bluuebunny/crossref_metadata_2025 huggingface dataset:
Felodipine Compared to Nifedipine as "Third-Line Drug" in Resistant Hypertension
Authors: Maclean Derek , Mitchell Elizabeth Thomson , Sandilands Readman Ann
Published: November 2007

Felodipine is a new dihydropyridine calcium antagonist, and in hypertension it is a much more effective "third-line" drug than hydralazine. Nifedipine, on the other hand, is the established dihydropyridine calcium antagonist that has been increasingly used to treat hypertension. Information is now needed on the relative merits and demerits of these two drugs. This study appraised, there fore, the therapeutic utility of twelve months' treatment with nifedipine 20-60 mg twice daily in 55 patients with previous drug-resistant hypertension who had been successfully treated for the previous year with felodipine 5-20 mg twice daily, each calcium antagonist being used in combination with atenolol 100 mg daily with or without chlorthalidone 25 mg daily. Initially, nifedipine main tained comparable blood pressure control to that which had been achieved by felodipine, although in the longer term (over eight months) nifedipine proved less effective than felodipine had (p < 0.02) and more patients became uncon trolled (supine diastolic blood pressure, Phase V, ≥90 mmHg) on the maximum tolerated dose of the calcium antagonist (χ2=4.13, p < 0.05 > 0.025). The former degree of blood pressure control was, however, reestablished by increas ing the dose of nifedipine or reintroducing the diuretic as necessary, and this control was maintained over the next four months.

Minor side efects were less common on nifedipine than they had been during the preceding felodipine treatment phase.

Felodipine thus has more pronounced and sustained antihypertensive effects than nifedipine, though its side effect burden may appear to be greater. Because of possible treatment order effects and the development of tolerance to dihydro pyridine side effects, formal comparison of these two compounds is warranted.
Flow Velocity Measurement Using Digital Subtraction Angiography for Hemodynamic Evaluation in Arterial Occlusive Disease
Authors: Sakurai Tsunehisa , Yamada Ikuo , Ohta Takashi
Published: November 2007

A method for mean flow velocity measurement using digital subtraction an giography (DSA) was evaluated, along with the results of phantom and animal experiments. The validity of its clinical use was studied by applying this tech nique in the arteries and bypass grafts in patients with arterial occlusive dis ease. Mean flow velocity was reliably determined by this method, but it could not be used as a determinant of arterial occlusive disease, because of a consider able overlapping between limbs with and without significant arterial lesions. A low value of mean flow velocity was not itself a reliable prognostic indicator of bypass failure. However, measurement of mean flow velocity was valuable in detecting functional abnormalities of the graft.
The Influence of R-Wave Amplitude on the Degree of ST-Segment Depression in Exercise Electrocardiography in the Individual Patient
Authors: Cokkinos Dennis V. , Papantonakos Apostolos , Perrakis Costas , Argyrakis Spyros , Kouvaras George , Tzonou Anastasia , Patsouros Kyriakos
Published: November 2007

Many factors have been found to influence the magnitude of ST-segment depression in the exercise electrocardiogram. We investigated whether R-wave amplitude is a significant factor. We studied the exercise electrocardiogram of 20 patients with angiographically documented coronary artery disease, including ≥ 70% stenosis of the left anterior descending artery, who had an ischemic response to exercise but no previous anterior myocardial infarction. Precordial leads V1-6 were taken into account.

When all 120 leads were measured, those with ST-segment depression ≥ 2.0mm at peak exercise had a mean resting R-wave amplitude of 19.03±5.81mm; those with ST-segment depression 2.0-1.0mm, R 11.42±5.99mm; and those with ST-segment depression < 1.0mm, R 5.9±5.21mm (p < 0.001 between groups). When the R-wave amplitude was correlated with the ST-segment depression in each precordial lead, the correlation was 1.0. In leads V1-6, when 67 tracings with ST-segment depression > 0.5mm were measured, the correlation was 0.537 (p < 0.001). In each precordial lead the t values of R-wave differences correlated very strongly (r < 0.883) with the differences in ST-segment depression. We conclude that precordial R-wave amplitude significantly influences the magnitude of ST-segment depression.
Titrated Extract of Centella Asiatica (TECA) in the Treatment of Venous Insufficiency of the Lower Limbs
Authors: Pointel J.P. , Boccalon H. , Cloarec M. , Ledevehat C. , Joubert M.
Published: November 2007

Ninety-four patients suffering from venous insufficiency of the lower limbs participated in a multicenter, double-blind versus placebo study. After randomization, they were allotted for a treatment period of two months to one of three groups: TECA 120 mg/day, TECA 60 mg/day, or placebo. A significant difference (p < 0.05) in favor of TECA was shown for the symptoms of heaviness in the lower limbs and edema, as well as for the overall evaluation by the patient. The venous distensibility measured by a mercury strain gauge plethysmograph at three occlusion pressures was improved for the TECA groups but aggravated for the placebo group.
Platelet Resistance to Prostacyclin. Enhancement of the Antiaggregatory Effect of Prostacyclin by Pentoxifylline
Authors: Manrique R.V. , Manrique V.
Published: November 2007

With regard to existence of high prostacyclin (PGI2) levels during atheromatosis and thrombus formation, resistance of platelets to prostacyclin and its analogues seems to play an important pathophysiologic key role for the clarifying of vasoocclusive phenomena.

