bluuebunny/crossref_metadata_2025 huggingface dataset:
Influence of Local and Environmental Temperatures on Cutaneous Circulation with Use of Laser Doppler Flowmetry
Authors: Winsor Travis , Haumschild Daniel J. , Winsor David , Mikail Amani
Published: July 2008

The purpose of this study was to determine a standard set of conditions for detecting peripheral arteriosclerosis with ischemia.

One series of studies was done to determine the influence of room tempera ture on peripheral flow in healthy subjects and patients with peripheral vascu lar disease. The room temperature was varied from 30° to 35°C. The temperature from 24° to 30°C had only minor effects on the circulation. Thus, it seemed appropriate to use a room temperature in the lower range, usually 23°C.

Another series of studies showed the effect of changing skin temperatures locally at the finger tip or toe tip on the plantar and volar surfaces in healthy subjects and in patients with peripheral vascular disease. Results showed that as temperature was increased from 10° to 45°, there was a marked increase in the finger and toe circulations, which was considerably greater in the normal sub jects as compared with those with digital disease. The ideal temperature at which to work as a routine is 40 ° C as opposed to the lower temperatures, which did not separate healthy subjects from patients with peripheral vascular dis ease.

A third experiment was done to study normal subjects and patients by using the finger circulation as control against the toe circulation when the conditions were a local skin temperature of 40 ° C and a room temperature of 23°C. A toe- finger index was established to detect abnormalities in the circulation. An index using a part of the body as its reference has been used in many other physical measurements such as the ankle/wrist pulsation ratio or Doppler pulse ratio. Use of the index excludes the cardiac output from the ratio measurements. The index narrows the range of normal subjects as compared with single measure ments made on various individuals.
Individually Controlled Aspirin in the Long-Term Treatment of Patients with Chronic Arterial Diseases
Authors: Misselwitz F. , Norden C. , Heine H.
Published: July 2008

A simple method of measuring the biological effect of acetylsalicylic acid (ASA), based on the determination of the disaggregation rate (DR) of plate let aggregation induced by adenosine diphosphate (ADP), is described. The DR was found to correlate with the inhibition of the production of ma londialdehyde (MDA) by platelets (r = 0.66, P < 0.001). Therefore, the DR was used for laboratory monitor ing of the ASA effect. The study in cluded 63 arteriosclerotic patients — patients with ischemic heart disease (IHD), peripheral arterial disease (PAD), or cerebrovascular insuffi ciency (CVI) — who were analyzed before treatment and after receiving ASA in an individually controlled dosage. Before treatment the authors found an increased level of MDA and a longer euglobulin clot lysis time in patients when compared with healthy volunteers (n=16). Extremely differ ent doses of ASA were required to normalize initially elevated MDA lev els in patients. Normalization of the MDA level corresponds to a DR of at least 50% (in comparison with 0-13% without treatment). When judging the ASA dose individually from the 50% DR, the authors demonstrated that there were no differences in the levels of cyclooxygenase- and lipoxy genase-derived eicosanoids between healthy volunteers (n = 16) and arteri osclerotic patients receiving 100-250 mg (n=18), 500 mg (n=17), or 750-1500 mg ASA per day (n=6). Thus, their results support the idea of using individually controlled ASA as the most promising way of resolv ing the "aspirin dilemma" and pro vide a simple and reproducible method of measuring the biological effect of ASA.
Increased Production of Oxygen Free Radicals by Polymorphonuclear Leukocytes in Heart Failure Due to Aortic Stenosis
Authors: Prasad Kailash , Kalra Jawahar , Massey K. Lorne , Bharadwaj Baikunth
Published: July 2008

Oxygen free radicals have been linked to a wide variety of cellular damage in biological systems. Poly morphonuclear (PMN) leukocytes stimulation is one of the known sources for oxygen free radicals. It has been suggested that oxygen free radicals depress the excitation-con traction coupling in cardiac muscle. It is possible that a decrease in the myocardial contractility in heart fail ure might be due to an increased oxy gen-free-radical-producing activity of PMN leukocytes. The authors studied, therefore, the release of oxy gen free radicals, as measured by luminol-dependent chemilumines cence activity, from the PMN leuko cytes in dogs with heart failure due to aortic stenosis. Hemodynamics and phagocytic activity of PMN leuko cytes were studied in 6 control dogs and 6 dogs with aortic stenosis of six to nine months' duration. There was a significant decrease in the index of myocardial contractility and an in crease in the left ventricular end- diastolic pressure in dogs with aortic stenosis, suggesting left ventricular failure in these dogs. Although there was a tendency for a decrease in the cardiac index in dogs with aortic stenosis, the decrease was not signifi cant. Phagocytic activity of PMN leu kocytes in blood was studied in con trol dogs and dogs with aortic steno sis. Phagocytosis was initiated by ad dition of opsonized zymosan and chemiluminescence was monitored by use of a luminometer. The peak chemiluminescence activity of the PMN leukocytes in blood of dogs with heart failure was about threefold greater than that in the blood from control dogs. The presence of super oxide dismutase, a scavenger of oxy gen free radicals, reduced the chemi luminescence from PMN leukocytes in both the control dogs and dogs with aortic stenosis. These results suggest that the increased production of oxygen free radicals by PMN leu kocytes might contribute to a de crease in the myocardial contractility and, hence, to heart failure in dogs with aortic stenosis.
Placebo-Controlled, Double-Blind Trial of Hemodilution in Peripheral Occlusive Arterial Disease
Authors: Ernst E. , Matrai A. , Kollar L.
Published: July 2008

