bluuebunny/crossref_metadata_2025 huggingface dataset:
The Use of Beta-Adrenergic Blockers in the Treatment of Angina and Hypertension
Authors: Caris Timothy N.
Published: November 2007

During the past decade, beta-adrenoreceptor blocking agents have proved to be valuable assets in our therapeutic armamentarium for management of both angina pectoris and essential hypertension.

In ischemic heart disease, these agents reduce myocardial oxygen require ments by decreasing the force of myocardial contraction and by reducing heart rate. Consequently, decreased blood supply to portions of the myocardium is tolerated better.1 The beta-blockers are effective in reducing the frequency and severity of episodes of angina pectoris and in extending exercise tolerance. If needed, additional benefit may be gained by adding long-acting nitrates, or calcium-channel blockers or both.2
Clinical Laboratory Assessment of Atherosclerosis — Role of Hyperlipidaemia and Hyperactive Platelets
Authors: Chitre Ajit P. , Velaskar D.S.
Published: November 2007

Hyperlipidaemia and platelet hyperfunction have been considered as high- risk factors for atherogenesis. Simultaneous study of these two parameters was undertaken in 43 patients with atherosclerosis (as evidenced by frank myocar dial infarction, MI, in 23 patients and ischemic heart disease, IHD, in 20 pa tients) ; and in 36 normal subjects who were matched for age (45 to 60 years). Incidence of either of these parameters being high was 36% in normals, 85% in atherosclerosis. Four subjects with circulating platelet aggregates and hyperli pidaemia showed progression of the lesion by crossing over from the category of normal to IHD (two) and from IHD to MI (two). These two risk factors, to gether or independently, appear to cause and control the progress of atheroscle rosis and their simultaneous study can be used for its diagnosis. A concept of subintimal hyperlipidosis is presented since none of the existing theories can explain the existence of atherosclerotic lesions exclusively on the developed vas cular musculature.
Nonionic Contrast Medium: Effects on Blood Coagulation and Complement Activation In Vitro
Authors: Parvez Zaheer , Moncada Rogelio
Published: November 2007

A nonionic contrast medium was evaluated in vitro for its effects on coagula tion and complement activation in comparison to a low osmolal contrast agent. In clotting assays each contrast medium was mixed with blood and clotting parameters were analyzed by using a thromboelastographic machine. Platelet function was studied by incubating platelet-rich plasma with individual contrast medium, and the subsequent challenge of a platelet aggregating agent. Comple ment activation was assessed by the hydrolysis of C3 protein into C3c fragment in contrast medium-incubated serum. Immunoelectrophoresis was used to detect C3c protein. Both the nonionic contrast medium and the low osmolal contrast agent acted as anticoagulant and antiplatelet agents, however, results with the low osmolal contrast agent were more pronounced compared to the nonionic contrast medium. Even at nonphysiologic concentration of contrast medium, no significant conversion at C3 to C3c was seen. Since these two agents caused hypo coagulable states in vitro, it is likely that patients with thrombocytopenia, se vere liver disease and with clotting factor deficiencies may present hemostatic complications during angiographic procedures.
Vasculitic Purpura in Vinyl Chloride Disease: A Case Report
Authors: Magnavita Nicola , Bergamaschi Antonio , Garcovich Antonio , Giuliano Giovanni
Published: November 2007

Vinyl chloride (VC), a volatile substance mostly used for polyvinyl chloride (PVC) synthesis, is a systemic toxicant particularly noxious to endothelium. Angiosarcoma of the liver, Raynaud's phenomenon, scleroderma-like lesions, acroosteolysis and neuritis are known to be typical vinyl chloride-associated manifestations (VC disease). A so far unknown feature of the disease is pur pura. This was first observed by the authors in a worker of a PVC-producing plant. The skin eruption was characterized by small purpuric maculae with tiny, palpable spots and papulae, mostly concentrated on the lower part of the legs, changing into bullae, pustules and crusts and tending to spontaneous re gression after withdrawal from VC exposure. A skin biopsy revealed marked inflammatory reaction with a mostly lymphocytic and histiocytic infiltration around and in the walls of dermal arterioles. The finding of increased circulat ing immune complexes and anti-smooth muscle autoantibodies strengthens the hypothesis that immunologic changes play a role in the appearance of "vinylic purpura."
Vascular Manifestations of Systemic Lupus Erythematosus
Authors: Ansari Azam , Larson Paul H. , Bates Henry D.
Published: November 2007

Systemic lupus erythematosus (SLE) is a well-known acute and/or chronic multisystem disease of complex autoimmune nature, having predilection for cardiovascular system. While its cardiac manifestations have been adequately studied, there is paucity of information on its vascular manifestations. Accord ingly, we studied the incidence of vascular manifestations in 50 consecutive SLE patients seen at our institutions and in private practice during the past 12 years.

Systemic hypertension (44%) was the most common vascular manifestation followed by vasculitis (30%), Raynaud's phenomenon (26%), telangiectasis (20%), premature coronary atherosclerosis (6%), digital ulceration (6%), thrombophlebitis (6%), pulmonary hypertension (4%) and portal hypertension (4%). Diffuse systemic vasculitis similar to polyarteritis nodosa was rare (2%). Often more than one lesion was found in the same patient. The clinical diagnosis of these vascular manifestations in the context of the primary disease (SLE) usually does not pose any difficulty except when they antedate it.

We also studied the pathology and pathogenesis of some of these vascular lesions in both autopsy and biopsy specimens by both light microscopy and immunofluorescent techniques. Our results as well as those of others who also studied these lesions indicate that immune complex deposition and subsequent complement activation play an important role in the pathogenesis of vasculitis, coronary arteritis and premature coronary atherosclerosis.

