bluuebunny/crossref_metadata_2025 huggingface dataset:
Use of the Information Content in Satellite Measurements for an Efficient Interface to Data Assimilation
Authors: Migliorini Stefano , Piccolo Chiara , Rodgers Clive D.
Published: July 2008

Satellite observations are the most assimilated data type by operational meteorological centers. Spaceborne instruments can make measurements all over the globe and provide observations for assimilation even where the coverage of other data is poor. It is therefore most important that such observations, which are only indirectly related to the state of the atmosphere, are assimilated as optimally as possible. In this study, a detailed characterization of both retrievals and observed radiances for assimilation is provided, along with an error analysis. A method for assimilating remote sounding data while preserving its information content is presented. The main features of the technique are as follows: (i) the retrieval–forecast error cross covariance is removed even when the retrieval is severely constrained by a priori information, (ii) the radiative transfer calculations for radiance assimilation are done offline, and (iii) the number of assimilated quantities per observation is reduced to the number of effective degrees of freedom in the observation.
Cloud-Resolving Modeling of Deep Convection during KWAJEX. Part I: Comparison to TRMM Satellite and Ground-Based Radar Observations
Authors: Li Yaping , Zipser Edward J. , Krueger Steven K. , Zulauf Mike A.
Published: July 2008

A global TRMM database of tropical cloud system precipitation features (PFs), which provides useful observational constraints on cloud system properties, is used to evaluate the bulk microphysics schemes in a cloud-resolving model (CRM). The simulation of the Mesoscale Convective System (MCS) of 11–12 August 1999 during the Kwajalein Experiment (KWAJEX) is executed using the 3D University of Utah CRM, which employs a one-moment bulk, three-ice category microphysical parameterization. The simulated precipitation features are compared with climatological “norms” for Kwajalein locations from the TRMM PF database to evaluate the precipitation microphysics of the cloud model simulation. The model-simulated reflectivities are also compared with vertical profiles of radar reflectivity obtained from a ground-based precipitation radar.

Comparison of simulation results with the TRMM observation statistics indicates that the model tends to underestimate microwave brightness temperatures at ice-scattering frequencies and overestimate radar reflectivities, especially for those associated with larger ice particles. The differences between the statistics of KWAJEX simulation and available ground-based precipitation radar observations are relatively small at the levels below 5 km. Above 6 km, the differences increase with height and reach a maximum near 9 km. The simulated radar reflectivities are statistically 5–13 dBZ higher than those from radar observations at levels between 7 and 10.5 km, where graupel is the dominant simulated ice species. The largest graupel mixing ratios, as high as 8 g kg−1, are the most likely reason for the unrealistically high simulated radar reflectivity. Comparison of model-simulated graupel mixing ratio with available microphysics data from the Citation aircraft indicates that the model overestimates graupel content at the level the Citation flew (about 6.4 km).
Using Teleconnections to Predict Wildfires in Mississippi
Authors: Dixon P. Grady , Goodrich Gregory B. , Cooke William H.
Published: July 2008

Previous wildfire research in the United States has been focused primarily on the western states. Much of this research has discovered relationships between wildfire variability and atmospheric teleconnections. Thus far, few published projects have addressed the effects of various teleconnections on wildfire in the southeastern United States. Index values for the El Niño–Southern Oscillation (ENSO), North Atlantic Oscillation (NAO), Pacific decadal oscillation (PDO), and Pacific–North American (PNA) pattern are all tested for relationships with fire variables in the state of Mississippi. Each of the indices displays significant correlations with wildfire occurrence and/or size in Mississippi. The findings of this research suggest that it might be feasible to create predictive fire-risk models for the southeastern United States based on the combination of these teleconnection indices.
Enalapril and Losartan Augment Endogenous Nitric Oxide Release in Takayasu's Arteritis
Authors: Sukau Gudrun , Pollok Manfred , Baldamus Conrad A. , Marsen Tobias A.
Published: July 2008

Prognosis in Takayasu's arteritis is limited owing to renovascular hypertension. The authors report a patient with Takayasu's arteritis who had been unilaterally nephrec tomized and presented with malignant hypertension due to renal artery stenosis. Hypertension was refractory to conventional antihypertensive treatment, and stenosis was not accessible by interventional angioplasty. Initiation of enalapril and losartan therapy was successful in improving blood pressure without deterioration of renal function due to ischemic failure. Antihypertensive treatment resulted in dramatically stimulated endogenous nitric oxide (NO) synthesis, while elevated plasma endothelin-1 levels were unchanged. Renovascular hypertension in Takayasu's arteritis is associated with an imbalance of vasoconstrictor peptide endothelin-1 and vasodilator peptide NO. Successful treatment of hypertension by enalapril or losartan results in improved endoge nous NO synthesis, which putatively counterbalances excessive vasoconstrictor actions and may retard the progression of renal failure.
Lamellar Bone Formation in an Atherosclerotic Plaque of the Carotid Artery, with a Review of Histogenesis
Authors: Pauli Steven , Lauwers Patrick , Hendriks Jeroen , Van den Brande Filip , Bogers John-Paul , Van Marck Erik , Eyskens Erik , Van Schil P.
Published: July 2008

Longer existing atherosclerotic lesions may contain calcifications; lamellar bone rarely develops within them. A 59-year-old man was referred with a progressive stroke. A high- grade stenosis of the left common carotid artery, formed by an ulcerating atherosclerotic plaque with a free-floating thrombus, was detected on angiography. An urgent endarterectomy was performed. Surprisingly this plaque contained pieces of lamellar bone, proved by histologic examination.
An Unusual Case of Cortical Blindness Associated with Aortography
Authors: Šabovič Mišo , Bonač Barbara , Šabovič M.
Published: July 2008

