bluuebunny/crossref_metadata_2025 huggingface dataset:
A Multiclinic Double-Blind Trial of Pyridinolcarbamate and Inositol Niacinate in Ischemic Ulcer Due To Chronic Arterial Occlusion
Authors: Mishima Yoshio , Kamiya Kisku , Sakaguchi Shukichi , Kusaba Akira , Sakuma Akira
Published: November 2007

A double-blind multiclinic trial compared the efficacies of pyridinolcarba mate and inositol niacinate in the patients with the ischemic ulcer due to chronic arterial occlusion. A thrice-daily dose of 1.5 g of pyridinolcarba mate or 1.2 g of inositol niacinate was given at random to the patients during cold seasons, and the effectiveness of treatment was assessed mainly on the basis of the clinical course of the ischemic ulcer and the rest pain. The patients were classified into 4- and 6-week groups. Beneficial results were recorded in 16 of 32 cases (50.0%) of the 4-week pyridinol carbamate group, and in 24 of 42 cases (57.1%) of the 4-week inositol niacinate group. In the 6-week group favorable results were observed in 54 of 79 cases (68.4%) on pyridinolcarbamate, and in 36 of 74 cases (48.6%) on inositol niacinate. Although sympathectomy is currently indicated for these ischemic lesions, long-term treatment with pyridinolcarbamate is recommended on the basis of the finding that the 6-week treatment ap pears superior to the 4-week treatment and also to the 6-week treatment with inositol niacinate.
Fibromuscular Dysplasia of the Superior Mesenteric Artery and Coexisting Cerebral Berry Aneurysms
Authors: Lie J.T. , Kim Han-Seob
Published: November 2007

Fibromuscular dysplasia of the systemic artery and cerebral "berry" (sac cular) aneurysm are nonatheromatous lesions of uncertain etiology. The coexistence of these vascular disorders in the individual reported here is unusual and may provide a possible explanation of their pathogenesis.
The Inside-Out Electrocardiographic Stress Test: a View From the Left Ventricular Cavity
Authors: Macalpin Rex N. , Cabeen William R.
Published: November 2007

A new method is described for measuring the unipolar left ventricular cavitary electrogram by means of a standard pigtail ventriculography catheter. Experiences with this technique in 30 patients are described with particular reference to changes in the S-T segment of the cavitary elec trogram during cardiac stress by atrial pacing. This method allows conve nient recording of His bundle potentials from the left ventricular outflow tract in most patients.
Angiographic Manifestations of Renal Hamartoma
Authors: Lee Won J.
Published: November 2007

Two types of renal hamartoma (angiomyolipoma) are presented with emphasis on angiographic findings. Careful analysis of the angiograms can suggest a specific diagnosis. Two important considerations other than angiographic findings are (1) multiplicity of tumors in patients with tu berous sclerosis, and (2) a solitary mass in 40-60-year-old women.
Angiographic Demonstration of an Acquired Internal Mammary-To-Pulmonary Artery Fistula
Authors: Edmiston W.A. , Walters J.R. , Finck E.J. , Turner F. , Lau Francis Y.K.
Published: November 2007

A patient with a continuous murmur due to flow through an internal mammary-to-pulmonary artery fistula is described. Previously reported cases have been thought to be congenital in origin. A history of an anteriorly placed chest tube suggests an acquired etiology for this malfor mation.
Percutaneous Indirect Lymphography with a New Experimental Contrast Medium: A Preliminary Report
Authors: Kaude Jüri V. , Abrams Robert M. , Daly James W.
Published: November 2007

Suspension of tetraiodotherephtalic acid-bis-oxyethylester (120-480 mg I/ml) was injected percutaneously into the testicles, mammary glands, and the cervix of the uterus in mongrel dogs. The suspension was rapidly absorbed by the lymphatics draining the injection sites and transported to the regional lymph nodes. Excellent filling of lymphatics and nodes was apparent immediately or a few minutes after injection. Because of locally produced inflammatory reaction, percutaneous indirect lymphography with tetraiodotherephtalic acid-bis-oxy ethylester is now applicable only in experimental animal studies.
Nonprolapsing Atrial Myxoma; Clinical, Echocardiographic, and Angiographic Correlations
Authors: Deep Chadda Kul , Pochaczevsky Rubem , Gupta Prem K. , Lichstein Edgar , Schwartz Ira S.
Published: November 2007

The auscultatory features typical of myxoma were absent in a patient with nonprolapsing left atrial myxoma. An giocardiographic and echocardiographic findings including B-mode cross-sec tional scanning are presented.
Angiographic and Pathologic Correlations in Prinzmetal Variant Angina
Authors: Rizzon Paolo , Rossi Lino , Calabrese Pietro , Franchini Giovanni , DiBiase Matteo , Rizzon Paolo
Published: November 2007

The coronary-arteriographic and pathologic findings in a case of Prinz metal's angina are reported. Right coro nary arteriograms performed in the ab sence of pain showed only minor stenotic changes, whereas those performed dur ing an anginal attack revealed a spastic occlusion involving almost the entire vessel. Anatomic examination revealed obstructive lesions of the right coronary artery, more pronounced at the site where spasm had started, due to con centric atherosclerotic thickening of the inner wall, whereas the elastic fibers and the muscular ring of the tunica media were preserved.

