bluuebunny/crossref_metadata_2025 huggingface dataset:
Circulating Biochemical Marker Levels of Collagen Metabolism Are Abnormal in Patients with Abdominal Aortic Aneurysm
Authors: Tachieda Rintarou , Niinuma Hiroyuki , Ohira Atsushi , Endoh Shigeatsu , Hiramori Katsuhiko , Makita Shinji , Nakamura Motoyuki
Published: July 2008

Changes in extracellular matrix composition induced by abnormal collagen metabolism in the aortic wall may be an important factor in the progression of aortic structural changes. The authors have measured several types of biochemical marker for collagen metabolism in plasma: carboxyterminal propeptide of type I collagen (PICP) for a pure collagen synthesis marker, matrix metalloproteinase-1 (MMP-1) for a degradation marker of collagen matrix, and tissue inhibitors of metalloproteinase-1 (TIMP-1) as a native inhibitor of MMP-1. Subjects of this study were 17 patients with abdominal aortic aneurysm (AAA), 14 patients with atherosclerosis obliterans (ASO), and 22 age/sex matched healthy controls (HC). Blood samples were drawn from a forearm vein and measured by radioimmunoassay or enzyme-linked immunosorbent assay. Plasma concen trations of PICP in patients with AAA were significantly decreased compared to those in HC patients (82.0 ±16.4 vs 111.3 ±40.3 ng/mL; p<0.01), but those in patients with ASO (105.4 ±55.4 ng/mL) were comparable to control concentrations. Although no differences in plasma concentrations of MMP-1 were observed among the three subject groups (HC, 20.0 ± 5.6 ng/mL; ASO, 21.4 ± 13.8 ng/mL; AAA, 24.5 ±11.7 ng/mL; NS), MMP-1/PICP ratio as an index of collagen degradation to collagen neosynthesis in AAA was significantly elevated compared to HC (0.32 ±0.18 vs 0.20 ±0.08; p < 0.01). Plasma concentrations of TIMP-1 in patients with AAA (293.8 ±61.2 ng/mL) or ASO (327.6 ±54.9 ng/mL) were significantly higher than in HC (227.3 ±60.2 ng/mL; both p < 0.01). In conclusion, these data suggest that although a compensatory mechanism such as increased TIMP-1 may be activated, collagen neosynthesis may decrease with relatively increased collagen degradation in patients with AAA.
Percutaneous Coronary Intervention as a Bridge to Renal Transplantation in a Patient with End-Stage Renal Disease
Authors: Safi Arshad M. , Kwan Tak , Rachko Maurice , Salciccioli Louis , Clark Luther T. , Safi Arshad M.
Published: July 2008

Renal transplantation is one of the preferred modes of replacement therapy in patients with end-stage renal disease. Cardiovascular disease remains the leading cause of morbidity and mortality in patients with end-stage renal disease and renal transplant recipients. The authors describe a patient with end-stage renal disease who developed unstable angina before renal transplantation. Emergent cardiac catheterization and percutaneous coronary intervention served as a bridge to his successful renal transplan tation without complications.
Monoclonal Cryoglobulinemia with Extensive Gangrene of All Four Extremities
Authors: Sanmugarajah Jasotha , Schwartz Joel M. , Friedman Sandor , Hussain Shafkat
Published: July 2008

The monoclonal immunoglobulin products of plasma cell neoplasm can give rise to a variety of manifestations including hyperviscosity, amyloidosis, cryoglobulinemia, neuropathy, and renal failure. A 50-year-old woman with monoclonal cryoglobulinemia developed extensive gangrene and ulceration of both hands and feet over several weeks requiring bilateral below-elbow and below-knee amputations. This case illustrates the importance of qualitative properties of paraprotein.
Takayasu's Arteritis Concurrent with Marfan Syndrome
Authors: Han Joo Baek  , Ki Chul Shin  , Yun Jong Lee  , Seong Wook Kang  , Eun Bong Lee  , Yeong Wook Song
Published: July 2008

Marfan syndrome (MS) is a dominantly inherited connective tissue disorder characterized by arachnodactyly, tall stature, the presence of aortic aneurysm, and lens dislocation. Takayasu's arteritis (TA) is a chronic vasculitis that primarily affects the aorta and its branches. The authors report the first case of TA in a patient with MS. The simultaneous presence of TA and MS could be a coincidence, however; the pathogenesis of TA might be linked with autoimmunity induced by abnormal extracellular matrix protein derived from the genetic mutations in MS.
Additive Effect of Coexistent Type 2 Diabetes and Arterial Hypertension on Endothelial Dysfunction in Resistance Arteries of Human Forearm Vasculature
Authors: Preik Michael , Kelm Malte , Rösen Peter , Tschöpe Diethelm , Strauer Bodo E.
Published: July 2008

