bluuebunny/crossref_metadata_2025 huggingface dataset:
Apical Hypertrophic Cardiomyopathy: Diagnosis with Contrast-Enhanced Echocardiography
Authors: Acartürk Esmeray , Bozkurt Abdi , Dönmez Yurdaer
Published: July 2008

Apical hypertrophic cardiomyopathy is a rare form of hypertrophic cardiomyopathy (HCM) recognized by a unique spadelike configuration on the left ventriculogram. Two-dimensional echocardiography is another useful tool in the diagnosis of this condition. The diagnosis may be difficult and may mimic akinesia or apical thrombus in some patients with poor acoustic windows. A 50-year-old woman with typical angina and left ventricular hypertrophy with T wave inversion in leads V3-V6, II, III and aVF is presented. Apical HCM was diagnosed with contrast-enhanced echocardiography and confirmed by finding a spadelike configuration on the left ventriculogram. Apical HCM should be considered in patients in whom symptoms and ECG findings mimic ischemic heart disease. Contrast-enhanced echocardiography is a reliable and simple method in the diagnosis of apical HCM.
Can P Wave Parameters Obtained from 12-Lead Surface Electrocardiogram be a Predictor for Atrial Fibrillation in Patients Who Have Structural Heart Disease?
Authors: Altunkeser Bülent B. , Özdemir Kurtuluş , Gök Hasan , Temizhan Ahmet , Tokaç Mehmet , Karabag Turgut
Published: July 2008

This study was planned to investigate the parameters detecting risk of developing atrial fibril lation (AF) in patients with sinus rhythm with structural heart disease. Forty-five patients with AF and 37 patients without AF but with structural heart disease (Group I) were included in this study. Thirty-eight patients (Group II) had successfully undergone medically or electri cally cardioversion after transesophageal echocardiography. The restoration of sinus rhythm could not be achieved in 7 patients who were excluded from this study. After providing sinus rhythm, amiodarone was given orally to the patients to prevent recurrences. Left ventricular ejection fraction (LVEF) was calculated and left atrial diameter (LAD) was measured by echocardiography in group I and in group II after cardioversion. A 12-lead electrocardiography (ECG) was simultaneously obtained from all the patients. In these ECG recordings, maximum P wave duration (P max), minimum P wave duration (P min), and P wave dispersion (P disper sion) were calculated. P dispersion was expressed as "P max-P min." Also, the highest P wave voltage is expressed as P amplitude maximum (P amp max), the lowest P wave as P amplitude minimum (P amp min), and P amplitude dispersion (P amp dispersion) was calculated as the difference of both. In univariate analysis, P max, P dispersion, P amp max, P amp dispersion, LAD, LVEF, and old age were significant predictors of chronic AF (p < 0.001, p < 0.01, p < 0.01, p < 0.01, p = 0.003, p = 0.02, and p = 0.01, respectively). However, in multivariate analysis, P max and LAD were independent predictors of chronic AF in patients with structural heart disease (r = 0.39, p < 0.05; r = 0.34; p < 0.05, respectively). In conclusion, in estimating the risk of devel oping chronic AF, P max and LAD are predictive parameters in patients with sinus rhythm with structural heart disease.
Left Coronary Artery Originating from Right Sinus of Valsalva with Diagnosis Confirmed by CT
Authors: Khouzam Rami , Marshall Timothy , Lowell Douglas , Siler John R.
Published: July 2008

A 57-year-old woman presented with classic exertional angina and was then discovered to have a rare coronary anomaly in which the left coronary artery originated from the right sinus of Valsalva. The diagnosis was made by coronary angiography and confirmed with computed tomography (CT). The patient then underwent surgical revascularization with complete reso lution of symptoms. The course of the aberrant artery between the aorta and pulmonary artery/right ventricular outflow tract was confirmed by gated thin-slice CT angiography with bolus contrast injection. To the authors' knowledge, this is the first case report where CT was used to confirm this diagnosis.
Restoration of Endothelial Function After Repaired Coarctation of the Aorta
Authors: Takahashi Yasuhiro , Takayama Morimasa , Sato Naoki , Nitta Takashi , Tanaka Shigeo , Takano Teruo
Published: July 2008

According to current literature, there is no clinical report regarding coronary spasm in the presence of aortic coarctation. There are no cases in which endothelial function was restored after the repair of aortic coarctation. A 29-year-old woman with aortic coarctation and acute myocardial infarction due to coronary spasm experienced restoration of endothelial function after the repair of aortic coarctation. This case may increase knowledge of the mechanism of coronary damage in human coronary arteries not only with a coarcted aorta but also with hypertensive heart.
Prediction of Short-Term Progression or Regression of Atherosclerotic Coronary Artery Disease by Lipoprotein (a): A Quantitative Coronary Angiographic Study
Authors: Uchida Toshihiko , Inoue Teruo , Kamishirado Hirotoshi , Takayanagi Kan , Morooka Shigenori
Published: July 2008

This study assessed whether progression of coronary artery atherosclerotic lesions could be predicted in the short term using various lipid profiles. In 37 patients (61.9 ±9.5 years) under going coronary angioplasty and with 6-month follow-up angiography, quantitative coronary angiography of a new or changed lesion was performed in the follow-up examination, except for intervention vessels. The progression-regression score of the assessed lesion was calcu lated as the baseline minus the follow-up minimal lumen diameter. The serum lipoprotein (a) level was higher in the progression group (progression-regression score >0.15 mm), than in the regression group (≤ -0.15 mm; p<0.01) and the no change group (within ±0.15 mm; p < 0.05). Remnant-like lipoprotein particle-cholesterol and apolipoprotein-B levels were also higher in the progression group. However, multiple regression analysis of the progression showed that the progression-regression score was independently correlated with lipoprotein (a) alone (R = 0.50, p < 0.05). This shows that lipoprotein (a) is an independent predictor of coronary atherosclerotic lesion progression over the short term.
Increasing Circulation in the Lower Limb Under General Anesthesia Using the A-V Impulse System
Authors: Urayama Hiroaki , Tanaka Kenichi , Fukui Daisuke , Kawasaki Seiji
Published: July 2008