These findings suggest (1) the need for great caution before assuming on purely angiographic bases that spasm may af fect a normal coronary artery and (2) the possibility that spasm occurs in a markedly diseased and stenotic segment of a coronary artery as long as the con tractile tissue of the tunica media is pre served.
Hyperkalemia-Induced Conversion of Chronic Atrial Fibrillation to Normal Sinus Rhythm;
Authors: Mathew P.K.
Published: November 2007

The electrocardiographic manifestations of hyperkalemia have been well described. We report a patient with chronic congestive heart failure and atrial fibrillation for 6

years, who converted to sinus rhythm during an episode of hyperkalemia. To our knowl edge, this is the first report of hyperkalemia- induced conversion of chronic atrial fibrilla tion to sinus mechanism.
Anemia Producing Mitral Valve Flutter on the Echocardiogram
Authors: Tye Kuang-Hung , Desser Kenneth B. , Benchimol Alberto
Published: November 2007

Thirty-four patients in sinus rhythm with anemia due to chronic renal failure and one subject with chronic uterine bleeding were studied by means of echo cardiography. Six patients (18%) had major diastolic fluttering of the mitral valve, and in 4 others the fluttering was equivocal. No subject had auscultatory or other clinical evidence of aortic insufficiency. In the patient with uterine hemorrhage, diastolic mitral valve motion reverted to normal after blood trans fusion. It is concluded that anemia may produce diastolic mitral valve flutter ing, which is probably based on increased blood flow in this setting. Caution should be exercised in ascribing diastolic murmurs associated with uremia to aortic regurgitation when anemia is present.
The Relative Resistance of Normal Young Women to Ethanol-Induced Myocardial Depression
Authors: Timmis Gerald C. , Gordon Seymour , Ramos Renato G. , Gangadharan V.
Published: November 2007

In contrast to previous reports from our own laboratory utilizing systolic time intervals (STI) and by others using ultrasound, no evidence of acute myocardial depression was observed in response to an ethanol (ETOH) dose of 1.25 ml/lb consumed over a period of 60 minutes by 6 young women (22.7 ± 7 years; 133 ± 6 lbs) who were monitored for 3 hours thereafter. Specifically, there was no significant change in fractional shortening (%ΔD), ejection frac tion, or mean circumferential fiber shortening velocity. Cardiac index and stroke index also remained stable, although heart rate increased ( P < 0.005) and systolic and diastolic blood pressure fell ( P < 0.01 and 0.25 respectively).

To examine further this unanticipated cardiac resistance to ETOH, we re- examined the sex-specific difference of STI response to acute ETOH exposure in a previously reported group of 32 normal subjects (20 men and 12 women). Significant increases in PEP, PEPI, ICT, and PEP/LVET ( P < 0.005, 0.005, 0.005, and 0.001 respectively) were observed in men only. Because we have previously observed that chronic ETOH consumption blunts acute myocardial depression, and because only 1 of 7 STI subjects historically consuming the least ETOH (< 1 oz/day) was a woman, STIs, were reassessed only in those subjects with a chronic consumption of 1 or more oz/day (14 men and 11 women). Myocardial depression as estimated by an increased ICT ( P < 0.05) and PEP/ LVET (P < 0.02) was again observed in men only.

We concluded that women are less susceptible than men to acute ETOH induced myocardial depression, as has recently been suggested for chronic ETOH consumption as well.
Detection of Early Myocardial Infarction by Radioimmunoassay of Myoglobin
Authors: McMurtry John P. , Wexler Bernard C.
Published: November 2007

A newly devised radioimmunoassay for the measurement of myocardial myoglobin has been modified by us to measure circulating myoglobin levels in rats subjected to isoproterenol-induced myocardial infarction of various degrees of severity. The method has been found to be very effective. Myoglobinemia proved to be a sensitive index of early myocardial damage in rats, perhaps superseding the enzyme CPK in detecting early myocardial damage. Both myoglobin and CPK were equally effective in providing an index of the extent of histopathologic myocardial infarction. The changes in myoglobin and CPK did not correlate well with the changes in plasma SGOT, SGPT, and LDH, which are more diagnostic of the later stages of acute myocardial infarction. Myo globinemia offers excellent promise as a diagnostic aid in detecting early myo cardial infarction in rats, and perhaps ultimately in humans, since there are only small differences between the immunologic specificity of human versus rat myoglobin.
Arrhythmias During Upper Gastrointesintal Endoscopy
Authors: Mathew P.K. , Ona Fernando V. , Damevski Kiril , Wallace Wayne A.
Published: November 2007

Electrocardiographic monitoring of 52 consecutive patients undergoing up per gastrointestinal endoscopy revealed that arrhythmias during the procedures were common (38.5%) and tended to occur more frequently in the elderly (75%), in persons with heart disease (54.5%), and in persons with chronic lung disease (89%). The incidence of ventricular premature contractions in patient with no evidence of heart or lung disease was 19%. In one patient with ad vanced chronic lung disease, the procedure had to be terminated because of de velopment of high-degree atrioventricular block. A high incidence of arrhyth mias during endoscopy has not been previously reported in patients with chronic lung disease.
Edema of the Lower Extremities Secondary to Obstructive Sarcoidosis
Authors: Sweeney Thomas , Ramsby Gale , Keohane Mary
Published: November 2007

Lower extremity edema is an unusual presentation of sarcoid. In this patient the diagnosis was established via lymphangiography and operative biopsy. Like the other manifestations of the disease, leg edema seems to respond to steroid therapy.
The Influence of Limb Elevation, Examination Technique, and Outflow System Design on Venous Plethysmography
Authors: Tripolitis A.J. , Blackshear W.M. , Bodily K.C. , Thiele B.L. , Strandness D.E.
Published: November 2007

The effect of limb elevation and the design of the thigh cuff outflow system on venous capacitance and venous outflow, as determined by strain gauge plethysmography, was reviewed in a group of normal limbs without evidence of deep venous thrombosis. We improved the reliability of plethysmography in evaluating venous outflow, particularly in the early period after cuff deflation, by using uniform leg elevation, large diameter outflow tubing, and single rather than simultaneous limb examinations.