Population studies suggest that vascular complications accumulate when arterial hyper tension supervenes on diabetes mellitus. Although it has been demonstrated that endothelial function is impaired in patients with either diabetes mellitus or arterial hypertension it is unknown whether or not both diseases exert additive effects on endothelial dysfunction. The authors therefore investigated endothelium-dependent and endothelium-independent vasodilation in the forearm vasculature of 44 individuals: in 10 type 2 diabetic patients (DM), in 12 patients with arterial hypertension (HT), in 10 patients with both DM and HT (DM+HT), and in 12 healthy control subjects (C). Forearm blood flow (FBF) was measured by venous occlusion plethysmography at rest and following intraarterial infusion of acetylcholine (ACh) and the NO-donor sodium nitroprusside (SNP) at increasing doses. FBF at rest was significantly lower in diabetic patients: 2.2 ±0.1 (DM) and 2.6 ±0.2 (DM+HT) versus 3.1 ±0.1 (HT) and 3.4 ±0.2 (C) mL/min per 100 mL of tissue. ACh and SNP both increased FBF dose-dependently in each group. The maximum response to ACh was progressively decreased in DM and HT: 13.7 (C) > 8.1 (DM) > 7.6 (HT) > and 5.7 (DM+HT) mL/min per 100 mL of ( continued on next page) tissue. Reduction of the endothelium-dependent flow reserve assessed as percent increase in maximum FBF was also impaired following the same rank order: 349 (C) > 268 (DM) > 160 (HT) > 126 (DM+HT) %. The flow response to the NO-donor SNP amounted to: 327 (C), 306 (DM), 200 (HT), and 194% (DM+HT). In DM+HT the reduction of endothelium-dependent flow response was more pronounced compared with the endothelium-independent flow response. The present data provide evidence that type 2 diabetes and arterial hypertension impair endothelium-dependent dilation of resistance arteries in an additive manner suggesting that this progressive endothelial dysfunction might contribute to the increased incidence of cardiovascular complications when both diseases are coexistent.
Transient U Wave Inversion During Treadmill Exercise Testing in Patients with Left Anterior Descending Coronary Artery Disease
Authors: Kodama Koji , Hiasa Go , Ohtsuka Tomoaki , Ikeda Shuntaro , Hashida Hidetoshi , Kuwahara Taishi , Hara Yuji , Shigematsu Yuji , Hamada Mareomi , Hiwada Kunio
Published: July 2008

The transient U wave inversion during exercise is specific for detecting left anterior descending coronary artery (LAD) disease. In a homogeneous patient group restricted to LAD disease, however, the significance of the electrocardiographic finding has not yet been clarified. Thus, clinical characteristics in patients with angiographically documented one-vessel disease of the LAD and exercise-induced U wave inversion were delineated. Symptom-limited treadmill exercise testing was performed in 60 patients (43 men, 17 women; mean age 64 ±8 years) with angina pectoris whose culprit lesion was located only in the LAD. U wave polarity and amplitude were determined before, during, and after exercise with the P-Q segment as the isoelectric line. Exercise-induced transient U wave inversion was defined as positive when there was a discrete negative deflection ≥ 0.05 mV within the T-P segment. Of all patients, 16 (27%) had exercise-induced U ( continued on next page) wave inversion. There were no differences in age, male gender, antianginal medication use, and coronary angiographic data between the two patients groups: patients with and without U wave inversion. Heart rate and double product of heart rate and systemic systolic blood pressure at peak exercise were also similar. Prevalence of abnormal exercise-induced S-T segment shift was 94% (15 of 16 patients) and 61% (27 of 44 patients) of patients with and without U wave inversion, respectively. The difference was statistically significant (p = 0.02). Among patients with exercise-induced S-T segment shift, the proportion of patients with S-T segment elevation to all the patients was larger in patients with U wave inversion than in patients without U wave inversion [3 (20%) of 15 patients vs 0 (0%) of 27 patients, p=0.03)]. In conclusion, the exercise-induced U wave inversion in patients with one-vessel disease of the LAD indicates the severe degree of myocardial ischemia induced in the territory perfused by the LAD. However, the elec trocardiographic finding does not appear to have independent significance since it closely correlates with the presence of S-T segment shift.
Nomograms Used to Define the Short-Term Treatment with PGE1 in Patients with Intermittent Claudication and Critical Ischemia. The ORACL.E (Occlusion Revascularization in the Atherosclerotic Critical Limb) Study Group. The European Study
Authors: Belcaro G. , Nicolaides A.N. , Cipollone G. , Laurora G. , Incandela L. , Cazaubon M. , Barsotti A. , Ledda A. , Errichi B.M. , Cornelli U. , Dugall M. , Corsi M. , Mezzanotte L. , Geroulakos G. , Fisher C. , Szendro G. , Simeone E. , Cesarone M.R. , Bucci M. , Agus G. , De Sanctis M.T. , Ricci A. , Ippolito E. , Vasdekis S. , Christopoulos D. , Helmis H. , Ramaswami G. , Ferrari P.G. , Pomante P. , Petrucci M. , Veller M. , Venniker R. , Iacobitti P. , Martines G. , Ciccarelli R. , Labropoulos N. , Bertelé V. , Andreozzi G.M. , Valentino San
Published: July 2008

Infusional, cyclic PGE 1 treatment is effective in patients with intermittent claudication and critical limb ischemia (CLI). One of the problems related to chronic PGE1 treatment in vascular diseases due to atherosclerosis is to evaluate the variations of clinical condi tions due to treatment in order to establish the number of cycles per year or per period (in severe vascular disease reevaluation of patients should be more frequent) needed to achieve clinical improvement. In a preliminary pilot study a group of 150 patients (mean age 67 ± 12 years) with intermittent claudication (walking range from 0 to 500 m) and a group of 100 patients with CLI (45% with rest pain, and 55% gangrene; mean age 68 ± 11 years) the number of PGE1 cycles according to the short-term protocol (STP) needed to produce significant clinical improvement was preliminarily evaluated. Considering these preliminary observations, the investigators established a research plan useful to produce nomograms indicating the number of cycles of PGE1-STP per year needed to improve the clinical condition (both in intermittent claudication and CLI). A significant clinical improvement was arbitrarily defined as the increase of at least 35% in walking distance (on treadmill) and/or the disappearance of signs and symptoms of critical ischemia in 6 months of treatment in at least 75% of the treated patients. With consideration of the results obtained with the preliminary nomograms a larger validation of the nomograms is now advisable. A cost-effectiveness analysis is also useful to define the efficacy of treatment on the basis of its costs. The publication of this report in two angiological journals (Angeiologie and Angiology) will open the research on nomograms to all centers willing to collaborate to the study. The data are being collected in the ORACL.E database and will be analyzed within 12 months after the publication of this report.
Expanded Polytetrafluoroethylene in External Valvuloplasty for Superficial or Deep Vein Incompetence
Authors: Nicolaides A.N. , Errichi B.M. , Incandela L. , De Sanctis M.T. , Laurora G. , Ricci A. , Belcaro G.
Published: July 2008

