bluuebunny/crossref_metadata_2025 huggingface dataset:
A Prospective Randomized Trial of Aspirin in Femoral Popiteal and Tibial Bypass Grafts
Authors: Satiani Bhagwan
Published: November 2007

A prospective, randomized clinical trial to study the effect of aspirin on late patency of femoral popliteal and tibial bypass grafts is reported. One hundred limbs in 93 patients were randomized to receive daily 650 mgs aspirin postoper atively (ASA, n=45) or no aspirin (NASA, n=55). Indication for surgery was limb salvage in 88% and poor runoff (0-1 vessel) was present in 68%. Graft material consisted of autogenous vein (AV) in 63, expanded PTFE in 82 and composite grafts in five limbs. Distal anastomosis was to the popliteal artery in 72 limbs, tibial vessels in 19 and sequential in nine limbs. Patient followup ranged from 1-51 months (mean 12.97).

Sixteen (16%) grafts occluded late, eight each in the ASA and NASA groups, (p>.05). No significant differences in graft patency existed between ASA and NASA groups in limbs with AV (88.5% vs 92.9%) or PTFE grafts (74% vs 62%) (p>.05). A total of 21 (19%) anastomoses occluded. No differences were noted between ASA and NASA limbs, although patency in AV was greater than PTFE (p < .05). Cumulative patency rates were 84.4% at 12 months, 81.5% at 24 months, 67.3% at 36 months and 52.4% at 48 months (ASA vs NASA, p>.05). Therefore, daily administration of 650 mgs of aspirin did not appear to influ ence late graft patency of femoral popliteal and tibial AV or PTFE bypass grafts at a mean followup period of 12.97 months.
Totally Implantable Indwelling Catheter System— Alternative Techniques of Insertion
Authors: Auguste Louis Joseph , Chardayoyne Rashmae
Published: November 2007

Totally implantable indwelling venous catheter systems represent a major advantage for patients requiring frequent or prolonged venous accesses. These catheters are usually inserted via the cephalic vein. When this approach is not feasible, alternative venous sites include the subscapular vein, the external jug ular vein, the subclavian vein by direct puncture, the internal jugular vein by direct puncture and the saphenous vein. These techniques are herein reported to help the surgeon faced in the operating room with a difficult venous catheter placement.
Idiopathic Spontaneous Deep Venous Thrombophlebitis in an Adolescent: A Case Report
Authors: Donath Gary R. , Portnoy Scott L. , Moynihan Patricia C. , Kerstein Morris D.
Published: November 2007

A rare case of spontaneous deep venous thrombophlebitis in a 15-year-old adolescent is presented. This case is remarkable as it lacks any associated condi tions and predisposing factors, as well as an etiologic diagnosis.
Hydatid Mesoarteritis in the Abdominal Aorta: Case Report
Authors: Pardal Humberto C. , Gonzalez-Orus Marcos J.M. , Dominguez Hernandez F. , Martin-Corral L.E. Ortega , Ingelmo Morin A. , Martin M.J. Alonso , Montero Gómez J. , Gómez Alonso A.
Published: November 2007

A rare case of hydatid disease, presenting as a 12 cm. cyst in the arterial wall of the abdominal aorta, with progressive chronic ischemia of the lower limbs and repeated episodes of shock is reported. The diagnostic problems, surgical procedure and follow-up are presented. This is the first reported case in the literature.
Effects of Synthetic Blood Combined with Contrast Medium on Coronary Endothelium: An Experimental Study
Authors: Harjula Ari LJ , Mattila Severi , Myllarniemi Hannu , Mattila Ilkka , Mattila Petri , Merikallio Erkki
Published: November 2007

The study described was carried out to evaluate endothelial injury following incubation of coronary material in contrast medium and in contrast medium diluted with fluorocarbon solution. Six porcine hearts were excised and isolated. Immediately thereafter, pieces of the main coronary arteries and ascending aortas were incubated in four different solutions: 1) blood, 2) contrast medium, 3) fluorocarbon solution, 4) fluorocarbon — contrast medium (1:1). Flow surfaces and coronary endothelial morphology were evaluated by scanning electron microscopy (SEM).

Porcine blood (at room temperature) preserved endothelial structures intact but, in two samples, small patchy areas of denuded surface were found. Four minutes' immersion in contrast medium resulted in easily visible changes in the endothelial lining and individual cells. Denuded flow surface areas were common, the intact surface morphology was flattened. After 7 minutes, destruction was total. The addition of fluorocarbon solution to contrast medium (1:1) diminished the changes, which also occurred later than after incubation in pure contrast medium. After 7 minutes, separate endothelial cells were still identifiable but the microvilli had disappeared. Fluorocarbon solution preserved the endothelial lining well during a 10-minute follow-up period.

