bluuebunny/crossref_metadata_2025 huggingface dataset:
Left Ventricular Doppler Characteristics in First-Degree Relatives of Patients with Hypertrophic Cardiomyopathy
Authors: Efthimiadis Georgios K. , Parharidis Georgios E. , Karvounis Haralambos I. , Papadopoulos Christodoulos E. , Gemitzis Konstantinos D. , Styliadis Ioannis H. , Karoulas Takis N. , Louridas Georgios E.
Published: March 2006

Left ventricular (LV) diastolic function may be affected early in patients with hypertrophic cardiomyopathy (HCM), regardless of the phenotypic expression of the disease. The aim of the present study was to detect whether LV diastolic performance, evaluated by conventional Doppler echocardiography, is impaired in first-degree relatives of patients with phenotypically expressed HCM, who had no clinical, electrocardiographic, or echocardiographic signs of the disease. Twenty-two young adults having the previously described characteristics comprised the study population and 22 sex- and age-matched healthy individuals served as controls. The 2 groups were compared according to several echocardiographic parameters and the following diastolic function indices: peak velocity of E wave, representing early filling; peak velocity of A wave, representing late filling; ratio of peak early to peak late velocity (E/A); deceleration time of E wave; and LV isovolumic relaxation time. Slower deceleration time of transmitral early filling in first-degree relatives of patients with HCM (192 ±31 vs 149 ±31 msec, p<0.001) was the only variable that significantly differentiated the 2 groups. This study shows that in healthy persons with a family history of HCM, Doppler-derived mitral filling pattern shifted toward that observed in HCM and the slower deceleration time may serve as an early sign of disease development.
Unique Spontaneous Unhealed Chronic Multivessel Coronary Artery Dissection in an Elderly Man
Authors: Özeren Ali , Aydın Mustafa , Bilge Mehmet , Gürsürer Metin , Özkökeli Mehmet , Peksoy Irfan
Published: March 2006

Spontaneous coronary artery dissection (SCAD) is relatively uncommon. It often occurs in healthy, middle-aged women without overt risk factors for atherosclerosis and is associated with the peripartum period. The pattern and severity of presentation are variable. There are only 5 reports in the literature about multivessel involvement. The etiopathogenesis of SCAD is unclear. Treatment strategy is not standard but is usually tailored to clinical features. Long-term survival of patients with SCAD who have had no problem at the initial event is good. The authors report the first case of unhealed chronic multivessel SCAD in the literature.
Renal Artery Stenosis Emerged After Angiotensin-Converting Enzyme Inhibitor Treatment for Myocardial Infarction
Authors: Takahashi Fumihiko , Hasebe Naoyuki , Ogawa Yuji , Tsuji Shiro , Kido Shinsuke , Aburano Tamio , Kikuchi Kenjiro
Published: March 2006

A 76-year-old woman with acute myocardial infarction underwent percutaneous coronary angioplasty followed by treatment with an angiotensin-converting enzyme (ACE) inhibitor, lisinopril. Her renal function deteriorated after the administration of lisinopril, so it was changed to another ACE inhibitor, temocapril. Renography suggested a complication of severe right renal artery stenosis, and renal angiography revealed bilateral renal artery stenoses. Her renal hemodynamics were assessed by 99mTc-Mercaptoacetyltriglycine (99mTc-MAG3)-renography before and after withdrawal of temocapril. The authors concluded the patient had essential hypertension complicated by atherosclerotic renovascular disease. In the treatment of elderly patients with heart disease, hypertension, or both, with ACE inhibitor, the possibility of coexisting renal artery stenosis should be considered. Renography is recommended as a reliable tool for detecting renal artery stenosis.
When Does Atherosclerosis Become Irreversible? Chronological Change from an Early to an Advanced Atherosclerotic Lesion Observed by Angioscopy
Authors: Ikeda Norimichi , Torii Ryuzou
Published: March 2006

Quite a large number of studies on atherosclerosis have been published to date. However, no report on the development and irreversibility of lesions has been published so far. The authors conducted the following experiments to examine in vivo lesions under direct vision. Atherosclerotic lesions were created in 11 Japanese macaques, and progress of the lesions was observed under changing feeding conditions. The efficacy of cholesterol-lowering therapy was also evaluated and the mechanism by which eicosapentaenoic acid (EPA) suppresses atherosclerosis was examined. The results of this long-term study were as follows: (1) Early lesions of atherosclerosis (fatty streaks) developed in the aortic wall owing to cholesterol loading disappeared when the serum concentration of total cholesterol was reduced. (2) Atheromas first developed at the orifices of major branches of the aorta. And even though serum cholesterol was reduced, the lesions gradually spread to nearby areas. (3) After atheromas developed, advancement of the lesions slowed, as assessed by angioscopy, when EPA was administered while cholesterol loading was continued. Thus, early lesions of atherosclerosis are reversible and cholesterol-lowering therapy is an effective treatment; however, since advanced lesions seem to be irreversible, cholesterol-lowering therapy may not be effective for such lesions. The results of angioscopic examination showed that EPA slowed the progression of atheromatous lesions, and probably suppression of the proliferation of smooth muscle cells is the mechanism of such effect.
Right Ventricular Myocardial Infarction: Presentation and Acute Outcomes
Authors: Chockalingam Anand , Gnanavelu G. , Subramaniam T. , Dorairajan Smrita , Chockalingam V.
Published: March 2006