The authors evaluated the long-term safety of expanded polytetrafluoroethylene (ePTFE) implants used in external valvuloplasty for treatment of incompetence of the long saphenous and common and superficial femoral veins. During a 15-year period patients with superficial and/or deep venous disease and hypertension due to pure superficial or deep vein incompetence underwent an external valvuloplasty with ePTFE sutures, or an ePTFE cardiovascular patch placed as a sleeve around the incompetent vein segment, or an ePTFE tubular graft placed around the venous segment. Postoperative follow-up evaluations consisted of clinical examinations, high-resolution ultrasonography, and color duplex scanning, and a complete blood count performed at 1, 3 and 6 months, and repeated for at least 4 years, every 2 years after the procedure. A total of 101 patients (38 men and 63 women; mean [± sd] age, 44 ±12 years) underwent external valvuloplasty between January 1983 and December 1998; 82 of them completed the 4-year follow-up. Forty of the 82 patients had been operated on for superficial vein incompetence, 42 for deep vein incompetence. Overall, the mean follow- up time was 7.8 ± 3.6 years (range, 4 to 13). There were no infections, thromboses, foreign-body reactions to the ePTFE implants, or other prosthesis-related complications requiring explantation. One granuloma (noninfected) developed in association with a tubular ePTFE implant around a long saphenous vein, but it did not necessitate implant removal. Seven patients required (at least after 4 years) a second procedure for recurrent or new venous incompetence. Therefore, in this observational study, ePTFE implants used to treat or correct venous incompetence were well tolerated on a long- term basis.
Is Color-Flow Duplex a Good Diagnostic Test for Detection of Isolated Calf Vein Thrombosis in High-Risk Patients?
Authors: Sugimoto Hiroatsu , Richardson Tracey , Webster Marshall W. , Makaroun Michel S. , Eskandari Mark K.
Published: July 2008

Color-flow duplex scanning (CDS) is a good diagnostic test for lower extremity proximal deep vein thrombosis (DVT). This report aims to evaluate the diagnostic accuracy of CDS in detecting isolated calf DVT in two in-hospital populations. A total of 166 patients had routine DVT testing with both CDS and venography: 99 total joint arthroplasty patients and 67 symptomatic in-hospital patients. Isolated calf DVT was noted in 34% of arthroplasty patients and 12% of symptomatic in-hospital patients. Peroneal DVT was most common. The sensitivity, specificity, positive predictive value, and negative predic tive value (with 95% confidence interval [CI]) of CDS in detecting isolated calf DVT in the symptomatic in-hospital group was 39% (16%-62%), 98% (94%-99%), 88% (65%- 99%), and 81% (71%-91%), respectively. In the arthroplasty patients these values were 13% (3%-23%), 92% (85%-99%), 60% (30%-90%), and 55% (45%-65%), respec tively. CDS has a low sensitivity in detecting isolated calf DVT among hospitalized patients and cannot be deemed an effective tool for identifying clots limited to only one or two tibial vessels.
Graft Patency Verification in Coronary Artery Bypass Grafting: Principles and Clinical Applications of Transit Time Flow Measurement
Authors: D'Ancona Giuseppe , Ricci Marco , Bergsland Jacob , Salerno Tomas A. , Karamanoukian Hratch L.
Published: July 2008

The increasing popularity of beating-heart coronary surgery has raised concerns and doubts about the quality of the coronary anastomoses performed. Intraoperative graft patency verification methods are not commonly used after coronary surgery and, most of the cardiac surgeons, rely on the simple clinical signs (electrocardiogram tracings and hemodynamic stability) to make a diagnosis of coronary graft occlusion. New transit time ultrasound based methods for graft-patency verification have been adopted in many centers during beating-heart and traditional bypass grafting. Although the results are very encouraging, correct interpretation of the flow findings may prove difficult if specific rules are not properly followed. Flow curves, pulsatility index, and flow values should always be considered simultaneously before revising a coronary graft. Measurements should also be always performed with and without a proximal coronary snare. This article summarizes the main features of flowmetry and provides some technical pitfalls and suggestions to achieve an adequate intraoperative flow measure ment adopting the transit time method.
QT Dispersion in Patients with Takayasu Arteritis
Authors: Kakuta Tsunekazu , Maruyama Yoshiaki , Hashimoto Yuji , Yoshimoto Nobuo , Numano Fujio , Kato Toru
Published: July 2008

This study was designed to test the hypothesis that myocardial involvement exists in patients with Takayasu arteritis and is associated with increased QT dispersion, which is a marker of repolarization inhomogeneity. Twenty-one consecutive patients with Takayasu arteritis and no significant coronary artery disease were included. Twelve-lead electrocardiogram and exercise-induced thallium-201 myocardial scintigraphy were performed in all patients. Ten of 21 patients (48%) had abnormal findings on scintig raphy. Patients were divided into two groups by the presence (group P, n = 10) or absence (group N, n=11) of exercise-induced thallium-201 myocardial scintigraphic perfusion abnormalities, including permanent defects in three, reversible defects in four, and slow washout in three. The QT dispersion at rest was significantly greater in group P than that in group N (54 ±12 vs 40 ±8 msec, p < 0.005). The QTc dispersion at rest was also significantly greater in group P than in group N (59 ± 15 vs 43 ±11 msec, p<0.01). In patients with Takayasu arteritis, myocardial involvement suggested by exercise-induced thallium-201 myocardial scintigraphic perfusion abnormalities is not rare, even when no significant coronary stenosis is present on angiography. Increased baseline QT dispersion was associated with scintigraphic abnormalities and may be a useful marker of myocardial involvement in patients with Takayasu arteritis.
Extrapleural Bronchial Artery Ligation for Life-Threatening Hemoptysis in Cystic Fibrosis
Authors: Kaukuntla H.K. , Amer K.M.A. , Honeybourne D. , Stableforth D.E. , Khalil-Marzouk J.F.
Published: July 2008

