bluuebunny/crossref_metadata_2025 huggingface dataset:
Impact of Endograft Material on the Inflammatory Response After Elective Endovascular Abdominal Aortic Aneurysm Repair
Authors: Gerasimidis Thomas , Sfyroeras Giorgos , Trellopoulos Giorgos , Skoura Lemonia , Papazoglou Konstantinos , Konstantinidis Konstantinos , Karamanos Dimitrios , Filaktou Asimina , Parapanisiou Efthimia
Published: June 2007

The purpose of this paper is to examine the impact of endograft material on the inflammatory response after elective endovascular abdominal aortic aneurysm repair. Consecutive patients (n=22, all men, 53 to 82 years old) were divided into 2 groups according to the graft material used: In group A (n=12) the endovascular device was made of polyester and in group B (n=10) the device was made of expanded polytetrafluoroethylene (ePTFE). All patients received antiinflammatory drugs in the perioperative period. Fever, white blood cells and platelet count, serum concentrations of cytokines (interleukin 6 [IL-6], tumor necrosis factor alpha [TNF-a], interleukin 8 [IL-8], acute-phase proteins high-sensitivity C-reactive protein [hsCRP] and alpha1-antitrypsin [a1-antitrypsin]), and complement protein (C3a) were measured preoperatively and 1, 3, 6, 24, 48, and 72 hours after aneurysm exclusion. One patient in each group had a systemic inflammatory response syndrome with 2 of the systemic inflammatory response syndrome (SIRS) criteria. No other complication associated with inflammation were present in any patient. Fever was more frequent in group A patients. Increases of white blood cells and serum concentrations of IL-6, TNF-a, hsCRP, a1-antitrypsin, and C3a and decrease of platelet count were recorded in both groups, but no statistically significant difference between them was recorded. However, serum concentrations of IL-8 were significantly higher in group A patients 24 hours postoperatively (p=0.01). No significant difference was apparent in the biological response between patients receiving a polyester or an ePTFE stent graft, except for fever and serum concentrations of IL-8.
Circadian Rhythm in Sudden Cardiac Death: A Retrospective Study of 2,665 Cases
Authors: Savopoulos Christos , Ziakas Antonios , Hatzitolios Apostolos , Delivoria Chrysanthi , Kounanis Andreas , Mylonas Stefanos , Tsougas Mathaios , Psaroulis Dimitrios
Published: June 2007

Several studies have reported a circadian variation in sudden cardiac death. The aim of this study was to determine whether in northern Greece sudden cardiac death shows a circadian rhythm and/or a weekly and seasonal distribution. We studied 2,665 sudden deaths due to coronary heart disease from 13,832 sudden deaths that merited autopsy; 1,429 (53.6%) of them were due to acute myocardial infarction (AMI) and 1,236 (46.4%) to chronic ischemic heart disease (IHD). The time of death was determined on the basis of autopsy results and witness interviews. There was a circadian rhythm of sudden cardiac death (p<0.010), with a low incidence during the hours 04.00-08.00 (13.1%) and an increased incidence during 20.00-24.00 (19.8%) (p<0.05). Women did not show the same significant circadian variation. Time of occurrence of sudden cardiac death attributed either to AMI or to IHD showed a similar 24-hour distribution (lowest incidence during 04.00-08.00 hours, 12.8% and 13.5%, respectively, and higher during 20.00-24.00, 19.5% and 20.3%, respectively). Weekday distribution of sudden cardiac death showed a significant statistical variation (p<0.005) with the highest frequency on Monday (21.1%) and the lowest on Sunday (7.5%). The same distribution was observed in men, whereas in women the lower frequency was also on Sunday but the higher was on Tuesday. Sudden cardiac death was evenly distributed over the months of the year, with the highest incidence in summer (27.3%) and the lowest in autumn (22%). Sudden cardiac death shows a circadian rhythm and a significant variation during the week.
Myocardial Injury Due to Lightning Strike
Authors: Alyan Omer , Ozdemir Ozcan , Tufekcioglu Omaç , Geyik Bilal , Aras Dursun , Demirkan Deniz
Published: June 2007

Lightning strike is a natural phenomenon with potentially devastating effects and represents one of the leading causes of cardiac arrest and death from environmental phenomena. Almost every organ system may be impaired as lightning passes through the human body taking the shortest pathways between the contact points. In this paper, the authors report a 38-year-old man who was injured by lightning, a typical example of “side splash,” and had transient electrocardiographic changes.
Relief of Left Ventricular Outflow Obstruction by Cibenzoline in a Patient With Fabry’s Disease
Authors: Morimoto Shin-ichiro , Sugiura Atsushi , Iwase Masatsugu , Kubo Natsuko , Hiramitsu Shinya , Uemura Akihisa , Ohtsuki Masatsugu , Kato Shigeru , Kato Yasuchika , Hishida Hitoshi
Published: June 2007

A 46-year-old man was admitted for further evaluation of exertional chest discomfort. One family member had experienced sudden death, and 2 others had died of heart failure, including 1 known to have had Fabry’s disease. The patient was also diagnosed with Fabry’s disease, based on reduced leukocyte a-galactosidase A activity, 2.0 nmol/mg protein/hour, as well as endomyocardial biopsy findings of marked sarcoplasmic vacuolization of cardiac muscle cells by light microscopy and lamellated “zebra bodies” in the cytoplasm shown by electron microscopy. Echocardiography disclosed marked left ventricular hypertrophy and systolic anterior motion of the mitral leaflets. On cardiac catheterization, a left ventricular peak systolic outflow gradient of 50 mm Hg was noted; this decreased to 10 mm Hg following intravenous administration of 100 mg of cibenzoline. It is imperative to recognize the existence of cases with Fabry’s disease associated with left ventricular outflow obstruction.
Prevention of Positive Coronary Artery Remodeling with Statin Therapy in Patients with Coronary Artery Diseases
Authors: Suzuki Makoto , Saito Makoto , Nagai Takayuki , Saeki Hideyuki , Kazatani Yukio
Published: June 2007