Transient cortical blindness is a rare but well-recognized benign complication of angiog raphy that is due to neurotoxicity of the contrast agent. The blindness completely resolves in a few days. This report describes a patient suffering an unusual course of cortical blindness following aortography resulting in permanent, partial blindness. It was found that blindness was the consequence of bilateral occipital embolisms. This case emphasizes that cortical blindness associatted with angiography does not always have a favorable outcome, since it might be, in rare cases, due to isolated occipital embolisms, which initially produce a clinical picture identical to that of the neurotoxic effect of contrast agents.
Neurally-Mediated Syncope Induced by Lung Cancer
Authors: Koga Tokushi , Kaseda Shigeru , Miyazaki Naoki , Kawazoe Nobuyuki , Abe Isao , Sadoshima Seizo , Onoyama Kaoru , Koga Tokushi
Published: July 2008

The authors present hemodynamic and autonomic features of recurrent and episodic neurally-mediated syncope in a man with lung cancer involving afferent vagus. He revealed extreme hypotension with bradycardia occurring during sitting or standing. A head-up tilt test also induced syncope. However, syncope attacks no longer occurred 2 weeks after admission. Alternatively, the paralyses of the left recurrent laryngeal nerve and the left phrenic nerve developed. It is suggested that the lung cancer involved upper rootlets of the left vagus and caused transient hypersensitivity of baroreceptor function that resulted in neurally-mediated syncope.
Calf and Forearm Blood Flow in Hypercholesterolemic Patients
Authors: Cortella Aldo , Zambon Sabina , Sartore Giovanni , Piarulli Francesco , Calabrò Alessio , Crepaldi Gaetano , Manzato Enzo
Published: July 2008

Patients with hypercholesterolemia without vascular disease have an impaired endothe lium-dependent (nitric oxide-mediated) vasodilation in coronary and peripheral vascular beds. This study was designed to establish whether hypercholesterolemia (and its reduction) affects also the microcirculation vasomotion during postischemic hyperemia in both calf and forearm. Thirteen male patients, aged 36.2 ±8.5 years, mean ±SD, with heterozygous familial hypercholesterolemia and 10 male control subjects, aged 32.2 ±3.6 years free from vascular lesions were studied. Plasma lipids, hematologic parameters, and limb vasoreactivity were evaluated while the patients were treated only with diet and during therapy with simvastatin. Calf and forearm blood flows were determined by venous occlusion strain gauge plethysmography at rest, during reactive hyperemia, and after sublingual isosorbide dinitrate administration. Calf resting flow rate of the hyperc holesterolemic patients during and without treatment was similar to that of the controls. Calf resting vascular resistance was greater in the untreated hypercholesterolemic subjects than in the normal controls, but during treatment this difference was abolished. Peak flow during reactive hyperemia and flow debt repayment were lower in the untreated hypercholesterolemic subjects as compared to the controls, but they were normalized following hypocholesterolemic therapy. No differences were observed in forearm blood flow measurements between hypercholesterolemic subjects (without and during therapy) and control subjects. The blood flow and vascular resistance after isosor bide dinitrate were modified in a similar manner in the hypercholesterolemic (without and during therapy) and control subjects at both calf and forearm. Hypercholesterolemia does not affect vasodilation in the forearm as determined by postocclusive reactive hyperemia, while in the calf hypercholesterolemia is associated with higher resting vascular resistance, lower peak flow during reactive hyperemia, and lower flow debt repayment. These abnormalities are corrected by the hypocholesterolemic treatment.
Adult Reversible Cardiomyopathy with Pituitary Adrenal Insufficiency Caused by Empty Sella
Authors: Koga Tokushi , Sakamoto Akira , Kawazoe Nobuyuki , Sadoshima Seizo , Onoyama Kaoru , Eto Kimika
Published: July 2008

The authors report a first case of reversible cardiomyopathy in an adult with adrenal insufficiency. A 62-year-old man was administered to hospital because of congestive heart failure. The electrocardiogram showed prolonged QT interval and negative T wave on the right precordial leads and frequent multifocal ventricular premature contractions. On the echocardiogram, the left ventricle was revealed to be diffusely hypokinetic with remarkable enlargement. 201Thallium single photon emission computed tomography (SPECT) revealed multiple flow defects in the left ventricular wall. He also had pituitary adrenal insufficiency secondary to an empty sella, which was diagnosed by hormonal studies and magnetic resonance images of the brain. After the replacement therapy with hydrocortisone, heart failure was sufficiently resolved. Abnormal flow defects in the myocardium on SPECT were also improved. To the authors' knowledge, adrenal insuffi ciency with cardiomyopathy has not been previously described in adult patients.
Transcranial Bypass for Spontaneous Intracranial Carotid Artery Dissection
Authors: Tazawa Toshiaki , Park-Matsumoto Y.C.
Published: July 2008