Platelet resistance to prostacyclin was studied in vitro and ex vivo in 160 atherosclerotic patients (assessed by objective diagnostic criteria) with and without thrombotic complications and in 50 controls. Prostacyclin resistance phenomena were more pronounced and frequent in patients with occlusive complications, the difference from controls being statistically significant. However, there was no significant difference between the controls and the nonthrombotic patient sample.

The intraplatelet cAMP levels might be the metabolic basis of the PGI2 resistance phenomenon, because in the patient group, platelet cAMP levels were decreased by 50% after Ca2+ stimulation.

Compared to controls β-thromboglobulin and thromboxane B2 plasma levels were significantly increased (30±9 to 87±26 ng/ml and 9±5 to 54±21 pg/ml, respectively), confirming the hyperreactivity state of resistant platelets.

From the therapeutic point of view, patients with resistant platelets require PGI2 doses that cause, however, increased side effects. We were able to demonstrate in vivo that IV pretreatment with pentoxifylline—a known stimulator of cAMP formation in platelets—followed by a simultaneous and continuous IV infusion of PGI2 + pentoxifylline, permitted us to reduce significantly the mean PGI2 doses needed for triggering an antiplatelet effect, without inducing side effects. In ex vivo studies, PGI2 resistant platelets of atherosclerotic patients pretreated with pentoxifylline showed normalized stimulation response, and platelet cAMP levels increased from 7.8±2.7 to 15.2±1.9 pmol/108 platelets.

Our data disclose a synergistic antiplatelet effect of PGI2 and pentoxifylline, which increases the antithrombotic potential and sheds light on the beneficial effects of pentoxifylline in the treatment of occlusive vascular disease.
Depressor Effects of Ionized Calcium Infusion in Essential Hypertension
Authors: Midtbo Kjell A. , Hals Ottar
Published: November 2007

The circulatory effects of an acute increase in serum ionized calcium were assessed in 27 patients with mild to moderate hypertension. Following a control period of fifteen minutes with confirmed circulatory variables, 1,375 mg calcium gluconate was infused over three minutes. Systemic mean arterial blood pressure and heart rate were recorded before, at one-minute intervals during, and for five minutes following the infusion. There was a brief increase of serum ionized calcium concentration (from 1.28±0.06 mmol/liter to 1.42±0.07 mmol/liter; p < 0.001) maximum by one minute after infusion with return toward control by a further four minutes. This was accompanied by a significantly decreased mean arterial blood pressure (from 117±8 mmHg to 110±9 mmHg at three minutes; p < 0.05) and heart rate (from 70±11 min-1 to 63±10 min-1 at three minutes; p < 0.01). There was a significant correlation between the change in ionized calcium and that of the systemic arterial blood pressure (r=0.68; p < 0.01). No major side effects were recorded. The blood pressure reduction may theoretically be related to increased membrane stabilization of vascular smooth muscle cells, the acute increase in extracellular ionized calcium impairing calcium ions influx.
Variability in Arteriographic Assessment of the Carotid Bifurcation
Authors: Fisher Mark , Ahmadi Jamshid , Zee Chi-Shing , Weiner John M.
Published: November 2007

We evaluated interobserver and intraobserver variability in the arteriographic assessment of the carotid bifurcation. Two neuroradiologists evaluated area stenosis and lumen surface morphology for 60 biplane carotid arteriograms in two reading sessions. Absolute interobserver differences for area stenosis averaged 8.8%, and interobserver differences were statistically significant for arteries of at least 50% stenosis. Analysis of observations for lumen surface morphology revealed statistically significant interobserver differences, averaging 29.5% disagreement. Intraobserver differences were not statistically significant. Observer variability for arteriography should be considered in the process of evaluating patients for carotid endarterectomy.
Thermography as a Predictor of the More Involved Side in Bilateral Carotid Disease: Case History
Authors: Soria Emilio , Paroski Margaret W.
Published: November 2007

Contact thermography using liquid crystals provides a simple, inexpensive method of evaluating carotid disease. It does not duplicate information provided by other noninvasive methods, because, whereas Dopplers give an indication of flow and degree of stenosis in the artery, thermography measures the actual hypoperfusion as demonstrated by diminished temperature in areas of the forehead supplied by branches of the ophthalmic artery.

A 74-year-old man presented with bilateral carotid distribution TIAs. Carotid Dopplers and angiography revealed 99% occlusion of both internal carotid arteries. Contact thermography showed diminished temperature in the right supraorbital artery territory. The patient subsequently underwent carotid endarterectomy. Following induction of anesthesia but prior to carotid clamping, the patient became transiently hypotensive. Intraoperative EEG monitoring showed marked attenuation of the background rhythm on the right with preservation of background on the left. Normal rhythm was quickly restored with pharmocologic restoration of the blood pressure. This case illustrates the usefulness of thermography, which predicted the hemisphere in jeopardy when Dopplers and angiography showed equal bilateral disease.
Portal Hypertension Workup by DSA
Authors: Sharma Rajinder P. , Shetty P.C. , Burke Matthew W. , Keller Cathrine E. , Swanson Dennis P.
Published: November 2007

