bluuebunny/crossref_metadata_2025 huggingface dataset:
Predictive Value of Manual ECG-Monitored Exercise Test Before Abdominal Aortic or Peripheral Vascular Surgery
Authors: Kaaja Risto , Sell Henrik , Erkola Olli , Harjula Ari
Published: July 2008

The value of manual ECG-monitored exercise test was studied in 58 patients (39 men and 19 women) with intermittent claudication scheduled for abdominal or peripheral vascular surgery. There was a high incidence of well-known risk factors (hypercholesterolemia, smoking, and hypertension) in men and women. History of coronary artery disease (CAD) was present in 29.3% of the patients. No correlation was found between patients with single or multiple stenoses in lower extremity arteries (angiography) and CAD. Ischemic response (ECG) to manual exercise testing was positive in 14 patients (24.1%), of whom 2 (14.3%) had major cardiovascular postoperative complications. Both died of acute myocardial infarction within fourteen days. They had slow recovery (thirty to sixty minutes) of the ST segment (0.3-0.6 mV).

The authors conclude that manual exercise testing might reveal serious CAD in patients with severe occlusive peripheral arterial disease of the lower extremities. In cases with slow recovery of ischemic response to exercise, coronary bypass or angioplasty could be advantageous before major vascular surgery.
Duplex Ultrasonography for the Detection of Deep Vein Thrombi After Total Hip or Knee Arthroplasty
Authors: Elliott C. Gregory , Suchyta Mary , Rose Steven C. , Talbot Steve , Ford Clynn , Raskob Gary , Hull Russell , Davidson Bruce
Published: July 2008

The usefulness of real-time duplex ultrasonography (DU) as a screening test for deep vein thrombosis (DVT) in high-risk patients remains uncertain. To determine the sensitivity and specificity of DU for the detection of DVT, the authors prospectively studied 178 consecutive patients after total hip (n=113) or total knee (n = 66) arthroplasty. The deep veins from the inguinal ligament to the ankle were examined first by continuous wave and then by pulsed Doppler signals as needed with real-time gray-scale ultrasound imaging using the criteria of vein noncompressibility to define DVT. Ascending contrast venography was performed within twelve hours after DU studies. Venograms and DU were interpreted independently. DU was attempted on 177 lower extremities (2 patients refused) but was judged adequate for interpretation for only 145 (82%). Venography could not be performed for 28 lower extremities and was technically inadequate for 8 studies. The primary analysis included 119 examinations for which adequate DU and ascending venograms were interpreted. DU was positive in 17 of 27 lower extremities with DVT (23 calf, 4 proximal) diagnosed by venography (sensitivity = .63; 95% confidence interval [CI] = .42 to .81), and DU was negative in 85 of 92 lower extremities with normal venograms (specificity = .92; 95% CI = .85 to .97). A secondary analysis of 81 prospectively collected anatomically complete DU studies demonstrated a sensitivity of .80 (95% CI = .56 to .94) and a specificity of .90 (95% CI = .80 to .96). The authors conclude that real-time DU is not sensitive for the detection of venographically demonstrable calf DVT in the operated-on lower extremity following total hip or knee arthroplasty. Real-time DU is specific for the diagnosis of DVT following total hip or knee arthroplasty.
Decreased Platelet Activity Without Change in Fibrinolytic Activity After Low Dosages of Fish Oil
Authors: Winther Kaj , Myrup B. , Hølmer G. , Høy C.-E. , Mehlsen J. , Schnohrt P.
Published: July 2008

The effects of low-dose (350 mg daily) polyunsaturated fatty acids from fish oil, either in gelatine capsules or microencapsulated, were investigated in a non-blind, randomized, crossover study of 12 healthy male volunteers. The authors measured the incorporation of eicosapentaenoic acid (EPA) into platelets membranes, platelet aggregability by adenosine diphosphate (ADP) and adrenaline, and fibrinolytic activity as euglobulin lysis time, after two and six weeks of therapy.

Both formulations resulted in increased incorporation of EPA into platelet membranes, and the microencapsulated formulation also significantly increased the platelet level of ADP for irreversible aggregation (by about 60%). Fish oil in gelatine capsules had a smaller, non-significant effect in the same direction. Both formulations reduced adrenaline-induced aggregability, but the effects did not attain significance. Neither formulation altered fibrinolysis.

The data show that low doses of fish oil in microencapsulated form significantly lower platelet aggregability, without affecting fibrinolysis.
Ethanol Modulates Cyclic GMP Metabolism in Cultured Coronary Smooth Muscle Cells
Authors: Kishi Yukio , Oniki Toshiyuki , Ashikaga Takashi , Numano Fujio
Published: July 2008

The authors tested the hypothesis that ethanol or its metabolite acetaldehyde might interfere in cyclic guanosine monophosphate (GMP) metabolism in coronary smooth muscle cells. Ethanol at the physiologically relevant concentration of 4.0 mg/mL or more significantly decreased basal guanylate cyclase activity and inhibited activation of the enzyme by sodium nitroprusside (SNP) in cultured porcine coronary smooth muscle cells. Two isoforms of phosphodiesterase (PDE), cyclic GMP-specific form and calmodulin-stimulated form, were both inhibited by 12.0 mg/mL or more ethanol. Intact cell study revealed that although 12.0 mg/mL or more ethanol was needed to significantly decrease cyclic GMP accumulation in control cells, 4.0 mg/mL or more ethanol significantly inhibited the increase of cyclic GMP accumulation induced by 1 μm SNP. Acetaldehyde showed similar effects, but the concentrations involved were more than physiological. Thus, ethanol may decrease cellular cyclic GMP levels and attenuate cyclic GMP accumulation in response to SNP in coronary smooth muscle cells by inhibiting soluble guanylate cyclase activity at physiologically relevant concentrations.
Septal Perforator Artery Angioplasty: The Advantage of Application of an Ultralow-Profile Balloon System— A Case History
Authors: Topaz On , Cacchione Joseph , Nair Ravi
Published: July 2008

