bluuebunny/crossref_metadata_2025 huggingface dataset:
Transjugular Approach to Treat Portal Vein Stenosis After Liver Transplantation
Authors: González-Tutor Andrés , Abascal Faustino , Cerezai Luis , Bustamante Manuel , Bustamante Manuel
Published: July 2008

The authors present a case of portal vein stenosis that developed shortly after liver transplantation in a 48-year-old woman treated successfully with portal stent implan tation by use of a transjugular approach to achieve portal vein access. To their knowledge, there are no other reports in the literature on the use of a transjugular approach with vein stent placement in the treatment of portal stenosis complicating orthotopic liver transplantation.
Noninvasive Evaluation of Arterial Abnormalities in Young Patients with Neurofibromatosis Type 1
Authors: Ratti Gennaro , Di Salvo Giovanni , Martiniello Alfonso Roberto , Limongelli Giuseppe , Grieco Michela , Calabrese Elvira , Grassia Carolina , Iacono Aldo , Lama Giuliana , Tedesco Michele Adolfo
Published: July 2008

Neurofibromatosis regroups at least two different autosomal dominant genetic disorders: neurofibromatosis type 1 (NF1) and neurofibromatosis type 2 (NF2). Vascular disease is an underestimated complication of NF1. Few studies are available on this, all based on case reports. Neurofibromin, NF1 protein product, has also been detected in aortic smooth muscle. The purpose of this study was to evaluate the physical properties of the vessels, by measuring the carotid-femoral pulse wave velocity (PWV). This parameter was assessed by the Complior®, a new noninvasive, validated device, used to screen a large population. The authors studied 64 neurofibromatosis patients (34 boys and 30 girls) with a mean age of 12 years (range 5-25 years). To investigate the presence of vascular lesions, aortic stiffness was evaluated by carotid-femoral PWV by using an automatic processor (Complior®). They compared data from the PWV with a control group (30 healthy children, 17 boys and 13 girls, mean age 11 years, range 5-23 years). The calculated mean PWV in the control group was 6.5 ±1.15 m/s. The mean PWV of the 64 young patients with NF1 was 6.3 ±1.02 m/s. There was no difference between the two groups (p=0.39). Nevertheless, analysis of the linear regression has shown a linear relationship between systolic blood pressure (SBP) and PWV in the control group, while in NF1 patients this relationship is not present. The authors suggest that the coexistence of different factors, such as intimal proliferation, thinning media, fragmentation of the elastic tissue, irregularity, stenosis and tortuosity of the vessels, dysplasia of the small vessels, that counterbalance PWV, normalize the mean value. They emphasize the impor tance of a careful vascular evaluation, using noninvasive method, such as Complior®. This device is well accepted by NF1 patients.
Endotoxemia and Mediator Release During Cardiac Surgery
Authors: Storck M. , Buttenschoen K. , Berger D. , Hannekum A. , Boelke E.
Published: July 2008

Endotoxemia in man is a controversial issue. However, endotoxin is a potent trigger of the inflammantory response. Therefore, endotoxin translocation and mediator release was investigated in patients undergoing cardiac surgery. In 40 patients (13 women and 27 men, ages ranging from 30 to 73 years with a median of 60 years), plasma concen trations of endotoxin, interleukin-6 (IL-6), and C-reactive protein (CRP) were determined during and after cardiovascular bypass. In a subgroup of 10 patients, myeloid-related proteins: MRP8, MRP14, and the soluble heterocomplex (MRP8/MRP14) levels were additionally studied. A significant increase (p<0.01) of plasma endotoxin concentrations was found during surgery, culminating in a peak (median value of 0.82 EU/mL) during reperfusion. Plasma levels of endotoxin continued to be slightly raised until the 5th post operative day, whereas those of interleukin-6 rose at the end of the operation and were at their highest level 6 hours postoperatively (median value of 218 pg/mL). CRP levels were increased 24 hours postoperatively with a median value of 114 mg/L and peaked on day 2 (191 mg/L). A statistically significant correlation between the intraoperative endotoxin plasma concentrations and IL-6 concentrations was established (p<0.05). The MRP8/MRP14 heterocomplex increased until day 2 after surgery, except MRP14, which showed the highest level at day 1 (55 ng/mL). Cardiac surgery is associated with endo toxemia and a marked acute-phase response. Therefore, endotoxin must be regarded as a pathophysiologic mediator. The role of the gut as a source of endotoxemia following cardiac surgery deserves further attention.
Acute Success Rates of Percutaneous Transluminal Coronary Angioplasty in the Treatment of Chronic Complete Occlusions with Use of the 0.014 Magnum Meier Wire
Authors: Mauser Manfred
Published: July 2008

The 0.014 inch magnum Meier wire was used as the primary tool for recanalization of chronic total coronary artery occlusions in 230 consecutive patients treated by a single operator over a 3-year period. Exclusive use of the magnum wire resulted in an acute success rate of 80.9% in all occlusions and 64.7% in occlusions with a duration of > 6 months. The complication rate of this procedure was extremely low with only one nontransmural myocardial infarction occurring. There were no vessel perforations, no in-hospital deaths, and no need for acute surgery. After failure to recanalize with the magnum wire, various other devices (conventional stiff guidewires, jagwire, crosswire) were used resulting in only six additional successful recanalizations but also in two vessel perforations with spontaneous closure of the perforation hole. Therefore, the 0.014-inch magnum Meier recanalization wire is highly effective for recanalization of chronic coronary artery occlusions, if used as the primary tool by an experienced operator, and is associated with an extremly low complication rate.
Effects of Perindopril on Left Ventricular Remodeling and Aortic Regurgitation in Rats Assessed by Echocardiography
Authors: Murakami Kazushi , Mizushige Katsufumi , Noma Takahisa , Kimura Shoji , Abe Yoichi , Matsuo Hirohide
Published: July 2008

