bluuebunny/crossref_metadata_2025 huggingface dataset:
Impact Assessment of Simulated Doppler Wind Lidars with a Multivariate Variational Assimilation in the Tropics
Authors: Žagar Nedjeljka , Stoffelen Ad , Marseille Gert-Jan , Accadia Christophe , Schlüssel Peter
Published: July 2008

This paper deals with the dynamical aspect of variational data assimilation in the tropics and the role of the background-error covariances in the observing system simulation experiments for the tropics. The study uses a model that describes the horizontal structure of the potential temperature and wind fields in regions of deep tropical convection. The assimilation method is three- and four-dimensional variational data assimilation. The background-error covariance model for the assimilation is a multivariate model that includes the mass–wind couplings representative of equatorial inertio-gravity modes and equatorial Kelvin and mixed Rossby–gravity modes in addition to those representative of balanced equatorial Rossby waves. Spectra of the background errors based on these waves are derived from the tropical forecast errors of the European Centre for Medium-Range Weather Forecasts (ECMWF) model.

Tropical mass–wind (im)balances are illustrated by studying the potential impact of the spaceborne Doppler wind lidar (DWL) Atmospheric Dynamic Mission (ADM)-Aeolus, which measures horizontal line-of-sight (LOS) wind components. Several scenarios with two DWLs of ADM-Aeolus type are compared under different flow conditions and using different assumptions about the quality of the background-error covariances.

Results of three-dimensional variational data assimilation (3DVAR) illustrate the inefficiency of multivariate assimilation in the tropics. The consequence for the assimilation of LOS winds is that the missing part of the wind vector can hardly be reconstructed from the mass-field observations and applied balances as in the case of the midlatitudes.

Results of four-dimensional variational data assimilation (4DVAR) show that for large-scale tropical conditions and using reliable background-error statistics, differences among various DWL scenarios are not large. As the background-error covariances becomes less reliable, horizontal scales become smaller and the flow becomes less zonal, the importance of obtaining information about the wind vector increases. The added value of another DWL satellite increases as the quality of the background-error covariances deteriorates and it can be more than twice as large as in the case of reliable covariances.
Probabilistic Forecast Calibration Using ECMWF and GFS Ensemble Reforecasts. Part I: Two-Meter Temperatures
Authors: Hagedorn Renate , Hamill Thomas M. , Whitaker Jeffrey S.
Published: July 2008

Recently, the European Centre for Medium-Range Weather Forecasts (ECMWF) produced a reforecast dataset for a 2005 version of their ensemble forecast system. The dataset consisted of 15-member reforecasts conducted for the 20-yr period 1982–2001, with reforecasts computed once weekly from 1 September to 1 December. This dataset was less robust than the daily reforecast dataset produced for the National Centers for Environmental Prediction (NCEP) Global Forecast System (GFS), but it utilized a much higher-resolution, more recent model. This manuscript considers the calibration of 2-m temperature forecasts using these reforecast datasets as well as samples of the last 30 days of training data. Nonhomogeneous Gaussian regression was used to calibrate forecasts at stations distributed across much of North America. Significant observations included the following: (i) although the “raw” GFS forecasts (probabilities estimated from ensemble relative frequency) were commonly unskillful as measured in continuous ranked probability skill score (CRPSS), after calibration with a 20-yr set of weekly reforecasts their skill exceeded that of the raw ECMWF forecasts; (ii) statistical calibration using the 20-yr weekly ECMWF reforecast dataset produced a large improvement relative to the raw ECMWF forecasts, such that the ∼4–5-day calibrated reforecast-based product had a CRPSS as large as a 1-day raw forecast; (iii) a calibrated multimodel GFS/ECMWF forecast trained on 20-yr weekly reforecasts was slightly more skillful than either the individual calibrated GFS or ECMWF reforecast products; (iv) approximately 60%–80% of the improvement from calibration resulted from the simple correction of time-averaged bias; (v) improvements were generally larger at locations where the forecast skill was originally lower, and these locations were commonly found in regions of complex terrain; (vi) the past 30 days of forecasts were adequate as a training dataset for short-lead forecasts, but longer-lead forecasts benefited from more training data; and (vii) a small but consistent improvement was produced by calibrating GFS forecasts using the full 25-yr, daily reforecast training dataset versus the subsampled, 20-yr weekly training dataset.
Implications of the Lymphatic System in CVI-Associated Edema
Authors: Mortimer P.S.
Published: July 2008

Lymph drainage is intimately linked with venous drainage in health and disease. Evidence exists to support the view that lymphatics frequently fail in venous disease, particularly in its advanced stages. The implications of this are to increase the risk of infection and the amount of edema, events which can only further the morbidity of venous disease.
Risk Factors of Atherosclerosis and Aortic Pulse Wave Velocity
Authors: Emura Sei , Takashima Toshinobu , Ohmori Keizo
Published: July 2008

Aortic pulse wave velocity (PWV) is a noninvasive technique that can estimate aortic stiffness or organic change quantitatively. The authors examined the correlation between age and the PWV value in 113 subjects and also examined the relationship between ather osclerotic associated diseases and PWV. A positive correlation was observed between age and the PWV value. No significant difference was found in the PWV value between groups with and without risk factors of atherosclerosis. No significant difference was observed in the PWV value between groups with and without a history of atherosclerotic disease.
Clinical Assessment of Vascular Thrombosis Using Indium-111 Platelet Scintigraphy
Authors: Sugimoto Takaki , Okada Masayoshi , Mukai Tomoichiroh , Morimoto Yoshihisa
Published: July 2008