The experimental protocol described confirmed the deleterious effect of con-trast medium on coronary endothelial lining, which could be reduced to some extent by adding fluorocarbon solution to contrast medium.
Effect of Propranolol on Baroreflex Control of Heart Rate in Young Patients with Essential Hypertension
Authors: Takata Shigeo , Ogawa Jun , Okuwa Hitoshi , Yagi Shinji , Iwase Nobuo , Ikeda Takayuki , Hattori Nobu
Published: November 2007

The effect of propranolol on baroreflex control of heart rate was studied in 12 young patients with essential hypertension and was compared with that of 12 age-matched normotensive subjects. Resting heart rate and cardiac index in patients with essential hypertension were significantly higher than those of con trol subjects (p < 0.001, p < 0.01, respectively). The reduction of heart rate and cardiac index after propranolol were significantly greater in paients with essen tial hypertension than in control subjects (p<0.01, p<0.05, respectively). In the control state, the baroreflex slope in young patients with essential hyperten sion was significantly less than that of control subjects (p < 0.01). After pro pranolol, the baroreflex slope was significantly increased in control subjects (p < 0.01), but remained unchanged in patients with essential hypertension. These results suggest, first that the antihypertensive action of propranolol must be due to a mechanism other than the augmented baroreflex function and, sec ond that increased β-adrenergic activity is not a factor contributing to impaired baroreflex function in young patients with essential hypertension.
Peripheral Vascular Disease: Flow Studies and Clinical Results After Isovolemic Hemodilution—Case Reports
Authors: Caputi C.A. , De Carolis G.
Published: November 2007

The authors, after a brief introduction concerning hemorheology pathophys iology, report the results of a study on 18 patients suffering from vascular dis ease at the second, third and fourth stage (Fontaine) who underwent isovolemic hemodilution therapy. The Travis Winsor index (evaluated by Doppler ultra sound) and the perfusion volume (evaluated by impedance rheography) were both significantly increased after treatment.

In some patients such increase were also associated with a reduction of sub jective symptoms.
Transcutaneous Flow Measurements in In-Situ Bypasses: An Assessment of Duplex Scanning
Authors: Leopold Peter W. , Chang Benjamin B. , Shandall Ahmed A. , Fitzgerald Kathleen M. , Shah Dhiraj M. , Leather Robert P. , Corson John D. , Karmody Allastair M.
Published: November 2007

Measurement of laminar flow using an ultrasound scanner was shown to have a high degree of correlation with quantified timed flows (r = 0.98, p ≤ .001). Sixty-one in-situ bypasses had flow assessed both proximally and dis tally. Mean fistula flow (proximal-distal flows) for time periods 1-8 weeks, 3 to 8, and 9+ months were 108, 85, and 16mls respectively. Distal bypass flow remained constant despite a significant decrease in fistula flow between the later time periods (p ≤ .001) (unpaired t-test). There was no evidence from the study that proximal flow through fistulas of varying resistances adversely affected the distal bypass flow.
Concomitant Use of Bevantolol and Hydrochlorothiazide in the Treatment of Hypertension
Authors: Morledge John H.
Published: November 2007

The efficacy of a bevantolol/HCTZ combination dosing regimen in the treat ment of patients with mild to moderate hypertension was evaluated in the dou ble-blind phase of a multicenter study conducted at ten different centers. The objectives of this study were to determine the additive diastolic blood pressure reducing effect of bevantolol in patients already treated with HCTZ and to compare the diastolic blood pressure reducing effects of a bevantolol/HCTZ combination concurrently with that of bevantolol monotherapy.
Motor Nerve Conduction Study in Raynaud's Phenomenon
Authors: Cavallaro A. , Di Marzo L. , Mattioli G.L.
Published: November 2007

The term Raynaud's phenomenon is the eponym of a clinical picture culmi nating into and dominated by accessorial vasomotor crysis which are triggered by different stimuli (cold, cigarette smoking, emotional stress); cold sensitivity however, is a rather constant feature.

Little is known about peripheral nerve involvement in Raynaud's phenome non but for cases secondary to thoracic outlet syndrome or to primary neuro logic diseases, systemic or not.

The aim of the present work was to evaluate non-invasively the involvement of arterial flow as well as of nerve function in subjects complaining of Ray naud's phenomenon.
Plasma β-Thromboglobulin Levels and Claudication Degrees in Patients with Peripheral Vascular Disease
Authors: Catalano Maria , Russo Umberto , Libretti Arnaldo
Published: November 2007

In 30 patients with varying degrees of claudication and 40 normal subjects, plasma levels of β-thromboglobulin were determined. These were significantly higher (p < 0.01) in the patients than in age-matched controls; in the control group the β-thromboglobulin values resulted slightly higher in older subjects. No correlation was found between β-thromboglobulin and the severity of the vascular disease, assessed on the basis of the pain-free interval on the treadmill.
Rapid Acquisition Computed Tomographic Assessment of Left Ventricular Regional Wall Motion Using a New Long Axis View
Authors: MacMillan Robert M. , Rees Michael R. , Maranhao Vladir , Clark Donald L.
Published: November 2007

A long axis view to demonstrate left ventricular regional wall motion was devised for the ultrafast CT scanner. The patients are positioned supine, head first, into the scanner. The scan table is slewed 20° counter-clockwise in the horizontal plane without tilt. A bolus of contrast is injected via a median antecu bital vein. Contiguous level R wave triggered cine studies are obtained during peak passage of contrast through the heart to image the entire left ventricular cavity. Fourteen patients had left ventricular wall motion compared by long axis CT and RAO 30° single plane ventriculography at catheterization. In all cases, regional wall motion in comparable segments by both methods was in agree ment. It is concluded that the ultrafast CT long axis view permits diagnosis of left ventricular regional wall motion abnormalities. This view images the apex and sections the interventricular septum and lateral free wall horizontally. Un like conventional CT views, it is comparable to the RAO left ventriculogram.
A Practical and Effective Protocol for the Post Angiographic Management of Patients with Critical Stenosis of the Left Main Coronary Artery
Authors: Boran Kevin J. , Phillips Matthew
Published: November 2007