This study investigated the effect of the angiotensin-converting enzyme (ACE) inhibitor perindopril on left ventricular (LV) remodeling and cardiac function in rats with aortic regurgitation (AR). Twenty male Sprague-Dawley rats in which AR was produced by closed-chest aortic valve puncture were divided into untreated and perindopril-treated (5 mg/kg/day) rats. Ten control rats were sham-operated. Blood pressure, body weight, and echocardiographic recordings were followed every 2 weeks for a period of 12 weeks. LV dimension (LVD) and fractional shortening (FS) were calculated. The heart was finally excised for weight, hydroxyproline measurements, and histopathology. At 12 weeks, end- diastolic LVD increased in untreated rats (10.8 ±0.2 mm) but did not dilate in treated rats (9.6 ± 0.3 mm, p < 0.01 vs untreated rats). FS decreased from 6 weeks in untreated rats (27.3 ±0.9% at 12 weeks), but did not change in treated rats (33.8 ±0.5%, p < 0.001). The ratio of LV weight to body weight in untreated rats (2.62 ±0.11 mg/g, p < 0.05) was higher than in sham-operated rats (1.52 ±0.02 mg/g) and than in treated rats (1.95 ±0.07 mg/g). Interstitial collagen accumulation histopathologically increased in untreated rats and was inhibited in treated rats. LV collagen of untreated rats (1.46 ±0.08 mg/100 mg, p = 0.03) was higher than those of treated (1.08 ±0.09 mg/100 mg) and sham-operated rats (1.06 ±0.14 mg/100 mg). Perindopril inhibited LV remodeling induced by volume overload and preserved LV function in AR rats.
Factors Influencing Efficacy of Nitrate Therapy for Stable Angina Pectoris: A Multiple Linear Regression Analysis
Authors: Jansen Rutger , Niemeyer Menco G. , Cleophas Ton J. , Zwinderman Aeilko H.
Published: July 2008

In an open-label self-controlled study of 1,350 patients with stable angina pectoris (SAP), we previously demonstrated that 50 mg of isosorbide mononitrate (ISMN) slow release formulation once daily not only provided a better antianginal effect but also a better quality of life (QOL) than did the daily administration of multiple small doses of the compound. It is unknown whether certain patient characteristics contribute to this benefit. The objective of this article was to determine what independent factors contribute to this benefit. Multiple linear regression analysis was performed on the data from these 1,350 patients. Quality of life was assessed by the Marquis QOL-question naire for patients with angina and included the domains of immobility, pain, and psycho logical distress. For the purpose of this study, overall QOL was calculated as the pooled sums of the domain scores and expressed as mean scores on an ordinal scale of 10.

Age did not influence the beneficial effect of nitrate therapy on QOL. Neither did gender, rhythmic disturbances, peripheral artery disease, or the concomitant use of calcium channel blockers or beta blockers. New York Heart Association (NYHA) angina classification was an independent variable: patients with a NYHA class I or II benefited less than did patients with NYHA III or IV (p = 0.02). Obese patients as well as hyper tensive patients benefited less (p = 0.04 and 0.02), and smokers tended to benefit less also (p = 0.08). In contrast, hypercholesterolemia and diabetes mellitus improved the beneficial effect of nitrates on QOL (p = 0.03 and 0.05).

The authors conclude that patients with coronary artery disease (CAD) and concomitant diabetes mellitus or hypercholesterolemia, a category particularly prone to early endothelial dysfunction and thus dysfunctional endogenous nitric oxide (NO) production, may benefit more from NO-donor therapy than patients without such concomitant conditions.
Permanent Left Ventricular Pacing from the Great Cardiac Vein of a Patient with Artificial Tricuspid and Mitral Valves
Authors: Batur Mustafa Kemal , Akgül Ebru , Övünç Kenan
Published: July 2008

Transvenous placement of a right ventricular pacemaker lead through the artificial tricuspid valve is a known contraindication, and in this situation, epicardial pacemaker implantation is the procedure of choice. However, permanent pacemaker implantation is a subject for debate when the use of the epicardial route is impossible. This report describes alternate transvenous routes for a pacemaker lead in a patient with an artificial tricuspid valve and mitral valve in whom the epicardial lead and pacemaker generator must be removed because of resistant infection.
Scleroderma Pericardial Disease Presented with a Large Pericardial Effusion
Authors: Gowda Ramesh M. , Khan Ijaz A. , Sacchi Terrence J. , Vasavada Balendu C.
Published: July 2008

Scleroderma pericardial disease is usually silent and benign. The incidence of pericardial involve ment in scleroderma is about 50% according to autopsy results, but symptomatic pericarditis manifests in about 16% of patients with diffuse scleroderma and in about 30% of patients with limited scleroderma. The clinically evident pericardial effusion is rare in scleroderma, although it can be detected in about 41 % of patients with echocardiography. In majority of the patients, the pericardial effusion is small and not associated with symptoms. The pericardial effusion manifests usually after the manifestation of the other clinical and serologic features of scle roderma. A case of scleroderma is reported that presented with a large pericardial effusion, which antedated the other clinical and serologic features of scleroderma. The pericardial involvement in scleroderma is reviewed.
Circulating Interleukin-1 Beta, Interleukin-6, Tumor Necrosis Factor-Alpha, and Soluble ICAM-1 in Patients with Chronic Stable Angina and Myocardial Infarction
Authors: Balbay Y. , Tikiz H. , Baptiste R.J. , Ayaz S. , Şaşmaz H. , Korkmaz Ş.
Published: July 2008