The authors reviewed the clinical value of platelet scintigraphy by using autologous platelets labeled with indium-111-oxine to detect thrombotic activity at vascular throm bosis sites. Thirty-nine patients with deep vein thrombosis, 28 with arteriosclerosis oblit erans, and 10 with pulmonary embolism were the subjects of this study. Platelet accu mulation on scintigrams had a tendency to correlate with aggravation of acute thrombotic symptoms in deep vein thrombosis and arteriosclerosis obliterans. In addition, appro priate thrombolytic and anticoagulant therapy resulted in reduced platelet accumulation in conjunction with improvement of acute symptoms. On the other hand, this type of scintigraphy was not so sensitive for assessment of pulmonary embolism. Platelet scintig raphy could facilitate the assessment of thrombotic activity and might be useful for deter mining the optimal indication of thrombolytic and anticoagulant therapy for acute vascular thrombosis.
Measuring Physical Activity in Peripheral Arterial Disease: A Comparison of Two Physical Activity Questionnaires with an Accelerometer
Authors: Liu Kiang , O'Brien Erin , Guralnik Jack M. , Criqui Michael H. , Martin Gary J. , Greenland Philip , McGrae McDermott Mary
Published: July 2008

Peripheral arterial disease (PAD)-related exertional leg pain may limit physical activity, thereby contributing to mobility loss and increasing cardiovascular morbidity and mortality in men and women with PAD. The objectives of this study were: (1) to compare objectively measured physical activity levels between patients with and without PAD, (2) to assess the validity of two physical activity questionnaires in patients with PAD. Twenty PAD patients from a noninvasive vascular laboratory and 21 patients without PAD from a general medicine practice wore an accelerometer continuously for 7 days to measure physical activity objectively. After 7 days, participants completed the leisure time physical activity questionnaire (LTPAQ), derived from the Health Interview Survey, and the Stanford 7-day physical activity recall questionnaire (PARQ). PAD participants had markedly lower physical activity levels than non-PAD participants as measured by accelerometer (803 kcal/week ±364 (range=284-2,000, median=708) vs 1,750 kcal/week ±1,296 (range=882-6,586, median=1,278), p<0.001). For the LTPAQ, physical activity levels in PAD and non-PAD participants were 609 kcal/week ±576 (range=0-2,085, median=529) vs 832 kcal/week ±784 (range=53-2,820, median= 623), p=0.128. For the PARQ, physical activity levels in PAD and non-PAD participants were 234 METS/week ±21 (range=214-301, median=229) vs 238 METS/week ±11 (range=225-268, median=234), p=0.454, respectively. Pearson's correlation coefficient for the association between the accelerometer and the log-transformed LTPAQ measure was 0.419 (p=0.006). Pearson's correlation coefficient was 0.348 for the association between the accelerometer and the log-transformed PARQ measure of physical activity (p=0.026). In conclusion, PAD patients have significantly lower physical activity levels than non-PAD patients. Two commonly used physical activity questionnaires were less sensitive than objective measurement to the association between PAD and inactivity.
Long-Term Follow-up of Primary Stenting with Coil Stent in Acute Myocardial Infarction
Authors: Yano Michiko , Kojima Shunichi , Sugi Toshihiko , Matsumoto Yuji , Kuramochi Morio , Yoshitomi Yuji
Published: July 2008

The authors evaluated clinical and angiographic outcomes for 1 year after primary stenting using coil stent for acute myocardial infarction. Twenty-eight patients underwent primary stenting with coil stent. Follow-up coronary arteriography at 3 months and 1 year was planned in all patients. Procedural success was achieved in 96%. There was no acute or subacute thrombosis. Minimal lumen diameter (MLD) was increased from 0.08 ±0.19 to 2.73 ±0.49 mm after stenting. MLD had decreased significantly for 3 months (MLD at 3 months: 2.03 ±0.86 mm, p = 0.001). On the other hand, MLD did not differ between 3-month; and 1-year follow-up (MLD at 1 year: 2.26 ±0.73 mm, p = NS). Only one patient manifested reocclusion at 3-month follow-up. The cumulative restenosis rate and target lesion revascularization rate at 1-year follow-up were 25.9% (7/27) and 11.1% (3/27). Primary stenting using coil stent is safe and feasible in patients with acute myocardial infarction and may improve clinical outcome and decrease restenosis and target lesion revascularization rate.
Three Treatments for Chronic Venous Insufficiency: Escin, Hydroxyethylrutoside, and Daflon
Authors: Frick Robert W. , Frick Robert W.
Published: July 2008

Escin, hydroxyethylrutoside (HR), and Daflon have been shown to be safe and effective for the treatment of chronic venous insufficiency (CVI). They seem to work differently than compression therapy, suggesting that they would usefully augment this therapy. All three phlebotonics attenuate the drop in adenosine triphosphate in venous endothelial cells during hypoxia. This attenuates (1) the inflammation response, (2) the attraction of neutrophils, (3) damage to the veins, and (4) the release of growth factors. These factors otherwise would perpetuate venous insufficiency and contribute to varicose veins. Additional independent effects that would be useful for the treatment of CVI are that they reduce permeability and fragility; HR, Daflon, and perhaps escin increase venous tone; escin inhibits hyaluronidase; Daflon and probably HR are attracted to the veins. With regard to similarity, no differences in effect have been established among these phlebotonics.
Echocardiographic, Morphologic, and Geometric Variations of the Left Ventricular Outflow Tract: Possible Role in the Pathogenesis of Discrete Subaortic Stenosis
Authors: Atalay Semra , Türkay Sadi , Gümüs Halil , Imamoglu Ayten , Ercan Tutar H.
Published: July 2008