Coronary artery disease can affect the septal perforator arteries and cause clinical sequelae, including angina, infarction of the interventricular septum, arrhythmias, and congestive heart failure. However, the size and the course of the septal perforator arteries significantly differ from those of the major epicardial coronary vessels. These anatomic features present certain technical challenges for angioplasty of the septal arteries. This case demonstrates that application of an ultralow-profile balloon-over-the-wire system can meet the specific requirements of septal artery angioplasty and achieve adequate results.
Complete Obstruction of Right Proximal Pulmonary Artery: A Case Report
Authors: Meno Hiroshi , Higashi Hideki , Hamanaka Norio
Published: July 2008

A fifty-five-year-old woman had worried about dyspnea for three years. A chest x-ray appeared normal except for hypovascularity of the upper lung field. On angiograms, a wedge-shaped obstruction was observed at the left proximal pulmonary artery, and well-developed collateral circulation from the right thoracic artery to the internal costal arteries was observed. On the exercise test, exertional dyspnea developed with tachycardia and a decreased saturation of arterial oxygen.
Compression of Vein Graft by Hematoma During Fibrinolytic Therapy Simulating Intrinsic Venous Stricture—A Case Report
Authors: Sprayregen Seymour , Bakal Curtis W. , Cynamon Jacob
Published: July 2008

Narrowing of a vein graft at an area of perigraft extravasation was encountered during fibrinolytic therapy for graft thrombosis. With cessation of fibrinolytic therapy, extravasation ceased and the vein lumen widened. Extrinsic compression and/or spasm due to a hematoma should be included as causes of vein graft narrowing in patients undergoing fibrinolytic therapy.
Combined Effects of Urokinase and Heparin on PTT Values During Thrombolytic Therapy
Authors: Sheiman Robert G. , Phillips David A.
Published: July 2008

The local infusion of urokinase may be complicated by hemorrhage. Except for maintaining fibrinogen levels above 100 mg/dL, no other criteria exist for titrating the dose of urokinase to avoid hemorrhagic complications. A retrospective examination of the fibrinolytic and coagulation states was performed on 11 patients receiving local high-dose urokinase (240,000 U/hr) and heparin for thrombolysis of acute occlusions to identify parameters other than fibrinogen levels that may correlate with bleeding complications. Five patients experienced bleeding complications, 3 of whom had partial thromboplastin time (PTT) values greater than 150 seconds. None of the five patients having hemorrhagic complications had fibrinogen levels below 100 mg/dL at any time. Urokinase began to enhance the effect of heparin on PTT values as a result of reducing fibrinogen levels. In 10 of 11 patients this effect caused PTT values to at least double when compared with heparin alone. This substantial rise in PTT occurred only after fibrinogen levels approached 200 mg/dL in 8 of 11 patients. Although the number of patients is small, these data suggest that when heparin is used during thrombolysis, closer PTT monitoring should be carried out as fibrinogen levels begin to decline, especially when they approach 200 mg/dL, to avoid excessive PTT elevations and subsequent bleeding.
New Approaches in the Medical Management of Venous Ulceration
Authors: Colgan Mary-Paula , Moore Dermot J. , Shanik D. Gregor
Published: July 2008

This literature survey of the medical treatment of venous ulcers of the lower extremities discusses five classes of agents: (1) fibrinolytics, (2) hydroxyrutosides, (3) prostaglandins, (4) methylxanthines, and (5) others. The authors conclude that all these agents require further research.
Tricuspid Valve Thromboembolus with Recurrent Pulmonary Embolism—A Case Report
Authors: Roistacher Nancy , Pierri Mary Kathryn , Keefe Deborah
Published: July 2008

The authors describe a fifty-one-year-old man with multiple pulmonary emboli in whom two-dimensional echocardiography clearly showed a large mobile thrombus transiently entrapped in the chordal apparatus of the tricuspid valve, a location rarely noted except in autopsy specimens. Subsequent lung scan and echocardiograms documented clinically silent nonfatal embolization of this large thrombus to the lungs.

Whereas most patients with this form of thromboembolic disease come to either surgery or autopsy, this case demonstrates how the combination of echocardiography and lung scanning can be used to differentiate the etiology of some right-heart masses.
Case of Fluoxetine-Induced Remission of Raynaud's Phenomenon—A Case Report
Authors: Bolte Mary Ann , Avery David
Published: July 2008

The authors report complete remission of digital ischemia, blanching, ulceration, pain, and poor fingernail growth associated with Raynaud's phenomenon in a thirty-one-year-old, nondepressed woman treated with fluoxetine.
Experimental Manufacture of a Catheter for the Measurement of Blood Flow Rate
Authors: Ota Toshiaki , Matsuda Hitoshi , Tsukube Takuro , Okada Masayoshi
Published: July 2008

The authors manufactured an experimental catheter to obtain blood flow rate, measuring not only the flow velocity but also the vessel diameter. This catheter consists of 3F Doppler and 7F external sheath catheters, and four thin wires 3 cm in length are attached to the catheters at both tips at a 90° pitch. After the insertion of the catheter into the vessel, vessel diameter is calculated from the maximal width of the wires, which are expanded to a spindle shape inside the vessel; the maximal width is corrected with calibration metal markers also attached at the proximal site of the external sheath catheter. The flow veloc ity of the blood is calculated with the FFT (Fast Fourier Transform) analyzer.

