bluuebunny/crossref_metadata_2025 huggingface dataset:
Phosphorus Magnetic Resonance Spectroscopy: A Noninvasive Technique for the Study of Occlusive Arterial Leg Disease and Peripheral Vasodilator Therapy
Authors: Wahl Denis G. , Simon Jean-Philippe , Robin Brigitte , Walker Paul , Jouanny Pierre , Escanye Jean-Marie , Paille François , Schmidt Claude , Brunotte François , Robert Jacques , Schmitt Jean
Published: July 2008

Using 31P nuclear magnetic resonance spectroscopy of the calf muscle, the authors studied patients with peripheral arterial occlusive disease. They studied PCr depletion and intra cellular pH during aerobic exercise in patients and controls. The phosphocreatine (PCr) index {[PCr] / ([PCr] + [Pi])} at rest was correlated with blood flow measured by plethys mography During aerobic exercise a greater decrease in pH was obtained in patients (p < 0.03). They also studied the work necessary to reach a PCr index = 0.5 during ischemic exercise. This workload was lower in patients than in controls: 32.99 ±3.04 J vs 58.89 ±8.55 J, p < 0.05. After vasodilator therapy the workload was improved in patients: 32.99 ±3.04 J vs 38.85 ±3.54 J, p < 0.05. These results suggest that therapy resulted in improved tissue perfusion in patients.
Pulmonary Artery Aneurysm Due to Severe Congenital Pulmonic Stenosis
Authors: Tami Luis F. , McElderry Michael W.
Published: July 2008

Although dilatation of the pulmonary artery (PA) is characteristic of pulmonic valve stenosis (PVS), the occurrence of a PA aneurysm in association with PVS is very rare. The authors describe a patient with severe, dome-shaped PVS who developed a 6.5 cm pulmonary trunk aneurysm. Long-term follow-up after surgical valvotomy demonstrated that the size of the aneurysm remained unchanged. Pertinent literature and implications on the natural history and management of these aneurysms are discussed.
Changes in Blood Pressure Reactivity and 24-Hour Blood Pressure Profile Occurring at Puberty
Authors: Modesti P.A. , Pela I. , Cecioni I. , Gensini G.F. , Neri Serneri G.G. , Bartolozzi G.
Published: July 2008

To evaluate blood pressure reactivity in children and its changes in adolescents, the acute pressor response to a video-game stress test and the noninvasive ambulatory blood pressure monitoring were evaluated in 62 healthy children divided into three age groups. Basal blood pressure values were measured according to the NIH Task Force. With baseline measures and body mass index controlled for, analysis of covariance showed that the video game provoked significant and incremental cardiovascular reac tivity across the games in adolescents when compared with the two other groups of children. The same group of children showed also a significantly higher systolic ambu latory pressure during the daytime, whereas no significant difference was observed by basal BP measurement.

In conclusion an increased reactivity to external stimuli was observed in adolescents, and this pattern was strictly associated with a higher daily blood pressure.
The Applicability of Color-Labeled Microspheres in a Rabbit Model of Ischemia-Reperfusion
Authors: Hasdai David , Fuchs Limor , Ohad Dan , Battler Alexander
Published: July 2008

This study was designed to examine the ability of color-labeled microspheres to depict different states of myocardial perfusion in a rabbit model of ischemia-reperfusion. A thread was passed under the left anterior descending artery (LAD) and the first left marginal artery of anesthetized New Zealand White rabbits. Blue-labeled microspheres (500/g body wt) were injected into the left atrium. The thread was tightened in rabbits belonging to the experimental group (n = 8), and red-labeled microspheres (500/g body wt) were injected. The snare was loosened, and yellow-labeled microspheres (500/g body wt) were injected before (n = 5) or after (n = 3) methylene blue injection. In animals belonging to the "sham" group (n = 4 and n = 2, respectively), the sequence of injections was similar, but the snare was not tightened. The animals were euthanized, and 0.3-1 g sections were cut from ischemic and nonischemic regions, as determined by methylene blue in the experimental subgroups and from the corresponding regions in the "sham" subgroups. The tissue samples were digested with 4 M KOH, ethanol 70%, and ultrasonication, and the microspheres were recovered by vacuum filtration. The dye was chemically removed from the microspheres, and the photometric absorption of each sample was determined.

There was no significant difference between the experimental and "sham" groups in baseline uptake of blue-labeled microspheres. Rabbits belonging to the experi mental subgroups had significantly lower mean uptake of red microspheres during ischemia relative to "sham" (0.51 ±0.08 vs 1.06 ±0.24 and 0.36 ±0.19 vs 0.91 ±0.12, respectively). After loosening of the snare there was no difference in uptake of yellow- labeled microspheres.

Color-labeled microspheres depict myocardial ischemia in the rabbit. The ability of color-labeled microspheres to depict reperfusion hyperemia remains to be proved.
Consequence of Diseases in Aorta on Evaluation of Aortic Regurgitation by Aortic Flow Velocity Profiles
Authors: Mitani Mayumi , Tamai Jun , Miyatake Kunio
Published: July 2008

The aim of the study was to investigate whether flow velocity profiles of the aorta are related to the severity of aortic valve regurgitation (AR) in patients with diseases of the aorta. Aortic root angiography, abdominal aortic flow velocity measurements by pulsed Doppler method, and regurgitant jet measurements by color Doppler echocardiography were performed in 62 patients with various etiologies of AR and 13 patients without AR. The regurgitant fraction of abdominal aortic flow velocity profiles was related to the angiographic severity of AR except for the patients with Takayasu's arteritis and those after thoracic aorta grafting who showed large regurgitant fraction regardless of AR. Color Doppler evaluation was also correlated well with angiographic findings, but it was not possible in 13 of 62 patients with AR because of the inadequate color Doppler images. Although the observation of abdominal aortic flow profiles is clinically of value in nonin vasive evaluation of AR, it could not be applied in patients with Takayasu's arteritis and those after graft surgery.
A New Preparation of Nifedipine for Sublingual Application in Hypertensive Urgencies
Authors: Kürkciyan Istepan , Sterz Fritz , Roden Michael , Heinz Gottfried , Hirschl Michael M. , Müllner Marcus , Laggner Anton Norbert
Published: July 2008