A number of uncontrolled trials has suggested that hemodilution is effective in peripheral occlusive arte rial disease. This study was aimed at proving or disproving the efficacy of hemodilution by using a randomized, placebo-controlled, double-blind crossover design. Twenty-four stable claudicants with long, collateralized femoropopliteal obstructions were treated with isovolemic hemodilution with 500 mL of 10% hydroxyethyl starch 200 and sham dilutions. Three weeks of hemodilution lowered blood and plasma viscosity, as well as hema tocrit, and increased resting blood flow and pain-free walking distance. Placebo treatments produced no such favorable changes. It is concluded that hemodilution therapy can be clinically effective in patients with ar terial obstructions in the lower ex tremities. Hemodilution seems particularly promising under hemo dynamic condition of low shear stresses in vivo.
Gated Intracoronary Thallium201 Scintigraphy: Feasibility and Potential Clinical Advantages
Authors: Siegel Michael E. , Chen David C. P. , Lee Kai , Rasmussen Deanna , Colletti Patrick , Thom Peter , Rahimtoola S.H.
Published: July 2008

Visualization of ventricular walls with true global motion and myocardial thickening is not possible with use of present scintigraphic techniques. When thallium 201 (201TI) is injected intravenously (IV), only about 5% reaches the myocardium. However, if201TI is injected intracoronarily, 100% reaches, and approximately 88% localizes in, the myocardium, which results in higher count rates than when given IV, permitting acceptable acquisition times for gated true wall motion studies. The authors describe a new technique using intracoronary (IC)201TI to acquire high count rate, high contrast, and short acquisition time in gated true wall motion studies.

Thirteen patients were studied at rest with gated IC thallium. Six of these patients also had resting IV201TI myocardial studies. After routine coronary angiography, 0.75 mCi of201TI was injected into each coronary artery. Multiple sequential one-minute gated studies were obtained in LAO and RAO projec tions, followed by sequential five-minute images for two hours to determine201TI redistribution kinetics. Regions of interest over segments of left and right ven tricles and background permitted definition of temporal and spatial distribu tions. Three one-minute gated studies were summed with a total count of 2,100 K for a three-minute acquisition.

Myocardium-to-background ratios were as high as 13:1 with a mean of 11.4:1 in the IC study compared with 2.3:1 in the IV studies. Washout half-time in normal myocardium was 95 ± 5 min. The detectability and size of perfusion defects were different on gated diastolic and systolic, nongated, and IV studies. Questionable defects seen on nongated studies or after IV administration were easily noted on gated diastolic images. Apparent alterations in wall thickness during the cardiac cycle were visualized.

Short-acquisition and high-resolution myocardial perfusion images demon strating the wall motion obtained by this new technique may be a useful adjunct to the blood pool and coronary anatomy detail acquired during cardiac cathe terization. The apparent advantages of the gated perfusion study are being ap plied to experimental99mTc-labeled myocardial perfusion agents presently being evaluated.
Systolic and Diastolic Septal and Posterior Wall Echocardiographic Measurements in Normal Subjects
Authors: Kounis Nicholas G. , Zavras George M. , Soufras George D. , Kitrou Michael
Published: July 2008

M-mode echocardiographic measurement of septal and left ventricular ex cursions and velocities was attempted in 109 subjects. Seventy subjects had ade quate echocardiograms enabling detailed measurement. Two groups of subjects were studied: a group of normal adults aged nineteen to seventy-eight years and a group of normal juveniles aged nine to eighteen years. The posterior wall excursion (PWE), systolic septal excursion (SSE), diastolic septal excursion (DSE), and diastolic septal velocity (DSV) did not differ in these groups. There were significant differences in the posterior wall excursion during isovolumetric contraction (B-Ce, p < 0.002), mean posterior wall velocity (PWV mean, p < 0.002), and systolic septal velocity (SSV, p=0.05) between the two groups. The measurements were obtained by using the recently published method of the specific points for labeling and description of the wall motion.
Importance of Blood Viscoelasticity in Arteriosclerosis
Authors: Hell K.M.D. , Balzereit A. , Diebold U. , Bruhn H.D.
Published: July 2008

Corpuscular and biochemical components of blood create the vis coelastic nature of blood flow, which varies because of changes in flow ve locity. The flow properties of blood are of special interest in arterioscle rotic diseases for vasoregulatory mechanisms are often disturbed in these states. The authors compared the rheologic properties of blood in patients with arteriosclerotic lesions (coronary heart disease: n=56; cere brovascular disease: n=37; periph eral arterial occlusive disease: n=29 and healthy controls: n=42).

With a new oscillating capillary rheometer imitating the physiologic pulsations of blood flow in an un branched artery, the viscosity (η') and elasticity (η") of whole blood and plasma were measured (diameter of the capillary: 0.9928 mm; pulse rate: 2/s; shear rate: γ=0.03-200/s; tem perature : 37°C).

In arteriosclerotic patients a sta tistically significant elevation of the viscoelasticity of whole blood and plasma was found. In addition, plasma fibrinogen levels were aug mented in the patients' groups. Clot ting parameters (Quick, partial thromboplastin time, platelet count) and total serum protein levels were in the normal range in all patients inves tigated.