Hemoptyses are common in cystic fibrosis (CF) patients. They range from massive life- threatening (>240 mL/24 hours) to recurrent minor streaking. Limited pulmonary reserve, potential concurrent chest infection, and the progressive nature of CF pose a high risk to this subgroup. Conservative management and selective bronchial artery embolization (BAE) control most acute episodes, but the recurrence rate is high. The possible need for lung transplantation in future makes an extrapleural approach for bronchial artery ligation desirable. The aim of this study was to assess the role of extrapleural bronchial artery ligation in the treatment of recurrent hemoptysis in CF patients. This is a retrospective analysis of four patients between 1986 and 1999 treated by extrapleural thoracotomy and ligation of bronchial arteries. Indications, surgical expe rience, and outcome are presented. Three patients underwent unilateral, and one patient bilateral extrapleural thoracotomy (in two separate sessions) for bronchial artery ligation. There were three men and one woman, with a mean age of 26.6 years (range 19-32 years). Indications were failure to stabilize the bronchial arterial catheter for BAE (three cases), recurrence after BAE previously controlled bleeding (one case), and communication with the right costocervical trunk signifying risk to the spinal circulation (one case). The mean follow-up was 68 months (range 3-144 months). There was one death in this series, a patient who was asphyxiated with hemoptysis, requiring ventilation preopera tively. He underwent successful extrapleural thoracotomy for bronchial artery ligation, with no further bleeding but succumbed to severe chest infection and multiorgan failure a few days later. Two patients had recurrent bleeding 12 and 36 months after surgery. Selective bronchial angiography proved the contralateral bronchial arteries to be the culprit. Extrapleural bronchial artery ligation is an effective method of controlling hemop tysis in CF, when BAE has failed. This approach minimizes pleural adhesions and is, therefore, desirable in the future consideration for lung transplantation. In this experi ence, muscle-sparing thoracotomy and postoperative epidural analgesia significantly improved the postoperative recovery.
Identification of Chlamydia pneumoniae DNA in Carotid Plaques
Authors: Chierichetti Fabio , Arbustini Eloise , Arici Vittorio , Moghadam Shahdeh Parsapour , Conti Barbara , Bagliani Attilia
Published: July 2008

Chlamydia pneumoniae (CP) is a bacterium that in recent years has been investigated as an etiologic agent for atherosclerosis. It is a ubiquitous microorganism that has been isolated in various regions of the vascular system and its prevalence is about 10% in the patient population. This study involved a group of 43 patients (27 men, 16 women, mean age 68 years) who underwent carotid endarterectomy. About 9.3% of the patients yielded plaques that tested positive for the DNA genome of Chlamydia pneumoniae.
Role of Activated Protein C Resistance in Left Atrial Thrombogenesis in Patients with Mitral Stenosis
Authors: Hisar Ismet , Ileri Mehmet , Yetkin Ertan , Atak Ramazan , Senen Kubilay , Kosar Feridun , Dundar Semra , Demirkan Deniz
Published: July 2008

Activated protein C resistance (APC-R) is the most common inherited cause of clinically apparent venous thromboembolism. Previous data indicate that left atrial thrombus (LAT) formation is a common complication in mitral stenosis (MS) and a hypercoagulable state exists in these patients. The aim of this study was to invastigate the association between APC-R and LAT formation in patients with MS. Seventy-seven consecutive patients with rheumatic MS were included in this study. Transesophageal echocardiography was performed on all patients to assess the presence of any thrombus or spontaneous echo contrast (LASEC) in the left atrial cavity or appendage. Thirty four of the patients had LAT and 43 did not. Prevelance of APC-R was smiliar between the two groups of patients with and without LAT (23% vs 16%, p=0.425). LAT(+) patients had higher incidence of atrial fibrillation (AF, 74% vs 51%, p=0.046) and LASEC (71% vs 19%, p<0.001) compared to LAT(-) patients. On multivariate regression analysis, only the presence of LASEC achieved statistical significance as an independent risk factor for LAT formation (p=0.0001, odds ratio=9.589, 95% confidence interval [CI] =3.143-29.251). Because on (continued on next page) univariate analysis both LASEC and AF were associated with LAT, we also compared the prevelance of APC-R in the subgroups of patients who have these risk factors with and without LAT. There was a correlation between the presence of APC-R and LAT in the AF(+) subgroup of MS patients (p=0.033, odds ratio=8.167, 95% CI=1.001-72.812). However, the presence of APC-R was not associated with the increased risk of LAT in LASEC(+) patients (p=0.217, odds ratio =1.200, 95% CI=1.003-1.435). Although the presence of APC-R itself is not an independent risk factor for LAT formation in MS, it may increase the risk of LAT when present in combination with AF (as an additional risk factor) in these patients.
Abdominal Aortic Aneurysm Infected with Helicobacter pylori
Authors: Hirose Hitoshi , Kugimiya Toshisada
Published: July 2008

