bluuebunny/crossref_metadata_2025 huggingface dataset:
Assessment of Adenosine-induced Coronary Steal in the Setting of Coronary Occlusion Based on the Extent of Opacification Defects by Myocardial Contrast Echocardiography
Authors: Masugata Hisashi , Peters Barry , Lafitte Stephane , Monet Strachan G. , Ohmori Koji , Mizushige Katsufumi , Kohno Masakazu
Published: July 2008

The authors examined the ability of real-time myocardial contrast echocardiography (MCE) to assess adenosine-induced coronary steal in the setting of coronary artery occlusion. The left anterior descending (LAD) coronary artery was occluded in 8 open-chest dogs. Real-time MCE was performed during LAD occlusion, and the extent of opacification defects from MCE was measured without and with adenosine infusion. Microsphere-derived myocardial blood flow (MBF) was measured in the LAD and left circumflex (LCx) coronary artery beds, and the LAD/LCx ratio of MBF was calculated. The LAD/LCx ratio of MBF decreased in response to adenosine administration (without adenosine: 0.66, with adenosine: 0.43, p < 0.01). The extent of opacification defects from MCE increased in response to adenosine administration (without adenosine: 18%, with adenosine: 22%, p < 0.01). Thus, real-time MCE allows for the detection of adenosine-induced coronary steal as changes in the extent of opacification defects in the setting of occlusion of 1 coronary artery accompanying another normally patent coronary artery.
Aggressive Antiplatelet Therapy Before Coronary Stent Implantation in Acute Coronary Syndrome with Essential Thrombocythemia
Authors: Fujimura Mitsunori , Akaike Masashi , Kato Midori , Takamori Nobuyuki , Abe Masahiro , Nishiuchi Takeshi , Azuma Hiroyuki , Matsumoto Toshio
Published: July 2008

A 52-year-old man was admitted to the hospital because of unstable angina pectoris. Coronary angiography revealed severe stenosis at a proximal site of the left anterior descending artery. Essential thrombocythemia (ET) was diagnosed on the basis of findings of marked thrombo cytosis (106 x 104/μL) and an increased number of immature megakaryocytes in the bone marrow. Because hyperaggregability of platelets was demonstrated by an ex vivo platelet aggregation assay and by elevated plasma levels of β-thromboglobulin (β-TG) and platelet factor 4 (PF4), antiplatelet therapy with aspirin and ticlopidine and cytoreduction therapy with hydroxyurea were started. This combination treatment resulted in a decrease in the platelet count to less than 60 x 104/μL and decreases in plasma levels of both β-TG and PF4 to almost normal values. Percutaneous coronary angioplasty and stenting were then performed success fully without thrombotic complications. These findings suggest that combination therapy with antiplatelet and cytoreduction agents before catheter intervention is useful for the prevention of thrombotic complications in patients with acute coronary syndrome associated with essential thrombocythemia.
Influence of Smoking on Predictors of Vascular Disease
Authors: Tsiara Stavroula , Elisaf Moses , Mikhailidis Dimitri P.
Published: July 2008

Beyond the already well-established strong causative relationship with cancer, smoking increases the risk for vascular disease. Smoking may act directly or adversely influence risk factors contributing to the development of vascular disease. Smoking causes endothelial dysfunction, dyslipidemia (decreased high-density lipoprotein cholesterol levels, hypertri glyceridemia and increased oxidation of low-density lipoprotein cholesterol) and platelet acti vation leading to a prothrombotic state. Smoking increases emerging risk factors (eg, fibrinogen, homocysteine, and high-sensitivity C-reactive protein) and increases insulin resis tance and the risk of developing type 2 diabetes mellitus. The beneficial effects of statins and antioxidants (eg, vitamins C and E, β-carotene) are counteracted by smoking. Smoking-induced alterations in growth factors, adhesion molecules, and even in genes can accelerate the progression of atherosclerosis. The aim of this review is to consider the adverse consequences of smoking on the factors predisposing to vascular disease and to emphasize the beneficial effects of smoking cessation.
A New Noninvasive Method for the Accurate and Precise Assessment of Varicose Vein Diameters
Authors: Baldassarre Damiano , Pustina Linda , Castelnuovo Samuela , Bondioli Alighiero , Carlà Matteo , Sirtori Cesare R.
Published: July 2008

The feasibility and reproducibility of a new ultrasonic method for the direct assessment of maximal varicose vein diameter (VVD) were evaluated. A study was also performed to demon strate the capacity of the method to detect changes in venous diameter induced by a phar macologic treatment. Patients with varicose vein disease were recruited. A method that allows the precise positioning of patient and transducer and performance of scans in a gel-bath was developed. Maximal WD was recorded both in the standing and supine positions. The intraassay reproducibility was determined by replicate scans made within 15 minutes in both positions. The interobserver variability was assessed by comparing WDs measured during the first phase baseline examination with those obtained during baseline examinations in the second phase of the study. The error in reproducibility of WD determinations was 5.3% when diameters were evaluated in the standing position and 6.4% when assessed in the supine position. The intramethod agreement was high, with a bias between readings of 0.06 ±0.18 mm and of -0.02 ±0.19 mm, respectively, in standing and supine positions. Correlation coefficients were better than 0.99 in both positions. The method appears to be sensitive enough to detect small changes in VVDs induced by treatments. The proposed technique provides a tool of potential valid use in the detection and in vivo monitoring of WD changes in patients with varicose vein disease. The method offers an innovative approach to obtain a quantitative assessment of varicose vein progression and of treatment effects, thus providing a basis for epidemiologic surveys.
Clustered Features of the Metabolic Syndrome and the Risk for Increased Aortic Pulse Wave Velocity in Middle-aged Japanese Men
Authors: Nakanishi Noriyuki , Suzuki Kenji , Tatara Kozo
Published: July 2008