In conclusion the question arises whether the increase of blood vis coelasticity is an additional risk fac tor for patients with arteriosclerotic disease or if it is just a consequence of the underlying disease. The authors' observations concerning blood vis coelasticity support the clinical im portance of improving blood rheology by appropriate therapeutic measures.
Effect of Buflomedil Chlorhydrate on Local Oxygen Delivery in Peripheral Vascular Disease
Authors: Mannarino E. , Pasqualini L. , Maragoni G. , Orlandi U.
Published: July 2008

Modifications in transcutaneous oxygen pressure (TcPO2), induced by the administration of 3 mg/kg/day buflomedil chlorhydrate for seven days were evaluated in 12 subjects suffering from peripheral vascular disease (PVD). After the treatment a significant increase in TcPO 2 basal values was observed in Stage III and Stage IV PVD patients (+32.2%) while a significant reduction of 12 % in the half-recovery time to basal val ues after an induced ischemia was re corded in Stage II PVD patients by the seventh day. Buflomedil did not, however, cause any significant varia tions in the ankle/arm pressure ratio or in the plethysmographic peak flow.
Favorable Effects of Prostacyclin Infusion in a Patient Given a Renal Transplant and with Severe Vascular Disease Secondary to Diabetes—A Case Report
Authors: Bedani Pier Luigi , Fiocchi Orazio , Soffritti Silvia , Farinelli Alberto
Published: July 2008

Microangiopathy is one of the most frequent diseases in diabetic patients. A diabetic man with a kidney transplant and with severe and progressive vasculo pathy with early necrosis of the fingers and toes was submitted to three prosta cyclin (PGI2) intravenous infusions (5 ng/kg/min for forty-eight hours) during a period of two months. Three months after the last infusion, radiographs of the hands and feet showed a marked reduction in the extent of the vascular calcifi cations and healing of the ischemic-necrotic areas. The authors discuss the im mediate and later effects of PGI2 infusion in a case of diabetic vascular disease.
Effects of Two Cocktails on Left Ventricular Diastolic Function in Normal Men
Authors: Gould L. , Vacek T. , Muller R. , Taddeo M. , Betzu R.
Published: July 2008

The effects of alcohol on diastolic function in normal males are unknown. Therefore, 12 male physicians had a Doppler echocardiogram performed in order to assess left ventricular diastolic performance. They then drank 4 ounces of whiskey, and forty-five minutes later a repeat Doppler echocardiogram was obtained. All the Doppler indexes of diastolic performance differed significantly after the ingestion of alcohol. The mean control D-F interval was 203±26 ms and after alcohol it was 237±51 (p < 0.01). The mean control EF slope was 4.4±0.35 m/s2 and after alcohol it was 3.2±0.73 (p < 0.01). The control E-F interval was 114 ±30 ms and it increased after alcohol to 150±37 (p < 0.001). The mean control E wave was 0.54±0.10 m/s and after alcohol it was 0.43±0.07 (p < 0.01). The mean control A wave was 0.30±0.04 m/s and after alcohol it was 0.35±0.04 (p < 0.01). The mean control E/A ratio was 1.80±0.20 and it fell to 1.25±0.23 after alcohol ingestion (p < 0.001). Thus, the results suggest that 4 ounces of whiskey can produce, in normal males, a significant impairment in diastolic function.
Exercise Testing, Clinical, and Angiographic Characteristics of Anginal Patients With and Without Diabetes Mellitus
Authors: Masuda Izuru , Sato Iwao
Published: July 2008

To elucidate the influence of coex isting diabetes mellitus (DM) on clini cal and pathophysiologic characteris tics in patients with coronary artery disease (CAD), the authors reviewed 1,211 consecutive patients who un derwent coronary angiography (CAG) and selected 80 patients with significant CAD but without myocar dial infarction, hypertension, or other heart diseases, who underwent both symptom-limited treadmill test (TM) and CAG within four weeks. DM was found in 22 of the 80 pa tients. No significant difference in the average number of diseased arteries or left ventricular ejection fraction at rest was found between DM patients and patients without DM (NDM pa tients). The incidences of exercise-in duced ST depression and anginal pain revealed no difference between DM and NDM patients. Mean dura tion of exercise was shorter in DM patients (345±97 sec) than in NDM patients (423±162 sec, p<0.01). Furthermore, anginal pain during exercise occurred earlier in DM pa tients (187±68 sec) than in NDM pa tients (248±99 sec, p<0.05). No significant difference in double prod uct or magnitude of ST segment de pression at the onset of anginal pain was found between DM and NDM patients. However, heart rate respon siveness to exercise in DM patients was higher than that in NDM pa tients. These findings may indicate that pathophysiology of the heart in CAD patients with DM is affected not only by CAD itself but also by myocardial damage due to DM.
Diagnosis of a Ruptured Deep Femoral Artery Aneurysm — A Case Report
Authors: Sadler Lawrence , Bolden Richard O. , Lenkey Joseph L.
Published: July 2008

Deep femoral artery aneurysms are rarely atherosclerotic in origin and in frequently rupture. A case of spontaneous rupture of an isolated deep femoral atherosclerotic aneurysm is presented. The computed tomographic, angio graphic, and clinical findings are discussed. These findings allowed preopera tive diagnosis of this lesion.
Recurrent Spinal Cord Ischemia Due to Abdominal Aortic Aneurysm—A Case Report
Authors: Desai Hiren B. , Rajput A.H. , Uitti Ryan J.
Published: July 2008

Ischemic spinal cord lesions with abdominal aortic aneurysm are rare and are usually characterized by a single catastrophic event. The authors report a seventy-five-year-old woman who, over a period of three years, had three at tacks of acute neurologic deficit. The clinical features were those of bladder incontinence, a mixture of upper and lower motor neuron lower limb motor deficit, and patchy sensory loss with a sensory level at T10-12. Investigations revealed a large abdominal aortic aneurysm that had enlarged with time. This case, they believe, represents an example of recurrent ischemic myelopathy due to occlusion at the mouth of radicular arteries or recurrent embolic events in those vessels.
Variability and Reproducibility of Transcutaneous Oxygen Tension Measurements in the Assessment of Peripheral Vascular Disease
Authors: Rooke Thom W. , Osmundson P.J.
Published: July 2008