Corticosteroids and vasodilators remain the drugs of choice for the manage ment of the majority of the symptoms arising from the vascular lesions of SLE.
Isosorbide Dinitrate: Relationship Between Pharmacokinetics and Brachial Artery Hemodynamics in Essential Hypertension
Authors: Frydman Armand M. , Safar Michel E. , Simon Alain Ch. , Levenson Jaime A. , Gaillot Jean , Roland Edmond
Published: November 2007

Pharmacokinetics of isosorbide dinitrate (ISDN) and brachial arterial hemo dynamics have been studied in 15 patients with sustained essential hypertension. The hemodynamic study was performed by using a pulsed Doppler device en abling evaluation of the diameter of the brachial artery with an error of less than 10%. After intravenous administration until plateau concentrations were reached, the ISDN infusion was stopped in order to study the disappearance curve of the drug and the pharmacokinetic parameters. ISDN caused a signifi cant decrease in systolic pressure, a significant increase in arterial diameter, and no change in heart rate. Brachial hemodynamics were not correlated with the plasma concentration in the steady state or the area under the disappear ance curve. In contrast, the changes in arterial diameter during perfusion were significantly correlated with the apparent distribution volume, a finding that might indirectly reflect the affinity of ISDN for vascular tissues.
Cardiovascular Effects of Polycyclic Antidepressants
Authors: Mahapatra Rajat K. , Paul Subir K. , Mahapatra Dipta , Winter Scott
Published: November 2007

Every day, thousands of people in the United States receive polycyclic antide pressants (PCAs) prescribed by their primary care physicians. We have exam ined the cardiovascular manifestations of polycyclic antidepressants in 14 patients with primary depression receiving various antidepressant drugs for a period of six months or more. None had suffered from any systemic illness. All 14 received a commonly prescribed PCA, such as doxepin, amitriptyline, imip ramine, desipramine or amoxapine, in therapeutic doses.

None developed any significant adverse reaction. Left ventricular function, as determined by M-mode echocardiogram, was within normal limit in all pa tients.

A twenty-four-hour ambulatory electrocardiogram revealed rare supraven tricular ectopic beats in 8 patients and ventricular ectopic activity (Lown grade 1) in 4 patients. In 1 patient, who received additional lithium carbonate for treatment of depression, both supraventricular and ventricular ectopic activity developed on rare occasions.

In 4 of the 8 patients the plasma concentration of PCA was optimal or near optimal, and in 4 of the 8 patients it was subtherapeutic (even though these 4 patients had shown clinical improvement with continued polycyclic therapy). It appears from the present data that antidepressant therapy with PCAs pre scribed in therapeutic doses was well tolerated, without any significant adverse cardiovascular reaction, in otherwise healthy young patients with primary de pression.
Catheter Separation During Cardiac Catheterization and Coronary Angiography. A Report of Four Incidents and Review of the Literature
Authors: Kyriakides Zenon S. , Bellenis Ion P. , Caralis Dennis G.
Published: November 2007

Four incidents of catheter separation in three patients during left heart cath eterization and coronary angiography are presented. In two cases the catheters had been used before. After the second incident, we decided to use angiography catheters once only.

All catheter fragments were removed under local anesthesia, and no further complications arose. In all incidents the point of catheter fracture was near the bond between the body of the catheter and its tip.

We believe that catheter separation is related to polymer aging. The cathe ters in the third and fourth incidents were unused, but there was no expiration date on their packages.

We recommend that (1) expiration dates be clearly stated on every catheter package, (2) catheter manufacturers issue warnings not to use catheters after expiration date, and (3) unused angiography catheters with no expiration date not be used. We also suggest that consideration be given to using catheters once only.
Massive Pulmonary Embolism: Short-Term Effects of Thrombolytic Treatment
Authors: Grau E. , Fontcuberta J. , Pagés M.A. , Martinez R. , Félez J. , Net A. , Rutllant M. Ll.
Published: November 2007

This study assessed the short-term effects of thrombolytic treatment in 38 patients with massive pulmonary embolism. Thirty-two were treated with strep tokinase and six with urokinase. Intrapulmonary artery instillation of fibrino lytic agents was utilized except in 3 patients. There was a marked hemodynamic and arteriographic improvement (p < 0.0005) in 33 patients (86.8%). Four pa tients (10.5%) died because of treatment failure. In these cases the fibrinogen concentration remained above 1 gr/liter during therapy. Bleeding was detected in 22 patients (57.8%) but was most often related to puncture or cut-down sites, and only 2 patients (5.2%) had major bleeding. One patient (2.6%) had cerebral hemorrhage. It is concluded that "classic" thrombolytic treatment is to be cho sen in life-threatening pulmonary embolism. However, the difficulties some times encountered in producing an intense lytic effect and its low fibrinolytic specificity for the thrombus do not permit the obtainment of better results.
Monitoring of Tissue-pO2 for Invasive Diagnostics in Angiology and Vascular Surgery
Authors: Hauss J. , Spiegel H.U. , Schönleben K. , Bünte H.
Published: November 2007

Hypoxic and ischemic states are the main problem makers in angiology and vascular surgery. It is therefore suggestive to employ the technique of tissue-pO2 measurement for the verification and support of diagnostic and therapeutic measures.

Two forms of registration are possible: continuous monitoring of partial oxygen pressures in eight different places and registration in the form of pO2-histograms, which represents a kind of "representative opinion poll" held in the tissue.

