bluuebunny/crossref_metadata_2025 huggingface dataset:
Effect of Physical Activity on the Distensibility of the Aortic Wall in Healthy Males
Authors: Kakiyama Tetsuji , Matsuda Mitsuo , Koseki Susumu
Published: July 2008

To study the effect of physical activity level on the distensibility of the human aortic wall, aortic pulse wave velocity (APWV) was estimated in 139 healthy male subjects (19-67 years) and was related to the energy expenditure by habitual physical exercise (physical activity index: PAI), which was evaluated by a 7-day total activity recall. The subjects consisted of 56 fun runners (runner group) and 83 general subjects, who were divided into 25 active subjects (active group: PAI ≥ 1,500 kcal/week) and 58 sedentary subjects (sedentary group: PAI < 1,500 kcal/week). The APWV index (APWVI: standardized APWV by the diastolic blood pressure) was found to be positively correlated with age and was negatively correlated with PAI. The age-adjusted APWVI of the runner group was significantly lower than that of the active and sedentary groups. The age-adjusted APWVI was also significantly lower in the active group than in the sedentary group. These results suggest that increased physical activity may retard the age-dependent loss of arterial distensibility in humans, in proportion to the amount and/or intensity of exercise.
Pulmonary Embolism in Patients with Isolated Soleal Vein Thrombosis
Authors: Ohgi Shigetsugu , Tachibana Maromi , Ikebuchi Masahiko , Kanaoka Yasushi , Maeda Teruo , Mori Tohru
Published: July 2008

This study investigated the features of calf deep vein thrombosis (DVT) as a pulmonary embolic source. Fifty-eight lower limbs in 29 patients who were suspected of having DVT distal to the popliteal vein were screened by ultrasonography. Then, ascending venog raphy was performed to confirm the diagnosis. Pulmonary embolism (PE) was diagnosed in suspected patients by use of pulmonary perfusion scanning or pulmonary angiography. Venography revealed calf DVT in 33 limbs in 28 patients. Of 28 patients, six had symp tomatic PE. Thrombosis was found in the muscle veins in 18 limbs, the trunk veins in 11, and both veins in four. Isolated single vein thrombosis was found in the soleal vein in 14 limbs (42%), the posterior tibial vein in eight, the peroneal vein in two, and the gastroc nemius vein in two. The overall percentage of soleal vein thrombi was 61%. All six patients with symptomatic PE had isolated soleal vein thromboses. Calf DVT was a pulmonary embolic source when isolated thrombosis of the large soleal vein was more than 7 mm in diameter. Soleal veins were the most frequent and important location of calf DVT, suggesting that these were an occasional embolic source of critical PE.
Bilateral Fistulas from the Internal Mammary Arteries and the Bronchial Arteries to the Pulmonary Arteries
Authors: Misumi Ikuo , Ueno Kazuhiro , Kimura Yoshihiro , Hokamura Youichi , Yamabe Hiroshige , Yasunaga Tadamasa , Oguni Tatsuro , Asao Chiaki
Published: July 2008

A 78-year-old man was admitted to hospital with heart failure and chronic bronchitis. A computed tomographic scan of the chest incidentally demonstrated bilateral abnormal vessels near the left atrium. Selective angiography showed that both internal mammary arteries and bronchial arteries communicated with the pulmonary arteries bilaterally. The patient refused surgery and was discharged on medical therapy. This is the first reported case of bilateral fistulas between the internal mammary arteries and bronchial arteries and the pulmonary arteries.
The Role of Leukocytes in the Pathogenesis of Vibration-Induced White Finger
Authors: Greenstein D. , Kester R.C.
Published: July 2008

Vibration white finger (VWF) is an occupational disorder associated with long-term exposure to hand-transmitted vibration. The condition exhibits features of secondary Raynaud's phenomenon. The etiology is unknown. The aim of this study was to examine the role of leukocyte rheology in the pathogenesis of VWF.

Fifty-two male subjects divided into two groups were exposed to controlled acute hand-transmitted vibration. One group consisted of 29 workers who have all had occu pational exposure to handheld vibration and all suffered from VWF (mean age 46.9 years, range 22-66) . The second group consisted of 23 controls. Venous blood was analyzed from the dorsum of the hand before and after vibration to determine granulocyte deformability, granulocyte morphology, and white blood cell count with differential. There was a subpopulation of hard and poorly deformable granulocytes in the VWF group when compared with controls (p < 0.05). Acute hand-transmitted vibration had no in vitro effect on leukocyte rheology in either group.

Leukocyte rheology may play a role in the pathogenesis of microvascular disease and tissue ischemia in VWF, although whether this is a cause or an effect of the disorder is not clear.
Young Woman's Digestive Arterial Occlusion
Authors: Crètel Elodie , Disdier Patrick , Chagnaud Christophe , Tournigand Pierre , Harlé Jean-Robert , Piette Jean-Charles , Weiller Pierre-Jean
Published: July 2008

The authors report the observation of a 31-year-old woman who presented with total occlusion of digestive arteries and was successfully treated pharmacologically. A review of the literature shows that digestive arteries thrombosis is a rare condition in young women. Only 15 cases have been previously reported. Prognosis was poor with a mortality rate of 71%; 93% used oral contraception and more than 50% were smokers. All these cases were curiously similar. The authors accentuate the role of iloprost in the recovery of the patient. Digestive artery occlusion should be taken into consideration in the differential diagnosis of abdominal pain, especially in young women who smoke and take estrogen-containing birth control pills.
An Improved Method for Coronary Sinus Blood Flow Monitoring by Intravascular Doppler Technique
Authors: Vandoni Pietro , Perondi Rodolfo , Saino Antonio , Pomidossi Guido , Ciulla Michele , Paliotti Roberta , Tortora Giovanni , Valentini Patrizia , Magrini Fabio
Published: July 2008