In experimental circuits as well as in the canine aorta, wires were adequately expanded, and the catheter was placed at the center of the tube or the aorta. The blood flow rate, which was calculated as a product of flow velocity and vessel diameter, was well correlated to that from the electromagnetic flowmeter, not only in the experimental circuits, but also in the canine aorta.
Value of Finger Arterial Blood Pressure in Diagnosis of Vascular Changes in Some Connective Tissue Diseases
Authors: El-Sayed Salem Mohamed , El-Girby Amira Hassan , Abd El-Moneim Nadia Ahmed , Khalil Selim Ahmed
Published: July 2008

This study was performed in 60 patients with the following connective tissue diseases: rheumatoid arthritis (RA—20 patients), systemic lupus erythematosus (SLE—20), and progressive systemic sclerosis (scleroderma=PSS-20). Twenty normal persons served as controls.

All patients and controls were subjected to complete history taking, complete physical examination, and laboratory investigations including: rheumatoid fac tor, anti-DNA, LE cell test, antinuclear factor (ANF), and ECG.

Finger arterial blood pressure (FABP) readings using an 8 MHz Doppler flow detector with a 24-mm-diameter cuff at a temperature of 24°C were made in all cases and controls. The mean age of incidence in patients with RA was 37.8 years; in those with SLE, 21.5 years; in those with PSS 34.6 years; and in the control group, 33.7 years. Women were predominant both in the diseases and the control groups. The FABP was measured in all groups and the range of difference between the brachial and finger arterial blood pressure in each group was estimated. In the control group the mean difference was 27.7 mm Hg; in the RA group, 45.8 mm Hg; in the SLE group, 58.1 mm Hg; and in the PSS group, 70.9 mm Hg. There were no significant peripheral vascular changes in the small arteries in the RA group, whereas in the SLE and PSS groups there was a significant difference, which suggests different underlying microvascular changes. The FABP appears to be a diagnostic tool in the diagnosis of PSS and it helps in differentiation between various types of collagen disease in equivocal cases.
Raynaud's Syndrome, an Enigma After 130 Years
Authors: Cleophas Ton J. M. , Niemeyer Menco G.
Published: July 2008

The recent literature concerning Raynaud's syndrome is reviewed. Ray naud's syndrome is as common as hypertension and diabetes. In spite of its generally benign character, it causes a lot of discomfort to individuals and sick ness absenteeism to society, especially in the colder regions of the world.

The etiology remains an enigma 130 years after its first description, perhaps even more so than ever before, the many new theories proposed in the litera ture. Clearly, in a condition where seventy different etiologic theories are advo cated, the culprit lesion is obviously missing, or there is not a culprit lesion but an accumulation of conditions having nothing in common but a few symptoms. Moreover a Raynaud attack may result, not from a single event, but from a cascade of events, just as, for example, hemostasis does.

Controversy about diagnosis exists all over. For example, how does one make a diagnosis? Patient history has been considered unreliable. A standardized cold test, though highly reproducible in the authors' hands, is far from common property.

Raynaud's syndrome is a condition for which thirty-eight therapies have been advocated in the last three years, but the curative answer is still to come.
Radiological Aspects of Arteriosclerosis: Follow-up Study of 588 Patients in Two Different Groups
Authors: Löhr E. , Herweg B. , Gocke P.
Published: July 2008

The authors retrospectively compared two groups of patients who had un dergone angiography over a twenty-one-year period. The first group consisted of 348 patients who had angiography in the years 1965-1967. The second group was made up of 222 patients who had had angioplasty in the years 1975-1986. Special risk factors such as diabetes and nicotine abuse were singled out to gether with localization of lesions and gender distribution.
Treatment of Arteriosclerotic Obstruction by LDL Adsorption
Authors: Agishi Tetsuzo , Naganuma Shinji , Nakasato Satoshi , Kitajima Kumiko , Ota Kazuo , Ban Kimio , Nomura Minoru
Published: July 2008

According to the authors' clinical analysis, about half of the patients who suffer from arteriosclerotic obstruction (ASO) in the lower extremity(-ies) with clinical manifestation are dyslipidemic (total cholesterol ≥ 220 mg/dL or LDL cholesterol ≥140 mg/dL). As suggested by clinical success in regression of ASO in the coronary arteries as a result of aggressive removal of LDL, LDL adsorp tion utilizing an extracorporeal circulation technique with a dextran sulfate/cel lulose adsorbent column was applied in 33 patients (22 men and 11 women) with ASO. Clinical results obtained after a series of 10 LDL adsorption procedures as a standard showed encouraging success. Improvement in subjective symp toms was achieved as follows: 88.5% for cold lower extremity, 87.1% for inter mittent claudication, 53.8% for leg/toe pain at rest, and 60% for disappearance/ size diminution of ulcer/necrosis. Improvements in objective examination find ings supported subjective ones: 85.7% by plethysmography, 81% by thermogra phy and 70% by ankle pressure index. No serious complications or untoward ef fects were observed during or after the adsorption procedures. In conclusion, LDL adsorption appears to be a useful and safe tool in treatment of ASO pa tients with dyslipidemia.
Traumatic Rupture of the Aorta with Ductus Diverticulum: A Case History
Authors: Baker Julie , Julsrud Paul , Welch Timothy
Published: July 2008

Traumatic rupture of the aorta is a life-threatening injury with an extremely high mortality rate if not promptly diagnosed and surgically repaired. Accurate diagnosis depends on a high index of suspicion and the correct assessment of the angiographic features revealed by aortography. A case is presented that illus trates the angiographic findings in a patient with traumatic rupture of the aorta with an accompanying ductus diverticulum. A ductus diverticulum, which is located just distal to the aortic isthmus, can be confused with an aortic tear angiographically and vice versa. The case discussed demonstrates the difference between these two entities.
Massive Spinal Cord Infarction With Multiple Paradoxical Embolism: A Case Report
Authors: Mori Sakan , Sadoshima Seizo , Tagawa Koichi , Iino Kouzo , Fujishima Masatoshi
Published: July 2008