The changes in serum concentrations of cytokines such as interleukin-1 (IL-1) beta, interleukin- 6 (IL-6), tumor necrosis factor (TNF) alpha and a soluble-intercellular adhesion molecule (sICAM- 1) has been investigated in patients with stable angina and acute myocardial infarction. Thirty- four patients with stable angina (SA), 15 with acute myocardial infarction (AMI), and 20 subjects in the control (C) group were included in the study.

The mean serum concentrations of sICAM-1, IL-1-beta, IL-6, and TNF-alpha differed signif icantly among the three groups. Serum concentrations of IL-1 beta, sICAM-1, and TNF-alpha were comparable in the AMI and SA groups and higher than those found in the C group (p<0.001). The serum concentration of IL-6 was more than twice as high in the AMI group as compared to the other two groups (p<0.001). The mean serum concentrations of IL-1 beta, TNF-alpha, and IL-6 were comparable in the AMI and SA groups and higher than in the C group.
The 1999 French Venous Disease Survey: Epidemiology, Management, and Patient Profiles
Authors: Lévy Emile , Los Frédéric , Chevalier Hélène , Lévy Pierre
Published: July 2008

A recent (1999) Sofres survey of representative samples of the adult French population aged 15 and over showed that almost half this population suffered from lower limb venous complaints and that 43% of them were untreated. Of those treated, 24.2% received venotropics, including 21.5% by prescription, while 6.0% practiced self-medication. Venous disease sufferers form a relatively underprivileged sector of the population in terms not only of age, income, work and living conditions, but also of general health and medical history. Despite its clinical efficacy and potential social utility, venotropic treatment is possible only if backed by adequate state health insurance coverage supplemented by mutual and private insurance schemes. Any restriction to such coverage will only decrease access to prescription venotropics.
Coronary Artery Ectasia, Aneurysm of the Basilar Artery and Varicose Veins: Common Presentation or Generalized Defect of the Vessel Wall?
Authors: Triantafillidi Helen , Rizos Ioannis , Androulakis Aristides , Stratos Konstantinos , Arvaniti Chrisa , Toutouzas Pavlos
Published: July 2008

A young man who suffered from an acute myocardial infarction is presented. He presented coronary artery ectasia along with coronary artery disease. Further evaluation revealed the presence of both a saccular aneurysm of the basilar artery as well as varicose veins of the lower limbs. A common pathogenic mechanism is discussed since all these findings are characterized by similar histologic substrate with the most profound defect being destruction of the myoelastic elements of the media.
St. Anthony's Fire (Ergotamine Induced Leg Ischemia)
Authors: Zavaleta Ernesto G. , Fernandez Bernardo B. , Grove Mark K. , Kaye Marc D.
Published: July 2008

Ergotism, once an epidemic disease, is now a rare disorder. The most common manifestation is acute peripheral ischemia due to vasospasm,1 with an incidence of 0.001%.2 We report a case of a middle-age woman who presented with ergotamine-induced leg ischemia, due to chronic use of ergotamine-containing medications for migraine headaches. The diagnosis was confirmed with arteriography results, and she responded well to vasodilator therapy. The pharmacology, clinical presentation, diagnostic approach, and therapy of ergotism are reviewed.
Severe Lower Limbs Lymphedema of Late Onset Revealing Polysplenia Syndrome
Authors: Granel Brigitte , Serratrice Jacques , Juhan Valérie , Champsaur Pierre , Weiller-Merli Claude , Pache Xavier , Swiader Laure , Disdier Patrick , Weiller Pierre-Jean
Published: July 2008

Polysplenia syndrome includes a group of congenital abnormalities involving the spleen, gastrointestinal tract, liver, and cardiovascular system. A case of severe lower limbs lymphedema occurring in a young woman with polysplenia, azygous continuation of the inferior vena cava, short pancreas, and preduodenal portal vein is reported. Lower limb lymphedema could represent a new clinical manifestation associated with polysplenia syndrome. Lymphedema could be the result of a primary anomaly of the lymphatic system or be induced by high pressure in the venous system or by compression of the lymphatic circulation by the hypertrophic azygous vessels in the posterior mediastinum.
Lower Extremity Blood Flow in Healthy Men: Effect of Smoking, Cholesterol, and Physical Activity — A Doppler Study
Authors: Ásgeirsdóttir Lilja Petra , Agnarsson Uggi , Jónsson Guomundur S.
Published: July 2008

Tobacco smoking is one of the principal risk factors of peripheral arterial disease (PAD); choles terol level has a lesser impact. The effect of leisure-time physical activity (LTPA) has not been studied in depth. The aim of this study was to determine the relative effects of smoking, total cholesterol, and leisure-time physical activity on blood flow parameters in the lower extremi ties of healthy middle-aged men with no prior symptoms or diagnosis of PAD.

The authors examined 130 men, aged 40-65 years, free of known arterial disease and hypertension. The men had either a total cholesterol concentration of <5.7 or > 7.0 mmol/L, and were either smokers or nonsmokers. LTPA was addressed by a questionnaire. Ankle-brachial index (ABI) was calculated and Doppler examination of the femoral artery was performed before and after an exercise test.