Based on this experience, an optimum technique of examination empha sizing precise limb elevation, sequential limb examination and proper design of the cuff outflow system was used to evaluate 21 patients with acute venous thrombosis. The results obtained were compared with previously reported re sults of strain gauge plethysmography in patients with acute venous throm bosis. This technique significantly reduced the incidence of false-positive re sults.
Blood Flow Measurement in Patients With Intermittent Claudication
Authors: Tudor Davies W.
Published: November 2007

Modified isotope clearance tests for the objective investigation of inter mittent claudication of the lower limb were performed in 14 normal subjects with clinically patent arteries and 9 patients with calf claudication and arteri ographically confirmed peripheral vascular occlusion. The tests involved a stan dard exercise performed in the supine position. During rest periods the limb under test was subjected to simultaneous venous occlusion plethysmography.

In the patients with intermittent claudication, results were abnormal when compared with those of the normal group. The modified testing procedure de scribed gave discriminatory results for each group. Their usefulness in mon itoring disease progression, treatment benefit, and patient selection for surgery is discussed.
Effect of Nitroglycerin Ointment on Hemodynamics in Patients With Mitral Insufficiency
Authors: Gould Lawrence , Reddy C.V.R. , Bujung Zen  , Singh B.K.
Published: November 2007

A reduction in impedance or afterload produces beneficial hemodynamic effects in patients with mitral regurgitation. This mechanism has been studied via intravenous infusion of nitroprusside, phentolamine, and hydralazine. But there is little information on the effect of nitroglycerin ointment in patients with mitral insufficiency. Thus 6 patients with mitral insufficiency underwent right and left heart catheterization. After the control hemodynamic measurements were recorded, a 21/2-inch strip of 2% nitroglycerin ointment was applied to the chest for half an hour. Pressure recordings and cardiac output were then re peated. The control cardiac index fell from 2.79 to a treatment value of 2.05 L/ min/m2 ( P < 0.01), while the stroke index also decreased from 29 to 22 ml/ beat/m2 ( P < 0.05). There was a nonsignificant increase in peripheral resis tance. Thus nitroglycerin ointment can be detrimental when given to patients with mitral insufficiency.
Electrophysiologic Effects of Diltiazem, a Calcium Antagonist, in Patients With Impaired Sinus or Atrioventricular Node Function
Authors: Sugimoto Tsuneaki , Ishikawa Tadao , Kaseno Kensuke , Nakase Shin'ichi
Published: November 2007

The electrophysiologic effects of diltiazem, a calcium antagonistic agent, were studied in 30 subjects with various degrees of sinus or AV node dysfunc tion. After diltiazem was administered, sinus activity was not depressed in con trol subjects, whereas marked inhibition was observed in some of the patients with sick sinus syndrome. Ventricular automaticity was little affected by this drug. The AV conduction system was significantly depressed, and there was no difference in degree between controls and AV block patients. The depression of the AV conduction system became more marked as the basic atrial cycle length was shortened. The drug had no apparent effects on atrial refractoriness, atrial echo zone, or the accessory pathway system.

Conclusively, diltiazem affects mainly sinus and AV conduction systems. Its effect on the sinus node may provide a hazardous problem in patients with the sick sinus sysdrome patients, while its effect on the AV node will have thera peutic value in patients with AV nodal re-entrant arrhythmias.
Corticosteroids in Acute Myocardial Infarction
Authors: Bush Charles A. , Renner William , Boudoulas Harisios
Published: November 2007

Forty-two patients admitted to the Coronary Care Unit with a diagnosis of acute myocardial infarction were studied within 24 hours of the onset of symp toms. In addition to therapy determined by the attending physician, there was a double-blinded administration of either a placebo or methylprednisolone, 30 mg/kg intravenously every 6 hours for four doses. This drug had no beneficial effect on infarct size, dysrhythmias, complications, or left ventricular function 2 weeks after infarction.
Systemic Hypoperfusion in a Neonate With Tricuspid Atresia and Transposition of the Great Arteries
Authors: Folger Gordon M.
Published: November 2007

Infants with the hypoplastic left heart syn drome present a reproducible appearance that terminates in irreversible shock during the neonatal period. There is disagreement over the exact cause of this appearance.

This case involves a newborn infant with tricuspid atresia and transposition of the great arteries, and with the clinical appear ance and course usually reserved for neo nates with the hypoplastic left heart syn drome. Accurate diagnosis is crucial in all such infants to correctly distinguish those with a hopeless outcome from those ame nable to palliative cardiovascular surgery. This case supports the contention that ductal closure alone is not the principal cause of death in infants with hypoplastic left heart syndrome.
Standardization of Venous Distensibility Measurements in Plethysmography
Authors: Van de Heyning-Meier J.
Published: November 2007

This paper comprises a summary of the literature on plethysmography, of study objectives, techniques, and interpretation of methods. The venous distension plethysmography is suitable for the evaluation of clinical venous pathology, but a standardization of the method is urgently needed. The test schedule is described, explained, and discussed. Some questions arising from the test schedule and some ideas that should be more closely discussed are offered.
Prognostic Value of Initial Blood Viscosity on Vascular Surgery and Treatment in Peripheral Disease
Authors: Charlesworth D.
Published: November 2007

The correlation between extent of arteriosclerosis and blood viscosity, and the reduction in viscosity after successful surgery support the hypothesis that a raised viscosity is a consequence rather than a cause of arteriosclerosis. Measurement of blood viscosity was of little practical help to our team of vascular surgeons when they were faced with the problem of which recon struction to do and when to do the procedure on a particular patient.

