and human studies. M has strong vasodilator action, and whether increased LV performance is due primarily to vasodilation or to a direct positive inotropic effect is unclear.

Ten mongrel dogs were studied. Disopyramide caused a significant and sus tained decrease in LV function and was a good model for myocardial depres sion. At equal reduction in systemic vascular resistance (SVR), M reversed this LV depression to a significantly greater degree than nitroprusside (NP) did.

At equal levels of vasodilation, M produced significantly greater improve ment in indices of LV function than NP did in our model of disopyramide- induced LV failure. This suggests that its effect on LV function is not due entirely to afterload reduction, or to reflex sympathetic stimulation, but has a substantial component of direct inotropic stimulation. This study also demon strated a reversal of disopyramide-induced LV dysfunction by M, which may be clinically useful since, as in many antiarrhythmics, myocardial depression may be a limiting factor in its use.
Evaluation of Blood Flow in Tumor Masses by Using 2D-Doppler Color Flow Mapping—Case Reports
Authors: Itoh Kouichi , Suzuki Osamu , Yasuda Yoshikazu , Aihara Toshinori
Published: November 2007

Blood flow in tumor masses was detected with 2D-Doppler color flow map ping in 3 cases; a pancreatic carcinoma in a sixty-five-year-old woman, a renal cell carcinoma in a sixty-two-year-old woman, and a chemodectoma in a sixty- six-year-old woman.
Comparison of Auscultation, Continuous Wave Doppler Imaging, Intravenous Digital Subtraction Angiography and Conventional Angiography in Diagnosis of Carotid Artery Disease
Authors: Caes Frank , Vierendeels Tijl , Janssens-Willem Eddy , Cham Bachir , Welch William
Published: November 2007

The reliability of auscultation, continuous wave (CW) Doppler imaging, and intravenous digital subtraction angiography (IV DSA) in the assessment of carotid artery disease has been evaluated in comparison with conventional angiography in 30 patients. With auscultation, specificity and sensitivity for internal carotid artery (ICA) stenosis of 50% or more were 81% and 67% respectively. CW Doppler imaging detected ICA stenosis of 50% or more with a sensitivity of 83% and a specificity of 92% and ICA occlusion with a sensitivity of 60%. The specificity of IV DSA was 95% and the sensitivity for ICA stenosis of 50% or more and ICA occlusion were 75% and 100% respectively. Combining CW Doppler and IV DSA findings raised sensitivity for ICA stenosis of 50% or more and ICA occlusion to 89% and 100% respectively and specificity to 95%. The combination of CW Doppler and IV DSA is a safe and accurate test battery in the detection and categorization of carotid disease.
Glucose and Erythrocyte ATP: Distinctive Effects of Dipyridamole and of Ticlopidine
Authors: Solvay H. , Kahn M. , Garreyn S. , Cloarec M. , Sneppe R. , Schram E. , Fenollar J.V.
Published: November 2007

This experiment suggests the following points:

1. Erythrocytes in control patients and in atherosclerosis patients seem to have a variable grade of affinity for adenosine and for plasma glucose. This variable grade seems to fix the level of the adenosine triphosphate (ATP) reserves and induces the erythrocytes' deformability.

2. The drop in the level of ATP reserves that induces the poor deformability of the erythrocytes in atherosclerosis patients would appear to be caused by two consecutive shortages: first a shortage that seems to be related to a deficiency of erythrocyte adenosine as the ATP shortage disappears with dipyridamole treatment and then a shortage induced by the lack of erythrocyte glucose and suppressed by the addition of ticlopidine to the dipyridamole treatment.
Catheterization of the Femoral Vein for Chronic Hemodialysis
Authors: Yurtkuran Mustafa
Published: November 2007