The authors present a case of an abdominal aortic aneurysm infected with Helicobacter pylori bacteria. In their literature search, the authors found no other report of the Helicobacter pylori involved in an infected abdominal aortic aneurysm.
Coronary Artery-Left Ventricle Fistula Complicating Balloon Angioplasty
Authors: Takenaka Takashi , Horimoto Masashi , Igarashi Kei-ichi , Inoue Hitoki , Sakuragi Hitoshi
Published: July 2008

The authors describe a coronary artery fistula complicated balloon angioplasty. The proximal left anterior descending coronary artery was dilated, but a septal branch was occluded by thrombus. Angioplasty was used on the septal branch, but a pseudoaneurysm communicating with the left ventricle occurred. Follow-up angiography revealed spon taneous closure of the fistula.
Stroke: Pathogenesis, Investigations, and Prognosis
Authors: Tegos Thomas J. , Kalodiki Evi , Sabetai Michael M. , Nicolaides Andrew N.
Published: July 2008

The aim of this review is to present the current knowledge regarding stroke. It will appear in three parts (in part I the epidemiology, clinical picture, and risk factors were discussed, while part III will consist of the management and rehabilitation). In the present part (II) the pathogenetic and pathophysiologic aspects of stroke are described. Regarding the investigations apart from the history and clinal examination and general investigations, the following specialized investigations and their role are discussed in detail: Computed tomography (CT), magnetic resonance imaging (MRI), xenon-blood-flow, positron emission tomography (PET), cerebral angiography, magnetic resonance angiography (MRA), ultrasonography, transcranial Doppler (TCD), echocardiography, Holter moni toring, and biopsies. In addition, taking into account the information from the above-cited modalities a prognosis for the final outcome is presented.
Aortic Distensibility is Closely Related to the Progression of Left Ventricular Hypertrophy in Patients Receiving Hemodialysis
Authors: Matsumoto Yuji , Hamada Mareomi , Hiwada Kunio
Published: July 2008

Aortic stiffening and left ventricular hypertrophy are believed to be major determinants for the prognosis of patients with end-stage renal disease. However, the relationship between left ventricular hypertrophy and aortic stiffness remains to be determined. Echocardiographically determined parameters and aortic distensibility determined with cine magnetic resonance were evaluated in 21 patients undergoing chronic hemodial ysis. Hemodynamic variables measured at the beginning of the study were compared with those measured after 28 months. Aortic distensibility determined at the descending aorta was markedly lower in patients undergoing hemodialysis than in healthy control subjects. During the follow-up period, blood pressure and hemodynamic variables, including left ventricular mass index, remained unchanged. However, multiple regression analysis indicated that aortic distensibility independently contributed to the left ventric ular mass index and to the change in left ventricular mass index between baseline and after 28 months. Baseline left ventricular mass index negatively correlated to aortic distensibility ( r = -0.74, p < 0.0001), and the changes in left ventricular mass index posi tively correlated to aortic distensibility ( r = 0.52, p < 0.05). Our study demonstrates that aortic distensibility at the descending aorta is a predictable marker for the development or regression of left ventricular hypertrophy. Therefore, patients with end-stage renal disease must be treated with appropriate drugs to improve aortic distensibility.
Temporal Arteritis and Fever: Report of a Case and a Clinical Reanalysis of 360 Cases
Authors: Hu Zhiping , Yang Qidong , Zheng Shan , Tang Jianguang , Lu Wei , Xu Niangui , Shong Xingwang , Jang Bo
Published: July 2008

The purposes of this article are to report a case with temporal arteritis (TA) and to summarize and reanalyze the cases of temporal arteritis associated with fever in published articles for understanding better the clinical features of TA. A case with biopsy- proven TA is reported. The publications with TA and fever were searched by using MEDLINE in English from 1966 to 1999. Three hundred sixty cases of temporal arteritis associated with fever were reanalyzed. The results showed that a case of biopsy-proven TA with typically clinical manifestation was initially misdiagnosed and that the reanalysis of 360 cases revealed that the common clinical findings at presentation were abnormal temporal arteries, headache, low fever, loss of weight, polymyalgia rheumatica, jaw clau dication, vision disorder, arthralgis or myalyias, and ear pain and that the uncommon clinical findings at presentation were high fever, malaise, anorexia, breast pain, transient ischemic attack/stroke, cough, mental disorder, diarrhea, and uterine prolapse, etc. Laboratory findings were the range of erythrocyte sedimentation rate (ESR) 14 to 149 with a mean of 97.0 mm/hr, white blood cells being normal or increased in the range of (continued on next page) 10.9 to 22.9 × 109/L, hemoglobin level 7 to 16 g/dL, the platelets count increased to 785 x 109/L, and microscopic hematuria. The diagnosis was made by a combination of clinical features, an increased ESR, a response to steroids, and, most specifically, temporal artery biopsy. The initial diagnosis was misdiagnosed in 38.2% of patients. In conclusion, the features of TA associated with fever have not been widely appreciated yet. TA is a common cause of fever of unknown origin (FUO) in the elderly. TA should be considered when patients complain of common and uncommon manifestations. An elevated ESR will aid in the diagnosis of TA, and temporal artery biopsy will provide certainty.
Stroke: Management and Rehabilitation
Authors: Tegos Thomas J. , Kalodiki Evi , Nicolaides Andrew N.
Published: July 2008