Acute inferior wall myocardial infarction can be complicated by right ventricular myocardial infarction (RVMI), and the excess mortality cannot be fully explained by mechanical reasons. The authors try to systematically assess the incidence, clinical presentation and early outcomes of right ventricular infarction in a tertiary-care setup. Their study was a prospective observational series of consecutive patients with RVMI. All patients with acute inferior myocardial infarction (n=135) were enlisted. RVMI was diagnosed by ≥1 mm ST elevation in lead V4R in a right-sided electrocardiogram. Right ventricular (RV) infarction occurred in 37% (n=50) of patients with acute inferior infarctions. Patients with isolated inferior infarction served as controls (n=85). Echocardiography was performed within 24 hours of admission. From both groups, 66% qualified for thrombolysis. The incidence of hypotension—bradycardia and heart blocks requiring pacing support was much higher in right ventricular infarction (n=21) than in inferior infarction (n=13). Clinically manifest RV dysfunction (raised jugular venous pulse [JVP], hypotension, tricuspid regurgitation) and right ventricular dilation detected by echocardiography were seen in only 13 patients. The in-hospital mortality rate was significantly higher (n=8, 16%) in right ventricular infarction group than in inferior infarction group (n=3, 3.5%). Right ventricular infarction was seen in a third of inferior myocardial infarctions (IMIs), but hemodynamically evident right ventricular dysfunction occurred in only a tenth of acute IMIs. Nevertheless, the acute in-hospital mortality rate of patients with right ventricular infarction was much higher than in those with inferior infarction owing to arrhythmic and mechanical complications.
Use of Intermittent Pneumatic Compression for Treatment of Upper Extremity Vascular Ulcers
Authors: Pfizenmaier David H. , Kavros Steven J. , Liedl David A. , Cooper Leslie T.
Published: March 2006

Ischemic vascular ulcerations of the upper extremities are an uncommon and frequently painful condition most often associated with scleroderma and small vessel inflammatory diseases. Digital amputation has been advocated as primary therapy because of the poor outcome with medical care. Intermittent pneumatic compression (IPC) pump therapy can improve ulcer healing in lower extremity ischemic ulcerations; however, the value of this treatment in upper extremity ischemic ulcerations is not known. This observational pilot study consisted of a consecutive series of 26 patients with 27 upper extremity ischemic vascular ulcers seen at the Mayo Gonda Vascular Center from 1996 to 2003. Inclusion criteria were documented index of ulcer size and follow-up ulcer size and use of the IPC pump as adjunctive wound treatment. Twenty-six of 27 ulcers (96%) healed with the use of the IPC pump. Mean baseline ulcer size was 1.0 cm2 (SD=0.3 cm2) and scleroderma was the underlying disease in 65% (17/26) of cases. Laser Doppler blood flow in the affected digit was 7 flux units (normal greater than 100). The mean ulcer duration before IPC treatment was 31 weeks. The average pump use was 5 hours per day. The mean time to wound healing was 25 weeks. Twenty-five of 26 patients reported an improvement in wound pain with pump use. Intensive IPC pump use is feasible and associated with a high rate of healing in upper extremity ischemic ulcers. A prospective, randomized, sham-controlled study of IPC is needed to determine whether IPC treatment improves wound healing compared to standard medical care.
Alterations in Plasma Oxidative Stress Markers After Laparoscopic Operations of the Upper and Lower Abdomen
Authors: Glantzounis G. K. , Tsimaris I. , Tselepis A. D. , Thomas C. , Galaris D. A. , Tsimoyiannis E. C.
Published: March 2006

The patient’s position during laparoscopic surgery can have a clinically relevant effect on lower limb and splanchnic circulation; this factor has not yet been investigated with respect to oxidative stress markers. In order to assess this effect, a prospective clinical trial was designed wherein 2 groups of patients were studied. In group A, 15 patients underwent upper abdominal nonhepatobiliary operations (13 modified Nissen fundoplications and 2 Taylor vagotomies) in the head-up position. In group B, 15 patients underwent lower abdominal operations (10 laparoscopic colectomies and 5 inguinal hernia repairs) in the head-down position. The pneumoperitoneum was maintained at 14 mm Hg in all cases. Plasma concentrations of thiobarbituric-acid reactive substances (TBARS), a marker of lipid peroxidation, plasma total antioxidant status (TAS), and serum uric acid concentrations were measured preoperatively, 5 minutes after deflation of the pneumoperitoneum, and 24 hours postoperatively. Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) serum activities were measured preoperatively and 24 hours postoperatively. In group A, there was a significant increase in TBARS levels (p<0.005) immediately after deflation of the pneumoperitoneum and a significant decrease in TAS and uric acid levels (p<0.005) in the first postoperative day. There was also a significant postoperative elevation in both ALT and AST activities (p<0.001). In group B, no significant increase was found in postoperative TBARS or transaminase levels. TAS and uric acid levels decreased significantly in the first postoperative day (p<0.05) and (p<0.005, respectively). In conclusion, these results show that a combination of pneumoperitoneum and the head-up position causes significant increase in lipid peroxidation, decrease in plasma TAS, and increase in transaminases. The mechanism responsible for these events could be the low-flow ischemia-reperfusion syndrome induced by the pneumoperitoneum and aggravated by the head-up position.
Venous Aneurysms of the Extremities
Authors: Ranero-Juárez Guadalupe Alejandra , Sánchez-Gómez Raúl Hiramm , Loza-Jalil Suria Elizabeth , Cano-Valdéz Ana María
Published: March 2006