Over the last ten years (1976-1986), 3,041 hemodialyses have been performed with 6,082 femoral vein catheterization in 336 patients with chronic renal failure. In the 3,041 hemodialyses, severe hematoma (0.29%), superficial hematoma (5.55%), and retroperitoneal hematoma (0.06%) have been observed. In 29 patients whose hemodialyses have been performed successively with femoral vein catheterization over a period of three to twelve months, subcutaneous fibrosis was observed in 24 and femoral vein regional narrowing was seen in 2.
Cerebral Arteriovenous Malformation: Report of 136 Chinese Patients in Taiwan
Authors: Thajeb Peterus , Hsi Mo-Song
Published: November 2007

The authors studied 136 Chinese patients with verified cerebral arteriovenous malformations (AVMs) in Taiwan. Intracranial hemorrhage (ICH) was the leading problem at presentation (83.8%), followed by epileptic seizures (21.3%) and vascular headache alone (9.6%). Patients less than forty years old and/or with small AVMs ( < 20 ml) had a statistically significantly higher risk of bleeding (P < 0.01 and P < 0.05 respectively). The risk of rebleeding remained unchanged in both small (<20 ml) and large (≥20 ml) AVMs once ICH had occurred. The average annual bleeding rate of a nonbleed AVM with seizure alone was 1.7%. Seizures with a partial component could be identified in less than half of the epileptic patients, and EEG abnormalities were found in 85.7% of 45 studied cases. The difference in mortality between medically and surgically treated patients was not of statistical significance. The numbers for both morbidity and good recovery were higher in the surgical group. The rationale for selection of surgical cases is discussed.
Interventional Radiology for Restoration of Vascular Patency in the Postoperative Patient—Case Reports
Authors: Mail John T. , Becker Gary J. , Holden Robert W. , Yune Heun Y.
Published: November 2007

The postoperative patient may present with one or more of a variety of prob lems amenable to management by interventional radiologic techniques, which may be curative by themselves or may, in addition, require or allow successful surgical intervention.

To optimize patient care, a good working relationship between the vascular surgeon and the interventional radiologist is essential. Consideration should be given to the patient's presenting signs and symptoms, the surgical history with its alteration of anatomy, the results of available noninvasive studies, and knowledge of various therapeutic alternatives.

Vascular radiologic interventions include angioplasty, thrombolytic therapy, a combination of both angioplasty and thrombolysis, and newer techniques such as percutaneous valvectomy. In this report, examples of some of the experience at Indiana University are presented. Emphasis is placed on the appropriate approach to the patient.
Effects of Blood and Crystalloid Cardioplegia on Cardiac Function at Organ and Cellular Levels During Hypothermic Cardiac Arrest
Authors: Prasad Kailash , Bharadwaj Baikunth , Card Robert T.
Published: November 2007

The present investigation was undertaken to compare the effects of cold crystalloid and blood cardioplegia on the functional recovery of the heart; on Ca+ + binding and uptake, Ca+ + -ATPase of the sarcoplasmic reticulum (SR), and sarcolemmal (SL) ATPase; and on serum MB fraction of creatine kinase (MBCK) after one and a half hours of reperfusion following one hour of ischemic cardiac arrest in dog. This study was made also to determine if the functional changes are related to the changes in biochemistry at the molecular level. The dogs were divided into three groups: sham bypass (SB), cold crystalloid cardioplegia (CC), and pump blood cardioplegia (PB).

There was a decrease in the cardiac index (CI), left ventricular work index (LVWI), and mean aortic pressure (MAP) in all three groups. The index of myocardial contractility ((dp/dt)/IIP) and CI were lower in the CC group as compared with the SB and PB groups. All the hemodynamic values for the PB group were similar to those of the SB group except total systemic vascular resistance (TSVR) and left ventricular end-diastolic pressure (LVEDP) which were lower in the PB group. The index of myocardial contractility and cardiac index appeared to be greater in the PB group than in the CC group. There was a decrease in the Ca ++ uptake by SR from both the CC and PB groups. Ca++ binding and Ca++ -ATPase of SR from the PB group were depressed. The sarcolemmal ATPase was unaffected in both groups. The serum MBCK increased in both PB and CC groups, though the increase was smaller in the PB group.