The aim of this review is to present the current knowledge regarding stroke. It appears in three parts (in part I the epidemiology, clinical picture, and risk factors were discussed, while part II dealt with the pathogenesis, investigations, and prognosis). In this part (III) the management is presented. In an acute stroke the role of the following is discussed in detail: Thrombolysis, anticoagulant agents, and prophylactic neuroprotection with phar macologic agents. For the prevention of stroke apart from the risk factors, which were presented in part I, the current knowledge with pharmacologic agents is discussed. Also the role of carotid endarterectomy, extracranial-intracranial bypass surgery, carotid artery angioplasty and stenting, and the treatment of cerebral hemorrhage are described. Finally the means and possibilities of rehabilitation are discussed.
Severe Postoperative Hemorrhage Attributed to Single-Dose Parenteral Ketorolac-Induced Coagulopathy
Authors: RuDusky Basil M.
Published: July 2008

Ketorolac is a nonsteroidal antiinflammatory drug that has been used as a postoperative analgesic since its introduction in the US in 1990. Although hemorrhagic side effects secondary to its use have been consistently described in the medical literature, its attendant complications have been commonly unappreciated by the medical profession. Two catastrophic, near-fatal, hemorrhagic postoperative events are described in which the use of ketorolac was unquestionably contraindicated.
Biatrial Thrombosis After Acute Inferior Wall Myocardial Infarction
Authors: Bilge Mehmet , Eryonucu Beyhan , Güler Niyazi
Published: July 2008

The authors describe a case of biatrial thrombosis after acute inferior wall myocardial infarction (MI) with sinus rhythm. The presence of atrial thrombosis in patients with acute MI has recently been recognized with the aid of echocardiography. However, to the author's knowledge, a case of biatrial thrombosis after acute MI has not been reported previously. In this case, blood stasis, resulting from both left ventricular and right ventricular systolic dysfunction, was the most likely cause of the biatrial thrombi formation. In summary, this case suggests that biatrial thrombosis may occur in acute MI, even in the presence of sinus rhythm.
Polymorphic Ventricular Tachycardia Due to Renal Artery Stenosis
Authors: Demir Ahmet Duran , Soylu Mustafa , Tikiz Hakan , Tezcan Uğur Kemal , Balbay Yücel , Kütük Emine
Published: July 2008

Atherosclerotic renal artery disease is common among patients with hypertension over the age 50 years who are resistant to medical treatment. In this case report, the authors present a 55-year-old woman with unilateral renal artery stenosis with a history of cardiac arrest. QT prolongation and evident hypokalemia were the main clinical findings of the patient. The patient also had an episode of polymorphic ventricular tachycardia during hospitalization that degenerated into ventricular fibrillation. After successful balloon dilation of the stenotic renal artery, the patient stayed normotensive and normokalemic without medication, and no arrhythmia was observed during the 6-month follow-up period.
Clinical Characteristics Influence Left and Right Ventricular Diastolic Function in Healthy Individuals
Authors: Demir Mesut , Acartürk Esmeray
Published: July 2008

The aim of this study was to determine whether clinical characteristics have an influence on left (LV) and right ventricular (RV) diastolic function indices measured by echocardiography in healthy individuals. Five hundred and three volunteers (253 women and 250 men) aged 18-66 years (mean 36.9 ±11.9) who were normotensive and free of clinically apparent heart disease were included in the study. Mitral and tricuspid peak E wave and A wave velocities, E/A ratio, deceleration time (DT) of the E wave, and left ventricular isovolumetric relaxation time (IVRT) were evaluated as left and right ventricular diastolic function indices. In order to determine the effects of age, gender, body surface area (BSA), waist/hip ratio (WHR), and heart rate (HR) on left and right ventricular diastolic function indices Student's t test and correlation and linear regression analysis were used. IVRT and deceleration time of the mitral E wave (DTm) were significantly longer in men. Mitral and tricuspid A wave velocities, tricuspid E/A ratio, and decel eration time of the tricuspid E wave (DTt) were similar in both genders. Mitral and tricuspid E wave velocities and mitral E/A ratio were greater in women. Mitral E wave velocity and IVRT mostly correlated with WHR. Age was found to be the most important factor affecting mitral A wave velocity, DTm, E/A ratio, and right ventricular diastolic function indices. This study shows that age, heart rate, body surface area, and waist/hip ratio have important correlations with Doppler echocardiographic diastolic indices in normal individuals and should be consid ered in the evaluation of LV and RV diastolic function.
Acral Necrosis of the Fingers as Initial Manifestation of Cutaneous Polyarteritis Nodosa
Authors: Stussi Georg , Schneider Ernst , Trüeb Ralph M. , Seebach Jörg D.
Published: July 2008

Cutaneous polyarteritis nodosa (CPN) is a well-known entity showing subcutaneous tender nodules, livedo reticularis, and ulcerations as predominant features; arthralgia, myalgia, periph eral neuropathy, and general symptoms such as fever and malaise may also be present. Although the localization of the disease is not specific, the characteristic primary lesions are painful subcutaneous nodules on the lower extremities. Here we report the case of a 33-year- old man with blue-colored distal phalanges and necrosis of several fingertips on both hands as the initial manifestation of CPN.
Left Ventricular Septal Aneurysm in Association with Bicuspid Aortic Valve
Authors: Yildirir Aylin , Batur Mustafa Kemal , Kabakci Giray
Published: July 2008

Diverticula of the left ventricle are rare cardiac anomalies. Most cases arise from the apex of the left ventricle and are usually found in children. Only a few cases have been documented in adults. The authors report a case of a 38-year-old woman who presented with dyspnea and chest pain. She was found to have a septal left ventricular diverticulum associated with bicuspid aortic valve, aortic stenosis, and aortic regurgitation. The aortic valve was replaced with the resection of the diverticulum. Pathologic examination confirmed the diagnosis of fibrous diverticulum.
The Genesis of Atherosclerosis and Risk Factors: A Review
Authors: Tegos Thomas J. , Kalodiki Evi , Sabetai Michael M. , Nicolaides Andrew N.
Published: July 2008