The action of foot impulse technology (FIT) in reducing the risk of deep vein thrombosis (DVT) is well established. We hypothesized that intraoperative use of FIT devices will be effective in the prophylaxis of DVT. The aim of this study was to investigate the effect of a FIT device (A-V impulse system) on the venous flow of the lower extremity using duplex ultrasound scanning while the patient was under general anesthesia. Thirteen surgical patients who had no lower limb vessel lesions were selected for the study. Duplex scanning was used to measure blood velocity in the right common femoral vein, with and without the foot pump, before and during general anesthesia. The mean resting velocity was 33.2 ±5.5 cm/sec in the pre-anesthetic state, 32.1 ±4.2 cm/sec under anesthetic, and 30.4 ±5.0 cm/sec postoperatively. The peak velocities with the pump active were 38.6 ±5.0 cm/sec before anesthetic, 54.6 ±5.9 cm/sec while anesthetized, and 52.7 ±7.8 cm/sec postoperatively. The measured increases while under anesthesia and postoperatively both reached statistical significance (p < 0.05). Our study demonstrated that use of the A-V impulse system causes a statistically significant increase in venous velocity of the lower extremity while the patient is under general anesthesia.
Sinus Node Dysfunction in a Heart Transplant Patient Secondary to Severe Sinus Node Artery Obstruction
Authors: Hasdemir Can , Chandrasekaran Krishnaswamy , Lazzara Ralph , Reynolds Dwight W.
Published: July 2008

A case of sinus node dysfunction is reported secondary to severe sinus node artery obstruc tion 3 years after orthotopic heart transplantation. The patient first presented with frequent dizzy spells and presyncopal episodes for 3 months and then recurrent syncope in the presence of an acute myocardial infarction. Coronary angiography showed a diffusely narrowed sinus node artery without any apparent collateral vessels. The sinus node artery had had only minimal distal disease 3 months previously. A dual chamber permanent pacemaker was implanted with significant improvement in clinical symptoms.
L-Arginine Ameliorates the Abnormal Sympathetic Response of the Dysfunctional Human Coronary Microvasculature
Authors: Gellman Joel , Hare Joshua M. , Lowenstein Charles J. , Gerstenblith Gary , Coombs Vicki , Langenberg Patricia , Brinker Jeffrey A. , Resar Jon R.
Published: July 2008

A nitric oxide (NO)-related defect may contribute to abnormal coronary sympathetic responses that can cause ischemia in patients with endothelial dysfunction. Because L-arginine, the NO synthase (NOS) precursor, augments NO bioactivity, we hypothesized that L-arginine would improve dysfunctional coronary sympathetic responses. Eleven patients with atherosclerosis or its risk factors were challenged with the cold pressor test, a specific provocative test of cardiac sympathetic activity, after 3 separate and sequential intracoronary infusions, as follows: 1) Normal saline; 2) L-NMMA, a competitive inhibitor of NOS; and 3) L-arginine. Study patients exhibited abnormal microvascular responses with coronary vascular resistance (CVR) increasing by 22.3 ±9.7% (mean ± 1 SEM), p<0.01. In addition, the change in coronary blood flow (CBF) did not correlate with the change in rate pressure product (RPP), r = -0.29, p = NS, suggesting an uncoupling of CBF from cardiac work. In the presence of L-NMMA, the CVR response, 10.3 ±9.8%, did not differ from the baseline response, and there was no relationship between the changes in CBF and RPP, r=0.13, p = NS. In contrast, L-arginine ameliorated the CVR response, -3.2 ±3.1%, p<0.05 vs baseline response, and restored the normal correlation between the changes in CBF and RPP, r = 0.74, p<0.01. L-arginine not only improved abnormal microvascular responses to sympathetic activation, but it also restored the coupling that normally exists between coronary blood flow and cardiac work. L-arginine warrants further investigation as a therapy for coronary artery disease.
Coronary Blood Flow in Evolving Myocardial Infarction Preceded by Preinfarction Angina: A Critical Reevaluation of Preconditioning Effects in Clinical Cases
Authors: Tomoda Haruo , Aoki Naoto
Published: July 2008

This study was undertaken to reevaluate the protective effects of preinfarction (pre-MI) angina in acute MI. The mechanisms involved in the apparent protective effects of pre-MI angina have been presumed to be preconditioning effects as defined by experimental studies. The phenom enon, has not, however, been observed in diabetic and/or elderly patients or in those treated by primary percutaneous coronary intervention (PCI). A total of 202 patients with anterior wall MI without a history of MI who underwent primary PCI with coronary balloon dilation and stenting (rate: 50%) < 6 hours after onset were studied. Patients included 59 with pre-MI angina (group 1) and 143 without pre-MI angina (group 2). The infarct-related coronary artery was patent on admission in 46% of group 1 and 31 % of group 2 (p = 0.045). Thrombolysis in Myocardial Infarction (TIMI) 1-2 flow was significantly more frequent in group 1 (29%) than in group 2 (11%, p = 0.005) on admission. Among risk factors, clinical background, coronary anatomy, and clinical outcome, the only significant predictor of pre-MI angina was a patent infarct-related coronary artery on admission (odds ratio: 2.39, p=0.015). There was no signif icant difference in left ventricular ejection fraction, peak creatine kinase, or the incidences of heart failure and in-hospital/follow-up deaths between these groups. In conclusion, the findings suggest that the protective effects reported in MI with pre-MI angina treated by thrombolysis are due to more fragile thrombotic occlusion, which can be more easily recanalized by throm bolysis, whereas the beneficial effects are not evident in those treated by primary PCI.
Prevalence of Peripheral Arterial Disease and Related Risk Factors in an Urban Mexican Population
Authors: Buitron-Granados Luisa Virginia , Martinez-Lopez Carlos , Escobedo-de la Peña Jorge
Published: July 2008

