bluuebunny/crossref_metadata_2025 huggingface dataset:
Late Development of Renal Arteriovenous Fistula Following Gunshot Trauma
Authors: Wang Kuang-Te , Hou Charles Jia-Yin , Hsieh Jen-Jer , Chou Yu-San , Tsai Cheng-Ho
Published: July 2008

A 43-year-old man presenting with symptoms of congestive heart failure, cardiomegaly, and impaired left ventricular (LV) function was diagnosed as having a huge left renal arteriovenous (AV) fistula. The AV fistula might be attributed to a gunshot wound suffered during his military service twenty years ago. Percutaneous transcatheter arterial embolization utilizing multiple spring coils in conjunction with cyanoacrylic glue success fully occluded the fistula, with subsequent improvement of LV function and reduction of LV size on his serial echocardiographic follow-up.
Blood Flux and Venoarteriolar Response of the Skin in Legs with Chronic Venous Insufficiency Measured at Two Different Depths by Using a Double-Wavelength Laser Doppler Technique
Authors: Malanin Ken , Vilkko Pekka , Kolari Pertti J.
Published: July 2008

The laser Doppler flux (LDF) and the venoarteriolar response (VAR) of the skin in legs with chronic venous insufficiency (CVI) was measured by using a new double-wavelength probe technique (543 nm and 780 nm). The recordings were taken in a recumbent and in a sitting position. Ten patients with CVI and 20 control subjects with healthy legs were investigated. The LDF was found to be significantly enhanced in a recumbent position at 543 nm and in a sitting position at 780 nm in legs with CVI compared with healthy legs (P<0.05 and P=0.02, respectively). The authors could not find the VAR to be impaired in either wavelength in legs with CVI compared with healthy legs. The double-wave length probe technique makes it possible to record simultaneously the LDF in the super ficial and deep layers of the skin on the same place in the leg.
Comparison of the Three Different Formulas for Doppler Estimation of Pulmonary Artery Systolic Pressure
Authors: Abaci Adnan , Kabukcu Mehmet , Övünç Kenan , Tokgözoğglu Lale , Tarrach Münir , Batur Mustafa Kemal , Aksöyek Serdar
Published: July 2008

Noninvasive pulmonary artery systolic pressure (PASP) is calculated by summing the right ventricular systolic pressure obtained from Doppler velocity of regurgitant flow through the tricuspid valve and the right atrial (RA) pressure. The RA pressure is generally assumed from different formulas. An accurate RA pressure estimation will add precision to PASP calculation. One of the methods to estimate RA pressure is the inferior vena cava collapsibility index (IVCCI) . In 45 patients referred for right heart catheteri zation, the authors tested a formula for the calculation of PASP based on the estimation of RA pressure from IVCCI and compared this method with two other formulas.

The first method (method 1) assumed a constant RA pressure of 10 mm Hg irre spective of right ventricular pressure. The formula used was Doppler gradient + 10 (mm Hg). In the second method (method 2), a clinical estimate of RV pressure was made from the formula: right ventricular-right atrial Doppler gradient x 1.1 + 14. In the third method (method 3), the patients were classified into three groups on the basis of IVCCI: group A, IVCCI greater than 45%; group B, IVCCI between 35% and 45%; and group C, IVCCI less than 35%. The formula used was Doppler gradient + 6, 9, or 16 mm Hg in the presence of normal (group A), moderately reduced (group B), or markedly reduced (group 3) IVCCI.

A good correlation between Doppler and catheter measurements of PASP was found for methods 1, 2, and 3, respectively (r=0.8933, SEE=6.4, r=0.8921, SEE=7.0, and r=0.8989, SEE=6.7). Correlation between invasive and noninvasive PASP was similar with the three methods, but correlation in method 2 was less satisfactory than with the other two methods. The mean difference between Doppler-derived and hemodynamic PASP was also high in method 2.

In conclusion, the result of this study validates a relatively new, simple echo-Doppler formula for Doppler estimation of PASP based on a noninvasive evaluation of RA pressure through the IVCCI. However, this method is not better than the traditional method 1 for noninvasive PASP estimation.
Coronary Artery Slow Flow Associated with Angina Pectoris and Hypotension
Authors: Burckhartt Barbara A. , Mukerji Vaskar , Alpert Martin A.
Published: July 2008

A 56-year-old woman with a history of angina pectoris developed substernal chest pressure and hypotension during coronary angiography. Her baseline coronary angiogram appeared normal. During this episode, injection of contrast medium into the left coronary artery demonstrated coronary artery slow flow in the left anterior descending artery and branches of the circumflex coronary artery, which normalized following the sublingual administration of nitroglycerin. There were no focal areas of coronary artery spasm. This phenomenon may represent a heretofore undescribed mechanism for myocardial ischemia and its sequelae.
Morphodynamics and Pathology of Blood Vessels III
Authors: Lin Ching-Shen , Goldfischer Michael , Sicular Arthur , Landais Gerald , Cohen Lawrence B.
Published: July 2008