Venous aneurysms are lesions that can be difficult to diagnose and may be a source of significant morbidity. Venous aneurysms have been reported to occur in most major veins, neck, central thoracic veins, and extremities. The authors report 4 cases of venous aneurysms: 1 of the upper and 3 of the lower extremity. All patients underwent aneurysmectomy with end-toend anastomosis and no complications after surgery were reported. These cases are presented along with a review of literature and their origin, diagnosis, and treatment.
Lemierre’s Syndrome: Unusual Cause of Internal Jugular Vein Thrombosis
Authors: Min Seung Kee , Park Yeon Ho , Cho Yong Kyun , Park Jeong Woong , Koh Young Hwan , Seo Tae-Seok
Published: March 2006

Lemierre’s syndrome is an uncommon septic thrombophlebitis of the internal jugular vein. The authors present the case of a 52-year-old woman with literature review. She developed flu-like symptoms and fever, and then painful swelling of the left side of her neck and left arm. Contrast-enhanced computed tomography of the neck revealed thrombosis in the left internal jugular vein, subclavian vein, and brachiocephalic vein and diffuse soft tissue inflammation around the veins. No microorganism was identified in the blood and venous thrombus, which was obtained by percutaneous aspiration thrombectomy. Systemic antibiotics and anticoagulation therapy achieved complete resolution of the symptoms. Recanalization of the thrombosed veins with no residual thrombi was observed on duplex scanning after 3 months. No pulmonary embolism or other metastatic infection was observed. Clinical suspicion seems to be essential to make an accurate diagnosis during the early stage of the disease, which is critical to obtain a successful outcome for Lemierre’s syndrome.
Stroke-Complicated Endocarditis with Positive Lupus Anticoagulant
Authors: Lydakis Charalampos , Apostolakis Stavros , Lydataki Niki , Tzortzakakis Emmanuel , Komis George
Published: March 2006

Twenty to 40% of patients with infective endocarditis (IE) suffer from neurologic complications. Also many and various markers of immunologic activation have been reported in patients with IE and no history of autoimmune or other rheumatologic diseases. The authors present a case of a patient suffering from IE complicated with major cerebrovascular event with concomitant appearance of lupus anticoagulant (LAC). After successful antibiotic treatment there was major clinical improvement with disappearance of LAC. LAC could be added to the list of immunologic markers appearing in the course of infective endocarditis.
Collaterals That Regressed After Angioplasty Can be Recruited to Protect the Left Ventricle in Case of an Acute Occlusion
Authors: Özdemir Özcan , Soylu Mustafa , Demir Ahmet Duran , Alyan Ömer , Topaloglu Serkan , Geyik Bilal , Kütük Emine
Published: March 2006

A considerable fraction of collaterals has been shown to regress immediately after percutaneous transluminal coronary angioplasty (PTCA), but the fate of these well-developed collaterals is unknown. The authors aimed to show the protective role of these recruitable collaterals in case of an acute myocardial infarction (MI). They identified 22 patients who underwent PTCA and then were rehospitalized owing to acute myocardial infarction. These patients were compared with a group consisting of 48 patients hospitalized owing to acute MI without a history of previous PTCA. Then, the patients with collaterals were compared with the patients without collaterals to define the factors affecting the collateral formation. All the patients with collaterals before PTCA were shown to have collaterals also after AMI, and collateral grades were greater after MI (1.67 ±0.98) when compared with those before PTCA (0.73 ±0.7) (p=0.001). Coronary collaterals were more commonly seen in patients with a history of previous PTCA (p=0.005), and the grades of collaterals were also higher in these patients when compared with those without PTCA. Left ventricle score indices were lower and left ventricular ejection fractions (LVEF) were higher in patients with a history of PTCA (p=0.001). Logistic regression analysis revealed that smoking increased the development of collaterals after AMI 3.8 fold, aspirin use 4.1 fold. On the contrary, diabetes mellitus (DM) decreased this 6.67 fold. As a result, well-developed coronary collaterals are preserved even if they have regressed after restoration of flow, and they may become functional and protect the myocardium against acute ischemia.
Secondary Prevention of Ischemic Cerebrovascular Disease. What Is the Evidence?
Authors: Paraskevas Kosmas I. , Daskalopoulou Stella S. , Daskalopoulos Marios E. , Liapis Christos D.
Published: March 2006

Patients who had a transient ischemic attack or stroke are at increased risk of experiencing recurrent cerebrovascular events. For this reason, secondary prevention of ischemic cerebrovascular disease is essential. Several modifiable, lifestyle-associated risk factors have been implicated, such as physical activity, smoking, and alcohol consumption. Established and emerging vascular risk factors are associated with an increased risk of stroke. Pharmacologic treatment, including the use of antiplatelet, antihypertensive, and lipid-lowering agents, has also been shown to reduce the risk of secondary cerebrovascular events. Surgical intervention, either open or endovascular, may be the preferred therapeutic option in well-defined subsets of patients. It is important to establish specific measures for the early detection and prevention of recurrent cerebrovascular disease. Therefore, further research and greater awareness in this field are needed.
Patterns and Predictors of Prehypertension Among “Healthy” Urban Adults in India
Authors: Chockalingam Anand , Ganesan N. , Venkatesan S. , Gnanavelu G. , Subramaniam T. , Jaganathan V. , Elangovan S. , Alagesan R. , Dorairajan Smrita , Subramaniam Ashwin , Rafeeq K. , Elangovan C. , Rajendran V.
Published: March 2006