The management of newly diagnosed left main obstruction varies through out institutions. At some Centers, very aggressive measures including intra- aortic balloon counterpulsation and emergent revascularization are routine protocol. Twenty consecutive patients with greater than 50% luminal narrowing of the left main coronary artery were treated over a 1 year period. Routine post catheterization protocol for 19 patients included intensive care observation, continuation of nonparenteral anti-anginal agents, and coronary revasculariza tion within 24 hours of diagnosis. One patient experienced severe hemodynamic embarrassment at the time of catheterization and underwent emergency coro nary bypass. All patients were discharged uneventfully following successful sur gery. Based on this experience, it is felt that with surgical support, patients with significant left main stenosis can be treated with standard anti-anginal therapy, and undergo elective revascularization without complications.
The Right Ventricular Pouch: A Proposed Explanation for the Electro-Vectorcardiographic Pattern of Double Chambered Right Ventricle
Authors: Folger Gordon M.
Published: November 2007

The presence of a specific deformity of the right ventricle in association with the double-chambered right ventricle (DCRV) has been discovered in 8 of 14 individuals undergoing detailed study for DCRV. Investigational study employ ing multiple angiographic projections with selective angiography has allowed precise morphological identification of this deformity as a contractile pouch located arising from the outflow tract of the right ventricle. Comparison of the angiographic data with the electro-vectorcardiographic findings of DCRV sug gests that these highly specific electrical features of DCRV correlate with the position and location of the contractile pouch.
Controlled Trial of Combined Urokinase and Dextran Sulfate Therapy in Patients With Acute Cerebral Infarction
Authors: Fujishima Masatoshi , Omae Teruo , Tanaka Kenzo , Iino Kozo , Matsuo Osamu , Mihara Hisashi
Published: November 2007

In this multiinstitute cooperative study, 143 patients were treated with either urokinase (UK) or combination of urokinase and dextran sulfate (UK-DS) within one to seven days following acute onset of cerebral thrombotic infarction. Of these, 81 randomized cases received a single dose of UK (2.83 x 105 units) by six-hour intravenous drip infusion and the remaining 62 received a combined dose of UK (2.84 x 105 units) and DS (3000mg) for only one day.

Moderate to marked clinical improvements assessed during the seven-day study period were observed in 30.9% of the patients treated with UK and in 61.3% of those with UK-DS, the latter being significantly higher. Hemorrhagic phenomena appeared in 3.2% of the cases treated with UK-DS and in none of those with UK alone, but mortality was 1.6% in the former and 2.5% in the latter.

UK-DS produced a prompt and sustained increase in plasma fibrinolytic activity with transient and relatively minor disturbance of the blood coagulation system.

The results indicate that combined therapy with UK and DS is more effective than UK alone for acute cerebral thrombotic infarction.
Varicography in the Management of Recurrent Varicose Veins
Authors: Thomas M. Lea , Keeling F.P.
Published: November 2007

Forty lower extremities in 29 patients with recurrent varicose veins have been investigated by varicography. In 29 lower extremities the recurrent vari cosities were on the long saphenous venous system and in 11 lower extremities on the short saphenous system. The recurrences consisted of varicose segments or tributaries of the long or short saphenous veins, varicose tributaries at the sites of previous ligations of varicose veins, and varicosities associated with in competent perforating veins in the midthigh and calf. It is suggested that varico graphy is a useful method for demonstrating the sites of recurrent varicose veins and for enabling definitive surgery to be performed.
Assessment of Percutaneous Transluminal Coronary Angioplasty by Atrial Pacing and Thallium-201 Myocardial Imaging: A Case Report
Authors: Stratmann Henry G. , Seuc Carlos A. , Mark Alexander L. , Walter Kenneth E. , Kennedy Harold L.
Published: November 2007

Combined atrial pacing and thallium-201 scintigraphy were performed in a man with multiple coronary artery lesions unable to perform exercise stress testing. Severe angina and ischemic ST depression in the inferior and anterior ECG leads occurred at a peak double product of 22,400 beats-mm Hg/min; thallium-201 scintigraphy showed reversible perfusion defects of the inferior, posterior, and septal segments. After angiographically successful angioplasty of a 95% right coronary artery lesion, repeat atrial pacing/thallium-201 scintig raphy (peak double product 27,750 beats-mm Hg/min) produced mild angina no ST depression in the inferior leads, and a normal thallium-201 scan. This case illustrates the value of the atrial pacing/thallium-201 stress test for evaluat ing the need for, and results of, coronary angioplasty in patients unable to per form exercise stress testing.
Angiographic Recognition of Ostial Left Main Coronary Artery Stenosis: Case Report
Authors: MacMillan Robert M. , Feldman Bruce , Maranhao Vladir
Published: November 2007

Ostial left main coronary stenosis has a poor prognosis and increased mor tality rate with coronary arteriography. Due to its anatomic location, visualiza tion of the stenosis may be difficult. A high index of suspicion based upon only a few signs should prompt the physician to perform certain maneuvers to obtain the correct diagnosis. Four illustrative cases are presented and discussed.
Doppler Color Flow Mapping of the Fetal Heart
Authors: Nanda Navin C. , Hsiung Ming C. , Youngblood James P. , Maulik Dev
Published: November 2007

The recently developed innovative technique of Doppler color flow mapping permits real time visualization of blood flow patterns superimposed on two-dimensional echocardiographic images of the heart.1,2 This study demonstrates, for the first time, the usefulness of this technique in characterizing fetal cardiac dynamics.
tcpO 2, Arterial Blood Flow and Lactate/Pyruvate Modifications Induced by a Single Dose of Naftidrofuryl IV During Stage III Lower-Limb Arteriopathies
Authors: Thomas Catherine , Mosnier Michel , Percebois Gérard , Debry Gérard , Pointel J.P.
Published: November 2007