The morphologic changes in the walls of hollow viscera caused by contraction and relax ation of smooth muscle cells were studied from autopsy and surgical specimens. The specimens studied included: esophageal spasm (corkscrew and nutcracker esophagus), contraction of the lower esophageal sphincter with marked esophageal dilatation, gaseous distension of the stomach, contraction of the gastric pylorus, bladder and anal sphincter, physiological segmental constriction of the small and large intestines, constric tion and distension of the gallbladder, urinary bladder and bronchi, and postpartum contraction of the uterus. In contrast to distension, the constriction of hollow viscera shows marked reduction of the external circumference and diameter with thickening of the wall, contraction of smooth muscle cells, thickening of muscle bundles, remodeling of wall structure, and narrowing or obliteration of the lumen. Morphologic evidence of contraction of smooth muscle cells is demonstrated by varying degrees of typical length- wise shortening of the cells and squeezing and folding of the nuclei depending on the degree of cytoplasmic contraction of the smooth muscle cells. Using these same classic morphologic signs, we have attempted to study constriction and distension of arteries and arterioles. We can demonstrate contraction of smooth muscle cells and remodeling of arterial and arteriolar walls in patients with spastic coronary artery thrombosis, cocaine- induced coronary artery thrombosis, acute constriction of mesenteric arteries with lacer ations of arterial wall, and dissecting hemorrhages induced by large doses of intravenous infusion of vasoconstrictors for hemorrhagic shock, and in patients with sustained, accel erated, or malignant hypertension.
Erythrocyte Passive Potassium Flux is Increased in Patients with Ischemic Coronary Disease (ICD) and in Subjects with Family History of ICD
Authors: Saitta Antonino , Saitta Michele N. , Bonaiuto Michele , Castaldo Maria , Sardo Adriana , Imbalzano Egidio , Cinquegrani Maurizio , Squadrito Francesco , Hannaert Patrick A.
Published: July 2008

Background. It has been proposed that ischemic coronary disease (ICD) associated potassium loss could be due to modifications of potassium permeability. We investigated whether a positive family history of ICD can influence this parameter. We have compared potassium permeability in erythrocytes from ICD patients and from positive family history subjects (FICD) with control subjects.

Methods. All patients and subjects were carefully selected for the absence of hypertension and dysmetabolic pathologies. ICD group: 24 patients (19 males, 5 females; ages 43 to 69) all affected by ischemic coronary disease, under no drug treatment; FICD group: 18 subjects (all males, ages 27 to 42) with a verified positive ICD family history, without hypertensive family history and cardiovascular pathology; control group: 16 subjects (11 males, 5 females; ages 28 to 48) without positive family history of ICD. Passive potassium efflux (PPE) was spectrophotometrically measured in K-free medium containing ouabain and bumetanide. The kinetic constant was calculated by dividing PPE by the erythrocyte potassium concentration. Results. No statistically significant differences were noted between the intracellular potassium content of the three groups. However, (1) the passive potassium permeability of the ICD group was significantly higher (kK=0.055 ±0.021 h-1, n=24) than that of the control group (kK=0.023 ±0.008 h-1, n=16; p<0.00001), (2) the FICD group was higher (kK=0.036 ±0.012 h-1, n=18) than the control group (p<0.001), and (3) the ICD group was higher than the FICD group (p<0.001).

Conclusions. Our results suggest an inheritability of ICD, paralleling the familial aggre gation of the pathology. Erythrocyte potassium permeability could represent an early marker of ischemic coronary disease and be used as a prophylactic tool.
Cerebral Venous Thrombosis and Procoagulant Factors
Authors: Lefebvre P. , Lierneux B. , Lenaerts L. , Van Maldergem L. , Marecaux G. , Daune M. , Bruninx G. , Delcour C. , Wautrecht J.-C.
Published: July 2008

Cerebral venous thrombosis is a polymorphic clinical entity for which diagnosis has become more frequent with the advent of neuroradiology. The superior sagittal and trans verse sinuses are frequently involved, whereas cavernous sinus thrombosis is much less frequent. Inherited resistance to the anticoagulant action of activated protein C (APC resistance), antithrombin deficiency, protein C and S deficiencies, and hyperhomocys teinemia seem to represent major causes of thrombophilia when unusual thromboembolic events (ie, before the age of 45 years) are observed. The authors present the combined occurrence of protein C and protein S deficiencies in a 32-year-old woman, manifested by extensive cerebral venous thrombosis.
Insulin Resistance, Hyperinsulinemia, and Hypertriglyceridemia in Patients with Coronary Artery Disease Independent of Obesity
Authors: Alexopoulos Dimitris K. , Kyriazopoulou Venetsana E. , Vagenakis Apostolos G. , Psyrogiannis A.
Published: July 2008

Insulin resistance and hyperinsulinemia both in normal persons and those with non- insulin dependent diabetes mellitus (NIDDM) (type 2 diabetes) appears to be related to obesity. It seems also that insulin plays a role in modulating the obesity-related factors (eg, hyperinsulinemia, hyperglycemia, hypertension, hypertriglyceridemia, hypercholes terolemia, low concentrations of high-density lipoprotein cholesterol) and takes its place among the many risk factors for coronary artery disease (CAD) associated with obesity. Insulin resistance and hyperinsulinemia could play the same role in pathogenesis of CAD independently of obesity.

The authors determined blood glucose and immunoreactive insulin and plasma triglyceride concentrations in the fasting state at 60 and 120 minutes after a glucose load of 75 g in 68 patients (54 men, 14 women) with angiographic evidence of CAD and in 65 healthy volunteers matched to the patients for age, gender, and body mass index (43 men and 22 women). Patients with CAD and the healthy volunteers were categorized as obese (body mass index ≥ 26 kg/m2) and nonobese (body mass index < 26 kg/m2) . Four groups of subjects were analyzed: Group A included 40 healthy (28 men and 12 women) nonobese volunteers; group B, 25 healthy (15 men and 10 women) obese volunteers; group C, 39 (30 men and 9 women) nonobese patients with CAD; and group D, 29 (24 men and 5 women) obese patients with CAD.