In order to obtain accurate measurements of coronary sinus blood flow (CSBF), a new catheter (7 French) with a radiopaque, flexible, and basket-shaped tip was developed for guiding a standard 3 Fr Doppler catheter in the coronary sinus (CS) in man. The radiopaque "basket" tip of the catheter allows the operator to stabilize the position of the Doppler transducer in the center of the CS and to accurately measure the CS internal diameter radiologically. CSBF was calculated as the product of CS cross-sectional area by mean CSBF velocity. Doppler-derived CSBF values at rest and during handgrip were compared with those obtained by the local thermodilution technique in 16 patients undergoing diagnostic coronary angiography. During handgrip, mean CSBF increased from 154 ±23 (rest) to 299 ±34 mL/min by the Doppler method and from 148 ±22 to 288 ±32 mL/min by the thermodilution technique. A good correlation (r = 0.86) between the CSBF values with the two techniques was observed. The authors conclude that the intravascular Doppler technique associated with the use of the basket guide catheter provides an accurate and simple tool for monitoring CSBF in patients.
Role of Human Immunodeficiency Virus in Primary Pulmonary Hypertension
Authors: Pellicelli Adriano M. , Palmieri Fabrizio , D'Ambrosio Cecilia , Rianda Alessia , Boumis Evangelo , Girardi Enrico , Antonucci Giorgio , D'Amato Carmelo , Borgia Maria Clotilde
Published: July 2008

Previous cases of pulmonary hypertension (PH) in human immunodeficiency virus (HIV) infection have been reported in the literature. The role of HIV in PH is still debatable. The purpose of this report was to analyze whether HIV plays a direct or indirect role in PH pathogenesis. Between February and November 1997, 56 HIV-infected patients with cardiac symptoms and signs were studied by serial color Doppler echocardiography. In four patients (7.1%), PH not related to other well-known associated conditions, was disclosed. In spite of a low serum HIV RNA viral load and a high-efficacy antiretroviral therapy, including a protease inhibitor in two patients, PH developed and worsened. It could be hypothesized that in some patients with an individual immunogenetic predis position, a high secretion of cytokines and endothelin-1 stimulated by an unidentified pathogen different from HIV could lead to PH. Antiretroviral therapy seems not to prevent or reduce right ventricle pressure gradient in PH.
Left Gastric Artery Arising from the Superior Mesenteric Artery
Authors: Ray Charles E. , Gupta Atul K. , Shenoy Sadashiv S.
Published: July 2008

Two case reports of a left gastric artery replaced to the SMA are presented. Normal left gastric anatomy and development are described, and the importance of such anomalies is discussed.
Increasing Plasma Neopterin and Persistent Plasma Endothelin During Follow-up After Acute Cerebral Ischemia
Authors: Anwaar I. , Gottsäter A. , Lindgärde F. , Mattiasson I.
Published: July 2008

Release of inflammatory mediators from leukocytes and endothelial release of vasoactive factors are both important in the pathogenesis of atherosclerosis. To evaluate the concen trations of a specific marker for macrophage activation, neopterin, and the potent endothelial derived vasoconstrictive peptide endothelin-1 (ET-1), during the acute and chronic stages of cerebral ischemia, plasma concentrations of neopterin and ET-1 were measured in 59 patients with acute cerebral infarction or transient ischemic attack (median age 73 years, range 43-93, 27 men) and after a 1-year follow-up in 57/59 (97%) of patients. Plasma neopterin was higher at follow-up (6.3 nmol/L [3.7-21.6] vs 5.6 nmol/L [3.5-17.2]; p < 0.05) than at the acute stage, whereas the plasma ET-1 concen tration was unchanged. Plasma concentrations of both neopterin and ET-1 correlated directly with age both in the acute stage ( r = 0.42 and r = 0.35, respectively; p < 0.01) and after follow-up ( r = 0.34; p < 0.05 and r = 0.27; p = 0.05, respectively). In conclusion, plasma neopterin increased after acute cerebral ischemia, indicating chronic inflammatory activity and continuous macrophage activation in ischemic cerebrovascular diseases.
Smooth Muscle Differentiation in Human Vein Wall at Valvular Level: Comparison with Nonvalvular Wall and Correlation with Venous Function
Authors: Renaudin Jean Marc , Fiscel Christine , Mercier Frederic , Denost Florence , Turpault Isabelle , Falson Odile Boutherin , Finet Michel
Published: July 2008

The aim of this study was to evaluate local differences in smooth muscle differentiation in venous valves of patients suffering from chronic venous insufficiency, in relation to functional hemodynamic parameters measured by echo Doppler. These functional para meters did not correlate with smooth muscle differentiation at the valvular site. These results failed to support an initiating role of valvular structure in the development of chronic venous insufficiency. However, this work stresses differences in cellular differ entiation of valve wall and nonvalvular smooth muscle cells in culture, and we found histologic differences in the structure of endovein and media (connective tissue relative content) between valvular and nonvalvular venous wall. The presence of smooth muscle cells in the valve cusp was demonstrated by smooth muscle alpha-actin-specific labeling and was observed to be restricted to one side of the valve cusp.
Diagnosis of Deep Venous Thrombosis of the Lower Limbs: It Is Premature to Introduce Ultrasound as a Routine Method
Authors: Pasquariello F. , Kurol M. , Wiberg S. , Krekmanova M. , Leppert J.
Published: July 2008