To provide information for preoperative planning, combined, selective intravenous (IV) and intraarterial (IA) digital subtraction angiography (DSA) studies were performed on 42 portal hypertension patients scheduled for portal systemic shunt procedures. Selective IV-DSA was performed to demonstrate the hepatic venous system, left renal vein, and inferior vena cava. Portal venous anatomy, direction of flow, and portal systemic collaterals were evaluated by selective IA-DSA. In addition, selective IA-DSA was performed postoperatively on 8 patients to assess shunt patency. Technically adequate DSA studies, suitable for surgical planning or postoperative assessment, were obtained in all of the 50 patients examined. Patient or internal organ motion was not a limiting factor in any study. Such use of DSA represents an efficacious, safe, and cost-effective alternative to conventional film-screen angiography for the evaluation of patients with portal hypertension.
Adrenal Cortical Adenoma and Adrenal Medullary Hyperplasia of the Right Adrenal Gland—A Case Report
Authors: Borrero Edgar , Katz Paul , Lipper Stanley , Chang John B.
Published: November 2007

The normal adrenal gland contains two types of tissue, the adrenal cortical tissue and the adrenal medullary tissue. The cortex is divided into three portions: the outermost "zona glomerulosa," the central "zona fasciculata," and the innermost "zona recticularis." The adrenal medulla is a developmentally separate organ, derived from neuroectoderm, and is the site of epinephrine and norepinephrine production.

Adrenal cortical adenoma is commonly the result of a basophilic tumor of the anterior pituitary that secretes excessive amounts of ACTH. Adrenal medullary hyperplasia (or pheochromocytoma) are clinically hazardous tumors because of their excessive secretion of catecholamines. Combined adrenal cortical adenoma and adrenal medullary hyperplasia of the right adrenal gland has never been described previously.
Failure of Pentoxifylline for End-stage Peripheral Vascular Disease
Authors: Loyd Robert G. , Prian Gregory W. , Gomez Henry , Laub James , Mertz George H.
Published: November 2007

In this trial of pentoxifylline, 15 patients with end-stage peripheral vascular disease had symptoms severe enough to warrant operation, but surgery was contraindicated because of anatomically noncorrectable disease, serious medical problems, or refusal. Their mean age was sixty-six years. Each patient received oral pentoxifylline, 400 mg tid, for twelve weeks. Pentoxifylline had no measurable clinical benefit in 14 of the patients. In addition, the authors noted an increased incidence of symptomatic coronary artery insufficiency during the trial period that may or may not have been drug related.
Thallium 201 Muscle Scintigraphy: Application to the Management of Patients with Arterial Occlusive Disease
Authors: Chevreaud C. , Thouvenot P. , Lapeyre G. , Laurens M-H. , Renard C.
Published: November 2007

Skull (S), thigh (T), and calf (C) scintigraphies were performed by using 2 mCi thallium 201 IV in 30 patients suffering from stages II, III, and IV arterial occlusive disease (Fontaine's classification). Two indexes were calculated: P=T/C-C/S (T/C and C/S were the absolute values of radioactivity ratios measured before medical treatment) and R=Δ(C/S)-Δ(T/C) (where Δ expressed the relative variation of the ratios measured after treatment and compared with initial values). Angiography was performed on all patients prior to treatment, and the results were quantified as 1 in the case of obliteration and 0.5 in case of stenosis of major arterial axes. Clinical improvement was demonstrated by a 100% increase in walking distance for stage II disease, abolition of pain at rest for stage III disease, and reepithelialization of trophic lesions for stage IV disease. Paraclinical effectiveness was evaluated by measuring ankle systolic pressure (SP) and index (SI) before and after treatment.

The correlation observed between the values of P and angiography results was p < 0.025 (Student t-test). The mean of P (measured before treatment) was 1.75 for the improved patients and 0.56 for the others (p < 0.005). After treatment, R was + 58% for improved patients versus —13% in those in whom the treatment was inefficient (p < 0.025).

P expresses the microcirculatory effects of arterial lesions detected by angiography. It is a prognostic index: satisfactory proximal perfusion (high T/C), associated with lesions that are essentially peripheral (low C/S), predicting a positive effect of medical treatment. R measures the increase in peripheral circulation (increase in C/S) at the expense of the proximal region (decrease in T/C) and quantifies the results of treatment. SI gives the same information, but the correlation is less precise.
Rheological and Anticoagulant Therapy of Patients with Chronic Peripheral Occlusive Arterial Disease (COAD)
Authors: Deutschinoff A. , Grozdinsky L.
Published: November 2007

In the course of a six-month study, a three-subgroup cohort of 113 patients (103 m, 10 f, mean age 58±8 years) with angiographically proven occlusive peripheral arterial disease (COAD) Fontaine stage II was analyzed regarding the therapeutic (improvement of walking performance) and prophylactic (prevention of new vascular events) effects of oral treatment with three different drug regimens. Group A (38 patients) was treated with the anticoagulants phenprocoumon or acenocoumarol; group B (32 patients), with the same anticoagulants plus pentoxifylline—800—1200 mg per day; and group C (43 patients) received irregular treatment with various vasodilators, such as xanthinolnicotinate, naftidrofuryl, pyridylmethanol, and others. At the end of the trial period a significant increase in systolic ankle pressure index and walking distance was observed in group B whereas the two other groups showed minor changes only. The elevated plasma fibrinogen concentration in group B was also significantly decreased. The percentage of atherosclerotic complications such as new arterial thrombosis in the lower limbs, newly appeared stenocardia, myocardial infarction, transient ischemic attack (TIA), and stroke was highest in group C (20%), relatively lower in group A (10%), and lowest in group B (3%). The percentage of hemorrhagic complications was minimal, with no significant differences between group A and group B. These complications were mild and disappeared quickly. The combined therapy with anticoagulants and pentoxifylline had a marked therapeutic and probably prophylactic effect as regards thromboembolic complications in patients with COAD and other localizations of atherosclerosis.
Nifedipine in the Treatment of Hypertension in Systemic Lupus Erythematosus
Authors: Bursztyn Michael , Many Amira , Rosenthal Talma
Published: November 2007