Fasting and postchallenged 60- and 120-minute glucose values were similar in groups A and C. However, significantly higher insulin values (mU/L) were observed in group C than in group A during fasting (12.2 ±6.2 vs 91 ±3, p<0.05), and postchallenged at 60 minutes (103.1 ± 53.2 vs 71.9 ±64.3, p < 0.01 ) and 120 minutes (5 7.9 ± 41.2 vs 44.9 ±41.3, p < 0.01 ) . Fasting glucose and insulin values were similar in groups B and D. However, significantly higher glucose (mg/dL) and insulin values were observed in group D than in group B postchallenged at 60 and 120 minutes: glucose at 60 minutes (188.7 ±45.1 vs 154.2 ±37.5, p<0.05); insulin at 60 minutes (127.5 ±98.5 vs 112.1 ±81.1, p < 0.05); glucose at 120 minutes (124.2 ±46.1 vs 99.5 ±28.9, p < 0.05); insulin at 120 minutes (86.1 ± 5 7.6 vs 62.8 ± 27.9, p < 0.05) . The glucose and insulin values during 60- and 120-minute fasting as well as postchallenged were similar in groups B and C.

Significantly higher plasma triglyceride concentrations were observed in group C than in group A (149.0 ±64.1 vs 114.6 ±46.6, p < 0.01 ) and in group D compared with group B (229.4 ± 104. 7 vs 144.9 ±65.1, p < 0.001. Plasma triglyceride concentrations were similar in groups B and C.

The authors conclude that patients with documented CAD are insulin resistant inde pendently of obesity.
Coronary Stent Deployment Without Predilation: Prevention of Complications of Venous Graft Angioplasty
Authors: Assali A. , Adler Y. , Solodky A. , Shor N. , Ben-Gal T. , Sclarovsky S. , Pardes Avraham , Herz I.
Published: July 2008

Saphenous vein graft stenting without predilation may potentially decrease procedural complications such as distal embolization and no-reflow phenomenon. In this report the authors describe the deployment of stents (three Wallstents, one Palmaz-Schatz, one Multilink, and one NIR) without predilation in five patients with unstable angina pectoris due to high-grade stenosis in old saphenous vein grafts. Stent deployment was successful in all patients without procedure-related complications. Stenting without predilation appears to be feasible in old bypass grafts with significant stenosis. The potential of this new stenting technique to reduce the risk of stenting complications should be tested by a randomized trial.
Aortic Dissection in a Young Corticosteroid-Treated Patient with Systemic Lupus Erythematosus
Authors: Chandna H. , Santhanam V. , Sehgal S. , Jain A. , Denes P. , Hussain K.M.A.
Published: July 2008

We report a rare case of acute aortic dissection in a young, corticosteroid-treated hyper tensive patient with a long-standing history of systemic lupus erythematosus (SLE). A brief review of literature on aortic dissection in lupus erythematosus is presented. A low threshold for performing transesophageal echocardiography in the management of chest pain syndrome in SLE is emphasized.
Paroxysmal Atrial Fibrillation as a Cause of Potentially Lethal Ventricular Arrhythmia with Myocardial Ischemia in Hypertrophic Cardiomyopathy
Authors: Hirayama Takeru , Marumoto Kazumasa , Okayama Hideki , Iwata Takeru , Suzuki Makoto
Published: July 2008

The mechanism(s) of myocardial ischemia in hypertrophic cardiomyopathy remain unclear. In this report, the authors present a 75-year-old Japanese woman with nonob structive hypertrophic cardiomyopathy in whom paroxysmal atrial fibrillation caused severe myocardial ischemia and induced sustained ventricular tachycardia. Her coronary angiogram showed normal findings, and no ischemic changes were provoked by either physical exercise testing or dobutamine stress echocardiography under sinus rhythm. In view of these findings, the rapid ventricular response in the absence of atrial contraction may aggravate or induce myocardial ischemia and predispose patients with hypertrophic cardiomyopathy to develop lethal ventricular arrhythmia.
Unexplained Fever and Aortic Regurgitation: A Rare Presentation of Takayasu's Aortitis
Authors: Sakakibara Yuzuru , Hiramatsu Yuji , Abe Masakazu , Ishimitsu Toshiyuki , Sakakibara Yuzuru
Published: July 2008

Takayasu's aortitis is rare in male patients. The authors describe the case of a 48-year-old man with a fever of unknown origin, progressive general fatigue, and dyspnea due to aortic regurgitation. A severely thickened aorta was noted during aortic valve replace ment. The diagnosis was based on a histologic examination of an operative specimen of the ascending aorta. Takayasu's aortitis should be considered even in male patients with fever of unknown origin and progressive aortic regurgitation.
Clinical Characteristics in Japanese Patients with Coexistent Hypertrophic Cardiomyopathy and Coronary Vasospasm
Authors: Hamada Mareomi , Kazatani Yukio , Matsuzaki Keisuke , Murakami Eiki , Shigematsu Yuji , Hiwada Kunio , Kodama Koji
Published: July 2008

There are only a few reports concerning coexistent hypertrophic cardiomyopathy (HCM) and vasospastic angina. Clinical characteristics in patients with both diseases have not been clarified yet. This study was designed to elucidate the relationship between chest pain and coronary vasospasm in HCM patients and to delineate clinical characteristics in patients with both HCM and coronary vasospasm.

First, 36 patients with HCM underwent acetylcholine provocation test for coronary vasospasm and were divided into two groups on the basis of presence or absence of coronary vasospasm. Next, the following risk factors for coronary artery disease were compared between the two groups: hypertension, smoking, hyperlipidemia, diabetes mellitus, and hyperuricemia.

Coronary vasospasm was induced in 10 (28%) of 36 patients with HCM. There were no significant differences in age and male gender between the two groups. Smoking was more prominent in HCM patients with than without coronary vasospasm (80% vs 35%, p<0.05), but there were no differences in the prevalence of other risk factors between the two groups.