A sixty-seven-year-old man suffered from acute anterior spinal artery syn drome at the level of T-10. Transverse myelopathy developed by the eighth day. Computed tomography of the brain on the thirteenth day demonstrated hemor rhagic infarction in the left occipital lobe and fresh ischemic infarction in the right cerebellar hemisphere. Respiratory distress was the cause of death on the fifteenth day. Autopsy study showed severe ischemic necrosis of the spinal cord below T-10, and multiple infarcted lesions in the brain, lung, kidney, and heart. Saddle thromboembolism of the bilateral trunk of the pulmonary artery was the major cause of his death. Deep venous thrombosis in the pelvis was disclosed to be the primary source of multiple paradoxical embolisms through the patent foramen ovale.
Observations on Plasma ANP Levels During Short-Term Transient Myocardial Ischemia Produced by PTCA in Patients with LAD Stenosis
Authors: Gasser R. , Luha O. , Dusleag J. , Eber B. , Rotman R. , Klein W. , Fueger G.R.
Published: July 2008

Ten patients with coronary artery disease and stable angina (mean age fifty- seven) were included in the study. Five of the patients had normal left ventricu lar function, 5 had local hypokinesia or akinesia; 8 had one-stem and 2 had two- stem disease, but all had left anterior descending (LAD) lesions ranging from 75% to 100%. Ejection fraction varied between 35% and 75% (mean 59%). Im munoreactive atrial natriuretic polypeptide (ANP) levels in the femoral vein (FV) and the coronary sinus (CS) were measured before, immediately after, and up to twenty-four hours after percutaneous transluminal coronary angioplasty (PTCA) of the LAD. ANP secretion increased by 83% (FV) and 11% (CS) with in minutes after PTCA and reached control levels after thirty to sixty minutes. In patients with hypokinesia of the anterior wall, ANP secretion was significantly lower, 48% (FV) and 11% (CS) respectively. ANP secretion during PTCA was higher in patients with concomitant increase in pulmonary capillary pressure (PCP) but was also observed without an increase of PCP, suggesting ventricular ANP secretion.

In conclusion, transient myocardial ischemia leads to immediate ANP secre tion even in the absence of significant pressure elevation in the left atrium.

As a part of the continuous medical education program of the American Col lege of Angiology the second part of the paper reviews the mechanisms that al low the ischemic heart to counteract the ischemic condition and thus to escape from myocardial infarction. A review on this subject is presently not available in the literature.
In Vitro Pulmonary Vasorelaxant Effect of the Phosphodiesterase Inhibitor Enoximone
Authors: Yazdani Butt A. , Tuan Dinh-Xuan A. , Pepke-Zaba Joanna , Cremona George , Clelland Colin A. , Higenbottam Timothy W.
Published: July 2008

Enoximone is a phosphodiesterase inhibitor that has both positive inotropic and systemic vasorelaxant activities. The latter are mediated by an increase in vascular smooth muscle concentration of cyclic 3'5' guanosine monophosphate. However, the effect of enoximone on pulmonary vasoreactivity is not estab lished. The authors, therefore, have studied its effect on endothelium-depend ent relaxation mediated by the endothelium-derived relaxing factor nitric oxide (NO), as well as endothelium-independent relaxation of isolated porcine pulmo nary arteries.

Enoximone (10-7 to 10-4 M) caused a dose-dependent relaxation in all pulmo nary arterial rings. This relaxation neither required the presence of the endo thelium nor was affected by the addition of the inhibitor of NO synthase ω-nitro-L-arginine methyl ester (10-4 M). Also, the vasorelaxant response of the rings to the endothelium-dependent vasodilator adenosine diphosphate (10-10 to 10-5 M) was not affected by pretreatment with enoximone.

The authors conclude that enoximone is a potent vasodilator that relaxes pulmonary vascular rings through mechanisms independent of the endothe lium. This endothelium-independent vasodilatory effect of enoximone makes it a potentially valuable drug for the treatment of pulmonary hypertension. This particularly applies to diseases in man where NO production by the endothelial cells is impaired.
Three-Month Therapy with Calcium-Heparin in Comparison with Ticlopidine in Patients with Peripheral Arterial Occlusive Disease at Leriche-Fontaine IIb Class
Authors: Andreozzi Giuseppe Maria , Signorelli Salvatore Santo , Cacciaguerra Giuseppe , Di Pino Luigi , Martini Romeo , Monaco Sergio , Butto' Giuseppe , Sardina Marco
Published: July 2008

Forty patients with a mean age of 62.6 ± 6 years, 36 men and 4 women, with peripheral arterial occlusive disease (PAOD) at Leriche-Fontaine IIb class, were randomly allocated to one of two treatment groups, receiving either 12,500 IU/ day of subcutaneous (sc) calcium-heparin (CAE) or 250 mg/day of oral ticlopi dine, each given for ninety days. The following parameters were evaluated be fore the start of the active treatment period and after thirty and ninety days of treatment: pain-free walking distance (PWD), maximum walking distance (WDmax), systolic and diastolic blood pressure (BP), posterior tibial arterial pressure and Winsor index at rest and after exercise (treadmill), transcutaneous oxygen and carbon dioxide pressures at rest (TcPO2 and TcPCO2 respectively), and time to 50% TcPo2 recovery after three-minute ischemia. Both treatments induced an improvement in PWD/WDmax, which, at the end of the study, were increased by 50.7/58.7% and 31.7/36.2%, respectively, for CAE and ticlopidine treatments, respectively.