A new preparation of nifedipine for sublingual application in hypertensive urgencies was investigated in a prospective study. Patients admitted to the Emergency Department with a persistent elevation of systolic blood pressure (SBP) greater than 190 mm Hg and/or a diastolic blood pressure (DBP) greater than 100 mm Hg received nifedipine 10 mg sublin gual with a sprayer. A second dose was administrated fifteen minutes later if an adequate response defined as a stable reduction of SBP below 180 mm Hg and DBP below 100 mm Hg had not occurred. Of 30 patients, 21 (70%) responded to the first nifedipine appli cation, 7 responded to the second dose, and 2 nonresponders had to be treated with urapidil. Overall mean SBP was 206 ± 19 mm Hg and mean DBP was 113 ± 15 mm Hg before treatment, and a significant antihypertensive effect was noted within fifteen minutes after nifedipine spray (p < 0.05). The maximum antihypertensive effect was for SBP in sixty minutes (146 ±19 mm Hg) and for DBP after one hundred twenty minutes (78 ± 18 mm Hg). The average reduction in SBP was 29% and in DBP 31%. In first-dose responders (n = 21) a significant antihypertensive effect was noted within fifteen minutes. SBP declined from 205 ±21 to a minimum of 142 ±15 mm Hg (22.3%) after sixty minutes and DBP from 113 ± 13 to a minimum of 77 ±11 mm Hg (22.2%) after one hundred twenty minutes. In second-dose responders (n = 7) a significant antihypertensive effect was noted within thirty minutes. SBP declined from 214 ±20 to a minimum of 151 ± 18 mm Hg (29.5%) after sixty minutes and DBP from 123 ± 14 to a minimum of 92 ±31 mm Hg (24.9%) after one hundred twenty minutes. After treatment with sublin gual nifedipine spray the authors could not observe any clinically significant side effects. Overall the heart rate decreased significantly from 100 ±21 beats per minute to a minimum of 84 ± 15 beats per minute after one hundred twenty minutes. The authors conclude that sublingual nifedipine spray application offers a new, highly effective, safe, and convenient method of treating patients with hypertensive urgencies.
Pharmacotherapy of Chronic Pulmonary Arterial Hypertension: Value and Limitations
Authors: Alpert Martin A. , Concannon Milton D. , Mukerji Basanti , Mukerji Vaskar
Published: July 2008

Efforts aimed at assessing pharmacotherapy of pulmonary arterial hypertension (PHT) have largely focused on patients with primary PHT, PHT associated with selected connec tive tissue diseases, and various forms of hypoxic secondary PHT. Part I of this review discusses the value and limitations of a wide variety of vasodilator drugs, oxygen, and warfarin in the treatment of primary PHT with special reference to their effects on pulmonary and systemic hemodynamics, functional capacity, and survival.
Plasma Sialic Acid and Acute-Phase Proteins in Patients with Myocardial Infarction
Authors: Crook M. , Haq M. , Haq S. , Tutt P.
Published: July 2008

Plasma total sialic acid (TSA) and lipid-associated sialic acid (LASA) were measured in 19 patients with a myocardial infarction (MI) on days 1, 2, and 5 and in 19 normal subjects. On each day plasma TSA was elevated in the MI patients as compared with that of normal subjects, although no significant difference was seen in the plasma LASA between the two groups. The following plasma acute-phase proteins were also assayed in the MI patients and the normal subjects: C-reactive protein (CRP), alpha-1 acid glycoprotein (AGP), alpha-1 antichymotrypsin (ACT), alpha-2 macroglobulin (AMG), and fibrinogen (FIB). Significantly elevated plasma concentrations were found in the MI patients as compared with normal subjects. Furthermore, a significant correlation was found between some of these plasma acute-phase proteins (ACT, AMG, and FIB) and plasma TSA in the MI patients and also in normal subjects (ACT, AMG, CRP and FIB). However, no significant difference was noted in any of the plasma acute-phase proteins, or plasma TSA, or plasma LASA between survivors and patients who died of their MI.
Isolated Congenital Left Ventricular Diverticulum in an Adult
Authors: Ichikawa Kazuhito , Makino Katsutoshi , Futagami Yasuo , Fujioka Hirofumi , Ito Masaaki , Hamada Masayuki , Konishi Tokuji , Nakano Takeshi
Published: July 2008

A sixty-three-year-old man presented himself with atrial flutter and congestive heart failure. Cardiac catheterization revealed that left ventricular diverticulum was located on the anterobasal wall with narrow connection to the left ventricular cavity. Coronary angiography revealed normal coronary arteries. The patient had been asymptomatic until adult life with no other thoracoabdominal or cardiac anomalies. This is an extremely rare finding in the adult population.
Evaluation of Suspected Deep Venous Thrombosis in Oncologic Patients
Authors: Keefe Deborah L. , Roistacher Nancy , Pierri Mary Kathryn
Published: July 2008

Impedance plethysmography (IPG) and duplex scanning with color flow Doppler were performed in 100 consecutive high-risk patients with clinically suspected deep venous thrombosis. Risk factors included recent surgery (<three weeks) in 23%, malignant disease in 91%, clotting abnormalities in 32%, and limited activity in 70%. Lower limb findings of either edema, calf tenderness, or both occurred in 92%. There was agreement between the two tests in 76 patients (29 positive and 47 negative). In 12 patients the IPG was positive and the duplex negative. Four of these had extensive pelvic disease, 2 had lung cancer with an obstructive profile, and 2 had heart failure, all of which are known to cause false-positive IPG results. In the other 12 patients the IPG was negative and the duplex positive; however, 3 of these patients had nonocclusive thrombi, 5 had pelvic disease, and 1 had a hemiparesis of the involved lower limb. In 15 patients (11 with positive duplex studies and 4 with negative) a venogram was obtained and confirmed the results. All patients were followed up clinically and none developed complications suggesting inaccurate duplex results.