A case of spontaneous intracranial artery dissection (IAD) of the anterior circulation is reported. A 32-year-old man developed left hemiparesis with headache. Angiographies (AGs) showed progressive occlusion of the distal end of the right internal carotid artery. He underwent a superficial temporal artery-middle cerebral artery anastomosis 20 days after his initial symptoms. He improved gradually after operation. The prognosis and treatment of IAD are discussed. The authors conclude that cases with IADs of the anterior circulation should be followed up by cerebral AG or magnetic resonance angiog raphy and that early bypass surgery should be considered to prevent massive cerebral infarction in some cases.
Prevention of Coronary Arterial Renarrowing by Continuous 3-Day Infusion of Tissue Plasminogen Activator After Successful Percutaneous Transluminal Coronary Angioplasty: A Randomized, Double-Blind, Placebo-Controlled Study
Authors: Ogawa Iwao , Hayashi Takahiro , Nakabayashi Takayuki , Otani Narutaka , Ishikawa Kinji , Kanamasa Ken
Published: July 2008

Vascular injury resulting from percutaneous transluminal coronary angioplasty (PTCA) and subsequent thrombus formation are important factors in the pathogenesis of coronary arterial restenosis. The present study was undertaken to determine whether infusions of tissue plasminogen activator (tPA), beginning immediately after PTCA, would decrease the renarrowing of the coronary arterial lumen. Patients were randomized and divided into two groups: one group (15 patients, 16 lesions) received continuous, 3-day, intravenous infusions of tPA (0.25 mg/kg/day in 0.9% saline), beginning immediately after successful PTCA, while the other group (17 patients, 17 lesions) received saline alone. Coronary angiography was performed before, immediately after, 24 hours after, and 3 months after PTCA. Coronary stenosis (%), reference diameters, and minimum luminal diameters were measured by quantitative coronary angiography. The incidence of restenosis tended to be lower in the tPA group than in the placebo group (tPA group, 13%; placebo group, 41%; NS), although diameter stenoses before and immediately after PTCA were not significantly different in the two groups. Three months later, however, diameter stenoses were significantly smaller in the tPA group (35.6 ± 13.3 vs 47.7 ± 18.9%; P<0.05). Thus, intravenous tPA infusion beginning immediately after successful PTCA may inhibit renarrowing of the coronary arterial lumen.
Study of the Value of Corrected Ejection Fraction in the Evaluation of Left Ventricular Function in Patients with Mitral or Aortic Regurgitation
Authors: Abd-El-Aziz Tarek A. , Frere Abd-El-Fattah H. , Khalil Tarek S. , Mansour Kamal S. , Abd-El-Hamid Akram F. , Abd-El-Barry Khalid H.
Published: July 2008

Evaluation of left ventricular function in the presence of valvular regurgitation is still a clinical problem because ejection phase indices including ejection fraction are heavily dependent on preload and afterload and cannot be regarded as reliable indices of contrac tility in diseases associated with altered loading conditions. The authors attempted to evaluate the usefulness of the new index-corrected ejection fraction in the evaluation of left ventricular (LV) function in patients with chronic mitral (MR) or aortic regurgitation (AR). The study included 21 patients with chronic severe MR (11 patients) and AR (10 patients) with a mean age of 18 years. All patients underwent valve replacement or repair. Echo Doppler study was performed preoperatively and postoperatively and included measurement of the following LV parameters: end-diastolic dimension (EDD), end-diastolic volume (EDV), end-systolic dimension (ESD), end-systolic volume (ESV), ejection fraction (EF), systolic blood pressure/end-systolic dimension (SBP/ESD); also mitral and aortic stroke volume were calculated cross-sectional area (CSA) x time velocity integral TVI. Corrected ejection fraction (EFc) was derived from the following equation: ( continued on next page) The mean preoperative EFc did not change significantly after surgical correction of mitral or aortic regurgitation. Preoperative EFc did not show significant difference compared with postoperative EF in the two groups. Preoperative EFc correlated significantly with other preoperative and postoperative indices of LV function. Postoperative EFc showed very close correlation with other postoperative parameters.

Thus, using the new index-corrected ejection fraction in the assessment of LV function in patients with mitral or aortic regurgitation has several advantages: Noninvasive, inde pendent of loading changes, helpful in predicting the immediate postoperative clinical course, and a reliable index for evaluation of LV systolic function preoperatively and postoperatively.
Giant Noninflammatory and Nonatherosclerotic Coronary Arterial Aneurysm in the Left Main Trunk Assessed by Intravascular Ultrasound Imaging
Authors: Eguchi Mariko , Kondoh Susumu , Takagi Yoh-ichi , Tsuchihashi Kazufumi , Abiru Masayoshi , Minatoya Youichi , Seino Ryukichi , Fujise Yukiyasu
Published: July 2008

A case of a giant noninflammatory and nonatherosclerotic coronary arterial aneurysm in the left main trunk of a 69-year-old female is reported. Preoperative intravascular ultra sound (IVUS) images were helpful for visualizing the morphologic and histologic features of the coronary aneurysm. They were also useful for determining the etiologic back ground and surgical procedure.
Pressure and Microcirculatory Effects of Treatment with Lercanidipine in Hypertensive Patients and in Vascular Patients with Hypertension
Authors: Incandela L. , Ledda A. , De Sanctis M.T. , Steigerwalt R. , Pellegrini L. , Bucci M. , Belcaro G. , Ciccarelli R. , Cesarone M.R.
Published: July 2008

The aim of this study was to evaluate the macrocirculatory and microcirculatory effects of treatment with lercanidipine, a new antihypertensive agent acting both on blood pressure and microcirculation in patients with moderate essential hypertension and without vascular disease and in patient with hypertension and vascular disease.

In hypertensive subjects target-organ damage associated with high blood pressure may now be objectively documented by noninvasive tests. These alterations constitute a model to evaluate not only the pressure effects of antihypertensive treatment but also the normalization of the peripheral microcirculatory network.