Since positive coronary artery remodeling with large plaque burden is associated with subsequent coronary events, the authors tested their hypothesis that secondary prevention of coronary events by a statin may be associated with inhibition of the process of positive coronary artery remodeling in underlying coronary atherosclerotic lesions in patients with coronary artery diseases. They evaluated the intravascular ultrasound imaging in angiographically normal coronary lesions at baseline and after 6 months of therapy in 64 patients with coronary artery diseases. External elastic membrane area was defined as the vessel area, and the difference between the vessel and lumen area was calculated as plaque area. The relative echogenicity of coronary plaque to adventitia was evaluated as acoustic characteristics of coronary plaque. Twenty-five patients were treated with a statin and 39 patients did not receive a statin. In patients treated with a statin, plaque area decreased by 12% (p=0.013) compared to an increase in plaque area of 13% (p=0.023) in those who did not receive a statin. The vessel area was not enlarged in patients treated with a statin but did show positive remodeling in patients who had plaque progression without a statin. The relative echogenicity of plaque was unchanged in patients treated with a statin but significantly decreased in patients not receiving a statin. A statin may prevent positive coronary artery remodeling via inhibition of plaque progression in underlying coronary atherosclerotic lesions in patients with coronary artery diseases.
High-Sensitivity C-Reactive Protein in Patients with Metabolic Syndrome
Authors: Guven Aytekin , Cetinkaya Ali , Aral Murat , Sokmen Gulizar , Buyukbese Mehmet Akif , Guven Alanur , Koksal Nurhan
Published: June 2007

,!High-sensitivity C-reactive protein (CRP) has been shown to predict cardiovascular disease. Metabolic syndrome has been found to play a critical role in the development of cardiovascular disease. The purpose of this report is to assess the relationship between CRP and the metabolic syndrome. A total of 50 patients with metabolic syndrome and 40 healthy persons were included in the study. Plasma concentrations of CRP were measured by means of particle-enhanced immunonephelometry with the Behring nephelometer using N Latex CRP mono reagent. CRP levels were higher in patients with metabolic syndrome than control group (10.6 ±5.4 mg/L vs 3.5 ±0.8 mg/L, p<0.001). In partial correlation, plasma CRP positively correlated with body mass index (p<0.001), waist circumference (p<0.001), waist-to-hip ratio (p<0.01), total cholesterol (p<0.001), LDL-cholesterol (p=0.033), triglyceride (p=0.023), and fasting blood glucose (p=0.043) in patients with metabolic syndrome. HDL-cholesterol did not significantly correlate with CRP (p>0.05). In multiple regression analysis, body mass index (p<0.01), waist circumference (p<0.01), and fasting blood glucose (p<0.01) showed independent correlations with plasma CRP. CRP levels were found higher in patients with metabolic syndrome. These results suggest that abdominal obesity is the critical correlates of elevated plasma CRP levels found in patients with metabolic syndrome. These patients carrying high risk for cardiovascular events must be followed closely.
Venous Hypertension Induces Increased Platelet Reactivity and Accumulation in Patients with Chronic Venous Insufficiency
Authors: Lu XinWu , Chen YuJie , YinHuang  , Li WeiMin , Jiang MiEr
Published: June 2007

The objective of this study was to determine whether there are changes in platelet activation and rheology in patients with chronic venous insufficiency (CVI) and what their impact is on this disease. Anticoagulated peripheral venous blood collected from 21 patients with CVI and 13 normal control subjects in different bodily positions was incubated either with 0.5 μmol/L adenosine diphosphate (ADP) or without agonist and analyzed by whole blood flow cytometry. Soluble P-selectin was analyzed in obtained sera by enzyme-linked immunosorbent assay. Platelet count was determined by a whole blood analyzer. Circulating platelets were more reactive to stimulation with 0.5 μmol/L ADP in patients with CVI compared with control subjects. There was no statistically significant change in platelet activation without ADP and the level of soluble P-selectin as a function of posture. Under simulated venous hypertension, platelet accumulation was observed in patients with CVI. Patients with CVI had increased platelet reactivity and accumulation during orthostasis, suggesting this might be a contributory factor to CVI pathogenesis.
Cramps and Muscular Pain: Prevention with Pycnogenol® in Normal Subjects, Venous Patients, Athletes, Claudicants and in Diabetic Microangiopathy
Authors: Vinciguerra G. , Belcaro G. , Cesarone M. R. , Rohdewald P. , Stuard S. , Ricci A. , Di Renzo A. , Hosoi M. , Dugall M. , Ledda A. , Cacchio M. , Acerbi G. , Fano F.
Published: June 2007