Treatment of hypertension in systemic lupus erythematosus (SLE) may be complicated by unwanted immunologic vascular and renal side effects of drugs. The safety of long-acting nifedipine tablets was studied in 8 SLE hypertensive subjects for six months. Nifedipine reduced blood pressure from a mean 151.9 ± 10/103.7 ± 8.6 mmHg to a mean of 130 ± 14.1/87.5 ± 5 mmHg. There was no deterioration of renal function or of hematologic or immunologic indices during that period. We believe nifedipine is a safe and effective hypotensive drug in SLE, either alone or combined with beta blockers and diuretics.
Treatment of Hypertension in the Elderly with Captopril
Authors: Birbari Adil E. , Dauk Majida , Mukaddam-Daher Suhayla
Published: November 2007

Fifteen elderly hypertensives aged fifty-nine to seventy-four years received captopril either as a monotherapy (group I, n=7) or as an addition to other antihypertensive drugs (group II, n=8) for twelve to fourteen months. Both the mean supine and erect blood pressure fell from 173.3 ± 3.4/93.3 ± 6.6 to 143.3±3.4/78.3±1.7 and from 166.7+8.6/98.3+4.4 to 146.7±12.0/85.0±2.9 mm Hg, respectively, in group I, and from 165.6±10.5/104.9±4.4 to 128.8±4.7/84.1±1.7 and from 154.0±10.1/107.8±3.3 to 126.3±6.0/88.8±1.2 mm Hg, respectively, in group II. There was a slight but insignificant reduction in pulse rate and body weight. Side effects were minimal. All patients experienced a sense of well-being. There was no impairment of renal function in most patients and no reduction in serum K. This study suggests that, in elderly hypertensives, captopril reduces blood pressure safely and effectively without impairing perfusion to the brain, heart, and kidneys and without causing edema or hypokalemia.
Prognostic Implications of Left Ventricular Function During Exercise in Asymptomatic Patients with Aortic Regurgitation
Authors: Lindsay Joseph , Silverman Angela , Van Voorhees Lucy B. , Nolan Nicholas G.
Published: November 2007

Few data are available that address the prognostic implications of the response of the left ventricle (LV) to exercise in asymptomatic patients with aortic regurgitation (AR) who have normal resting LV function. Thirty-one such patients were contacted two to seven years after rest and exercise radionuclide ventriculography. Eleven had had significant cardiovascular events. Event-free survival at forty-eight months was 64%.

Ten of eleven events occurred in 21 patients with decline in ejection fraction (EF), but the magnitude of decline did not further separate the group with regard to prognosis. Eight events (73% of total events) occurred in the 11 patients (35% of total patients) with an EF during exercise of 0.55 or less.

The short and intermediate outlook for asymptomatic patients with AR and normal resting LV function is good regardless of the response of the EF to exercise, but an exercise EF ≤ 0.55 does identify a relatively high-risk subset for deterioration beyond twenty-four months.
The Influence of Sympathetic Nerves on Transcutaneous Oxygen Tension in Normal and Ischemic Lower Extremities
Authors: Rooke Thom W. , Hollier Larry H. , Osmundson Philip J.
Published: November 2007

The authors evaluated the relationship between sympathetic nerve activity and transcutaneous oxygen tension (TcpO2) in normal and ischemic lower extremities. Dorsal foot TcpO2 was measured by using oxygen-sensing electrodes with surface temperatures of 42 ° C and 45°C; in theory, changes in sympathetic activity should affect vasomotor tone and TcpO2 in skin beneath an electrode at 42 °C (submaximal vasodilation), but not at 45°C (maximal vasodilation). The vasodilation index (TcpO2 at 42°C/TcpO 2 at 45°C) was created as an index of vasomotor tone (vasodilation index increases as tone decreases). In normal limbs (n=24) averages for TcpO 2 at 42°C, TcpO2 at 45°C, and vasodilation index were 30.3 mmHg, 62.1 mmHg, and 0.47, respectively. In subjects (n=5) with quadriplegia and reduced sympathetic tone secondary to cervical cord trauma, TcpO 2 at 42 ° C and vasodilation index were increased (45.0 mmHg and 0.61); TcpO2 at 45 ° C did not change. When normal subjects (n=7) were chilled for twenty minutes with a cooling blanket at 5 ° C (to increase sympathetic tone) average vasodilation index dropped from 0.50 to 0.29. Among ischemic limbs (n = 34) vasodilation index was highly variable (range: 0-0.77); in general, vasodilation index fell as the ischemia worsened. In a subset of patients with ischemic limbs, the vasodilation index increased after the limb was wrapped in a warm dressing (average vasodilation index=0.25without dressing, 0.37 with dressing). The authors conclude: (1) TcpO2 can be used to assess the degree of vasomotor tone (and sympathetic activity) in skin; (2) tone generally increases as ischemia worsens; and (3) local warmth can improve cutaneous circulation in ischemic limbs.
Effect of Pindolol and Propranolol on Sinus Node Recovery Time and Atrioventricular Conduction Intervals
Authors: Kostis John B. , Binenbaum Steve Z. , Oliveri Philip , Sclar Craig , Hosler Maryhelen
Published: November 2007

In a randomized, observer-blind study, the effect of incremental doses of pindolol 0.001, 0.002, 0.003, and 0.004 mg/kg IV and propranolol 0.01, 0.02, 0.03, and 0.04 mg/kg IV on SA nodal recovery time (SNRT) and atrioventricu lar conduction interval (AH) was assessed in 20 patients (15 men and 5 women age range thirty to seventy-two, mean age fifty-three). AH and His bundle-to- ventricle (HV) intervals and SNRT were measured at spontaneous heart rate and at incremental atrial pacing rates (80, 100, 120, 140 bpm). Both drugs caused significant beta blockade as estimated by the percentage suppression of heart rate increment induced by 3 mcg isoproterenol administered intraven ously (pindolol 67.6±5.3%, P < 0.007; propranolol 38.6±10.6%, P < 0.001).