Atherosclerosis constitutes the most common medical and surgical problem. This can be mani fested clinically as stroke, coronary artery disease, or peripheral vascular disease. In the present review the microscopic appearance of the normal arterial wall, the definition of atherosclerosis and the five theories of atherogenesis are described. These are: the lipid theory, the hemody namic theory, the fibrin incrustation theory, the nonspecific mesenchymal hypothesis and the response to injury hypothesis. Based on the above theories the sequence of events in athero genesis is analyzed. The classification of the atherosclerotic lesions according to Stary (types I-VI) and their characteristics appear in a table. The epidemiology and the role of the following risk factors are presented in detail: age, sex, lipid abnormalities, cigarette smoking, hyperten sion, diabetes mellitus, physical inactivity, alcohol consumption, obesity, and hemostatic factors. In addition, less common genetically determined associations like homocystinuria, Tangier disease, Hutchinson-Gilford syndrome (progeria), Werner's syndrome, radiation induced ather osclerosis and the implications of Chlamydia pneumoniae on the arterial wall are discussed.
Superficial Thrombophlebitis and Anticardiolipin Antibodies
Authors: Pereira de Godoy José Maria , Batigália Fernando , Braile Domingo Marcolino
Published: July 2008

The aim of this study was to determine a possible association between recidivist superficial thrombophlebitis and anticardiolipin antibodies. Forty-five patients with two or more episodes of superficial thrombophlebitis in lower limbs (33 women and 12 men with ages ranging from 17 to 60 years, average: 39.8) were studied. The control group was formed by 100 voluntary donors from the blood bank (83 men and 17 women, age range: 21 to 59 years, average: 35.4). Anticardiolipin antibody concentrations were determined by enzyme-linked immunosorbent assay (ELISA). For semiquantitative detection in human sera with use of QUANTA Lite™ ACA IgG/IgM-INOVA Diagnostic, Inc., and positive values were considered as 15 GPL units/mL and 12.5 MPL units/mL for immunoglobulin G (IgG) and IgM, respectively, as recommended by the test. The Odds Ratio method was chosen for statistical analysis with a confidence interval (CI) of 95%.

In 15 patients (33.3%) anticardiolipin antibody positivity was detected, whereas in 12 patients (26.7%) it occurred as immunoglobulin M (IgM) anticardiolipin and in 3 (6.7%) as immunoglobulin G anticardiolipin. In the control group, positivity was found in 7 patients (7%) for those antibodies. Furthermore, the Odds Ratio = 6.64 with CI = 95% and values ranging from 2.48 to 17.82 (p<0.05) were significant, as well as for IgM/IgG anticardiolipin proportion with Odds Ratio = 5.09, CI=95% and values varying from 1.33 to 19.54 (p<0.05). The authors conclude that there is a correlation between the presence of anticardiolipin antibodies and recurrent superficial thrombophlebitis.
Acute Myocardial Infarction Secondary to Coronary Vasospasm During Withdrawal from Industrial Nitroglycerin Exposure
Authors: RuDusky Basil M.
Published: July 2008

Industrial exposure to nitrates is known to produce acute and chronic effects on the cardio vascular system. A case of acute inferior myocardial infarction in a young, otherwise healthy, white male that occurred during the usual weekend withdrawal period is presented.
Prevalence of Subclavian Artery Stenosis in Patients with Peripheral Vascular Disease
Authors: Gutierrez Godofredo R. , Mahrer Peter , Aharonian Vicken , Mansukhani Prakash , Bruss Jeffrey
Published: July 2008

Internal mammary arteries (IMA) as conduits in coronary artery bypass grafting are superior to saphenous vein grafts. If there is subclavian artery stenosis (SAS) proximal to the IMA graft, impairment of flow to the IMA may occur. If the stenosis is severe, retrograde flow from the grafted coronary artery to the brachial artery may lead to angina. Following the identification of 2 cases of angina secondary to subclavian artery stenosis at their institution, the authors prospectively performed arch angiography in a cohort of patients with manifestations of periph eral vascular disease undergoing diagnostic coronary angiography to assess the prevalence of subclavian stenosis. Fifty-two patients were enrolled in the protocol, with 48 patients having technically acceptable studies. Of these 48, 41.6% had measurable stenosis of at least one of the brachiocephalic arteries, with 35% of patients with at least a 30% stenosis of the left subclavian artery and 18.7% with more than 50% stenosis.

They conclude that patients with significant peripheral vascular disease undergoing coronary angiography who are potential candidates for revascularization may benefit from arch angiography as part of their initial evaluation.
Ergotamine-Induced Acute Vascular Insufficiency of the Lower Limb
Authors: Halloul Zuhir , Meyer Frank , Lippert Hans , Buerger Thomas
Published: July 2008

Ergotamine-containing drugs are widely used in the treatment of acute migraine attacks. Spastic vasoconstriction is one of the possible side effects usually affecting the lower extremities and sometimes leading to gangrene. A 28-year-old woman was hospitalized for severe acute arterial insufficiency of the limbs. The initial surgical approach was not successful since the diagnosis was missed. Overuse of ergotamine derivative was acknowledged by the patient, who had a long history of migraine headaches. Therefore, the patient was treated conservatively with intravenous heparin and prostaglandin infusion and sympatheticolysis via epidural catheter. The vascular complications, angiographic findings, and different modalities of treatment of ergotamine-induced peripheral vascular insufficiency of the lower limb are reviewed.
Ehlers-Danlos Syndrome Type IV and Multiple Aortic Aneurysms
Authors: de Paiva Magalhães Eduardo , Fernandes Sandra Regina M. , Zanardi Verônica Araújo , Medeiros Charles Angotti Furtado , Midori Rosemeire Yamada , Sachetto Zoraida , Samara Adil Muhib
Published: July 2008