The aim of this study was to assess the preventive action of Pycnogenol® (Horphag Research Ltd, UK) on cramps and muscular pain in different groups of subjects and patients. The study included a 5-week observation period (4 weeks treatment and one follow-up week after the suspension of treatment) to evaluate the efficacy of Pycnogenol after its withdrawal. Four 50 mg capsules (total dose 200 mg/day) were prescribed with suggestion to drink at least 1.5 liters of water every day. In the first part of the study 66 healthy subjects completed a 5-week follow-up period. The difference between number of cramps attacks recorded within the 2 weeks before inclusion and the number of episodes during the fourth (p<0.05) and fifth (p<0.05) week were statistically significant. In normal subjects the average number of episodes was reduced from 4.8 (1.2) events per week to 1.3 (1.1) at 4 weeks (p<0.05). In venous patients the decrease in events was from 6.3 (1.1) to 2.6 (0.4) per week (p<0.05). In athletes the number of episodes decreased from 8.6 (2) to 2.4 (0.5) (p<0.05). The decrease was still present at 5 weeks in the 3 groups, to levels significantly lower than inclusion values (p<0.05). In the second part of the study, patients with intermittent claudication and diabetic microangiopathy were evaluated and treated (4 weeks). The groups treated with Pycnogenol and the control, placebo groups were comparable. There was a significant decrease in the number of cramps episodes (p<0.05) and in the score concerning muscular pain (p<0.05) in claudicants and diabetics. No significant effects were observed in the placebo groups. In conclusion, cramps and muscular pain, common in these 2 types of patients, were decreased by the use of Pycnogenol. Globally, these results suggest that the use of Pycnogenol prevents cramps, muscular pain at rest, and pain after/during exercise in normals, in athletes prone to cramps, in patients with venous disease, in claudicants, and in diabetics with microangiopathy. The difference is statistically significant considering objective observations (cramps episodes) and evaluating more subjective aspects (score). This indicates that Pycnogenol is effective in reducing pain and cramps during retraining and rehabilitation increasing its efficiency. In starting any physical rehabilitation program, particularly in vascular subjects, the limitation in mobility associated with muscular pain and with cramps tends to be relevant, and controlling these symptoms is useful to speed up the retraining process.
Aortic Pseudoaneurysm as a Rare Cause of Superior Vena Cava Syndrome
Authors: Baldari Duccio , Chiu Sungwai , Salciccioli Louis
Published: June 2007

This case is about an aortic pseudoaneurysm after Dacron graft replacement that presented as a rapidly evolving superior vena cava syndrome.
Gemcitabine and Acute Myocardial Infarction
Authors: Bdair Fadi M. , Graham Susan P. , Smith Patrick F. , Javle Milind M.
Published: June 2007

The objective of this paper is to report a case of acute, non-q-wave myocardial infarction, presumably secondary to gemcitabine chemotherapy for nonsmall cell lung cancer. A 43-year-old woman with postpartum cardiomyopathy and ischemic heart disease was treated with gemcitabine for metastatic nonsmall cell lung cancer. Three days after her 5th treatment with gemcitabine, she developed chest pain and was diagnosed as having acute, non-q-wave myocardial infarction. She made an uneventful recovery. An objective causality assessment revealed that the adverse event was possible. Gemcitabine has been previously reported to be causative of acute myocardial infarction. Ischemic complications of chemotherapeutic agents are discussed. A review of literature on this subject is presented. Gemcitabine should be administered with caution in patients with underlying cardiac disease.
Comparison of Direct Stenting Versus Conventional Stent Implantation on Blood Flow in Patients With ST-Segment Elevation Myocardial Infarction
Authors: Ozdemir Ramazan , Sezgin Alpay Turan , Barutcu Irfan , Topal Ergun , Gullu Hakan , Acikgoz Nusret
Published: June 2007

As compared with balloon angioplasty, stent implantation in treatment of acute myocardial infarction (AMI) reduces abrupt vessel closure, restenosis, and reocclusion rate. However, a few studies have demonstrated the safety and feasibility of direct stenting compared to conventional stent implantation technique. This study was designed to compare possible advantages of direct stenting with conventional stent implantation on immediate coronary blood flow and short-term clinical benefits in patients with AMI. Fifty patients with AMI who underwent mechanical revascularization were eligible for the study. The patients were randomly assigned to undergo either direct stenting (n=25) or conventional stent implantation (n=25). Before and after the procedure thrombolysis in myocardial infarction (TIMI) flow and postprocedural corrected TIMI frame count (cTFC) of the infarct-related artery were measured. There was no difference in TIMI flow distribution at baseline between the 2 groups. TIMI 3 flow rate significantly increased after procedure in both groups compared to baseline (p<0.05). Postprocedural cTFC was found significantly lower in the direct stent arm compared to conventional stenting (p<0.001). Both during and after the procedure the complication rate and procedural time were lower in the direct stenting arm. Direct stenting provides better immediate coronary blood flow and is a safe and feasible method compared with conventional stenting in patients with AMI. Improvement in coronary blood flow measured by the corrected TIMI frame count method may suggests a significant reduction of microvascular injury.
Increased Carotid Artery Stiffness Without Atherosclerotic Change in Patients With Aortic Dissection
Authors: Makita Shinji , Ohira Atsushi , Naganuma Yujiro , Moriai Yoshiteru , Niinuma Hiroyuki , Abiko Akihiko , Hiramori Katsuhiko
Published: June 2007