A single dose of 600 mg of naftidrofuryl perfused IV during three hours in 12 stage III arteriopathic patients did not modify the average blood flow at the calf but did significantly increase transcutaneous oxygen pressure (33 vs 52 mmHg) and also improved lactates (1.44 vs 0.88 mmol/liter), pyruvate (59 vs 79 μmol/liter), and lactates-pyruvates ratio (33.48 vs 20.92).
A Modified ECG-Triggered Cinefilm-Mark Unit for DSA Studies of the Heart and Great Vessels
Authors: Janssen Johan , Ackermans Sjef , Mulkens Guy , Winter Roland
Published: November 2007

The authors developed an inexpensive, reliable, and easy-to-install, ECG-triggered cinefilm-mark device that permits performance of high-quality subtraction studies of the coronary circulation.
Effects of Fibrinogen, Globulin, Albumin and Hematocrit on the Kinetics of Erythrocyte Aggregation in Man
Authors: Yamamoto Masahiro
Published: November 2007

The effects of fibrinogen, globulin, albumin, and packed blood cell volume (hematocrit) on the kinetics of erythrocyte aggregation (RBC-A) after stasis were quantitatively evaluated by recording the changes of light transmission through the blood in transparent tubing with an apparatus consisting of a light-emitting diode and a silicon photodiode. The measurements were done on samples of heparinized whole blood, suspensions of erythrocytes containing various concentrations of fibrinogen (0.5 to 25 g/L) or gamma globulin (25 to 150 g/L), and blood of various hematocrit values prepared from three samples of whole blood having different concentrations of fibrinogen. The half-time of the increase of light transmission after the flow-stop was used as an index of the kinetics of RBC-A (T1/2).

This simple and rapid method for estimating erythrocyte aggregation had excellent reproducibility (N = 51, r = 0.99). The values of T1/2 showed significant negative correlations with the concentrations of fibrinogen and globulin but a positive correlation with that of albumin. The T1/2 value decreased markedly and then remained almost constant with increase in the value of hematocrit, but the influence of hematocrit on T1/2 was markedly dependent on the concentration of fibrinogen.
Oral and Dental Complications of Sickle Cell Disease in Nigerians
Authors: Okafor L.A. , Nonnoo D.C. , Ojehanon P.I. , Aikhionbare O.
Published: November 2007

A clinical evaluation of the oral and dental complications of sickle cell disease in Nigerians was carried out in 37 consecutive patients with homozygous sickle cell disease Hb-SS (Sicklers) compared to a control group of 24 persons with normal haemoglobin Hb-AA (control group) matched for age and sex. The significant abnormalities found in sicklers included intrinsic opacity of the teeth in 67.5% of sicklers compared to 28.83% in the control group; malocclusion of the teeth with over-jet and over-bite in 35% of sicklers compared to 16.66% in the control group; dental caries is present in 35.13% of sicklers which was less than its occurrence in 54% of the control group due to widespread avoidance of sweets by most local sicklers. Diastemata (gaps between the teeth) was present in approximately equal frequency in sicklers (27%) and control group (25%). In view of the aesthetic and medical implications of these abnormalities, it is recommended that sicklers should receive regular dental check-up with a view to ameliorating or preventing these complications by prophylactic measures including the use of orthodontic appliances such as braces, etc. The above findings are discussed in relation to the other complications of sickler cell disease in other organs of the body.
Bedside Hemodynamic Monitoring in the Management of Acute Cardiac Patients
Authors: Hutchison S.J. , Rankin A.C. , Hutton I.
Published: November 2007

Hemodynamic monitoring was performed in 100 acutely ill patients admit ted to a Coronary Care Unit, 72 of whom had sustained an acute myocardial infarction (AMI). In patients with AMI, the initial pulmonary capillary wedge (PCW) pressure was related to prognosis, with a mortality of 68% in those with elevated pressures. The mean PCW pressure was 25 mmHg in those who died as compared with 17mmHg (p < 0.001) in the survivors. Cardiac catheterization confirmed the clinical impression of high risk in the majority of cases but also identified those in whom the clinical signs were misleading; 9 of those with AMI (12.5%) had high PCW pressures in the absence of clinical or radiological heart failure. The diagnosis of serious hemodynamic complications of AMI (right ven tricular infarction, ventricular septal defect, and mitral regurgitation) was es tablished in 14 cases (19%). There were no serious complications related to catheterization, and we conclude that pulmonary artery catheterization is safe and of clinical value in acutely ill cardiac patients.
Vertebral Arteriovenous Fistula Following Central Venous Cannulation: A Case Report
Authors: Motte S. , Wautrecht J.C. , Delcour C. , Bellens B. , Vincent G. , Dereume J.P.
Published: November 2007

The authors report a case of vertebral arteriovenous fistula that has been disclosed three years after central venous cannulation (CVC). The real inci dence of this complication is discussed and various clinical presentations are enumerated. From a review of the literature, some recommendations are made to prevent the diagnosis from being missed and chiefly to reduce the risk of arterial puncture that results in fistula formation.
Myocardial Ultrastructure in Kearns-Sayre Syndrome
Authors: Nakano Takeshi , Imanaka Kyoko , Uchida Hideki , Isaka Naoki , Takezawa Hideo
Published: November 2007

Myocardial ultrastructural changes are described in a twenty-five-year-old female with typical Kearns-Sayre syndrome.

The electrocardiogram revealed complete atrioventricular block with an occasional torsades de pointes type of ventricular tachycardia. His bundle recording demonstrated HV block with normal AH interval.