Peripheral arterial disease (PAD) is a growing and often underdiagnosed health problem that predicts cardiovascular events and mortality. Estimating its prevalence in the general popula tion is a major issue for assessing health needs and planning health services. The aim of this study was to determine the prevalence of PAD and its risk factors in an urban Mexican popu lation. A random sample of 400 adult subjects was selected from a Family Medical Unit of the Mexican Institute of the Social Security. Clinical examination was performed and a question naire was applied to all subjects. After an overnight fast, serum glucose, triglyceride, and cholesterol concentrations were measured. Blood pressure was taken and the ankle-brachial index (ABI) was calculated by Doppler examination in both sides. PAD was diagnosed if one of the ABIs was less than 0.90. Prevalence was estimated with 95% confidence intervals (CI95%), and odds ratios (OR) with CI95% were obtained to assess association with some atherogenic risk factors in a multiple logistic regression analysis. The prevalence of PAD was 10.0% (CI95%, 7.24%-13.37%), and it was higher in men. Most subjects with PAD had no signs or symptoms, although the presence of either signs or symptoms was more frequent in subjects with PAD. The main risk factors related to PAD were serum triglycerides ≥150 mg/dL (OR 2.25; CI95% 1.0-5.1), heavy smoking (OR 2.5; CI95% 0.9-6.7) and a history of diabetes mellitus for longer than 7 years (OR 1.9; CI95% 0.6-5.8). The prevalence of PAD is high in this Mexican urban population. Asymptomatic PAD may be highly frequent, and low-cost, noninvasive Doppler ultrasonography should be considered as an adequate screening procedure in primary care to detect individuals at high risk for major cardiovascular events.
Effects of Calcium Antagonists and Nitroglycerin on Atrial Natriuretic Peptide in Normal Subjects and Patients with Essential Hypertension
Authors: Iwasaki Tsutomu , Niwa Akihiro , Shinoda Toshio , Ishihara Masaki , Aizawa Toru , Yamada Takashi
Published: July 2008

Acute effects of coronary vasodilators (nifedipine, nicardipine, and nitroglycerin) on atrial natriuretic peptide (ANP) and the renin-angiotensin-aldosterone system were studied in normal subjects and patients with essential hypertension. Nifedipine lowered blood pressure both in normal subjects and in patients and elevated ANP, plasma renin activity, and angiotensin II in normal subjects but not in hypertensive patients. Nicardipine lowered blood pressure but failed to elevate ANP and angiotensin II in normal subjects. Nitroglycerin failed to elevate ANP in normal subjects.
Incidence of Arteriosclerotic Lesions of the Carotid Arteries in Chronic Peripheral Arterial Disease and Myocardial Infarction
Authors: Spürk P. , Angelkort B. , Selter P.
Published: July 2008

Arteriosclerotic lesions in the carotid arteries are the main cause of ischemic cerebral infarction. Only a few studies of the incidence of carotid lesions in patients with chronic peripheral arterial disease (CPAD) and myocardial infarction (MI) have been made. Thus the aim of this study was to investigate the pathoanatomy of the carotid arteries in a representative number of patients suffering from CPAD or MI by using highly sensitive and specific noninvasive methods. Results by other authors are discussed. The authors' own study of cerebrovascular disease (CD), which covers epidemiologic aspects, is presented.

Methods: "duplex scanning" and continuous-wave Doppler ultrasound. Pa tients: myocardial infarction, N = 73; chronic peripheral arterial disease, N =112; cerebrovascular disease, N = 73. Results: MI: stenosis > 50% N = 31 (42.4% of cases) - in the case of recurring infarction 67.8% of cases; CPAD: stenosis > 50% N=54 (48.2%); CD: stenosis > 50% N=35 (48%).
Intrinsic Sympathomimetic Activity Counteracts Beta-Blocker Inhibition of Renin Activation
Authors: Ruddy Michael C. , Bialy Grace B. , Kostis John B.
Published: July 2008

Enzymatically inactive renin (IR) is the predominant circulating form of renin. Sympathetic activity may influence plasma renin activity (PRA) by regulation of the conversion of IR to active renin (AR, PRA). It has been demonstrated previously that beta blockade lowers PRA at least partly through inhibition of this conversion process. The authors hypothesized that beta blockade and intrinsic sympathomimetic activity (ISA) would have opposing effects on production of AR from its inactive precursor.

Eighteen primary hypertensives (12 male, 6 female, mean age 57.7 ± 2.7) were entered in a placebo-controlled, double-blind crossover study of the effects of equipotent doses of pindolol and propranolol on mean ± SEM systolic BP, diastolic BP, heart rate, active renin (AR), total renin (TR), inactive renin (IR), and % AR/TR. Drug dose was titrated to achieve a goal DBP of 90 mmHg or less. Active renin was defined as the rate of generation of angiotensin I in 37°C plasma at pH 5.7. Total renin was determined by preincubation of plasma aliquots with 1.5 mg/mL trypsin in the presence of 5 mM benzamadine for one hour at -4°C prior to assay of renin activity. Inactive renin was calculated as TR minus AR.