The association between different features of the metabolic syndrome (MS) (obesity, hyper tension, hypercholesterolemia, low high-density lipoprotein cholesterol level, hypertriglyc eridemia, high fasting plasma glucose level, and hyperuricemia) and the risk for increased aortic pulse wave velocity (PWV) of ≥ 8.0 m/sec was examined in 2431 Japanese men aged 35 to 54 years who were not taking antihypertensive medication. After controlling for age, cigarette smoking, and alcohol intake, the odds ratios for increased aortic PWV in subjects with 1, 2, 3, and ≥ 4 features of the MS, compared with those without features of the MS, were 1.35 (95% Cl, 0.86 to 2.11), 1.90 (95% Cl, 1.18 to 3.06), 1.57 (95% Cl, 0.89 to 2.76), and 2.38 (95% Cl, 1.26 to 4.49), respectively (p for trend = 0.003). A 9-year longitudinal study was also performed to prospectively examine the association between clustered features of the MS and the devel opment of increased aortic PWV in 2073 men without aortic stiffness with a PWV <8.0 m/sec and without antihypertensive medication during the follow-up period. The multivariate-adjusted hazard ratios for the incidence of increased aortic PWV in subjects with 1, 2, 3, and ≥ 4 features of the MS, compared with those without features of the MS, were 1.39 (95% Cl, 1.10 to 1.77), 1.46 (95% Cl, 1.11 to 1.92), 1.75 (95% Cl, 1.27 to 2.40), and 2.22 (95% Cl, 1.52 to 3.25), respec tively (p for trend < 0.001). These results suggest that clustered features of the MS are closely associated with the risk for increased aortic PWV in middle-aged Japanese men.
Mitral Annular Calcification and Aortic Valve Calcification May Help in Predicting Significant Coronary Artery Disease
Authors: Acartürk Esmeray , Bozkurt Abdi , Çayli Murat , Demir Mesut
Published: July 2008

Mitral annular calcification (MAC) and aortic valve calcification (AVC) are manifestations of atherosclerosis. To determine whether mitral annular calcification and aortic valve calcification detected by transthoracic echocardiography (TTE) might help in predicting significant coronary artery disease (CAD), 123 patients with significant CAD and 93 patients without CAD detected by coronary angiography were investigated. MAC and AVC identified CAD with a sensitivity and specificity of 60.2%, 55.9% and 74.8%, 52.7%, respectively, and with a negative and a positive predictive values of 51.5%, 64.3% and 61.3% and 67.6%, respectively. The positive predictive value of MAC was greater than gender, hypertension, and hypercholesterolemia. AVC showed a positive predictive value greater than gender, hypertension, family history, and hypercho lesterolemia. The negative predictive values of MAC and AVC for CAD were greater than those of all risk factors except diabetes mellitus. In conclusion, presence of MAC and AVC on TTE may help in predicting CAD and should be added to conventional risk factors. Absence of MVC and AVC is a stronger predictor for absence of CAD than all conventional risk factors, except diabetes mellitus. Patients with MAC and AVC should be taken into consideration for the presence of significant CAD and thereby for diagnostic and therapeutic interventions in order to improve the prognosis.
Increased Systemic and Regional Coagulation Activity in Patients with Mitral Stenosis and Sinus Rhythm
Authors: Atak Ramazan , Yetkin Ertan , Yetkin Ozkan , Ayaz Selime , Ileri Mehmet , Senen Kubilay , Turhan Hasan , Erbay Ali Riza , Cehreli Sengül
Published: July 2008

A hypercoagulable state has been reported in patients with mitral stenosis (MS) and sinus rhythm (SR). However it has been suggested that the coagulation activity may be increased only within the left atrium in MS, with normal peripheral blood levels. The aim of the present study was to assess regional left atrial and systemic coagulation activities by measuring PF 1 +2 in patients with severe mitral stenosis and sinus rhythm, normal blood clotting times, and no left atrial thrombus. The study was conducted in 25 consecutive patients with moderate-to-severe MS and sinus rhythm who underwent percutaneous balloon mitral valvu loplasty. Transesophageal echocardiography was performed before the valvuloplasty procedure in all patients to exclude the presence of left atrial thrombus and left atrial spontaneous echo contrast (LASEC). There were no statistically significant differences between LASEC-positive and LASEC-negative patients with respect to age, gender, fibrinogen levels, prothrombin time, mitral valve area, mean mitral gradient, pulmonary artery pressure (in all p> 0.05). Regional (left atrial) PF1+2 levels of both LASEC-positive and LASEC-negative patients were significantly elevated when compared to control subjects (p<0.01). Statistically significant elevated systemic level of PF 1 +2 was observed only in LASEC-positive patients when compared to control subjects (p<0.01, p>0.05, respectively). In conclusion patients with severe mitral stenosis and SR have increased regional coagulation activity in both LASEC-negative and LASEC-positive groups. Although this increased regional coagulation activity has been reflected in peripheral blood of LASEC-positive patients, it has not been reflected in peripheral blood of LASEC-negative patients.
Clinical Perspectives of Primary Cardiac Lymphoma
Authors: Gowda Ramesh M. , Khan Ijaz A.
Published: July 2008