Propranolol significantly prolonged SNRT (P < 0.05) and AH interval (P < 0.05).

Pindolol did not significantly affect either SNRT (P=0.25) or AH intervals (P=0.78).

Significant effects on HV interval were not seen.

Thus, in the doses tested that resulted in significant beta blockade, pro pranolol prolonged SA nodal recovery times and depressed AV nodal conduc tion while pindolol did not affect these variables.
Subacute Hemodynamic Effects of Nebivolol in Man at Rest and During Exercise
Authors: De Crée Jean , Geukens Hedwig , Cobo Carlos , Verhaegen Herman
Published: November 2007

In a subacute experiment 7 apparently healthy volunteers received a daily oral dose of 5 mg nebivolol for seven days, followed by a seven-day washout period with placebo. From the first day during treatment with nebivolol, peak exercise heart rate and systolic blood pressure, as measured during a standard ized submaximal treadmill exercise, significantly decreased by 15% and 19% respectively. A prolonged treatment for one week did not further increase the response of exercise heart rate and systolic blood pressure to nebivolol. How ever, the ratio of preejection period (PEPc) to left ventricular ejection time (LVETc), an indirect and valuable measure of left ventricular performance, pro gressively and significantly decreased during the seven-day treatment period with nebivolol from a mean value of 0.37±0.012 to 0.31±0.009. The improve ment of systolic time intervals resulted from a shortening of the PEPc and a lengthening of the LVETc. At rest, heart rate did not change significantly with nebivolol, whereas both systolic and diastolic blood pressure gradually and sig nificantly lowered. The postexercise LVET c significantly shortened during treat ment with nebivolol, and this shortening was more pronounced after seven days of treatment. After discontinuation of treatment with nebivolol, all these effects persisted for more than thirty hours after the last intake and gradually returned to pretreatment values thereafter. From these data it appears that nebivolol effectively reduces blood pressure at rest and during exercise in healthy volun teers, beneficially influencing preload and afterload, as measured by systolic time intervals. The negative influence on myocardial contractility during the exercise test, generally observed with beta-adrenergic antagonists, does not oc cur with nebivolol. Presumably this is due to an ancillary property of nebivolol, neutralizing the negative inotropic effect due to beta blockade.
Shunt Thrombosis Prevention in Hemodialysis Patients — A Double-Blind, Randomized Study: Pentoxifylline vs Placebo
Authors: Radmilović A. , Borić Z. , Naumović T. , Stamenković M. , Muśikić P.
Published: November 2007

Previous studies demonstrated a high incidence of local thrombosis in patients in whom external arteriovenous shunts were used for vascular access. This procedure provides, therefore, a useful model for the evaluation of potential antithrombotic agents.

The effect of the hemorheologically and hemostasiologically active drug Pentoxifylline on the incidence of thrombosis of arteriovenous shunts (Ramires shunt) was investigated in a long-term, double-blind, placebo-controlled study in 51 patients on chronic hemodialysis. The two treatment groups were comparable in age, sex, concomitant medication, and dialysis program (three times per week for four hours). Drugs known to affect platelet function or coagulation were excluded, with the exception of heparin, during the dialysis procedure. All shunts were placed in the forearm and inserted into the distal part of the radial artery and basilic antebrachial vein. Simultaneously, for medical reasons, in all patients an arteriovenous fistula was performed (proximal part of radial artery and cephalic antebrachial vein). Shunt thrombosis was assumed when the flow in the shunt discontinued under visual and auscultatory control. Thrombi were documented by physical removal from the arterial part of the shunt by use of gentle suction or by complete shunt thrombosis (both arterial and venous part of the shunt). Thereafter, the patients' trial period terminated. The total number of thrombi during the observation period was 44 in the pentoxifylline group

(26 patients), compared with 82 in the placebo group (25 patients). The mean number of thrombi per patient was 1.69±1.29 in the pentoxifylline group, significantly lower than that in the placebo group (3.28±1.99 / p < 0.05). Further, the periods until the occurrence of first thrombosis (in the arterial part of the shunt) and complete shunt thrombosis were assessed per patient in days: in the pentoxifylline group the first shunt thrombosis occurred after 34.8±6.7 days (x±s.e.) and with placebo after 16.7±4.4 days (p < 0.05). The complete thrombosis was recorded in the pentoxifylline group after 46.8±6.5 days and with placebo after 24.6±5.8 days (p < 0.05).