The arterial properties and pathogenesis of aortic dissection remain obscure. To examine the arterial properties of patients with aortic dissection, the authors studied the ultrasonographic characteristics of the carotid artery in patients with an aortic dissection (AD, n=86), and compared these findings with data of patients suffering from arteriosclerosis obliterans (ASO, n=151), coronary artery disease (CAD, n=163), and with healthy controls (HC, n=77). Atherosclerotic intimal changes, such as intima-media thickness (IMT) and plaque formation, were milder in AD than in ASO or CAD (IMT: 0.83 ±0.16 vs 0.93 ±0.20/0.86 ±0.17 mm, p<0.05; plaque number: 0.6 ±1.1 vs 2.7 ±2.4/2.5 ±2.1, p<0.05). Luminal diameter in AD, ASO, and CAD was significantly higher than in HC. The luminal distensibility in AD was decreased compared with HC but was the same as in ASO and CAD. Intra-AD group analysis showed that in patients with an intramural hematoma (IMH) or a dissection with a thrombosed false lumen (TLF) the IMT was higher than in patients with a classic dissection. In addition, plaque formation was more severe in AD patients with a coexisting abdominal aortic aneurysm (AAA). Reduced distensibility without severe intimal disease was found in AD. These findings suggest that patients with AD may have several arterial alterations, including structural abnormalities. Patients with IMH, TFL, or coexisting AAA may differ from patients who have a classic type of dissection or who do not have AAA, in terms of arterial characteristics including intimal disease and wall elastic property, and the initiating cause of the dissection. Introduction Owing to the progress that has been made in various imaging modalities, the improvement in the accuracy of diagnosing an aortic dissection has resulted in an increase in the detection rate of the various subtypes of classic dissection, such as those associated with an intramural hematoma (IMH), hemorrhage, or a penetrating atherosclerotic ulcer.1,2 However, the etiology and pathogenesis of these catastrophic aortic disorders remain obscure. From the clinical perspective, it has Angiology 57:478–486, 2006 From the Department of Medicine II, Iwate Medical University, Morioka, Japan Correspondence: DOI: 10.1177/0003319706290625 Copyright © 2006 Sage Publications
Predictors of Failure of Endovascular Therapy for Peripheral Arterial Disease
Authors: Yacyshyn Vincent J. , Thatipelli Mallikarjun R. , Lennon Ryan J. , Bailey Kent R. , Stanson Anthony W. , Holmes David R. , Gloviczki Peter
Published: June 2007

The objective of this study was to assess the usefulness of a comparison of clinical failure and restenosis rates of endovascular procedures at 1 year in patients with peripheral arterial disease. The resulting comparison is presented as “clinical failure/restenosis coordinate.” The authors screened 171 papers describing the outcome of lower extremity angioplasty or stent placement. In 20 of them, authors reported detailed outcomes of interest, including baseline demographic measurements, location of arterial occlusive lesions, a measure of restenosis (measured by ankle-brachial indices, ultrasonography, or angiography), and clinical outcomes (mortality, repeat percutaneous transluminal angioplasty, or amputation). An overview of these 20 angioplasty papers was performed. Besides the usual meta-analyses of each end point separately, data were also plotted as coordinates of clinical failure versus restenosis. The clinical failure-to-restenosis coordinate was calculated and reported for percutaneous transluminal angioplasty of the aortoiliac and femoropopliteal distributions. Clinically reported outcomes in the literature were used to calculate the clinical failure/restenosis coordinate. This value was significantly different for various locations of the angioplasty and various baseline angiographic characteristics. A numeric coordinate pair of clinical failure and restenosis is identifiable in patients undergoing endovascular treatment of peripheral arterial disease. The varying coordinates may be important in elucidating the incidence and mechanisms of clinical failure after endovascular treatment. The coordinate reported in this article is hypothesis-generating about mechanisms of endovascular treatment failure. This coordinate is important in determining the role of restenosis in the clinical failure of endovascular therapy of peripheral arterial disease.
Beneficial Effect of Gabexate Mesilate on Microscopic Polyangiitis With Renal Dysfunction and Pulmonary Hemorrhage
Authors: Miyawaki Kiichiro , Shiraishi Jun , Tsutsumi Yasuhiko , Shiraishi Emi , Ohtsuki Katsuichi , Inoue Miho , Tatsumi Tetsuya , Azuma Akihiro , Matsubara Hiroaki
Published: June 2007

Corticosteroids and cyclophosphamide are the mainstay of the treatment of microscopic polyangiitis involving pulmonary hemorrhage or rapidly progressive glomerulonephritis. However, patients with advanced age are unable to tolerate this combined therapy, because of a relatively high incidence of side effects including infection, hemorrhagic cystitis, and bone marrow suppression. The authors encountered an 80-year-old patient with pulmonary hemorrhage and renal dysfunction ascribed to microscopic polyangiitis and achieved successful treatment by employing gabexate mesilate in addition to corticosteroids. The present case suggests that gabexate mesilate may be a therapeutic option for microscopic polyangiitis with progressive renal failure and pulmonary hemorrhage.
The Relationship Between Ankle-Brachial Index and Leisure-Time Physical Activity in Patients With Intermittent Claudication
Authors: Gardner Andrew W. , Clancy Ryan J.
Published: June 2007