Ultrasound is sometimes employed as an alternative technique to phlebography in the diagnosis of deep venous thromboses (DVT). To evaluate the efficacy of ultrasound, 74 patients suspected of DVT in the lower limbs were examined with both ultrasound and phlebography. The results indicate that positive reports following ultrasound exami nation are reliable but that negative reports are not very dependable. The authors urge, therefore, a degree of caution before ultrasound is introduced as a routine method in hospital care.
Early Detection of Anthracycline-Induced Cardiotoxicity by Radionuclide Angiocardiography
Authors: Suzuki Jun , Yanagisawa Atsuo , Shigeyama Toshiki , Tsubota Jun , Yasumura Toshiaki , Shimoyama Katsuya , Ishikawa Kyozo
Published: July 2008

For the early detection of myocardial damage associated with anthracycline therapy, electrocardiography, echocardiography, and radionuclide angiocardiography were used to assess cardiac function in 37 patients receiving anthracyclines (ie, adriamycin and daunorubicin at a total dose of 100-2,030 mg/m2). None of the patients developed clinical congestive heart failure. There were no significant changes of electrocardio graphic and echocardiographic parameters after anthracycline administration. The left ventricular ejection fraction did not change significantly on radionuclide angiocardiog raphy. However, the 1/3 peak filling rate (PFR) corrected by the end-diastolic count (EDC) (1/3 PFR/EDC) and the 1/3 filling fraction (1/3 FF), the indices of early diastolic function, showed a significant decrease. These findings suggest that the 1/3 PFR/EDC and 1/3 FF determined by radionuclide imaging are useful for detecting silent myocardial damage induced by anthracyclines.
Accelerated Coronary Reperfusion Through the Use of Rapid Bedside Cardiac Markers
Authors: Dadkhah Shahriar , Fisch Cynthia , Zonia Carolynn , Foschi Alberto
Published: July 2008

Each year, acute myocardial infarctions (AMI) account for more than half a million deaths in the United States. Complicating treatment of AMI is the difficulty in accu rately diagnosing the event, for patients have nondiagnostic electrocardiograms (ECG) more than 50% of the time. In this population, cardiac markers are essential to confirm the diagnosis. The new bedside cardiac markers, which use eight drops of whole blood and require 15 minutes to be read negative, make it possible to shorten time needed to diagnose AMI. One hundred twenty-seven consecutive patients presented to the emergency department complaining of atypical chest pain. All had ECGs that were nondiagnostic for myocardial infarction. Serial cardiac markers were performed: myoglobin, troponin I, rapid myoglobin, and rapid troponin I. One hundred eighteen patients with negative serial cardiac markers had exercise treadmill tests in the emergency department. Nine patients with positive serial cardiac markers received emergent primary angioplasty. Six of the nine patients were treated based on the positive results of the rapid bedside cardiac markers. A 100% correlation existed between the quantitative serum results and the rapid bedside markers. With the avail ability of rapid bedside assays, dependency on the laboratory can be minimized, since quantitative cardiac markers require at least 1 hour of turnaround time. Rapidly and correctly diagnosing AMIs in patients with ECGs nondiagnostic for AMI has always been a dilemma. Rapid bedside assays enable the physician to accurately diagnose myocardial infarction and safely decrease the time in evaluating chest pain, thus maximizing the benefits of early reperfusion.
Palmar Aneurysm Accompanied by Ipsilateral Clubbing Finger A Case Report
Authors: Abe Kunihiko , Sasaki Tatsuya , Kawazoe Kohei , Nakamura Shin-ichi
Published: July 2008

A 33-year-old man presented with a palmar aneurysm accompanied by painful ipsilateral clubbing finger in his right hand. Following resection of the aneurysm and arterial recon struction with a cephalic vein graft, the pain in his fingers disappeared. Histologic exam ination identified the resected tissue as a true aneurysm. The clubbing finger was ascribed to chronic ischemia due to a stenotic lesion associated with palmar arch hypoplasia and aneurysm. The following is the first reported case of palmar aneurysm accompanied by ipsilateral clubbing finger.
Congenitally Corrected Transposition of the Great Arteries with a Patent Foramen Ovale in an 81-Year-Old Man
Authors: Misumi Ikuo , Kimura Yoshihiro , Hokamura Youichi , Yamabe Hiroshige , Ueno Kazuhiro
Published: July 2008

Congenitally corrected transposition of the great arteries is a rare cardiac anomaly with a poor prognosis. In this report, the authors describe an 81-year-old man admitted to the hospital with generalized fatigue, chest pain, and cyanosis. Computed tomography and cardiac catheterization revealed corrected transposition of the great arteries. Transesophageal echocardiography disclosed moderate right atrioventricular regurgita tion and a right-to-left shunt across a patent foramen ovale during systole. Because this patient had no other congenital cardiac anomalies, the right-to-left shunt through the patent foramen ovale was thought to be the major cause of cyanosis.
A Double-Blind, Placebo-Controlled Study of the Effects of Policosanol in Patients with Intermittent Claudication
Authors: Castaño Gladys , Más Rosa , Roca Juan , Fernández Lilia , Illnait José , Fernández Julio César , Selman Eugenio , Más Rosa
Published: July 2008