These findings indicate that pentoxifylline medication markedly reduced the incidence of thrombosis of arteriovenous shunt and distinctly extended the shunt survival period, suggesting an effective antithrombotic property of the drug.
Functional Vascular Disorders: Treatment with Pentoxifylline
Authors: Neirotti Massimo , Longo Flavia Flavia , Molaschi Mario , Macchione Carmine , Pernigotti Luigi
Published: November 2007

A group of 11 female patients (mean age 33.7±8 years) with a clearly proven primary Raynaud's syndrome of up to five years' duration were subjected to a two-month oral treatment with 3 x 400 mg pentoxifylline per day. The following parameters were studied without and with exposure to cold conditions: hemody namics (finger photoplethysmography), red cell deformability (filtration test), various clotting variables (prothrombin activity, antithrombin III, plasma fi brinogen, partial thromboplastin time, thrombin time, thrombelastogram), and clinical symptomatology.

After treatment 7 of the 11 patients showed a distinct improvement of pe ripheral blood flow and of symptoms (decrease or removal of asphyxia attacks, pain, color change) under basal conditions, as well as after exposure to cold. Red cell filtration was significantly (p < 0.05) improved, increasing by 35% un der normal conditions and by 30% after exposure to cold. Positive changes were also found in respect to antithrombin III (increase) and plasma fibrinogen (de crease). The thrombelastogram was unchanged.

Clinical and instrumental improvements were probably ascribable to better microcirculatory flow due to increased red cell deformability, reduced viscosity, and decreased fibrinogen, all capable of influencing in various degrees the blood flow at the microcirculatory level.
Hemorheology in Surgery—A Review
Authors: Müller R. , Mušikić P.
Published: November 2007

The rheological behavior of blood and its components under physiologic and pathophysiologic conditions is reviewed, with a focus on the type and extent of pathohemorheological changes in surgical patients during hospitalization and thereafter, as well as their clinical consequences with regard to thromboembolic complications.

During the operation and the postoperative period various hemorheological and hemostasiological alterations acquire clinical signifcance:

1. hyperreagibility of platelets with increased aggregation and adhesion ten dency

2. changes in fibrinogen, albumin, and globulin concentrations, which af fect viscosity and red cell aggregation

3. impairment of red cell deformability

4. increase in clotting factors

5. disturbance of fibrinolysis characterized by diminution of plasmatic plas min and increase in antiplasmin activity

In addition, anesthetic techniques have also been shown to affect he morheological and hemostasiological parameters.

The complex pattern of pathohemorheological and hemostasiological changes shows that thromboembolism in the course of surgical interventions is provoked by multifactorial disorders.

Thrombosis prevention should, therefore, counteract both hemorheological and hemostasiological disturbances.

Since pathohemorheological and pathohemostasiological changes are al ready detectable before, and increase during operation, preventive measures should start before the surgical intervention to obtain maximum benefit.

Therapeutic possibilities for the avoidance of these multifactorial distur bances are discussed with particular reference to pentoxifylline, which satisfies the complex requirements of a hemorheologically and hemostasiologically active therapeutic agent.
Pulmonary Artery Sarcoma—Unusual Pulmonary Angiographic Findings—A Case Report
Authors: Schermoly Martin , Overman John , Pingleton Susan K.
Published: November 2007

The authors report unusual angiographic findings in a patient with pulmo nary artery sarcoma who presented with clinical features suggestive of recur rent pulmonary emboli. These angiographic findings have not been described previously in pulmonary artery sarcoma.
Prolonged Beneficial Effects of Dobutamine in Refractory Heart Failure—Case Histories
Authors: Puram Brahmaji , Margolis Jack , Puram Vijayalakshmi
Published: November 2007

Two patients with refractory congestive heart failure were treated with do butamine for forty-eight to seventy-two hours with close monitoring of weight and symptomatology. After two to four cycles of dobutamine treatment, 1 pa tient showed sustained hemodynamic benefit after six months, whereas the sec ond patient had partial improvement. At the end of a one-year follow-up, both had sustained improvement in effort tolerance, documented by a stress test. The quality of life has markedly improved, and they have not required further hos pital care.
Atrial Pacing During Percutaneous Transluminal Coronary Angioplasty: Results and Comparison with Exercise Treadmill Testing
Authors: Stratmann Henry , Aker Umit T. , Vandormael Michael G. , Ischinger Thomas , Wiens Robert , Kennedy Harold L.
Published: November 2007

Right atrial pacing (RAP) was used to immediately assess improvement in threshold for myocardial ischemia in 23 patients undergoing angiographically successful percutaneous transluminal coronary angioplasty (PTCA). Multiple coronary lesions were present in 19 patients, and 15 had incomplete revascular ization. All patients had RAP done immediately before and after completion of all dilatations, and in 13 patients pre- and post-PTCA exercise treadmill tests (ETT) were also performed. Angina occurred in 16 (70%) patients during pre- PTCA RAP, but in only 4 (17%) after PTCA (p < .05). The electrocardiogram was positive for ischemia (horizontal or downsloping ST depression ≥ 1 mm) in 18 patients (78%) during pre-PTCA RAP. However, 13 patients (57%) continued to have an ischemic response during post-PTCA RAP (not significant—NS). In 4 patients with multiple coronary lesions who had sequential pacing studies after PTCA of each lesion, the maximum degree of ST depression decreased by 1 mm or more after each dilatation in 3 patients but remained ≥ 1 mm in all. In the 13 patients undergoing both RAP and ETT, angina developed in 7 during pre- PTCA RAP and in 2 after PTCA (p < .05), compared with 8 and 3 (p < .05) during pre- and post-PTCA ETT, respectively. Ischemic ST depression occurred in 9 patients during pre-PTCA RAP and in 6 after PTCA (NS), and in 8 and 6 (NS) during pre- and post-PTCA ETT, respectively. Concordance between the two tests was good. The authors conclude that RAP can be used to document improvements in the threshold for ischemia as assessed by angina and, less consistently, by ST depression. However, use of RAP to guide PTCA of individ ual lesions is limited in patients with multiple coronary lesions (especially those undergoing incomplete revascularization), owing to difficulty in determining which lesion(s) are responsible for persistent ischemic ST depression (present in most patients with positive pre-PTCA tests) after PTCA. RAP does compare favorably with ETT for assessing post-PTCA ischemia and can be used as a substitute for exercise testing in patients unable to perform an adequate ETT.
Systemic Noninflammatory Vasculopathy with Prominent CNS Involvement—A Case Report
Authors: Molaie Majid , Collins George H.
Published: November 2007