The purpose of the study was to examine the relationship between ankle-brachial index (ABI) and leisure-time physical activity (LTPA) in patients with peripheral arterial disease limited by intermittent claudication. Patients included 342 sedentary men and women between the ages of 45 and 85 with intermittent claudication confirmed by a resting ABI of less than 0.90. Patients were categorized into either a low ABI group (ABI <0.50; n=84), a middle ABI group (ABI = 0.50 to 0.69; n=164), or a high ABI group (ABI = 0.70 to 0.89; n=94). The Minnesota LTPA questionnaire was used to estimate physical activity patterns, and a treadmill test, 6- minute walk test, and Walking Impairment Questionnaire were used to measure ambulatory function. A progressive decrease (p=0.030) in the total LTPA was observed among the high ABI (180 ±131 kcal/day; mean ± SD), middle ABI (138 ±127 kcal/day), and low ABI (110 ±89 kcal/day) groups. Progressive decrements in LTPA spent at moderate intensity (p=0.016) and high intensity (p=0.009), as well as the mean intensity of LTPA (p=0.024) were observed among the three respective ABI groups. Group differences in the LTPA measurements were no longer present (p>0.05) after adjusting for group differences in the absolute claudication distance during a treadmill test, and the 6-minute walk distance. The decline in total daily LTPA with progressively lower ABI in patients with intermittent claudication was due to their decreased participation in physical activities requiring moderate and high intensities. In addition, group differences in the LTPA measurements were explained by differences in ambulatory function.
Oral Mycophenolate Mofetil Prevents In-Stent Intimal Hyperplasia Without Edge Effect
Authors: Ilkay Erdogan , Tirikli Latif , Ozercan Ibrahim , Yavuzkir Mustafa , Karaca Ilgin , Rahman Ali , Arslan Nadi
Published: June 2007

Neointimal hyperplasia is in the forefront in in-stent restenosis. Prevention of in-stent restenosis is possible by reducing and inhibiting the hyperplasia of smooth muscle cells. The authors planned this study to test the hypothesis that when administered orally, mycophenolate mofetil (MMF) could inhibit in-stent neointimal hyperplasia. The study included 14 New Zealand rabbits. The rabbits were allocated to 2 different groups: Group 1 included 7 rabbits that were given MMF, 40 mg/kg/day by oral route. Group 2 included 7 rabbits that were not given MMF after the stenting. Sampling materials were taken before and after stenting by incising the artery so as to cover a 5-mm area. The samples taken from the edge of the stent in Group 1 showed focal neointimal cell proliferation, but it was less than that from the control group. Neointimal thickness was 0.048 ±0.009 mm and neointimal area was 0.0925 ±0.019 mm2. Apparent neointimal cell proliferation and thickening of the intimal layer were observed in Group 2. Neointimal thickness at the stent edge was 0.147 ±0.051 mm and the neointimal area was 0.154 ±0.023 mm2. The differences between groups in terms of neointimal thickness and neointimal area were statistically significant (p=0.001 for thickness and p=0.001 for area). In-stent artery samples of Group 1 showed that some subjects had no neointimal cell proliferation, while others had very limited focal intimal thickening. Neointimal thickening was 0.071 ±0.003 mm and neointimal area was 0.073 ±0.003 mm2. In Group 2 apparent, and mostly focal, neointimal cell proliferation and formation of intimal layer were observed in the stent. Neointimal thickening was 0.154 ±0.069 mm and neointimal area was 0.279 ±0.059 mm2. The comparison between groups showed significant differences (p=0.011 for thickness and p=0.001 for area). It was established in the third month that endothelialization was completed in both groups. Oral MMF decreased in-stent intimal hyperplasia without edge effect. It was concluded that for the prevention of in-stent restenosis, studies should be conducted for using systemic immunosuppressive treatments in humans as well.
The Presence of a Calcific Plaque in the Common Carotid Artery as a Predictor of Coronary Atherosclerosis
Authors: Kanadaşı Mehmet , Çaylı Murat , Şan Mustafa , Aikimbaev Kairgeldy , Alhan C. Cumhur , Demir Mesut , Demirtaş Mustafa
Published: June 2007

Many contradictory reports have been published investigating the relationship between coronary artery disease (CAD) and the increased intima-media thickness (IMT) in the common carotid artery (CCA). However, only a limited number of studies evaluate the relationship between CAD and CCA disease as reflected by both the plaque morphology (fibrous and calcific plaques) and IMT. We have studied the associations between CAD and the wall morphology of CCA by B-mode ultrasound (US). One hundred and forty-four subjects, whose angiography was planned on the basis of suspected CAD, were included into the study. The patients were divided into 4 groups on the basis of B-mode US findings; Group I: normal, Group II: increased IMT (IMT ≥ 0.8 mm and plaque absent), Group III: fibrous plaque, Group IV: calcific plaque. Coronary artery disease was diagnosed in 63 patients. A statistically significant correlation was found between CAD and CCA wall morphology (r =0.42, CI (95%) = 0.30-0.51, p<0.001). Positive predictive values were 45.0%, 48.4%, and 75.0% in patients with increased IMT, fibrous plaque, and calcific plaque, respectively. None of the women with normal CCA wall morphology had significant coronary artery lesion. With respect to the normal group, the risk for CAD increased by 4.3 fold with the existence of fibrous plaque (p=0.02) and by 9.9 fold with the existence of calcific plaque (p<0.001). It has been shown that the CCA wall morphology determined by B-mode US is correlated with CAD in patients with chest pain, and the presence of calcific plaque is a better predictor for CAD than that of fibrous plaque and increased IMT. Women with chest pain and normal CCA wall morphology may not need coronary angiography.
Infective Endocarditis in an Adult Patient With CHARGE Association: A Case Report
Authors: Antonatos Dionisios , Patsilinakos Sotirios , Touliatou Vassiliki , Sotirelos Konstantinos , Frisira Elena , Tsigas Dimitrios
Published: June 2007

A case of an adult patient with CHARGE association complicated with infective endocarditis is presented.
Mobile Stenosis in a Left Internal Mammary Artery Graft: A Case Report
Authors: Nakamura Takeshi , Azuma Akihiro , Sawada Takahisa , Sakamoto Kenzo , Yamano Tetsuhiro , Yaku Hitoshi , Matsubara Hiroaki
Published: June 2007