This study was undertaken to evaluate the efficacy and tolerability of policosanol, a new cholesterol-lowering drug with concomitant antiplatelet effects, in patients with inter mittent claudication. After a baseline period of 6 weeks, 62 patients were randomized to receive, under double-blind conditions, either placebo (31 patients) or policosanol (31), 10 mg twice daily. Walking distances in a treadmill (constant speed 3.2 km/hr, slope 10°) were assessed before and after 6 months of treatment. Both groups were similar at randomization. Policosanol increased significantly (p<0.01) the initial claudication distance from 132.5 ±13.5 m (baseline) to 205.7 ±36.3 m (after therapy) and the absolute claudication distance (p<0.0001) from 229.5 ±22.0 m to 365.4 _±46.9 m; meanwhile both variables remained unchanged in the placebo group (p<0.05). The reduction of lower limb symptoms showed a greater benefit in the policosanol group. There was no significant change in either group in the ankle/arm pressure ratio. The treatment was well tolerated. There were 10 discontinuations (seven placebo, three poli- cosanol) from the study. Six withdrawals occurred because of adverse events (AE); all were in placebo patients. There were five serious vascular AEs in the placebo group but none in the policosanol group (p<0.05). Overall, 12/31 (38.7%) placebo patients and 3/31 (9.7%) policosanol patients experienced AEs after randomization, which showed a lesser incidence of AEs in the policosanol group (p<0.01). The present study demon strates a beneficial effect of policosanol in patients with intermittent claudication.
Relation of Mass/Volume Ratio to ECG Abnormalities and Symptoms in Children with Aortic Stenosis/Insufficiency
Authors: Atalay Semra , Imamoğlu Ayten , Tutar H. Ercan , Altug Nahide , Atalay Semra
Published: July 2008

In this study, to determine whether symptoms and ECG abnormalities relate to left ventricular (LV) mass, volume, and mass/volume (M/V) ratio in children with aortic stenosis (AS) and/or insufficiency (AI), the authors examined 23 patients with echocar diography. LV volumes and mass were calculated with echocardiography. Also, the peak and mean gradients across the aortic valve and left ventricular meridional wall stress (ESWS) were determined by use of echo Doppler techniques. Fourteen patients (mean age 5.84 ±3.49 years) had AS alone. Of these, 14 had symptoms and seven had abnormal-appearing ECGs. Nine patients (mean age 6.91 ±4.35 years) had AS/AI. Of these nine, four had symptoms and two had ECG abnormalities. The authors observed that the incidences of symptoms and ECG abnormalities were higher in the patients with AS than in those with AS/AI. There was no significant correlation between symptoms and ECG abnormalities with peak gradient, mean gradient, valve area, LV mass, volume, and mass/volume ratio in patients with AS/AI. However, significant correlation was found between symptoms and ECG abnormalities and ESWS in AS/AI patients. In conclu sion, ECG abnormalities and symptoms do not always indicate the severity of AS and AS/AI.
ST-T Alternans and Myocardial Ischemia
Authors: Kwan Tak , Feit Alan , Alam Mahmood , Afflu Ernest , Clark Luther T. , Kwan Tak
Published: July 2008

Previous studies using intracoronary electrocardiography have demonstrated that ST-T alternans can develop during standard balloon coronary angioplasty. Total occlusion with a large amount of myocardium in jeopardy is the postulated prerequisite. In this study, the authors used perfusion balloons instead of standard balloons, so coronary perfusion was maintained and ischemia was minimized. Fourteen patients with standard balloon technique and 11 patients with perfusion balloon technique were studied. The ST segment was less elevated during perfusion angioplasty (0.15 ±0.05 mV vs 1.04 ±0.19 mV, p<0.001). There were six (43%) patients with ST-T alternans with standard balloon technique compared with none in the perfusion balloon group (p<0.001) . In this study, the authors found that there was less ischemia, less ST segment elevation, and lack of ST-T alternans on the intracoronary electrocardiogram during perfusion balloon angioplasty. These findings support the postulate that a large amount of ischemic myocardium is a prerequisite for ST-T alternans.
Impaired Response of the Forearm Resistance but not Conductance Vessels to Reactive Hyperemia in Hypertrophic Cardiomyopathy
Authors: Krzanowski Marek , Surdacki Andrzej , Nizankowski Rafal , Szczeklik Andrzej , Dubiel Jacek S. , Petkow Dimitrow P.
Published: July 2008

It has been suggested that in hypertrophic cardiomyopathy (HC), vascular abnormali ties are not restricted to the heart. Flow-mediated dilation of peripheral conductance arteries (reflecting their endothelial function) has not yet been studied in HC. Our aim was to assess both flow-dependent dilation of the brachial artery and flow responses (dependent on resistance vessels) during forearm reactive hyperemia (RH) in nontreated HC patients.

The authors studied 13 HC patients and 14 age- and sex-matched healthy controls. None of them exhibited any factors known to be associated with endothelial dysfunc tion. Using 7 MHz ultrasound, brachial artery diameter and Doppler flow velocity were measured continuously at baseline and throughout 1 min of RH following 5 min of forearm ischemia induced by inflation of a blood pressure cuff. Arterial diameter and RH flow are expressed as percent changes with respect to the baseline.

Flow-dependent dilation was similar in the HC patients and control subjects (7.2 ±9.5% vs 9.9 ± 10.4%, p>0.05). Compared to the control group, RH flow in HC was decreased; however, differences did not reach statistical significance until 60 sec of RH (112 ±102% vs 261 ±217%, p<0.05; HC vs controls).