The effects of a surgical intervention (endarterectomy, bypass operation) and the efficacy of blood flow-promoting drugs were studied in several series. In 9 patients the effect of the blood flow-promoting agent pentoxifylline (3,7-dimethyl-1-(5-oxohexyl)-xanthine) was studied. The pO2-histograms exhibited a shift to the right by an average of 7 mmHg after administration of this drug.

Moreover, findings obtained with sodium nitroprusside and nitroglycerin during induced hypotension indicate that the continuous measuring of tissuepO2 and recording of oxygen pressure distribution curves (pO2-histogram) provide the clinician with essential guidance data for the improvement of diagnostics and therapeutic control.
Kaposi's Sarcoma Following Corticosteroid Treatment for Temporal Arteritis—A Case Report
Authors: Di Giacomo Vincenzo , Nigro Daniela , Trocchi Gloria , Meloni Fortunato , Verallo Patrizia , Bottazzi Marco , Bellisario Giuseppe
Published: November 2007

After three months of corticosteroid treatment, a sixty-nine-year-old man, suffering from temporal arteritis, developed a Kaposi's sarcoma (KS) initially located on the left ankle and subsequently spread over both feet and hands. Laboratory data showed a deficiency of both humoral and cellular immunity and constant positivity in the tests for cytomegalovirus.

The onset of KS during corticosteroid treatment of temporal arteritis is an extremely rare occurrence, this case being only the second one reported in the literature.

In our case the development of this neoplasm can be related to an immunodeficiency that led to a deficit in the immunological surveillance, along with an activation of oncogenic viruses.
Shortcomings of Physical Examination and Impedance Plethysmography in the Diagnosis of Lower Extremity Deep Venous Thrombosis
Authors: Vaccaro Patrick , Van Aman Michael , Miller Susan , Fachman Jacque , Smead William L.
Published: November 2007

Accuracy in the diagnosis of lower extremity deep venous thrombosis (DVT) by physical examination and impedance plethysmography (IPG) is reviewed. Physical examination proved unreliable in distinguishing patients with and without acute disease. Swelling in the leg was, however, more prevalent in patients with DVT. The sensitivity and specificity of IPG were less than those reported by other groups. Venography remains the most reliable diagnostic procedure in our institution.
Effect of Oral Treatment with Pantethine on Platelet and Plasma Phospholipids in IIa Hyperlipoproteinemia
Authors: Prisco Domenico , Rogasi Pier Giorgio , Matucci Marzia , Paniccia Rita , Abbate Rosanna , Gensini Gian Franco , Semeri Gian Gastone Neri
Published: November 2007

In a single-blind, crossover, completely randomized study, the effects of oral treatment with pantethine or placebo on fatty acid composition of plasma and platelet phospholipids were investigated in 10 IIa hyperlipoproteinemic patients. A significant decrease of total cholesterol and total phospholipids was observed both in plasma and in platelets after a twenty-eight-day treatment. In plasma, pantethine induced a decrease of the ratio sphingomyelin/phosphatidylcholine. Moreover, a relative increase of n3-polyunsaturated fatty acids both in plasma and in platelet phospholipids and a decrease of arachidonic acid in plasma phospholipids were observed. These results indicate that pantethine can affect plasma and platelet lipid composition with possibly favorable influences on the determinants of cell membrane fluidity.
Systolic Hypertension in Patients with Arteriosclerosis Obliterans of the Lower Limbs
Authors: Safar M.E. , St. Laurent  , Asmar R.E. , Safavian A. , London G.M.
Published: November 2007

Intraarterial blood pressure, brachial artery compliance and diameter, and pulse wave velocity were determined in 20 patients with arteriosclerosis obliterans of the lower limbs (AOD) in comparison with 10 age- and sex-matched controls. With the same mean arterial pressure as in controls, patients with AOD exhibited a significant increase in systolic pressure and decrease in diastolic pressure, resulting in an increase in pulse pressure. While brachial artery diameter and pulse wave velocity remained nearly within the normal range, arterial compliance was significantly reduced and was negatively correlated with the level of pulse pressure. The study provided evidence that: (1) atherosclerotic modifications in patients with AOD are associated with an increase in pulse pressure, which predominates on the increase in mean arterial pressure, (2) increased pulse pressure is related to decreased arterial compliance, which reflects intrinsic modifications of the viscoelastic properties of the arterial wall.
Myocardial Reperfusion by Thrombolysis After Acute Total Left Main Artery Occlusion—A Case Report
Authors: Finzi Luiz Antonio P. , Secches Antonio Luis , Barbosa Evora Paulo Roberto , de Freitas Ribeiro Paulo José , Ferez Marcus Antonio , Amaral Fernando T. V.
Published: November 2007

Coronary recanalization with thrombolytic agents is a new therapeutic approach to the treatment of acute myocardial infarction that can be beneficial even to patients in cardiogenic shock. Although few cases have been reported in the literature, treatment of acute occlusion of the left main coronary artery (LMCA) has been made possible by myocardial reperfusion. This communication concerns a patient with acute LMCA occlusion who was successfully treated by thrombolytic therapy with streptokinase followed by revascularization of the myocardium seventy-two hours after reperfusion was achieved.
Effect of Angiotensin Blockade and Converting Enzyme Inhibition on Renovascular Hypertension: Comparison Between Unilateral and Bilateral Renal Artery Stenosis
Authors: Takabatake Toshikazu , Ohta Hiromichi , Yamamoto Yoshiharu , Ishida Yoh-ichi , Hara Hiromoto , Ushiogi Yasuyuki , Nakamura Saburo , Hattori Nobu
Published: November 2007