Although the clinical features and natural course of discrete subaortic stenosis (DSS) are well defined, the etiology remains speculative. The purpose of this study was to identify the echocardiographic, morphologic, and geometric variations of the left ventricular outflow tract associated with DSS in children and to determine whether these variations have a role in the pathogenesis of DSS. The aortoseptal angle (ASA), mitral-aortic valve separation (MAS), and the size of the aortic annulus were determined in two groups of children. Group 1 comprised 11 patients with isolated DSS, who were compared with an age- and body surface area- (BSA) matched healthy children (Group 1A, n: 20). Group 2 comprised 10 patients with DSS and ventricular septal defect (VSD). Group 2 was compared with an age- and BSA-matched patients with isolated perimembranous VSD (Group 2A, n: 22). Measurements were carried out from previously recorded echocar diographic studies. The ASA was steeper (119.3 ±6.1° vs 137.5 ±5.6°, p < 0.001), and the MAS was wider (6.1 ±1.6 vs 3.2 ±0.7 mm, p < 0.001) in patients with isolated DSS than in healthy control subjects. Similar differences were found between patients in Group 2 and Group 2A; the ASA was steeper (122.2 ±6.5° vs 141.3 ±5.0°, p< 0.001), and the MAS was wider (5.8 ±1.5 vs 3.8 ±1.1 mm, p < 0.001). The size of the aortic annulus was not different among the four study groups. Although the MAS was significantly wider in patients with DSS, there was significant overlap in MAS between patients and controls. However, if an ASA ≤ 130° was chosen as a predictive variable, it was found to be a highly sensitive, specific, and positive predictive marker for the development of DSS. This study demonstrates that DSS is associated with a steeper ASA, and a wider MAS, in patients with or without associated VSD. These morphologic abnormalities, especially a steeper ASA, may be risk factors for the development of DSS.
Sensitive Detection of Myocardial Contraction Abnormality in Chronic Hemodialysis Patients by Ultrasonic Tissue Characterization with Integrated Backscatter
Authors: Mizushige Katsufumi , Tokudome Takeshi , Seki Makoto , Kondo Isao , Hirao Kenichi , Nozaki Shiro , Miki Shigehiro , Yuasa Shigekazu , Matsuo Hirohide , Mizushige Katsufumi
Published: July 2008

Since acoustic properties of the myocardium are sensitive to the myocardial structure and the contractile conditions of myocyte, the authors evaluated cardiac dysfunction based on the integrated ultrasonic backscatter in 18 hemodialysis (HD) patients (duration: 102 ±84 months, mean age: 57.6 ±9.7 years) and 11 age-matched normals. The cyclic variation of integrated backscatter (CV-IB) at interventricular septum (IVS) and left ventricular posterior wall (PW) was measured and compared with percent fractional short ening (%FS) and percent wall thickening (%Th). The CV-IB of HD patients was smaller than that of control subjects (IVS: 6.2 ± 1.1 dB vs 8.2 ± 1.1 dB, p = 0. 0003 and PW: 8.4 ±2.2 vs 10.3 ±1.3, p = 0.025). No significant difference was observed in %FS and %Th between HD patients and control subjects. In HD, the ratio of velocities of early diastolic inflow (E) to late atrial inflow was decreased (0.7 ±0.2 vs 1.1 ±0.7, p = 0.049) and decel eration time of E was prolonged significantly (200 ±28 msec vs 159 ±30 msec, p = 0.0082). In the absence of overt cardiac systolic dysfunction, myocardial damage indicated as a decrease in CV-IB and diastolic dysfunction identified on transmitral velocity waveform were detected, which may reflect from the myocardial fibrosis. As a mechanism, pressure overload, hyperparathyroidism, and anemia were neglected, and the other humoral factors may contribute to the myocardial damage in chronic renal failure.
Pulsatile Venous Insufficiency in Severe Tricuspid Regurgitation: Does Pulsatility Protect Against Complications of Venous Disease?
Authors: Wolfson Vladimir , Tsikonova Irena , Keren Dean , Barmeir Elisha , Yeshurun Daniel , Naschitz Jochanan E.
Published: July 2008

Prior observations showed that the consequences of venous hypertension depend not only on the magnitude of the venous pressure but also on the efficiency of compensatory mechanisms that protect against the effects of excessive pressures on the microcircula tion. Pulsatile venous insufficiency (PVI) associated with severe tricuspid regurgitation (TR) provides the opportunity to investigate the effect of the pulsatile shear stress on the outcome of venous insufficiency. The authors conducted a study to assess the flow char acteristics and clinical outcome of PVI associated with TR. Five patients were evaluated, presenting venous insufficiency associated with ectasia, varices, and visible systolic pulsa tions of the leg veins. Characteristics of the venous flow were assessed by duplex ultra sound. In two patients, flow in the distal calf veins was evaluated by power Doppler sonography, and the supine-to-sitting leukocyte trapping was calculated. Results of the latter measurements were compared with measurements in five control patients who presented chronic nonpulsatile venous insufficiency. A survey of complications of PVI was conducted. On follow-up for 6 to 15 years (average 9.4 years) none of the patients developed venous thrombosis, phlebitis, or cutaneous ulcer. Flow in the distal calf vessels was increased in PVI (12-20 vessels/field) as compared with nonpulsatile venous insuf ficiency (0-7 vessels/field). Leukocyte trapping in the upright position was diminished in PVI (0.8-3%) as compared with nonpulsatile venous insufficiency (7-22%). In conclu sion, PVI is characterized by increased flow in the distal calf veins, diminished leukocyte trapping, and a benign clinical course. These data are in agreement with experimental studies showing that pulsatile shear stress enhances secretion of cytokines by venous endothelial cells and, consequently, counteracts a predisposition to platelet aggregation, hypercoagulability, and white cell adhesion and promotes healing of leg ulcers.
Evaluation of Effective Aortic Regurgitant Orifice Area and Its Effect on Aortic Regurgitant Volume with Doppler Echocardiography
Authors: Nozaki Shiro , Ohmori Koji , Matsuo Hirohide , Mizushige Katsufumi
Published: July 2008