The BP responses achieved by dose titration of propranolol and pindolol were virtually identical at rest, indicating equivalent depressor effects of the two beta blockers. Heart rate and active renin were, however, lowered to a much greater extent with propranolol as compared with pindolol. The lack of significant pindolol-induced fall in % AR/TR suggests that this drug has little net effect on the formation of AR from IR. These findings indicate that the presence of ISA attenuates the inhibitory action of beta blockade on AR. This effect may be a result of ISA-mediated partial disinhibition of conversion of inactive prorenin at renal or extrarenal sites.
Effects of Exercise Training on Biochemical and Biomechanical Properties of Rat Aorta
Authors: Matsuda Mitsuo , Nosaka Toshiya , Sato Masaaki , Iijima Jyunichi , Ohshima Norio , Fukushima Hideo
Published: July 2008

The authors studied the effect of prolonged physical exercise on the mechanical properties of rat aorta in relation to the amounts and qualities of arterial connective tissue fibrous proteins. Twelve male rats were divided into two groups: 6 sedentary rats (S) and 6 training rats (T), which were forced to swim from nine weeks to twenty-five weeks of age. The ultimate tensile stress and the ultimate tensile extension ratio of ring specimens at the descending thoracic aorta were larger in T than in S (192.3 ± 47.9 g/mm2, mean ± SD, vs 147.8 ± 26.0, p < 0.05; 3.52 ± 0.13 vs 3.18 ± 0.27, p < 0.05; respectively). The elasticity parameter, calculated by fitting stress-strain curves to exponential function in the stress level of 0-20 g/mm2, was lower in T than in S (1.79±0.15 vs 2.13±0.24, p < 0.01). The contents of elastin (alkali-insoluble elastin preparation) and collagen were higher in T than in S (0.44 ± 0.11 g/g dry aorta vs 0.30 ± 0.06, p < 0.05; 0.15 ± 0.04 g/g dry aorta vs 0.11 ± 0.04, NS, respectively). Although the aortic calcium content did not significantly change in the training rats (T 1.17 ± 0.23 mg/g dry aorta, S 0.95 ± 0.34), the content of calcium in elastin was lower in T than in S (1.75 ± 0.51 mg/g dry elastin vs 2.63 ± 1.00, p < 0.05). Elastin isolated from the training rats showed significant decreases in some of the polar amino acids: arginine (3.18±1.00 residues/1000 residues vs 4.12 ± 0.40, p < 0.05), threonine (6.79 ± 1.91 vs 8.69 ± 1.51, p < 0.05), and serine (9.66 ± 1.56 vs 11.97± 1.41, p < 0.05). The authors conclude that prolonged physical exercise from an early age provides training rat with a strong and extensible aorta, which is related to the larger amount of elastin with probably fewer degenerative changes.
Atrioventricular Block in Accidental Hypothermia— A Case Report
Authors: Bashour Tali T. , Gualberto Agathon , Ryan Colman
Published: July 2008

The finding of second-degree and high-grade atrioventricular block in a patient with severe accidental hypothermia is described. Additional findings included atrial fibrillation, severe sinus bradycardia, and prominent J (Osborn) waves. This case represents, to the authors' knowledge, the first report of advanced spontaneous AV block not induced by atrial pacing in severe accidental hypothermia. Reversal of the block, and other characteristic changes, suggest a relationship to low temperature.
Microvasculopathy May Precede Idiopathic Cerebral Calcifications — Case Report
Authors: Gomez Camilo R. , Luque Antonio , Horenstein Simon
Published: July 2008

Cerebral and cerebellar calcifications were discovered by computerized tomography (CT) in a man who presented with a dementing illness characterized by progressive memory loss, irritability, and dystonia. He had no known family. Magnetic resonance imaging showed areas of absent signal corresponding to the calcifications and areas of high-intensity signal on the T2-weighted images without counterpart on the CT. These are postulated to be static liquid pools secondary to endothelial membrane incompetence and leakage of plasma-derived fluid.
Echocardiographic Confirmation of Mitral Valve Prolapse: A New Finding on Radionuclide Ventriculography- A Case Report
Authors: Fig Lorraine M. , Mountz James M. , Gross Milton D.
Published: July 2008

A prominent filling defect was depicted on a radionuclide ventriculogram in a patient with mitral regurgitation. This defect was later shown, by cardiac ultrasound, to be due to mitral valve prolapse into the left ventricle during diastole. This case illustrates that mitral valve prolapse should be added to the list of clinical entities that can result in an intraventricular defect on a radionu clide ventriculogram.
Evaluation of Myocardial Perfusion Abnormality by Profile Analysis for Digital Subtraction Angiogram
Authors: Takeda Tohoru , Matsuda Mitsuo , Ogawa Takeshi , Ajisaka Ryuichi , Kakihana Masaaki , Sugishita Yasuro , Ito Iwao , Akisada Masayoshi , Akatsuka Takao
Published: July 2008

For quantitative estimation of ischemia, ECG-synchronized digital subtrac tion angiography was performed for selective coronary arteriography. The au thors obtained sequential myocardial perfusion images at the arterial, capillary, and venous phases. Profile densitometry was performed along the cross section perpendicular to the long axis of the left ventricle to assess regional myocardial perfusion at the capillary phase quantitatively. By this densitometry, the vol umes of vascular bed perfused by the left coronary artery could be estimated, and further, nontransmural myocardial infarction could be differentiated from transmural myocardial infarction through the profile of its density curve. This method appears to be useful for the analysis of myocardial perfusion of ischemic heart disease.
Quinapril—A Preclinical Review of the Pharmacology, Pharmacokinetics, and Toxicology
Authors: Kaplan Harvey R. , Taylor David G. , Olson Stephen C. , Andrews Laura K. , Kaplan Harvey R.
Published: July 2008