In conclusion, the IPG is of limited utility in this population with a sensitivity of 71%, specificity of 80%, and false-negative rate of 29% when duplex Doppler and clinical outcome are used as the standard. Where available, duplex Doppler should be preferred for evaluation of suspected deep venous thrombosis in patients with extensive medical disease.
Impact of Risk Factors on Limb Salvage After Angioplasty in Chronic Critical Lower Limb Ischemia
Authors: Matsi Pekka J. , Manninen Hannu I. , Laakso Markku , Jaakkola Pekka
Published: July 2008

The impact of various general risk factors on long-term results of percutaneous transluminal angioplasty (PTA) in chronic critical lower limb ischemia is poorly known. In a prospective trial 209 PTAs were performed in 103 consecutive patients with 117 limbs with chronic critical ischemia. The general risk factors that might affect the long-term results of PTA in this patient population were reviewed. Among the factors that showed no statistical significance were all associated diseases, smoking history, and medication used. Of the various clinical chemical parameters, only serum high density lipoprotein (S-HDL) cholesterol and plasma fibrinogen had a statistically significant influence on limb salvage rate in Kaplan-Meier analysis. These parameters proved to be significant determinants also in Cox multiple regression analysis when PTA target-vessel-related parameters (peripheral runoff and number of diseased vessels) were also included in the model. Cox model predicts up to 86% one-year limb salvage for the "good" group (one to five diseased lower limb vessels/limb, S-HDL cholesterol > 0.78 mmol/L, plasma fibrinogen < 4.9 g/L).
Two-Vessel Coronary Artery Dissection in the Peripartum Period
Authors: Madu Ernest C. , Kosinski Daniel J. , Wilson William R. , Burket Mark W. , Fraker Theodore D. , Ansel Gary M.
Published: July 2008

The authors report a case of early peripartum myocardial infarction resulting from spontaneous dissection of the left anterior descending coronary artery and right coronary artery in a twenty-four-year-old woman. This is the first report of double-vessel coronary dissection involving both the left and right coronary arteries diagnosed antemortem and successfully treated.
Quantitative Coronary Arteriography and Its Assessment of Atherosclerosis
Authors: Fleming Richard M. , Harrington Gordon M. , Gibbs Harry R. , Swafford Joseph
Published: July 2008

Background. Previous work has demonstrated that quantitative coronary arteriography (QCA) can accurately measure phantom images to within ±0.1 mm and has been accepted as a reliable and reproducible method of measuring human coronary artery disease (CAD). Assessment of CAD by QCA involves the measurement of numerous variables, which are currently required to calculate stenosis flow reserve (SFR).

Methods and Results. In this study 1040 stenotic lesions were analyzed by two well- accepted methods with demonstrated accuracy and reproducibility. These methods measure percent diameter stenosis (%DS), absolute diameter, percent area stenosis, length, as well as entry and exit angles to and from a stenotic coronary artery lesion respectively Based upon these results, the mean ± standard deviations and range seen in CAD were determined for each of these independent variables. This study demonstrated that atherosclerotic coronary artery lesions do not appear to exceed an entry angle of -39°, an exit angle of +35°, or an absolute length of 4.84 cm when accurately measured by QCA. It was also noted that, once percent diameter stenosis exceeded 89% (regardless (continued on next page) of the visual estimate) or percent area stenosis exceeds 99%, coronary arteries become completely occluded as measured by QCA.

Conclusions. While previously suspected that once certain critical limits are exceeded in the deposit of cholesterol and calcium within the coronary artery, the artery will close, this study demonstrated by QCA what the limitations in human coronary arteries appear to be. These limits may be in part due to turbulent factors resulting in platelet activation or local mediators from endothelium of the coronary artery.

ABSTRACT

Contemporary quantitative coronary arteriography (QCA) was used to measure the different variables present in atherosclerotic coronary arteries. While the interaction of each of the independent variables undoubtedly plays a role in the determination of coronary artery blood flow and closure, the limitations of each of these variables have not yet been defined in humans. This study, based on the results of human coronary arteri ograms as analyzed by QCA, demonstrates the limitations of each of these variables, after which coronary arteries close and blood flow equals zero.
Quantitative Coronary Arteriography and Its Assessment of Atherosclerosis
Authors: Fleming Richard M. , Harrington Gordon M.
Published: July 2008

Background. Assessment of coronary artery disease by quantitative coronary arteriog raphy (QCA), while highly accurate, is more expensive than visual estimates of disease and involves the measurement of numerous variables requiring specialized equipment and personnel, thereby reducing its clinical applicability. In part 1 of this paper, the indepen dent variables that influence flow of 1040 coronary artery segments were analyzed.