Beside atherosclerosis, aortic aneurysms can be part of the clinical spectrum of many systemic diseases, including infectious, inflammatory, genetic and, less often, congenital disorders. A 48- year-old white man presented with multiple large aneurysms of the aorta and its main branches. Medical history was unremarkable except for the presence of a softened abdominal mass since he was 28 years old. On the physical examination, an arterial murmur was heard over the left carotid artery and a palpable mass was noted in the whole right side of the abdomen. No skin or joint abnormalities were noted. Aortography, computed tomography, and magnetic resonance angiography showed multiple large aneurysms of the descending thoracic and abdominal aorta. Aneurysms of the innominate, left subclavian, and carotid arteries were also seen. This case resembles those previously reported, in which multiple aortic aneurysms were associated with abnormalities of the type III procollagen gene (COL3A1). Although the classic stigmas of the Ehlers-Danlos syndrome type IV were lacking, this genetic disease may be the cause of the multiple aneurysms in this patient.
Intact Insulin, Insulin Propeptides, and Intima-media Thickness in the Femoral Artery in 58-year-old Clinically Healthy Men
Authors: Bokemark Lena , Wikstrand J. , Fagerberg B.
Published: July 2008

The aim of this study was to examine the association between intact insulin, insulin propep tides, and femoral artery intima-media thickness. The design was a cross-sectional study and the study group (n = 391) consisted of randomly recruited clinically healthy 58-year-old Swedish men. The intima-media thickness of the common femoral artery was measured with ultrasound. Fasting plasma insulin; intact insulin; proinsulin; 32,33 split-proinsulin; and C-peptide concen trations were assessed.

The results showed that the common femoral artery intima-media thickness correlated significantly and univariately with waist-hip ratio, systolic blood pressure, serum total choles terol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, triglycerides, ApoB, low-density lipoprotein peak particle size, and cigarette years. Furthermore, of intact insulin and insulin propeptides, only intact insulin and C-peptide were univariately associated with common femoral artery intima-media thickness (r= 0.14, p < 0.01; r= 0.18, p < 0.01; respec tively). In a multiple regression analysis, common femoral artery intima-media thickness was independently associated with systolic blood pressure (beta-coefficient = 0.004, p = 0.002), ApoB (beta-coefficient = 0.338, p < 0.001) and cigarette years (beta-coefficient = 0.0004, p < 0.001), (R2 = 25%, p < 0.00 1 ).

In conclusion, smoking, systolic blood pressure, and ApoB but not insulin or insulin propep tides were independently associated with femoral atherosclerosis.
Interaction Between Gene Polymorphisms of Renin-angiotensin System and Metabolic Risk Factors in Premature Myocardial Infarction
Authors: Petrovič Danijel , Zorc Marjeta , Kanič Vojko , Peterlin Borut
Published: July 2008

The renin-angiotensin system is involved in the pathogenesis of coronary artery disease (CAD) and myocardial infarction (MI). The authors investigated the association of genetic variability in the renin-angiotensin system (RAS) with premature MI and interactive effects between gene polymorphisms and metabolic risk factors on MI risk. Their study compared 142 patients with MI younger than 55 years with 142 healthy subjects. Polymorphisms of angiotensin-I converting enzyme (ACE) gene (insertion/deletion), angiotensinogen gene (M235T), and angiotensin-II type-1 receptor (AGT 1R) gene (A1166C) were tested. The ACE-DD (deletion/deletion) genotype conferred a twofold independent risk for MI (confidence interval [CI] = 1.1-3.7; p=0.01) after adjustment for cardiovascular risk factors, whereas angiotensinogen-TT genotype and AGT1R- AA genotype were not independent risk factors for MI. An interactive effect on MI risk was found between ACE-DD and AGT1R-AA genotypes (odds ratio [OR] = 2, 95% CI = 1-3.9), between ACE-DD and angiotensinogen-TT genotypes (OR=2.7, 95% CI= 1-7.3), as well as among ACE-DD, angiotensinogen-TT, and AGT1R-AA genotypes (OR = 4.8, 95% CI = 1-22.8). Similarly, metabolic risk factors interacted with angiotensinogen-TT genotype (OR=2, 95% CI = 1.1-3.9) on MI risk. The ACE-DD genotype is an independent risk factor for MI in patients younger than 55 years. Additionally, the authors provide evidence of an interactive effect on MI risk between risk genotypes of RAS, as well as between the angiotensinogen-TT genotype and metabolic risk factors.
Cardiac Amyloidosis Presenting as Microvascular Angina
Authors: Ogawa Hisao , Mizuno Yuji , Ohkawara Susumu , Tsujita Kenichi , Ando Yukio , Yoshinaga Masaru , Yasue Hirofumi
Published: July 2008

Cardiac amyloidosis usually presents with heart failure, but rarely leads to coronary insuffi ciency. The authors report a case of a 69-year-old Japanese woman with cardiac amyloidosis presenting as microvascular angina. She had exertional angina with positive exercise test and normal coronary angiograms. However, heart failure developed, and she died 3 years after symptom onset. On autopsy, coronary arteries were patent. In contrast to that of the epicar dial coronary arteries, histologic examination of the heart revealed severe obstructive alter ations of the intramural coronary arteries with amyloid. Furthermore, amyloid was present mainly in the endocardium and the intramural coronary arteries, but there was little present in the myocardium. This case was a rare AL amyloidosis. There have been only 4 reported cases of cardiac amyloidosis that presented with exertional angina, a positive exercise test, and normal coronary angiograms and histologic examination.