Quinapril is an orally active, non- peptide, nonsulfhydryl angiotensin- converting enzyme (ACE) inhibitor that acts potently and specifically to interrupt the conversion of angioten sin I to angiotensin II in both plasma and tissue. Quinapril is enzymatically hydrolyzed to a pharmacologically active diacid form quinaprilat. Quinapril is efficacious in hyperten sive models exhibiting both high (re nal hypertensive rats, diuretic- treated dogs) and normal (spontan eously hypertensive rats) plasma re nin activity. Quinapril does not pre vent the development of hypertension when plasma renin activity (PRA) is markedly suppressed as in the deoxy corticosterone-saline treated rat. He modynamic studies in dogs indicate that quinapril decreases total periph eral and renal vascular resistance. Quinaprilat produces natriuresis and mild diuresis at doses that do not al ter mean arterial blood pressure. Quinapril has the potential to affect plasma lipids beneficially or at least be "lipid neutral." Oral absorption of quinapril is rapid in rats, dogs, and monkeys. There is rapid and exten sive distribution of radiolabel to most tissues except brain. Plasma radiola bel concentration-time profiles ex hibit polyexponential decay with a prolonged terminal phase at low con centrations in all species. Metabolism to compounds other than quinaprilat is not extensive. Quinapril is excreted primarily as quinaprilat and to a lesser degree as quinapril. Quinapril is well tolerated in a variety of phar macologic safety screens and its tox icity profile is similar to that of other ACE inhibitors. Quinapril does not adversely affect reproduction; it is not teratogenic, carcinogenic, or mu tagenic. Preclinical studies indicate that quinapril is a safe and effective ACE inhibitor and that its activity re sides mainly in the diacid form (quinaprilat). The reduction in per ipheral vascular resistance associated with plasma and tissue ACE inhibi tion most likely accounts for the ther apeutic benefit of quinapril in hyper tension and congestive heart failure in man.
Clinical Pharmacology of Quinapril in Healthy Volunteers and in Patients with Hypertension and Congestive Heart Failure
Authors: Sedman Allen J. , Posvar Edward , Sedman Allen J.
Published: July 2008

Quinapril is converted to quina prilat, a long-acting angiotensin con verting enzyme (ACE) inhibitor, and is currently being studied for the treatment of hypertension and con gestive heart failure. In studies of healthy volunteers, single quinapril doses of 0.625 mg to 80 mg inhibited plasma ACE activity for up to forty- eight hours. Dose-related inhibition of angiotension I pressor response oc curred after administration of quina pril doses of 0.625 mg to 20 mg. In addition, plasma renin activity in creased and aldosterone and an giotensin II concentrations decreased following single or multiple doses of quinapril.

Subsequently, dose-ranging stud ies were conducted in patients with mild to moderate hypertension and congestive heart failure. Pilot studies suggested that 5 mg of quinapril given once daily had minimal antihy pertensive effect. Therefore, a defini tive, multiple-dose, placebo-con trolled, double-blind study of 5, 10, and 20 mg once daily doses of quina pril was performed. Quinapril doses of 10 mg and 20 mg were statistically significantly superior to placebo (p < 0.05) in lowering sitting diastolic blood pressure (DBP), whereas 5 mg of quinapril had only marginal clini cal effectiveness. A twenty-four-hour blood pressure monitoring study in dicated that quinapril administered once or twice daily effectively low ered DBP in patients with mild to moderate hypertension. This study suggested, however, that some pa tients may not achieve sustained re ductions in DBP over the entire twenty-four-hour interval with quinapril administered once daily and may require twice daily therapy. In studies of patients with refractory congestive heart failure, acute favor able hemodynamic effects were dem onstrated after the administration of quinapril. Quinapril doses of 2.5 mg to 10 mg increased cardiac index by 30% and decreased peripheral vascu lar resistance and pulmonary capil lary wedge pressure by 20% to 30%.
A Comparison of the Efficacy and Safety of Quinapril with that of Enalapril in the Treatment of Mild to Moderate Essential Hypertension
Authors: Taylor Stanley H.
Published: July 2008

This twenty-eight-week double- blind study in patients with mild to moderate essential hypertension showed quinapril (10, 20, and 40 mg/ day) to be similarly effective to enal april at the same doses in producing clinically significant reductions in sit ting DBP. Hydrochlorothiazide could be safely added to quinapril therapy in nonresponders. Quinapril and enalapril were well tolerated. Both agents can safely be administered as first-line therapy.
Preliminary Hemodynamic Report of the Efficacy and Safety of Quinapril in Acute and Chronic Treatment of Patients with Congestive Heart Failure
Authors: Banas John S.
Published: July 2008

A two-part hemodynamic trial of the efficacy and safety of quinapril hydrochloride was conducted in 26 patients with congestive heart failure (NYHA Class III or IV) who had not optimally responded to treatment with diuretics and digitalis. A total of 25 patients had evaluable data after receiving single doses (2.5, 5, or 10 mg) of quinapril. Following acute dosing, favorable hemodynamic changes began within thirty minutes to one hour and usually reached a maximum within four hours post dose. Nineteen evaluable patients who had responded to acute therapy received an additional sixteen weeks of chronic treatment with quinapril in individualized dosage regimens. Hemodynamic responses did not dif fer markedly between acute and chronic therapy. Favorable hemody namic responses were maintained or enhanced following chronic doses of 5 to 30 mg/day (given either once daily or in divided doses). The most fre quent doses were 10-15 mg/day in di vided doses. The mean maximum percent changes in four primary he modynamic parameters after chronic dosing (compared with baseline) were: mean arterial blood pressure, -3.9%; pulmonary capillary wedge pressure, -39.7%; cardiac output, +31.7%; and systemic vascular re sistance, -25.2%. Changes in heart rate and mean arterial blood pres sure did not result in clinically signif icant bradycardia or hypotention. Overall, quinapril produced both acute and sustained beneficial hemo dynamic effects in patients whose congestive heart failure was not clini cally controlled with diuretics and digitalis.
Catheter Embolization from Implanted Venous Access Devices: Case Reports
Authors: Carr Marcus E.
Published: July 2008