An endomyocardial biopsy showed "ragged-red fibers" by the modified Gomori trichrome stain, and on electron microscopy there were increased numbers of morphologically abnormal mitochondria: ie, giant mitochondria, a whorled pattern of the cristae, and electron-dense substances, and paracrystalline inclusions in the mitochondria.

The patient has been well since pacemaker implanatation, but she may develop a clinically overt cardiomyopathy due to progression of myocardial involvement.
Radiolabeled Platelets in Detecting the Source of Recurrent Pulmonary Emboli—A Case Report
Authors: Poskitt Keith R. , Payne Mark N. , Lane Ian F. , McCollum Charles N.
Published: November 2007

Multiple pulmonary emboli are recognized to be the cause of progressive pulmonary failure. In these patients, the source of emboli may be difficult to detect, even by venography. The authors describe the use of autologous Indium 111-labeled platelets to locate the origin in a patient with progressing right heart failure.
Influence of Pentoxifylline on Muscle Tissue Oxygen Tension (pO2) of Patients with Intermittent Claudication Before and After Pedal Ergometer Exercise
Authors: Ehrly A.M. , Saeger-Lorenz K.
Published: November 2007

Ten patients with Stage II chronic arterial occlusive disease (intermittent claudication) took part in a randomized, intraindividual crossover study involving acute intravenous administration of 200 mg pentoxifylline or physiological saline solution (placebo). The tissue oxygen tension (pO2) response (pO2 kinetics) following treatment with placebo revealed a nominal but statistically nonsignificant increase in arithmetic mean and median pO2 immediately after the end of exercise. Values thereafter reverted approximately to the initial values recorded at rest. Comparison of the pooled pO2 histograms during the individual periods before and after the end of exercise, however, revealed a broadening of the histogram base, reflecting both higher pO2 values and, more particularly, increased numbers of hypoxic and anoxic pO 2 values. This is interpreted as an expression of nonhomogeneous capillary perfusion (maldistribution). Following administration of pentoxifylline to the same patients, there was a statistically significant increase in mean and median pO2 at ten and twenty minutes after the end of exercise. Even after thirty and sixty minutes, these values were in some cases still clearly higher than the initial preexercise values. Study of the pooled pO 2 histograms discloses a right shift compared with the initial preexercise histograms. This suggests that pentoxifylline exerts a positive effect on maldistribution by making capillary perfusion more homogeneous. The results support the conclusion that, in the context of reactive hyperemia after muscular exercise, tissue oxygen supply is markedly improved by pentoxifylline in comparison with saline solution. The measurement of tissue pO2 before and at intervals after pedal ergometer exercise is a new objective technique for assessing the efficacy of blood flow-promoting therapy, permitting close simulation of the pathophysiological situation in the muscles of the lower leg in intermittent claudication.
Anomalous Origin of the Coronary Arteries
Authors: Teplitsky I. , Wurzel M. , Melamed R. , Aygen M.
Published: November 2007

The incidence and the clinical significance of various forms of anomalous aortic origin of coronary arteries are not well known. Among 2,000 consecutive patients who underwent selective coronary aretriography, 11 had such anomalies (0.55%). Two patients with atresia of the left main ostia developed ischemic symptoms at the ages of thirty-five and fifty-two, and both benefitted from coronary bypass graft operation. In other forms of anomalies the presence of ischemic symptoms was also associated with atherosclerotic stenosis (7 patients) or with constricting muscle bridge (1 patient).
Acquired Amputation and Prostheses Before the Sixteenth Century
Authors: Padula Patricia A. , Friedmann Lawrence W.
Published: November 2007

Amputation has been practiced at least since 43,000 B.C.E. for ritualistic, punitive, curative, or vocational reasons. Fitting with prostheses has been done since at least 1,500 B.C.E.

Anesthetics were used, but which ones is not known. Analgesics such as salicylates in plants, narcotics such as cocaine and opium, and soporifics such as alcohol and peyote were common.

Amputation was done with knives, axes, and saws. Control of bleeding was by ligature, cautery, bandaging pressure, and plant and animal products. Suture was with cotton or human hair, acacia and other thorns, ant jaws, and sinew, with or without a drain.

Prostheses were made of fiber, wood, bone, and metals, often lined with rags.
Anomalous Right Coronary Artery Arising from the Midportion of the Left Anterior Descending Coronary Artery—Case Reports
Authors: Nath Amar , Kennett Jerry D. , Politte Lenard L. , Sanfelippo John F. , Alpert Martin A.
Published: November 2007

Although coronary artery anomalies are detected during 0.8-1.2% of routine adult cardiac catheterizations, anomalies of the right coronary artery are relatively uncommon and are generally of no clinical significance. This report focuses, however, on 2 patients whose RCA originated from the midportion of the left anterior descending artery, an anomaly with potentially important clinical implications, which are explored.
Simultaneous Bilateral Central Retinal Arterial Occlusion in a Patient with Sneddon Syndrome: Case History
Authors: Pauranik Apoorva , Parwani Sudhir , Jain Satish
Published: November 2007

A unique occurrence of simultaneous bilateral central retinal arterial occlusion in a thirty-four-year-old Indian male is reported. The patient's condition was an example of Sneddon syndrome because of association of recurrent strokes and cutaneous livedo reticularis.
Tissue pO2 of Human Brain Cortex—Method, Basic Results and Effects of Pentoxifylline
Authors: Schultheiss Rolf , Leuwer Rudolf , Leniger-Follert Elfriede , Wassmann Hansdetlef , Wüllenweber Rolf
Published: November 2007

A polarographic multiwire surface electrode was used for measurement of local oxygen partial pressure (pO2) on human brain cortex during neurosurgical operations. The two major problems encountered in this application of the electrode involved sterility of the equipment and mounting of the electrode. The described method of sterilization does not alter the electrical properties of the electrode. A special mount was designed to allow free three-dimensional placement of the electrode without exerting pressure on the cortex.