Tobacco smoking related significantly to abnormal ABI and Doppler results (odds ratio [OR] 2.42) while the total cholesterol level did not. LTPA had a favorable effect (OR 0.51). Abnormal ABI response was greatest in smokers with high total cholesterol (p < 0.01).

Tobacco smoking is a significant risk factor for abnormal ABI response and blood flow abnormalities in healthy men. Regular physical activity has a measurable protective effect. An abnormal ABI suggests early atherosclerosis and indicates risk factor assessment and physician intervention.
The Significance of Chlamydia pneumoniae in Symptomatic Carotid Stenosis
Authors: Katsenis Constantin , Kouskouni Evangelia , Kolokotronis Ludovikos , Rizos D. , Dimakakos P.
Published: July 2008

An association between symptomatic carotid stenosis and recent infection with Chlamydia pneumoniae is reported. Thirty-five patients (20 symptomatic and 15 asymptomatic) with carotid stenosis of 70% to 90% underwent carotid endarterectomy. Endarterectomy was performed without patch and shunt; the average occlusion time of the internal carotid artery was 14 ±3 min. The atheromatic plaque and a portion of the thyroid artery were examined with polymerase chain reaction and peripheral vein blood was obtained for serologic detection of systematic infection, and IgG and IgM antibodies to C. pneumoniae by enzyme-linked immunosorbent assay.

Twenty of 35 patients (57.1 %) had increased titers of IgG antibodies to C, pneumoniae. Eight patients revealed IgG plus IgM antibodies; two of the eight had IgG, IgM, and positive findings on polymerase chain reaction. No C pneumoniae was detected on the thyroid arteries. Sixty-five percent (13/20) of the patients with increased IgG antibodies to C. pneumoniae, 87.5% (7/8) with IgG + IgM, and 100% with IgG + IgM + positive polymerase chain reaction were symptomatic. Plaque morphology in association with symptoms did not reveal a significant correlation between soft plaques and symptoms, whereas the majority of the symptomatic patients had plaques of type III-V. Patients having recent contamination and positive poly merase chain reaction had a significant relationship between C. pneumoniae infection and symptomatic carotid disease. This supports the hypothesis that C. pneumoniae infection can produce a kind of instability of the carotid plaque. The results of this study demonstrate that patients with advanced atherosclerotic carotid disease have an increased incidence of C. pneu moniae infection. Recent infection could be responsible for instability of the carotid plaque, causing cerebral ischemic episodes.
Adenoviral-Mediated Transfer of Tissue Plasminogen Activator Gene into Brain Capillary Endothelial Cells In Vitro
Authors: Ai Kim Jeong , Hedrick Catherine C. , Dangci Xie  , Fisher Mark J.
Published: July 2008

Tissue plasminogen activator (tPA) has a critical role in fibrinolysis, converting plasminogen into active protease plasmin. Because intravenous tPA has only limited effectiveness as acute stroke therapy, enhancement of endogenous tPA represents a potential alternative to stroke treatment. Adenoviral-mediated gene transfer was used to enhance production of tPA in bovine brain capillary endothelial cells (BEC). Antigen and activity levels of tPA and plasminogen activator inhibitor-1 (PAI-1) in media from BEC infected with AdCMVtPA were analyzed. Conditioned media were analyzed for thrombomodulin, the integral membrane antithrombotic molecule that co-activates protein C. BEC infected with AdCMVtPA demonstrated enhanced expression of tPA antigen (40.2 ±0.4 ng/mL vs 1.1 ±1.5 ng/mL [p<0.001] and 0.3 ±0.5 ng/mL [p<0.0001 ], respectively) and increased tPA enzymatic activity (27.4 ±5.7 IU/mL vs 8.3 ±1.7 IU/mL [p<0.05] and 13.3 ±3.2 IU/mL [p<0.05], respectively) compared to BEC infected with the control adenovirus (AdI327) or uninfected BEC. There was a moderate increase in PAI-1 protein 4 days after transfection with AdCMVtPA, and the integral membrane protein throm bomodulin was released into media by transfected BEC. These results demonstrate that aden oviral-mediated delivery in vitro of the human tPA gene resulted in high levels of expression of tPA in BEC. Transient overexpression of tPA by gene transfer might be a useful strategy to protect against thrombotic occlusion during the period of risk of acute stroke.
Renal Vascular Resistance in Progressive Systemic Sclerosis: Evaluation with Duplex Doppler Ultrasound
Authors: Aikimbaev Kairgeldy S. , Canataroglu Abdullah , Özbek Süleyman , Usal Ayhan
Published: July 2008

The study was planned to evaluate renal vascular resistance by means of duplex Doppler ultra sonography in patients with progressive systemic sclerosis (PSS) with or without signs of renal involvement. Twenty-two female patients with PSS (mean age 38.5 ± 17.3 years) and 20 age-matched (mean age 36.7 ±7.2 years) female healthy controls participated to the study. Doppler indices of renal vascular resistance—resistive index (RI), pulsative index (PI), and systolic-to-diastolic flow velocities ratio (S/D ratio)—were determined on main renal artery and interlobar artery. RI, PI and S/D ratio were found to be increased in PSS patients with signs of renal involvement as compared to those without renal manifestations and healthy controls (p<0.0001 for all groups). Doppler indices of renal vascular resistance were closely related to the duration of the disease, age, and plasma renin activity. Doppler ultrasound is a useful and informative technique in the monitoring of PSS patients with renal involvement.
Use of Recombinant Hirudin in Heparin-Induced Thrombocytopenia and Thrombosis (HITT) and Renal Failure
Authors: Whelen Suzy , Carr Marcus E.
Published: July 2008