Two cases of catheter embolization from implanted venous access devices are reported and the available literature is reviewed. The catheter from an im planted venous access device migrated into the right heart after slippage of the O-ring, which attaches the catheter to the infusion port. The distal 6 cm of an infusion port catheter embolized to the right heart after spontaneous fracture of the catheter at the point where it passed between the clavicle and first rib. Both catheters were removed percutaneously without complication. Risk factors for embolization were apparent on x-ray films with evidence of O-ring slippage in 1 case an obvious kinking of the catheter in the other. Symptoms of embolization included chest discomfort, right upper quadrant pain, and nausea. In 1 case, an extra heart sound, initially thought to be an S3, disappeared when the catheter was removed.
The Thrombolytic Effects of Native Tissue-Type Plasminogen Activator (AK-124) on Experimental Canine Coronary Thrombosis
Authors: Tomaru Takanobu , Uchida Yasumi , Sonoki Hiroyuki , Tsukamoto Masami , Sugimoto Tsuneaki
Published: July 2008

To evaluate the thrombolytic effects of the native tissue-type plasminogen activator (t-PA), the authors used a thrombus model simulating clinical situa tions. The native t-PA (AK-124) was obtained from human-derived normal cells. Experimental canine coronary thrombosis was produced by partial con striction and endothelial denudation of the vessel. In 19 dogs, coronary occlu sive thrombus was produced. Three hours after total occlusion of the coronary artery with thrombus, the authors attempted the thrombolytic therapy in 16 dogs. Histologically, three-hour thrombus was composed of a mixture of platelet aggregates, fibrin, and blood cells. They infused 0.375 mg/kg t-PA intraven ously in 7 dogs and 20,000 IU/kg urokinase (UK) in 9. Coronary recanalization was achieved in 5 (71%) with t-PA infusion and 6 (67%) with UK infusion. Plasma fibrinogen levels decreased to 76% of preinfusion value in the dogs with t-PA infusion and to 34% in those with UK infusion. Coronary reocclusion oc curred in 2 dogs with t-PA and 3 with UK. Thus, the native t-PA (AK-124) can provide coronary thrombolysis without severe depletion of plasma fibrinogen levels.
The Natural History of Unexpected Doppler Mitral Regurgitation
Authors: Kinney Evlin L. , Wright Robert J.
Published: July 2008

It is common for patients to be di agnosed as having valvular regurgita tion by Doppler echo when no such murmur has been heard by the refer ring clinician. To test the hypothesis that such patients have clinically un important heart disease, the authors evaluated the records of 213 consecu tive men in whom mitral regurgita tion had been found by pulsed Doppler. In 95 patients (group I) mi tral regurgitation was audible, whereas in the other 118, it was not. In 97 patients with inaudible mitral regurgitation there were no struc tural mitral valve abnormalities by 2D echo. This group of 97 patients (group II) was defined as having un expected Doppler mitral regurgita tion. In group II patients there was a high prevalence of hypertension (50%), congestive heart failure (44%), alcohol abuse (46%), diabetes (27%), coronary artery disease (63%), and atrial fibrillation (13%). The following variables were distrib uted similarly in groups I and II: sur vival time, age, presence of congestive heart failure or coronary artery disease, left ventricular short- axis end diastolic and end systolic di mensions, E point septal separation, and the severity of dyssynergy. Atrial fibrillation was more common in group I (p = 0.017), and group I pa tients had a higher Quetelet's Index (weight/ height squared) (p=0.03). In group II, the factors most closely related to survival were the presence of dyssynergy, of atrial fibrillation, or of congestive heart failure. Al though no group II patient had endo carditis or required mitral valve replacement, their survival was markedly decreased compared with people of similar age in the general population. The majority of car diogenic deaths in group II patients were due to coronary artery disease. These data suggest that unexpected mitral regurgitation is common but is not a benign condition. Rather, it is associated with decreased survival due largely to the presence of ische mic heart disease.
Usefulness of Immediate Postexercise Two-Dimensional Echocardiography in Post-Myocardial Infarction Patients Without Ischemic ECG Changes in Stress Testing: Comparison with Radionuclide Angiography
Authors: Pines Amos , Fisman Enrique Z. , Ben-Ari Efraim , Modan Michaela , Kessler Gerald , Drory Yaacov , Kellermann Jan J.
Published: July 2008

Of 38 post-myocardial infarction (MI) applicants for a cardiac rehabilitation program, 17 (45%) did not have ischemic ECG changes in exercise testing. Ten (59%) of these 17 patients had echocardiographic wall motion abnormalities at rest. Immediate postexercise two-dimensional echocardiography demonstrated exercise-induced changes in 8 (47%) patients (2 with normal and 6 with abnor mal results from rest studies). The comparative radionuclide (RNA) examina tions showed that there were 6 patients with abnormal findings from rest RNA; exercise-induced changes were detected in 7 (44%) of 16 patients (3 with normal and 4 with abnormal results from rest RNA tests). Statistical analyses, using RNA as reference point, revealed that the total correctly diagnosed cases for the echocardiographic rest studies was 13/17 (77%) and for the exercise studies, 13/16 (81%). The negative predictive values were 7/7 (100%) and 7/8 (88%), respectively. The corresponding positive predictive values were 6/10 (60%) and 6/8 (75%). The same pattern was observed when each segment (septal, apical, and posterolateral) was evaluated separately. The authors conclude that in post- MI patients with a negative stress test, the efficacy of postexercise echocardiog raphy equals that of RNA in the identification of additional patients with ische mia.
New Ultrasonic Femoropopliteal and Tibiofemoral Tests in the Study of Patency of the Deep Venous System
Authors: Barták Jaroslav Vladimir
Published: July 2008