Cardiovascular disease is still on the increase in India owing to changing socioeconomic factors and unhealthy lifestyles. Better understanding of the role of hypertension (HTN) has led to new Joint National Committee (JNC-7) guidelines for its diagnosis and management. The authors aimed to evaluate the predictors and correlates of prehypertension (PreHTN) among adults in urban India. Study design is a cross-sectional survey among 2,007 adults in Chennai in July 2003; 1,505 men and 502 women over the age of 18 years were studied. Demographic data collected by direct interview were the following: age, smoking, alcohol intake, type of work, exercise patterns, and monthly income. Anthropometric data of height, weight, and waist and hip dimensions were measured. Blood pressure (BP) was recorded thrice, with at least 15 minutes between readings 2 and 3. The mean of readings 2 and 3 was taken for the study. Of the 2,007 people studied, 951 (47.4%) had PreHTN and 696 (34.7%) had HTN. PreHTN was found in 46.6% of the men and 49.8% of the women. PreHTN was prevalent in 47.4% of adults, and another 34.7% had hypertension (Stage I, 20%, and Stage II, 14.7%). In urban India less than 18% of adults have normal BP of less than 120/80. Multiple logistic regression analysis after age and sex correction identified obesity, diet, family history and middle-income group as correlating with PreHTN. The factors that predict HTN were age, sex, smoking, alcohol intake, sedentary lifestyle, and type of work.
The Glucose Tolerance Test, But Not HbA 1c, Remains the Gold Standard in Identifying Unrecognized Diabetes Mellitus and Impaired Glucose Tolerance in Hypertensive Subjects
Authors: Salmasi Abdul-Majeed , Dancy Mark
Published: March 2006

The objective of this study was to compare the value of the oral glucose tolerance test (GTT), glycated hemoglobin concentration (HbA1c), and fasting plasma glucose (FPG) for identifying unrecognized diabetes mellitus (DM) and impaired glucose tolerance (IGT) in hypertensive subjects. One hundred forty-four consecutive subjects who were not known to have DM and who were attending the Hypertension Clinic underwent 24-hour ambulatory blood pressure (BP) monitoring. A GTT and an HbA1c measurement were also carried out. Abnormal results from GTT were found in 94 patients (65%). Results from FPG were not different between those with DM and IGT but were significantly higher than in the euglycemic subjects. The FPG was between 110-125 mg/dL (6.1-6.9 mmol/L) in 31% (n=20) of patients with IGT and in 53% (n=16) of those with DM. With use of the previously published criteria to diagnose DM of FPG ≥103 mg/dL (5.7 mmol/L) and HbA1c ≥5.9%, 33% of our diabetic subjects and 75% of those with IGT would have been misclassified as euglycemic. The previously reported cut-off point for HbA1c of >6.1% to diagnose DM was present in 77% of our patients with DM and in 14% (n=9) of the patients with IGT. Multiple regression analysis showed that an abnormal result from GTT was independent of the level of clinical or ambulatory BP, nocturnal BP dip, cholesterol level, smoking history, race, or class of antihypertensive medication taken. FPG levels or HbA1c, or their combination, are not accurate enough to identify DM or IGT in patients attending a hospital Hypertension Clinic. A GTT may be required in these patients to reliably identify those with DM or IGT.
Hemodynamic Benefits of Matrix Metalloproteinase-9 Inhibition by Doxycycline During Experimental Acute Pulmonary Embolism
Authors: Palei Ana C.T. , Zaneti Rafael A.G. , Fortuna Geisa M. , Gerlach Raquel F. , Tanus-Santos Jose E.
Published: March 2006

The authors examined whether acute pulmonary embolism (APE) increases lung matrix metalloproteinase (MMP)-2 and MMP-9 activities and whether inhibition of MMPs with doxycycline attenuates the hemodynamic changes associated with APE. Anesthetized male Wistar rats were monitored for mean arterial blood pressure (MAP) and heart rate (HR). Rats in the control group (n=5) received only saline IV; rats in the embolism (Emb) group (n=8) received saline IV followed 10 minutes later by an injection of Sephadex microspheres (9 mg/kg) IV; rats in the doxycycline (Doxy) group (n=4) received only doxycycline (30 mg/kg) IV, followed 10 minutes later by an injection of saline IV; rats in the Doxy + Emb group (n=8) received the same dose of doxycycline followed 10 minutes later by the same amount of microspheres described above. Lung samples were homogenized and assayed by SDS-polyacrilamide gel electrophoresis gelatin zymography to evaluate lung MMP-2 and MMP-9 activities. Saline or doxycycline produced no significant changes in MAP, HR, and in MMP-2 and MMP-9 activities. Conversely, lung embolization significantly reduced MAP by >32 mm Hg and HR by >90 bpm for more than 60 minutes, and increased MMP-9 activity by 43% (all p<0.05). No significant differences were observed in MMP-2 activity. However, lung embolization produced only transient hypotension in rats pretreated with doxycycline. In this group, MAP returned to baseline values 5 to 10 minutes after embolization. In addition, pretreatment with doxycycline blunted the increase in lung MMP-9 activity after lung embolization (p<0.05). This study demonstrates for the first time that MMP-9 inhibition with doxycycline attenuates APE-induced hemodynamic changes in the animal model examined. These findings indicate that MMP-9 activation plays a role in the pathophysiology of APE and suggest that pharmacologic strategies targeting specific MMPs with selective inhibitors may prevent the detrimental acute hemodynamic consequences of APE.
Tricuspid Valve Perforation by Permanent Pacemaker Lead
Authors: Erdinler Izzet , Okmen Ertan , Turek Onur , Yapici Fikri , Ozler Azmi , Cam Nese , Ulufer Tanju
Published: March 2006