Primary cardiac lymphoma is a very rare malignancy, which is typically of a non-Hodgkin type, and involves only the heart and pericardium with no or minimal evidence of extracardiac involvement. Primary cardiac lymphoma account for about 1% of the primary cardiac tumors and 0.5% of the extranodal lymphomas. On the other hand, disseminated lymphoma with cardiac involvement can occur in up to 20% of patients with lymphoma. About 80% of cases of the primary cardiac lymphoma in immunocompetent hosts are of diffuse B-cell lymphoma, and in patients with immunodeficiency states, small noncleaved or immunoblastic lymphomas are more frequent. The right atrium and right ventricle are the 2 most frequently involved sites. Clinical presentation is heterogeneous and is generally related to the site of involve ment in the heart. The diagnosis is suspected when patients present with a cardiac mass or an unexplained refractory pericardial effusion. A thorough workup should include transtho racic and transesophageal echocardiography, computed tomography, and magnetic resonance imaging. Diagnosis is confirmed by cytology of the serous fluid from pericardial or pleural effusion or biopsy of the pericardial mass or endomyocardial tissue. The exploratory thoraco tomy should not be delayed if indicated. Chemotherapy has been used alone or combined with radiotherapy. Similarly, palliative cardiac surgery has been performed, mainly for tumor debulking. Combination of chemotherapy and radiation therapy is considered as the treatment of choice. The survival is generally less than a month without treatment but has been prolonged up to 5 years with palliative treatments in selected cases.
Chordae Tendineae Rupture Resulting in Pulmonary Edema in a Patient with Discrete subvalvular Aortic Stenosis
Authors: Adler O. , Kalidindi S. , Butt A. , Hussain K.M.A.
Published: July 2008

This report concerns an apparently healthy elderly woman who presented with gradually worsening mitral regurgitation secondary to chordae tendineae rupture leading to pulmonary edema in the presence of discrete subvalvular aortic stenosis with a severe gradient reflecting the left ventricular outflow tract obstruction. The gradual worsening of heart failure took place parallel to the increase in severity of mitral regurgitation in a short period. The patient underwent successful mitral valve replacement with myectomy. Surgical inspection revealed rupture of the chordae tendineae to the posterior leaflets without any significant primary intrinsic disease of the mitral valve. The predominant mechanism of chordae tendineae rupture in this patient with discrete subvalvular aortic stenosis is a severe pressure gradient. It is suggested that increased awareness of chordae tendineae rupture as a cause of mitral regur gitation and the prompt use of appropriate diagnostic tools may facilitate the timely recogni tion of this potentially fatal, but treatable, cause of mitral regurgitation in patients with left ventricular outflow tract obstruction.
Relationship Between Plaque Morphology of Carotid Artery and Aortic Valve Calcification
Authors: Soylu Mustafa , Demir Ahmet Duran , Özdemir Özcan , Uzun Yücel , Korkmaz Şule
Published: July 2008

Aortic and mitral valvular calcifications are found to be associated with atherosclerotic risk factors and are largely accepted as part of a generalized atherosclerotic process. As well as the severity of stenosis, embologenic properties of plaques are also responsible for ischemic poten tials of atherosclerotic plaques in carotid arteries. In this study, the authors aimed to define the characteristics of plaque morphology in patients with and without aortic valvular calcification (AVC) and to show the association between AVC and carotid plaque characteristics. Carotid plaque morphology in 182 consecutive patients with AVC was compared with plaque charac teristics in 170 patients without AVC. Risk factors for atherosclerosis, age, and gender were similar in patients with and without AVC. The presence of carotid atherosclerosis, complex atheromas, and carotid artery stenosis was significantly higher in patients with AVC when compared with those without AVC (p < 0.001, p < 0.001, and p < 0.05, respectively). Unstable plaques (Types I and II) were also found to be more common in the patients with AVC than in those without AVC (p < 0.001). This study demonstrated the strong correlation between AVC and carotid atheromas. The plaques in patients with AVC are more unstable in morphology than in those without AVC, and this may explain the higher stroke incidence in these patients.
Stroke Rate of Off-pump Coronary Artery Bypass; Aortocoronary Bypass Versus in-Situ Bypass
Authors: Hirose Hitoshi , Amano Atushi
Published: July 2008

Off-pump coronary artery bypass (OPCAB) using in-situ grafts does not require aortic manip ulation, and it is theoretically free from the risk of stroke. Because of the limited availability of in-situ grafts, aortocoronary bypass has been conducted in addition to in-situ grafting. In this paper, the authors prospectively investigated whether or not on aortocoronary bypass increases the incidence of stroke after off-pump bypass. Perioperative data were collected prospectively from patients who underwent isolated off-pump bypass at their hospital group between March 1997 and February 2002. The patients were divided into 2 groups; group AC (patients with at least 1 aortocoronary bypass, n = 280) and group IS (patients with all in-situ grafts, n = 234). Patients with 3-vessel disease more frequently underwent aortocoronary bypass and patients with a history of stroke, calcified ascending aorta, or renal failure more often underwent in-situ graft. The number of distal anastomoses was greater in group AC (3.5 ± 1.0) than in group IS (2.7 ± 1.1), p < 0.0001. Patient recovery and complication rates were similar, including the occurrence of postoperative stroke: 3.0% (7/234) in group IS vs 0.7% (2/280) in group AC, p=0.051, NS. The graft patency and remote results were not significantly different between the 2 groups. Side clamping of the aorta used in off-pump aortocoronary bypass does not increase the risk of postoperative strokes compared to in-situ bypass. Postoperative stroke after OPCAB may depend on the patient's preoperative comorbidities.
Comparison of Changes in Diastolic Functions After Aortic Valve Replacement with Freestyle Stentless Porcine Xenografts in Patients with Restrictive and Nonrestrictive Physiology
Authors: Soylu Mustafa Özcan , Demir Ahmet Duran , Özdemir Özcan , Uzun Yücel , Kunt Ayşegül , Korkmaz Şule , Taşdemir Oguz
Published: July 2008