Statistical analysis did not show any difference between treatments, al though a statistically significant difference was found in comparison with basal measurements for both CAE and ticlopidine treatments (p < 0.01). Neverthe less, the effects determined by ticlopidine were, on the whole, less impressive than those of CAE.

In fact, interestingly, although not in a statistically significant way, the CAE group walked longer in comparison with the ticlopidine group irrespective of the more critical baseline clinical conditions.

Moreover, TcPo2 was favorably modified by CAE (p < 0.01) but not by ticlopidine treatment while the other parameters remained unchanged.

In conclusion, CAE, given at the daily dose of 12,500 IU in patients with PAOD at the Leriche-Fontaine IIb class, showed beneficial clinical effects, which, in turn, could be due both to the removal of the thrombophilic im balance and to the restoration of the fibrinolytic-coagulatory hemostasis in the involved microvascular circulation.
Echocardiographic Features of Embolized Inferior Venacaval Filter to the Right Ventricle—A Case Report
Authors: Alam Mohsin , Levine T. Barry
Published: July 2008

The authors describe two-dimensional echocardiographic features of an infe rior venacaval filter that migrated to the right ventricle. As far as they can determine, this is the first description of the echocardiographic aspects of this clinical entity.
Primary Muscular Hydatid Cyst Causing Arterial Insufficiency: Case Report and Literature Review
Authors: Yörükoglu Yavuz , Zengin Mustafa , Dolgun Alp , Nazliel Kemal , Salman Ergun , Paşaoglu Eşref , Yucel Ertan
Published: July 2008

Hydatid disease, though known to occur in most organs and areas of the body, is extremely rare in skeletal muscle. In this article the authors present a case of a primary muscular hydatid cyst, originating from the adductor muscle group, causing obstruction of the femoral artery and vein.
Coronary Artery Ectasia-A Case Report and Literature Review
Authors: Tomaru Akihisa , Takigawa Kazutoshi , Kagawa Noboru , Suzuki Yasuhiro , Sue Hiroyuki , Arai Takahiro , Inoue Hajime , Hamada Mitiyasu , Yoshikawa Makoto , Nishiyama Naoki , Okano Hiroshi
Published: July 2008

A case report of coronary artery ectasia is presented. A middle-aged man was admitted with sudden onset of respiratory arrest which is a rather rare occurrence. Relevant articles are reviewed, and discussion mainly concerns the etiologic and pathophysiologic point of view.
Prevalence of Ventricular Premature Complexes in Healthy and Untreated Hypertensive Elderly People
Authors: Komsuoglu Baki , Duman Ekrem , $ener Komsuoglu Sezer , Görçin Bilal
Published: July 2008

Twenty-four-hour ambulatory electrocardiographic examination was per formed in 130 elderly patients (49 healthy, active subjects; 40 hypertensive with out left ventricular hypertrophy; and 41 hypertensive with left ventricular hypertrophy). In the study group, mean age was 72.4±7.1 (sixty-five to eighty- eight) years. A significantly high prevalence of ventricular ectopic complexes was found both in hypertensive and in normotensive groups. According to the Lown grades, in grade 1, VPCs had very high prevalence in healthy subjects, in grade 2, VPCs had a high prevalence in hypertensives with left ventricular hy pertrophy (73.5% and 48.8%, respectively). The results of this study demon strate that ventricular premature complexes were common in hypertensive patients and healthy elderly but did not cause high complexity in either group. Ventricular premature complexes detected by ambulatory ECG monitoring in healthy, active subjects and in untreated hypertensive patients are not an inde pendent risk factor in elderly patients.
Results of Directional Peripheral Atherectomy with Reference to Histology, Histochemistry, and Ultrastructure
Authors: Gonschior Peter , Höfling Berthold , Mack Brigitte , Simpson Lindi , Gerheuser Florian , Nerlich Andeas , Bauriedel Gerhard , Welsch Ulrich
Published: July 2008

One hundred patients with symptomatic peripheral vascular disease were treated with a directional atherectomy catheter; 153 lesions comprising 98 stenoses and 55 occlusions were located in the iliac (n=22), superficial femoral (n = 114), popliteal (n = 16), and anterior tibial (n=1) arteries. The majority of these patients were poor candidates for balloon angioplasty because of the com plexity of lesions. There were 70 eccentric and 28 concentric lesions and 55 occlusions (mean length 4.2 ± 2.9 cm). Acute success rate was 94% for both stenoses and occlusions. Four patients were treated in both lower extremities. The stenoses were reduced from 85 ± 12% to 12 ± 10% acutely (occlusions 100% to 9 ± 9%). Six-month angiographic follow-ups were performed in 81% of treated patients, the others refusing angiography. Mean stenosis after six months was 33 ± 25% (occlusions 44 ± 28%). Restenosis (> 50%) was found in 20% of treated lesions: 26% in concentric lesions, 8% in eccentric lesions, and 32% in occluded vessels.