In conclusion, coronary vasospasm appears to play a significant role in the etiology of myocardial ischemia in Japanese patients with HCM, and smoking might be a major risk factor for coexistence of HCM and coronary vasospasm.
Gas Tensions in Cardiac Lymph as a Reflection of the Interstitial Space of the Heart
Authors: Palmer Arthur S. , Miller Albert J. , Davis Cornelius , Greene Rodney
Published: July 2008

The purpose of this study was to determine the feasibility of measuring partial pressure of oxygen (pO2), partial pressure of carbon dioxide (pCO2), and pH in cardiac lymph and to evaluate the relationship of these parameters to comparable measurements in arterial and coronary sinus blood in the normal heart under various respiratory conditions. In four anesthetized open-chest dogs, the principal cardiac lymphatic as well as the femoral artery and coronary sinus were cannulated. Ventilation was varied by changing oxygen concentration, tidal volume, and respiratory rate. PO2, pCO2, and pH were measured in the cardiac lymph, arterial blood, and coronary sinus blood after each change in venti lation. For pH and pCO2, good correlations were observed between the arterial blood and cardiac lymph, arterial blood and coronary sinus blood, and coronary sinus blood and cardiac lymph. The correlation between the pO2 measured in the arterial blood and the pO2 measured in the cardiac lymph was not as strong, and this may have been related to difficulty achieving a steady state. Gas tensions (pO2, pCO2, and pH) can be measured in cardiac lymph and may provide a window to the interstitial compartment of the heart. This is an additional tool for the laboratory study of ischemia and other forms of heart disease.
Homocysteine Associated Hypercoagulability and Disseminated Thrombosis
Authors: Stern John M. , Saver Jeffrey L. , Boldy Robert M. , DeGregorio Frank
Published: July 2008

The authors report the occurrence of vascular occlusion due to hyperhomocysteinemia without significant underlying atherosclerotic disease. This unique observation supports the potential of hyperhomocysteinemia to induce thrombosis and the independence of the thrombosis from hyperhomocysteinemia's associated atherosclerosis. The case demon strates the clinical relevance of the effects of hyperhomocysteinemia on the coagulation cascade. A 42-year-old woman who lacked signs of classic homocystinuria developed disseminated thrombosis with a 24-hour urine homocysteine concentration of 384 mg, twelve times the upper limit of normal. Thrombosis was present in the aortic arch and its major branches and in the mesenteric arteries and veins. A fatal stroke resulted from the thrombosis. Autopsy revealed minimal atherosclerotic disease and no complicated plaques. This case demonstrates an expanded role of hyperhomocysteinemia in clinically significant vascular occlusion. Serum homocysteine concentration determination may be a factor in the evaluation of a hypercoagulable state. Hyperhomocysteinemia should be considered when evaluating arterial or venous thrombosis in a young person regardless of whether atherosclerosis or other signs of abnormal homocysteine metabolism are present.
Effects of Picotamide on Release of Endothelin-1, Thromboxane, and Prostacycline After Treadmill Stress in Patients with Peripheral Artery Disease
Authors: Saitta Antonino , Sardo Adriana , Bonaiuto Michele , Giordano Giuseppe , Imbalzano Egidio , Castaldo Maria , Cinquegrani Maurizio , D'Arrigo Daniele , Campo Giuseppe M. , Squadrito Francesco
Published: July 2008

To assess the effects of picotamide, an antithromboxane receptor and antithromboxane synthase drug, on vascular function and endothelin-1 release, 20 patients with peripheral arterial disease, without hypertension or diabetes mellitus, receiving placebo and pico tamide (900 mg/day) were studied. The modifications of vascular parameters were evaluated by arterial distensibility index and postischemic hyperemia test (postischemic perfusion index and recovery time). Endothelin-1, prostacycline, and thromboxane B2 were determined under resting conditions and after treadmill test. Picotamide treatment caused a decrease of resting thromboxane B2 and endothelin-1 concentrations, produced an improvement of the vascular function as seen by the increase of vascular parameters reported, and attenuated the ischemic treadmill-induced increase of thromboxane B 2, but not of endothelin-1. These data confirm that the picotamide improved vascular flow by the reduction of thromboxane-mediated effects, reduced resting endothelin-1 levels, but did not attenuate endothelin-1 concentrations induced by the treadmill stress.
Effect of Moxonidine and Cilazapril on Microcirculation as Assessed by Finger Nailfold Capillaroscopy in Mild-to-Moderate Hypertension
Authors: Martina Benedict , Surber Christian , Jakobi Clemens , Sponagel Lucas , Gasser Paul
Published: July 2008

Disorders in peripheral microcirculation are observed in arterial hypertension and may be improved by antihypertensive treatment. In this pilot study the authors measured capillary blood cell velocity in the finger nailfold in 14 patients (mean age 50 ± 14 years, range 30-71 years; 9 men, 5 women) with mild-to-moderate essential hypertension. After a 3-week placebo period, patients received double-blind randomized treatment with either 0.2- to 0.4-mg moxonidine (n=7) or 2.5- to 5.0-mg cilazapril (n=7). Finger nailfold video capillaroscopy was performed at baseline and after 8 weeks of treatment. Blood pressure was measured by conventional office technique.

Capillary blood cell velocity, 1 minute after local finger cooling, increased in the Moxonidine group (0.65 ±0.53 mm/sec to 1.13 ±0.77 mm/sec; p<0.05) after 8 weeks treatment compared to the baseline. The increase in the Cilazapril group from 0.79 ±0.45 mm/sec to 0.93 ±1.03 mm/sec did not reach a level of statistical significance. Blood pressure decreased from 151 ±8/101 ± 5 to 147 ±6/98 ± 7 mmHg in the Moxonidine group and from 164 ± 12/102 ±6 to 140 ±9/93 ±9 mmHg in the cilazapril group.