With color duplex scanning, flow velocity in the central retinal artery and retinal flow velocity can be measured and with use of laser-Doppler-flowmetry, it is also possible to evaluate microcirculation alterations in hypertensive subjects. These evaluation methods are completely noninvasive and may be used to assess the microcirculatory effects of antihypertensive drugs.
Test-Retest Reliability Study of a New Improved Leg-O-Meter, the Leg-O-Meter II, in Patients Suffering from Venous Insufficiency of the Lower Limbs
Authors: Zuccarelli François , Bérard Anick
Published: July 2008

The objective of this study was to evaluate the interobserver and test-retest reliability of the new improved Leg-O-Meter, the Leg-O-Meter II, an instrument designed to measure leg circumference. The new Leg-O-Meter consists of a tape measure fixed to a stand attached to a small board on which the patient is in standing position. Only the left limb is measured. For this study the tape measure of the Leg-O-Meter was fixed at 13 cm from the board. Subjects were recruited from patients consulting the phlebology clinic of Hôpital St-Michel, Paris, France. Thirty-nine patients were asked to participate in the test phase and a subsample of 20 patients were asked to participate in addition to a retest phase 10 minutes after their first measurement. Patients were asked to enter a closed room where four independent and blinded observers consecutively took measurements of their left calf with the Leg-O-Meter II. Twenty patients were also asked to come back 10 minutes later for a second round of measurements. While waiting, patients were seated. Variables collected included leg circumference, presence of edema, clinical presentation, and venous insufficiency treatment history. The order of the observers was randomized between patients. Under the assumption of a two-way random effects model, an intraclass correlation coefficient (ICC) was used to determine the reliability of a measure with the Leg-O-Meter II as well as the test-retest reliability. The interobserver and test-retest reliabilities of the Leg-O-Meter II were 98.28% [96.90%, 100.00%] CI95% and 95.90% [92.00%, 100.00%]CI95%, respectively. The Leg-O-Meter II has higher inter observer reliability and is easier to manipulate than the previous version. In addition, it has substantive test-retest reliability.
Neutralization of Prostaglandin E1 Intravenous Solution Reduces Infusion Phlebitis
Authors: Hatori Nobuo , Shimizu Masafumi , Yoshizu Hiroshi , Segawa Daisuke , Kimura Tamizou , Iizuka Yasuhiro , Tanaka Susumu , Fujita Masanori
Published: July 2008

Previous studies have shown moderate or severe phlebitis at the site of venipuncture in some patients who receiving prostaglandin E1 (PGE1) infusion therapy. Such phlebitis is sometimes severe enough to necessitate the cessation of PGE1 therapy.

This study investigated how to continue PGE1 infusion therapy for 3 weeks with tolerable phlebitis. Although a 60 μg dose of PGE1 is usually dissolved in 500 mL of fluid to avoid phlebitis, we used 200 mL to prevent volume overload. This PGE1 solution was neutralized to pH 7.4 with 4 mL of 7% sodium bicarbonate. We examined the frequency and severity of phlebitis among patients who received a 2-h PGE1 infusion twice daily.

Eighteen patients who were hospitalized for peripheral vascular disease between June 1998 and May 1999 were studied. All of them were men and their mean age was 63.3 ±8.9 years (range: 47-78 years). Fourteen patients had arteriosclerosis obliterans and four had Buerger's disease. When the severity of phlebitis was determined according to Dinley's criteria, two patients (11%) had grade 0, four patients (22%) had grade 1, eleven patients (61%) had grade 2, and one patient (6%) had grade 3 phlebitis. Usually, PGE1 infusion therapy is stopped when phlebitis reaches grade 4 or more, but there were no such cases in this study. We also found that aging was significantly correlated with a decrease in the severity of phlebitis (Spearman's rank correlation test: r = -0.545, p = 0.0193).
Preoperative Angiography and Intraoperative Transit Time Flow Measurement to Detect Coronary Graft Patency in Reoperations: An Integrated Approach
Authors: D'Ancona Giuseppe , Karamanoukian Hratch , Ricci Marco , Bergsland Jacob , Salerno Tomas A. , Karamanoukian Hratch
Published: July 2008

Coronary angiography is the gold standard for preoperative diagnosis of coronary artery disease. In reoperative coronary artery surgery the physiologic significance of suspect lesions by angiography can be confirmed by direct intraoperative measurement of blood flow in the old grafts; such interpretation can prevent unnecessary graft revisions.
Diffuse and Severe Left Ventricular Dysfunction Induced by Epicardial Coronary Artery Spasm
Authors: Sakata Kazuyuki , Nawada Ryuzo , Ohbayashi Kazuhiko , Tamekiyo Hiromichi , Yoshida Hiroshi
Published: July 2008