In HC patients, endothelial function of peripheral conductance arteries is preserved. Hence, a defect in the forearm arterial bed in HC seems to be limited to mechanisms maintaining the dilation of resistance vessels during decreasing RH flow.
Calf Pain in Middle-Aged Individuals as a Predictor of Ischemic Cerebrovascular Disease
Authors: Elneihoum A.M. , Lindgärde F. , Eriksson K.F. , Falke P. , Elneihoum Ali M.
Published: July 2008

In middle-aged individuals, calf pain while walking may be an early marker of general ized ischemic vascular disease. We investigated whether the symptom of calf pain while walking was a predictor of ischemic cerebrovascular disease (CVD). In a nested case control study, part of the Malmö Prevention Program Project, we evaluated 105 patients with ischemic CVD for the symptom of calf pain reported at screening more than a decade before their illness. Their baseline characteristics were compared with those of an age- and sex-matched control group drawn from the population cohort. Calf pain while walking was reported by 16.2% of the patient group but by only 7.6% of the control group; p < 0.0001. Multiple logistic regression analysis with adjustment for all other significant risk factors showed a history of calf pain while walking to be an independent predictor of ischemic CVD (odds ratio, 1.9; 95% confidence interval, 1.3-3.7; p < 0.002). Thus, in middle-aged individuals, the symptom of calf pain while walking would seem to be a significant independent predictor of ischemic CVD. Our data serve to target a high- risk group for improved preventive efforts.
Takayasu's Arteritis: An Unusual Manifestation
Authors: Safi Arshad M. , Kwan Tak , Afflu Ernest , Feit Alan , Clark Luther T. , Safi Arshad M.
Published: July 2008

Takayasu's arteritis is a rare entity. The authors describe a case of a middle-aged woman with an atypical form of Takayasu's arteritis. This manifestation has not been described previously.
Elective Intracoronary Micro-Stent II™ Implantation Without Quantitative Coronary Angiography or Intravascular Ultrasound Guidance and Without Subsequent Anticoagulation: Short- and Long-Term Results
Authors: Salachas Anastasios J. , Patsilinakos Sotirios P. , Tsilias Karmelos P. , Stefanou Ioannis , Margaris Nikolaos G. , Ifantis George P. , Kranidis Athanasios J. , Tavernarakis Antonios G. , Rokas Stylianos G. , Antonellis Ioannis
Published: July 2008

Intracoronary stenting has been shown to reduce acute closure and restenosis rate in patients treated with coronary angioplasty. The use of high inflation pressures and intravascular ultrasound guidance allowed the substitution of anticoagulants with antiplatelet agents but increased the cost. The aim of this study was to investigate the effectiveness, safety, and long-term outcome of the elective implantation of a relatively new type of stent (Micro-Stent II™), without the use of quantitative coronary angiog raphy or intravascular ultrasound guidance and without subsequent anticoagulation.

The study included 361 patients who underwent elective microstent implantation. Stent expansion was performed at 8 atm followed by higher inflation pressure at 14-20 atm. Heparin was given intraarterially only once immediately after the arterial sheath insertion. Ticlopidine was started at least 48 hours before the procedure and continued for 1 month while aspirin was continued indefinitely. All patients were followed up for 12.9 ±3.6 months. Short term outcome (first month): Stent implantation was successfully achieved in 361 of 366 patients (98.6%). Seven patients (1.9%) were excluded from the study and received anticoagulants because of a suboptimal result. In total, 423 stents were implanted. There was no subacute thrombosis, but acute vessel closure occurred in one patient (0.3%). Non-Q wave myocardial infarction occurred in six patients (1.7%), Q wave myocardial infarction occurred in one patient (0.3%), and only one death (0.3%) of nonischemic origin was reported. No major peripheral vascular complications were observed. Late results: Q or non-Q wave infarction occurred in 13 patients (3.6%), 26 patients (7.2%) underwent a repeat angioplasty, eight patients (2.2%) underwent coronary artery bypass grafting, and four patients (1.1%) died. Overall, 284 patients (78.7%) were free of symptoms, while 77 (21.3%) had recurrent coronary ischemia.

In conclusion, Micro-Stent II™ implantation without quantitative coronary angiog raphy or intravascular ultrasound guidance and without anticoagulation was found to be effective, safe, and with good long-term outcome.
Dendritic Cells in Venous Pathologies
Authors: Cherian Sanjay Mammen , Bobryshev Yuri Veniaminovich , Inder Stephanie Jane , Lord Reginald Sidney Albert , Ashwell Kenneth William Scott , Lord R.S.A.
Published: July 2008

Dendritic cells are potent antigen-presenting cells responsible for the activation of T-lymphocytes in various immune responses. Their role in the initiation of immune reactions in allergies, autoimmune diseases, tumors, transplantation, and, more recently, in atherosclerosis has been well established, but their involvement in venous pathologies has not been previously investigated. The aim of this study was to determine whether dendritic cells are present in veins affected by varicosity and thrombophlebitis. Three groups of veins obtained at operation were studied: (1) varicose veins of the great saphenous vein from patients who were undergoing vein stripping for primary varicosity; (2) segments of the great saphenous vein from patients with varicosity complicated by thrombophlebitis; and (3) great saphenous veins without varicosity or thrombophlebitis from patients who were undergoing femoropopliteal bypass grafting. The specimens were fixed in 10% neutral buffered formalin and embedded in paraffin, and the sections were stained with antibodies to S-100 (to identify dendritic cells), CD3 (T-lymphocytes), CD68 (macrophages), von Willebrand factor (endothelial cells), alpha-smooth muscle actin (smooth muscle cells), and CD15 (mast cells) by use of avidin-biotin complex (ABC) immunoperoxidase technique. Immunohistochemical examination showed that no S-100 positive dendritic cells were present in normal saphenous veins. In contrast, S-100- positive cells with dendritic cell morphology were detected in the intima and media of veins with varicosity and thrombophlebitis, where they represented a minor cell popula tion. S-100-positive dendritic cells were located between smooth muscle cells as well as around areas of neovascularization where they colocalized with T-lymphocytes. The present work suggests that dendritic cells might be involved in pathological processes in veins affected by varicosity and thrombophlebitis. The authors speculate that dendritic cells may be involved in the inflammatory mechanisms in these veins through their inter action with T-lymphocytes.
Apical Hypokinesis in a Patient with Hypertrophic Cardiomyopathy and Myocardial Bridging: Reversal with Beta-Blockade
Authors: Rentoukas Elias I. , Deftereos Spiros G. , Alpert Martin A. , Nikas Dimitris J. , Lazaros George A. , Petropoulou Evdokia N. , Zacharoulis Apostolos A. , Rentoukas Elias
Published: July 2008