Tricuspid valve perforation with pacemaker lead is one of the extremely rare complications of transvenous pacemaker implantation. Approximately all reported cases have been diagnosed at autopsy. The authors present a case of tricuspid valve perforation caused by pacemaker lead that was diagnosed during cardiac surgery and treated successfully by removing the lead and suturing the tricuspid valve.
Cardiac Catheterization Complicated by Iliacus Abscess: A Rare Complication of Transfemoral Approach
Authors: Yeh Yung-Hsin , Chang Chi-Jen , Hsu Tsu-Shiu , Ko Yu-Shien , Hsu Lung-An , Kuo Chi-Tai
Published: March 2006

Iliacus abscess is an extremely rare complication of percutaneous transfemoral artery catheterization. This is a report of a case of iliacus abscess and Acinetobacter baumanii sepsis following percutaneous transfemoral artery catheterization. After a 43-day course of intravenous antibiotics treatment and repeated drainage, clinical recovery was achieved, though without complete radiologic resolution.
Acute Non-ST-Elevation Myocardial Infarction Presented as Occipital Headache with Impaired Level of Consciousness
Authors: Korantzopoulos Panagiotis , Karanikis Pavlos , Pappa Eugenia , Dimitroula Vasiliki , Kountouris Evaggelos , Siogas Konstantinos
Published: March 2006

Headache represents a rare manifestation of myocardial ischemic pain. It is believed that this clinical symptom results from convergence of heart autonomic fibers with somatic inputs originating from the head. The authors describe for the first time the case of a 73-year-old woman who experienced an acute non-ST-elevation myocardial infarction that manifested solely with intense occipital headache associated with vomiting and impaired level of consciousness. This unusual case highlights that the exclusion of an intracranial event in patients presenting with a severe headache and ischemic-like electrocardiographic abnormalities should raise the possibility of an acute coronary event, especially in elderly individuals with cardiovascular risk factors. Furthermore, the occurrence of episodic short-lasting headaches during exertion should direct diagnostic work-up toward ischemic heart disease.
Repetitive Monomorphic Ventricular Tachycardia Associated with Exercise
Authors: Dunbar Christopher C. , Kassotis John T. , Heyda Ewa K. , Saul Barry I. , Khan Aslam , Gelles Jeremiah
Published: March 2006

The case of a 45-year-old man suffering from a catecholamine-sensitive ventricular tachycardia originating from the right ventricular outflow tract is reported. The authors describe a novel noninvasive treatment strategy for the management of this patient.
Continuous Intravenous Administration of a Low Dose of Epoprostenol Greatly Decreased Serum Concentrations of Endothelin-1 in Primary Pulmonary Hypertension
Authors: Kakinuma Yoshihiko , Honma Satoshi , Morimoto Takashi , Maruyama Hidekazu , Yamazaki Akira , Ishimitsu Toshiyuki , Yamaguchi Iwao
Published: March 2006

Endothelin-1 (ET-1) is known to be a principal factor in the pathogenesis of primary pulmonary hypertension (PPH). Recently intravenous administration of epoprosterol improved the survival rate in PPH. However, the effect of epoprosterol on ET-1 remains to be investigated. Therefore, we studied a patient with PPH who was treated with a low dose of epoprosterol and examined the serum concentration of ET-1 during the treatment. Epoprosterol greatly decreased the serum concentration of ET-1 in parallel with improvement of the clinical course, suggesting that ET-1 level may be a marker for treatment of PPH.
The Relation Between Chronic Obstructive Pulmonary Disease and Coronary Collateral Vessels
Authors: Topsakal Ramazan , Eryol Namık Kemal , Abacı Adnan , Oymak Sema , Özdogru Ibrahim , Yılmaz Yücel , Seyfeli Ergün , Oguzhan Abdurrahman , Ergin Ali
Published: March 2006

Coronary collateral vessels can provide a perfusion reserve in case of increased myocardial oxygen demand. Development of coronary collateral vessels (CCV) is triggered by the pressure gradient between the coronary bed of arteries caused by an obstruction and myocardial ischemia. Myocardial hypoxia can facilitate development of CCVs. There is a chronic hypoxemia in patients with chronic obstructive pulmonary disease (COPD). The aim of this study was to evaluate the effect of COPD on CCVs. The study included 98 patients with COPD who underwent coronary angiography. Those patients in whom coronary angiography is normal or severity of coronary artery stenosis in thought not to be sufficient for the development of CCVs (<80%) were excluded from the study. A total of 98 patients (mean age, 62 ±9 years) met the criteria for the COPD group. For case-control matching, 98 consecutive without COPD patients (mean age 62 ±10) who had one or more diseased vessels with 80% or greater stenosis were included in the control group. The CCVs were graded according to the Rentrop scoring system, and the collateral score was calculated by summing the Rentrop numbers of every patient. The mean number of diseased vessels in patients with COPD and without COPD were 1.61 ±0.69 and 1.77 ±0.89 (p=0.155), respectively. The mean collateral score was 2.15 ±2.03 in the COPD group and 1.32 ±1.54 in the control group. After confounding variables were controlled for, the collateral score in patients with COPD group was significantly different from that in patients without COPD group (p=0.002). These findings suggest that CCV development is better in patients with COPD than in those patients without COPD. Thus, COPD may be an important factor affecting CCV development, which may be related to the presence of chronic hypoxemia in patients with COPD.
Effect of Obesity on Coronary Collateral Vessel Development in Patients with Coronary Artery Disease
Authors: Tatlı Ersan , Yildiz Mustafa , Gül Çetin , Birsin Atilla , Karahasanoglu Erhan , Özçelik Fatih , Özbay Gültaç
Published: March 2006