The results of our studies show that in patients with arteriosclerosis, in whom only the major arteries are affected, the viscosity of the blood is not grossly abnormal and a knowledge of the blood viscosity does little to influence treatment. Patients with peripheral vascular disease affecting the small arteries and arterioles often have a high blood viscosity. In these circumstances manipulation of blood viscosity by hemodilution or drugs may be of benefit, and there is evidence that isoxsuprine given intravenously can achieve a reduction in viscosity.
Experience with Isoxsuprine in the Treatment of Sickle Cell Crisis: A Proposed Mechanism of Action
Authors: Psomadakis C. , Kallerghi G. , Bourantas C. , Papageorgiou J.
Published: November 2007

An accidental clinical observation triggered this investigation into the possible beneficial effects of isoxsuprine in the treatment of painful sickle cell crisis.

Twenty-four patients were studied with a total of 34 episodes of painful crisis. As they had all been previously treated by us we knew the duration of their crisis under conventional treatment, so that the two regimens with and without isoxsuprine could be compared. Isoxsuprine was administered in 3 successive steps: (1) as an IM injection (5-10 mg), (2) as a rapid IV infusion (1 mg/minute), and (3) as a slow, continuous IV infusion (0.1-0.3 mg/minute).

The results from this study suggest that isoxsuprine exerts in fact a remarkable action in sickle cell crisis by bringing about prompt relief in approximately 80% of the cases within 5 hours, and in 40% of the cases within 2 hours. There were only 2 cases of absolute failure.

The hospitalization time was remarkably reduced and the use of narcotics was minimized. Side effects (tachycardia, palpitations, somnolence) have been observed mainly in cases where relatively high doses of isoxsuprine had to be administered IV.
Systemic Arterial Compliance and Diastolic Runoff in Essential Hypertension
Authors: Levenson Jaime A. , Safar Michel E. , Simon Alain C. , Kheder Adel I. , Daou Joseph N. , Levy Bernard I.
Published: November 2007

Systemic arterial compliance was estimated in 31 men, including 15 pa tients with sustained essential hypertension and 16 normal subjects of the same age. Values were derived from analysis of the monoexponential blood pressure-time curve during diastole, according to a simple viscoelastic model. In normal subjects, baseline arterial compliance was 2.56 ± 0.18 ml/mm Hg. A significant decrease (1.88 ± 0.13 ml/mm Hg; P < 0.001) was observed in hypertensives. Administration of vasoactive substances (angiotensin and sodium nitroprusside) showed that, for the same blood pressure levels, normal subjects and hypertensives had similar values for compliance. How ever, the correlation between the basal values of diastolic pressure and compliance was significant in normal subjects (r = -0.76) but not in hyper tensives (r = -0.33); these results suggested differences between acute and long-term conditions in patients and controls. Calculated diastolic runoff was similar in both groups, approximating 58 and 55% of the stroke volume respectively.

This study provides evidence that, in sustained essential hypertension, (1) the reduced arterial compliance cannot be related exclusively to the level of blood pressure, but also requires some abnormality of the volume of large arteries, and (2) the reservoir role of the large arteries is maintained.
Abnormal Left Ventricular Contraction Revealed by Impedance Cardiograms and Arterial Tracings in Bundle Branch Blocks and Old Myocardial Infarcts
Authors: Luisada Aldo A. , Perez Gloria L. , Kitapci Haluk , Knighten Vincent
Published: November 2007

Following the observation of an unusual pattern of the first derivative of the impedance cardiogram in cases of bundle branch block, a systematic study was performed both in normal controls and clinical cases. This graphic study was supplemented by the simultaneous recording of the first derivative of an arterial tracing, preferably the indirect aortic pulse at the suprasternal notch.

These studies were performed in 70 subjects: 30 normal subjects, 14 cases of right bundle branch block, 14 cases of left bundle branch block, and 12 cases of old infarcts.

Out of 30 normal subjects, only 2 old persons showed splintering of the main systolic wave. Both right and left bundle branch blocks had in common either a splitting of this wave in 2 peaks or multiple splintering; however, 4 cases in each type of bundle branch block had a normal pattern. Among old infarcts, 7 had a splitting, 3 had multiple splitting, and 2 had a normal pattern. The derivative of the arterial tracings showed a remarkable similar ity with that of the impedance cardiogram, revealing that abnormal left ventricular ejection (dyssynergy) was present in all 3 types of lesion.