In this study, the effect of valve replacement on diastolic parameters was evaluated preop eratively and postoperatively at 3, 6, and 12 months by comparing diastolic parameters in patients after aortic valve replacement with freestyle stentless porcine xenografts for aortic stenosis. Depending on deceleration time (DT) and isovolumetric relaxation time (IVRT) with preoperative echocardiographic assessment, patients were divided into two groups: restrictive physiology (DT ≤ 150 msec and IVRT < 100 msec, 20 patients), and nonrestrictive physiology (DT > 150 msec and IVRT ≥ 100 msec, 27 patients). Although left ventricular mass index signif icantly decreased in both groups, improvement in DT, IVRT, and ejection fraction occurred only in patients with restrictive physiology. As a result, the patients with restrictive diastolic characteristics had more benefit than the patients with nonrestrictive physiology after aortic valve replacement.
Early Benefit from Structured Care with Atorvastatin in Patients with Coronary Heart Disease and Diabetes Mellitus
Authors: Athyros Vasilios G. , Papageorgiou Athanasios A. , Symeonidis Athanasios N. , Didangelos Triandafillos P. , Pehlivanidis Anthimos N. , Bouloukos Vasilios I. , Mikhailidis Dimitrios P.
Published: July 2008

This is a prospective evaluation of the effect of structured care of dyslipidemia with atorvas tatin (strict implementation of guidelines) versus usual care (physician's standard of care) on morbidity and mortality of patients with coronary heart disease (CHD) and diabetes mellitus (DM). From 1600 consecutive CHD patients randomized to either form of care in the GREek Atorvastatin and CHD Evaluation Study (GREACE), 313 had DM: 161 in the structured care arm and 152 in the usual care arm. All patients were followed up for a mean of 3 years. In the structured care group, patients were treated with atorvastatin to achieve the National Cholesterol Education Program (NCEP) low-density lipoprotein cholesterol (LDL-C) treatment goal of < 2.6 mmol/L (100 mg/dL). Primary endpoints were all-cause and coronary mortality, coronary morbidity, and stroke. In the structured care group, 156 patients (97%) were taking atorvastatin (10-80 mg/day; mean, 23.7 mg/day) throughout the study; the NCEP LDL-C treatment goal was reached by 150 patients (93%). Only 17% (n = 26) of the usual care patients were on long-term hypolipidemic drug treatment and 4% (n = 6) reached the NCEP LDL-C treatment goal. During the study, 46 of 152 (30.3%) CHD patients with DM on usual care experienced a major vascular event or died versus 20 of 161 (12.5%) patients on structured care; relative risk reduction (RRR) 58%, p < 0.0001. RRR for all-cause mortality was 52%, p = 0.049; coronary mortality 62%, p = 0.042; coronary morbidity 59%, p < 0.002; and stroke 68%, p = 0.046. Event rate curves started deviating from the sixth treatment month and the RRR was almost 60% by the 12th month. RRRs remained at that level until the end of the study, when they became statistically significant. The cost/life-year gained with structured care was estimated at US $6200. In CHD patients with DM, structured care of dyslipidemia with atorvastatin to achieve the NCEP LDL-C treatment goal, reduces all-cause and coronary mortality, coronary morbidity, and stroke by more than one half within a 3-year period, in comparison to usual care. Clinical benefit is manifested as early as the sixth month of treatment.
A Pedigree Analysis of Familial Hypercholesterolemia in Monozygote Twin Brothers
Authors: Li Jian-Jun , Chen Ming-Zhe , Chen Xin
Published: July 2008

The current study was designed to investigate the features of a family with familial hyperc holesterolemia (FH). Twenty members of 3 generations in a family with hypercholesterolemia were enrolled in the study. The data collected were from clinical observation and subjected to pedigree analysis. The proband was a 41-year-old male who suffered from angina pectoris with multi-vessel stenosis of coronary arteries at the age of 40. Among 20 members, 8 indi viduals had FH in this family with a total incidence of 40% (54.5% [6/11] in male and 22.2% [2/9] in female). The serum total cholesterol level was increased in childhood from 7.1 to 10.8 mmol/L and tended to increase with increasing age. In addition, the level of total cholesterol was increased in monozygote twin brothers and their offspring in the family. This pedigree analysis showed that FH appears to be a hereditary disease of autosomal dominance, and attention should be paid, especially in the only son or daughter society of China.
Aortic Dissection After Aortic Valve Replacement
Authors: Picchi Andrea , Focardi Marta , Capannini Gianni , Mondillo Sergio
Published: July 2008

Type A aortic dissection occurs in 0.6% of patients late after aortic valve replacement. However, little information is available about risk factors for developing this complication, nor are recommendations for elective replacement of the ascending aorta available. The authors present a 78-year-old woman who developed type A aortic dissection thirty months after aortic valve replacement; ascending aorta was normal at the time of aortic valve replacement.
Spontaneous Coronary Artery Dissection in a Woman Receiving 5-Fluorouracil
Authors: Abbott J. Dawn , Curtis Jeptha P. , Murad Khalil , Kramer Harvey M. , Remetz Michael S. , Setaro John F. , Brennan Joseph J.
Published: July 2008