The authors measured the aortic regurgitant orifice area (ROA) using Doppler echocar diography and attempted to clarify how important the ROA is in determining the regur gitant volume (RV) in 22 patients with chronic aortic regurgitation (AR). The RV was calculated from the difference between the left ventricular ejection flow volume and transmitral inflow volume as measured by Doppler echocardiography. The ROA was obtained by two methods: RV/time velocity integral of AR jet measured by continuous wave Doppler (calculation method) and manual tracing of minimum cross-sectional area of short-axis color Doppler. The RV ranged from 10 to 90 mL/beat and the ROA by calculation method was from 0.05 to 0.35 cm2, which showed a strong correlation ( r = 0.93, p < 0.001). The time velocity integral of aortic regurgitant jet showed a poor correlation with the RV (r = 0.45, p < 0.05). The values of ROA by the two methods showed a good correlation ( r = 0.93, p < 0.001). Thus, the authors conclude that the ROA is a basic determinant of the RV in AR and that color Doppler can be employed to precisely assess the ROA.
"No-Reflow" Phenomenon Following Percutaneous Coronary Intervention: An Uncommon Complication
Authors: Safi Arshad M. , Kwan Tak W. , Safi Arshad M.
Published: July 2008

The no-reflow phenomenon has been recognized as an uncommon complication after reperfusion therapy (thrombolytic or mechanical) for acute myocardial infarction and after percutaneous coronary intervention. As management and outcomes differ, early diagnosis and angiographic exclusion of other causes of impaired blood flow are important. The authors describe a case report of a patient with no-reflow following emergent stenting of the left circumflex artery (LCX). Pathophysiology and management of the no-reflow phenomenon are described along with the case report.
Transient Global Amnesia and Amaurosis Fugax in a Patient with Common Carotid Artery Occlusion
Authors: Chen Sien-Tsong , Tang Lok-Ming , Lee Tsong-Hai , Ro Long-Song , Lyu Rong-Kuo , Chen Sien-Tsong
Published: July 2008

The etiology of transient global amnesia (TGA) is debatable. The hypothesis of a throm boembolic cause of TGA has been questioned by recent case control studies. Occlusion of the common carotid artery (CCA) is rare. Although amaurosis fugax (AF) is a hallmark of ipsilateral internal carotid artery disease, its occurrence in CCA occlusion is less known. Association of these three conditions in a patient may imply pathophysiologic signifi cance. Here, the authors report a 76-year-old man who suffered from a spell of TGA and then several attacks of AF of the right eye. Progressive occlusion of the right CCA was documented by repeat carotid duplex scans and was finally confirmed by cerebral angiog raphy. In this patient, the occurrence of CCA occlusion and AF implicates a vascular etiology for the event of TGA. A noninvasive carotid ultrasonographic screen may, therefore, be worthwhile for patients with TGA.
Usefulness of Carotid Intima-Media Thickness Measurement and Peripheral B-Mode Ultrasound Scan in the Clinical Screening of Patients with Coronary Artery Disease
Authors: Buttitta Flavio , Limbruno Ugo , Petronio Anna Sonia , Baglini Roberto , Strata Giancarlo , Mariotti Rita , Ciccone M. , Mariani Mario , Balbarini Alberto
Published: July 2008

Previous observational studies have shown a relationship between carotid intima-media thickness (IMT) and coronary artery disease (CAD). In this study the authors evaluated the accuracy of the common carotid IMT measurement in predicting the presence and severity of CAD and the additional information offered by the detection of carotid, iliac, and lower limb plaques. One hundred and fifty consecutive patients were subjected to coronary angiography and carotid, iliac, and lower limb ultrasound scan. The mean value of six IMT measurements of the far wall of the common carotid artery was calculated in each patient. The mean IMT was significantly correlated to the number of stenosed coronary vessels (r = 0.43, p < 0.001), although the positive and negative predictive value of mean IMT in identifying patients with CAD was low (81% and 46%, respectively). The combined information offered by IMT measurements and peripheral (carotid, iliac, and lower limb) plaque detection was then used to obtain the best multivariate regression model able to predict CAD status. The multivariate model showed a highly significant multiple correlation coefficient (r = 0.60, p < 0.0001) and a sharp improvement in the negative predictive value (92%) with respect to the univariable model. B-mode ultra sound scan including common carotid IMT measurement and peripheral plaque detection may be of clinical value in the screening of patients with CAD.
Expression of Muscarinic Receptor Genes in the Human Coronary Artery
Authors: Esumi Mariko , Kusumi Yoshiaki , Sato Yutaka , Sakurai Isamu , Niihashi Mari
Published: July 2008

The authors investigated the role of muscarinic receptors in functional control of coronary arteries affected by intimal thickening due to arteriosclerosis. They first examined the genetic subtypes of muscarinic receptors expressed in human coronary arteries. Twelve samples of human coronary artery, obtained by autopsy from eight subjects, were examined for the expression of four genetic subtypes of muscarinic receptor, m1 to m4, by reverse transcription and polymerase chain reaction (RT-PCR). Two subtypes, m2 and m3, were found to be expressed in the coronary artery. The m2 gene was expressed in seven of the 12 vessels, and m3 in eight of the 12. Expression of both m2 and m3 genes was observed in five of the 12 vessels. Neither the m1 nor m4 was expressed in these samples. These results indicate that the m2 and m3 genes are mainly expressed in the coronary arteries and suggest that these patterns of expression are differentially controlled to induce the diversity of contraction/relaxation reactions induced in the coronary arteries by acetylcholine.
Femorofemoral Bypass, Even in Pregnancy
Authors: Avrahami Ram , Dahan Jack , Stelman Eldad , Koren Arnon , Zelikovski Avigdor , Haddad Menashe
Published: July 2008