The response to angiotensin II analog infusion during sodium deletion and the effects of a one-month captopril treatment were compared between 15 re novascular hypertensive patients with unilateral and 6 with bilateral renal ar tery stenosis. Plasma renin activity, its response to sodium depletion, and the renal vein renin ratio during sodium depletion were greater in unilateral than in bilateral stenosis. A fall in diastolic blood pressure induced by analog infusion during sodium depletion was correlated with the preinfusion plasma renin ac tivity and with the renal vein renin ratio. Treatment with captopril showed a comparable hypotensive effect in unilateral and bilateral stenosis. The reduc tion in blood pressure was not correlated with the pretreatment renin levels or changes in blood pressure observed during analog infusion. Plasma renin activ ity rose and plasma aldosterone level fell in all patients. These results indicate that the mechanism maintaining high blood pressure is more renin dependent in unilateral than in bilateral stenosis and that the long-term effect of captopril does not not depend solely on the suppression of the renin-angiotensin-aldoster one system.
Adrenal Hemorrhage: A Complication of Anticoagulant Therapy—A Case History
Authors: Ognibene Andre J. , McBride Heyoung
Published: November 2007

A seventy-five year-old woman developed adrenal hemorrhage and acute adrenal insufficiency while receiving anticoagulant therapy. Abdominal CT scan was consistent with bilateral adrenal hemorrhage and was an important contribution to diagnosis and therapy. Acute adrenal hemorrhage should be suspected in patients, especially the elderly, who have recently begun anticoagu lant therapy and develop upper abdominal pain followed by decreased senso rium, high fever, hypotension, and hyponatremia. Any consideration of the diagnosis of sepsis with shock in a recently anticoagulated elderly hospital pa tient should suggest the possibility of acute adrenal hemorrhage. Abdominal CT scan and a cosyntropin stimulation test should be performed to confirm the diagnosis. Failure of diagnosis has generally been associated with death in most patients, whereas prognosis in patients treated with corticosteroids is excellent.
Small, Bilateral, Calcified Intrarenal Aneurysms— A Case Report
Authors: Saku Keijiro , Higashi Yoshitaka , Ueki Mitsuhiko , Sasaguri Manabu , Sasaki Jun , Ikeda Masaharu , Arakawa Kikuo
Published: November 2007

With increased use of renal angiography and ultrasonography, intrarenal aneurysms and arteriovenous malformations have been easily diagnosed. The authors report a case of small, bilateral intrarenal aneurysms with calcifications that were associated with a visible pulsatile wall motion recorded by M-mode ultrasonography. The finding of selective renal angiography was consistent with bilateral intrarenal aneurysms. Accelerated atherosclerosis and long-term his tory of hypertension were thought to have caused them.
Angiopyroplasty Using Electromagnetically Induced Focused Heat
Authors: LePage James R. , Lewis John E. , Ruiz Oscar F. , Yamanashi William S. , Padron Gustavo M. , Hood Cynthia H.
Published: November 2007

A metal-tipped catheter capable of inducing and withstanding extremely high temperatures suitable for angiopyroplasty has been developed. The probe utilizes external radiofrequency (RF) energy focused on the tip.

A relatively inexpensive catheter and RF source make this a very plausible alternative to laser systems.
Therapeutic Efficacy of Ketanserin, a Selective Antagonist of the Serotonin (5-HT 2) Receptors, in Primary and Secondary Raynaud's Phenomenon
Authors: Meloni Fortunato , Transi Maria Grazia , Sciacca Vincenzo , De Felice Carlo , Bagarone Amedeo , Sciacca Andrea
Published: November 2007

Fourteen ambulatory and hospitalized patients with primary and secondary Raynaud's phenomenon have been examined before and after a thirty-one-day therapeutic trial.

The treatment was conducted in two cycles. The first one lasted ten days, during which placebo was administered. The second cycle lasted three weeks, during which ketanserin, a selective antagonist of 5-hydroxytryptamine (5-HT2) receptors, was administered.

The therapeutic effect consisted of the complete healing of digital ulcers in 4 of 5 patients and a considerable decrease in the number, length, and severity of daily attacks.

To evaluate the digital blood flow, each patient was submitted to a medical dynamic telethermographic test. This, after the cooling test, demonstrated an average decrease of twenty minutes in the time necessary to reestablish basal thermal conditions (T') at the end of an adequate period of therapy using optimal doses of the drug. The authors affirm that orally administered ketanserin has a beneficial effect and can be well tolerated in subjects with Raynaud's phenomenon.
Placebo-Controlled Trial of Ketanserin in the Treatment of Intermittent Claudication
Authors: Cameron H.A. , Waller P.C. , Ramsay L.E.
Published: November 2007

The effect of ketanserin on the symptoms of 21 patients with stable intermittent claudication was examined in a double-blind, placebo-controlled, parallel-group study. Benefit was assessed by repeated treadmill exercise tests, recording claudication and total walking times. After three months' treatment with ketanserin (mean dose 167 mg/day) there was no significant change in claudication time (mean change +12%, 95% CI -9; +33%) or total walking time (mean change -14%, 95% CI - 47%; + 19%). The confidence intervals show that ketanserin treatment is unlikely to be associated with clinically important improvement.
Right Atrial Thrombus and Recurrent Pulmonary Emboli Secondary to Permanent Cardiac Pacing—A Case Report and Short Review of Literature
Authors: Porath Avi , Avnun Luna , Hirsch Menachem , Ovsyshcher Ilya
Published: November 2007