The first derivative of the impedance cardiogram was often more typical than that of the arterial tracings, because it had fewer secondary vibrations or artifacts. Thus, the former seems more sensitive to diagnosing left ven tricular abnormalities of contraction, even when the electrocardiogram is normal.
A Computer Program for Determining Vmax from the Uncalibrated Left Ventricular Pressure Signal and its First Derivative
Authors: Stefadouros Miltiadis A. , Williams Maryon J.
Published: November 2007

A computer program was developed to simplify the conventional method for determining the maximal contractile element shortening velocity at zero load (Vmax) by analysis of pressure-velocity graphs during the isovolumic contraction period. From an uncalibrated left ventricular (LV) pressure signal and its first derivative (dP/dt), the graph relating developed LV pressure (Pd) to the corresponding instantaneous value of (dP/dt)/28 Pd was constructed by the computer. The segment of the graph that encom passed approximately the second half of the isovolumic contraction period, as determined by analysis of the dP/dt waveform, was then extrapolated to provide V'max on the ordinate. This V'max was compared with the conven tional Vmax obtained from calibrated LV and aortic pressure signals. In 5 dogs both in the control state and during inotropic (epineprine, propranolol) and noninotropic interventions (phenylephrine or dextran infusion), a high degree of correlation was found relating V'max and Vmax both derived by either linear (Vmax = 0.91 V'max + 0.14; r = 0.933; P < 0.001) or exponential (Vmax = 0.99 V'max - 0.06; r = 0.959; P < 0.001) extrapolation of the pressure-velocity graph to zero load. By use of this program, Vmax can be easily and reliably estimated from the uncalibrated LV pressure signal and its first derivative.
The Inhibition of Ischemic Lesions of the Rat Gastric Mucosa by a Novel Serotonin- Antagonist: a Light and Electron Microscopic Study
Authors: Van Reempts J. , Borgers M. , Xhonneux R. , De Clerck F. , Awouters F.
Published: November 2007

Two methods that provoke severe lesions in the rat gastric wall were used to study the pathologic action of serotonin. In a first group of rats 1 mg/kg of compound 48/80 was injected IV. The lethal shock that follows within about 30 minutes was prevented by subcutaneous administration of a H1- antagonist. This treatment did not suppress the gastric gland activity, in particular the gastric secretion, and resulted in time-related lesions situated in the gastric corpus and to a lesser extent in the antrum. In a second group of rats similar lesions were induced by slow infusion of 30 μg/kg/min serotonin into the femoral vein.

The earliest observed light microscopic events concerned mucosal vessel appearance. Most of the vessels were heavily dilated and engorged with blood cells. The most important ultrastructural changes were seen in the various epithelial cells. These were characterized by an early disappearance of intramitochondrial granular deposits. In a later stage progressive necrosis of the epithelial cells was observed. Lesions evolving from focal edematous erosions into deep necrotic and hemorrhagic wounds were found throughout the whole gastric wall. These final severe lesions were attributed to a local vascular congestion which led to cellular ischemia and a consequent energy deficiency of the mucosal cells.

When rats were orally pretreated with the novel serotonin-antagonist R 41 468 at a dose of 0.63 mg/kg, the light and electron microscopic picture was almost completely comparable to that of unchallenged animals. This indi cates that R 41 468 is a potent antagonist of peripheral venoconstriction induced by infused exogenous serotonin as well as by released endogenous serotonin.
Tissue pO2 and Transcutaneous pO2 as Guidelines in Experimental and Clinical Drug Evaluation
Authors: Sunder-Plassmann L. , Messmer K. , Becker H.M.
Published: November 2007

Tissue pO2 measurements on skeletal muscle surface both in patients and in ani mals in a model of occlusive disease re vealed local tissue hypoxia that, until now, had not been detected with any other method. This kind of local tissue hypoxia is interpreted as a disturbance of local micro- flow distribution in the presence of un changed regional blood flow rate.

In response to buflomedil infusion, tissue p02 histograms improved without any change in regional blood flow or distal blood pressure.

In comparison to healthy volunteers, transcutaneous pO2 measurements in pa tients allowed establishment of tcpO2 pro files along the lower extremity which were in agreement with angiographic localization of vessel occlusion. In a preliminary study, buflomedil infusion (3 mg/kg) over 30 min utes caused a significant increase in tcpO2 in 5 patients in the absence of any signifi cant change of segmental blood pressure.

It is concluded that both tissue p02 and tcpO2 measurements are able to provide unique information about local changes of the microcirculation in occlusive vessel dis ease.
Massive Embolism from Cardiac Myxoma
Authors: Yeoh N.T.L. , Clegg J.F.
Published: November 2007

Two cases of massive embolism from atrial myxoma are described. One of these patients survived aortic surgery, and this is only the third recorded survival of this condition. Pre-operative angiography is essential to successful management of these cases, and direct aortic surgery is the only way to remove these firm tumor emboli.
Quantitative Evaluation of the Skin Circulation in Ischemic Legs by Transcutaneous Measurement of Oxygen Tension
Authors: Ohgi Shigetsugu , Ito Katsuaki , Mori Tohru
Published: November 2007

We tried to apply transcutaneous oxygen tension (tcPo2) in evaluating the ischemic leg quantitatively from the standpoint of the skin circulation. The tcPo2 measurement was performed on the pretibial and dorsal skin at rest, on exercise loading, and during oxygen inhalation; tcPo2 on the chest wall was measured as a standard value. The subjects consisted of 47 patients with ischemic legs and 20 normal healthy males without ischemic legs.

tcPo2 in the pretibial skin had a tendency to decrease with aging. There was a correlation between pretibial tcPo2 and ankle pressure (r = 0.51, p < 0.02). In the affected leg, each mean pretibial tcPo2 under 3 different conditions was much lower than that of control. Pretibial tcPo2 of patients also correlated well with the Fontaine classification of clinical severity of ischemic legs.