Transcutaneous oxygen tension (TcPO2) was measured according to a standard protocol in 43 limbs from 23 subjects, by use of oxygen-sensing electrodes attached to the chest (at a single site) or dorsum of the foot (at proximal and distal sites, located 1-2 cm apart). With the subjects supine, distal foot TcPO 2 differed from proximal by an average of ±7.4 mmHg, and in 80% of all limbs the differences were between -6 mmHg and + 15 mmHg. The two TcPO 2's were subsequently combined to yield a single "average" value for each foot. TcPO2 measurements were repeated twenty-four to forty-eight hours later; in the supine position the change in "average" foot TCPO 2 from the first to second measurement was ±6.9 mmHg, and in 80% of limbs the changes were between -11 mmHg and +9 mmHg. Similar reproducibility data were also obtained for ankle/brachial blood pressure indices (ABIs), chest TcPO2, and foot TcPO2 during three minutes of leg elevation at 30 degrees. The authors conclude that: (1) TcPO2 measurements from adjacent areas on the dorsum of the foot usually differ by 20-25% or less and (2) the short-term reproducibility of TcPO2 between studies is comparable to that for ABIS.
Noninvasive Surveillance of Allografted Kidneys by Ultrasonic Duplex Scanning
Authors: de Gaetano Anna Maria , Boldrini Giuseppe , Nanni Giuseppe , Serino Francesco , Giovannini Ivo , Castagneto Marco
Published: July 2008

Over a one-year period 1,000 duplex Doppler evaluations were performed in 70 patients submitted to kidney transplantation for end-stage renal failure. Duplex monitoring was performed to evaluate transplant status from hemodynamic patterns of the graft arteries. A duplex scanner with a 3.75 MHz sector transducer was used; pulsed Doppler was utilized to detect blood flow velocities in the main renal, segmental, interlobar and arcuate arteries.

Arterial signals were quantified through a pulsatility index (PI). Three cases of acute rejection (AR), 9 cases of chronic rejection (CR), 2 cases of cyclosporine nephrotoxicity (Csa Tox), and 4 cases of acute tubular necrosis (ATN) were recognized and biopsy proved.

At each arterial site PI values of normally functioning allografts were lower than 1.5; AR patients showed PI values ranging from 1.7 to 3.1, promptly lowered by immunosuppressive treatment. CR patients had a spectrum of PI from 0.5 to 3.1. Patients with Csa Tox and ATN showed in all the explored sites normal arterial signals and thus normal PI values. PI variations reflect even slight blood flow reductions due to immunologically mediated increases in intrarenal arterial resistances.

Duplex sonography of allografted kidneys shows great diagnostic attitudes in the noninvasive characterization of transplant malfunction.
Sonography of Vertebral Arteries in De Kleyn's Position in Subjects and in Patients with Vertebrobasilar Transient Ischemic Attacks
Authors: Arnetoli Graziano , Amadori Andrea , Stefani Paolo , Nuzzaci Giuseppe
Published: July 2008

Two groups of subjects, matched for age, were studied. The first group consisted of 190 healthy subjects, the second, of 60 patients with vertebrobasilar transient ischemic attacks (TIAs), 22 of whom underwent angiography. After it was ascertained that the findings from continuous-wave (cw) Doppler of carotid and vertebral arteries, performed in the standard position, were normal, the examination was then done in De Kleyn's position, the velocity signal being detected at the mastoidal slopes. The abnormal findings were classified into two groups: "loss of diastolic velocity signal" and "absence of velocity signal."

In the control group, changes of flow were detected in 6.31%, whereas in the group of patients abnormal Doppler parameters were detected in 33.33%. None of the patients who were submitted to angiography showed abnormal hemodynamic findings. The authors suggest that the detection of the velocity signal of the vertebral arteries in De Kleyn's position could be of help in revealing conditions that could cause, in time, signs and/or symptoms of vertebrobasilar insufficiency in subjects with possible asymptomatic anomalies of the circle of Willis.
Stress Testing in Patients with Coronary Spasm: Comparison of Those With and Without Fixed Coronary Artery Disease
Authors: Castelló Ramón , Alegría Eduardo , Merino Alvaro , Hidalgo Ricardo , Aparici Manuel , Martínez-Caro Diego
Published: July 2008

Stress testing is one of the preferred noninvasive methods of identifying patients with coronary artery disease (CAD). Its value in patients with coronary artery spasm (CAS) is, however, difficult to ascertain.

The authors studied 91 consecutive patients with angiographically documented CAS. All patients underwent a symptom-limited bicycle exercise test before coronary angiography. Eight patients (8.8%) showed ST-segment elevation during exercise; 37 (40.7%), ST-segment depression; and 46 (50.5%), no changes. Thirty patients had normal coronary arteries; 19, one-vessel disease ; 19, two-vessel disease; and 23, three-vessel disease.

Stress testing yielded abnormal results in 7 of 30 patients (23%) with no CAD and in 38 of 61 (62%) with fixed CAD (p < 0.01).

ST-segment response to exercise did not correlate with most clinical findings such as age, type of angina, duration of pain episodes, or the degree of disease activity. However, a significant correlation was found with the extent and severity of CAD. Absence of ST changes or ST-segment elevation did not differentiate those patients with or without CAD, but only 4 of 37 patients with ST-segment depression had no significant fixed lesions.