Methods and Results. Using the information previously reported in part 1 of this paper, we set out to determine the importance of each of the independent variables (percent diameter and area stenosis, length, absolute diameter, entry and exit angles) in the prediction of stenosis flow reserve (SFR). Analysis of variance (ANOVA) was used to determine the importance of each of these variables, as well as their interactions, on the determination of SFR. Only percent diameter stenosis (%DS) demonstrated statis tical significance (P < 0.001) in determining stenosis flow reserve. When the results of SFR were plotted against %DS, a quadratic relationship was demonstrated with an R2 value of 0.903 (r = 0.95). To verify the quadratic equation, the %DS of 100 different arterial stenoses was measured and used to calculate an SFR by the quadratic formula. The QCA and quadratic (calculated) determined SFRs compared favorably, with a correlation of 0.97. (continued on next page)

Conclusions. The ability to calculate SFR directly from measured %DS allows the incor poration of calculated SFR into the clinical setting, where cardiologists can interpret lesion severity both anatomically and hemodynamically. This incorporation can be done without additional cost to the physician, hospital, patient, or third-party payers.

ABSTRACT

Contemporary quantitative coronary arteriography (QCA) methods accurately measure stenosis flow reserve (SFR) under conditions of coronary artery disease but are too expensive for practical clinical use. A simple laminar flow (Poiseuille) model was fitted to 1040 stenotic lesions and cross-validated on an independent sample of 100 lesions. This simple model was found adequate for practical use with a cross-validated correlation of 0.97 with QCA measurement. Turbulence and other known complexities had no practical effect.
Quantitative Polymerase Chain Reaction (PCR) to Analyze Messenger-RNA Expression in Tissue Obtained by Directional Atherectomy
Authors: Köster Ralf , Windstetter Ulrich , Gulizia James M. , Uberfuhr Peter , Baumann Günther , Höfling Berthold
Published: July 2008

There is a widely recognized need to evaluate gene expression in human vascular plaque tissue. Directional atherectomy made it possible to sample plaque tissue from primary stenoses and subsequently from restenoses from one individual. Conventional approaches to analyze mRNA content of lesions, such as Northern blot analysis, and slot blot analysis are not sensitive enough to evaluate mRNA levels in atherectomy specimens limited by low cell number or low copy number per cell. The purpose of this study was to investigate whether gene expression, as reflected in mRNA copy number, in atherectomy biopsies, could be sufficiently analyzed by quantitative polymerase chain reaction (PCR). The authors applied PCR to detect platelet-derived growth factor-A mRNA expression in 12 human lesions sampled percutaneously by directional atherectomy. After reverse tran scription, specific amplification of the resulting cDNA was performed. This was successful with cDNA from less than 0.5 μg of total cellular RNA. To quantitate mRNA content of specimens, the authors coamplified cDNA copies of mRNA from lesions and from a synthetic reference RNA in the same reaction vessel. Quantitative PCR is best applied if tissue is more than 45 mg in weight and of high cellularity with low calcification. This method allows quantitation of mRNA in human primary and restenotic lesions, and it complements histochemical approaches and in situ hybridization of coronary and periph eral atherectomy specimens.
The Potential Impact of the Thrombolytic Era on Cardiac Rupture Complicating Acute Myocardial Infarction
Authors: Salem Bakr I. , Lagos Julio A. , Haikal Maged , Gowda Siddhesh
Published: July 2008

Cardiac rupture complicating acute myocardial infarction (AMI) remains a serious diag nostic and therapeutic challenge. The authors present 27 consecutive patients who died from cardiac rupture following AMI. These included 22 patients from 1975 through 1983 (prethrombolytic era) and 5 patients from 1984 through 1992 (postthrombolytic era) and all had postmortem examination.

There were 16 men and 11 women with a mean age of seventy-two years. Myocardial infarction was anterior/anterolateral in 10 and inferior/inferoposterior in 17. Cardiac rupture followed AMI within one day in 14 (52%), two to five days in 8 (30%), and six to fourteen days in 5 (18%). Chest pain followed by sudden hypotension leading to electromechanical dissociation was the common terminal event. Cardiopulmonary resus citation was unsuccessful in all patients. Postmortem findings showed three-vessel coronary disease in 21 (78%) and two-vessel disease in 6 (22%). Isolated free left ventric ular wall rupture was found in 22 (81%), was anterior/anterolateral in 13 (48%), posterior in 9 (33%), and in conjunction with interventricular septum or papillary muscle in 5 (18%).

Patients encountered in this series were mostly elderly hypertensives with multivessel coronary disease and postinfarction angina. Furthermore, cardiac rupture commonly occurred within the first five days of AMI and cardiopulmonary resuscitation was uniformly unsuccessful. During the thrombolytic era at their institution, this complication is now being seen much less often. These observations suggest that such interventions are expected to have a favorable impact on reducing the incidence of this catastrophic event.
Hypertension and Ischemic Heart Disease Role of Dipyridamole Echocardiography Test
Authors: Gulizia Michele M. , Lo Giudice Pietro , Doria Giuseppe , Valenti Rosalba , Circo Antonio G.
Published: July 2008

The aim of this study is to try to evaluate the relationship between arterial hypertension and ischemic heart disease (IHD) in the light of the physiopathologic response pattern to the dipyridamole echocardiography test (DET) in hypertensive patients, in pharmaco logic washout, without any electrocardiographic ST segment depression during exercise tests or at rest. Sixty patients affected by mild to moderate asymptomatic essential arterial hypertension were studied: the subjects had a sitting diastolic blood pressure ≥95 ≤ 114 mmHg; there were 38 men and 22 women with a mean age of 49.8 ± 7.6 years (range twenty-nine to sixty-eight). All patients had undergone high-dose DET (0.84 mg/kg in ten minutes). No patients developed side effects or asynergy in cardiac contractility during the test. In the absence of any significant coronary artery obstruction assessed angio graphically, 18 patients (30%) showed ST segment depression > 1.0 mV during DET, sometimes with the presence of ventricular and/or supraventricular extrasystoles. In this group of patients the left ventricular mass index (LVMI) and duration of hypertension (in (continued on next page) months) were higher as compared with those of the other 42 patients (respectively: 160.2 ±5.1 vs 129.2 ±9.2 g/m2, P < 0.02; and 30 ±4.8 vs 9 ±5.4 months, P < 0.007).