These results indicate that the functional recovery of the heart was slightly better with pump blood cardioplegia than with cold crystalloid cardioplegia. The depressed myocardial contractility and cardiac function in the CC group were associated with a decrease in the Ca+ + uptake by SR. However, the decreases in the Ca+ + binding, Ca+ + uptake, and Ca+ + ATPase by SR from the pump blood cardioplegic group were not accompanied by decreases in the cardiac contractility and cardiac function. Myocardial damage as assessed by serum MBCK was smaller in the PB group than in the CC group.
Coronary Angiography of Kawasaki Disease with the Coronary Vasodilator Dipyridamole: Assessment of Distensibility of Affected Coronary Arterial Wall
Authors: Matsumura Kaname , Okuda Yasuyuki , Ito Tsunao , Hirano Tadanori , Takeda Kan , Yamaguchi Nobuo
Published: November 2007

The authors evaluated the disten sibility of the coronary arterial wall by pharmacoangiography with intra venous administration of dipyrida mole in 38 patients with Kawasaki disease. In the acute stage of the ill ness, the coronary arteries were eval uated for aneurysms by two-dimen sional echocardiography. After the acute stage of the illness, selective coronary cineangiographies were performed by Seldinger's method un der general anesthesia before and af ter intravenous administration of 0.6 mg/kg of dipyridamole for four min utes. The calibers of aneurysms and normal appearing segments of coro nary arteries, at most 7 segments in 1 patient, were measured before and after dipyridamole administration on the high-quality cineangioanalyzer and percentages of coronary arterial dilatation were calculated. In 14 cases without evidence of coronary arterial lesions, the distensibility was 10.2 ± 4.7% (mean±SD) . The disten sibility of 32 aneurysms in 16 cases was 0.6 ± 1.1% and was significantly decreased (p < 0.001). In 24 cases with coronary arterial lesions, aneu rysms, stenosis, or obstruction, the distensibility of normal appearing segments of coronary arteries was 4.5 ± 4.9% and was significantly de creased (p < 0.001). This method is useful in evaluating distensibility and appears to be effective in detecting pathologic changes of the coronary arterial wall, even if it appears nor mal in shape. The patient with previ ously diseased coronary arteries should be kept under careful long- term surveillance.
Clinical Experiences Using Pneumatic Massage Therapy bfor Edematous Limbs Over the Last 10 Years
Authors: Yamazaki Zenya , Idezuki Yasuo , Nemoto Tetsu , Togawa Tatsuo
Published: November 2007

A pneumatic massage apparatus has been developed for the treatment of peripheral lymphedema. The stag nant lymph and venous blood are dis placed toward the heart by this pneu matic massage. It has been applied to more than 650 patients with edema tous limbs in the authors' Hadomer clinic over the last ten years. Satisfac tory results were obtained, including decrease in swelling, pain, and indu ration. The authors' clinical experi ences and statistical analysis of the patients are reported here.

Statistical analysis: 9 primary (4 males and 5 females) and 646 second ary (28 males and 618 females) pa tients with lymphatic edema of ex tremities have been treated. The ma jority of the patients had postmastec tomy edema of the upper extremity.

Clinical studies: The circumfer ence of the edematous limb was mea sured before and after pneumatic massage treatment of forty to sixty minutes, daily or every second day.

sage was effective in the treatment of edema of the limbs, and its effective ness was confirmed also by core tem perature measurement of the hand during pneumatic massage. The de creased circumference of the edema tous limb was kept constant for a long period of time by daily repeated pneumatic massage and ordinary conservative treatments.