Treatment of critically ill patients who have heparin-induced thrombocytopenia and throm bosis (HITT) and also renal failure is a challenge. Recombinant hirudin (Refludan, Hoechst Marion Roussel) is a direct thrombin inhibitor indicated for anticoagulation in HITT and approved by the United States Food and Drug Administration. Because this drug is renally cleared, a single dose of hirudin may induce prolonged (up to one week) unpredictable antico agulation in patients with renal insufficiency. There are a few case reports of patients with renal failure and suspected heparin-induced thrombocytopenia (HIT) in which patients were anticoagulated with Refludan for catheter thrombosis. There is no literature on the thera peutic use of Refludan to treat HITT in patients with diffuse thrombosis and renal failure. The authors report the case of a 44-year-old female dialysis patient with HITT and extensive life- threatening thrombosis. The patient developed common iliac vein occlusion extending to the right atrium with progressive right internal jugular vein thrombus developing while on heparin. Her platelet count dropped to 60,000/μL. She was lethargic and hemodynamically unstable. Refludan was initially given as a bolus of 0.2 mg/kg (total, 12 mg) at a 50% dose reduction based on the patient's ideal body weight. This dose was based on the published pharmacoki netics of Refludan in patients with renal failure. Only 2 additional boluses of 6 mg and 3 mg were needed to extend the duration of therapeutic anticoagulation (measured by PTT) to 140 hours. The patient improved both clinically and radiographically after the treatment with Refludan. There were no additional thromboembolic events or bleeding complications. The platelets returned to normal within a few days. The patient was transitioned to coumadin and discharged from the hospital. She remains stable at 1-year follow-up.
Asymptomatic Left Ventricular Permanent Pacemaker Malposition Detected on Routine Follow-up
Authors: Kassotis John , Mirhoseni Nader , Makan Majesh , Reddy C.V.R.
Published: July 2008

The authors present an asymptomatic left ventricular pacemaker lead malposition that was detected upon routine 2-D Echocardiography. Clinical implication diagnosis and therapeutic options on left ventricular pacemaker lead malposition are discussed.
Aortic Valve Calcification: Its Significance and Limitation as a Marker for Coronary Artery Disease
Authors: Hisar Ismet , Ileri Mehmet , Yetkin Ertan , Tandoğan Izzet , Cehreli Sengül , Atak Ramazan , Senen Kubilay , Demirkan Deniz
Published: July 2008

Aortic valve calcification (AVC) is correlated with atherosclerotic risk factors; however, its significance remains largely unknown. The aim of this study was to investigate whether AVC detected by transthoracic echocardiography can be a useful marker for the identification of significant coronary artery disease (CAD), particularly in elderly patients. The study included 432 consecutive patients with suspected CAD who were admitted for the first time for coronary angiography. Two-dimensional transthoracic echocardiography and selective coronary angiography were performed in all patients. Aortic valve calcification was defined as bright dense echoes of > 1 mm on one or more cusps and decreased mobility of the involved cusp. Aortic valve calcification was detected in 64 of the 337 patients with significant CAD, but only in 9 of 95 cases with normal or mildly stenotic coronary arteries (19% vs 9%, p < 0.001). The severity of coronary artery disease (defined as the number of obstructed vessels) was not related to the presence of AVC (p > 0.05). Stepwise multiple logistic regression analysis of the study patients revealed only age (p = 0.003, odds ratio = 1.56) and AVC (p < 0.001, odds ratio = 2.03) as independent predictors of CAD. When the study population was divided into two groups as those below (n = 338) and above (n = 94) 75 years old, AVC failed to be a predictor of CAD in those > 75 years old (p > 0.05, odds ratio = 0.8) while it remained the most significant predictor of CAD (p < 0.001, odds ratio = 2.19 in patients aged < 75 years. In conclusion, detection of AVC by transthoracic echocardiography may be a useful noninvasive marker for identification of significant CAD in patients younger than 75 years old. Its clinical usefulness is limited in elderly patients.
Ultrasonic Correlates of Common Carotid Atherosclerosis in Patients with Coronary Artery Disease
Authors: Takashi Wada , Tsutomu Fukumoto , Kentaro Fujishiro
Published: July 2008

Increased intima-media thickness and plaque development in the extracranial carotid arteries reportedly correlate well with the prevalence of coronary artery diseases. The location of these atherosclerotic lesions in the carotid artery varies with age in patients with coronary artery atherosclerosis. Intima-media thickness, plaque, and calcification in the common carotid artery and bifurcation were assessed with high-resolution B-mode ultrasonography. Forty patients with severe atherosclerosis of the coronary artery and 56 healthy control subjects with no risk factors for coronary atherosclerosis were included in this study. The subjects were divided into a middle-age group (40-59 yr) and an old-age group (60-79 yr). In both groups, the intima- media thickness in the patients was significantly higher than that in the controls. Intima-media thickness of at least 0.7 mm in the middle-age group and at least 1.0 mm in the old-age group was specific and positively predictive of coronary artery disease. Plaque (> 1.0 mm) and calci fication were more significant in patients than in controls. In the middle-age group, intima- media thickness in the common carotid artery was correlated with coronary atherosclerotic severity. Conversely, in the old-age group, the presence of plaque and calcification at the bifur cation was correlated with coronary atherosclerotic severity. The characteristic manifestation of the atherosclerotic lesion in the carotid artery varied with age in patients with coronary artery disease.
Exaggerated Endothelin Release in Response to Acute Mental Stress in Patients with Intermittent Claudication
Authors: Mangiafico Roberto Antonio , Malatino Lorenzo Salvatore , Attinà Teresa , Messina Rossella , Fiore Carmelo Erio
Published: July 2008