In conclusion it is reasonable to speculate from these data that the ischemic-like" dipyridamole-induced ST segment depression, like that shown by patients affected by Syndrome X, might involve a worse prognosis in hypertensive patients. This may be because of increased coronary resistance due to structural modification or anatomic background.
A Study on Left Atrial Transport Function
Authors: Nishigaki Kazuhiko , Arakawa Michio , Miwa Hiroshi , Kagawa Kensaku , Noda Toshiyuki , Ito Yoshimi
Published: July 2008

Left atrial (LA) storage fraction is defined as the ratio of storage volume of the left atrium (LA) during ventricular systole to left ventricular (LV) stroke volume. To test their hypothesis that left atrial (LA) storage fraction is increased to compensate for impaired LV filling in the heart of aged subjects or with impaired LV ejection fraction, the authors studied 33 "normal" subjects and 25 patients with coronary artery disease. LA volume was measured by LA cineangiocardiography, and LV stroke volume and LV ejection fraction were measured by LV cineangiocardiography. To further evaluate the determi nants of changes in LA storage fraction, they measured the ratio of LA active release volume to LV stroke volume, and the ratio of LA passive release volume to LV stroke volume. In "normal" subjects, LA storage fraction was increased with age ( r = 0.584, P < 0.01). In patients with coronary artery disease, LA storage fraction was increased as LV ejection fraction was decreased ( r = -0.525, P < 0.01). In both cases, LA active release fraction was significantly associated with changes in LA storage fraction rather than in LA passive release fraction. They conclude that LA storage fraction may be an important determinant of LV filling mainly through the LA active release fraction.
Anomalous Origin of the Right Coronary Artery Above the Left Posterior Sinus of Valsalva Associated with a Normal Aortic Valve
Authors: Chadow Hal , Kwan Tak , Huber Michael , Feit Alan
Published: July 2008

This case report describes a right coronary artery arising from the ascending aorta, above the left posterior sinus. Unlike previously reported cases, this was associated with a normal aortic valve. The clinical significance and approach during angiography are discussed.
Brain Hemorrhage in Mixed Connective Tissue Disease
Authors: Toyoda Kazunori , Tsuji Hiroshi , Sadoshima Seizo , Horimoto Choji , Fujishima Masatoshi
Published: July 2008

Mixed connective tissue disease (MCTD) uncommonly develops stroke, although collagen disease is an important condition for stroke. A nonhypertensive woman with MCTD developed massive putaminal hemorrhage. No obvious predisposing factors were revealed by clinical and pathologic examination. MCTD may contribute to the develop ment of brain hemorrhage by some mechanism other than hypertension.
Percutaneous Transluminal Coronary Angioplasty of "Superdominant" Left Anterior Descending Artery
Authors: Ohte Nobuyuki , Hibino Takeshi , Satoh Takaaki , Horie Kenji , Fujinami Takao
Published: July 2008

A seventy-one-year-old woman suffering from angina pectoris had a superdominant left anterior descending artery with a 95% stenosis just after it extended the apex. This super dominant artery was demonstrated angiographically by the findings that it ran in the posterior interventricular sulcus and reached the crux of the heart. Percutaneous trans luminal coronary angioplasty for the stenosis beyond the apex was successfully performed. After the procedure, she was relieved from chest pain.
Pheochromocytoma with Echocardiographic Features of Obstructive Hypertrophic Cardiomyopathy
Authors: Balthazar Jacob José Luiz , da Silveira Luiz Carlos , de Freitas Claudia Giovanna , Pereira Cêntola Crescêncio Alberto , Nicolau Jose Carlos , Menezes Lorga Adalberto
Published: July 2008

The authors report a case of pheochromocytoma in which the echocardiographic features suggested obstructive hypertrophic cardiomyopathy.

The angiographic study and the computed tomography showed the tumor and its arterial supply.

One month after resection of the tumor the echocardiographic features showed a tendency to normalization.

The preoperative echocardiographic aspect was probably due to excessive produc tion of catecholamines by the tumor.

José Luiz Balthazar Jacob, M.D.
Measurements of Human Coronary Vascular Impedance
Authors: Chauhan Anoop , Potter Charles D. , Mullins Paul A. , Wheeldon Derek R. , Petch Michael C. , Schofield Peter M.
Published: July 2008

The aim of this study was to develop a method of measuring human coronary circulation impedance in a clinical setting. The authors measured coronary flow reserve (CFR) in 27 patients with chest pain and normal coronary arteries. A Judkins-style, 8F Doppler-tipped angiographic catheter was positioned in the left coronary ostium. Resting coronary flow velocity (RFV) and response to a hyperemic 12 mg intracoronary dose of papaverine (PFV) were measured. The signals were recorded by a recorder connected to a micro processor with analogue-to-digital converter and a maths coprocessor. Using this the authors could obtain values for impedance at RFV (IR) and at PFV (IP). The CFR was defined as the ratio: PFV/RFV An impedance index (II) was obtained as the ratio of coronary vascular impedance at peak hyperemia to the impedance at rest. The CFR was 3.2 ±1.2 and the II was 0.33 ±0.11. There was a strong inverse correlation between the CFR and the II (r = -0.9).