A 39-year-old woman with cervical cancer treated with pelvic radiation therapy and 5-fluo rouracil (5-FU) was hospitalized for dehydration and intractable vomiting. She developed an acute ST-elevation myocardial infarction (MI) that extended electrocardiographically after thrombolytic therapy. Coronary angiography demonstrated a completely occluded left anterior descending (LAD) artery with extensive coronary dissection that was treated successfully with stenting. The authors discuss several factors that may have contributed to the sponta neous coronary artery dissection (SCAD) including chemotherapy-induced vasospasm, hemo dynamic stress of vomiting, and hormonal changes associated with pelvic radiation.
Polymyositis Complicated with Complete Atrioventricular Block
Authors: Alyan Omer , Ozdemir Ozcan , Geyik Bilal , Demirkan Deniz
Published: July 2008

A 35-year-old woman, diagnosed with polymyositis about 5 years before was admitted to the authors' clinics with syncope attack due to complete atrioventricular (AV) block. Progression of left bundle branch block to complete AV block despite all immune-suppressive treatment, and rarity of this complication in patients with polymyositis prompted the authors to report this case.
Coronary Arteriomegaly in a Patient with Ehlers-Danlos Syndrome and Multiple Aneurysms
Authors: Dieter Robert S. , Murtaugh Thomas , Black Jennifer , Russell Douglas C.
Published: July 2008

The authors report a case of coronary arteriomegaly in a patient with Ehlers-Danlos syndrome and multiple aneurysms who presented with myocardial infarction. Coronary arteriography revealed distal "pruning" of vessels without occlusive disease. Fibroblast cultures excluded Ehlers-Danlos syndrome types IV and VII. Literature review suggests this may represent a previously unidentified vascular syndrome.
Dynamics of Cutaneous Laser Doppler Flux with Concentration of Moving Blood Cells and Blood Cell Velocity in Legs with Venous Ulcers and in Healthy Legs
Authors: Malanin Ken , Havu Väinö K. , Kolari Pertti J.
Published: July 2008

Laser Doppler flux (LDF) is a product of the concentration of moving blood cells (CMBC) and the blood cell velocity (BCV). In an attempt to obtain more information about the cutaneous microcirculation in legs with venous ulcers and in healthy legs, the dynamics of the curves of the LDF, the CMBC, and the BCV were analyzed in 8 patients with venous leg ulcers and in 10 subjects with healthy legs. The curves of the CMBC and of the BCV were found to be in opposite phases both in the ulcerous legs and in the healthy legs. The maximal amplitude of the curves of the LDF and of the CMBC was greater in the legs with ulcers than in the healthy legs (p = 0.021 and p = 0.0085, respectively). The finding that the curves of the CMBC and the BCV were in opposite phase can be interpreted to reflect the capillary blood flow by fits and starts both in legs with venous ulcers and in healthy legs. The greater amplitude of the LDF and the CMBC in legs with venous ulcers reflects the blood flow in anatomically altered capillaries in those legs. It is useful to record the curves of the CMBC and the BCV together with the LDF because this gives additional information about the microcirculation of the skin.
Electrocardiologic and Echocardiographic Features of Patients Exposed to Scorpion Bite
Authors: Alan Sait , Ulgen Mehmet S. , Soker Murat , Geyik Faruk , Karabulut Aziz , Toprak Nizamettin
Published: July 2008

The purpose of this study is to examine clinical progress and hemodynamic and electrocardi ologic features (QT depression and heart rate variability [HRV]) of patients exposed to a scorpion bite.

Seventeen patients bitten by scorpions, and, as a control group, 15 healthy subjects were included in the study. Standard electrocardiograph (ECG) records, 24-hour Holter-ECG, and Doppler echocardiographic examinations were performed.

Holter ECG indicated sinus tachycardia, sinus bradycardia, paroxysmal supraventricular tachycardia, atrial fibrillation, first-degree and second-degree atrioventricular block not requiring treatment, early atrial beats, and early ventricular beats in the patients at frequen cies of 82%, 12%, 35%, 12%, 8%, 70%, and 47%, respectively.

HRV parameters that reflected parasympathetic activity (SD 35 ±13-43 ±16, RMS-SD: 20 ±9-30 ± 12, high frequency: 7.8 ±2-4.3 ±3, p<0.05) were significantly lower (p<0.05). Low frequency, which especially showed sympathetic activity (LF: 11 ± 13-11 ±23, p>0.05), was similar in both groups. In addition, the LF/HF ratio, which reflected sympathovagal balance, was significantly increased in the patient group (1.5 ±1-3.0 ±2, p = 0.005).

Corrected QT and QT dispersion values were not significantly different with respect to the control (p>0.05).

In the patient group compared to the control, a significant decrease was determined in the proportion of mitral E velocity to mitral A velocity (mEv/mAv), diastolic filling period (DFP), and left ventricular ejection fraction (LVEF), while a significant increase was noticed in pulmonary artery pressure (PAP) (mEv/mAv: 0.9 ±0.4-1.7 ±0.6, DFP: 362 ±8.5-425 ±89, LVEF: 53.1 ±6.7-68.6 ±5.8, PAP: 38.1 ±13-27.2 ±6, p<0.05).