In conclusion, most lymphedema is of a secondary type. Pneumatic massage was effective in the treat ment of peripheral lymph edema, and the improvement was maintained by repeated daily pneumatic massage and ordinary conservative treatment. Therefore, before it becomes worse, lymphedema of the limb should be treated by use of conservative treat ments, including pneumatic massage continued as a long-term schedule.
Elephantiasis Nostras—A Case Report
Authors: Baughman Shanny A. , Beninson Joseph
Published: November 2007

Elephantiasis nostras, the result of chronic lymphedema, is character ized by marked edema of the affected extremity with a thickened, verru cous, pebbly appearance of the skin. The pathogenesis is thought to be re lated to fibroblast proliferation fol lowing impaired lymphatic drainage, leading to fibrosis and further re striction of lymph drainage with pro gressive edema. A case report of a patient with massive chronic lymphe dema of her feet is presented.
An Autopsied Case of Systemic Lupus Erythematosus with Pulmonary Hypertension—A Case Report
Authors: Kanemoto Nariaki , Sato Michiko , Moriuchi Junko , Ichikawa Yukinobu , Goto Yuichiro , Sasadaira Hidekazu
Published: November 2007

The authors report an autopsied case of systemic lupus erythematosus (SLE) with pulmonary hypertension. The patient was a forty-five-year-old female who had been troubled by obstinate Raynaud's phenomenon for ten years before the definite diagnosis of pulmonary hypertension was made. Microscopic examina tion of the pulmonary vasculature yielded findings consistent with plexogenic pulmonary arteriopathy. However, the deposition of immune complexes in the pulmonary vascular endothelium was not detected by enzyme antibody study. This case suggests, therefore, that "pulmonary Raynaud's phenomenon" is a possible pathogenesis of pulmonary hypertension in patients with SLE.
Acute Myocarditis Versus Myocardial Infarction: Evaluation and Management of the Young Patient with Prolonged Chest Pain—Case Reports
Authors: Stratmann Henry G.
Published: November 2007

Both acute myocarditis and myocardial infarction must be considered in the differential diagnosis of the young patient with angina-like chest pain. Initial assessment may be difficult, since both diseases may produce similar clinical presentations, electrocardiographic changes, and elevations in cardiac enzymes. Early differentiation is important, however, since myocarditis and myocardial infarction differ greatly in their management and prognosis. These difficulties are illustrated by the 2 cases presented, and guidelines for diagnosis and treat ment are given.
Double-Chambered Right Ventricle Demonstrated by Magnetic Resonance Imaging Before Cardiac Catheterization—Case Report
Authors: Nishimura Tsunehiko , Fujii Takashi
Published: November 2007

Double-chambered right ventricle is often misdiagnosed clinically and may be missed at cardiac catheterization. The authors encountered a fifty-six-year- old man who had double-chambered right ventricle, which was clearly demon strated by magnetic resonance imaging (MRI) before cardiac catheterization. The right ventricle was divided into two chambers by hypertrophic muscular bands at the coronal planes. This finding was confirmed by selective angiogra phy, and the pressure gradient in the right ventricle was 98 mmHg. Thus, MRI should be performed in the case of right ventricular obstruction to evaluate the site and extent of obstruction before cardiac catheterization.
Disappearing False Aneurysm of the Ventricular Septum Without Rupture: A Complication of Acute Inferior Myocardial Infarction—A Case Report
Authors: Kanemoto Nariaki , Hirose Satoru , Goto Yuichiro , Matsuyama Seiya
Published: November 2007

An interseptal false aneurysm of the left ventricle due to the dissection of the septum in a patient with acute inferior myocardial infarction is described.

The aneurysm was demonstrated as a cystic bulge of the left ventricular cavity into the inferoposterior interventricular septum with a small orifice from the left ventricle without any protrusion or rupture into the right ventricular cavity.

Two-dimensional echocardiography, magnetic resonance imaging, and dy namic computed tomography were the most useful and reliable noninvasive di agnostic modalities.