Moxonidine increased nailfold capillary blood cell velocity 1 minute after local finger cooling in patients with mild-to-moderate hypertension. This improvement of the peripheral microcirculation may be associated with reversal of vascular dysfunction in hypertension.
Amplified Amplitudes of Circadian Rhythms and Nighttime Hypotension in Patients with Chronic Fatigue Syndrome: Improvement by Inopamil But Not by Melatonin
Authors: van de Luit Leonie , van der Meulen Jan , Cleophas Ton J. M. , Zwinderman Aeilko H.
Published: July 2008

Fatigue is an important symptom of a disturbed circadian rhythm. To date, no studies of circadian rhythms in patients with chronic fatigue syndrome (CFS) have been published. The objectives of the study were to study rhythms of heart rate and systolic and diastolic blood pressure in patients with chronic fatigue syndrome compared with age-matched normotensive controls and to study the effects of melatonin and inopamil on such rhythms.

Ambulatory blood pressure (ABP) measurements (Space Lab, Inc, validated) of 18 patients with CFS were made according to the 1987 U.S. Center for Disease Control Criteria, and measurements of 12 age-matched normotensive controls were used in a cosinor analysis of the two groups. The effects of melatonin and inopamil on ABP were studied subsequently in four patients in an 8-week open-label evaluation.

One patient was hypertensive (diastolic blood pressure > 90 mm Hg at least once every 4 hours), and was, therefore, excluded. The data of the remaining 17 patients (15 women, 2 men) revealed a significant 12-hour rhythm in heart rate and 24-hour rhythm in systolic and diastolic blood pressure with 95% confidence intervals not significantly different from sinusoidal patterns. Although these rhythms were synchronous with the control group rhythms, their amplitudes were not and showed, respectively, 2.8, 2.8, and 9.0 times the size of the control group rhythms (p < 0.001, p < 0.001, and p < 0.0001, respectively). Systolic blood pressures in the patients with CFS were consistently below 100 mm Hg during the nighttime. In a subsequent pilot study of four patients from the study population treated with melatonin 4 mg daily and inopamil 200 mg daily for 4 weeks, inopamil reduced nighttime hypotension (p<0.05), whereas melatonin increased nighttime hypotension (p < 0.02).

Patients with CFS have increased amplitudes of circadian rhythms and systolic blood pressures consistently below 100 mm Hg during the nighttime. Positive inotropic compounds may be beneficial in such patients, but melatonin may not be.
Staged Reperfusion Preserves the Coronary Flow Reserve, Especially in the Regions Not Severely Damaged by Ischemic Injury in the Canine Heart
Authors: Hattori Ritsuo , Matsui Haruo , Kitano Motoki , Ichihara Yoshio , Ogawa Syozo , Hirai Makoto , Hayashi Hiroshi , Saito Hidehiko
Published: July 2008

The objective of this study was to determine the effects of staged reperfusion on the progressive reduction in coronary blood flow (CBF) and coronary flow reserve during reperfusion and on the infarct size in the canine heart. Fifteen dogs underwent 90 min of left circumflex coronary artery occlusion and 3 hr of reperfusion. In the abrupt reperfu sion group, the occluder was released completely at the initiation of reperfusion. In the staged reperfusion group, CBF was maintained at 20% of preocclusion values for 10 min after initiation of reperfusion, then gradually released, and completely released 20 min after initiation of reperfusion. There was no significant difference in CBF between the staged (n = seven) and abrupt (n = eight) groups after 3 hr of reperfusion. The repayment of flow debt in the staged reperfusion group was significantly greater than in the abrupt reperfusion group after 3 hr of reperfusion (260 ±120% vs 100 ± 60%, staged vs abrupt at 3 hr, p < 0.03). The ratio of peak reactive hyperemic flow to resting flow in the staged reperfusion group was significantly greater than in the abrupt reperfusion group throughout the reperfusion phase (4.4 ±1.0 vs 2.6 ±0.6 at 3 hr, p < 0.001), and had returned to the preocclusion values after 3 hr of reperfusion. This preservation of the coronary flow reserve in the staged reperfusion group was observed in the epicardium (4.1 ±0.6 vs 2.8 ±0.7, staged vs abrupt at 3 hr, p < 0.01), but not in the endocardium or midmyocardium. Infarct size did not differ significantly between the two groups. Staged reperfusion in this study did not appear to attenuate the reduction of CBF, or to reduce infarct size, however preserved the coronary flow reserve, especially in the regions not severely damaged by ischemic injury.
Catheter Fracture and Embolization from Totally Implanted Venous Access Ports
Authors: Vadlamani Pramod , Dawn Buddhadeb , Perry Michael C.
Published: July 2008

Totally implanted venous access ports are excellent devices for delivering chemothera peutic agents and prolonged intravenous infusions in patients with cancer. Catheter fracture and embolization are rare and potentially serious complications of these widely used devices. Retrieval of the embolized fragment is generally indicated but may not be possible. The authors report three cases of catheter embolization in their center over a period of 9 years. Catheter "pinch-off," fracture, embolization, and retrieval are discussed.
Usefulness of Cardiopulmonary Bypass in Reconstruction of Inferior Vena Cava Occupied by Renal Cell Carcinoma Tumor Thrombus
Authors: Yamashita Chojiro , Azami Takasi , Okada Morihito , Toyoda Yoshiya , Wakiyama Hidetaka , Yoshida Masato , Ataka Keiji , Okada Masayosi
Published: July 2008

Aggressive surgical treatment in renal cell carcinoma is still controversial. The aim of this paper is to assess inferior vena caval (IVC) reconstruction for suprahepatic vena caval renal cell carcinoma (RCC) tumor thrombus.