The authors report a case of percutaneous transluminal angioplasty (PTA) with coronary stent for stenosis in a left internal mammary artery (IMA) graft, which led to newly developed stenosis at both sides of the stent in the IMA graft. The intravascular ultrasound (IVUS) revealed that the stenotic lesion consisted of intramural hematoma, which had shifted owing to the stent deployment. They suggest that the cause of stenotic lesions in IMA grafts at the early postoperative period is luminal compression by intramural hematoma, which can be visualized by use of IVUS. The strategy of PTA for IMA grafts performed at the early postoperative period should include consideration for hematoma shift.
Management of a Patient With a Null Low-Density Lipoprotein Receptor Mutation
Authors: Kolovou Genovefa D. , Dedoussis George V.Z. , Anagnostopoulou Katherine K. , Hatzigeorgiou George Ch. , Salpea Klelia D. , Choumerianou Despoina M. , Rammos Spyridon , Mikhailidis Dimitri P. , Cokkinos Dennis V.
Published: June 2007

A 13-year-old Greek boy with severe dyslipidemia, large tuberous xanthomas over the knees and elbows, Achilles’ tendon xanthomas, and a bilateral corneal arcus was referred to the Lipid Clinic. He had a supravalvular aortic stenosis, 50% to 60% stenosis of both carotid arteries, and normal coronary arteries. Familial hypercholesterolemia was clinically diagnosed. A V408M null low-density lipoprotein receptor (LDLR) mutation was identified in homozygosity. He responded to lipid-lowering drugs by decreasing total cholesterol by 32%, low-density lipoprotein cholesterol by 33%, and triglyceride levels by 30%. Additional treatment with low-density lipoprotein-apheresis further decreased total cholesterol by 52%, low-density lipoprotein cholesterol by 55%, and triglycerides by 43%. Low-density lipoprotein cholesterol levels between apheresis sessions showed a declining pattern. A significant regression of tuberous xanthomas was noted. A suitable combination of lipid-lowering drugs is effective even in this case of homozygosity for a null LDLR mutation. Furthermore, the coadministration of statins, cholestyramine, and ezetimibe during low-density lipoprotein-apheresis tends to counterbalance the postapheresis relapse in low-density lipoprotein cholesterol levels.
Effects of Statins on Restenosis After Coronary Stent Implantation
Authors: Kamishirado Hirotoshi , Inoue Teruo , Sakuma Masashi , Tsuda Tatsuhiro , Hayashi Terumi , Takayanagi Kan , Node Koichi
Published: June 2007

Experimental data and preliminary clinical studies suggest that lipid-lowering drugs might have a beneficial effect on restenosis after coronary angioplasty. Recently, statins have been focused on prevention of restenosis after coronary stent implantation. However, their benefit has not yet been established. The authors studied the effects of statins on stent restenosis. We compared retrospectively the quantitative coronary angiographic (QCA) variables between 62 dyslipidemic patients treated with statins (pravastatin or fluvastatin) and 62 normolipidemic patients, as a control, treated without statins after undergoing successful coronary stent implantation with 6-month follow-up angiography from May 1999 to December 2002. Major cardiac events were about the same in both groups. Each of the QCA variables before and immediately after coronary stenting was similar in the 2 groups. At follow-up angiography, however, minimal lumen diameter (MLD) (2.12 ∓0.73 vs 1.78 ∓0.7; p<0.01) was larger in the statin group than in the normolipidemia group. Both restenosis rate (15% vs 31%; p=0.05) and target lesion revascularization rate (10% vs 24%; p=0.05) were lower in the statin group than in the normolipidemia group. Statin reduced restenosis rate. The efficacy of statins appears to be dependent on their pleiotropic effects on vascular wall rather than on lipid-lowering effects.
Effects of Heart Rate on Brachial-Ankle Pulse Wave Velocity and Ankle-Brachial Pressure Index in Patients Without Significant Organic Heart Disease
Authors: Su Ho-Ming , Lee Kun-Tai , Chu Chih-Sheng , Lee Ming-Yi , Lin Tsung-Hsien , Voon Wen-Chol , Sheu Sheng-Hsiung , Lai Wen-Ter
Published: June 2007

This study evaluated the effects of heart rate (HR) on brachial-ankle pulse wave velocity (baPWV) and ankle-brachial pressure index (ABI). Thirty-two patients without significant organic heart disease underwent elective cardiac catheterization or electrophysiologic study, and were then enrolled in right atrial pacing (RAP; 11 men, 9 women; aged 48 ∓15 years) or right ventricular pacing (RVP; 6 men, 6 women, aged 45 ∓13 years) studies. Three different HR levels (90, 100, and 110 beats per minute) were paced in random order. By stepwise, multiple linear regression analysis, age, systolic blood pressure (SBP), and pulse pressure (PP) correlated positively with baseline baPWV. In the RAP group, as HR increased, baPWV and left brachial diastolic blood pressure increased significantly (p ≤0.015), while ABI, left ankle SBP, left brachial PP, and left ankle PP decreased significantly (p ≤0.013). In the RVP group, as HR increased, baPWV also increased significantly (p=0.001), while ABI, left ankle SBP, and PP decreased significantly (p ≤ 0.034). Values of baPWV and ABI may be influenced by HR in young and middle-aged patients without significant organic heart disease. When these values are used to evaluate and follow up cardiovascular risk in patients, HR changes should be considered.
Simultaneous Multivessel Coronary Spasm Causing Acute Myocardial Infarction
Authors: Saito Hidenori , Itoh Tomonori , Itoh Masahiro , Kanaya Yoshinori , Suzuki Tomomi , Hiramori Katsuhiko
Published: June 2007