Endothelial dysfunction and effectiveness of treatment of calcium antagonists are sugges tive of coronary artery spasm as an underlying disorder in dilated cardiomyopathy (DCM). The aim of this study is to determine whether or not the epicardial coronary artery spasm can induce severe cardiac dysfunction like DCM. Thirty-four consecutive patients with angiographically normal coronary arteries and diffuse left ventricular hypokinesis whose causes had been unknown underwent acetylcholine provocation test and left ventricular biopsy. Eight patients were excluded according to the clinical and laboratory data and biopsy findings suggesting myocarditis or other systemic diseases. According to the results of the acetylcholine provocation test, 17 patients were finally diagnosed as having DCM, and nine patients (35% of the study patients), who had acetyl choline-induced diffuse and multivessel coronary spasm, were diagnosed as having DCM- like vasospastic angina pectoris (VSA). Clinical and cardiac catheterization data including hemodynamics and biopsy findings were similar between the two groups except that left ventricular end-systolic volume was significantly greater in DCM than in DCM-like VSA. After the acetylcholine provocation test, DCM patients received both a beta blocker and an angiotensin-converting enzyme inhibitor, and DCM-like VSA patients received antiang inal drugs. In echocardiographic findings at predischarge and those after 6-month drug (continued on next page) treatment, both DCM-lke VSA and DCM showed significant reduction in end-diastolic and end-systolic diameters and significant increase in fractional shortening and ejection fraction, whereas changes in ejection fraction and fractional shortening were significantly greater in DCM-like VSA than those in DCM. Epicardial coronary artery spasm can induce diffuse and severe left ventricular dysfunction like DCM in VSA. Although antianginal drugs markedly improve left ventricular function of these patients, only the acetylcholine provocation test can identify DCM-like VSA.
Effects of Estrogen Therapy on Arterial Resistance and Pulsatility in Postmenopausal Women
Authors: Federici Antonio , Ciccone Marco , Cicinelli Ettore , Lombardi Maristella , Pitzalis Maria Vittoria , Galantino Pietro , Pinto Vincenzo
Published: July 2008

The hypothesis of this study was that changes in arterial determinants of afterload due to static muscular contraction can be modified, in postmenopausal women, by estrogen replace ment therapy. Two groups of 14 postmenopausal and 15 premenopausal women were enrolled. Hemodynamic changes induced by right handgrip were recorded between days 7 and 10 of the menstrual cycle in premenopausal women. The same recordings were performed in post menopausal women, before and after receiving transdermal estrogen replacement therapy for 8 days. Handgrip was performed at 50% of maximal voluntary contraction and maintained until exhaustion. Arterial pressure and blood velocity were recorded in the resting hand with photo plethysmographic and Doppler techniques. indices of arterial elasticity and resistance were calculated. In postmenopausal women, these indices increased during effort only slightly less after therapy than before, if the mean values and statistical significance were considered, but the most evident effect of therapy was a decrease in interindividual differences in the effort induced changes. This means that, after therapy, increases in arterial resistance and elasticity indices were appreciably prevented mainly in those postmenopausal women who, before therapy, showed the greatest increases. Differences due to therapy were negligible in post menopausal women in whom, before estrogen replacement, increases in elasticity and resis tance indices during effort were similar to those obtained in premenopausal women. After therapy, no differences were found in resting conditions in any of the investigated cardiovas cular parameters. Estrogen replacement did not appreciably affect changes in some arterial afterload-related indexes during handgrip, if the average values were considered in a group of postmenopausal women, but uneven and unpredictable peaks in individual responses were cut off, with a better predictability of the responses to sustained muscular contractions, as well as of the related risk factors.
Primary Pulmonary Hypertension in HIV Patients: A Systematic Review
Authors: Pellicelli Adriano M. , Barbaro Giuseppe , Palmieri Fabrizio , Girardi Enrico , D'Ambrosio Cecilia , Rianda Alessia , Barbarini Giorgio , Frigiotti Daniela , Borgia Maria Clotilde , Petrosillo Nicola
Published: July 2008

The relationship between grade of pulmonary hypertension and factors associated with human immunodeficiency virus among patients with HIV infection is poorly documented. This report documents the most extensive attempt made thus far to determine whether a relationship exists between degree of pulmonary hypertension and the following conditions: HIV risk factor, degree of immunosuppression, presence or absence of AIDS, and presence or absence of liver cirrhosis. A retrospective study involving a search of the published literature on primary pulmonary hypertension among HIV cases from 1987 to 1998, using the Medline and Aidsline databases was conducted.

Patients for whom secondary causes of pulmonary hypertension could be excluded were selected, and the following information for each was recorded: age, gender, risk factors for HIV infection, HIV disease stage according to the Centers for Disease Control, previous oppor tunistic and neoplastic diseases, CD4+ cell count (cells/L), presence or absence of liver cirrhosis, pulmonary systolic artery pressure level, and lung pathology specimens. Information about the patient's survival time was also recorded. Seventy-six patients were judged to have primary pulmonary hypertension and were included in the study.

While no correlation was found between pulmonary systolic artery pressure level and CD4+ cell counts, a statistically significant difference was found between HIV-positive patients with and without AIDS as determined by the Centers for Disease Control criteria with regard to the degree of pulmonary hypertension, expressed as pulmonary systolic artery pressure level (85.4 ± 17 mm Hg vs 71.8 ± 15 mm Hg, p < 0.013). Although a higher PAPS was present in HIV cirrhotic patients, a statistically significant difference was not found between degree of pulmonary hyper tension and evidence of hepatic cirrhosis (85 ±21 mm Hg vs 73.1 ± 15 mm Hg, p < 0.062).