Scorpion bite leads to serious cardiovascular disorders, associated with decreased HRV, decreased systolic and diastolic functions, increased arrhythmic events, and hemodynamic disturbance with sympathetic and parasympathetic balance disturbance.
Fever and Inflammatory Response as Principal Manifestation of Chronic Aortic Type A Dissection
Authors: Lorenzen Hans Peter , Kurowski Volkhard , Jain Deepak , Geist Volker , Richardt Gert
Published: July 2008

Aortic dissection usually presents with sudden onset of severe pain. Unfortunately, in more than half of these patients, the diagnosis is missed on admission. If the patient survives, the aortic dissection becomes chronic, whereas the patient may have few or minor symptoms. A rare manifestation may be subfebrile temperatures and inflammatory response. The authors describe a patient in whom aortic dissection resulted in night sweats, weight loss, and subfebrile temperatures.
Origin of All Major Coronary Arteries from Left Sinus of Valsalva as a Common Coronary Trunk: Single Coronary Artery
Authors: Gowda Ramesh M. , Khan Ijaz A. , Undavia Manish , Vasavada Balendu C. , Sacchi Terrence J.
Published: July 2008

Coronary anomalies are divergent and can occur in up to 1% to 2% of patients. The most common of these anomalies is separate ostia of the left anterior descending and left circum flex arteries, followed by origin of the circumflex coronary artery from the right coronary artery and the left coronary artery from the right sinus of Valsalva, either as a separate ostium or as a part of single coronary artery. Anomalous origin of right coronary artery from the left sinus of Valsalva with a separate ostium or from the left main coronary artery is very rare. These coronary anomalies may be incidentally diagnosed on routine angiography or may present with myocardial ischemia, infarction, or sudden death. A case is described in which all 3 coronary arteries were originating from the left sinus of Valsalva as a common trunk (single coronary artery), which trifurcated to left anterior descending, left circumflex, and right coronary artery.
Plethysmographic Confirmation of the Beneficial Effect of Calcium Dobesilate in Primary Varicose Veins
Authors: Androulakis G. , Panoysis P.A.
Published: July 2008

Sixty patients with varicose veins, in the age range 25 to 52 years, entered the trial and were divided by random allocation into 2 equal groups. The first group received calcium dobesilate orally in dosage of 750 mg daily while the second remained untreated.

Out of 25 patients who completed the 3-month treatment course, clinical improvement occurred in 19 (76%). Mercury strain gauge plethysmography in those 19 patients showed a statistically significant mean fall in the venous distensibility index, in maximum venous outflow and in the capillary filtration coefficient after the course of calcium dobesilate. The mean erythrocyte sedimentation rate in the 25 patients fell from 40 mm in 1 hour (Westergren) before treatment to 10 mm at the end of the course. In 42% of the patients there was a fall in serum globulin concentration and correction of the albumin/globulin ratio and in 35% there was a slight fall in serum fibrinogen concentration. Possibly calcium dobesilate's known action in lowering blood viscosity contributes to its beneficial effect in varicose veins.
Subacute Cor Pulmonale Due to Tumor Embolization to the Lungs
Authors: He Xian-wu , Tang Yi-hai , Luo Zhong-qiang , Gong Lian-di , Cheng Tsung O.
Published: July 2008

Six patients with subacute cor pulmonale due to tumor embolization to the lungs were reported from China. Five of the 6 patients suffered from progressive unrelenting dyspnea; 4 had completely normal cardiopulmonary findings on physical examination. Four of the 5 patients who had chest roentgenograms showed diffuse bilateral mottling of the lungs with no evidence of cardiomegaly. At autopsy right ventricular hypertrophy was present in all. The pathologic findings in the lungs consisted of multiple microscopic tumor emboli distributed diffusely in the pulmonary arterioles and/or perivascular lymphatics; the lumen of these vessels was obliterated with or without hyperplastic endarteritis. Although the outcome of this not uncommon clinicopathologic entity is generally fatal, early diagnosis followed by prompt effective therapy for the underlying primary neoplasm has been reported to prolong survival.
Indirect, Noninvasive Evaluation of Pressure Wave Transmission in Essential Hypertension
Authors: Pannier B.M. , Safar M.E. , Laurent St , London G.M.
Published: July 2008

Blood pressure, carotid-femoral and brachioradial pulse wave velocities were measured in 123 male subjects: 32 normal subjects and 91 age-matched patients with susained essential hypertension. The ratio between brachioradial (BR) and carotid-femoral (CF) pulse wave velocities was used as a marker of pressure wave amplitude changes from the aorta to the brachial artery. The ratio was similar in normotensive and hypertensive subjects and decreased with age to the same extent in both populations. In older subjects, the decrease in the ratio indicated that the amplitude of pulse pressure was quite similar in the aorta and the brachial artery whether the subjects were normotensives or hypertensives. The study provided evidence that adaptive changes occur in the arterial (aortic) wall in hypertension, for the effects of age on pressure wave transmission are similar in normal subjects and hypertensive patients. Such findings may be of prime importance in understanding the brachial blood pressure readings of patients with hypertension.
What Do Medical Students Know About In-Hospital Radiation Hazards?
Authors: Janssen Johan H.A. , Wellens Hein J. J.
Published: July 2008

A questionnaire (eight multiple-choice questions) administered to 49 fourth-year medical students from the Limburg State University in the Netherlands shows that several misunderstandings, misconceptions, and erroneous beliefs exist in regard to in-hospital radiation hazards.