A 42-year-old man presented with effort angina pectoris of 20 minutes' duration. Hypertrophic obstructive cardiomyopathy, severe myocardial bridging involving the midleft anterior descending coronary artery, and apical hypokinesis were identified. Regional wall motion normalized following the initiation of beta blockade.
Takayasu's Arteritis Accompanied with Massive Pericardial Effusion
Authors: Narita Hitomi , Yoneyama Akihiko , Hashimoto Takeshi , Akita Sachie , Sakuma Nagahiko , Ohte Nobuyuki
Published: July 2008

A 40-year-old woman who had been treated for Takayasu's arteritis was admitted to the hospital with fever, fatigue, malaise, and severe chest pain. Computed tomography of the chest demonstrated massive pericardial effusion and bilateral pleural effusion. In laboratory data, the C-reactive protein was high at 22.0 mg/dL, and erythrocyte sedi mentation rate was also high at 80 mm/hr. The diagnosis was pericarditis with a recur rence of the systemic inflammatory process of Takayasu's arteritis. The patient was treated with methylprednisolone pulse therapy. Her massive pericardial effusion disap peared without pericardiocentesis.
Combination of Calcium Channel Blockers and Beta Blockers for Patients with Exercise-Induced Angina Pectoris: A Double-Blind Parallel-Group Comparison of Different Classes of Calcium Channel Blockers
Authors: van der Vring J.A.F.M. , Daniëls M.C.G. , Holwerda N.J.H. , Withagen P.J.A.M. , Schelling A. , Cleophas T.J. , Hendriks M.G.C.
Published: July 2008

The combination of calcium channel blockers and beta blockers is more effective for the treatment of exercise-induced angina pectoris than beta blocker monotherapy. Since ischemia in exercise-induced angina is essentially preceded by an increase in heart rate, calcium channel blockers with negative chronotropic property may perform better for this purpose than nonchronotropic compounds. A 335-patient, 10-week, double-blind, parallel-group comparison of amlodipine 5 and 10 mg, diltiazem XR 200 and 300 mg, and mibefradil 50 and 100 mg treatment added to baseline beta blocker treatment was performed. Exercise testing (ETT) was performed by bicycle ergometry.

Although none of the calcium channel blockers improved duration of exercise or amount of workload, all of them significantly delayed onset of 1 mm ST segment depres sion on ETT (p<0.001 for any treatment versus baseline). In addition, mibefradil, both low- and high-dose treatment, produced the largest delays (low dose: different from diltiazem and amlodipine by 24.1 and 29.8 s, p<0.003 and <0.001, respectively; high (continued on next page) dose: different from diltiazem and amlodipine by 33.7 and 37.0 s, p<0.001 and <0.001, respectively). These effects were linearly correlated to the amount of rate pressure product (RPP) reduction. Serious symptoms of dizziness likewise occurred significantly more frequently with mibefradil (p<0.05) and led 19 patients taking mibefradil to withdraw from the trial.

The authors conclude that calcium channel blockers with negative chronotropic property provide better delay of ischemia in patients with exercise-induced angina but that the concomitant risk of intolerable dizziness largely reduces this benefit.
Effects of Triflusal on Arteriosclerosis Progression Assessed with High-Resolution Arterial Ultrasound
Authors: Cesarone M.R. , Laurora G. , DeSanctis M.T. , Incandela L. , Fugazza L. , Girardello R. , Poli A. , Peracino L. , Ambrosoli L. , Belcaro G.
Published: July 2008

In order to evaluate the effect of triflusal (2-acetyloxy-4-trifluoromethyl benzoic acid), an orally active antiplatelet agent, on arteriosclerosis progression, a pilot, parallel, double- dummy, double-blind clinical trial vs acetylsalicylic acid (ASA) was carried out in patients with subclinical atherosclerotic lesions. The trial consisted of a 2-week run-in placebo phase, followed by a 12-month oral treatment with triflusal (600 mg/day) or ASA (300 mg/day). The primary variable was identified in the ultrasonic biopsy (UB) score; the secondary variables were the UB class changes of each arterial site, the rate of progres sion (ROP), the intima-media thickness (IMT), and the symptoms of arteriosclerosis. Data were evaluated by use of analysis of variance and Chi-square test. Forty-three patients (31 men, 12 women, mean age 62.8 ±8.4 SD) were randomized to triflusal (15 men, 6 women, mean age 64.3 ±6.7) or to ASA (16 men, 6 women, mean age 61.3 ± 9.6) . The analysis of variance on the UB score showed no difference between treat (Abstract continued) ments: the patients' UB scores remained unchanged with no progression, thus indicating that no patient worsened during treatment. When all arterial sites under evaluation are considered, 86% of the sites in the triflusal group and 85% in the ASA group remained unchanged. No relevant change was recorded in vital signs and routine laboratory tests. Gastric disturbances were reported by two and three patients treated with triflusal and ASA, respectively. In conclusion, triflusal appears as effective as ASA in slowing arterio sclerosis progression.
Peripheral Vascular Resistance Limits Exercise Functional Capacity of Mild Hypertensives
Authors: Modesti Pietro Amedeo , Olivo Giuseppe , Pestelli Francesco , Rocchi Federica , Vanni Simone , Tedeschini Renzo Camajori , Cecioni Ilaria , Gensini Gian Franco
Published: July 2008