The authors conclude that this new approach may allow a further insight into the coronary pathophysiology and may become useful in clinical cardiology, eg, in the assess ment of heart transplant and Syndrome X patients.
Inferior Vena Caval Thrombosis Associated with Acute Pancreatitis: An Unusual Vascular Complication—Its Presentation and Management
Authors: Antony Suresh J. , Loomis Terri , Brumble Lisa , Hannis Mark D.
Published: July 2008

Vascular thrombosis and systemic hypercoagulable states are known complications of acute pancreatitis. They are thought to be secondary to the release of proteolytic enzymes of the pancreas. Inferior vena caval thrombosis is an extremely rare complication of chronic pancreatitis and has, to the authors' knowledge, never been reported in acute pancreatitis.

The clinical presentation and radiographic findings are reviewed to illustrate the disease spectrum. Early treatment with intravenous heparin appears to be an effective therapy. Familiarity with this complication will aid physicians in its early diagnosis. However, a high degree of suspicion for this complication is necessary to make a diagnosis.
Prevalence of Infection from Subclavian Dialysis Catheters with Two Different Postinsertion Catheter Cares: A Randomized Comparative Study
Authors: Huraib Sameer , Askar Akram , Abu-Aisha Hassan , Al-Wakeel Jamal
Published: July 2008

A comparison of the outcome of two different protocols concerning the postinsertion catheter care are reported and the literature of the subject is reviewed. Forty patients had the "Quinton" double-lumen catheter in the subclavian vein for hemodialysis. These catheters were kept in place for a total of 1392 days. The patients were divided randomly into two groups (A and B), each consisting of 20 patients. The care of group A catheters was done by the hospital intravenous (IV) team using heparin flushing three times/day The care of group B catheters was done by dialysis nurses using heparin 1 mL of 2500 units in each lumen only after dialysis, ie, three times/week. The bacteremia rate of group A was 15% while that of group B was 5%.

In conclusion, flushing the catheter with heparin 1 mL/2500 units in each lumen of the catheter at the end of dialysis, ie, three times/week along with changing the dressing once per week were found valuable in decreasing the rate of bacteremia from catheter infection.
Effect of Administration and Withdrawal of Doxazosin on Ambulatory Blood Pressure in Patients with Essential Hypertension
Authors: Takata Yutaka , Yoshizumi Takayuki , Ito Yasuo , Hirota Yasuo , Fujishima Masatoshi
Published: July 2008

The effect of both administration and withdrawal of doxazosin on patients with essential hypertension was evaluated by twenty-four-hour ambulatory blood pressure (BP) monitoring. Six hypertensive men were treated with doxazosin starting at 1 mg/day, and the dosage was titrated at weekly intervals up to a maximum of 8 mg/day. The twenty-four-hour BP profile was monitored noninvasively before treatment, in the fourth week of treatment, and on days 2 and 7 after the discontinuation of doxazosin. The average twenty-four-hour systolic and diastolic BPs (SBP and DBP) were lowered by doxazosin treatment and returned to the pretreatment levels within two days of doxazosin withdrawal. Doxazosin treatment produced a significant decrease in the daytime SBP and DBP but not in the nighttime BP values. The daytime BP decrease was no longer detected on days 2 and 7 after drug withdrawal. The twenty-four-hour pulse rate was not influenced by either doxazosin administration or discontinuation. The plasma norepinephrine concentration and plasma renin activity were increased by doxazosin treatment and were decreased by drug withdrawal. There was no rebound hypertension following doxazosin withdrawal. Thus, the present study using twenty-four-hour BP monitoring showed that doxazosin treatment reduced the daytime BP in patients with essential hypertension and that this reduction was abolished within two days after doxazosin discontinuation.
Determinants of Left Ventricular Function Two Weeks and One Year After an Acute Myocardial Infarction
Authors: Brzostek Tomasz , Van de Werf Frans , Scheys Ilse , Mortelmans Luc , Aubert André , Dubiel Jacek S. , De Geest Hilaire
Published: July 2008

This study examines possible covariates of left ventricular function two weeks and sixteen months after an acute infarction. It was performed in a group of 312 patients randomized double blindly to recombinant tissue plasminogen activator (rt-PA) (n=156) or placebo treatment and followed thereafter for at least one year. Two weeks after the infarction, enzymatic infarct size, infarct-related vessel, and number of diseased coronary arteries were significant determinants of the infarct-related regional wall motion (centerline method) (R2=0.25 to 0.60, P=0.0001). Enzymatic infarct size, regional wall motion of both infarct-related and remote areas, reinfarction, and treatment allocation were significant independent correlates of ejection fraction (R2=0.76), end-diastolic volume (R2 =0.20), and end-systolic volume (R2=0.69, P < 0.0001).

Infarct-related coronary artery and predischarge end-systolic volume were significant independent covariates of ejection fraction at rest (R2=0.47) after sixteen months. Age, enzymatic infarct size, and predischarge end-diastolic volume were independent determinants of the maximal (R2=0.49, P < 0.0001) and peak exercise ejection fraction (R2=0.49, P < 0.0001).
Heparin-Associated Thrombocytopenia (HAT)—Still a Diagnostic and Therapeutical Problem in Clinical Practice
Authors: Kleinschmidt Stefan , Seyfert U.T.
Published: July 2008