In phlebology, every new noninvasive examining method is of great importance. Now there are new femoropopliteal and tibiofemoral tests, described originally by Odisio in Argentina and, in a modified form applying ultrasound, introduced in Europe by Krcilek and Barták.

An experiment with 25 patients was performed to verify the conclusive evidence of the tests. The diagnosis of deep venous thrombosis was examined here by clinical and femoropopliteal and tibiofemoral tests according to Odisio. Finally the diagnosis was verified by the Doppler ultrasonic method.

The principle of the femoropopliteal test is the palpative perception, when the fingertips of the left hand applied to the inguen somewhat medially from the femoral artery detect the deep venous wave caused by a repeated percussion of the right hand in the fossa poplitea. Getting some experience enables one to practice simple examinations leading to verification of a suspected diagnosis of femoral thrombosis. Replacing the palpating hand by a sonde of an ultrasonic detector gave substantial precision to examinations in the test modification. Similarly the diagnosis of deep venous thrombosis of the calf was verified by the percussional tibiofemoral test, when the right hand repeatedly percussed on the calf in the course of crural veins, while the left hand palpated the transmission of the wave to the inguen. Both modifications of the femoropopliteal and tibiofemoral tests were verified by the classical ultrasonic examination method.

The results were compared with those from a control group of 25 patients without clinical and phlebologic symptoms of disease of the lower limbs.
35th Annual Meeting — American College of Angiology Orlando, Florida — October, 1988 Symposium Proceedings
Authors: Heck Albert F.
Published: July 2008

Mitral valve prolapse (MVP), the most frequently encountered valvular condition in the population, has been reported in an increasing variety of neurologic, muscular, and psychiatric disorders during the last twelve years. Extensive review of reports indicates this has resulted from observations of either (1) inordinate incidence of MVP in well-defined neurologic entities or (2) development of neurologic or ophthalmologic complications attributed to MVP. In the review presented, basis is found for categorizing MVP by its association with (1) well-defined, genetically determined neurologic disorders; (2) disorders characterized by structural abnormalities, many genetically determined, or inflammatory processes of connective tissues; (3) "mechanical" prolapse resulting from disproportion of mitral valve annulus and left ventricular size, which is, at times, reversible; and (4) a generally asymptomatic state that, at times, is associated with ischemic, thrombotic, embolic, and infectious disorders of the brain and eye. The paradox between the large number of persons with MVP in the general population who remain healthy and a subpopulation of patients with complications of MVP (eg, stroke) or other entities has been identified. A second paradox is found between the well-known increased incidence of MVP, especially in young patients with stroke, and the apparent rarity of stroke among patients with both common (eg, migraine) and unusual (eg, myotonic dystrophy) neurologic entities in which an extraordinary high prevalence of MVP is known to exist.
Catheter Atherectomy: Functional Results in Peripheral Arterial Disease
Authors: Langes Klaus , Schofer Joachim , Bleifeld Walter , Mathey Detlef G.
Published: July 2008

In 10 patients with peripheral ar terial disease (PAD) atherectomy was performed with the Simpson atherec tomy catheter. PAD was diagnosed by clinical evaluation, oxzillography, Dop pler ultrasound examination, tread mill walking, and angiography. Eight patients belonged to stage II and 2 to stage IV. Two stenoses were located in the iliac artery, and the others in the superficial femoral artery or pop liteal artery or both. The treadmill walking distance before the interven tion ranged from 24 to 67 m before and 105 to 115 m after the procedure (speed 2 mph; gradient 12.5%). After atherectomy, the walking distance im proved by 35% to 126%. No patient in stage II perceived pain. In these patients treadmill exercise was termi nated because of dyspnea. The ankle/ arm ratio (Doppler ultrasound) ranged from 0.4 to 1.0 before atherectomy with a mean improvement of 0.15 after ward (stages II and IV). Control an giography within three to six months in 4 patients did not reveal any signif icant change at the site of the original stenosis.
Attenuation of the Vasoconstrictor Action of Neuropeptide-Y by Calcium-Channel Blockers
Authors: Aizawa Yoshifusa , Niwano Siniti , Aizawa Masami , Tamura Makoto , Shibata Akira
Published: July 2008

Neuropeptide-Y (NPY) was administered intracoronarily in dogs to see the modification of its vasoconstrictor action by the calcium (Ca)-channel blockers nisoldipine (0.1 μg/kg) and nifedipine (1 μg/kg).

Dogs were anesthetized and the left circumflex artery was cannulated with out opening the chest by using a specially designed cannula perfused at constant pressure. The change in coronary flow due to NPY was determined before and after the systemic administration of the two Ca-channel blockers. With adminis tration of 1 to 2 nmol of NPY, coronary blood flow decreased maximally by 23.4±7.8% without changes in perfusion pressure or central venous pressure and it became significantly less after nisoldipine: 16.0±5.7% (p < 0.02). A simi lar attenuation in the decrease in coronary flow was observed in the nifedipine study: 23.2±7.5% to 12.0±6.7% (p < 0.02). A fall in systemic arterial blood pressure was observed after administration of both Ca-channel blockers, but it was significant only after nisoldipine (p < 0.01). Nonsignificant increases in heart rate were observed after both drugs.