A patient with a right atrial thrombus and recurrent pulmonary emboli sec ondary to permanent pacemaker insertion is described. Possible precipitating factors were damage to the subclavian vein, congestive heart failure, paroxys mal atrial fibrillation, and immobilization. Venography demonstrated a large atrial thrombus in the superior vena cava and right atrium. The patient was successfully treated with heparin and subsequently with warfarin and dipyrida mole.
Communicating Hydrocephalus as a Complication of Isolated CNS Angiitis—A Case Report
Authors: Ibrahim Waseem N. , Paroski Margaret W.
Published: November 2007

A sixty-six-year-old man presented with headache, left hemiparesis, right crural monoparesis, and urinary and fecal incontinence. A picture consistent with cerebral angiitis was seen angiographically. After systemic angiitis and CNS infection were excluded, the diagnosis of isolated angiitis of the central nervous system was made. The patient responded well to corticosteroid therapy. However, a few months after initial presentation, he developed signs and symp toms suggestive of hydrocephalus. Serial CT scans of the head and radioisotope cisternography confirmed this diagnosis. The communicating hydrocephalus that developed was considered a complication of the CNS angiitis. A review of the literature on angiitis of the CNS is presented and the mechanism of the development of hydrocephalus is discussed.
Giant-Cell Arteritis Causing Severe Aortic Regurgitation Secondary to Aneurysm of the Ascending Aorta— A Case Report
Authors: Marchionni Niccolo , Di Bari Mauro , Ferrucci Luigi , Moschi Guya , Dabizzi Roberto P. , Di Donato Marisa , Biancalani Mauro , Gori Franca
Published: November 2007

This report describes a case of aneurysm of the ascending aorta with second ary, severe, aortic valve incompetence following temporal arteritis in a sixty- five-year-old woman.
Holt-Oram Syndrome in a Puerto Rican Family —Case Reports
Authors: Cheng Tsung O.
Published: November 2007

The Holt-Oram syndrome is reported for the first time in a Puerto Rican family of one mother and two daughters. All had severe upper limb anomalies and secundum atrial septal defect. One daughter, the proband, had, in addition, a persistent left superior vena cava, a cardiac anomaly that has not been previ ously reported in association with the Holt-Oram syndrome.
Syndrome of Coronary Artery Spasm of Normal Coronary Arteries. Clinical and Angiographic Features
Authors: Castelló Ramón , Alegría Eduardo , Merino Alvaro , Soria Federico , Martinez-Caro Diego
Published: November 2007

To define the clinical and angiographic features of the syndrome of spasm of angiographically normal coronary arteries, 77 patients with spasm and fixed coronary stenosis equal to or greater than 50% (group A) were compared with 35 patients with spasm and normal or minimally diseased coronary arteries (group B).

Statistically significant differences between groups A and B were as follows: the incidence of rest angina (50.6% vs 85.7%; p<0.01) and mixed angina (32.5% vs 5.7%; p < 0.01); the appearance of ST segment depression (53.3% vs 16%; p < 0.01) and no electrocardiographic changes during stress test (35.6% vs 76%; p < 0.01); and the tendency for arteriographically documented spasm to be focal (87.5% vs 71.4%; p<0.05) and to affect only one vessel (76.6% vs 57.1%; p < 0.05). No differences were found between groups A and B in major coronary risk factors, history of previous myocardial infarction, electrocardiographic abnormalities at rest or during pain episodes, or arteries affected by spasm.

Thus, angina appearing exclusively at rest is the main clinical feature of spasm of normal coronary arteries. The electrocardiogram, whether at rest or during pain episodes, has no value for predicting the existence of underlying coronary lesions, whereas stress testing does. Spasm of normal arteries tends to be more diffuse than that superimposed on organic lesions and to affect more than one artery, suggesting different mechanisms in the genesis of both types of spasm.
Biphasic Thallium 201 Spect-Imaging for the Noninvasive Diagnosis of Myocardial Perfusion Abnormalities in a Child with Kawasaki Disease—A Case Report
Authors: Hausdorf Gerd , Nienaber Christoph Anton , Spielman Rolf Peter
Published: November 2007

The mucocutaneous lymph node syndrome (Kawasaki disease) is of increas ing importance for the pediatric cardiologist, for coronary aneurysms with the potential of thrombosis and subsequent stenosis can develop in the course of the disease. The authors report a 2½-year-old female child in whom, fourteen months after the acute phase of Kawasaki disease, myocardial infarction oc curred. Biphasic thallium 201 SPECT-imaging using dipyridamole depicted an terior wall ischemia and inferolateral infarction. This case demonstrates that noninvasive vasodilation-redistribution thallium 201 SPECT-imaging has the potential to predict reversible myocardial perfusion defects and myocardial ne crosis, even in small infants with Kawasaki disease.
Influence of Videofilm-Induced Emotional Stress on the Flow Properties of Blood
Authors: Ehrly A.M. , Landgraf H. , Hessler J. , Saeger-Lorenz K.
Published: November 2007

The hemorheologic effects of emotional stress induced by a videofilm were investigated in 10 healthy volunteers. Blood samples were obtained from the antecubital vein before, during, and after the end of the videofilm. Blood pressure and heart rate were simultaneously measured. There was a statistically significant increase in blood and plasma viscosity during and immediately after the end of the videofilm, which correlated with an increase in plasma catecholamine concentrations. This hemorheologic behavior can be explained as a result of an endogenous hemoconcentration that takes place if the Starling equilibrium of intravascular vs extravascular fluid is changed. These observations could lead to new aspects of the pathophysiology of acute myocardial infarction initiated by severe emotional stress.
Application of Tapered Teflon Dilator to PTCA
Authors: Lee Don W. , Garnic J. Daniel
Published: November 2007