Repeated examinations demonstrated a significant reduction of the aneu rysm in six months.
A Controlled Study on the Effect of Pentoxifylline and an Ergot Alkaloid Derivative on Regional Cerebral Blood Flow in Patients with Chronic Cerebrovascular Disease
Authors: Hartmann Alexander , Tsuda Yoshiyasu
Published: November 2007

Regional cerebral blood flow (rCBF) in 90 patients with CBF decreased due to vascular diseases was studied by using the xenon 133 inhalation technique and a 32-detector setup. Whereas 30 patients received their standard basic ther apy only and were regarded as controls, 30 others received 3 x 2 mg/day of an ergot alkaloid (co-dergocrine mesylate), and 30 others received 3 x 400 mg pen toxifylline (slow-release formulation)/day orally. Therapy was performed for eight weeks and CBF measured before start of treatment, after a four-week treatment period, and at the end of the study. CBF did not change significantly in the control group; both the pentoxifylline and the ergot alkaloid group pre sented with a significant increase in the CBF. This positive effect was signifi cantly more pronounced in the pentoxifylline group and affected more ischemic than other brain tissues. In addition, symptoms like sleep disturbances, vertigo, and tinnitus improved significantly during the pentoxifylline observation peri od.
Pigtail-Guidewire Technique for Retrograde Crossings of Stenotic Aortic Valve—A Case Report
Authors: Feit Alan , Rao Narasimha
Published: November 2007

A new technique for retrograde crossing of stenotic aortic valves using the pigtail catheter and a straight guidewire is described.
The Apoprotein Pattern in Normolipemic Peripheral Vascular Disease
Authors: Mannarino Elmo , Siepi Donatella , Pistola Lorenza , Pasqualini Leonella
Published: November 2007

The relationship between periph eral vascular disease (PVD) and plasma apoproteins has still not been well defined. The lipid and apopro tein pattern of a group of 20 normoli pemic patients affected by peripheral vascular disease has been compared with 20 healthy normolipemic sub jects. Mean triglyceride plasma levels were higher in normolipemic patients than in the healthy controls (107.8±31.5 mg% vs 73.3±28.6 mg%; p<0.03) while mean HDL cholesterol values were significantly lower (36.5±5.4 mg% vs 44.4±7.1 mg%; p < 0.003). No significant dif ference was observed between the two groups in the mean values of the apoproteins AI (112.1±41.2 mg% in PVD vs 117.2±17.7 mg% in con trols), All (45.1±12.2 mg% vs 50.1±11.1 mg%), B (93.7±23.5 mg% vs 91.3±21.6 mg%), CII (3.9±2.6 mg% vs 2.6±1.7 mg%), CIII (6.7±1.5 vs 5.9±1.4 mg%) and E (3.09±1.4 mg% vs 3.3±0.9 mg%). On the contrary the mean triglycer ide/Apo-E ratio was higher in PVD patients than in the controls (52.3±42 vs 23.3±10; p<0.03).
Ketanserin in the Treatment of Progressive Systemic Sclerosis
Authors: Altomare G.F. , Pigatto P.D. , Polenghi M.M.
Published: November 2007

Now progressive systemic sclerosis (PSS) is considered a disease of small vessels with which many immunologic alterations are associated. The presence in the blood of large amounts of serotonin can be considered a very important aggravating factor able to cause the sclerodermic alterations.

The authors have treated 10 PSS patients with ketanserin, a selective antagonist of the S2 serotonin receptors, which are found in small vessels and platelets.