Treatment of peripheral vascular disease with the atherectomy device is safe and effective therapy with good long-term results. These results were obtained in complex lesions with 55 occlusions. Atherectomy seems to be particularly beneficial in the treatment of eccentric and complex stenoses and is not limited by occlusion or calcification. Furthermore, insight into the pathogenesis of arte riosclerosis and the development of restenosis is enabled by analysis of removed plaque material.
The Importance of the Subfascial Lymphatics in the Diagnosis of Lower Limb Edema: Investigations with Semiquantitative Lymphoscintigraphy
Authors: Bräutigam P. , Vanscheidt W. , Földi E. , Krause T. , Moser E.
Published: July 2008

A new method of semiquantitative lymphoscintigraphy for the evaluation of lower limb edema is characterized by (1) the evaluation of both the epifascial and subfascial system in order to assess type and stage of the edema, (2) the use of high-resolution digital whole-body imaging to facilitate the calculation of functional parameters, and (3) the use of active, standardized ergometry for reproducibility. The appearance time of 99mTc-labeled human albumin nanocol loid in inguinal lymph nodes after injection and the percent uptake of colloid into lymph nodes at 40 and 120 min after injection served as functional parame ters. Patients with edema of the lower limb were compared with normal sub jects. In patients with primary lymphedema the two lymphatic compartments are functionally compromised. Early and advanced stages of postthrombotic syndromes can be distinguished by characteristic lymphoscintigraphic patterns in epifascial and subfascial lymphatic compartments. These results indicate that only the separate evaluation of both the epifascial and subfascial compartments allows an accurate functional assessment of the lymphatics in lower limb edema.
Oxygen Transport in Peripheral Arterial Occlusive Disease: Effects of Calf Blood Dialysate
Authors: Rossano Carlo , Weiner Murray , Haigis Eric
Published: July 2008

The obvious relationship of arterial blood flow to tissue hypoxia has led to the relative neglect of secondary mechanisms that might influence the functional and morphologic consequences of major vessel obstruction. Oxygen diffusion through capillaries, both locally and systemically, may be disturbed in subjects with chronic local ischemia. Follow-up data after a double-blind, placebo-con trolled evaluation of the effect of treatment with a calf blood dialysate confirm that such treatment may alleviate the consequences of peripheral arterial ob structive disease even though there is no improvement in blood flow through the arterial system involved.
The Clinical Outcome of Acute Myocardial Infarction Is Related to the Circadian Rhythm of Myocardial, lnfarction Onset
Authors: Hansen Ole , Johansson Bengt W. , Gullberg Bo
Published: July 2008

In order to study whether the circadian rhythm of acute myocardial infarc tion (AMI) onset has any impact on the clinical outcome, in terms of enzymati cally estimated infarct size, circulatory arrest from ventricular tachyarrhyth mias, and in-hospital mortality, the authors studied a representative population of 10,791 AMIs treated in the same center between 1973 and 1987. In 6,763 cases (63%) the time of symptom onset was known. In these cases a major peak in AMI incidence was observed between 7:01 AM and 10:00 AM, and minor peaks at 12:01 noon, 3:01 PM-4:00 PM, and 8:01 PM-9:00 PM. In a set of multiva riate analyses including several clinical characteristics, symptom onset between 6:00 AM and 12:00 noon significantly predicted a greater infarct size, and symp tom onset between 12:00 AM and 6:00, AM was associated with a significantly lower risk of circulatory arrests from ventricular tachyarrhythmias. The time of symptom onset was not significantly associated with in-hospital mortality after adjustment for other clinical characteristics, including infarct size. The authors suggest that the time of day has an impact, not only on the incidence, but also on the severity of AMI and that the ability of beta blockers to blunt the morning increase in AMI incidence may possibly contribute to the beneficial secondary preventive effects of such drugs after AMI.
Light-Reflection Rheography and Acute Deep Vein Thrombosis
Authors: Antignani Pier Luigi , Pillon Sergio , Grassi Flavio , Paiella Maria Laura , Bartolo Mauro
Published: July 2008

The authors examined 47 subjects affected by acute phlebothrombosis of the lower limbs by means of light-reflection-rheography (LRR). The diagnosis was based on the results of clinical, Doppler, and duplex scanner evaluations. The results were compared with those obtained in 30 healthy subjects (control group).

The LRR examinations were performed by two methods: the one consisting of a passive execution of postural movements of the limb, the other using the technique of plethysmographic venous occlusion.

The pathological LRR curves were characteristic for each type of disease and for the site of thrombosis and were different from the normal ones.

The results obtained show the usefulness of the method and it potential in studying the collateral circulation and the effects of different therapies.
Budd-Chiari Syndrome: Analysis of 30 Cases
Authors: Bayraktar Yusuf , Balkanci Ferhun , Kansu Emin , Kayhan Burhan , Arslan Serap , Eryilmaz Muzaffer , Telatar Hasan
Published: July 2008

The authors report their experience with 30 adult patients with Budd-Chiari syndrome (BCS), which is a rare and serious disorder, characterized by hepatic outflow obstruction caused by many different conditions.

The diagnosis was based on the clinical data, ultrasonography (US), vena cavography and hepatic venography, computed tomography (CT), and liver bi opsy. Behçet's disease (BD) was found in 10 patients with BCS as an underlying disease. Two patients used oral contraceptive drugs, 2 had liver tumor hepato cellular carcinoma and liver lymphoma, and 1 patient had chronic lymphocytic leukemia. Despite full investigation, the authors could not find any obvious un derlying cause in the other 15 patients.