We concluded that transcutaneous measurements of oxygen tension at the pretibial region are useful in evaluating the ischemic leg quantitatively.
Propranolol-induced Reverse Vascular Steal in Arteriopathic Patients
Authors: Brevetti Gregorio , Chiariello Massimo , Ferulano Giuseppe Paolo , Betocchi Sandro , Paudice Giampaolo , Lavecchia Giuseppe , Abate Sergio , Verrienti Salvatore , Condorelli Mario
Published: November 2007

The vascular steal phenomenon, i.e., the shunting of blood from ischemic to normally perfused areas, has been described in the affected limbs of arteriopathic patients after taking vasodilating drugs. This study was per formed to ascertain whether the reverse situation can be induced, i.e., whether vasoconstriction of the vessels supplying the nonischemic zone could increase the amount of blood reaching the ischemic area. Accordingly, 49 arteriopathic subjects were selected on the basis of the plethysmographic evidence of a reduction of blood flow in the affected limb following an IV injection of xanthinol-nicotinate. In a first group of 10 patients, the reduction of blood supply to the affected limb induced by xanthinol-nicotinate was inhibited when this drug was administered in combination with 5 mg of propranolol. In another 22 patients, the plethysmographic response observed after xanthinol-nicotinate alone was reversed when this drug was injected after 10 mg of propranolol. Actually, the blood perfusion to the affected limb rose significantly at all times of recording as compared to basal values. Finally, in a third group of 10 patients in whom xanthinol-nicotinate induced a significant reduction of blood flow, propranolol did not modify it. The angiographic studies performed in 3 patients confirm the plethysmographic results. Xanthinol-nicotinate alone induces a reduction of the vascular filling in the affected limb, while the combination of the vasodilating drug with 10 mg of propranolol is able to improve the vascular filling in the affected area. These results indicate that the overwhelming action of α-adrenoceptors obtained in the normal area by the β-receptors' blockade favors a beneficial redistribution of blood flow which might be considered a reverse vascular steal.
M-mode Echocardiographic Failure to Consistently Identify the Equally Bicuspid Aortic Valve: Correlation with Orifice-View Aortography
Authors: Folger Gordon M. , Alam Mohsin , Stein Paul D.
Published: November 2007

The M-mode echocardiogram is considered a satisfactory diagnostic tool for the determination of the presence of a bicuspid aortic valve. M-mode echocardiographic failure to determine this condition is occasionally encoun tered and has been suggested to be due to the anatomic configuration wherein the two aortic valve leaflets are nearly equal in size. By employing a specific angiographic study (orifice-view aortography), it has been shown that accurate identification of aortic valve anatomy is possible. Ten patients having orifice-view aortographic findings of an aortic valve having two essentially equally sized leaflets have been studied both by this technique and M-mode echocardiography. Five of these had M-mode echographic evidence of a bicuspid aortic valve. However, 3 exhibited no criteria diagnos tic of a bicuspid valve and 2 had only suggestive criteria. The results confirm that M-mode echocardiography alone is insufficient to determine reproduc ibly the presence of an aortic valvular malformation with or without stenosis when the anatomy is that of an equally bicuspid aortic valve.
Therapeutic Effect of Ticlopidine, a New Inhibitor of Platelet Aggregation, on Chronic Arterial Occlusive Diseases, a Double-blind Study versus Placebo
Authors: Katsumura Tatsuki , Mishima Yoshio , Kamiya Kisaku , Sakaguchi Shukichi , Tanabe Tatsuzo , Sakuma Akira
Published: November 2007

The clinical efficacy of ticlopidine, a platelet aggregation inhibitor, was evaluated in a double-blind placebo-controlled study on 193 patients with ischemic ulcers due to chronic arterial occlusion. In the group treated with ticlopidine, significantly better efficacy was noted over the placebo group in terms of judgment on overall improvement by doctors in charge as well as by the committee assessing with color slide films. The drug was particularly effective for the treatment of patients with occlusion in the arteries on the distal side and for the ischemic ulcer with relatively small size. In the group with ticlopidine, granulation was significantly improved compared to the placebo group. Those patients who had pain due to arterial occlusion on the distal side were significantly improved by this agent. The mean diameters of ulcers were clearly reduced. Therefore, this agent could possibly be claimed as an effective remedy against the main symptoms of chronic arterial occlu sion. The frequencies of side effects and abnormalities in laboratory tests were comparable in the group treated with ticlopidine to those of the group with placebo. It was, therefore, concluded that this agent has an outstanding clinical value as a conservative treatment in chronic arterial occlusion.
Pattern of Arterial Occlusion in Buerger's Disease
Authors: Shionoya Shigehiko , Hirai Masafumi , Kawai Seiichi , Seko Toshiyuki , Ban Ichiro
Published: November 2007

The pattern of arterial occlusion in Buerger's disease was analyzed by simultaneous bilateral femoral arteriography in 210 limbs of 105 patients with Buerger's disease. In 55 limbs of 42 patients, the femoropopliteal segment was affected in addition to the infrapopliteal arterial obstructive lesion. The pattern of crural arterial occlusion was similar in about 40% of both the patients with femoropopliteal occlusion and the patients with crural occlusion. Toes were ulcerated in 4 of 58 limbs with continuous arterial flow, and ulceration occurred in 86 of 152 limbs with a discontinuous flow. The rate of occurrence of bilateral trophic lesion in the group with an arterio graphically similar occlusion pattern was not significantly higher than that in the group with a different pattern. The pattern of arterial occlusion in Buerger's disease seemed to be fixed mainly within 1 year after the onset of symptoms, and the skip-lesion in the main artery was favorable to proximal progression of the disease.
Fallibility of Intra-Operative Gram Stain in the Diagnosis of Vascular Infection
Authors: Samson Russell H. , Gupta Sushil K. , Scher Larry A. , Veith Frank J.
Published: November 2007