Type II of heparin-associated thrombocytopenia (HAT) is well known, but the cardinal symptom, thrombocytopenia, is rarely adequately considered. Serious and potential lethal complications such as pulmonary embolism, cerebral stroke, or limb gangrene are often falsely regarded as insufficient anticoagulation. Guided diagnosis and therapy are of vital importance for the patient's outcome. Based on the experience of patients with HAT Type II treated in the intensive care unit, a diagnostic and therapeutic approach to the cardinal symptom thrombocytopenia is presented. A recently developed heparin-induced platelet activation assay (HIPAA) seems to be a highly sensitive laboratory test. The first therapeutic principle in case of presumed and diagnosed HAT is the cessation of unfractioned or low-molecular-weight heparins. ORG 10172 (Orgaran@), a low-sulfated heparinoid with a low cross-reactivity (10%) to heparins, can be regarded as the most effective anticoagulant in patients with HAT Type II.
Capillary Microscopy Is a Diagnostic Aid in Patients with Acral Ischemia
Authors: Ubbink D. Th. , Janssen H.A.M. , Schreurs M.M.A. , Jacobs M.J.H.M.
Published: July 2008

The diagnosis of peripheral ischemic diseases is a challenge to the vascular specialist, since discrimination of the different entities on clinical grounds is not always clear. Capillary microscopy is a noninvasive diagnostic technique that can visualize in particular the morphology and perfusion of the digital capillaries. The authors investigated all 522 patients who were referred to the vascular laboratory over a six-year period, in an attempt to obtain more certainty about the diagnosis of their acral ischemic complaints. Patients with clinically manifest Raynaud's phenomenon and control subjects were compared to obtain differentiation criteria. Thus, capillary microscopy scored a sensitivity of 67%, a specificity of 84%, and an accuracy of 81% to detect Raynaud's phenomenon. A disturbed capillary morphology was virtually pathognomonic in Raynaud's disease secondary to systemic disorders (specificity 100%); the accuracy was but 74%. In 69% of the patients with clinically atypical acral ischemia, capillary microscopy yielded a diagnosis. Digital blood pressure measurements, however, appeared of no use in the diagnosis of Raynaud's phenomenon. Hence, capillary microscopy appears to be a useful aid in the diagnosis of acral ischemic syndromes.
Doppler Ultrasound in the Diagnosis of Venous Thrombosis
Authors: Markel Arie , Weich Yehuda , Gaitini Diana
Published: July 2008

Deep vein thrombosis (DVT) has known morbidity and mortality. New noninvasive techniques such as B-mode scanning and Doppler ultrasonography (duplex) are highly accurate in the diagnosis of this problem but are relatively expensive and time consuming. Continuous-wave Doppler, a precursor noninvasive technique, is simple, cheap, and easy to perform at the patient's bedside. To test the effectiveness of this technique the authors prospectively studied patients with clinical suspicion of DVT by Doppler ultrasound and compared the results with those from venography.

During fourteen consecutive months, patients with a clinical suspicion of DVT underwent continuous-wave Doppler examination of both inferior limbs. Each case was diagnosed as positive, negative, or inconclusive. In addition, the patients underwent a questionnaire regarding risk factors, symptoms, and mean relevant physical findings. Doppler examination was blinded to venography results.

A total of 116 patients with clinical suspicion of DVT were examined by Doppler ultrasound. Their mean age was fifty-five years (range: eighteen to eighty-eight). There were 57 men and 59 women, and from this group a total of 40 patients underwent both Doppler ultrasound examination and venography in the course of forty-eight consecutive hours. When cases with an inconclusive result were excluded, Doppler ultrasound showed a sensitivity of 89%, a specificity of 100%, and an accuracy of 94% for the diagnosis of DVT when compared with venography. When a similar analysis was done for the proximal named veins, continuous-wave Doppler examination showed a very high specificity and positive predictive value and a moderate sensitivity and negative predictive value. (continued on next page)

In the entire group of patients with a Doppler ultrasound examination (n=116), 48 cases had a positive study. Prolonged bed rest, previous surgery, and previous DVT were the most frequent risk factors, pain and swelling the most frequent symptoms, and edema and tenderness the main clinical signs. In patients without DVT (n=57), trauma, malignant obstructing tumors, and cellulitis were the most frequent final diagnoses. The study was inconclusive in 11 patients.

In conclusion, continuous-wave Doppler is accurate and may be used as the initial technique in the diagnosis of DVT. Cases that are inconclusive, or cases in which clinical findings are in evident contradiction to Doppler findings, should undergo duplex examination or venography.
Ramipril and Experimental Vein Graft Intimal Hyperplasia
Authors: Davies Mark G. , Klyachkin Michael L. , Barber Lizzie , Svendsen Einar , Hagen Per-Otto
Published: July 2008

Angiotensin-converting enzyme (ACE) inhibitors have been shown to reduce the intimal proliferation in animal models of arterial angioplasty and vein bypass grafting. This study examines the effect of high-dose ramipril, an ACE inhibitor that does not contain a sulfhydryl group, on the development of intimal hyperplasia in experimental vein bypass grafts. Twenty New Zealand White rabbits underwent common carotid interposition bypass grafting. Twelve were treated with ramipril (2mg/kg/day; po) five days prior to surgery and thereafter until harvest. The remaining 8 animals were used as controls. Vein grafts were harvested at twenty-eight days by pressure fixation (80 mmHg). The grafts were sectioned into proximal, middle, and distal thirds, and the thickness of the intima and the media and the area of the lumen from each segment were determined by videomorphometry. The effect of ramipril on the [H3]thymidine incorporation into DNA of serum-stimulated smooth muscle cells (culture passage 6 to 12) was also assessed. There was a 50% mortality rate in the rabbits that received ramipril, and this was assumed to be related to the high dose of the drug. Ramipril treatment reduced mean vein graft intimal area by 34% (P > 0.05), but this was accompanied by an increase of 73% in the mean medial area of the vein grafts as compared with controls. These changes resulted in a decrease in the mean intimal ratio (intima/[intima + media]) by 39% in the ramipril group as compared with controls. Ramipril did not inhibit [H3]thymidine incor poration into DNA of serum-stimulated smooth muscle cells. This study shows that treatment with the nonsulfhydryl ACE inhibitor ramipril, even at a high dose, produces only a marginal reduction in the formation of intimal hyperplasia in experimental vein grafts.
Enhanced Migratory Activity of Vascular Smooth Muscle Cells with High Expression of Platelet-Derived Growth Factor A and B
Authors: Köster Ralf , Windstetter Ulrich , Überfuhr Peter , Baumann Günther , Nikol Sigrid , Höfling Berthold
Published: July 2008