Nisoldipine seemed to attenuate the NPY-induced vasoconstriction in dogs, and its equimolar potency is about ten times that of nifedipine.
Effect of Intravenous Naftidrofuryl on Transcutaneous Oxygen Pressure in Severe Peripheral Vascular Disease
Authors: Taggart I. , Wishart G.C. , Cuschieri R.J. , MacBain G.C.
Published: July 2008

Intravenous naftidrofuryl has been shown to improve transcutaneous oxygen pressure values in patients with severe ischemia of the lower limbs who were considered unsuitable for reconstructive surgery. Although it did not alter the outcome in patients with rest pain, the clinical impression is that it afforded symptomatic relief for a period of time. Clinical implications of these findings require further long-term studies.
Left Ventricular Excursions and Velocities During Coronary Arterial Ligation. Effects of Nitroglycerin Infusion in an Experimental Model
Authors: Kounis N.G. , Zavras G.M. , Soufras G.D. , Papadaki P.J. , Poulos E.A. , Antoniou D.J.
Published: July 2008

To determine the effects of intravenous nitroglycerin on the velocities and excursions of the acutely ischemic myocardium, 20 open-chest dogs were stud ied by use of ultrasound. In 10 dogs with acute septal ischemia, the posterior wall excursion during contraction (B-C excursion), the mean systolic posterior wall velocity, and the posterior wall excursion remained unaltered. Nitroglyc erin, however, increased all these parameters (P < 0.01). In 10 dogs with acute posterior wall ischemia the B-C excursion (aneurysmal bulging) increased (P < 0.01), but the mean systolic posterior wall velocity and posterior wall excursion decreased (P < 0.01). Nitroglycerin increased even more the aneurysmal bulg ing (P < 0.01) and the other parameters (P < 0.01). Increased regional blood flow, reduced afterload, and mechanical pulling of the ischemic myocardium seem to be a possible mechanism. The measurements were obtained using the recently described method of the specific points.
Thrombosis of Congenital Double Popliteal Vein: Case Report
Authors: Bronzi Giovanna , Venarucci Vincenzo , Monache Guido Delle , Scudieri Maria , Bellagamba Giovanni
Published: July 2008

The authors present the case of a patient with phlebothrombosis of the left lower limb, not diagnosed with traditional ultrasonographic methods (Doppler c w) but recognized by the echo Doppler (duplex scanner) method. The diagno sis was made difficult by the presence of a congenital double left popliteal vein, with hypoechogenic thrombosis of only one of the two twin veins. The authors stress the diagnostic importance of the duplex scanner method in the study of the phlebobstructive pathologies of the lower limbs.
Rapid Volume Replacement With Warmed Blood and Fluids
Authors: Falcone Robert E. , Fried Steven J. , Zeeb Paul , Satiani Bhagwan
Published: July 2008

A prospective clinical study was undertaken in 50 consecutive patients suf fering from severe traumatic shock to evaluate the clinical efficacy of a set for rapid administration of solutions (RSAS), which allows for rapid infusion and simultaneous warming of blood and fluids. The mechanism of injury was blunt in 37 patients and penetrating in 13. Admission trauma score averaged 7.5, and the injury severity score averaged 46. Average preresuscitation systolic blood pressure was 71 mmHg, pulse was 105 beats/minute, and temperature was 34.3°C. Initial resuscitation was with the RSAS, and total fluid infused in the first twenty-four hours averaged 4,632 mL of blood, 1,914 mL of blood prod ucts, and 11,248 mL of crystalloid. The average postresuscitation systolic blood pressure was 120 mmHg, pulse was 96 beats/minute, and temperature averaged 34.9°C. Survival at twenty-four hours was 29/50 (58%). There were no local complications of RSAS use and no evidence of infusion-related coagulopathy. The RSAS provided an effective and safe way to infuse large volumes of blood and fluid at body temperature.
Clinical Results of Epidural Spinal Cord Electrical Stimulation in Patients Affected with Limb-Threatening Chronic Arterial Obstructive Disease
Authors: Mingoli Andrea , Sciacca Vincenzo , Tamorri Marco , Fiume Dario , Sapienza Paolo
Published: July 2008

Between 1982 and 1990, 76 patients (33 women, 43 men, mean age 71.4±10 years) affected with limb-threatening peripheral vascular disease (claudication < 20 m: 3 patients; rest pain: 10 patients; necrosis1 smaller than 3 cm2: 28 patients ; necrosis2 larger than 3 cm2: 35 patients) not amenable to medical and/or surgical therapy, were treated by epidural spinal cord electrical stimulation (ESES). Effectiveness of ESES was evaluated by consideration of pain control, walking distance, and healing of ischemic lesions. At a mean follow-up of twenty-six months (range: one to seventy-six) 44 limbs (58%) were amputated (rest pain 2; necrosis1 13; necrosis 2 29) and 39% of necrotic lesions smaller than 3 cm2 healed. The overall limb salvage rate was 42%. Pain control was obtained in 80% of patients at the one-year and 75% at the two-year follow-up, with infrequent use of pain relievers. Despite the poor clinical results observed, the limb salvage rate testifies to the effectiveness of ESES in limb-threatening ischemia. Moreover, the authors noticed a good ESES effect on pain relief, maximal in the early and intermediate postimplant periods.

In conclusion ESES must be considered the last resort in peripheral vascular disease in patients in whom medical and/or surgical therapies are ineffective or impossible. Necrotic lesions larger than 3 cm2 contraindicate, in their opinion, ESES implant.