In conclusion, half of the patients with CAS had a normal stress test. ST-segment elevation is an uncommon finding in these patients and does not reliably differentiate those with and without fixed CAD. The only relevant finding of stress testing in CAS patients is ST-segment depression, which strongly suggests the presence of underlying CAD.
Effects of Nitroglycerin on Myocardial Excursions and Velocities in the Early Hours of Acute Myocardial Infarction
Authors: Kounis Nicholas G. , Zavras George M. , Papadaki Paraskevi J. , Soufras George D. , Kitrou Michael P.
Published: July 2008

The effects of sublingual nitroglycerin on septal and left ventricular wall motion were determined by echocardiography in the early hours of acute myocar dial infarction (MI) in 20 patients admitted via a mobile coronary care unit. Left ventricular and septal echoes were obtained in 11 patients with acute anterior MI and in 9 with acute inferior MI before and after administration of 500 μg sublingual nitroglycerin. In the group with acute anterior MI, nitroglyce rin did not significantly affect the B-C excursion, posterior wall excursion, and mean posterior wall velocity. Nitroglycerin significantly increased (P < 0.01), however, the systolic septal excursion, systolic septal velocity, diastolic septal excursion, and diastolic septal velocity. In the group with acute inferior MI, nitroglycerin significantly increased the B-C excursion (P < 0.01); posterior wall excursion (P < 0.01); mean posterior wall velocity (P < 0.01); systolic septal excursion (P < 0.01); diastolic septal excursion (P < 0.05), and diastolic septal velocity (P = 0.01) but did not affect the systolic septal velocity. All measure ments were obtained by use of a method of labeling and describing specific points of the wall motion that has been described recently.
Diagnosis of Arteriosclerosis Obliterans by Impedance Technique with Special Reference to Relative Blood Flow of the Lower Extremity
Authors: Okuda Noriaki , Okuda Noriaki , Yamada Masami , Shoudao Feng  , Asai Yasushi , Fujinami Takao
Published: July 2008

Simultaneous recordings of impedance cardiography of the chest and impe dance plethysmography of the lower extremity were performed on 105 limbs with or without arteriosclerosis obliterans (ASO) documented by angiography. The ratios of blood flow to the lower extremity—leg stroke volume/cardiac stroke volume—(LSV/CSV) were 11.2 ± 3.3% in normal male subjects, 11.1 ± 5.5% in normal female subjects, and 3.1 ± 1.2% in lower extremities with ASO, respectively.

The normal value (range) for LSV/CSV calculated from the normal groups by the percentile method was between 4.9% and 17.8%, and the diagnostic accuracy of this value was 100% for sensitivity and 97.5% for specificity.

LSV/CSV is a good index for the diagnosis of ASO and makes it possible to minimize error when expressed as an absolute value.
Attenuation of Reactive Hyperemia Caused by Aspirin in Canine Coronary Artery
Authors: Miyajima Seiichi , Aizawa Yoshifusa , Shibata Akira
Published: July 2008

Effects of intracoronary aspirin on coronary blood flow and reactive hyperemia were evaluated in closed- chest, anesthetized dogs. In 18 dogs the left circumflex coronary artery was cannulated and perfused by arte rial blood at a constant pressure. Coronary blood flow was measured by an electromagnetic flowmeter. In tracoronary aspirin at doses of 5, 10, and 20 mg reduced coronary blood flow in a dose-dependent manner. In jection of aspirin at doses of 10 to 25 mg also inhibited reactive hyperemia following the coronary occlusion for fifteen seconds. The mean peak flow ratio was reduced from 2.13 ± 0.42 to 1.75 ± 0.35 (p < 0.005). The incre ment of coronary blood flow provoked by intracoronary arachidonic acid at doses of 150 to 300 μg was almost entirely inhibited by the pretreatment of the coronary artery with aspirin.

The authors conclude that aspirin increases coronary arterial resistance in a dose-dependent manner and also restricts the maximal dilating capac ity, possibly by inhibition of pro stacyclin synthesis.
Experimental Atherosclerosis and Oxygen Free Radicals
Authors: Prasad Kailash , Kalra Jawahar
Published: July 2008

Oxygen free radicals are known to produce cellular injury by peroxidation of phospholipids in the cell membrane. These free radicals might damage the endothelial cell and thus set the stage for atherosclerosis. The authors studied the effect of high-cholesterol diets on the genesis of atherosclerosis and lipid peroxidation products, malondialdehyde (MDA) in rabbits. The animals were divided into four groups each comprising 5 rabbits, on the basis of their diets. Group I, control diet; group II, cholesterol; group III, coconut oil; group IV, a mixture of cholesterol, coconut oil, and cholic acid. Rabbits were sacrificed five months after being on the respective diets. Blood samples were obtained for the measurements of total cholesterol, high density lipoprotein cholesterol (HDL- C), low density lipoprotein cholesterol (LDL-C), very low density lipoprotein cholesterol (VLDL-C), triglycerides, and MDA at the end of the protocol. The aortas were removed from different animals for the identification of athero sclerotic plaques. Plaques were detected in all the animals in group II and group IV. The serum total cholesterol, LDL-C, and VLDL-C were significantly higher in animals of group II and IV than in those of group I. The values for serum total cholesterol, HDL-C, LDL-C, and VLDL-C in group III were not signifi cantly different from those in group I. The blood MDA and serum triglycerides were also higher in animals of group II and IV than in those of group I. There were, however, no significant differences in these parameters in group III as compared with those in group I. This study showed that there was an increase in the lipid peroxidation product (MDA) in all those rabbits that had atheroscler otic changes in the aorta. This increase might be due to an increase in oxygen free radicals, which may be involved in the genesis and maintenance of choles terol-induced atherosclerosis.
Use of Computerized Digital Thermometry for Diagnosis of Raynaud's Phenomenon
Authors: Caramaschi P. , Codella O. , Poli G. , Perbellini L. , Biasi D. , Bambara L.M. , Corrocher R. , De Sandre G.
Published: July 2008

The authors have used computerized digital thermometry for the instrumen tal diagnosis of Raynaud's phenomenon; such a technique enables them to eval uate the temperature of the ten fingers of the hands separately in baseline conditions, during and after the "cold test."