To evaluate the physiological basis for suboptimal peak exercise oxygen consumption (VO2p) observed in the early stage of hypertension, 25 WHO Stage I hypertensive men with normal left ventricular mass and 10 healthy control subjects of equivalent age underwent the maximal cardiopulmonary exercise test with contemporary measurement of cardiac output with Tc99m angiocardiography. At peak exercise hypertensive patients had lower VO2p (p < 0.045) and cardiac output (p < 0.014) and higher vascular resis tance (p < 0.010) than controls. At multiple regression analysis VO2 was positively related to cardiac output in controls ( r = 0.80, p < 0.02), whereas in hypertensives the best (negative) correlation was observed with peripheral vascular resistance ( r = -0.72, p < 0.04). Thus reduced cardiopulmonary function during physical exercise in hyperten sives seems to be mainly related to impaired peripheral vascular autoregulation.
Saphenous Vein Graft Ectasia: An Unusual Late Complication of Coronary Artery Bypass Surgery
Authors: Sharifi Mohsen , Dillon James C. , Pompili Vincent J.
Published: July 2008

Aneurysms and ectasias of saphenous vein grafts are infrequent complications of coronary artery bypass surgery. They usually present as an expanding asymptomatic mediastinal mass on chest x-ray film or computed tomography scan. Though rare, they must be excluded from the differential diagnosis of mediastinal masses to avoid potentially dangerous needle biopsy. The authors describe ectasia of a saphenous vein graft in a 62- year-old man 14 years after coronary artery bypass surgery. The relevant literature is also discussed.
Trousseau's Syndrome with Brachiocephalic Vein Thrombosis in a Patient with Uterine Carcinosarcoma
Authors: Kimura Takuma , Chino Masao , Ogasawara Nobuyuki , Nakano Takayuki , Izumi Shigeru , Takeuchi Hiroshi
Published: July 2008

The authors treated a patient with the previously unreported occurrence of brachio cephalic vein and superior vena cava thrombosis in association with a distantly located cancer. A 71-year-old woman presented with swelling over the right side of the neck and abdominal distension. Physical examination revealed a huge mass, and computed tomog raphy demonstrated thrombosis of the brachiocephalic vein and superior vena cava accompanied by jugular vein dilatation. No coagulation disorder was demonstrable. After anticoagulation and thrombolysis, hysterectomy was performed; microscopic examination of the specimen revealed uterine carcinosarcoma. Even though local tumor obstruction is a much more common cause of neck vein thrombosis, a distant occult cancer can present as this form of Trousseau's syndrome. In patients with otherwise unexplained neck vein thrombosis, examination not only of the head and neck but also of the abdomen and pelvis should be pursued.
Superficial Thrombophlebitis of the Legs: A Randomized, Controlled, Follow-up Study
Authors: Belcaro G. , Nicolaides A.N. , Errichi B.M. , Cesarone M.R. , De Sanctis M.T. , Incandela L. , Venniker R. , Belcaro G.
Published: July 2008

The aim of the present study was to evaluate the effects of different treatment plans (compression only, early surgery, low-dose subcutaneous heparin [LDSH], low- molecular-weight heparin [LMWH], and oral anticoagulant [OC] treatment) in the management of superficial thrombophlebitis (STP), by considering efficacy and costs in a 6-month, randomized, follow-up trial. Patients with STP, with large varicose veins without any suspected/documented systemic disorder, were included. Criteria for inclusion were as follows: presence of varicose veins; venous incompetence (by duplex); a tender, indurated cord along a superficial vein; and redness and heat in the affected area. All patients were ambulatory. Exclusion criteria were obesity, cardiovascular or . neoplastic diseases, bone/joint disease, problems requiring immobilization, and age > 70 years. Patients with superficial thrombophlebitis without varicose veins and patients under treatment with drugs at referral were also excluded. Color duplex (CD) was used to detect concomitant deep vein thrombosis (DVT) and to evaluate the extension or reduction of STP at 3 and 6 months. Venography was not used.

Of 562 patients included, 3.5% had had a recent DVT in the same limb affected by SVT and 2.1% in the contralateral limb. In six patients DVT was present in both limbs. These patients were treated with anticoagulants and excluded from the follow-up. After 3 and 6 months the incidence of STP extension was higher in the elastic compression and in the saphenous ligation groups (p < 0.05). There was no significant difference in DVT incidence at 3 months among the treatment groups. Stripping of the affected veins was associated with the lowest incidence of thrombus extension. The cost for compression alone was the lowest and the cost including LMWH was the highest. The average cost was 1,383 US$. However the highest social cost (lost working days, inactivity) was observed in subjects treated only with stockings.
External Femoral Vein Valvuloplasty with Limited Anterior Plication (LAP): A 10-Year Randomized, Follow-up Study
Authors: Belcaro Gianni , Nicolaides Andrew N. , Ricci Andrea , Laurora Giuseppe , Errichi Bruno M. , Christopoulos Dimitri , Cesarone Maria Rosaria , De Sanctis Maria Teresa , Incandela Lucrezia , Belcaro G.
Published: July 2008