The results suggest that (1) BCS must be considered as a possible complica tion in patients with Behçet's disease when they have hepatomegaly even if there were no cardinal manifestations of the disease at the time of admission, and BD is the most common etiologic factor in BCS (33%) in Turkey, where the inci dence of Behçet's disease is relatively high. (2) Anti-aggregant treatment seems to be effective in many instances. (3) There were space-occupying lesion-like appearances in the liver of 7 cases by CT and US examination in the acute stage, and these disappeared on the follow-up CT and US in 5 patients but continued in 2. BCS should thus be differentiated from other liver lesions. (4) There were other great-vessel involvements in 43% of the cases, mostly venous, but only 1 pulmonary arterial occlusion.
Clinical Case Reports
Authors: Numaguchi Kohtaro , Ibayashi Setsuro , Yao Hiroshi , Takano Kentaro , Sadoshima Seizo , Maeda Hirotaka , Fujishima Masatoshi
Published: July 2008

Two normotensive pregnant women who developed cerebral hemorrhage during delivery are reported. The hematoma was small and subcortical in one and large and putaminal in the other. They had no history of hypertension, cerebrovascular disorders, or eclampsia. Cerebral angiography studied in one case revealed no abnormalities. Idiopathic cerebral hemorrhage during delivery without any evidence of vascular risk factors is discussed.
Tissue Plasminogen Activator Treatment of Digital Thrombosis in Severe Raynaud's Phenomenon— A Case Report
Authors: Bridges Alan J. , Spadone Donald P.
Published: July 2008

A thirty-one-year-old woman with long-standing mixed connective tissue dis ease and severe obliterative vasculopathy of the digits developed digital throm bosis of the first three digits of the left hand after using an electric blow dryer. The digits remained cool, cyanotic, and painful for thirty-six hours before medi cal evaluation. She was given 100 mg recombinant tissue plasminogen activator (TPA) intravenously. Within one hour the blood flow to the digits returned, accompanied by severe intermittent vasospasm of the digits. The thumb did not necrose; however, the second and third digits required amputation. No im provement was noted in the patient's baseline Raynaud's phenomenon or digital pressures of the uninvolved digits after TPA treatment. This case documents the usefulness of TPA for digital thrombosis in the setting of vasculopathy of con nective tissue disease. However, it does not support the utility of a single dose of TPA for severe Raynaud's phenomenon and recurrent digital ischemia in pa tients with connective tissue disease.
Tricuspid Endocarditis: A Rare Infectious Complication of Cardiac Pacemaker in a Patient with Chagas' Disease—A Case Report
Authors: Teno Luiz A.C. , Bestetti Reinaldo B. , Oliveira Waldynéia M. , Zanardi Marcelo C.T. , Freitas Olavo C. , Cozac Eduardo P. , Deus Dilson M. , Castilho Oswaldo T.
Published: July 2008

Tricuspid endocarditis was diagnosed in a sixty-four-year-old patient with Chagas' disease who had a permanent cardiac pacemaker and whose generator had been replaced five months before an infection in the pocket. The pacing system was replaced by an epicardial one and the patient received antibiotics with good results.
Features of Coronary Artery Lesions Related to Left Ventricular Aneurysm Formation in Anterior Myocardial Infarction
Authors: Inoue Teruo , Morooka Shigenori , Hayashi Terumi , Takayanagi Kan , Sakai Yoshihiko , Fujito Tsuneo , Takabatake Yutaka
Published: July 2008

To determine the factors of left ventricular aneurysm formation in acute myocardial infarction, the authors studied the distribution of coronary artery lesions and the left ventricular wall motion of 43 patients with anterior myocar dial infarction.

Of 15 patients with aneurysm, 9 (60%) showed a single-vessel disease with severe stenosis of the proximal left anterior descending artery. Of 9 patients with triple-vessel disease, 8 (89%) had no aneurysm. In patients with the aneu rysm, the Gensini score of the culprit lesion was significantly higher (p<0.05) and the score except for the culprit lesion was less (χ 2=5.7, p<0.05). In 23 patients with single-vessel disease, the collateral score was significantly less (p < 0.05) in patients with the aneurysm.

The systolic wall motion on the ventriculogram appeared more impaired in the anterior infarct area but well maintained in the posterior noninfarct area in patients with the aneurysm.

In conclusion, the important factors of left ventricular aneurysm formation were as follows: (1) A culprit lesion of the myocardial infarction was severe, but other coronary artery lesions were mild. (2) Collateral vessels were poor. (3) The left ventricular wall motion of the infarct area was impaired, but that of the noninfarct area was relatively good.
Carotid Ultrasonographic Findings in Intracranial Internal Carotid Artery Occlusion
Authors: Lee Tsong-Hai , Ryu Shan-Jin , Chen Sien-Tsong , Chan Jin-Lieh
Published: July 2008

Five cases of unilateral intracranial internal carotid artery (ICA) occlusion received both carotid angiographic and ultrasonographic studies. The Doppler examination showed that the resistive index (RI) of the common carotid artery (CCA) and ICA was higher but the peak systolic velocity was lower on the diseased side as compared with the normal side. Absence of the diastolic phase was found in the CCA flow in 2 cases and in the ICA flow in 3 cases on the diseased side. The mean CCA flow volume on the diseased side (271±82 mL/min) was half or less than that on the normal side (680±86 mL/min) (P < 0.01). The flow volume of the diseased ICA (49±20 mL/min) was markedly lower than that of the normal side (344±49 mL/min) (P < 0.01) and was also less than that of the ipsilateral external carotid artery (ECA) (129±43 mL/min). The Doppler ophthalmic artery flow all showed a forward direction.