Their results show that ketanserin represents an efficacious and very well tolerated therapy for treatment of the initial vascular symptoms of PSS.
Pathogenesis of Atherosclerosis: I: Role of the Nervous System
Authors: Yao Jun-shen , Wang Jia-fu , Li Hong-ying , Liu Tong-mei , Wu Giang  , Duan Wen-zhuo
Published: November 2007

The new method of lateral carotid artery original-location autograft was used in the present study. An animal model was prepared with which to investi gate the neurogenic role in the pathogenesis of atherosclerosis. Two experiments were performed in 16 operated rabbits to whom was fed a cholesterol-rich diet for four months. In the first experiment, the expected results were obtained in 9 rabbits. Significant atherosclerotic plaques were observed in 4 of 9 (44.4%) samples of intact carotid artery; lipid deposition was found in another 3 (33.3%) samples in which atherosclerotic plaques were not observed by the naked eye but were exhibited by light microscopy; negative results were shown only in 2 (22.2%) samples both by the naked eye and by light microscopy. However, ath erosclerotic plaques were found only in autograft anastomoses but not within the segment of carotid artery autograft.

Then, a second experiment as performed with 7 operated rabbits, and simi lar results were obtained.

These results clearly indicate that the nervous system plays a very important role in the pathogenesis of atherosclerosis.
Experimental Evaluation of the Mitroflow Pericardial Heart Valve Prosthesis. Part I. In Vivo Hemodynamic Evaluation
Authors: Hassoulas J. , Ayzenberg O.
Published: November 2007

Evaluation of possible enhanced durability of the Mitroflow pericardial heart valve prosthesis was undertaken in an experimental animal model using the Chacma baboon. For comparison purposes a small series of 4 Ionescu-Shiley pericardial valves were also implanted.

The 33 Mitroflow prostheses implanted were all manufacturer's size 21mm and belonged to 4 different groups according to the process used for the prepa ration of the pericardium (Process I to IV). The Ionescu-Shiley prostheses were all manufacturer's size 19mm and were commercially available valves. The valves were implanted in the mitral position, except one each Mitroflow and Ionescu-Shiley prosthesis that was implanted in the tricuspid position.

Four animals died in the early postoperative period, between 2 and 14 days. Two died from a probable viral infection, one from a low cardiac output state and the fourth one from bacterial endocarditis. The clinical evaluation of the animals for an implantation time of up to twelve months was unremarkable. Hemodynamic studies were performed immediately after implantation (n = 29), at an intermediate cardiac catheterization at 9 months after implantation (n = 4) and at the time of terminal elective sacrifice of the animals (n=33). From the data obtained the resultant prosthetic valve area at the time of elective sacrifice of the animals was also calculated. The data obtained for each of the 5 groups of valves tested are presented in the text. Transvalvular gradients measured at the time of sacrifice of the animals were elevated. Statistically however the rate of change of pressure gradient per month did not differ significantly from the controls (Ionescu-Shiley valves) for each of the processes I to IV.

As far as it could be ascertained in this study the Mitroflow size 21mm bo vine pericardial heart valve prosthesis, although it went through multiple modi fications during the study period, did not prove to have any significant long-term hemodynamic advantage over the Ionescu-Shiley size 19 mm bovine pericardial heart valve prosthesis.
Arteriovenous Anastomoses' Function and Raynaud's Phenomenon
Authors: Nuzzaci Giuseppe , Pesciullesi Enrico , Lucarelli Franco , Lucente Eleonora , Ferri Paolo , Tonarelli Argene Patrizia , Righi Daniele , Mangoni Nicola
Published: November 2007

By intrabrachial artery injections of a bolus of human albumin microspheres labeled with 99 mTc in patients with primary or secondary Raynaud's phenome non (RP) and in a group of healthy volunteers, the authors developed a method of detecting the patency rate of arteriovenous anastomoses (AVA) in the hand, after local heat and cold stimulation, by quantifying the radioactivity of the lungs expressed as a percentage of an intravenously injected radionuclide dose. With strain gauge plethysmography, simultaneous changes in the digital total (DTF) flow were also measured. After exposure of fingers to cold, 25 of 26 subjects had a clear reduction in both DTF and the AVA patency rate (APR) in comparison with the corresponding heat values. The RP patients, in particular, showed a statistically significant reduction in DTF (P < 0.001) and in APR (P < 0.001).