This is a case report of a thirty-seven-year-old man with systemic noninflam matory vasculopathy who developed a slowly progressive dementia with multi ple sites of stroke. Cerebral angiography revealed abnormal terminal vascula ture with beading and occlusions. Brain biopsy confirmed a noninflammatory vascular pathology. We have also reviewed the world literature relevant to this clinicopathologic entity and have discussed its relationship to thromboangiitis obliterans cerebri.
Intermittent Claudication Associated with Cancer— Case Studies
Authors: Naschitz Johanan E. , Schechter Lori , Chang John B.
Published: November 2007

Cancer was diagnosed in 15 patients among 300 consecutive patients with intermittent claudication. The cancer-associated claudication is characterized by a more accelerated course of claudication, more often requires vascular sur gery, and moreover, the lasting relief of claudication depends upon the effi ciency of cancer therapy. It is the authors' impression that cancer-associated claudication is predetermined by atherosclerosis and aggravated by cancer through the chronic hypercoagulability state secondary to neoplasm. The clini cal picture is characterized by rapid progression, with the frequent necessity of vascular surgery for limb salvage and a higher incidence of graft occlusion. Awareness of this possibility of hidden malignancy may be related to the clinical picture of hemodynamic deterioration of the underlying arterial insufficiency. A high index of suspicion leads to earlier diagnosis of neoplasm. Effective onco logic therapy will often bring the symptomatic relief of ischemic symptoms in the lower extremities. This report indicates that associated neoplasm has a more vicious course of the underlying arterial insufficiency and intermittent claudica tion.
Vasospastic Angina in Thyrotoxicosis—Case Reports
Authors: Nakano Takeshi , Konishi Tokuji , Takezawa Hideo
Published: November 2007

We encountered 2 patients with thyrotoxicosis accompanied at its onset by progressive angina. The ST segment was elevated in one patient and depressed in the other patient during the spontaneous attacks. Coronary arteriographic findings were normal during control, and spasm was induced by ergonovine. No patients had chest pain even without antianginal medication after successful treatment of thyrotoxicosis. The coronary artery may become sensitive to spasm during thyroid hormone excess even in cases without significant coronary artery disease and previous chest pain.
Clinical Application of Laser Doppler Flowmetry for Measurement of Cutaneous Circulation in Health and Disease
Authors: Winsor Travis , Haumschild Daniel J. , Winsor David W. , Wang Ying , Luong Thanh N.
Published: November 2007

The cutaneous laser Doppler device (LDF) was employed to determine its usefulness in differentiating the circulation of the feet in normal subjects from that in patients with arteriosclerosis obliterans.

It is shown that the laser Doppler frequencies correlated well with results from venous occlusion plethysmography, which measured volume rate of flow. Thus, one can determine volume rate of flow by the simple Doppler method. There was a linear relationship between these two methods of measurements.

Using the LDF method, it was determined that normal individuals have toe flows that on the average are 42% of finger flows in supine resting subjects. In peripheral vascular disease of the lower extremities, the LDF measurements showed a decreased circulation in the large toes when the patients are supine and the lower extremities flat. The results between health and disease are exaggerated by elevating the feet, at which time the diseased circulation falls to extremely low values compared with those of normal subjects. A similar decrease in skin oxygen tension in the diseased lower extremities was observed when the limbs were elevated.
Prediction of "Critical" Coronary Disease: Are the "Consensus Conference" Guidelines Adequate?
Authors: Hutchison S.J. , Millar-Craig M.W.
Published: November 2007

Presenting features of 100 patients with significant left main coronary stenosis (LMCS) were reviewed. All presented with angina — on minimal exertion in 45, moderate exertion in 38, and severe exertion in 6 — and 11 had unstable angina. Although the resting ECG was normal in 44, exercise testing was positive in 92 % of patients tested. The authors conclude that symptoms and the resting ECG alone are unhelpful in predicting "critical" coronary disease. However, application of a management plan similar to that suggested by the Consensus Conference on coronary artery surgery would have selected the vast majority of such patients for angiography.
Incidence and Clinical Course of Right Ventricular Infarction: Assessment with Radionuclide Ventriculography
Authors: Konishi Tokuji , Ichikawa Takehiko , Yamamuro Masashi , Koyama Takao , Futagami Yasuo , Nakano Takeshi , Takezawa Hideo
Published: November 2007

The incidence and prognosis of right ventricular infarction were studied by radionuclide ventriculography (RNV) in 50 consecutive cases of acute myocardial infarction. RNV was performed within thirty-six hours of symptoms and one month after onset. Right ventricular infarction was absent in all 25 patients with anterior infarction. It was found in 15 of the 25 patients with inferior infarction, accompanied by a marked reduction in right ventricular ejection fraction (28 ± 8%), but was notably alleviated one month later with normalization of right ventricular ejection fraction (39 ± 7%) and wall motion. These phenomena seem to be specific in right ventricular infarction.
Evaluation of Enzymes in Serum and Cerebrospinal Fluid in Cases of Cerebrovascular Accidents
Authors: Nand Nitya , Gupta S. , Sharma M. , Khosla S.N. , Saini A.S. , Lal H.
Published: November 2007

Gamma glutamyl transpeptidase (GGTP), glutamic oxaloacetic transaminase (GOT), and glutamic pyruvic transaminase (GPT) were measured serially in the serum and cerebrospinal fluid (CSF) of 22 patients with fresh stroke and an equal number of age- and sex-matched healthy control subjects.