A 29-year-old pregnant woman sustained blunt, left lower abdominal trauma, with hip and pelvic fractures, and progressive dissection of an intimal flap in the left iliac artery, which manifested two days later as profound ischemia of the left leg. The patient underwent distal thromboembolectomy, fasciotomies and revascularization of the leg by femorofemoral polytetrafluoroethylene bypass. The patient recovered completely and gave normal birth three months later to a healthy child. Four years after the operation she gave uneventful birth to another child. Various considerations pertinent to this complex traumatic-vascular-gestational state are discussed.
Pseudoaneurysm Formation in Surgically Treated Behçet's Syndrome
Authors: Sarigül Ali , Koramaz Ismail , Demirtürk Orhan , Böke Erkmen , Sükrü Mercan A.
Published: July 2008

Behçet's syndrome is a multisystem disorder with unknown etiology. Clinically it is mostly seen as a systemic vasculitis; almost 30% of the patients have vascular involvements, and most of these are venous thrombosis and arterial aneurysms. Obstructions of the femoral and tibial arteries have also been reported in the literature. The authors present here a patient with Behçet's syndrome who had pseudoaneurysms on both femoral arteries after aortobifemoral bypass surgery.
Alterations of Venous Drug Reactivity in Humans: Acquired and Genetic Factors
Authors: Szekacs Bela , Dachman William , Vajo Zoltan
Published: July 2008

Until recently, studies dealing with veins have almost always been the neglected part of vascular research. Recent data show an increasing rate of venous disease, and increasing evidence supports a role for veins in systemic diseases. The authors discuss and comment on findings of recent studies on venous drug reactivity. Alterations in venous reactivity to alpha- and beta-adrenergic, NO-dependent, and other drugs have been shown in many genetically determined and acquired conditions, such as hypertension, smoking, and aging. In some of them, the changes of venous responsiveness are most likely secondary to another process, while in others the they seem to play a primary role in the develop ment of systemic disease states. Studying the drug reactivity of the venous system more extensively provides useful information for clinicians and researchers and will no doubt help to further knowledge of the normal and pathologic processes of the vasculature.
Retrospective Analysis of Rt-pa Thrombolysis Combined with PGE1 in Patients with Peripheral Arterial Occlusions
Authors: Kröger K. , Buss C. , Rudofsky G. , Kröger Knut
Published: July 2008

Although thrombolysis has been established for recanalization of acute and in part chronic peripheral artery occlusions, only smaller studies exist regarding the use of long- term rt-pa infiltration-thrombolysis. The objective of this study was to evaluate the benefit of additional long-term thrombolysis in patients with peripheral arterial occlusions for whom acute thrombolysis failed. From 1992 to 1997, 323 patients with peripheral arterial occlusions were treated with rt-pa (recombinant tissue-type plasminogen activator). When the thrombolysis failed during the first 3 hours, the thrombolytic therapy was continued as a long-term treatment with 3 mg rt-pa alternated by PGE 1 (2.1 mL/hr for 3 hours, concentration: 20 μg/50 mL NACl) every 3 hours. Additional heparin was applied in doses of 15,000 IE/24 hr or more to slightly increase the partial thromboplastin time. Angiographic controls were performed every 24 hours. If necessary, a final angioplasty was performed. In 142 of the 323 patients the occlusions were recanalized during the first 3 hours; 119 patients were treated with a long-term thrombolysis and in 72 (61%) a recanalization was ultimately achieved. Thus, the recanalization rate increased to 214 of 323 patients (p<0.02). Mean treatment time was 2.8 ±2.2 days, range: 1 to 13 days. The rates of recanalization were not different in iliac, femoral, or crural arteries. Fibrinogen levels did not decrease during thrombolysis. Severe bleeding (with a decrease of more than 3 g/dL hemoglobin requiring transfusion) occurred in four patients after finishing the thrombolysis with short-term and in six with long-term therapy; two required surgical treatment. The 1-, 2-, and 3-year cumulative patency rates were respec tively 90.1%, 74.2% and 64.9%. Patency rates in patients with acute or long-term throm bolysis were not different. A composite thrombolytic treatment using low-dose rt-pa in combination with PGE 1 offers significantly better results than an acute thrombolytic treatment alone. It can be an effective and practicable regimen in about 60% of patients in whom acute thrombolysis fails.
Impact of a Clinical Pathway on the Care and Costs of Myocardial Infarction
Authors: Kucenic Michael J. , Meyers David G. , Meyers David G.
Published: July 2008

A time series of 110 patients with acute myocardial infarction admitted between January 1992 and June 1997 examined the effects of a clinical pathway. The pathway reduced length of hospital stay by 2.2 days and hospital charges by $1,008 without compro mising care quality and outcomes.
Prothrombin Gene 20210 G→A and Factor V Arg 506 to Gln Mutation in a Patient with Buerger's Disease
Authors: Avcu Ferit , Akar Nejat , Akar Ece , Beyan Cengiz , Yalçin Atilla
Published: July 2008

Thromboangiitis obliterans, or Buerger's disease, is a segmental occlusive inflammatory disorder of the arteries and veins most commonly affecting the lower extremities of young male cigarette smokers. The etiopathogenesis of the thromboangiitis obliterans is still obscure. The authors have identified heterozygosity for the recently described prothrombin gene 20210 G→A variation and Factor V Arg 506 to Gln (Factor V Leiden) mutation in a patient with Buerger's disease. Both mutations confer a high risk of throm bosis. This coincidental observation may serve as further evidence that a thrombotic mechanism is involved in Buerger's disease.
Inappropriate Shocks Diagnosed by Stored Electrograms of Implantable Cardioverter Defibrillators
Authors: Oto Ali , Yildirir Aylin , Kabakci Giray , Atalar Enver
Published: July 2008

An implantable cardioverter defibrillator is an important therapeutic option for patients with high risk of life-threatening ventricular arrhythmias. However, their use is also asso ciated with several complications including inappropriate shock. Although the most frequent cause of inappropriate shock is supraventricular tachyarrhythmias, lead fracture can also be associated with inappropriate shock. Diagnosis of lead fracture can be made by chest x-ray radiography, fluoroscopic examination, interrogation of the device, and intracardiac electrograms.