Endothelin-1 (ET-1) is an endothelial-derived 21-amino-acid peptide with potent vasocon strictor and mitogenic properties implicated in several cardiovascular disorders. To evaluate the plasma ET-1 response to mental stress in patients with intermittent claudication, plasma endothelin concentrations were measured by radioimmunoassay in 15 claudicant outpatients (13 men and 2 women; mean age 62 ±4 years) and in 15 sex- and age-matched healthy control subjects (12 men and 3 women; mean age 60 ±8 years) before and after mental arithmetic performed for 10 minutes. Venous blood samples were drawn from an antecubital vein at baseline, at the end of the mental arithmetic, and at 10 minutes of recovery. Baseline ET-1 values were higher in patients with intermittent claudication as compared with control subjects (4.5 ±0.5 pmol/L and 2.2 ±0.3 pmol/L, respectively, p<0.0001). At the end of mental stress, ET-1 levels rose significantly in both groups from baseline (p < 0.00 1 ) reaching a higher value in patients with intermittent claudication than in control subjects (5.6 ±0.7 pmol/L and 2.4 ±0.4 pmol/L, respectively, p < 0.0001). The percent increases (Δ%) in ET-1 plasma concen trations from baseline in response to mental stress were significantly greater in claudicant patients than in control subjects (+23 ±9% and +9 ±7%, respectively, p < 0.0001). ET-1 plasma concentrations returned to baseline values similarly in both groups at minute 10 of the recovery period. These findings show that acute mental stress causes an exaggerated release of ET-1 in patients with intermittent claudication and suggest that this could be a potential pathophysiological mechanism through which mental stress may trigger adverse acute cardiac events and accelerate progression of atherosclerosis in these patients.
Cumulative Incidence of Venous Thromboembolism During Pregnancy and Puerperium: A Hospital-Based Study
Authors: Soomro R.M. , Bucur I.J. , Noorani S.
Published: July 2008

Pregnancy is associated with an increased risk of venous thromboembolism. The rate of occur rence of this complication has not been reported from this area previously. The aim of this study was to establish the incidence of venous thromboembolism in pregnancy and puer perium by using objective diagnostic methods. From January 1986 to December 1998, 39,757 deliveries were registered at King Fahad Hospital, Al Baha, and 59 of these were referred to hematology services with a clinical suspicion of venous thromboembolism. The majority (86%) of these underwent objective diagnostic methods such as ascending venogram (AV) and color Doppler imaging (CDI) of the venous system for the diagnosis of deep venous thrombosis (DVT). Pulmonary scintigraphy was performed when available and echocardiog raphy was included towards the end of the study. Fifty-nine patients with suspicion of pregnancy-associated venous thromboembolism (PAVTE) were studied. The diagnosis was confirmed in 50 patients, who received anticoagulation therapy. DVT was diagnosed in 35 (70%) cases and pulmonary embolism in 27 (54%) cases. The cumulative incidence of PAVTE was 1.25 cases per 1,000 deliveries (95% confidence interval = 0.89-1.16 ). One patient died during the study period (0.025 case per 1,000 deliveries). There was a predominance of venous thromboembolism during the postpartum period (66%), and DVT occurred more frequently in the left leg (77%). The risk of pregnancy-associated venous thromboembolism is low and a resulting death rare. Proximal or whole-limb DVT occurs more frequently and there is a predilec tion for the left leg. The majority of events occur in the postpartum period. A hypercoagulable state probably exists and needs further evaluation.
Favorable Response to High-Dose Interferon-Alpha in Idiopathic Hypereosinophilic Syndrome with Restrictive Cardiomyopathy
Authors: Baratta Luigi , Afeltra Antonella , Delfino Massimo , De Castro Stefano , Giorgino Flavia , Rossi-Fanelli Filippo
Published: July 2008

The idiopathic hypereosinophilic syndrome is characterized by a prolonged overproduction of eosinophils of unknown cause in addition to specific organ damage due to eosinophil-derivated protein toxicity. Its prognosis is correlated with heart involvement that results in a restrictive cardiomyopathy. This is frequently biventricular. Isolated left ventricular infiltration has rarely been reported. The authors report a case of idiopathic hypereosinophilic syndrome with cardiac involvement obliterating the left ventricular cavity with a favorable clinical outcome following a combination therapy with interferon-alpha, hydroxyurea and prednisone. Data from other studies dealing with the treatment of idiopathic hypereosinophilic syndrome with interferon- alpha are reviewed and discussed.
Lethal Heparin-Associated Pulmonary Embolism
Authors: Claeys Luc G. Y.
Published: July 2008