It was observed that levels of these enzymes in the CSF of control subjects were very low but were significantly elevated (p < 0.001) in both serum and CSF in patients with stroke. The elevation was greater in the CSF than in the serum and was maximum during the first four days of stroke. Thereafter, the enzymatic activity declined. Of all these enzymes, GGTP in CSF correlated best with the clinical picture. It was possible to differentiate between the ischemic and hemorrhagic type of stroke on the basis of CSF levels of GGTP ( > 60.0 units in hemorrhagic stroke). There was no correlation between GGTP levels in CSF and serum or among GOT, GPT, and GGTP in CSF.

It can be concluded, therefore, that estimation of GGTP in CSF is helpful not only in predicting the degree of cerebral damage and functional outcome of the patient following stroke but also in differentiating the type of stroke.
Lower Extremity Blood Flow in Intermittent Claudication The Role of Oral Glucose Tolerance Test
Authors: Hanson Martin
Published: November 2007

Tobacco smoking is a risk factor for peripheral arterial disease. During oral glucose tolerance tests (OGTT) in a population study the author and co-workers have earlier shown that smokers have higher blood glucose values early postload and lower values at two hours compared with nonsmokers. Eighty-three patients, all with intermittent claudication but with a normal OGTT, have now been studied according to their response to an oral glucose load. The blood flow resistance during reactive hyperemia, as measured with a calf plethysmograph, was compared between subjects in the quartile of patients with the highest forty-five-minute blood glucose and those in the lowest quartile. The blood flow resistance was significantly higher in the group with a high forty-five-minute blood glucose, 13.3 ± 1.34 vs 9.5 ± 0.65 (mean ± SEM), p < 0.02. Blood pressure and blood lipids were similar in the two groups. It is suggested that an exaggerated early response in the OGTT might be an independent risk factor for peripheral arterial disease.
Primary Lower Extremity Telangiectasias — Relationship of Size to Color
Authors: Biegeleisen Ken
Published: November 2007

Sclerotherapy remains the treatment of choice for primary telangiectasias of the lower extremities, a half century after the treatment was first devised. No substantial improvements have been made, largely because little or no attention has been paid to the underlying physiology. Evidence is presented that these vessels are dilated by virtue of their proximity to small arteriovenous communications. This would explain the response these vessels demonstrate when injected with sclerosing solutions, as well as the relationship between their size and their color, which is documented by objective and subjective measurements.

Two novel methods of treating telangiectasias with existing sclerosing solutions are described, and the characteristics of an ideal sclerosant for these vessels are proposed.
Changes in Hemodynamics Due to the Contrast Medium During Left Ventriculography
Authors: Koeda Toshihiko , Motegi Itaru , Ichikawa Takashi , Suzuki Tomoyuki , Kato Masataka
Published: November 2007

Seventeen patients with heart diseases examined by left ventricular angiography were divided into two groups consisting of those with a clinical history of heart failure (CHF+) and those without (CHF-). Changes in hemodynamics, circulating blood volume, and plasma volume due to injection of the contrast medium were studied, and the following results were obtained.

Both the CHF - and CHF + groups showed an increase in heart rate after injection of the contrast medium, but a statistically significant difference (p < 0.05) was noted only at one and two minutes after angiography in both groups. Left ventricular systolic pressure decreased after injection of the contrast medium in both groups, but the CHF+ group required a longer time for recovery. In the CHF - group, the left ventricular end-diastolic pressure increased slightly after injection of the contrast medium, but in the CHF+ group it increased markedly with a statistically significant difference (p < 0.01). Stroke volume, measured by a noninvasive, continuous cardiac output monitor according to the impedance method, increased upon injection of the contrast medium in the CHF— group. However, in the CHF+ group it decreased, although no statistically significant difference was noted in either group. Cardiac index increased markedly upon injection of the contrast medium in the CHF— group with a statistically significant difference (p < 0.01), but hardly any change was observed in the CHF+ group. Circulating blood volume increased in both groups ten minutes after injection of the contrast medium, but whereas the CHF - group showed no statistically significant increase and had a gradual reduction to the original state an hour afterward, a statistically significant increase over original values in the CHF+ group was observed at ten minutes and one hour after injection. The mean value of the CHF+ group was statistically significantly higher than that of the CHF- group at one hour after injection. Circulating plasma volume showed statistically significant mean increases over original values in both groups at ten minutes and at one hour after injection of the contrast medium. The mean value of the CHF+ group was statistically significantly higher than that of the CHF- group at one hour after injection.

In conclusion, patients with heart failure, in comparison with those without, showed different changes in hemodynamics, circulating blood, and plasma volumes caused by the contrast medium, and thus it was necessary to be cautious when the contrast medium was injected into patients with a history of heart failure.