In this report, the authors present two cases of inappropriate shock due to lead fractures in the costoclavicular region that could only be diagnosed by the help of stored intracardiac electrograms. Methods for diagnosis of lead fractures and modalities to avoid recurrences are also discussed.
Nonfilling of Contrast in Deep Leg Vein Isolated Nonfilling of Contrast in Deep Leg Vein Segments Seen on Phlebography, and a Comparison with Color Doppler Ultrasound, to Assess the Incidence of Deep Leg Vein Thrombosis
Authors: Björgell Ola , Nilsson Paul E. , Jarenros Hartmut , Björgell Ola
Published: July 2008

Nonfilling of contrast in deep veins on phlebography is claimed to be an indirect sign of deep vein thrombosis (DVT) by some authors but rejected by others. The aim of this study was to prospectively assess, with color Doppler ultrasound (CDU), the occurrence and distribution of DVT in isolated, nonfilling, deep vein segments seen on a phlebo gram. One hundred consecutive patients with clinical signs of acute DVT, in whom phle bography displayed nonfilling of the posterior tibial veins and/or the deep calf muscle veins, were examined with CDU on the same occasion. Ultrasound confirmed a DVT in 31 (31%) patients; in another 38 (38%) patients other pathology, without concomitantly detected DVT, such as edema, bleedings, ligament and muscle ruptures, Baker cysts, or superficial thrombophlebitis were found instead; and in the remaining 31 (31%) patients no pathology that could explain the nonfilling was identified. Isolated, nonfilling of the posterior tibial and/or deep muscle veins of the calf found by phlebography may be an indirect sign of DVT but is equally commonly caused by other pathological conditions or arises without any detectable explanation. When the thrombotic burden is to be scored, and to facilitate the establishment of the correct diagnosis, additional CDU is recom mended when isolated nonfilling is present.
Feasibility and Reliability of Ankle/Arm Blood Pressure Index in Preventive Medicine
Authors: Papoz Laure , Ponton Alice , Segond Patrick , Becker François , Drouet Ludovic , Levenson Jaime , Marazanof Marc , Sentou Yves , Chollet Emmanuelle , Etiemble Jeanne , Simon Alain
Published: July 2008

Despite its potential usefulness for assessing preclinical atherosclerosis and cardiovas cular risk, the ankle/arm blood pressure index (AAI) has not yet been the matter of study evaluating its feasibility and reliability by nonspecialist doctors in a general population. This study was planned for two steps. In step 1, the measurement of AAI, (ratio between Doppler systolic pressure at the ankle for each lower limb and the highest value of Doppler systolic pressure of the two upper limbs), should be performed by 50 general practitioners (GPs), 50 social security center physicians, and 50 occupational health physicians in 3,000 male smokers, 40 to 59 years, without clinical cardiovascular disease. In step 2, AAI measurement, coupled with echography-Doppler of iliofemoral arteries, should be repeated by a specialist in all subjects with decreased AAI (<0.90) and the first two subjects with normal AAI recruited in step 1 by each nonspecialist. The number of physicians and subjects participating in step 1 was lower than planned (80 physicians and 962 subjects) with the greatest defect for GPs (six physicians and 35 subjects) and the prevalence of decreased AAI was low (28 subjects). AAI measurement was repeated in step 2 in only 12 subjects with decreased AAI in step 1 and in 124 subjects with normal AAI in step 1. Five of the six subjects with decreased AAI in step 2 also had decreased AAI in step 1 and 123 of the 130 subjects with normal AAI in step 2 also had normal AAI in step 1. As regards echographic stenosis, decreased AAI had a sensitivity of 44% and a specificity of 98%. AAI seems more feasible for occupational health physicians and social security center physicians and AAI is also reliable for nonspecialists previously trained, but its predictive value as regards echographic stenosis is poor in asymptornatic subjects, which may limit its usefulness for detecting preclinical atherosclerosis.
Prevalence of Anticardiolipin Antibodies in Peripheral Arterial Thrombosis
Authors: Fernandes de Godoy Moacir , Braile Domingo Marcolino , Torres Carlos Alexandre Andrade , Pereira de Godoy José Maria
Published: July 2008

The aim of this study was to assess prospectively the prevalence of anticardiolipin anti bodies in patients with peripheral arterial thrombosis. Fifty-nine patients with arterial thrombosis (38 men, 21 women), ages ranging from 24 to 80 years, mean age, 45.5 years, were studied. The control group included 100 volunteer blood donors. After confir mation of the thrombotic event, anticardiolipin antibodies were dosed by the immunoassay enzyme method and by dilution. In Group I these antibodies were present in 62.7% of the patients, of which 33.9% were borderline and 28.8% were positive. In the control group 6% of the patients were borderline and 1% was positive. The statistical analysis showed that the prevalence found was statistically significant (p < 0.001), even when the borderline titers were not considered positive. Patients with peripheral arterial thrombosis have a high prevalence of anticardiolipin antibodies.
Homocysteine Is Related to Neopterin and Endothelin-1 in Plasma of Subjects with Disturbed Glucose Metabolism and Reference Subjects
Authors: Gottsäter A. , Anwaar I. , Eriksson K.-F. , Mattiasson I. , Lindgärde F. , Gottsäter Anders
Published: July 2008