The purpose of this study was to compare coronary collateral circulation and with other risk factors in patients with coronary artery disease and different body mass index. Between January 1999 and December 2001, of 867 patients who underwent angiography for the first time, 90 patients (24 women and 66 men), with occlusion in only 1 coronary artery participated in the study. Information regarding age, body mass index, sex, smoking, hypertension, diabetes mellitus, hyperlipidemia, preinfarction angina, and use of oral beta blockers and nitrates were recorded for all patients. The patients were separated into 2 groups in accordance with development of their coronary collateral circulation; those with insufficient (Rentrop 0, 1, and 2) and those with sufficient coronary collateral circulation. They were also divided into 3 groups on the basis of body mass index as follows: (I) 18.0-24.9 kg/m2, (II) 25.0-29.9 kg/m2, and (III) more than 30 kg/m2. In the obesity and overweight groups, hyperlipidemia, diabetes mellitus, and nitrate use were identified more frequently than in the other groups (p<0.05). Use of oral nitrates more than 6 months before the myocardial infarction and existence of preinfarction angina affected collateral coronary vessel development in the positive direction (p=0.01, p=0.03, respectively). There was no correlation between coronary artery disease and coronary collateral vessel development in the obese patients (p=0.6). Although it has been shown that coronary collateral vessel development was affected negatively in obese patients with coronary artery disease, no statistical significance was identified.
A Study on the Safety, Efficacy, and Efficiency of Sulodexide Compared with Acenocoumarol in Secondary Prophylaxis in Patients with Deep Venous Thrombosis
Authors: Cirujeda J. Lasierra , Granado P. Coronel
Published: March 2006

This study was carried out to study the safety and efficacy of a fixed dosage of sulodexide compared to adjusted dosages (INR) of acenocoumarol as secondary prophylaxis in patients with deep vein thrombosis (DVT) in lower limbs. An economic evaluation based on the criteria of use in normal clinical practice was also performed. One hundred and fifty patients of both sexes were included, all over 18 years of age and diagnosed with proximal DVT of the lower limbs by color echo-Doppler, and with clinical evolution of less than 1 month. The patients were initially treated with low-molecular-weight heparin (LMWH) and urokinase in accordance with the established protocol. They were then randomized to continue treatment with acenocoumarol and INR adjustments every 30 days, or with sulodexide. Treatment was extended for 3 months with monthly follow-up visits and a final visit at 3 months posttreatment. No differences between the groups were detected concerning demographic or basal characteristics in clinical evolution or adverse reactions. In the group treated with sulodexide, no major/minor hemorrhagic complications were detected. On the other hand, in the acenocoumarol group, 1 major hemorrhage and 9 minor hemorrhages were produced (13.3%), reaching statistical difference in relation to the sulodexide group (p=0.014; CI from 95% of 4.7% to 19.4%). Regarding the economic impact, treatment costs with sulodexide are much less than those with acenocoumarol, the data confirmed by the sensitivity analyses performed. The results prove the efficacy, safety, and efficiency of sulodexide as a secondary prophylaxis in thromboembolic disease, avoiding hemorrhagic risks and the monitoring of patients, and providing significant savings to the health system.
Visceral Fat Obesity Contributes to the Tortuosity of the Thoracic Aorta on Chest Radiograph in Poststroke Japanese Patients
Authors: Mochida Manabu , Sakamoto Hironosuke , Sawada Yoshie , Yokoyama Hironori , Sato Mahito , Sato Hiroko , Oyama Yuko , Kurabayashi Masahiko , Tamura Jun-ichi , Sakamaki Tetsuo
Published: March 2006

Tortuosity of the thoracic aorta on chest radiographs is characteristic of atherosclerotic disease. Aging and hypertension are associated with the tortuosity, but little is known about the influence of other atherosclerotic risk factors on this abnormality. The purpose of this study was to examine which atherosclerotic risk factors are determinants for tortuosity of the thoracic aorta. Forty-five poststroke Japanese patients (31 men and 14 women, age range 41-78 years and mean 60.5 ±8.6) were studied. The distance factor, ie, the ratio of meandering vessel length to the straight-line distance between its end points, was used to measure arterial tortuosity. The hospital records were reviewed for clinical and biochemical variables. Tortuosity of the thoracic aorta had a significant positive relationship with body mass index (BMI) ( r =0.397, p<0.01), waist circumference ( r =0.360, p<0.05), and the cardiothoracic ratio (CTR) ( r =0.526, p<0.001), and a significant negative relationship with ankle-brachial pressure index (ABPI) ( r =-0.360, p<0.05). Stepwise regression analysis showed that waist circumference and CTR were independently correlated with increased tortuosity, whereas ABPI was negatively correlated with it. These results suggest that visceral fat obesity is a novel contributor to tortuosity of the thoracic aorta, which may be as a shortening of the distance between aortic tethering points due to elevation of the diaphragm by excessive intraabdominal fat and as a consequence of aortic elongation due to arteriosclerosis caused by obesity-related metabolic disorders.
Recurrent Tuberculous Pseudoaneurysm of the Descending Thoracic Aorta
Authors: Sirvanci Mustafa , Onat Levent , Karaman Kutlay , Yagan Naci , Sonmez Bingur
Published: March 2006

Tuberculous pseudoaneurysm of the aorta is a rare disease that is uniformly fatal if not treated properly. The authors present a case of a recurrent tuberculous false aneurysm of the descending thoracic aorta that was treated surgically with excision and primary repair of the lesion. To their knowledge, this is the first reported case of recurrent disease after a successful surgical treatment.
Occupation-Related Vascular Disorders of the Upper Extremity
Authors: Aleksic Marko , Heckenkamp Jörg , Gawenda Michael , Brunkwall Jan
Published: March 2006