A technique using a tapered teflon dilator was applied to percutaneous transluminal coronary angioplasty (PCTA). Seven of 10 cases were successfully dilated by using this technique. These lesions could not be dilated in the usual manner using standard PTCA balloons. This technique converted 7 of 10 failed procedures into technical successes and is the basis of this report.
Routine Reduction of Pulse Generator Voltage
Authors: Gould Lawrence , Betzu Robert , Judge D. , Lee J. , Taddeo M.
Published: November 2007

The porous-tip electrode has led to a significant advancement in pacing sys tem technology. Experience with 38 patients with unipolar tined CPI porous endocardial electrodes, is reported. All patients had programmable pulse gener ators, CPI model number 531. The voltage in this pulse generator can be re duced from 5 to 2.5 volts. The pulse width threshold (PWT) at implantation was 0.06 ms at 5 volts in all 38 patients, and the PWT at implantation varied be tween 0.06 and 0.16 ms at 2.5 volts, with a mean PWT of 0.092+0.026 ms. The 38 patients were restudied six months later. The mean PWT measured at 5 volts was 0.076±0.018 ms. The PWT measured at 2.5 volts varied between 0.08 and 0.30 ms with a mean PWT of 0.178±0.067 ms. Twenty-three patients were restudied one year after lead implantation. The PWT measured at 2.5 volts varied between 0.08 and 0.30 ms with a mean PWT of 0.156±0.061 ms. All of the pulse generators were reprogrammed to 2.5 volts. This permitted a substan tial prolongation of the pulse generator life (three to five years) with an im provement in the cost effectiveness of the pulse generator.
Bevantolol vs Propranolol: A Double-Blind Controlled Trial in Essential Hypertension
Authors: Maclean Derek , Maclean Derek
Published: November 2007

Bevantolol is a novel β 1-selective beta-adrenoceptor antagonist. The Study Group evaluated its therapeutic utility (100-300 mg bid) compared with pro pranolol (80-240 mg bid) in 266 patients with mild to moderate essential hyper tension (WHO Grades I and II, sitting diastolic blood pressure (DBP) ≥ 95 mmHg). There was no difference in their antihypertensive efficacy over six months, 77% being controlled (DBP ≤ 90 mmHg) on bevantolol and 81 % on propranolol. Hydrochlorothiazide 25-50 mg bid added later improved BP con trol in those incompletely controlled on bevantolol monotherapy. Both β- adrenoceptor antagonists also reduced intraocular pressure. Bevantolol caused significantly fewer adverse effects than propranolol with many fewer with drawals during long-term therapy. This unique clinical pharmacologic profile of bevantolol enhances its therapeutic usefulness and may relate to alpha-adreno ceptor antagonist activity, as well as to its β1-selectivity.
Efficacy of Pentoxifylline in Patients with Stable Angina Pectoris
Authors: Insel Jerald , Halle A. Arthur , Mirvis David M.
Published: November 2007

Pentoxifylline, a methyl xanthine derivative, improves symptoms of periph eral vascular disease probably by reducing whole blood viscosity. The authors assessed the value of this agent in treating myocardial ischemia in 11 patients with angiographically documented coronary artery disease and stable angina pectoris. Maximal, symptom limited treadmill exercise stress tests were per formed before and after six weeks of therapy with 1200 mg of pentoxifylline per day. Clinical symptoms improved in 9 [82%] of patients; none developed drug side effects. After therapy, mean total exercise time [7.7±1.3 vs 10.1±1.2 min utes], time to onset of angina [5.5 ±0.9 vs 7.9 ±1.0 minutes], heart rate at onset of angina [93.4±6.7 vs 112.0±10.5 beats/min] and rate at onset of ST depres sion [94.0±5.8 vs 115.9±7.4 beats/min] all increased significantly [p < 0.05]. Mean maximum ST segment depression also decreased [1.6±0.3 vs 1.2±0.4 mm], but the difference was not significant. Thus, pentoxifylline increases exer cise performance in patients with angina pectoris and increases exercise capac ity before development of myocardial ischemia. It may, therefore, be a useful agent for treating ischemic heart disease.
Extracranial Carotid Atherosclerosis Evaluation and Stroke Occurrence: Role of the Echotomographic Analysis
Authors: Parnetti Lucilla , Mercuri Michele , Susta Adelaide , Lupattelli Graziana , Ciuffetti Giovanni , Senin Umberto
Published: November 2007

High-resolution real-time echotomography was used in a longitudinal study on 118 atherosclerotic plaques of the extracranial carotid tract with the aim of identifying those most likely to cause a cerebrovascular event.

Seventy patients (average age 61 ± 7 years), referred to our Clinical Vascu lar Laboratory because suffering from transient cerebral ischemic attacks (TIA), coronary heart disease (CHD), peripheral artery disease (PAD), or cervi cal bruits (CB), were followed up for two years. Medical treatment remained that of the referring physician.

Ten patients suffered from clinical events caused by stroke, TIA, and/or carotid occlusion during the follow-up.

The echostructural profile of the lesions most often correlated with the clini cal event was characterized by a mixed or hard echogenic pattern, an irregular surface, and an initial vascular stenosis of more than 50%.
Noninvasive Measurement of the Human Peripheral Circulation: Relationship Between Laser Doppler Flowmeter and Photoplethysmograph Signals from the Finger
Authors: Almond Nicholas E. , Jones Deric P. , Cooke Ernest D.
Published: November 2007

Under certain conditions laser Doppler flowmeter (LDF) signals obtained from the finger pulp may appear very similar to those obtained by use of a direct current (dc) photoplethysmograph (PPG). A combined LDF/PPG system was used in conjunction with a circumference strain gauge as an index of vol ume change to identify the conditions in which the correlation between these signals was good.