Hyperhomocysteinemia is an independent risk factor for vascular disease. In order to evaluate relations between hyperhomocysteinemia and endothelial and leukocyte function, the investigators related homocysteine to indices of endothelial function (plasma endothelin-1 [p-ET-1] and intraplatelet levels of the nitric oxide [NO] and prostacyclin mediators 3'-5' guanosine monophosphate [cGMP] and cyclic 3'-5' adenosine monophosphate [cAMP]) and the monocyte-derived inflammatory mediator neopterin in 168 men (mean age 69, range 49-72 years) with disturbed glucose metabolism and a reference group of 52 male subjects (mean age 70, range 61-79 years). Among the 168 patients with disturbed glucose metabolism plasma (p)-homocysteine correlated signifi cantly with age (r=0.20; p < 0.01), glycosylated hemoglobin (HbA1c) (r=0.17; p < 0.05), triglycerides (r=0.20; p<0.05), intraplatelet GMP (r=0.16; p<0.05), p-ET-1 (r=0.21; p<0.05), and p-neopterin (r=0.31; p<0.001). The correlation between p-homocysteine and p-ET-1 persisted (p<0.01) in multiple regression analysis. Among the 52 reference subjects p-homocysteine correlated significantly with p-ET-1 (r=0.32; p<0.05) and p-neopterin (r=0.37; p<0.01). The correlation between p-homocysteine and p-neopterin persisted (p<0.05) in multiple regression analysis. In conclusion, homocysteine is related to neopterin and endothelin-1 in plasma of subjects with disturbed glucose metabolism and in reference subjects, suggesting that homocysteine exerts its deleterious effects on vascular function through interference with endothelial and leukocyte function.
Increased QT Interval Dispersion After Hemodialysis: Role of Peridialytic Electrolyte Gradients
Authors: Yetkin Ertan , Ileri Mehmet , Tandogan Izzet , Boran Mediha , Yanik Ahmet , Hisar Ismet , Kutlu Makbule , Çehreli Sengül , Korkmaz Şule , Göksel Siber , Yetkin Ertan
Published: July 2008

Chronic renal failure patients on maintenance hemodialysis (HD) have a number of ECG abnormalities and cardiac arrhythmias. Clinical and experimental data have shown that increased QT dispersion is associated with severe ventricular arrhythmias and sudden cardiac death. Therefore, the aim of this study was to investigate whether the uremic patients receiving long-term HD have increased QTc interval and/or QTc dispersion compared to normal subjects and to evaluate the effect of electrolyte changes between the predialysis and postdialysis phases on these parameters. Forty patients with end-stage renal failure on long-term HD (22 men, 18 women, mean age 44 years) were included in this study. Serum concentrations of K +, Na+, Ca++, Mg++, Cl-, phosphate, urea, creati nine, HCO3 -, and arterial blood gases (PO2, PCO2), together with blood pH, were monitored and QTc intervals and QTc dispersion were measured from 12-lead ECG in predialysis and postdialysis phases. The hemodialyzed patients had an increased predial ysis QTc maximum interval and QTc dispersion compared to normal subjects (480 ±51 vs 310 ±38 msec, p < 0.001 and 61 ±17 vs 42 ±14 msec, p < 0.001, respectively). Both QTc maximum interval and QTc dispersion increased significantly at the end of the HD (480 ± 51 vs 505 ±49 msec p< 0.001 and 61 ± 17 vs 86 ± 18 msec, p< 0.001, respec tively). The serum K+(5.3 ±0.56 vs 3.36 ±0.41 mEq/L, p < 0.001), phosphate (7.19 ± 1.62 vs 3.81 ± 1.02 mg/dL, p <0.001), magnesium (0.87 ± 18 vs 0.75±0.14 mg/dL) and urea concentrations (174 ±22 vs 74 ± 14 mg/dL, p < 0.001) significantly decreased, whereas the Ca++ (2.21 ±0.18 vs 2.47 ±0.24 mg/dL, p < 0.001), HCO3- (15.5 ±3.2 vs 20.1 ±3.4 mmol/L, p< 0.001) concentrations and pH (7.27 ± 1.1 vs 7.43 ± 1.2, p < 0.001) significantly increased after HD compared to predialysis values. There was significant correlation between the QT dispersion increase and serum electrolyte changes (K+, Ca++, and pH levels) (p < 0.05). The association between serum electrolyte changes, acid-base status and QT measurements might provide new insights into the evaluation of the ionic bases involved in inhomogeneous ventricular repolarization.
Acute Occlusion of an Abdominal Aortic Aneurysm
Authors: Hirose Hitoshi , Takagi Masatake , Hashiyada Hiroshi , Miyagawa Naotaka , Yamada Takafumi , Tada Seiichi , Kugimiya Toshiyasu , Hirose Hitoshi
Published: July 2008

Acute thrombosis of an abdominal aortic aneurysm (AAA) is a surgical emergency. Only 44 cases have been reported in the literature. The mechanism of the thrombosis has not been delineated. The proposed etiologies include propagation of thrombus from distal artery occlusion, cardiac thromboembolism, and dislodgment of a mural thrombus. Patients often present bilateral lower extremity ischemia, mimicking a saddle embolism. Systemic heparinization immediately after diagnosis and prompt surgical revasculariza tion can reduce the mortality rate. The authors present a patient with sudden throm bosis of an AAA who was successfully treated with an axillobifemoral bypass graft. All published cases of thrombosed AAAs are analyzed.
Middle Aortic Syndrome: An Atypical Case
Authors: Adovasio Roberto , Canci Ulio , Adovasio Roberto
Published: July 2008

This case concerns a 61-year-old woman presenting with middle aortic syndrome treated by an aortoaortic thoracoabdominal polytetrafluoroethylene bypass and a right renal Dacron bypass. The case was atypical because of the patient's advanced age at the time of clinical presentation.
Endovascular Sclerotherapy, Surgery, and Surgery Plus Sclerotherapy in Superficial Venous Incompetence: A Randomized, 10-Year Follow-up Trial Final Results
Authors: Belcaro Gianni , Nicolaides Andrew N. , Ricci Andrea , Dugall Mark , Errichi Bruno M. , Vasdekis Spiros , Christopoulos Dimitris
Published: July 2008