Twelve patients with suprahepatic vena caval thrombus from renal cell carcinoma who underwent surgical repair with cardiopulmonary bypass were evaluated. The vena caval defect was reconstructed by direct suture, patch repair, or graft replacement.

Of 12 patients undergoing partial cardiopulmonary bypass, tumor thrombus extended to the junction of the hepatic vein in three patients and to the right atrium in one. Tumor thrombus was removed manually or with balloon catheter. Tumor thrombus in the right atrium was removed during electrical ventricular fibrillation. Repair of the IVC was performed by direct suture of the IVC wall in two patients, patch repair with expanded polytetrafluoroethylene (EPTFE) graft in seven, and graft replacement with an EPTFE graft in three. There were no operative deaths and the only postoperative complication was one patient death from pulmonary emboli. The four patients with nonlocalized disease died within 2 years, but four patients lived for more than 3 years postoperatively. Survival was 37.5% at 3 years and 18.8% at 5 years by the Kaplan-Meier's method.

Conclusions: (1) Partial cardiopulmonary bypass is useful for the control of bleeding when tumor thrombus in the IVC extends to the junction of the hepatic vein. (2) Nephrectomy with tumor thrombectomy of the IVC is valuable, and long-term survival is possible in patients without distant metastases or regional lymph node metastases.
Primary Stenting of the Superior Mesenteric Artery for Treatment of Chronic Mesenteric Ischemia
Authors: Forauer Andrew R. , McLean Gordon K.
Published: July 2008

Percutaneous transluminal angioplasty (PTA) has been well described in the treatment of mesenteric artery stenoses but has met with limited success in ostial lesions. The authors describe a case of a 79-year-old woman diagnosed with chronic mesenteric ischemia associated with a 22-pound weight loss and postprandial pain. The celiac axis and inferior mesenteric artery were occluded. A high-grade, calcified stenosis was present in the proximal superior mesenteric artery. This was treated with primary stent placement using a Palmaz stent deployed from an axillary approach. A brief discussion of mesenteric ischemic and visceral artery PTA is included.
Absence of the Azygos Vein Associated with Double Superior Vena Cava
Authors: Arslan Gökhan , Ozkaynak Can , Çubuk Metin , Sindel Timur , Lüleci Ersin
Published: July 2008

A rare case of absence of the azygos vein associated with double superior vena cava is presented. Imaging findings on plain chest film and on contrast-enhanced computed tomography are described, and the embryology of azygos and hemiazygos veins is reviewed.
Noninvasive Measurement of Cardiac Output: Two Methods Compared in Patients with Mitral Regurgitation
Authors: van der Meer Nardo J. M. , Noordegraaf Anton Vonk , Kamp Otto , de Vries Peter M. J. M. , van der Meer N.J.M.
Published: July 2008

In search for the origin of the less reliable cardiac output (CO) estimations by means of electrical impedance cardiography (EIC), the authors hypothesized that cardiac valve pathology might be one of the reasons. Twenty-six patients were examined by means of echo Doppler (ED) and EIC. The cardiac valve status was obtained by means of echocar diography and color Doppler flow, while CO was obtained by means of both methods. Seventeen patients had no valve pathology (nVP) while nine patients had mild to moderate mitral regurgitation (MVR). The overall correlation between the calculation of CO by means of the two methods was good (r = 0.85, p < 0.001, mean difference and standard deviation: 0.20 ± 0.74 L/min), while there was no significant difference between the paired values. After division into an nVP and an MVR population, the results showed an even closer agreement between the CO values in the nVP population (r = 0.88, p < 0.001, mean difference and standard deviation: 0.15 ± 0.68 L/min). Further more, significant differences were found in the first derivative of the impedance (dZ/dt) signals of these groups. Although the agreement between ED and EIC was slightly lower in the MVR population, EIC reliably estimated CO, even in case of MVR. The impedance signal itself gave an indication for the existence of MVR.
Immunoscintigraphy of Venous Thrombi: Clinical Effectiveness of a New Antifibrin D-Dimer Monoclonal Antibody
Authors: Ciavolella Massimo , Tavolaro Rosanna , Di Loreto Mario , La Torre Filippo , Nicolai Alessia , Schillaci Orazio , Ierardi Maria , Scopinaro Francesco , Ciavolella Massimo
Published: July 2008

Safety and thrombus imaging capabilities of the 99mTc-labeled form of a new F(ab')2 monoclonal antibody (MoAb) against fragment D dimers from cross-linked human fibrin, previously shown to be effective labeled to 131I in detecting venous thrombi in the rabbit, were investigated.

Sixteen patients (seven men, mean age: 60 ± 7 years) with deep (n = three) and superficial (n= 13) venous thromboses of the lower limbs documented at echo-Doppler study underwent, 24 hours before saphenous vein stripping, a scintigraphic study after IV injection of the 99mTc-MoAb (1,129 ± 275 MBq/mL), acquiring dynamic images, as well as early and delayed static images of lower limbs. Tracer activity was compared in normal and pathologic areas. At the operation, vessel wall including the thrombotic lesion was isolated, weighed, and counted. Blood radioactivity and MoAb concentra tion were also measured.

No adverse reaction was observed after MoAb administration. Thrombus site appeared as a focal area (hot spot) of asymmetrically increased tracer uptake, already detectable at early images in all patients. All thrombi detected at echo-Doppler study (n=25) were confirmed at scintigraphic study, which showed four additional hot spots subsequently confirmed to represent thrombi at operation. Average percent ratio between pathologic and normal regions was 1.51 ± 1.34 (p < 0.05) at time-activity curves, 2.27 ± 1.1 (p < 0.05) at early static images, and 2.15 ± 1.2 (p < 0.05) at delayed images, respectively. Thrombus-to-blood uptake ratio was 4.3 ± 0.9 (p < 0.01).