Three cases of arterial-graft infection are presented. In all cases the gram stain obtained at surgery demonstrated white blood cells but no bacteria. Cultures obtained at operation subsequently grew Pseudomonas aeruginosa in two patients and Bacteroides fragilis in one patient. Failure to recognize the fallibility of the gram stain in the diagnosis of vascular infection may result in incorrect management decisions.
Minoxidil in Severe and Moderately Severe Hypertension, in Association with Methyldopa and Chlortalidone
Authors: Cotorruelo Julio G. , Llamazares César , Florez Jesus
Published: November 2007

Minoxidil is a potent antihypertensive drug widely used in severe arterial hypertension and in that refractory to treatment. Its effectiveness in less severe forms of hypertension was evaluated in 15 patients who had either a severe to moderate arterial hypertension not previously treated, or who did not tolerate the side effects of other antihypertensive drugs. The usefulness of methyldopa and chlortalidone to prevent a potential minoxidil-induced tachycardia and fluid retention, respectively, was also tested. The patients were initially treated with chlortalidone 100 mg/day, and methyldopa 500 mg/day. Minoxidil was then given in increasing doses until the diastolic blood pressure was equal to or inferior to 90 mmHg. This occurred consistently at doses which ranged from 5 to 50 mg/day (average, 29 mg). Treatment with minoxidil was continued for four months; tolerance to the drugs was not observed. Low doses of methyl dopa and chlortalidone were effective in controlling the tachycardia and the retention of sodium and water induced by minoxidil. The three associated drugs were well tolerated and the life quality improved in most patients. Hypertrichosis was the most consistent side effect. Two patients were with drawn from the study after the blood pressure was controlled by minoxidil, because of the appearance of angor in one, and edema and heart failure in the other.
Suprarenal Aortic Aneurysm: An Unsuccessful Attempt at Renal Autotransplantation
Authors: Cameron A.E.P. , Graham J.C. , Hamilton W.A.P. , O'Neal H. , Rudge C.J. , Bewick M. , Cotton L.T. , Cameron A.E.P.
Published: November 2007

An abdominal aortic aneurysm extending above the renal vessels was managed by resection, grafting and renal autotransplantation. The use of the technique is discussed.
Beneficial Effects of Sublingual Nifedipine in Patients with Ischemic Heart Disease and Depressed Left Ventricular Function
Authors: Losardo Anthony A. , Klein Neal A. , Beer Nusen , Strom Joel A. , Wexler John P. , Sonnenblick Edmund H. , Frishman William H.
Published: November 2007

The effects of sublingual nifedipine, a calcium channel beta-blocking drug, were assessed in eleven patients with coronary artery disease and depressed left ventricular function. All patients had a previous documented myocardial infarction. Specifically examined were the effects of a 20 mg dose on left ventricular ejection fraction as assessed through gated pool nuclear imaging. All patients had their anti-anginal drugs stopped forty-eight hours prior to inclusion in the study. Baseline resting determinations included a mean heart rate of 80 beats/minute, mean arterial pressure of 97 mmHg and an ejection fraction of 36 percent. Thirty minutes following a 20 mg sublingual dose, these parameters were reassessed. Mean heart rate increased to 89 beats/minute, p<0.02; mean arterial pressure decreased to 78 mmHg, p<.002; while ejection fraction increased to 48± 17 percent, p<.001. No adverse reactions were reported. These results demonstrate that nifedipine will acutely improve de creased left ventricular function in patients with coronary artery disease. While calcium blockers can significantly depress myocardial contractility, nifedipine's ability to decrease mean arterial pressure and peripheral vascular resistance reduces afterload, improves myocardial performance which offsets any negative effects on contractility that may exist. This drug promises to be especially useful in patients with coronary artery disease and severely de pressed left ventricular function where agents such as beta-blockers are con traindicated.
Intra-Pulmonary Artery Streptokinase
Authors: Demeter Stephen L. , Fuenning Charles
Published: November 2007

Fibrinolytic agents have been advocated for the treatment of massive pulmonary emboli. The usual mode of infusion is via a peripheral vein. Theoretically, infusion into the pulmonary artery would be expected to be more efficacious. A case representing the failure of intra-pulmonary artery infusion of fibrinolytic agents is presented. However, a literature review suggests that this mode of therapy may achieve a greater success in clot lysis than does peripheral infusion. Additionally, this form of treatment may allow the clinician to lower the administered dose which may represent an advantage to the patient.
Clinical Significance of the Radioisotope Test Using I-131 Labelled Serum Albumin for Evaluating the Peripheral Circulation in the Foot During a Period of Reactive Hyperemia
Authors: Cuypers Y. , Steels P.
Published: November 2007

The radioisotope test using I-131 labelled serum albumin, performed during a period of reactive hyperemia, provides quantitative data which express the rate at which radioactive blood flowing from the leg replaces the non radioactive blood present in the foot. It has been applied in normal subjects and in patients with arterial occlusions in the lower limbs. High washout rates, i.e. small M/2 index values, were found in the former, whereas low washout rates with higher M/2 indices were observed in the latter. Surprisingly, patients with a very low washout rate could be without subjective symptoms. The usefulness of the test in clinical practice is explained.
Non-Invasive Diagnosis of a Free-Floating Left Atrial Thrombus With Emphasis on Two- Dimensional Echocardiographic Features
Authors: Szkopiec Roman L. , Torstveit Jeremy R. , Sri Prakash N. , Desser Kenneth B. , Benchimol Alberto
Published: November 2007