Hypothenar hammer (HH) syndrome and vibration-induced white finger (VWF) syndrome are the main occupation-related vascular diseases of the upper extremity. The clinical presentation is similar to that of Raynaud’s phenomenon. The characteristic history will lead to the appropriate diagnosis being confirmed by angiographic features in HH and by functional tests in VWF. While in HH the underlying cause, which is mostly thought to be an aneurysm of the ulnar artery, might be cured surgically, in VWF only medical treatment offers relief from the symptoms. The knowledge of these entities is necessary to suspect such disorders so that further exposure to risk factors like repetitive hypothenar trauma or work with vibrating hand-held tools can be avoided, which is of great importance for the overall prognosis of these patients.
Bilateral External Iliac Artery Catheter-Induced Vasospasm During Angiography
Authors: Gallagher Chris , Shanklin Chris , Roonsritong Chanwit , Halldorsson Ari , Tsikouris James , Meyerrose Gary
Published: March 2006

The occurrence of catheter-induced vasospasm of small-caliber arteries during cardiac angiography is well documented. In contrast, little documentation of catheter-induced vasospasm in large-caliber arteries exists. This case presents reproducible catheter-induced vasospasm with bilateral asymptomatic occlusion of the femoral and iliac arteries.
Recurrent Aortic Angiosarcoma
Authors: Tulsyan Nirman , Valentin Marlene D. , Ombrellino Michael , Moritz Mark , Agis Harry , Kabnick Lowell
Published: March 2006

Primary aortic tumors are rare; only 86 cases of primary aortic angiosarcoma have been reported since its first description in 1873. The diagnosis of aortic angiosarcoma is usually confirmed by postoperative pathologic examination or postmortem study. The authors present a case of primary aortic angiosarcoma with postresection recurrence.
Recurrent Peripheral Arterial Embolism from Metastatic Lung Choriocarcinoma
Authors: Spácil Jiří , Hradec Jaromír , Král Jiří
Published: March 2006

A patient with choriocarcinoma, most likely of ovarian origin, with lung metastasis is presented. The disease manifested itself by recurrent embolism into the peripheral arteries. Literature on this topic is reviewed.
Every Nose Counts: A New Influenza Vaccine for All Healthy Schoolchildren?
Authors: Gaglani Manjusha J. , Herschler Gayla B.
Published: March 2006

Influenza is a vaccine-preventable disease. However, influenza virus spreads among children in schools and daycare centers, then to families and communities, causing uncontrolled epidemics every winter. The United States Food and Drug Administration evaluated and approved an investigational live-attenuated, cold-adapted, trivalent influenza vaccine for licensure, for prevention of influenza in healthy children and healthy adults, 5 through 49 years of age. Could protection of healthy schoolchildren against influenza limit its spread and benefit society?
22q13 Deletion Syndrome: An Update and Review for the Primary Pediatrician
Authors: Havens Joaquim M. , Visootsak Jeannie , Phelan Mary C. , Graham John M.
Published: March 2006

Recent advances in genetic testing can help to provide a specific diagnosis to children born with syndromes that result in congenital anomalies and developmental delay. One such emerging condition is the 22q13 deletion syndrome. With the introduction of subtelomeric fluorescence- in-situ hybridization (FISH) analysis, the 22q13 deletion has become recognized as a relatively widespread and underdiagnosed cause of mental retardation. Primary-care physicians play an important role in the care of children with 22q13 deletion syndrome, from suspecting the diagnosis in a developmentally delayed child through the medical, developmental, and behavioral aspects of their care. Furthermore, they serve as a valuable source of support and advocacy for the family and a resource for other care providers. The remainder of this article addresses the current state of knowledge regarding 22q13 deletion syndrome and offers the primary-care physician a framework in which to provide care and information.
Management of Febrile Children in the Conjugate Pneumococcal Vaccine Era
Authors: Gabriel Michael E. , Aiuto Leslie , Kohn Nina , Barone Stephen R.
Published: March 2006

The objective of this study was to evaluate physician attitudes toward the management of young febrile children since the introduction of the conjugate heptavalent pneumococcal vaccine (PCV 7). Seven thousand five hundred pediatricians and 7,500 emergency department (ED) physicians were surveyed with regard to their management of a febrile 7-month-old child and 20-month-old child without an apparent fever focus. Specifically, physicians were asked how they would manage a febrile child who had and who had not been vaccinated with PCV 7. When evaluating a febrile 7-month-old child, pediatricians would order 5% fewer complete blood cell (CBC) counts and 6% fewer blood cultures (p<0.0001) if a child was vaccinated. ED physicians would order 13% fewer CBC’s and 15% fewer blood cultures (p<0.0001). ED physicians and pediatricians ordered fewer chest radiographs, an 8% and 3% decrease, respectively (p<0.0001). For the PCV 7 immunized 20-month-old child, pediatricians ordered 6% fewer CBC counts and 8% fewer blood cultures (p<0.0001). ED physicians would perform 12% fewer CBC counts and cultures (p<0.0001). Four percent fewer pediatricians and 10% fewer ED physicians would order chest radiographs (p<0.0001). When treating the vaccinated 7-month-old child, pediatricians would use 11% less ceftriaxone and ED physicians 20% less (p<0.0001). Twelve percent fewer pediatricians and 19% fewer ED physicians would administer ceftriaxone (p<0.0001) for the 20-month-old vaccinated child. Our survey suggests that pediatricians and ED physicians would order fewer CBC counts and blood cultures and administer less empiric ceftriaxone if a child was vaccinated with PCV 7.
Adenovirus Infection in Hospitalized Immunocompetent Children
Authors: Peled Nir , Nakar Charles , Huberman Henri , Scherf Edna , Samra Zmira , Finkelstein Yaron , Hoffer Vered , Garty Ben-Zion
Published: March 2006