The authors conclude that it is unlikely that ignorance about this subject is restricted to Dutch medical students.
Augmented Fragmentation of Atrial Activity Upon Premature Electrical Stimuli by Verapamil
Authors: Aizawa Y. , Miyajima S. , Niwano S. , Tamura M. , Shibata A.
Published: July 2008

The significance of fragmented activity obtained from the atrium during electrophysiologic study (EP study) was confirmed since it was al ways observed just at the onset of fi brillation. It was preceded by extra stimuli or atrial flutter, and the initial site of fragmentation varied from case to case. The premature-stimu lus-induced widening of the atrial wave was observed in some cases who had normal size of atrium and no heart failure. The widening was aug mented by administration of vera pamil but not by procainamide, suggesting that for such widening or fragmented activity, slow-fiber-medi ated conduction seems to be responsi ble. One case with intraatrial reen trant tachycardia developed fragmentation lasting for 1.0 second after verapamil.

Therefore, some apparently nor mal atria may have a subclinical elec trophysiologic abnormality that can be disclosed by premature stimula tions or verapamil.
Can the Parasternal Long Axis Plane Replace the Apical Four-Chamber Plane in Diagnosing Mitral Valve Prolapse?
Authors: Kinney Evlin L. , Wright Robert J.
Published: July 2008

Since the mitral anulus is now known to be saddle-shaped, use of the qualitative motion of the mitral valve (MV) leaflets in the apical four- chamber plane to diagnose mitral valve prolapse (MVP) may be un sound, in that superior systolic dis placement of the MV leaflets would occur in normal subjects, as well as in patients with MVP. It has therefore been suggested that the parasternal long axis (PLAX) plane should be used to diagnose MVP. To test the feasibility of this approach, the au thors examined the predictive accu racy of PLAX prolapse and other isolated echocardiographic abnor malities versus a multivariate deci sion tree approach. PLAX prolapse, which was significantly associated with marked (> 0.7 cm) apical four- chamber prolapse, mitral regurgita tion, the presence of a thick mitral valve, and low relative body weight, was 100% specific for MVP but only 44% sensitive. Similarly, marked api cal four-chamber prolapse was 100% specific but only 53% sensitive. Api cal four-chamber prolapse, if gauged only qualitatively as present or ab sent, was 94% sensitive but only 50% specific. By contrast, the decision tree classified all 32 initial patients correctly, and in a second, test set, se lected 6 additional patients; these 6 patients had many of the clinical fea tures of MVP. These observations suggest that: (1) if prolapse is seen in the PLAX plane, the patient does have MVP; on the other hand, lack of prolapse in this plane does not ex clude the diagnosis of MVP and (2) the apical four-chamber plane, used qualitatively, does not reliably distin guish patients with MVP from those without MVP.
Arterial Fibrodysplasia: A Regional Cause of Peripheral Occlusive Vascular Disease
Authors: Esfahani Fraydoon , Rooholamini S.A. , Azadeh Bahram , Daneshbod Khosrow
Published: July 2008

The authors studied 17 cases of symptomatic arterial fibrodysplasia involv ing peripheral arteries without concomitant renovascular hypertension in Ira nian males (age range: twenty-two to forty-five years). Affected arteries were most commonly the femoral, iliac, and popliteal, but in 2 cases the axillary and brachial arteries were also affected. Three cases were progressive. Differential diagnosis of arterial fibrodysplasia is discussed. It is concluded that this entity is the most common cause of peripheral occlusive vascular disease in younger Ira nian males.
Vibrotactile Sensation and Response to Nifedipine Dose Titration in Primary Raynaud's Phenomenon
Authors: Challenor V.F. , Waller D.G. , Hayward R.A. , Griffin M.J. , Roath O.S.
Published: July 2008

The clinical response to two doses of sustained-release nifedipine was as sessed during a double-blind, randomized, placebo-controlled trial in 22 pa tients with primary Raynaud's phenomenon. Nifedipine at doses of 20 mg and 40 mg daily reduced the mean number of attacks by 40% compared with pla cebo with no significant differences between the two doses in the number of attacks or their severity. Unwanted effects were more common and more per sistent with the higher dose of nifedipine. Fingertip vibrotactile thresholds mea sured at 31.5 and 125 Hz were unchanged by treatment with nifedipine. There was, however, a correlation between the pretreatment threshold at 125 Hz and the response to treatment with nifedipine, the most favorable responses occur ring in patients with the lowest thresholds.
Ultrasonic Treatment of Varicose Veins
Authors: Schultz-Haakh Helmuth , Li John K-J. , Welkowitz Walter , Rosenberg Norman
Published: July 2008

Varicose veins and venous ailments are common among adult Americans. Treatment procedures vary but are mostly invasive. The current investigation utilizes focused high-intensity ultrasound for producing destruction of the ve nous wall in experimental dogs and in patients with varicose veins. Results are encouraging and suggest that focused ultrasonic irradiation can be an effica cious means of treating varicose veins and other venous disorders.
Simultaneous Monitoring of Electrocardiogram and Arterial Blood Pressure During Exercise-Induced Syncope in a Patient with Severe Aortic Stenosis - A Case Report
Authors: Yano Katsusuke , Kuriya Taira , Hashiba Kunitake
Published: July 2008

A sixty-six-year-old man with severe aortic stenosis, in whom simultaneous and continuous monitoring of the electrocardiogram and arterial blood pres sure was performed immediately before, during, and following recovery from exercise-induced syncope, is reported. During exercise the patient developed anginal pain associated with a gradual fall of arterial blood pressure followed by syncope. At the onset of the syncope, arterial blood pressure was extremely low, and the electrocardiogram showed sinus tachycardia. It was assumed from these findings that profound hypotension, induced by peripheral vasodilatation and ischemic myocardial depression leading to inappropriately low cardiac out put, was the underlying factor mainly responsible for the occurrence of exer cise-induced syncope in the present case.
Is Increased Plasma Viscosity A Risk Factor for High Blood Pressure?
Authors: Koenig Wolfgang , Sund Malte , Ernst Edzard , Matrai Arpad , Keil Ulrich , Rosenthal Julian
Published: July 2008

Data from several epidemiologic studies have suggested that, among other variables, hematocrit and fibrinogen may constitute risk factors for high blood pressure. As part of a population survey for cardiovascular risk factors, plasma viscosity and hemoglobin were measured. Blood pressure was determined under standardized conditions according to the recommendations of the AHA. A two- stage age-sex-stratified cluster sample of 5,312 persons, aged twenty-five to sixty-four years, was selected from a mixed urban/rural target population of 282,279 (total population approximately 533,000). A net response of 79.3% was achieved.