Basic results of this technique demonstrated that it is possible to distinguish different pO 2 distribution patterns displayed in pO2 histograms for various types of brain tumors and edematous brain tissue. In patients with arteriovenous malformations (AVMs) of the brain, an increase of tissue pO2 in cortical areas adjacent to the AVM was the result of extirpation of the lesion.

The effect of intravenously administered pentoxifylline was studied during extraintracranial bypass operations in patients with cerebrovascular disease. In 7 patients a consistent shift of the pO2 histograms to the right, i.e., to higher pO2 values, could be demonstrated. Mean pO2 values increased statistically significantly by 16±7 mmHg as early as ten minutes after infusion of pentoxifylline. The rapid improvement of tissue oygenation of human brain cortex is thought to be the result of an improvement of microcirculation, for other parameters influencing tissue pO2 showed no significant alterations if any.
Electromagnetic Flowmetry in Bypass Shunt During Carotid Endarterectomy
Authors: Owen William S.
Published: November 2007

By use of a custom-designed electromagnetic flow probe, continuous measurement of flow in a bypass shunt system is possible. This permits real-time evaluation of shunt function during carotid endarterectomy and will allow evaluation of changes made in future shunt designs. Although limited to the carotid circulation in this study, the method has applicability to any vascular region where bypass shunts are used.
Different Effects of Beta-1-Adrenergic Blocking Agents With ISA or Without ISA on Peripheral Blood Flow
Authors: Karnik R. , Valentin A. , Slany J.
Published: November 2007

Until recently beta-adrenergic blocking agents were considered contraindicated in peripheral arterial occlusive disease (PAOD). However, in recent years several studies have failed to show negative effects on peripheral blood flow. It was the aim of this study to compare the effects of celiprolol, a beta-1-adrenergic blocking agent with intrinsic sympathomimetic activity (ISA), and of metoprolol, a beta-1-adrenergic blocking agent without ISA, on peripheral blood flow of patients with and without PAOD. In an acute trial 24 patients (group I: 12 patients with PAOD stage I and II; group II: 12 patients without PAOD received a single dose of 200 mg celiprolol or 200 mg metoprolol in a double-blind crossover design. Celiprolol induced no significant changes in calf and skin blood flow at rest or during reactive hyperemia. Basal vascular resistance (BVR) and minimal vascular resistance (MVR) were not affected. Metoprolol, however, significantly reduced muscle blood flow and increased BVR in both groups. Subsequently the patients were treated in a randomized double-blind design with a daily dose of 200 mg celiprolol or metoprolol for three weeks. In long-term treatment skin and muscle blood flow at rest and during reactive hyperemia, BVR, and MVR were not affected by celiprolol. Metoprolol significantly lowered calf blood flow at rest in patients with PAOD; other parameters remained unchanged. In patients without PAOD, metoprolol caused a significant decrease of calf blood flow at rest and an increase of BVR. Calf blood flow during reactive hyperemia, as well as skin blood flow at rest and during reactive hyperemia, showed no significant changes. Our results suggest that celiprolol— owing to its ISA or other mechanisms not yet clarified—in contrast to other beta-1-adrenergic blocking agents without ISA, neither reduces muscle blood flow nor increases BVR.
Noninvasive Hemodynamic Assessment of Vasospasm in Patients with Primary Raynaud's Phenomenon
Authors: van de Wal Henry J. C. M. , Wijn Pieter F. F. , van Lier Henk J. J. , Kneepkens Wim G. H. J. , Skotnicki Stefan H.
Published: November 2007

In order to assess vasospastic ischemic disease objectively 41 patients with primary Raynaud's phenomenon and 21 normal volunteers were investigated noninvasively by digital systolic blood pressure and digital skin temperature measurements before and after instant cold provocation. Much care had been taken to be certain that all patients had primary Raynaud's phenomenon.

The results of digital pressure measurements appeared to be affected by interindividual variations in systemic systolic blood pressure. By introducing a digit-to-brachial systolic blood pressure index (DBI), such variations could be eliminated. Instant cold provocation did not change DBI significantly. No pressure drop due to a closing phenomenon could be observed.

Both digital skin temperature and DBI differed significantly between healthy males and females. In the patient group males and females did not show significant differences. The results in healthy females were hardly different from the results in patients. Healthy males could be well discriminated from patients with both techniques. Sex differentiation appeared to be essential for the objective assessment of primary Raynaud's phenomenon.
Sustained Ventricular Tachycardia Associated with Influenza Syndrome in a Young Girl—A Case Report
Authors: Bashour Tali T. , Wald Steven
Published: November 2007

Ventricular arrhythmias in children with no demonstrable heart disease are rare. In a thirteen-year-old girl, a typical influenza syndrome was complicated by sustained ventricular tachycardia. Exercise tests, echocardiography, electrophysiological studies, and endomyocardial biopsy were negative. Viremia, fever, or medications may be responsible for this unusual complication.
Unilateral Moya Moya Disease in an Adult— A Case History
Authors: Gomez Camilo R. , Hogan Patrick A.
Published: November 2007