The aim of this study was to evaluate the effects after 10 years of external valvuloplasty of the femoral vein (limited anterior plication or LAP). After informed consent patients with venous hypertension due to deep and superficial venous incompetence were randomized into two treatment groups. Both groups were treated with superficial vein surgery (ligation and section of the major incompetent superficial veins). Group 2 was treated with the same procedure and with LAP. External valvuloplasty of the superficial femoral vein was performed with plication of the anterior vein wall after limited dissec tion of the vein. Results were evaluated with color-duplex scanning and ambulatory venous pressure (AVP) measurements. Endpoints were AVP, refilling time (RT), presence/absence of reflux at the superficial femoral vein, the variation in the diameter of the vein, and quality of life score (QLS). No complications were observed. All femoral veins treated with LAP were competent after 10 years. Significantly lower AVP and longer RT were observed in the LAP group. Also the average diameter of the vein was smaller in the LAP group. Moreover, QLS was significantly better in the LAP group after 10 years. In conclusion, in selected subjects, with moderate deep venous incompetence, functional cusps, or incompetence mainly due to relative enlargement of the femoral vein, LAP may be an effective alternative to external valvuloplasty.
Age-Related Progressive Brachial Artery Endothelial Dysfunction Precedes the Changed Carotid and Left Ventricular Geometry in Healthy Humans
Authors: Djuric Dragan , Popovic Zoran , Petrovic Jordan , Bojic Milovan , Djuric Dragan M.
Published: July 2008

In this study the authors evaluated correlation between aging and brachial endothelial and vascular smooth muscle dysfunction, changes in carotid geometry, and left ventric ular remodeling. Vasomotor influences of brachial endothelium and brachial smooth muscle function to reactive hyperemia and nitroglycerin (400 μg, sublingual spray) were assessed by noninvasive ultrasound in 66 healthy subjects of different ages (20-82 years). Carotid intima-media thickness and left ventricular mass index were also assessed by ultrasound and compared with brachial hemodynamic parameters. All results were analyzed by linear regression analysis.

The response of brachial artery diastolic diameter to reactive hyperemia decreased with aging (p < 0.0001). Also, the response of brachial artery diastolic diameter to nitro glycerin increased relative to aging (p < 0.004). Age-related correlations between increased carotid intima-media thickness and brachial artery diastolic diameter response to reactive hyperemia (p<0.01) as well as between increased carotid intima-media thickness and increased left ventricular mass index (p < 0.001) were found. However, there was no correlation between brachial artery diastolic diameter response to reactive hyperemia and increased left ventricular mass index (p > 0.05).

The study showed that aging influences not only brachial endothelial vasomotor properties but also vascular and cardiac geometry. The authors believe that modern ther apeutic approach should take these results into consideration to establish new vasculo protective and cardioprotective strategies.
Coronary Artery Bypass Surgery in Nonagenarians
Authors: Miller David J. , Samuels Louis E. , Kaufman Marla S. , Morris Rohinton J. , Thomas Matthew P. , Brockman Stanley K.
Published: July 2008

As the number of nonagenarians increases yearly in the United States, surgeons will be asked more often to evaluate the possibility of intervention for coronary artery disease in this age group. The purpose of this study is to document experience with patients 90 years of age or older in order to determine whether coronary artery bypass grafting surgery is justified. Eleven patients aged 90 years or more underwent cardiac surgery for symptomatic coronary artery disease refractory to medical management between January 1, 1987, and December 31, 1996. All patients were in NYHA Class IV preoper atively. In-hospital death occurred in two patients (18%). In-hospital morbidity occurred in all patients (100%) including seven cardiac, four respiratory, two neurologic, and one infectious. All survivors left the hospital symptomatically improved. The mean length of stay was 28 days. Four patients died at a mean of 2 years and 2 months post operatively. Five patients remain alive at a mean of 1 year and 7 months. Coronary artery bypass grafting in nonagenarians can be performed successfully in selected cases. However, increased mortality and morbidity rates and length of stay are associated with this age group. For survivors, the quality of life is improved and the projected life expectancy restored.
Behavior of Circulating Endothelin-1 in a Group of Patients with Acute Myocardial Infarction
Authors: Battistelli Sandra , Billi Mario , Manasse Giacomo , Vittoria Aurelio , Roviello Franco , Forconi Sandro
Published: July 2008

The aim of this study was to investigate the behavior of plasma endothelin-1 (ET-1) in 23 patients with acute myocardial infarction, complicated and uncomplicated by left ventric ular failure, and treated with and without thrombolytic agents. ET-1 was measured on admission; on days 2, 3, and 5; and again on discharge. In addition, on discharge, ET-1 was correlated with left ventricular systolic function. Left ventricular failure was present, on admission, in 14 patients, whereas the other nine did not have any hemodynamic impairment. On discharge, no patients had left ventricular failure, but 11 had moderate to severe left ventricular systolic dysfunction, defined as left ventricular ejection fraction (LVEF) < 40%. Fourteen subjects, matched for age and sex, served as a control group. Compared with the control range, ET-1 was highly elevated on the first day, in both uncomplicated (p < 0.01) and complicated patients (p < 0.001). Then it decreased rapidly in the uncomplicated group, reaching the control range within day 5, whereas in the complicated group it remained significantly elevated in comparison with both the control (continued on next page) (Abstract continued) subjects and the uncomplicated patients, until discharge. ET-1 was not correlated with the peak of creatine-kinase MB isoenzyme in any group. In seven patients submitted to thrombolytic treatment ET-1 was always significantly lower than in the nonthrombolyzed patients (p<0.05), but the pattern of variation across time was no different. On discharge, the difference in plasma ET-1 between patients with LVEF <40% and the control group was significant (p < 0.001), as was the difference between patients with and without moderate to severe systolic dysfunction (p<0.01). ET-1 was closely and inversely correlated with LVEF when patients were considered as a whole (p < 0.001). These results suggest that the ET-1 increase in the early phase of myocardial infarction could be due to an ischemic process, to stress reaction, and to cardiac hemodynamic impairment, and therefore, ET-1 may be a good marker of disease. In the following phase the ET-1, being correlated with LVEF, could be a reliable index of systolic function.