Thrombocytopenia is a known adverse reaction occurring in some patients receiving heparin. Two different types of heparin-induced thrombocytopenia have been described. Heparin- induced thrombocytopenia type I is a mild thrombocytopenia after 1 to 4 days of heparin therapy, attributed to a direct interaction between heparin and circulating platelets. No specific treatment is necessary. Heparin-induced thrombocytopenia type II is a severe thrombocy topenia mediated by an immunologic mechanism. Type II generally develops after 5 to 10 days of heparin therapy and can be associated with potentially devastating thromboembolic compli cations. The incidence of heparin-induced thrombocytopenia type II is below 3%. Thrombo embolic events are always accompanied by a decrease in the platelet count, however, compli cations in the absence of absolute thrombocytopenia have been reported. Diagnosis of HIT type II is based on clinical features and laboratory studies for the heparin-dependent platelet antibody. Immediate cessation of heparin administration is essential. Several alternative anti coagulant therapies have been studied and have shown promising results when used for this purpose. Two patients undergoing coronary artery bypass surgery are presented in whom pulmonary embolism developed due to heparin-induced thrombocytopenia type II. In both cases, platelet counts were within the subnormal range at the time of the first thromboembolic complication. The clinical, therapeutic, and prognostic implications are discussed.
Middle Aortic Syndrome Diagnosed at 54 Years of Age
Authors: Seki Akiko , Ogawa Hiroshi , Fujiu Katsuhito , Kawagoe Yasuhiro , Kasanuki Hiroshi
Published: July 2008

A 54-year-old woman was admitted to our hospital because of heart failure, upper-limb hyper tension, and lower-limb claudication. A loud systolic bruit was audible along the middle lower back. An arteriogram confirmed long-segment stenosis from the lower thoracic to the upper abdominal aorta with normal aortic arch. The patient was diagnosed as having middle aortic syndrome. This case was atypical because most cases of this disease are seen in children and young adults. After administration of diuretics and ACE-I, the heart failure and hypertension were both improved. However, the lower limb claudication was aggravated because of decreased blood pressure of the lower limb. In this patient, percutaneous angioplasty or surgical treatment will be required to prevent the recurrence of heart failure and to improve long-term quality of life by relief from intermittent claudication.
Angiographic Concurrence of Coronary Artery Disease and Aortoiliac Lesions
Authors: Rangel Alberto , Albarrán Héctor , Solorio Sergio , Hernández-González Martha Alicia
Published: July 2008

The importance of recognizing the association between aortoiliac disease and coronary artery disease includes the following: (1) Long-term morbidity is higher and survival ratio poorer in patients with coronary heart disease compared with isolated lower extremity revascularization surgery. (2) Coronary artery bypass grafting is a relatively high-risk procedure in patients with severe vascular disease. (3) There is the prospect that the patient will eventually face simul taneous coronary artery and vascular surgery, or coronary artery angioplasty previous to aortoiliac surgery. The aim of this investigation is to know the frequency of the association of coronary artery disease with aortoiliac lesions and to stratify the risk factors related to such an association. In total, 65 men and 19 women (30 to 76 years of age) with a history of coronary heart disease underwent abdominal aortography after selective coronary artery and left ventricle angiography. Aortoiliac lesions were identified at angiograms. Relevant coronary artery disease was diagnosed when at least 1 coronary artery was obstructed > 50%. The frequency of association between aortoiliac and coronary artery lesions was established, as well as the relationship of these lesions to the following clinical variables: age, weight, height, smoking habit, history of coronary heart disease, systemic arterial hypertension, diabetes mellitus, intermittent claudication, glycemia, uricemia, and triglyceridemia. There were 36 patients (42.9%) with aortoiliac lesions. In 34 patients (40.5%) coronary artery disease was associated with aortoiliac lesions. Abdominal aortic dilations were found in 10 instances, abdominal aortic stenosis in 13 patients, and stenosis of the iliac arteries or their branches on 28 occasions. The variables statistically related to the presence of aortoiliac lesions were smoking habit and a history of intermittent claudication. The number of affected coronary arteries was directly related to the frequency of aortoiliac lesions. In the entire sample, 11 patients (13%) had no coronary artery disease, and 15 (17.9%) had 1-vessel, 24 (28.6%) 2- vessel, and 34 (40.5%) 3-vessel disease. The extent of coronary disease was directly related to the frequency and extent of aortoiliac lesions. Frequencies of aortoiliac lesions were strongly related to a history of smoking habit and intermittent claudication and directly related to the extent of coronary artery disease.
The LONFLIT4-Venoruton Study
Authors: Cesarone Maria Rosaria , Belcaro Gianni , Brandolini Rossella , Di Renzo Andrea , Bavera Pietro , Dugall Mark , Simeone Emilio , Acerbi G. , Ippolito Edmondo , Winford Michelle , Candiani Carlo , Golden Gerard , Ricci Andrea , Stuard Stefano
Published: July 2008