A case of ischemic infarction in a young woman who also had angiographic findings consistent with "Moya Moya" disease is presented. Unusual features of the case, such as the presentation as an infarction rather than subarachnoid hemorrhage and the unilaterality of the angiographic abnormalities, are discussed. The literature is reviewed and emphasis is directed to the importance of the inclusion of this entity in the differential diagnosis of cerebral ischemic events in young adults, owing to the possible therapeutic implications.
Patterns of Fibrin Deposits in Carotid Artery Plaques
Authors: Fisher Mark , Sacoolidge John C. , Taylor Clive R.
Published: November 2007

We evaluated 40 consecutive carotid endarterectomy specimens for the presence of fibrin. Intraplaque hemorrhage was noted in 93% of specimens. At the plaque surface, there were two patterns of fibrin distribution. Type I, suggesting a lumen thrombus, was found in 7 specimens. Type II, suggesting an intraplaque hemorrhage at the lumen surface, was found in 15 specimens. These changes were not significantly associated with the presence of ischemic symptoms or the use of antiplatelet or anticoagulant medications. All specimens with Type I change had arteriographic evidence of at least 70% diameter stenosis. The frequent lack of fibrin at the plaque surface suggests that there may be inherent limitations of standard medical treatment for carotid artery disease.
Treatment of Complications of Peripheral Obstructive Arterial Disease with Prostaglandin E1
Authors: Killion Dennis D. , Ambrus Julian L.
Published: November 2007

Forty-one subjects diagnosed with complications of peripheral obstructive arterial disease were treated with continuous infusions of Prostaglandin E1(PGE1) over a three-week period during 1981-1982 in an open-label, uncontrolled study under ward conditions. Ischemic rest pain and ulcers were treated with intravenous infusions of PGE1at dose rates of 14-21 ng kg-1min-1for seventy hours, once a week. Symptomatic relief of rest pain and spontaneous healing of stable ulcers occurred.

Whereas classically dependable noninvasive circulation evaluations were not prognostic of the treatment's success, they did suggest local and rheological changes rather than a generalized vasodilation. The PGE1infusion is efficacious for an unknown length of time, which may somehow be related to inhibition of platelet aggregation.

Since transient ischemic attack (TIA) and cerebrovascular accident (CVA) were found to be associated with PGE1infusion, cerebrovascular evaluation must be conducted prior to considering PGE1replacement therapy for the individual patient.
Reliability of Walking Endurance with an Incremental Treadmill Test
Authors: Lee Kirby R. , Marlow Ronald W.
Published: November 2007

Treadmill walking endurance is the major outcome measure for intervention studies on patients with intermittent claudication. The measurement properties of this test have not, however, been well documented. We assessed the test-retest reliability of treadmill walking endurance in 10 normal subjects with a mean (±1SD) age of 27.5 (±3.3) years. On four occasions, at intervals of at least one week, each subject walked on a motorized treadmill to the limits of his or her capabilities. With the standard protocol, subjects began at a very low exercise intensity (0.25 m/sec, 0% grade), which increased in either speed or grade at ninety-second intervals through a maximum of fifteen stages to 2.75 m/sec and 20% grade. On the final occasion, 5 of the subjects were tested twice with a fifteen-minute interval, using a truncated protocol starting at stage five (1.25 m/sec, 0% grade). Within-subject standard deviations were low, averaging twenty-three seconds (2.1%). Reliability was very high for the first three tests with the standard protocol (r ≥ 0.98, p < 0.0001) and for the 5 subjects tested and retested with the short interval and truncated protocol (r=0.99, p < 0.0002), while the correlation between the standard protocol and the truncated protocol was somewhat lower (r > 0.81, p < 0.01). For young normal subjects the measurement of walking endurance with an incremental treadmill test is highly reliable, but the limits of reliability need to be considered when conclusions are drawn from such measures.
Acute and Short-Term Effects of Clonidine in Heart Failure
Authors: Giles Thomas D. , Thomas Madaelil G. , Quiroz Antonio C. , Rice Janet C. , Plauche Wade , Sander Gary E.
Published: November 2007

The authors performed a randomized, double-blind, placebo-controlled trial to assess the tolerance and effects of chronic oral clonidine administration on the clinical status, exercise tolerance, and ventricular function of 10 male patients with chronic heart failure. Patients were given either oral clonidine (400 μg/day) or matching placebo for twelve weeks and then tapered off medication over a two-week period.

Results are summarized as follows: Profiles over time between groups were significantly different for resting heart rate (p = 0.0005), were different for arterial pressure (p=0.04), were different for left ventricular ejection fraction (p < 0.006), and were different for mean accumulated workload (p=0.076).

Exercise double product at 25 watts changed little in three patients and showed a decrease in 2 patients following six weeks of oral clonidine; after twelve weeks, it decreased in three patients, increased in 1, and changed little in another. After washout, double product returned toward baseline values. In the placebo groups, double product showed little change.

Resting of the heart by decreasing heart rate, systemic arterial blood pressure, and venous tone are thought by the authors to be major contributing factors to the observed beneficial effect of chronic oral clonidine in chronic heart failure.
Ectasia in the Origin of the Left Subclavian Artery—A Case Report of Congenital Malformation of the Aortic Arch
Authors: Aguinaga Miguel A. G. , Sanchez Nievas Gines , Barcia de Luis Francisco , Leal Javier
Published: November 2007

A rare congenital anomaly of the aortic arch is presented, consisting of an ectasia of the left subclavian artery associated with narrowing of the aortic arch in an asymptomatic twenty-three-year-old woman.
Congenital Vascular Abnormalities in Okihiro's Syndrome— A Case Report
Authors: Rashad Fouad , Keith Michael W. , Shields Robert , Barre Peter S. , Sobel Mark
Published: November 2007

In this report, the authors describe the angiographic findings in the forearm and hand in Okihiro's syndrome. To the best of their knowledge, it has not been described before.