Two-dimensional echocardiography permitted identification of a large free-floating left atrial thrombus in a patient with mitral stenosis. A specific pattern of motion afforded its recognition and differentiation from mural left atrial thrombosis and tumors. Phonocardiographic tracings revealed a non- ejection systolic click and opening snap. A gated blood pool scintigram dis closed a left atrial filling defect. Subsequent left atrial angiography and left atriotomy confirmed the non-invasive findings.
Klinefelter's and Takayasu's Syndromes in One Patient—A Pure Coincidence?
Authors: Berginer Vladimir M. , Paran Esther , Hirsch Menachem , Abeliovich Dvora
Published: November 2007

The patient is a classical case of Klinefelter's syndrome and has, in addi tion, pulseless disease. In angiography, the involvement of the subclavian arteries and its main branches, consistent with Takayasu's arteritis type 1, was demonstrated. Is it a pure coincidence that the patient with a 47 XXY karyotype also has an illness that affects mostly women?
The Efficacy of Ajmaline in Ventricular Arrhythmias after Failure of Lidocaine Therapy in the Acute Phase of Myocardial Infarction
Authors: Grenadier E. , Alpan G. , Keidar S. , Weiss D. , Marmor A. , Palant A.
Published: November 2007

Forty-three patients in the acute phase of myocardial infarction who were resistant to conventional doses of lidocaine received Ajmaline intravenously (50 mg bolus followed by constant infusion rate of 1-1.5 mg/min).

Dangerous ventricular arrhythmias were abolished in 72% of this group of patients (group A). In the remaining patients (28%), Ajmaline was found to be ineffective (group B). There was no reduction of systolic or diastolic blood pressure and there was an insignificant increase in heart rate.

Atrio-ventricular or intraventricular conduction defects appeared in 46% of the patients described. There was a statistically significant increase in occur rence of heart blocks in group B patients and among these complete left bundle branch block (CLBBB) was the most prevalent.

Atrio-ventricular or intraventricular conduction defects were transient, appearing between 8-36 h (mean 23 h), and were not accompanied by reduction of ventricular rate. Conduction defects disappeared within several hours (up to 24 hours) after Ajmaline was discontinued.

It is concluded that Ajmaline administered by this regimen is an effective alternative agent for patients with ventricular arrhythmia not controlled by lidocaine in the acute phase of myocardial infarction.
The Underlying Problems Resulting in Controversies in the Clinical Management of Transient Ischemic Attacks: An Overview
Authors: Slade Walter R. , Enker Stanley , Borras Rafael , Jia Rhon Chen
Published: November 2007

Of all the controversial topics in the management of cerebrovascular dis eases the subject of transient ischemic attacks is perhaps the most controver sial. A preponderance of literature related to the subject, reflecting a remarka ble degree of interest in the topic, is a result of this controversy. Each conclu sion serves to stimulate more interest, more evaluation, and more controversy. We will attempt to give an overview of the controversies in the management of transient ischemic attacks.
Treatment of Raynaud's Syndrome with Adrenergic Alpha-Blockade with or without Beta-Blockade
Authors: Cleophas Ton J. M. , van Lier Henk J. J. , Fennis Jan F. M. , van 't Laar Albert
Published: November 2007

In a double blind placebo-controlled cross-over trial of 24 weeks 31 patients with Raynaud's syndrome were treated with the alpha-blocker phenoxybenzamine (10-20 mg daily) and with the combination of the alpha-blocker phenoxybenzamine (10-20 mg daily) and the beta-blocker sotalol (40-80 mg daily). A favourable effect on recovery of finger temperature after finger cooling was demonstrated after alpha-blockade as com pared to the before treatment situation. This favourable effect was not different when the group received the combined alpha- and beta-blockade. The blood pressure was not influenced by either of the 2 medications. Fluid retention appeared with alpha-blockade and was absent with combined alpha- and beta-blockade. Decrease of heart rate oc curred with alpha- plus beta-blockade and was absent with alpha-blockade alone. Clinical symptoms of Raynaud's syndrome equally were alleviated by the two medica tions. Common, and equally frequent side effects of the two medications were nasal congestion, disturbed ejaculation and potence, dry mouth, exercise-induced and ortho- static dizziness.

We conclude that alpha-blockade is beneficial in Raynaud's syndrome and that additional beta-blockade counteracts the alpha-blocker side-effect fluid retention, re duces the heart rate and thus may prevent alpha-blocker induced tachycardia, and that it does not cause hypotension.
Isolation and Characterization of Salt-Soluble Cross-Linked Elastin From Vascular Tissue
Authors: Davis Paul F. , Ryan Patricia A. , Manning John N. , Stehbens William E. , Skinner Stephen J. M.
Published: November 2007

Fibrous elastin, a stable and important constituent of vascular tissue undergoes degenerative changes including fragmentation in atherosclerosis. The nature of the protein fragments produced during the in vivo degradation of elastin is largely unknown. From salt extracts of haemodynamically stressed tissue in sheep, polypeptides were isolated by hydrophobic interaction chromatography. These polypeptides coacervated and had amino acid compositions similar to those of in vitro solubilized elastins. The presence of the cross-links, desmosine and isodesmosine, in the isolated material indicates that the fragments originated from fibrous elastin and that cleavage of cross- links is not necessary for the solubilization of the fibre.
Unusual Takayasu's Arteritis: Case Report
Authors: Camici M. , Pentimone F. , Evangelisti L. , Pingitore R.
Published: November 2007

Takayasu's disease, a condition with unusual clinical symptoms and peculiar radiologic manifestations is described. The clinical and physiopathological implications are discussed together with a literary review.