The study was planned to evaluate efficacy and costs of endovascular sclerotherapy (ES) in comparison with surgery and surgery associated with sclerotherapy in a prospective (10-year follow-up), good-clinical-practice study. Patients with varicose veins and pure, superficial venous incompetence were included. Of the patients randomized into the three groups 39 (group A) were treated with ES, 40 (B) with surgery + sclerotherapy, and 42 with surgery only (C). Surgery consisted of ligation of the SFJ (saphenofemoral junction) and of incompetent veins detected with color duplex. Of the preselected 150 patients, 121 subjects entered the study; 96 completed the 10-year follow-up (mean age 52.6 ±6 years; 51 men, 45 women). Dropouts were due to nonmedical problems. At 10 years no incompetence was observed in subjects treated with SPJ ligation (B and C). In the ES group 18.8% of the SFJs were patent and incompetent and in 43.8% of limbs the distal (below-knee) venous system was still incompetent [16.1% in the surgery + scle rotherapy group (p < 0.05) and 36% in the group treated with surgery only (p < 0.05 vs B and 0.05 vs A)]. Color duplex of the long saphenous vein indicated atrophy or obstruc tion of a segment (average 6.7 cm) after SFJ ligation (4.2 cm after ES). The cost of ES was 68% of surgery while the cost of surgery and sclerotherapy was 122% of surgery only. Endovascular sclerotherapy is an effective, cheaper treatment option, but surgery after 10 years is superior.
An Open-Label, Randomized Multicenter Study Comparing the Efficacy and Safety of Cyclo 3 Fort® Versus Hydroxyethyl Rutoside in Chronic Venous Lymphatic Insufficiency
Authors: Beltramino Raul , Penenory Adolfo , Buceta Ana Maria
Published: July 2008

The present study was designed to compare the safety and efficacy of a combination of Ruscus aculeatus, hesperidin methyl chalcone, and ascorbic acid (Cyclo 3 Fort®) versus that of hydroxyethyl rutoside in treatment of chronic venous lymphatic insufficiency. This open-label, randomized multicenter study was conducted on outpatients treated for 90 days. The patients were from three different regions of Argentina. Eighty patients, men and women, 30 to 70 years of age, with symptoms of chronic venous lymphatic insuffi ciency, ie, heavy, tired, swollen, or painful legs, were enrolled and assigned to two groups: one group treated with Cyclo 3 Fort®, the other with rutoside. The symptoms were assessed at baseline, and after 30, 60, and 90 days. The patient was asked to assess subjec tive symptoms, and the physician measured the size of the affected limbs. The efficacy was rated on a 3-point scale and safety was evaluated by the number of side effects. The results show that when all patients were comparable at baseline, after 90 days, patients treated with Cyclo 3 Fort® reported more rapid and complete regression of symptoms than those in the rutoside group, a statistically significant difference (p < 0.01). Likewise, a significant reduction in affected limb size was observed in both groups but persisted after 90 days in the Cyclo 3 Fort® group only (p < 0.01). Cyclo 3 Fort® was safe and more effective than rutoside in the treatment of venous lymphatic insufficiency, and the Cyclo 3 Fort® efficacy is probably associated with its unique mechanism of action.
Accumulation of Lymphocytes, Dendritic Cells, and Granulocytes in the Aortic Wall Affected by Takayasu's Disease
Authors: Inder Stephanie Jane , Bobryshev Yuri Veniaminovich , Cherian Sanjay Mammen , Albert Lord Reginald Sidney , Masuda Kazuyoshi , Yutani Chikao
Published: July 2008

The aim of this study was to analyze the cellular composition of the arterial wall in Takayasu's disease and to investigate the contribution of the various cell types to the immunoinflammatory processes and degenerative alterations of the vessel wall in this disease. Specimens of aorta were obtained at operation from 10 patients with Takayasu's arteritis. The duration of disease ranged from 2 months to 13 years. Immunohisto chemical investigation was carried out using the antibodies CD3 (to identify T-cells), CD20 (B-cells), S-100 (dendritic cells), CD68 (macrophages), CD15 (granulocytes), von Willebrand factor (endothelial cells), and alpha-smooth muscle actin (smooth muscle cells). All specimens showed distinctive histologic features of Takayasu's arteritis and contained inflammatory infiltrates, but the degree of their accumulation within the aortic wall varied. Inflammatory infiltrates within the deep part of the intima, around areas of neovascularization and within the adventitia contained T-cells colocalizing with dendritic cells. Nodules formed by large numbers of intermingling T-cells and B-cells enriched with dendritic cells were observed in the adventitia. Massive accumulation of granulo- ( continued on next page) cytes and their destruction within the adventitia were prominent in all cases. This is the first study that establishes the presence of dendritic cells and granulocytes in Takayasu's disease. Dendritic cells are probably involved in the immunoinflammatory processes through their interaction with T-cells and B-cells. The present observations may help understanding of the pathogenesis of Takayasu's disease.
Ticlopidine-Induced Severe Agranulocytosis After the Placement of Coronary Artery Stent
Authors: Sari Ramazan , Sevinc Alper , Buyukberber Suleyman
Published: July 2008

Ticlopidine is an oral antiplatelet agent frequently utilized in the treatment of cere brovascular disease. It is rarely associated with severe bone marrow suppression. A case of an elderly woman is reported who developed febrile agranulocytosis two months after commencing ticlopidine but who had a favorable outcome after cessation of that drug and treatment with granulocyte colony-stimulating factor (G-CSF). All patients should have regular monitoring of their blood counts during therapy with ticlopidine.