Proliferation and migration of vascular smooth muscle cells (SMCs) are major events in atherogenesis. It is known that platelet-derived growth factor (PDGF) stimulates both of these processes in a paracrine fashion, whereas autocrine stimulation has been shown only for proliferation. The aim of this study was to investigate the influence of PDGF expression in SMCs on migratory activity of these cells. SMCs were cultivated from the vascular tissue of 23 patients. Cellular motility was analyzed by a computer-assisted motion analysis system; 54 images per sample, obtained during an observation period of eighteen hours, were analyzed. PDGF-A and PDGF-B mRNA levels were determined by quantitative polymerase chain reaction (PCR) following reverse transcription. To quan titate mRNA content of SMCs, the authors coamplified cDNA copies of mRNA from cells and from a synthetic reference RNA in the same reaction vessel. Cells derived from ather osclerotic lesions produced a 1.6-fold increase of PDGF-A (P < 0.05) and a 5-fold increase of PDGF-B mRNA (P < 0.05) as compared with those from normal vessels. The migratory velocity (range 11.1-49.2 μm/hr) was independent of PDGF-A and PDGF-B mRNA expression. A significant correlation between levels of PDGF-A mRNA and PDGF-B mRNA and the degree of directional changes of SMCs on the covered track (klinokinesis) was found (P < 0.05).

Conclusion: PDGF-A and PDGF-B mRNA expression is significantly correlated with positive klinokinesis without affecting migratory velocity. This finding reflects enhanced migratory activity of SMCs. Besides its known mitogenic effects, the authors present evidence that PDGF may act as an autocrine motogen* in SMCs.
Arteriographic Morphology and Intracoronary Thrombus in Patients with Unstable Angina, Non-Q Wave Myocardial Infarction and Stable Angina Pectoris
Authors: Hussain K.M.A. , Gould L. , Bharathan T. , Angirekula M. , Choubey S. , Karpov Yu.
Published: July 2008

Coronary artery lesions were compared in 71 patients with unstable angina, 15 patients with non-Q wave myocardial infarction (MI), and 40 patients with stable angina. In the unstable angina group, 29 patients had new-onset angina, 31 had crescendo angina, and 11 had rest angina. In a subgroup of patients with unstable angina, three-vessel disease was less frequently (P < 0.05) seen in patients with new-onset angina (10.3%) than in the patients with crescendo angina (51.6%) or rest angina (54.5%). An angina-producing artery could be identified in 59 patients with unstable angina, in 11 with non-Q wave MI, and in 30 with stable angina. Type II eccentric stenosis (asymmetric narrowing with narrow neck and overhanging irregular edges) was present in 31 patients (52.5%; P < 0.01) with unstable angina, in 7 (63.6%; P < 0.01) with non-Q wave MI, and in only 2 (6.7%) with stable angina. Abrupt occlusion of a vessel was observed in 7 patients (11.9%) with unstable angina and in 2 (18.2%) with non-Q wave MI. None of the patients with stable angina had this type of occlusion. In the group of unstable angina and non-Q wave MI, angiographic evidence of intracoronary thrombi was present in 16 (27.1%) and 3 patients (27.3%), respectively, but in stable angina in only 1 patient (3.3%; P < 0.05). Intracoronary thrombi were most frequently found in rest angina (88%; P < 0.001) and crescendo angina (33.3%; P < 0.01) compared with new-onset angina (3.7%). These findings suggest that Type II eccentric lesions and intracoronary thrombi are frequent in patients with unstable angina and non-Q wave MI. Within the group of patients with unstable angina intracoronary thrombi are more frequently observed in patients with rest angina and crescendo angina.
Ankle/Arm Pressure Index in Asymptomatic Middle-Aged Males: An Independent Predictor of Ten-Year Coronary Heart Disease Mortality
Authors: Kornitzer M. , Dramaix M. , Sobolski J. , Degre S. , De Backer G.
Published: July 2008

Purpose of the study: to evaluate the predictive power of a reduced ankle/brachial pressure index (ABPI) (≤ .90) in an asymptomatic middle-aged male working population free of coronary heart disease.

Materials and Methods: 2023 subjects forty to fifty-five years old were screened at their work place. Standard techniques were used. Blood was drawn in the fasting state. Ankle and brachial blood pressures were measured by Doppler signals and all measures were done by one observer, duly trained in epidemiologic methodology

Results: in univariate analysis, an ABPI ≤ .90 was significantly associated with age, total serum cholesterol, body mass index, smoking, and awareness of diabetes. In multi- variate analysis, it was associated with awareness of diabetes, age, Ln triglycerides (P=.073), and smoking (P=.088).

Relative risks for reduced versus normal ABPI are 2.77 (P=.010), 4.16 (P=.011) and 4.97 (P=.006) for ten-year all causes, cardiovascular, and coronary mortality, respec tively. In a multiple logistic regression analysis, the following variables were significant independent predictors of coronary mortality: smoking (odds ratio [OR] =4.84), reduced ABPI (OR=3.63), and low density lipoprotein cholesterol (OR for 1 SD=1.69). Reduced ABPI is also an independent predictor of cardiovascular mortality

Conclusion: a reduced ABPI is an independent risk factor for coronary and cardio vascular mortality in asymptomatic middle-aged Belgian males.