Multiple logistic regression analyses including plasma viscosity, hemoglobin, body mass index, alcohol consumption, smoking behavior, and total serum cho lesterol as independent variables were run controlling for both age and sex. Plasma viscosity appeared as a significant main effect in all analyses and dem onstrated the strongest association with high blood pressure next to body mass index. Whether this association implies a causal relationship cannot be an swered from cross-sectional data. However, even if plasma hyperviscosity rep resents a secondary phenomenon in hypertension, it might be of prognostic relevance. There is evidence that increased plasma viscosity may contribute to myocardial hypertrophy. Therefore hypertensives with impaired blood fluidity might constitute a subgroup at particular risk for cardiovascular complications. When antihypertensive drugs are selected, their influence on blood viscosity should be taken into account.
In Vivo and in Vitro Evidence of an Adenosine-Mediated Mechanism of Calcium Entry Blocker Activities
Authors: Di Perri T. , Laghi Pasini F. , Pecchi S. , De Franco V. , Damiani P. , Pasqui A.L. , Capecchi P.L. , Orrico A. , Materazzi M. , Domini L. , Ralli L. , Monaci A. , Blardi P. , Ceccatelli L.
Published: July 2008

Drugs such as dipyridamole (200 μg/kg/min), an adenosine uptake in hibitor, and theophylline (300 μg/kg/min), an adenosine receptor antagonist, respectively increased and decreased postischemic hypere mia in normal subjects, as well as in POAD patients. Moreover, dipyrida mole pretreatment was able to antag onize the reduction of peak flow in duced by nifedipine, and the potenti ating effect of flunarizine on postis chemic hyperemia was affected sig nificantly by theophylline, thus sug gesting a possible interference of calcium entry blocker drugs with the endogenous adenosine system. In a cellular model (polymorphonuclear leukocytes — PMN) the inhibitory ef fect of calcium entry blockers on stimulated functions (degranulation and free radical production) was highly antagonized by theophylline. Finally, a1H-NMR spectroscopy study showed a binding interaction between adenosine and flunarizine on the cell membrane. An adenosine-re ceptor coupling to the calcium entry blocker channels is suggested.
Late Cardiac Deaths After Isolated Valve Replacement for Aortic Stenosis. Relation to Impaired Left Ventricular Diastolic Performance
Authors: Lund Ole , Jensen Finn Taagehøj
Published: July 2008

Sixty-three patients took part in a follow-up study ten to seventeen years after valve replacement for aortic stenosis. Data obtained were used to predict cardiac deaths (n = 14) occurring in the following three-year period. The degree of residual left ventricular (LV) hypertrophy correl ated inversely with indices for LV sys tolic and diastolic performance (radionuclide cardiography). A logis tic regression (LR) model had a posi tive predictive value for cardiac deaths of 100% (10/10) with 8% (4/53) false negatives. Evaluating LV performance indices exclusively, LR analysis showed that only peak filling rate had independent predictive value. Subnormal and normal LV ejection fractions were associated with equal three-year cardiac death rates (29%).

Depressed LV function was re lated to residual hypertrophy. Im paired diastolic performance was the prime predictor of cardiac deaths.
Primary Arteriovenous Fistula Between Common Iliac Vessels: Ultrasound, Computer Tomographic, and Angiographic Findings — A Case Report
Authors: Walstra B.R.J. , Janevski B.K. , Jörning P.J.G.
Published: July 2008

A giant aneurysm of the right common iliac artery presenting with an arteri ovenous fistula (AVF) between the iliac artery and iliac vein and deep venous thrombosis of the right lower extremity is reported. The clinical signs and the radiologic and surgical management of the condition are discussed. In addition a brief review of the literature is given.
Quinapril: A Double-Blind, Placebo-Controlled Trial in Essential Hypertension
Authors: Maclean Derek
Published: July 2008

Quinapril HCl is a novel, nonsulf hydryl angiotensin-converting en zyme (ACE) inhibitor. The Study Group evaluated its efficacy (20, 40, 80 mg daily with forced dose titration determination at trough blood pres sure) once daily versus twice daily versus placebo, as well as its tolera bility and safety, in 270 patients with mild to moderate essential hyperten sion (WHO Stages I and II, sitting diastolic blood pressure [DPB] ≥95 mm Hg), for twelve weeks. Reduc tions in DBP of up to 13 mm Hg were obtained, and in full dosage more than 65% of patients achieved a re duction in DBP of 10 mm Hg or more from baseline or reduced their DBP to 90 mm Hg or less. Quinapril was well tolerated, and reported adverse effects were scarcely more frequent than in the placebo group. Once daily doses of quinapril were as safe and effective as twice-daily doses. Quina pril is likely to exhibit good therapeu tic utility in the management of essential hypertension.