The aim of this independent study was to evaluate the protective effects, on the development of flight edema, of Venoruton. The study included patients with venous disease traveling in economy in long-haul flights (9 hours). Edema is a relevant aspect of long-haul flights affecting both patients with venous disease and normal subjects. Microcirculatory variations during flights cause a microangiopathy and biochemical and coagulation alterations. This condition may be defined as flight microangiopathy. A group of 203 subjects with chronic venous disease (uncomplicated varicose veins) at low-medium risk for DVT were contacted; 43 subjects were excluded for several nonmedical, travel-related problems or inconvenient eval uation time; the remaining 160 were randomized, after informed consent, into 2 groups to evaluate 2 prophylaxes in 7-8-hour, long-haul flights: The treatment group received Venoruton (hydroxyethyl rutosides) 1 g twice daily for 3 days (2 days before the flight and the day of the flight). The control group received comparable placebo. The edema score was based on the edema tester, ankle circumference, volume measurements, subjective swelling, and discomfort score. Items 1, 4, and 5 are based on an analogue scale line (1 to 10) directly defined by the subjects before and after the flights. Of the 160 included subjects 139 completed the study. Dropouts (21) were due to poor compliance, traveling, and/or connection problems (11 in the control group, 10 in the treatment group). Age and sex distribution were comparable in the 2 groups as were risk factors distributions. The level of edema at inclusion was comparable in the 2 groups of subjects. After the flight there was an average score of 7.2 (sd 2) in the control group, while in the Venoruton group the score was on average 3.2. (sd 1.1) (p < 0.05), 2.25 times lower than in the control group (p < 0.05). In the control group 89% of the subjects had an evident increase in ankle circumference and volume, which was clearly visible at inspec tion and associated with discomfort. In the Venoruton group edema was clearly present in 12% of subjects (associated with discomfort between 5 and 7 on the analogue scale line) and it was mild-moderate, not associated with symptoms (pain, discomfort between 2 and 4 on the analogue scale line). Therefore, the control of flight edema with Venoruton was clear both considering parametric data (circumference and volume) and nonparametric (analogue scale lines) measurements. The combined evaluation of the edema score is significantly favorable for patients treated with Venoruton. No deep vein thrombosis or superficial vein thrombosis was observed in this study.
Primary Stenting Produces Earlier and More Efficient Myocardial Reperfusion than Primary PTCA Alone in Patients with Acute ST Segment Elevation MI
Authors: Karavidas Apostolis J. , Vrachatis Antony D. , Alpert Martin A. , Nikas Dimitris J. , Achtypis Dimitrious J. , Foukarakis Masolis G. , Matsakus Evangelos P. , Thedocharis Costas S. , Zacharoulis Apostolos A.
Published: July 2008

Restoration of blood flow in the infarct-related artery and subsequent myocardial reperfusion are major goals of both thrombolysis and primary percutaneous interventions. Whether percu taneous transluminal coronary angioplasty (PTCA) with immediate stenting (primary stenting) produces reperfusion more rapidly than primary PTCA alone is uncertain. This study deter mines whether primary stenting produces earlier myocardial reperfusion than primary PTCA alone in patients with acute ST segment elevation myocardial infarction using troponin T release kinetics. Primary stenting was performed on 60 patients and primary PTCA alone on 44 patients with typical ischemic chest pain and greater than 1.5 MV ST segment elevation in more than 2 contiguous electrocardiographic leads. Serum troponin T concentrations were measured before and after intervention; every 6 hours for 24 hours; then at 36, 48 and 72 hours. The mean time from onset of chest pain to peak serum troponin T concentration was 7.8 ±2.7 hours after primary stenting and 14.5 ±4.4 hours after primary PTCA (p < 0.0005). The mean peak serum troponin T concentration was 9.8 ±6.3 ng/dL after primary stenting and 13.6 ±6.4 ng/dL after primary PTCA (p < 0.012). A significant univariate association with time to peak concentration of serum troponin T was identified for primary stenting (p < 0.0005), time from onset of chest pain to intervention (p < 0.04), and diabetes mellitus (p < 0.01). The only significant univariate marker associated with peak concentration of serum troponin T was primary stenting (p < 0.012). Multivariate analysis indicated that primary stenting (p < 0.0005), time from onset of chest pain to intervention (p < 0.048), and diabetes mellitus (p < 0.022) significantly influenced time to peak serum concentration or troponin T. Primary stenting produces earlier myocardial reperfusion than primary PTCA in patients with acute ST segment elevation myocardial infarction.
Differential Benefits and Outcomes of Tirofiban vs Abciximab for Acute Coronary Syndromes in Current Clinical Practice
Authors: Gowda Manohar S. , Vacek James L. , Lakkireddy D.J. , Brosnahan Kathleen , Beauchamp Gary D.
Published: July 2008

Little comparative data exist for glycoprotein IIb/IIIa inhibitors in acute coronary syndromes (ACS). Two hundred twenty-eight patients were studied: 114 received tirofiban (TI) and 114 received abciximab (AB) for either unstable angina (UA) or myocardial infarction (MI). All patients received aspirin, heparin, and ticlopidine or clopidogrel. Baseline characteristics were similar between the 2 groups for admitting diagnosis (UA vs MI), age, gender, ejection fraction, diabetes mellitus, prior coronary artery disease, prior myocardial infarction (MI), prior bypass surgery, hypertension, congestive heart failure, hyperlipidemia, MI type (Q vs non-Q), or location. Drug administration time (mean) was 13 hours (AB) and 24 hours (TI). All AB was administered in the catheterization laboratory as compared to TI (34% in laboratory and 66% before laboratory). More AB patients received angioplasty or stent (92% vs 80%, p = 0.008) while more TI patients had CABG (10% vs 3%, p = 0.027). In-hospital complications including death, MI, urgent revascularization, cerebrovascular accidents or transient ischemic attacks, and access site bleeding were similar (p = NS). Multivariate predictors of events (odds ratios) were prior coronary artery bypass graft (2.3), diabetes (1.7), and prior percutaneous translu minal coronary angioplasty (1.7), but not the agent used. Over a mean follow-up of 13 months, the individual endpoints of death, MI, revascularization, or hospitalization were similar for both groups. The AB patients had improved freedom from revascularization (100% vs 81%, p=0.015) in an emergent setting and TI patients had improved freedom from revascularization (93% vs 77%, p= 0.038) with elective procedures. Tirofiban and abciximab appear effective and safe when used for ACS when recommended dosing and precautions are followed. Major adverse outcomes are rare and bleeding complications uncommon.