Simultaneous LDF and dc PPG measurements were made on 10 normal vol unteers by using arterial occlusion and on 7 normal subjects by using the Val salva maneuver at different elevations of the forearm and hand with respect to the midsternum. By altering the elevation of the upper limb the influence of venous filling on each of the signals during these maneuvers was observed.

Since the dc PPG signal always appeared similar to the volume change indi cated by the circumference strain gauge, it is concluded that the dc PPG signal is related to blood volume change if allowance is made for the effects of blood oxygenation. In circumstances of low venous filling, however, blood volume changes correlate well with blood flow changes, producing the correlation be tween the dc PPG and LDF traces.

The dc PPG signal may be used as a means of monitoring changes in blood flow in the finger only when venous filling is low and the return remains unre stricted. Thus, in investigations using this method, the relative position of the limb with respect to the heart should always be indicated. The LDF method appears to be a reliable indicator of blood flow changes in the microcirculation irrespective of the degree of venous filling.
Partial Resection of Atrial Septal Aneurysm with Multiple Fenestrations — A Case Report
Authors: Kondo Teruki , Iwasaki Tsutomu , Hiramatsu Kunihide , Katakura Masafumi , Shirota Toshihide , Yamada Takashi , Miwa Hiromichi , Fukaya Yukio , Morimoto Masami , Iida Futoshi
Published: November 2007

Aneurysms of the interatrial septum are uncommon lesions that are often accompanied by other cardiac anomalies or systemic thrombosis. The authors report 1 case of atrial septum aneurysm that was diagnosed by two-dimensional contrast echocardiography. At surgery a membrane-like, fenestrated aneurys mal protrusion to the right atrium without thrombosis was seen. The atrial septum was closed without using an artificial patch after some of the aneurysm with fenestrations was resected.
Impotence Caused by Traumatic Pelvic Arteriovenous Communication — A Case Report
Authors: Khoury Maroon B. , Contractor Farhad M.
Published: November 2007

A case of traumatic arteriovenous (AV) communication between the internal iliac artery and vein presented with impotence and buttock claudication simu lating the iliac artery steal syndrome. Surgical resection of the AV fistula re sulted in satisfactory coitus and abolishment of the claudications.
Vasculitis of Breast in Behget's Disease— A Case Report
Authors: Dündar Semra V. , Sivri Bülent , Gököz Aytaç
Published: November 2007

This is the case report of a thirty-one-year-old woman who presented with a large skin lesion on a breast that was first thought to be a malignant or inflam matory process. After a biopsy, the lesion was diagnosed as nonspecific vascu litis. No similar case has been found in a review of the literature.
Properties of Electromagnetic Field Focusing Probe
Authors: Yamanashi William S. , Yassa Nabil A. , Hill Deborah L. , Patil Angelo A. , Lester Patrick D.
Published: November 2007

The electromagnetic field focusing (EFF) apparatus consists of a radio fre quency generator, solenoidal coil, and a hand-held or catheter probe. Applica tions such as aneurysm treatment, angioplasty, and neurosurgery in various models have been reported. The probe is operated in the near field (within one wavelength of an electromagnetic field source) of a coil inducing eddy currents in biological tissues, producing maximal convergence of the induced current at the probe tip.

The probe produces very high temperatures depending on the wattage se lected for the given radio frequency of output power.

The high temperature can be used in cutting, cauterizing, or vaporizing. The EFF probe is comparable to different types of lasers and to bipolar and mono polar cautery. The EFF probe can be used with catheters or endoscopes. Objec tives of this study were to determine what the thermal properties of the EFF probe are and how instrument parameters can be varied to obtain different temperatures in the tissue near the probe tip.

In this study an F2 catheter was used as an insulated sheath and the tip of the guide wire was used as the probe tip. Different powers, wave forms, coil-to- probe distances, and probe-tip lengths were tested on a phantom that simulates tissue electrical properties. Some of the experiments were conducted under nor mal saline to simulate treatment of tissue with body fluids such as blood vessels or brain tissue under normal physiologic conditions.

It is concluded that the EFF probe has the advantages of easy manipulation, relative safety, cost effectiveness, and a high degree of spatial control. Only at the point of contact do extremely high temperatures occur. Small volumes of heat dissipation occur around the tip, especially when the sinusoidal wave form is used. Temperatures delivered are related to power applied, coil-to-probe-tip distance, and probe-tip length.
Acute Hemorrhage and Oxygen Free Radicals
Authors: Prasad Kailash , Kalra Jawahar , Buchko Greg
Published: November 2007

Oxygen free radicals are known to produce cellular injury. There are various mechanisms during hemorrhagic shock that can lead to an increase in the oxy gen free radicals, which would produce a loss of membrane integrity and a decrease in cardiac function and cardiac contractility. The authors studied the effect of acute hemorrhage and reperfusion on the hemodynamics, blood lac tate, and oxygen free radicals.

Dogs were divided into two groups, group I, hemorrhagic shock and reinfu sion; group II, hemorrhagic shock and reinfusion with superoxide dismutase (SOD) and catalase treatment. The dogs were bled (50% of the estimated blood volume) over a period of five to twelve minutes. After an hour of bleeding, the shed blood was transfused over twenty to twenty-five minutes. Group II re ceived SOD (0.7 mg/kg, IV) and catalase (0.7 mg/kg, IV) within ten minues of bleeding. The hemodynamic measurements and collection of blood samples for measurement of oxygen free radicals and lactate were made before hemorrhage and at fifteen, thirty, and sixty minutes of hemorrhage and at fifteen, thirty, and sixty minutes after reperfusion of shed blood.