Patients with AIDS and primary pulmonary hypertension present a higher degree of pulmonary hypertension than non-AIDS patients. Pulmonary hypertension associated with HIV seems to be related to a cytokine-related stimulation and proliferation of endothelium. High levels of cytokines present in AIDS patients can favor pulmonary hypertension, but the role of a host response to HIV—determined by one or more HLA subtypes—is suspected to enhance high cytokine production levels.
Idiopathic Bilateral External Jugular Vein Thrombosis
Authors: Sengupta Shantanu , Kalkonde Yogesh , Khot Rajashree , Paithankar Madhuri , Salkar Ramesh , Salkar Harsha
Published: July 2008

The authors report a patient with the rare presentation of bilateral external jugular vein throm bosis. A 45-year-old man presented with swelling over both sides of the neck and puffiness of the face. Physical examination revealed cordlike thickening of both the external jugular veins. Two-dimensional echocardiographic and Doppler studies showed thrombosis of both the external jugular veins and digital subtraction angiography (DSA) revealed nonvisualization of external jugular veins of either side. No malignancy, coagulation disorder, or any infection was demonstrable. A regular follow-up for 1 year was done, but no other cause could be found and there was no progression of the disease.
Robotically Assisted Video-Enhanced-Endoscopic Coronary Artery Bypass Graft Surgery
Authors: Tang Lawton W. , D'Ancona Giuseppe , Bergsland Jacob , Kawaguchi Akira , Karamanoukian Hratch L.
Published: July 2008

Since 1988, through fierce industry-driven competition and patients' preference for minimally invasive procedures, widely diffused through the media, laparoscopic cholescystectomy was universally adopted and rapidly became the "gold standard" for symptomatic cholelithiasis. Robotically assisted video enhanced-endoscopic coronary artery bypass surgery (RAVE-CABG) will most likely follow suit with its similar developmental processes for symptomatic coronary artery disease. Since 1998, there are currently two surgical robotic systems that have been used in a clinical setting for endoscopic coronary artery bypass (ECABG): the da Vinci™ and the ZEUS™ system. Although each has separate learning curves to overcome, as with any new technology, both offer the promise to contribute in the interests of reduced hospital days, earlier return to normal activity, less pain, better cosmesis, and the rethinking of surgical dogma such as wide exposure.
Comparison Between Isosorbide Dinitrate in Aerosol and in Tablets for the Treatment of Hypertensive Emergencies
Authors: Rubio-Guerra Alberto Francisco , Vargas-Ayala Germán , Narváez-Rivera Jorge Luis , Rodríguez-López Leticia , Lozano-Nuevo José Juan , Trejo-Orozco Nancy
Published: July 2008

Sixty patients with a hypertensive emergency (mean arterial pressure > 130 mm Hg and evidence of target organ damage) were randomly divided into two groups of 30 patients each. Group A received 1.25 mg of isosorbide dinitrate aerosol upon arrival and a second dose 15 minutes later when the mean arterial pressure reduction was < 15%. Group B received a single 5 mg tablet of sublingual isosorbide dinitrate. Electrocardiography was performed in both groups prior to and 30 minutes after the medication. Blood pressure was monitored for 6 hours. Blood pressure in Group A patients decreased in an average time of 10 minutes from 191 ±12/122.3 ±5 to 151.5 ±9.2/93 ±4 mm Hg, p<0.005. Mean arterial pressure decreased by 22.8%: 145 ±7 to 112 ±7.5 mm Hg, p<0.005. No adverse effects occurred. Five patients in Group B did not respond; in the rest of the group blood pressure decreased 45 minutes after receiving the medication from 194 ±8/125 ±5.5 to 160 ±11/98 ±6 mm Hg; p<0.005. Mean arterial pressure decreased by 20.1 %: 148.3 ± 12 to 118.6 ±9 mm Hg, p<0.002; ten patients suffered headache. Three patients in Group A had a subepicardial lesion in the first electrocardiograph, which disap peared with the use of the aerosol. In Group B, electrocardiography results were normal. These results seem to indicate that isosorbide dinitrate aerosol is better than tablets for the treatment of patients with a hypertensive emergencies.
Refractory No-Reflow Successfully Treated with Local Infusion of High-Dose Adenosine and Verapamil
Authors: Dillon William C. , Hadian Djavid , Ritchie Michael E.
Published: July 2008

No-reflow is an unpredictable complication following percutaneous coronary intervention. No- reflow is associated with myocardial ischemia and infarction and increased mortality. A case of refractory no-reflow is described that was rapidly and successfully treated with multiple infusions of high doses of verapamil and adenosine applied directly at the site of no-reflow through a perfusion catheter.
Percutaneous Balloon Mitral Commissurotomy During Pregnancy
Authors: Abouzied Amr Mousa , Al Abbady Maged , Al Gendy Mohamed Fared , Magdy Ahmed , Soliman Hamdy , Faheem Faik , Ramadan Tarek , Yehia Ahmed
Published: July 2008

Percutaneous balloon mitral commissurotomy was performed in 16 pregnant women aged 23 ±3 years (range, 16-39 years) who had severe mitral stenosis at pregnancies of mean gesta tional age 25 ±6 weeks. Ten patients were in New York Heart Association functional class III, and six patients were in functional class IV at the time of the procedure. All patients were symptomatic despite maximal medical therapy. The procedure was performed with the Inoue balloon. The mitral valve area increased from 0.9 ±0.3 to 1.8 ±0.3 cm2 (p < 0.05). The mitral valve pressure gradient decreased from 23 ±7 to 6 ±3 mm Hg (p < 0.05). The left atrial pressure decreased from 28 ±8 to 10 ±4 mm Hg (p < 0.05). The pulmonary artery pressure decreased from 59 ±18 to 33 ± 12 mm Hg (p<0.05). Fourteen patients continued their pregnancies to mean gestational age 37 ±2 weeks; all infants were healthy. Two patients had premature deliv eries more than 1 month after the procedure due to obstetrical reasons. The two newborns died at day 2 of respiratory distress. Eleven women had vaginal deliveries and five had cesarean sections. All clinically improved to New York Heart Association functional class I or II. Excessive blood loss from the femoral puncture site that required transfusion occurred in one patient. Mitral regurgitation increased one degree in four patients, from 0 to 1 +. Patients were observed until delivery. None had restenosis. The degree of mitral regurgitation remained unchanged. Percutaneous balloon mitral commissurotomy can be performed safely during pregnancy. It will effectively improve hemodynamics and symptoms in pregnant patients who have severe mitral stenosis and persistent congestive heart failure symptoms despite conventional medical treatment. There are no immediate detrimental effects of radiation on the fetus. Risks are lower than previously reported when surgical commissurotomy was performed.
QTc Dispersion Measurement for Risk of Syncope in Patients with Aortic Stenosis
Authors: Koşar Feridun , Hisar Ismet , Durmaz Tahir , Ileri Mehmet , Tandogan Izzet
Published: July 2008