In baseline conditions the mean digital skin temperature was 31.2°C (SD 1.67) in control subjects and 26.8°C (SD 2.84) in patients suffering from Ray naud's phenomenon (p < 0.001).

During the cold test the mean skin temperature decreased to 12.7°C (SD 1.94) in control subjects and to 13.0°C (SD 1.67) in patients (p=n.s.). The mean final skin temperature, at the end of the recovery period after the cold test, was 31.1°C (SD 1.76) in controls and 21.9°C (SD 2.78) in patients (p < 0.001).

The sensitivity of the computerized digital thermometry was high (63.6% and 92.7% for basal and final temperature, respectively), while the specificity was 100% for both values. In conclusion, computerized digital thermometry is a useful technique for the diagnosing and quantifying the extent of Raynaud's phenomenon.
Norepinephrine and Forearm Vascular Resistance Responses to Tilt and Cold Pressor Test in Essential Hypertension: Effects of Aging
Authors: Sowers James R. , Mohanty Pramod K.
Published: July 2008

Heart rate, blood pressure, forearm vascular resistance (FVR), and catecholamine and renin responses to head-up tilt at 80 degrees and cold pressor test were investigated in 15 hypertensive men aged less than fifty-five (mean 44 ± 7 years; M ± SD) and 13 similarly hypertensive men aged more than fifty-five (mean 62 ± 4 years; M±SD). Baseline plasma norepinephrine levels, as well as norepinephrine responses to tilt and cold pressor stress, were similar in the two groups, suggesting a lack of age-related increase in plasma norepi nephrine (NE) responses in patients with essential hypertyension. Normalized FVR responses (% change) to tilting (28 ± 21 vs 95 ± 36; M ± SE) and cold pressor test (33 ± 12 vs 64±21; M ± SE) were signifiantly less (p<0.01) in older hypertensives. These results, but not the plasma NE responses to reflex sym pathetic activation by tilt and cold pressor testing in older hypertensives, sug gest an impaired forearm vasoconstriction.
Hypercoagulability in Arterial Disease
Authors: Spillert Charles R. , Milazzo Vincent J. , Suval William D. , Lazaro Eric J.
Published: July 2008

Isolated human monocytes generate tissue factor when stimulated with endo toxin. Tissue factor generation provides a marker for activation of the monocyte and of the clotting system. Determination of the recalcification time of blood after incubation with endotoxin detects minute changes in coagulability. This clotting assay was utilized to assess the presence of a hypercoagulable state in patients with peripheral arterial occlusive disease when compared with healthy volunteers. Citrated blood was incubated with endotoxin for two hours, CaCl2 was added, and the recalcification time determined. Hypercoagulability was indicated by shortened recalcification time. The recalcification time ± standard deviation for saline (control) and endotoxin-activated samples from 19 healthy volunteers was 6.55 ±0.8 and 5.69±0.7 minutes, respectively, whereas it was 4.93±1.2 and 4.55 ±0.9 minutes for 31 patients with peripheral arterial occlu sive disease (p < .001 for each). This hypercoagulable state can accentuate the arterial occlusive process in patients with peripheral vascular disease and may prove to be of diagnostic, therapeutic, and prognostic significance.
Beneficial Effect of a New Prostacyclin Derivative on the Walking Capacity in Patients with Peripheral Arterial Insufficiency
Authors: Brevetti Gregorio , Rossini Arturo , Perna Sergio , Policicchio Antonio , Attisano Tiziana , Ciotola Maria , Quattrin Stefano , Condorelli Mario , Chiariello Massimo
Published: July 2008

The efficacy, tolerance and safety of iloprost, a stable analogue of car baprostacyclin, were evaluated in 7 patients with peripheral arterial in sufficiency at stage II of Fontaine's classification. After washout, placebo was infused intravenously for seven days, then iloprost was given by a six- hour intravenous infusion of 1 ng/kg/min over the next seven days. At the end of each period, the initial (ICD) and the absolute (ACD) claudi cation distance were measured by distance experienced by such pa tients, an increase in ACD≥50% was considered as clinically relevant. In 3 patients, who experienced such an improvement, iloprost continued to be infused at the same dosage as be fore, for an additional seven days. In the remaining 4 patients (nonrespon ders), the dose was increased to 2 ng/kg/min. At the end of the second week of treatment, all but 1 patient exhibited a > 50% increase in ACD, which was 308±132 meters, a value significantly higher (p < 0.05) than that recorded after the first treat ment period. In contrast, no statisti cal difference was found between the two treatment cycles in regard to ICD and WI. One month after discontinu ation of therapy, ICD was 121±78 meters and ACD 186±110 meters, both values being still significantly higher (p < 0.05) than those recorded on placebo. No significant side effects were observed throughout the study. In conclusion, this study demon strates that iloprost is an effective and well-tolerated means of treating patients suffering from peripheral arterial insufficiency.
Pupil-Sparing Oculomotor Palsy Caused by Fusiform Ateriosclerotic Aneurysm of the Basilar Artery—A Case Report
Authors: Soria Emilio , Camell Helena , Dang Hien
Published: July 2008

Paresis of the oculomotor nerve is a very rare complication of an unrup tured arteriosclerotic fusiform aneu rysm of the basilar artery. A handful of cases are described in the world literature.