Okihiro et al described hypoplasia of the thenar eminence in association with a congenital disorder of ocular motility previously reported in Duane's syn drome.
Aortic Ejection Fraction: A New Hemodynamic Parameter and Its Relationship to Aortic Insufficiency
Authors: Siegel Michael E. , Chen David C.P. , Kantor Jason , Colletti Patrick , Lee Kai , McKay Charles , Rahimtoola Shahbudin H.
Published: November 2007

Pulsations of the ascending aorta during fluoroscopy in patients with aortic insufficiency (AI) have been described. The authors present their observations of a similar phenomenon in patients who have AI undergoing scintiangiography. In addition, this paper describes a technique to validate and quantitate this finding. They studied 17 patients with documented AI and 14 subjects of a control group. First-pass studies were acquired in the RAO 15° projection. Regions of interest were placed over the proximal aorta during systole and dia stole. An aortic ejection fraction (AF) was determined. The calculated AEF data were correlated with the presence or absence of AI.

The mean AEF from the 17 AI patients was 27.1 ± 7.2%, while the mean for the non-AI group was 12.0 ± 6.5% with p < .001. An AEF of 18% separates the two groups with a sensitivity, specificity, and accuracy of 88%, 86%, and 87% respectively. Preliminary data demonstrate a mean reduction in AEF of 12.2 percentage points in 7 AI patients who underwent aortic valve replace ment. The AEF may be a useful new parameter to evaluate hemodynamic changes associated with aortic valve replacement in patients with aortic insuffi ciency.
Doppler Echocardiographic Detection of Traumatic Ventricular Septal Defect — A Case Report
Authors: Missri Jose , Sverrisson Jon
Published: November 2007

A case of traumatic ventricular septal defect diagnosed by Doppler echocardiography is described. The characteristic pulsed Doppler findings of a left-to-right shunt were recorded and the two-dimensional echocardiographic images of septal interruption were shown. Combined Doppler and two-dimensional echocardiography enhances the ability to detect the presence of a ventricular septal defect. Doppler echocardiography appears to be a useful noninvasive imaging modality in the evaluation of patients with cardiac trauma.
Primary Hemangiopericytoma of the Heart Associated with Pseudoaneurysm of the Pulmonary Artery—A Case Report
Authors: Nakamura Yukio , Nishiya Yasushi , Kawada Masaaki , Ishikawa Tadao , Kaseno Kensuke , Fujimura Mitsuo , Kitagawa Masanobu , Miwa Atsuo
Published: November 2007

A thirty-three-year-old male with malignant hemangiopericytoma of the right ventricular outflow tract and the pulmonary artery associated with pseudoaneurysm formation at the latter is presented. Contrast computed tomography was helpful in diagnosing the pseudoaneurysm of the pulmonary artery. The positional change of the murmur, with a tumor plop caused by the pedunculated tumor of the right ventricular outflow tract, was detected.
Deep Venous Thrombosis of the Upper Extremity— A Case Report
Authors: Featherstone Terence , Bayliss Anthony P.
Published: November 2007

This report describes a case of deep venous thrombosis (DVT) of the upper extremity following a routine blood donation by a regular donor. This cause of an upper limb DVT has not been previously reported. A review of the literature follows.
Atrial Pacing and Thallium 201 Scintigraphy: Combined Use for Diagnosis of Coronary Artery Disease
Authors: Stratmann Henry G. , Mark Alexander L. , Walter Kenneth E. , Fletcher James W. , Williams George A.
Published: November 2007

To evaluate the presence of coronary artery disease (CAD), atrial pacing and thallium 201 scintigraphy were performed in 36 patients with stable angina pectoris who were unable to perform an adequate exercise stress test. All patients underwent cardiac catheterization. Nine patients had previously undergone coronary artery bypass surgery. Significant CAD (one or more lesions ≥ 50%) was present in 33 patients. Atrial pacing produced ischemic ST segment depression (≥1 mm) in 18 (55%) patients with CAD, and angina in 20 patients (61%). As the number of vessels with CAD increased, there was no significant change in the sensitivities of pacing-induced angina or ST segment depression for detecting CAD. In the 3 patients without CAD, ST segment depression occurred in 1 patient and angina in none. Thallium 201 scintigraphy demonstrated perfusion defects in 27 (82%) patients with CAD, with fixed defects seen in 13 studies (39%) and reversible defects in 15 (45%). In the 3 patients without CAD, no perfusion defects were seen. The thallium 201 scan successfully predicted the presence of CAD in patients with single-vessel disease but usually underestimated the number of vessels involved in patients with multivessel disease. Combined sensitivity of pacing-induced ST segment depression and an abnormal thallium 201 scan finding for detecting CAD was 91%. The authors conclude that combined atrial pacing and thallium 201 scintigraphy is a useful test for detecting CAD in patients unable to perform an adequate exercise stress test.
Mesenteric Vein Thrombosis Associated with Klinefelters Syndrome—A Case Report
Authors: Murray Frank E.
Published: November 2007

A case of mesenteric vein thrombosis presenting as gastrointestinal hemorrhage in a patient with Klinefelter's syndrome is reported, an association not previously described. The diagnosis was made preoperatively and was confirmed by angiography. The patient underwent a small bowel resection and made an uneventful recovery. A possible association between Klinefelter's syndrome and a hypercoagulable state, previously suggested elsewhere, is emphasized.