Spontaneous simultaneous multivessel coronary artery spasm in patients with acute myocar-dial infarction (AMI) is uncommon. A 79-year-old Japanese man was transferred to this hospital because of severe prolonged chest pain and faintness. Left coronary angiography revealed total occlusion of the left anterior descending and the left circumflex coronary arteries. Moreover, right coronary angiography revealed 99% stenosis of the right coronary artery. After intracoronary administration of nicorandil, left coronary artery and right coronary artery angiography revealed no organic stenosis or thrombus. This is the first report in which simultaneous 3-vessel spasm was documented by emergency angiography in AMI.
Wasted lives
Authors: Fullagar Simone
Published: June 2007

Youth suicide is a specific gesture of waste, a throwing away of the gift, and thus it embodies a powerful statement about young people's refusal to live. In this article I suggest that it is a refusal to engage with, and be sustained by, the particular economies of value, morality and meaning that govern identity within contemporary cultural life. From a post-structuralist perspective the metaphors through which suicide comes to be known are examined via indepth interviews conducted with young people ( n = 41) as part of a larger study also involving adults/professionals ( n = 40) within urban and regional communities. Shame figures predominantly in young people's accounts of suicidal experiences and the everyday social relations that govern the expression of emotion. In contrast to the positivist bent of much suicide research and policy, this article argues for the necessity of understanding the social dynamics of shame in relation to the forces of affect that constitute the emergent subjectivities of young people.
Managing Pediatric Atopic Dermatitis
Authors: Raimer Sharon Smith
Published: June 2007

Although atopic dermatitis is a very common inflammatory skin condition in children and results in many pediatric healthcare visits, its exact cause is unknown. No single laboratory test can reliably diagnose atopic dermatitis, but a relatively simple set of diagnostic criteria was recently validated for use by practicing physicians. Because existing remedies for atopic dermatitis do not cure the disorder, a program of disease control and management should be pursued. Patients and their caregivers should be advised that current therapies are primarily preventive and palliative. However, a comprehensive plan that includes routine general skin care, medical management of symptoms, identification and avoidance of aggravating factors (including psychological factors), and attention to quality-of-life issues can reduce the occurrence of skin flares. Successful treatment of acute flare-ups can be achieved with appropriate use of topical corticosteroids, but occasionally children afflicted with severe atopic dermatitis require more intensive therapies (e.g., ultraviolet light exposure, systemic corticosteroids, and cyclosporine) that need close physician monitoring. Physicians must remain mindful of the psychological and quality-of-life burdens imposed on children with atopic dermatitis and their families and tailor treatments to the needs of each individual patient.
Etiologic Factors of Acute Aortic Dissection in Children and Younrg Adults
Authors: Fikar Charles R. , Koch Simone
Published: June 2007

Current concepts in the pathophysiology and predisposing conditions of acute aortic dissection in children, adolescents, and young adults are presented. Timely diagnosis is required for this life-threatening condition. Most children and adolescents with aortic dissection have congenital cardiovascular anomalies. Certain heritable disorders involving connective tissue also predispose to this disorder. Newer associations include cocaine abuse and weight lifting. To facilitate early diagnosis, the salient physical findings of the known predisposing conditions are reviewed. Clinical presentation and diagnostic imaging of aortic dissection are briefly summarized. Physicians working in an acute care setting, particularly in the emergency room, should be aware of disorders predisposing to acute aortic dissection in the pediatric and young adult population. Practitioners conducting school or college preparticipation sports evaluations can make use of such information in their assessment of risk for sudden death.
The Ketogenic Diet in Refractory Epilepsy: The Experience of Children's Hospital of Pittsburgh
Authors: Katyal Neelam G. , Koehler Anita N. , McGhee Bill , Foley Catherine M. , Crumrine Patricia K.
Published: June 2007

The ketogenic diet appears to be effective in reducing seizure frequency in patients with epilepsy refractory to antiepileptic drug therapy. Reported seizure frequencies before and after the diet was initiated were obtained for 48 patients started on the ketogenic diet between December 1994 and January 1998 at Children's Hospital of Pittsburgh. The majority of patients (71%) were able to achieve?50% reduction in seizure activity. Of these, more than half (53%) had >90% reduction in seizures after 45 days of diet therapy. Complications included gastrointestinal complaints and infrequent lipid abnormalities. The ketogenic diet appears to be an effective method of treatment for children with epilepsy refractory to drug therapy.
New Developments in Type 1 (Insulin-Dependent) Diabetes
Authors: Silverstein Janet H. , Rosenbloom Arlan L.
Published: June 2007