A fifty-four-year-old man with a history of hypertension and diabetes mellitus presented with painless par tial oculomotor palsy of sudden onset. A cerebral angiogram demonstrated a tortuous fusiform deformity of the basilar artery and the origin of the posterior cerebral arteries, indica tive of all arteriosclerotic aneurysmal dilation.

A sudden onset of a pupil-sparing ophthalmoplegia is the typical history of a microvascular infarct of the third nerve, whereas pupillary sparing in aneurysmal oculomotor paresis is a very rare event. Special emphasis has been placed on the pupillary size as a guide for the indication of arteriog raphy. The many exceptions to this ruie suggest that cerebral arteriog raphy may be indicated more often than generally believed.
St. Anthony's Fire: A Medieval Disease in Modern Times: Case History
Authors: Weaver Rhett , Phillips Matthew , Vacek James L.
Published: July 2008

Ergot intoxication is a syndrome recognized in the Middle Ages that was due to the effects of intense vasoconstriction upon the extremities. The authors present a patient with self-induced ergotamine poisoning who presented with vasospasm of the right lower extremity and had historical evidence suggestive of vasoconstriction involving other vascular systems. Excess ergot effect should be considered in the differential diagnosis of vascular insufficiency.
Evaluation of Skin Blood Flow and Venoarteriolar Response in Patients with Diabetes and Peripheral Vascular Disease by Laser Doppler Flowmetry
Authors: Belcaro Gianni , Vasdekis Spiros , Rulo Alexander , Nicolaides Andrew N.
Published: July 2008

Skin blood flow in the distal foot was evaluated in patients with peripheral vascular disease and diabetes and compared with skin blood flow in normal volunteers by use of laser Doppler flowmetry. Resting blood flow (RBF) and standing blood flow (SBF) were recorded in a room at a constant temperature (20-22°C). The RBF was found to be different in the five groups (normal, dia betics, patients with intermittent claudication, those with rest pain and those with impending gangrene.

In diabetics RBF was significantly higher than in normal subjects. Even on standing, SBF in diabetics was higher and not different from RBF, indicating an ineffective venoarteriolar response (VAR). The VAR was also reduced in pa tients with claudication and was abolished in patients with rest pain and im pending gangrene. In patients with rest pain SBF was increased.

Laser Doppler flowmetry is a useful technique for evaluating skin perfusion in patients with peripheral arterial disease and for discriminating among differ ent classes of patients.
The Valsalva Maneuver in Vasodepressor Syncope
Authors: Lagi Alfonso , Arnetoli Graziano , Vannucchi Pier Luigi , Ciolli Paola , Grifoni Stefano , Morettini Alessandro , Nozzoli Carlo
Published: July 2008

In this work the authors propose the Valsalva maneuver as a diagnostic test in a group of patients shown, by anamnestic, physical, and instrumental crite ria, to be affected by vasodepressor syncope. They studied the response of heart rate and baseline arterial pressure to the maneuver performed in passive orthostasis in 7 healthy volunteers and 24 patients. These patients showed a hypotensive response and a time of recovery to the initial values that was signifi cantly longer than in the control group (p < 0.01). The authors conclude that studying the response to the Valsalva maneuver can be useful in the diagnosis of vasodepressor syncope.
Treatment of AIDS-Associated Heart Disease
Authors: Kinney Evlin L. , Monsuez Jean-Jacques , Kitzis Michel , Vittecoq Daniel
Published: July 2008

Although the diagnosis of AIDS-associated heart disease is becoming rou tine, its treatment has not been reported except in anecdote. Also, it has been unclear whether the odds of successful treatment are altered because of the presence of cardiac involvement per se. This communication reports the au thors' treatment of 18 patients with AIDS-associated heart disease. Their results are combined with the treatment results of all patients reported in the literature to date with AIDS-associated heart disease. Treatment success, defined as eradi cation of the organism and no relapse, was achieved in their patients with M. tuberculosis (M. tb), cardiac cryptococcosis, and Salmonella typhimurium. M. tb required emergency pericardiectomy (well tolerated in all patients), then admin istration of rifampin, isoniazid, and ethambutol. Cryptococcosis was treated acutely with amphotericin B and flucytosine, then with maintenance amphoteri cin B. The response, which included resolution of congestive heart failure, oc curred within a week. Salmonella endocarditis was cured with administration of ampicillin and netilmicin for one month. When the patients' data were com bined with those of patients from the literature, the authors found that the odds of successful treatment for tuberculous pericarditis were somewhat lower than if the tuberculosis was extracardiac (50% vs 67%). With cryptococcal heart disease, the odds of successful treatment were actually significantly better than when only extracardiac disease was present. The authors conclude that infec tious forms of AIDS-associated heart disease are often treatable. Although some cardiac infections are less likely to respond to treatment if there is cardiac in volvement, mostly the response to treatment is similar to the response with only extracardiac involvement.
Results of Hemorheologically Active Treatment with Pentoxifylline in Patients with Cerebrovascular Disease
Authors: Schneider Rolf
Published: July 2008

Ten patients with acute stroke and impaired erythrocyte deformability received pentoxifylline parenterally in daily doses of 1.2-1.5 g for ten days (Study A). Hemorheologic parameters: erythrocyte aggregation, erythrocyte deformability, plasma viscosity, and yield shear stress were monitored. While plasma viscosity and erythro cyte aggregation did not change sig nificantly, there was marked improve ment in erythrocyte deformability and yield shear stress. Nine patients improved clinically, 1 died.