The F(ab')2 MoAb proved to be safe, and low levels of antimouse antibodies were detected in response, although further studies are needed to assess tolerance and effec tiveness in case of a second administration in the same patient. The 99mTc-labeled MoAb was very effective in identifying venous thromboses both at deep and superficial local izations, although its sensitivity and specificity need be evaluated in a more numerous group, including also patients with different and clinically more relevant localizations, such as caval thromboses. However, the possibility of obtaining high-quality images within 4 hours of MoAb administration is clinically relevant, and carries also therapeutic implications, especially in pulmonary thromboembolism.
Isosorbide Aerosol: An Option for the Treatment of Hypertensive Crises
Authors: Rubio-Guerra Alberto Francisco , Vargas-Ayala German , Lozano-Nuevo José Juan , Narvaez-Rivera Jorge Luis , Rodríguez-López Leticia , Caballero-González Francisco Javier , Rubio-Guerra Alberto Francisco
Published: July 2008

In this study the authors assessed the effectivenes and safety of isosorbide dinitrate aerosol administered through the oral mucosa in 30 adult patients who presented with a hypertensive crisis (mean arterial pressure > 130 mm Hg and evidence of target organ damage). The patients were given a first dose of 1.25 mg of aerosol when they were admitted to the hospital; a second dose was administered 15 minutes later if the mean arterial pressure had not decreased by > 15%. An electrocardiogram (ECG) was obtained for every patient immediately prior to and 30 minutes after administration of the medica tion. Nine patients (30%) had a good response with one dose, whereas 21 patients (70%) required a second dose. All 30 patients had a significant reduction of the arterial blood pressure (187 ± 13/121 ± 6.6 to 153 ± 15.3/92.3 ± 7.6 mm Hg; p < 0.005) as well as of the mean arterial pressure (136.6 ±8 to 109.5 ±7 mm Hg; p<0.005) in a period of 30 minutes. No adverse effects, rebound hypertension, or severe hypotension were observed. These figures remained under control for 6 hours. Two of the patients had angina pectoris at admission and their ECG showed subepicardial ischemia, both of which disappeared with the medication. A second ECG appeared normal. A reduction of 14% in heart rate was obtained (95 ± 15 to 82 ± 14 beats per minute; p < 0.005) . These observations suggest that isosorbide dinitrate aerosol is an effective and safe alternative for the treatment of patients with hypertensive crises.
Bilateral Subclavian Steal Syndrome Through Different Paths and From Different Sites
Authors: Aseem Wali M. , Makaroun Michel S. , Aseem Wali M.
Published: July 2008

Cases of cerebro-subclavian steal syndrome have been reported in the medical literature since 1960. This most often occurs on the left side because of the higher rate of involve ment of the left subclavian artery in comparison to the other brachiocephalic branches of the aortic arch. With the use of the internal mammory artery as a conduit for coronary artery bypass, in the past three decades increasing numbers of coronary-subclavian steal in addition to the cerebro-subclavian steal have been observed. The authors report a case of bilateral subclavian steal syndrome through both vertebral arteries, the right common carotid artery, and the left internal mammory artery, without significant signs and symptoms of cerebral ischemia or anginal pain.
An Unusual Vascular Graft Infection by Aspergillus
Authors: Fuster Rafael García , Clará Alberto , di Stefano Salvatore , Legarra Juanjo , Sarralde José Aurelio , Garcia Fuster Rafael
Published: July 2008

Vascular graft infection due to Aspergillus is a rare event. Only 11 previous case reports have been documented. All of these infections were in the aortic position, and infrain guinal arterial prosthetic graft involvement has been uncommon. The usual clinical presentation was back pain. Fever and systemic complaints were usually present. An unusual case that began with bilateral groin pain is reported and a review of the clinical presentation and the management of the other cases described in the literature is presented.
Randomized Reliability Study Evaluating Constant-load and Graded-exercise Treadmill Test for Intermittent Claudication
Authors: Cachovan Milan , Rogatti Waltraud , Woltering Franz , Creutzig Andreas , Diehm Curt , Heidrich Heinz , Scheffler Peter , Cachovan M.
Published: July 2008

The aim of this randomized study was to compare the reliability of the treadmill test at constant-load (C-test, 3 km/hr; fixed grade of 12%) recommended in Germany with that of the graded-exercise test (G-test, 3 km/hr; increase in grade of 3.5% every 3 minutes) propagated in the United States.

In 50 patients with an absolute claudication distance (ACD) in the C-test of between 50 and 400 m, the two treadmill tests were carried out in randomized order on one and the same day, and repeated on 3 days within 1 week. For the initial claudication distance (ICD), the intraclass correlation was 0.88 in the C-test and 0.87 in the G-test. For the ACD the coefficients were identical at 0.91. The within-subject variation (CVwithin) in the C-test and G-test was 25% and 27% for the ICD and for the ACD 24% and 21%, respectively. The between-subject variation was very similar with 72% and 73% (ICD) and with 78% and 68% (ACD). However, in ACDs below 100 m and between 100 to 150 m, the C-test showed significantly smaller coefficients of variation than the G-test: 13% vs 81% and 14% vs 50%, respectively. In conclusion, the results showed that both C-test and G-test are equally well reproducible.
Smoking is Associated with Dose-Related Increase of Intima-Media Thickness and Endothelial Dysfunction
Authors: Poredoš Pavel , Orehek Marta , Tratnik Erika , Poredoš Pavel
Published: July 2008