The authors propose that the following extracranial carotid ultrasono graphic findings may be helpful in the prediction of intracranial carotid artery occlusion: (1) diminished frequencies, increased RI, and a more than 50% re duction of flow volume in the CCA as compared with the opposite side; (2) diminished frequencies to loss of the diastolic phase, a more than 50% reduction of the flow volume, and reversed ICA/ECA flow volume in the ICA as com pared with the opposite side; and (3) a forward Doppler ophthalmic artery flow.
Platelet-Derived Growth Factor Release and Antiplatelet Treatment with Low-Dose Acetylsalicylic Acid
Authors: Vissinger Henrik , Husted Steen Elkjaer , Kristensen Steen Dalby , Nielsen Hans Kraemmer
Published: July 2008

Platelet-derived growth factor (PDGF) and β-thromboglobulin (β-TG) are released from alpha granules during platelet activation. PDGF may play a role in the development of atherosclerosis and the late restenosis after percutaneous transluminal coronary angioplasty (PTCA). The effect of acetylsalicyclic acid (ASA) on PDGF release was studied in healthy volunteers before and twelve hours after ingestion of 300 mg ASA. PDGF, β-TG, and thromboxane B2(TxB 2) were measured by radioimmunoassay (RIA) in serum and in platelet rich plasma (PRP) after submaximal stimulation with collagen. TxB2 decreased sig nificantly from 0.9 ± 0.3 ng/(mL x 106 platelets) to 0.006 ± 0.005 ng/(mL x 10 6 platelets) (mean ± SD) in serum after ASA ingestion while PDGF and β-TG remained unchanged. Measurements in PRP after stimulation with collagen showed a significant decrease in PDGF (from 21.5 ± 1.4 pg/(mL x 106 plate lets) to 1.8 ± 4.1 (pg/mL x 106 platelets)), in β-TG (from 21.0 ± 13.3 ng/(mL x 10 6 platelets) to 2.2 ± 1.4 ng/(mL x 106 platelets)) and in TxB2 (from 143.6 ± 80.7 pg/(mL x 106 platelets) to 0.5 ± 0.6 pg/(mL x 106 platelets)) after treat ment with ASA. In conclusion low-dose ASA inhibits collagen-induced release of both β-TG and PDGF in PRP and TxB2-synthesis in PRP and serum.
Late Neovascularization of Longstanding Left Ventricular Mural Thrombus—A Case Report
Authors: Kwan Tak , Feit Alan
Published: July 2008

Serial coronary angiography done in a patient with left ventricular mural thrombus demonstrated abnormal neovascularity from the coronary artery to the left ventricle occurring eight to eighteen months after thrombus formation. This is the first case report describing such late neovascularization of left ven tricular mural thrombus. The formation of coronary neovascularity to left ven tricular mural thrombus need not occur in the early stage of the thrombus.
Leiomyosarcoma of the Inferior Vena Cava Causing Budd-Chiari Syndrome—A Case Report
Authors: Satoh Motohiko , Katoh Junichi , Onodera Sokichi
Published: July 2008

A forty-eight-year-old Japanese woman with leiomyosarcoma of the inferior vena cava presenting as Budd-Chiari syndrome is reported. A large tumor orig inating from the venous wall grew into the lumen, obstructing the hepatic vein, and extended up to the right atrium. Although this is a very rare tumor, care should be taken in order to make an early diagnosis and manage the condition effectively.
Arterial Mapping with Color Flow Duplex Imaging of the Lower Extremities After Excimer-Laser-Assisted Angioplasty
Authors: Visonà Adriana , Miserocchi Luigi , Lusiani Luigi , Bonanome Andrea , Mayellaro Valeria , Pesavento Raffaele , Liessi Guido , Pagnan Antonio
Published: July 2008

The purpose of the present study was to evaluate the role of color flow du plex imaging (CFDI) in the follow-up of patients who have undergone excimer- laser-assisted angioplasty of peripheral arteries.

Sixty-one patients (40 men and 21 women) were studied (mean age ± SD sixty-three ± nine years). All patients were affected by peripheral vascular dis ease and, for this reason, underwent percutaneous excimer-laser-assisted angio plasty. Digital angiography and CFDI were performed before the laser procedure. CFDI was repeated at months 1, 3, 6, 9, and 12 after the laser procedure, whereas angiography was repeated after twelve months. Common, superficial, and profunda femoral arteries and popliteal arteries were visualized in looking for the presence of lesions and occlusions, and spectral analysis of Doppler signals was recorded.

After the initial success, claudication was reported again by 9 patients, 7 of whom showed total occlusions. All reocclusions were discovered by CFDI and confirmed by angiography; 3 of these 7 patients underwent a second laser pro cedure. The remaining 2 symptomatic patients showed patent vessels and did not undergo angiography. Another 9 patients redeveloped an occlusion, unsus pected from clinical history and symptoms. All the reocclusions, confirmed by angiography, were diagnosed by CFDI.

The data show that CFDI provides an accurate noninvasive technique for following up patients after excimer laser angioplasty, allowing for asymptomatic reocclusions to be recognized and treated if necessary, and permitting symptoms not due to reocclusions to be properly identified, thus avoiding unnecessary angiography.
Angina and Coronary Artery Disease in Patients with Aortic valve Disease
Authors: Alexopoulos Dimitrios , Kolovou Genovefa , Kyriakidis Michalis , Antonopoulos Athanasios , Adamopoulos Stamatios , Sleight Peter , Toutouzas Pavlos
Published: July 2008

The significance of angina pectoris in patients with aortic valve disease (AVD) and the need for coronary arteriography before valve replacement are controversial. The history of chest pain and coronary arteriographic findings were reviewed in 333 patients ≥ forty years old, with AVD: 142 with aortic stenosis, 87 with mixed AVD and 104 with aortic regurgitation. The prevalence of coronary artery disease (CAD) was similar among different types of AVD. Angina pectoris was more frequent in patients with aortic stenosis (56%) and mixed AVD (53%) than in patients with aortic regurgitation (24%) (p < 0.0001). Similar results were found in patients with and without CAD. Twenty-six of 95 (27%) patients with CAD had no chest pain at all. The absence of any chest pain in CAD patients was more frequent in those ≥ sixty years old than in those < sixty (p < 0.05). Thus, since a significant number of patients had CAD in the absence of any chest pain, the authors recommend coronary arteriography for all patients ≥ forty years of age before aortic valve replacement.