The Diabetes Control and Complications Trial has conclusively demonstrated that improved metabolic control leads to reduction in the rate of microvascular complications of diabetes. In order to allow patients to achieve improved metabolic control, much research has focused on improved methods of glucose monitoring and more physiologic ways of insulin delivery. The 2 most promising methods of minimally invasive blood glucose monitoring are the Glucowatch, using the technique of reverse iontophoresis to measure interstitial fluid glucose levels every twenty minutes and an implantable sensor, in which a catheter resembling that used for insulin delivery through a pump is impregnated with glucose oxidase at the tip. This device monitors blood sugars every few minutes, but like a holter monitor, must be downloaded in the physician's office. Still under development are (1) implantable subcutaneous sensors with a high and low blood glucose alarm and (2) sensors in which the patient will be able to download the data using a home PC. Advances in insulin delivery have included the availability of new insulin analogs which more closely simulate endogenous insulin release, with rapid acting analogs simulating the increase in insulin production that normally occurs after meals. Phase III clinical trials are in progress of a long-acting basal insulin without peak actions to simulate the low dose continuous production of the insulin which normally inhibits hepatic glucose production. In addition, use of the insulin pump has increased markedly since publication of the DCCT with the greatest increase being among adolescents. In addition to advances in treatment of diabetes, research has continued on curing the disease using islet cell transplantation and preventing the disease with agents such as insulin (DPT-1 Trial) and nicotinamide (ENDIT). This article provides an overview of recent advances in diabetes management and prevention.
Relationship Between Scholastic and Health Behaviors and Reading Level in Adolescent Females
Authors: Matson Steven C. , Haglund Kristin A.
Published: June 2007

This was a study of 102 adolescent females, 12-20 years of age, presenting to a central city clinic for medical care. Participants completed an oral questionnaire that included demographics, and questions regarding scholastic history, sexual behavior, and substance use. Each subject completed the Accuracy Level Test (ALT), a reading test. The subject's reading test grade level was subtracted from her appropriate grade in school to give a reading delay level (RDL). The mean reading grade level for all subjects was 6.7 2.6 and the average reading delay was 4.5 2.5 grades. Poor school attenders had greater reading delays (5.8 3.4 grades behind vs. 4.3 .2 for good attenders p<0.04), and those who repeated grades were also significantly delayed (5.5 .4 grades behind vs. 3.7 .3, p<0.0007). Previously pregnant students had a greater delay in reading level than their nonpregnant peers (5.2 .3 vs. 3.9 .5 respectively p<0.01). Delayed reading levels appear to correlate with some risk behaviors. The ALT may serve as a tool to identify high-risk patients who need more intensive clinical intervention.
Spontaneous-Onset Atrial Fibrillation in a Toddler with Review of Mechanisms and Etiologies
Authors: Zachary Christopher H. , Cyran Stephen E.
Published: June 2007

Atrial fibrillation is a relatively rare form of arrhythmia in the pediatric population. When it is seen in an infant or child, it is often associated with a structural heart abnormality, particularly after surgical repair or palliation of congenital heart disease. Other episodes may be associated with metabolic derangements. This report discusses the unique case of a toddler with newonset atrial fibrillation that was devoid of a readily identifiable etiology. It also reviews the literature and the implications of such a case for the primary care practitioner.
An Examination of the Unintended Consequences of the Rule-Out Sepsis Evaluation: A Parental Perspective
Authors: Paxton Richard D. , Byington Carrie L.
Published: June 2007

In order to document unintended consequences of the “rule-out” sepsis (ROS) evaluation, a survey of parents of infants who had undergone such an evaluation at Primary Children's Medical Center in 1997 was conducted. Sixty parents were interviewed. Parental perceptions of the sepsis evaluation and its impact on their families were recorded. Specific data evaluated included parental anxiety, impact on breastfeeding, perceived complications, financial stress, and parental preferences. The majority of parents found the ROS evaluation very stressful. Parental perception of illness increased significantly after being told the infant would require an ROS evaluation, with nearly 30% of parents, after speaking with a physician, believing their infant might die. Breastfeeding problems were reported by 36% of the mothers. latrogenic complications were reported by 33%. Although all infants were covered by some form of insurance, 43% of parents reported financial stress. Forty-two percent of parents would have preferred to be treated at home and all parents would prefer an evaluation that could be accomplished in 24 hours. We conclude that unintended consequences of the ROS evaluation included excessive parental anxiety, cessation of breastfeeding, iatrogenic complications, and financial stress. Suggestions to decrease these adverse consequences are given.
Injury Reduction and Bounce Characteristics of Safety Baseballs and Acceptability by Youth Leagues
Authors: Yamamoto Loren G. , Inaba Alson S. , Okamura Daryl M. , Yamamoto Julienne A. , Yamamoto Joelle B.
Published: June 2007

The only reasonable way to reduce the potential for ball-related youth baseball injuries sustained by the defensive players (the majority of ball-related injuries) is to make the ball less injurious. The American Academy of Pediatrics' 1994 statement on youth baseball injuries in this regard reads, “Consideration should be given to utilizing low-impact NOCSAE-approved baseballs and softballs for children 5 to 14 years of age, if these balls demonstrate satisfactory playing characteristics and reduce injury risk. A variety of studies should be undertaken to determine the efficacy of low-impact balls in reducing serious impact injuries.” The purpose of this study, in accordance with this AAP policy, is to investigate the following: A) injury reduction potential of softer baseballs, B) their bounce characteristics, and C) their acceptability by youth leagues. Six simple injury models were studied, baseball bounce characteristics were analyzed, and attitudes of safety baseballs among statewide Little League district presidents were surveyed. Injury models demonstrated less injury potential with safety baseballs compared to that with standard hard baseballs. Safety baseballs bounced higher after vertical drops and slow throws, but during fast throws (with the greatest injury potential), the bounce heights were similar for all ball types. Of 27 survey cards sent out, 13 were returned. While 9 respondents indicated that they were already using safety baseballs for the younger players, none of the 13 respondents indicated that they were planning to expand the use of safety baseballs in their leagues. In conclusion, safety baseballs are less injurious in these models. The bounce characteristics of safety baseballs are satisfactory. Youth baseball league officials are not very willing to expand the use of safety baseballs. We recommend using safety baseballs as a standard for all youth baseball leagues because these balls are safer.