Cigarette smoking is firmly established as a risk factor for atherosclerosis. However, the exact mechanism causing smoking-related damage to the arterial wall and its relation to the atherosclerotic process is not known. Also unknown is the time delay between the start of smoking and the sequence of functional and morphologic changes occurring in the arterial wall caused by smoking and their interrelationship. Therefore, the aim of this study was to evaluate the acute and chronic effects of smoking on endothelium- dependent (flow-mediated) dilation (FMD) of the peripheral arteries, the effects of dose and duration of chronic smoking on intima-media thickness (IMT) of the carotid arteries, and their interrelationship. The study encompassed two groups of smokers. In group A there were 40 subjects of both sexes, who smoked on average 17.6 ±6.5 cigarettes per day, for 5 to 15 years (mean 8.95 ±4.0 years), mean age 28.1 years. Group B consisted of 42 smokers of both sexes who smoked 21.15 ±8.2 cigarettes/day for more than 15 years (mean 21.15 ±3.4 years), mean age 39.5 years. The control group consisted of 40 healthy subjects without major risk factors of atherosclerosis, mean age 29.1 years. By means of high-resolution ultrasound the brachial artery diameter was measured at rest and during reactive hyperemia (after release of a forearm tourniquet) and the flow- mediated, endothelium-dependent dilation was calculated. ( continued on next page)

The IMT of the carotid arteries was determined in all subjects by use of B-mode ultra sonography. Resting blood flow in the brachial arteries was significantly less in the smokers' groups than in controls (78.8 ±31.9 vs 134.9 ±45.0 mL/min, p<0.0001) . This decrease was much more evident in female than in male smokers. Female smokers also had significantly smaller brachial artery diameter at rest. In smokers the FMD of the brachial artery was reduced (11 ±4% vs 7 ±4%, p<0.004) and the mean IMT was signif icantly greater than in controls (0.68 ±0.13 vs 0.59 ± 0.04 mm, p<0.001). Impairments of FMD and IMT increase were related to the duration and to the number of cigarettes smoked. In all subjects IMT was significantly correlated with total and LDL cholesterol, fibrinogen, lipoprotein(a) concentration, body mass index, and age of the subjects, but multivariate analysis showed that only total dose smoked and fibrinogen concentration were independently related to IMT.

The results of this study show that smoking is associated with dose-related impair ment of FMD and increased IMT of the carotid arteries. Impairment of FMD occurs in smokers very early and is the earliest detectable event, preceding morphologic changes of the vessel wall. Some harmful effects of smoking on the vessel wall are gender related.
QT Dispersion and Early Arrhythmic Risk During Acute Myocardial Infarction
Authors: Paventi Saverio , Bevilacqua Umberto , Parafati Maria A. , Di Luzio Enza , Rossi Francesco , Pelliccioni Patrizia R. , Paventi Saverio
Published: July 2008

It has been suggested that QT dispersion (maximal minus minimal QT interval calcu lated on a standard 12-lead electrocardiogram) could reflect regional variations of ventricular repolarization and could provide a substrate for reentry ventricular arrhyth mias. The present study evaluates QT dispersion in patients with acute myocardial infarc tion, assessing its relation with early severe ventricular arrhythmias and some clinical features. Three hundred three patients with acute myocardial infarction and a control group of 297 healthy subjects were studied. QT and QTc dispersion were determined on the electrocardiogram taken after 12 hours and on days 3 and 10 after symptoms onset and on the electrocardiogram taken in the control group. The average values of QT and QTc dispersions (ms) were as follows: 70.5 ±42.5-87 ±45.6 (12th hour), 66.7 ±37.6-76.8 ±43.6 (day 3), 68.8 ±42.7-76.8 ±42.8 (day 10), versus 43 ±13.2- 53.9 ±16.2 (control group). There were statistically significant differences between QT and QTc dispersion recorded in normal subjects and in each of the three electrocardio grams taken in patients with infarction. A greater QT dispersion was recorded in patients with anterior infarction (78.9 ±38.5 vs 64.9 ±42.8 in inferior/lateral infarction). In the first 3 days QT dispersion was not different in patients treated and untreated with throm bolysis, whereas on day 10 it was greater in untreated patients (74.9 ±45.3 vs 60.5 ±37.2). Creatine kinase peak level did not influence QT dispersion. In the first 72 hours of infarction, 37 patients developed ventricular fibrillation or sustained ventricular tachy cardia. Higher early values of QT and QTc dispersion were found in patients who developed severe ventricular arrhythmias (107.8 ±62 and 124.8 ±67.5 ms) than in patients without serious arrhythmias (62.9 ±32.2 and 80.1 ±37.9 ms).

These data suggest that: (1) QT dispersion increased during acute myocardial infarc tion. (2) The values were higher in the early hours and fell late after infarction with throm bolysis. (3) Greater QT dispersion is associated with severe ventricular arrhythmias.
Successful Percutaneous Balloon Mitral Valvuloplasty in a Patient with Left Atrial Thrombus
Authors: Nseir Georges , Kwan Tak , Mandawat Mahandra , Feit Alan , Clark Luther T. , Nseir Georges
Published: July 2008

Percutaneous balloon mitral valvuloplasty (PBMV) described by Inoue et al, is a safe FDA (Food and Drug Administration) approved procedure in patients with severe mitral stenosis. One of the contraindications of the procedure is presence of a left atrial thrombus; however, it has been reported that intense warfarin therapy may led to disso lution of the thrombus. The authors report a patient who was referred for PBMV and was found to have a left atrial thrombus. After intense warfarin therapy, successful PBMV was undertaken without complications.