The purposes of this study are to evaluate the clinical usefulness of maximum QTc and QTc dispersion determination in aortic stenosis, and to compare the effects of maximum QTc and QTc dispersion on the risk of syncope in aortic stenosis. The QT interval dispersion has long been known to be a marker of dispersion of ventricular repolarization and, hence, electrical instability. Additionally, it has been shown that these patients have a propensity to ventricular tachyarrhythmic syncope. The study included 86 patients with aortic stenosis who underwent left-heart catheterization and coronary angiography during investigation of syncope and 30 healthy subjects. The patients were characterized with regard to the presence or absence of a history of syncope and the severity of aortic stenosis (the degree of peak transvalvular gradient). In addition, QT max and QT dispersion measurements were corrected for heart rate according to Bazett's formula. The QTc max and QTc dispersion were greater in patients with aortic stenosis than in the healthy subjects (477 ±49 ms vs 370 ±22 ms, p < 0.001; 60 ± 13 ms vs 38 ± 1 ms, p < 0.001). Similarly, the QTc max and QTc dispersion were greater in the patients with a history of syncope than in the patients with no history of syncope (493 ±48 ms vs 459 ±4 ms, p < 0.001; 68 ±12 ms vs 53 ± 10 ms, p < 0.001). In addition, both parameters were greater in the patients with a high transvalvular gradient than in the patients with a low transvalvular gradient (489 ±49 ms vs 451 ±39 ms, p < 0.001; 65 ± 12 ms vs 50 ±9 ms, p < 0.001). Multivari ate logistic regression analysis showed that only a increased QTc dispersion had significant value for the risk of syncope in aortic stenosis. An increased QTc dispersion caused a 10.4% increase in the occurrence of syncope in aortic stenosis. These results suggest that high values of QTc dispersion are sensitive noninvasive markers to determine the risk for syncope in aortic stenosis.
Use of a Fogarty Catheter to Open an Incompletely Expanded Vena Tech-LGM Vena Cava Filter
Authors: Danikas Dimitrios , Constantinopoulos George S. , Stratoulias Constantinos , Ginalis Ernest M.
Published: July 2008

A Vena Tech-LGM 30D/U filter (B. Braun/Vena Tech; Evanston, IL) opened incompletely after transjugular placement in the infrarenal vena cava. The cephalic points of the stabilizing side rails were open and had engaged the caval wall. The base of the filter failed to open. The filter would not successfully inhibit the clots and could possibly migrate. The filter base was not placed in a clot as shown with intraoperative venography before and after the placement. The balloon of a 6F Fogarty catheter was used successfully to dilate the distal legs of the filter, and fully expand the base.
Diurnal Variation of QT Dispersion in Patients With and Without Coronary Artery Disease
Authors: Yetkin Ertan , Senen Kubilay , Ileri Mehmet , Atak Ramazan , Topaloglu Serkan , Ergün Kumral , Yanik Ahmet , Tandogan Izzet , Cehreli Sengül , Duru Erdal , Demirkan Deniz
Published: July 2008

QT dispersion defined as interlead QT variability in a 12-lead electrocardiogram was proposed by Day and associates as a simple method to evaluate the repolarization heterogenicity of the ventricular myocardium. The frequency of onset of myocardial infarction and sudden death has been reported to have a circadian variation, with a peak incidence in the early morning hours. The authors investigated whether there is diurnal variation of QT interval and QT interval dispersion in healthy subjects and in patients with coronary artery disease. The study popula tion consisted of two groups. Group I consisted of 62 subjects without coronary artery disease and group II consisted of 82 patients with coronary artery disease. Twelve-lead ECG was recorded for each patient in the morning (between 7 AM and 8 AM), afternoon (between 3 PM and 5 PM) and at night (between 11 PM and 1 AM), on the day after performance of coronary angiography. QTc dispersion was significantly higher in patients with coronary artery disease than in healthy subjects in the morning hours and afternoon (p< 0.001). Although the differ ences were much prominent in group I than group II, both QTc dispersion of morning and afternoon were significantly greater than those at night. There were no statistically significant differences between group I and group II at nighttime with respect to maximum QTc , minimum QTc intervals, and QTc dispersion (p>0.05). In conclusion, QT dispersion shows diurnal variation with an increase in the morning hours in both patients with coronary artery disease and subjects without coronary artery disease. The mechanism of diurnal variation of QT dispersion in patients with coronary artery disease is quite different from that of healthy subjects.
Percutaneous Balloon Pericardiotomy for Patients with Malignant Pericardial Effusion Including Three Malignant Pleural Mesotheliomas
Authors: Övünc Kenan , Aytemir Kudret , Özer Necla , Atalar Enver , Aksöyek Serdar , Nazh Nasih , Gürsel Güner , Kes Sirri
Published: July 2008