These results appear to be consistent with the onset of critically reduced patency of the AVA of the hand during the ischemic phase of RP.
Hemodialysis with Calcium-Free Dialysate Prevents Myocardial Creatine Kinase Depletion After Brief Coronary Artery Occlusion in Dogs
Authors: Darsinos John , Karli Joan , Pistevos Anastasios , Levis Gabriel , Moulopoulos Spyridon
Published: November 2007

To evaluate the effect of hypocalcemia on myocardial creatine kinase (CK) depletion after brief coronary artery occlusion and reperfusion, dogs were ren dered hypocalcemic via systemic hemodialysis for eighty minutes in the absence of Ca. Control animals were hemodialysed in the presence of Ca. The left ante rior descending coronary artery was then occluded for six minutes and reperfu sion for eighty minutes occurred at low flow of dialysate. A 50% decrease in serum Ca of the hypocalcemic animals during the eighty minutes of hemodialy sis resulted in a significant (about 35%) decrease of myocardial Ca. Comparison of the myocardial creatine kinase activity following reperfusion showed preser vation of the enzyme in the ischemic areas of the hypocalcemic animals, whereas the CK activities of the ischemic areas of the normocalcemic animals were much lower (p < 0.005). During the reperfusion period serum Ca of the hypocalcemic group increased to 75% of that of the normocalcemic group while myocardial Ca of both ischemic and nonischemic areas reequilibrated to normocalcemic values. Hemodynamic parameters during the various phases of the experiment were not altered significantly. It is concluded that transient decrease of myocar dial Ca produced by hypocalcemia prior to occlusion leads to protection against myocardial damage after brief coronary ligation.
Complement Activation by Vascular Prostheses and Its Role in Progression of Arteriosclerotic Lesions
Authors: Miyauchi Masayuki , Shionoya Shigehiko
Published: November 2007

This study, using C3a, C4a, and C5a assay and crossed immunoelec trophoresis in vitro and in vivo, was designed to determine whether vascular prostheses activate the complement system. The degree of complement activa tion and the pathway of activation were also studied. The complement levels (C3, C4, CH50) in different arterial diseases were measured, and the relation ship of complement levels to serum lipids in patients with arteriosclerosis obli terans (ASO) was also investigated, in order to clarify a relationship between the complement system and arteriosclerosis or other arterial diseases.

Bovine graft, dacron, and PTFE activated the complement system in vitro. In order of the degree of complement activation, bovine graft ranked first, followed by dacron and PTFE. The patient group with acute arterial occlusion showed high C3 and C4 levels. The healthy elderly group showed higher C3 and C4 levels than the healthy persons in their twenties. In ASO patients, C3 levels correlated with serum lipid levels.

Judged from the relation of complement activation by vascular prostheses to the progression of arteriosclerotic changes, vascular prostheses should be as sessed with regard to complement activation.
Should Echocardiography Be Used to Screen Dizzy Patients?
Authors: Kinney Evlin L. , Wright Robert J.
Published: November 2007

The value of echocardiography in the evaluation of dizziness was studied in 151 consecutive patients. Twenty-two patients, on further review, were found to have related complaints, seizures and syncope mainly, but not dizziness. Twenty-four patients had vertigo, 67 had nonvertiginous dizziness, and in 38 patients, there was insufficient information to categorize the dizziness as being vertigo or nonvertiginous dizziness. When the 22 nondizzy patients were com pared with the 129 dizzy patients, the only statistically significant differences were that there were more blacks in the nondizzy group and that the aortic root dimension was, on average, 0.4 cm larger in the nondizzy group. These find ings, although statistically significant, appeared to be clinically insignificant. There was, however, a high prevalence of valvular heart disease in both the nondizzy and two of the three dizzy subgroups. In most cases, the valvular abnormality had not been suspected clinically. But in no case was significant information added by echocardiography that helped in patient management. Thus, in the dizzy patient, echocardiography should be reserved for specific cardiac indications and not used as a routine screening test.