There was a decrease in the cardiac function and index of myocardial con tractility associated with an increase in the blood lactate after hemorrhage in group I. Similar but less marked changes in these parameters were observed in group II. Recovery of hemodynamic parameters with reinfusion was better in group II as compared with that in group I. There was an increase in blood oxygen free radicals (superoxide anions) in group I, especially after reinfusion.

No such changes were observed in group II. These results suggest that oxygen free radicals might be involved in acute hemorrhagic shock. Use of scavengers of oxygen free radicals might, therefore, be helpful in hemorrhagic shock.
Capillary Filtration and Ankle Edema in Patients with Venous Hypertension Treated with TTFCA
Authors: Belcaro Giovanni V. , Rulo Alex , Grimaldi Roberto
Published: November 2007

The variation of capillary filtration rate (CFR), ankle circumference (AC), and ankle edema (AE) was evaluated in three groups of patients with venous hypertension (ambulatory venous pressure > 42 mmHg) and in a group of normal subjects before and after treatment for four weeks with Total Triterpenic fraction of Centella Asiatica (TTFCA), a venoactive drug acting on the microcirculation and on capillary permeability. Group A (20 patients) was treated with TTFCA 60 mg tid; Group B (20 patients) was treated with 30 mg tid; Group C (12 patients) was treated with placebo; and Group D (10 normal subjects) was treated with TTFCA 60 mg tid in an open study.

Capillary filtration rate was assessed by venous occlusion plethysmography, ankle edema by a new system called AECT (Ankle edema coin tester). Subjective symptoms of venous hypertension were assessed by an analogue scale line considering four symptoms: swelling sensation, restless lower extremity, pain and cramps, and tiredness. CFR, AC, and AE were significantly higher in patients in comparison with normal subjects.

After four weeks of TTFCA treatment there was a significant decrease of the abnormally increased CFR, AC, and AECT time in patients.

This was also greater in the higher dose group. No significant change was observed in the placebo group and in normal subjects treated with TTFCA. Symptoms were also significantly improved in the two groups treated with the active drug according to the dose. No significant changes were observed in the placebo group.

In conclusion the improvement of symptoms by TTFCA observed in patients with venous hypertension was well correlated with the improvement of CFR and ankle edema, and dose ranging showed that 180 mg/day is more effective in improving both symptoms and CFR.
Clinical Significance of Initial Systolic Hypertension After Myocardial Infarction
Authors: Katayama Tomoyuki , Yamasaki Hidefumi , Honda Yukiharu , Mori Mitsuhiro
Published: November 2007

To clarify the clinical significance of acutely raised systolic blood pressure (SBP) after myocardial infarction, 60 patients who were admitted within six hours after onset were studied. Initial systolic hypertension was shown in 26.6% of patients. Time-corresponding plasma epinephrine and norepinephrine levels were abnormally high in 61% and 86% of patients respectively. These high values of catecholamines were not, however, specific to systolic hypertension. On the contrary, an inverse correlation was observed between systolic blood pressure and plasma epinephrine value. It appeared that the anxiety and stress of chest pain do not contribute to raising blood pressure through catecholamine liberation. In the high pressure group (SBP ≥ 160 mmHg), only 3 of 16 patients were classified into severer grades (III or IV) of Killip's classification. This proved to be statistically significant. A similar result was obtained in Lown's grading. Only 1 of 16 patients showed severe ventricular tachyarrhythmia.

It appeared obvious from these data that patients who showed initial systolic hypertension are well protected from severe congestive heart failure and from life-threatening ventricular tachyarrhythmia in acute myocardial infarction.
Review of the Validity of National Coronary Heart Disease Mortality Rates
Authors: Stehbens William E.
Published: November 2007

Epidemiologic studies of coronary heart disease are heavily dependent on national mortality rates. The diagnostic error for the coronary heart disease is substantial but unquantifiable and is conservatively at least ± 30%. When this error is superimposed on innumerable errors and omissions in the compilation of monocausal mortality rates, the reliability of such vital statistics currently precludes their use for scientific purposes.
Improved Left Ventricular Function in Myocardial Infarction Following Intravenous Thrombolytic Therapy with Acylated Plasminogen Activator
Authors: Ovsyshcher I. , Silber H. , Hausman M.I. , Margolis G. , Gueron M.
Published: November 2007

Forty-six patients with acute myocardial infarction (MI) were treated within three hours of the onset of chest pain with an intravenous bolus (IV) of 30 units of anisolated plasminogen activator streptokinase complex (APSAC). Reperfusion was detected in 31 patients (67%) by clinical, electrocardiographic, and enzymatic criteria. The mean time elapsed between the onset of the chest pain to thrombolytic therapy was 114±53 minutes.

Left ventricular ejection fraction (LVEF) was significantly better in patients with anterior and inferior myocardial infarction who had successful reperfusion, as compared with those who did not (48.8 ±13.0 vs 35.3 ±10.9, p<0.05 and 59.7±12.6 vs 47.9±15.3, p<0.05, respectively). The rate of reocclusion within three weeks was 22%. The overall one-year mortality was 4%. There were no serious adverse reactions following the thrombolytic treatment. Thus bolus IV injection of 30 units of APSAC is both safe and effective in preserving left ventricular function when given early in the course of acute myocardial infarction.