Ten patients were enrolled in this study to evaluate the therapeutic value of percutaneous balloon pericardiotomy in patients with symptomatic pericardial effusion secondary to malignant diseases. Four patients had breast cancer; 2 had lung cancer; 1 had non-Hodgkin's lymphoma; and 3 had malignant pleural mesothelioma, which is commonly seen in Central Anatolian region of Turkey. All patients underwent percutaneous balloon pericardiotomy with monofoil balloons (Mansfield, NuMed). No complication was seen during these procedures. In 3 patients, the balloon could not be expanded completely and was entered from a more lateral position by a second puncture. There was no recurrence of pericardial effusion in 6 of 7 patients without mesothelioma. After percutaneous balloon pericardiotomy, surgical subxiphoid windowing was performed due to drainage greater than 100 mL/day in a patient with lung cancer and in 1 patient with mesothelioma. In the other 2 patients with mesothelioma, recur rence of pericardial effusion was seen and then subxiphoid surgical windowing was performed due to development of cardiac tamponade in 1 of them. All the patients died 68.6 ±36 days later due to the primary malignancies. The survival time of patients with mesothelioma was shorter than that of the others (p < 0.05).

These results suggest that percutaneous balloon pericardiotomy may be used in the treatment of patients with malignant pericardial effusion as an alternative to surgical pericar dial window creation. But in patients with malignant pleural mesothelioma, the success rate of this procedure was lower than that of the others.
Differences in Frequency of the Deletion Polymorphism of the Angiotensin-Converting Enzyme Gene in Different Ethnic Groups
Authors: Mathew James , Basheeruddin Khaja , Prabhakar Suresha
Published: July 2008

A polymorphism characterized by the insertion or deletion of a 287-bp Alu repeat sequence in intron 16 of the angiotensin-converting enzyme gene determines about half the serum angiotensin-converting enzyme level variability among individuals. The deletion polymorphism is associated with higher levels of angiotensin-converting enzyme and perhaps with a greater risk of cardiovascular diseases. The relative frequency of this genetic polymorphism in different ethnic groups is not known. The objective of this study was to compare the frequency of angiotensin-converting enzyme gene insertion/deletion polymorphism in different ethnic groups. Angiotensin-converting enzyme genotype was determined in middle-aged healthy hospital workers of three different ethnic origins (African Americans, whites, and Indians). There were 142 African Americans, 136 Indians, and 82 whites. The distribution of the deletion-deletion, insertion-deletion, and insertion-insertion genotypes in African Americans (29%, 60%, and 11 %, respectively), Indians (19%, 50%, and 31 %, respectively) and whites (29%, 40%, and 31 %, respectively) was significantly different (p = < 0.005). The frequency of the deletion allele among African Americans, Indians, and whites (0.59, 0.49, and 0.44, respectively) was also significantly different (p = 0.05). African Americans had the highest frequency of deletion allele and the lowest frequency of the insertion-insertion genotype among the three groups. The frequency of the deletion polymorphism of the angiotensin-converting enzyme gene is different among African Americans, whites, and Indians. This may be important in relation to the high risk of cardiovascular morbidity and mortality in African Americans and may be relevant in explaining differences in cardiovascular diseases in different populations. This finding also emphasizes the importance of studying angiotensin-converting enzyme gene polymorphism in genetically homogenous populations. Because of the small size of this study, however, these findings need further confirmation.
Association of Left Ventricular Hypertrophy and Aortic Dilation in Patients with Acute Thoracic Aortic Dissection
Authors: Iarussi Diana , Caruso Aurelio , Galderisi Maurizio , Covino Franco Enrico , Dialetto Giovanni , Bossone Eduardo , de Divitiis Oreste , Cotrufo Maurizio
Published: July 2008

This study was designed to evaluate the impact of left ventricular mass on aortic diameters in patients who presented with acute thoracic aortic dissection where aortic dilation is common. Retrospective review of transthoracic and transesophageal echocardiograms was conducted for 63 patients treated for acute thoracic aortic dissection and for 16 normal subjects who were comparable for gender prevalence, age, heart rate, and blood pressure. The diameter of the aortic root was measured by transthoracic echocardiography. Diameters of the ascending aorta, and of the aorta at locations of 25, 30, and 35 cm from the dental arch were measured by transesophageal echocardiography. The findings indicated that all aortic diameters were significantly larger in patients with aortic dissection. Patients with aortic dissection also presented with greater left ventricular mass indices (p < 0.00001) than normal subjects. Fractional shortening and left atrial diameter measurements obtained in patients with aortic dissection were similar to those obtained in the control group.

Overall, the left ventricular mass index exhibited univariate relationships with aortic root diameter (r= 0.27, p<0.02) and aortic diameters at 25 cm (r=0.51, p < 0.00001), 30 cm (r= 0.58, p < 0.00001), and 35 cm (r= 0.55, p < 0.00001) distal to the arch but not with the diameter of the ascending aorta. After adjusting for gender, body mass index, history of hyper tension and aortic dissection extent (Stanford types) by separate multivariate models, the authors found that the left ventricular mass index was independently associated with aortic diameters at 25 cm (β = 0.32, p < 0.001), 30 cm (β = 0.38, p < 0.0001), and 35 cm (β = 0.34, p < 0.0005) distal to the arch. They conclude that left ventricular mass is independently asso ciated with aortic arch and descending aorta diameters in patients with acute thoracic aortic dissection. Left ventricular hypertrophy may be considered a risk factor for aortic enlarge ment and subsequent dissection.