This study investigated the clinical features of immunocompetent children with adenovirus infection requiring hospitalization. The files of 78 children (mean age 17 ± 10 months) with community-acquired adenovirus infection admitted over a 2-year period were reviewed. The children were referred after 5.7 ± 3.4 days of illness, all with fever (mean peak 39.8 ± 0.8°C). Temperature normalized after 3.5 ± 2 days. Duration of hospitalization (mean, 7.0 ± 3.9 days) correlated with lethargy, lung crackles, cracked lips, hypoxia, impaired liver tests, and high serum lactic dehydrogenase (LDH) concentration at admission. Serum LDH concentrations and hypoxemia predicted 70% of the variance in hospital stay. All patients recovered. Adenovirus infection may cause considerable morbidity, even in immunocompetent children. Disease severity, defined by duration of hospitalization, correlates with serum LDH concentrations and oxygen saturation at admission.
The Diagnosis of Intussusception
Authors: Klein Eileen J. , Kapoor Divya , Shugerman Richard P.
Published: March 2006

The aims of this study were to identify features in the history, physical examination, and radiologic studies that were associated with the diagnosis of intussusception and to determine if there was a subset of patients being evaluated for intussusception who can be spared from undergoing a contrast enema based on a combination of historical, clinical, and radiographic findings. A retrospective cohort study at a regional children’s hospital emergency department (ED) was conducted. Mean age was 1.2 years among both those with and without intussusception. Predictors of intussusception in the univariate analysis included history of vomiting (P=0.02), abdominal pain (P=0.1), and rectal bleeding (P=0.003); physical examination findings of abdominal mass (P<0.001), abdominal tenderness (P=0.02), and guiac positive stool (P=0.004); and plain radiograph finding of the absence of stool in the ascending colon (P<0.05). We were unable to develop a prediction model that would reliably identify all patients with the diagnosis of intussusception. Previously identified predictors of intussusception remain important in increasing suspicion of this important diagnosis. At this point there is no reliable prediction model that can accurately identify all patients with intussusception. A prospective study may aid in the development of a clinically more useful model.
Pediatricians’ Training and Identification and Management of Psychosocial Problems
Authors: Leaf Philip J. , Owens Pamela L. , Leventhal John M. , Forsyth Brian W. C. , Vaden-Kiernan Michael , Epstein Leonardo D. , Riley Anne W. , Horwitz Sarah M.
Published: March 2006

This study evaluated the association of pediatrician training on the identification and management of current and ongoing emotional or behavioral problems among children ages 4-8 years in 19 practices in south-central Connecticut. Pediatricians with advanced training in psychosocial issues were more likely to identify children’s psychosocial problems and use multiple management strategies compared with pediatricians with no specialized training. Although pediatricians with moderate training in psychosocial issues were more likely to identify psychosocial problems compared with pediatricians with no training, there was no relationship between moderate training and management of psychosocial problems. These results suggest that identification and manage ment of young children’s psychosocial problems demands advanced training and support the American Academy of Pediatrics’ call for more extensive training.
Post-Tonsillectomy Hemorrhage and Pediatric Emergency Care
Authors: Peterson Jeffrey , Losek Joseph D.
Published: March 2006

A cross-sectional, retrospective review of consecutive patients who presented to 1 of 2 pediatric emergency departments with post-tonsillectomy hemorrhage was undertaken. The study population included children who had secondary hemorrhage (bleeding at greater than 24 hours after tonsillectomy). Over a period of 2 years, 90 children received emergency care for secondary post-tonsillectomy hemorrhage. The average age was 8.5 years and there were 40 (44%) males. The average time from tonsillectomy to emergency department (ED) presentation was 7.3 days. One patient was hypotensive, and 7 had hemoglobins <10 mg/dL. Signs of bleeding on examination of the tonsillar fossa were active (4), oozing (18), clots (48), and none (14). Of the 70 children with signs of bleeding, 63 (90%) were treated surgically and 7 (10%) were observed. Four (6%) of the 63 children who had signs of bleeding and were managed surgically and 3 (43%) of the 7 children who had signs of bleeding and were managed by observation had repeat episodes of bleeding. Of the 14 patients with no signs of bleeding, all were observed and none had repeat episodes of bleeding. Signs of bleeding were not documented in 6 patients. Active hemorrhage and cardiovascular compromise were uncommon in this study population. Surgical management is recommended for children who have signs of bleeding, while observation appears to be appropriate for children who have no signs of bleeding.
Intranasal Mucocele of the Nasolacrimal Duct: An Important Cause of Neonatal Nasal Obstruction
Authors: Brachlow Allison , Schwartz Richard H. , Bahadori Robert S.
Published: March 2006

Anterior nasal obstruction secondary to cystic or solid masses is believed to be uncommon. Previous single or series case reports of intranasal mucoceles of the nasolacrimal duct have been published in otolaryngology, ophthalmology, or radiology journals but were not found in general pediatric journals. A 5-year retrospective chart review from our children’s hospital found 10 previously unreported cases of intranasal mucocele of the lacrimal duct causing neonatal nasal obstruction. The purpose of this report is to familiarize pediatricians with this entity, which was the most common cause of anatomic anterior nasal obstruction at our hospital.