In 40 patients with lacunar in farcts (Study B) clinical and hemo rheologic data were recorded during a three-month treatment with 800 to 1,600 mg oral pentoxifylline per day. The above-quoted variables, being pathologically altered in comparison with healthy controls, were again monitored. Thirty-six patients com pleted the study (4 dropouts). Clini cally, 34 patients improved during treatment, 2 worsened. Hemorheologic variables, which were pathologically altered at baseline, improved signifi cantly. Improvement of accompanying disturbances in the retinal microcir culation (confirmed by video fluores cence angiography) during therapy indicated a close correlation between hemorheologic factors and microcir culation.
Increase of Walking Capacity After Acute Aminophylline Administration in Intermittent Claudication
Authors: Picano Eugenio , Testa Roberto , Pogliani Mauro , Lattanzi Fabio , Gaudio Vincenzo , L'Abbate Antonio
Published: July 2008

In the presence of peripheral atherosclerotic disease, inappropriate adeno sine release during exercise might promote excessive arteriolar dilation leading to steal phenomena and ischemia.

In order to test this hypothesis, IV aminophylline (6 mg/kg over fifteen min utes), a dosage known to effectively block adenosine receptors, was acutely ad ministered—in a double-blind, placebo-controlled study design—in 13 patients with intermittent claudication and documented atherosclerotic disease. All pa tients performed two treadmill exercise tests at the same hour on two consecu tive days, five minutes after aminophylline or placebo administration randomly allocated. Pain-free time was 109±133 (mean±SD) seconds after placebo and 173±165 seconds after aminophylline (p < .01); maximum time to claudication was 273±191 seconds after placebo and 397±318 seconds after aminophylline (p < .05).

The authors conclude that intravenous aminophylline markedly increases the walking capacity in patients with intermittent claudication, possibly by pre venting flow maldistribution phenomena through adenosine receptors block ade.
Myocardial Imaging Using Thallium 201 Scintigraphy after Dipyridamole Infusion: A Case History
Authors: Niemeyer M.G. , van der Wall E.E. , Leijtens J.P.A.M. , Wever J. , van der Pol J.M.J. , Willekens F.G.J.
Published: July 2008

Coronary artery disease frequently occurs in combination with peripheral vascular disorders and is an important cause of morbidity and mortality during or after peripheral vascular surgery. However, the detection of coronary artery disease in patients with peripheral vascular disease may be complicated, since most of these patients are unable to perform conventional exercise testing. The authors report a sixty-two-year-old man with an infrarenally located aneurysm of the abdominal aorta who underwent thallium 201 scintigraphy combined with dipyridamole infusion as an alternative exercise test. The subsequent thallium 201 images showed perfusion defects indicative of severe coronary artery disease. Coronary angiography showed an occluded right coronary ar tery and a significant proximal stenosis in the left anterior descending coronary artery. The patient underwent successful aortocoronary bypass surgery, and two months later, the aortic aneurysm was operated on without complications. As a result, dipyridamole thallium 201 scintigraphy should be considered as a valuable diagnostic test to detect coronary artery disease in patients with pe ripheral vascular disorders.
Arterial Infusion of Combination Therapy Using Dibutyryl Adenosine 3' , 5' -Monophosphate and Mitomycin C for Hepatocellular Carcinoma Occluding Main Portal Vein: Case Studies
Authors: Ishii Kohdoh , Karube Hitomi , Shibata Hisao , Okabe Haruya , Okudaira Masahiko , Tsuchiya Masaharu
Published: July 2008

Intraarterial infusion therapy combining dibutyryl adenosine 3',5' monophosphate and mitomycin C was administered to 8 patients with hepato cellular carcinoma occluding the main portal vein. Three patients survived more than nine months, including 1 who has been well for forty-eight months with technical imaging showing complete regression. A decreased level of serum α-fetoprotein of more than 90% was obtained in 38% of patients. Causes of death included hepatic failure, rupture of esophageal varices, acute gastric ul cer, and cerebral hemorrhage. It is concluded that the combination therapy may be useful for HCC.
Functional Benefits of Peripheral Vascular Bypass Surgery for Patients with Intermittent Claudication
Authors: Regensteiner Judith G. , Hargarten Melanie E. , Rutherford Robert B. , Hiatt William R.
Published: July 2008

Many patients with peripheral arterial disease (PAD) undergo peripheral bypass surgery to relieve the symptom of intermittent claudication. However, measurement of graft patency alone, assessed by change in ankle blood pressure, may not adequately reflect the improvement in functional status following the operation. Fourteen patients with moderately severe intermittent claudication were evaluated before and after bypass surgery to assess changes in hemodynamics (by resting ankle-brachial indices-ABIs), exercise performance (by a graded treadmill protocol), and community-based walking ability (by a questionnaire that characterizes self-reported walking speed and distance). Six weeks after surgery, resting ABIs improved in surgical patients (from 0.56 ± 0.09 to 0.93 ± 0.16, P < 0.05). Peak treadmill walking time improved from 6.2 ± 5.9 to 11.8 ± 7.1 min (90%), peak oxygen consumption from 15.5 ± 6.5 to 19.1 ± 8.5 mL/kg/min (23%), and pain-free walking time from 1.5 ± 0.4 to 6.0 5.5 min (290%). Questionnaire scores for walking distance improved by 203% and for walking speed by 130% (all P < 0.05). After twelve weeks, improvements other than pain-free walking time were maintained. Changes in peak treadmill performance or questionnaire scores were not correlated with the initial ABI, changes in ABI six or twelve weeks after surgery, or the type or extent of bypass surgery. The results demonstrate that surgical treatment of PAD, indicated for the relief of intermittent claudication, improves exercise performance and self-reported community-based walking ability. The change in functional status of the patient is an important outcome of surgery that cannot be predicted from routine noninvasive testing alone and should be measured directly.