bluuebunny/crossref_metadata_2025 huggingface dataset:
Effect of Long-Term Administration of Buflomedil on Regional Cerebral Blood Flow in Chronic Cerebral Infarction
Authors: Kobayashi Shotai , Yamaguchi Shuhei , Okada Kazunori , Kitani Mitsuhiro , Yamashita Kazuya , Shimote Kouichi , Tsunematsu Tokugoro
Published: November 2007

The influence of long-term oral administration of buflomedil on regional cerebral blood flow was investigated in 10 patients with chronic cerebral infarc tion and mild to moderate mental deterioration. Patients were given 150 mg buflomedil three times daily for a period of eight weeks. Regional cerebral blood flow (rCBF) was measured in patients before they began buflomedil treat ment and during the last week of treatment. The interval of the rCBF measure ments in the control subjects (n=12) ranged from seven to forty-eight days. Mental function in the patients studied was evaluated by use of Hasegawa's simple intelligence scale for the aged and Zung's self-rating depression scale, before and during the last week of buflomedil treatment. The results showed a mean increase in rCBF of 10.5%±12.1% in the patient group. The control group demonstrated virtually no change in rCBF measurements. Improvements in the mental function scores of the buflomedil-treated group were noted, and 5 of the 10 patients reported improvement in subjective symptoms.
Assessment of Captopril and Nicardipine Effects on Chronic Occlusive Arterial Disease of the Lower Extremity Using Doppler Ultrasound
Authors: Bernardi Daniele , Bartoli Paolo , Ferreri Andrea , Geri Antonio Brandinelli , Ieri Aldo
Published: November 2007

The effects of two potent vasodilating drugs, captopril (C) (25 mg tid), nicar dipine (N) (20 mg tid), and placebo (P) were evaluated and compared, in 10 men (mean age of sixty-five years) with intermittent claudication from moderate to severe multilevel chronic occlusive arterial disease (COAD) of the lower extrem ity, by use of the Doppler ultrasonic method, at rest and after Carter's exercise test. All the examined subjects were normotensive, without diabetes or cardio pathy; all have been smokers.

The eight-week total protocol consisted of an initial two-week placebo run-in period followed by two active drug phases and a two-week placebo phase, ac cording to a double-blind, randomized, crossover design. At the end of each two-week period, ankle-arm index (AAI) and, following exercise, onset of lower extremity discomfort time (ODT), duration of exercise (ET), decrease of ankle systolic pressure after test (APD), and recovery time (RT) were determined. Moreover, at rest, just after exercise, and after recovery, simultaneous common femoral artery velocity waves were recorded and analyzed by a quantitative approach to detect the peripheral vasomotor adjustments.

None of the patients required the withdrawal of the active treatments. Com pared with P, C significantly reduced APD and RT, and N reduced RT and AAI; furthermore N caused a significant decrease in ODT, whereas C showed a trend, although not statistically significant, to increase ODT. Neither active therapy modified ET.

These results suggest that C and N have different short-term effects on pe ripheral circulation in COAD. During exercise, C induces hemodynamic im provement in the ischemic lower extremity probably by inhibition of the sympathetic system and consequent reduction in collateral vessel vasoconstric tion.
Occult Thyrotoxicosis in Patients with Atrial Fibrillation and an Acute Arterial Embolism
Authors: Monreal M. , Lafoz E. , Foz M. , Sanmarti A. , Salinas I. , Audi L. , Viver E.
Published: November 2007

Serum total thyroxine, triiodothyronine, and thyrotropin response to thyro tropin-releasing hormone (TRH-TSH test) were measured in 126 consecutive patients admitted with atrial fibrillation: 33 patients with an acute arterial limb embolism (Group I), 31 patients with an acute embolic stroke (Group II), and 62 patients without any arterial occlusion (Group III). A blunted TRH-TSH test, suggestive of thyrotoxicosis, was found in 5 patients in Group I, 8 patients in Group II, and 2 patients in Group III. The diagnosis of hyperthyroidism was confirmed in 8 patients (by repeated TRH-TSH test and scintigraphy): 4 pa tients in Group I (12.1%) and 4 patients in Group II (12.9%). All of them had a nonvalvular atrial fibrillation. Thyrotoxicosis should not be recognized in 6 of them if TRH-TSH test was not performed, because peripheral hormone levels were normal. Five of these 8 patients with thyrotoxicosis had reversion to sinus rhythm after treatment with carbimazole, either spontaneously or after car dioversion. This outcome prevented prolongation of anticoagulant therapy for an indefinite time.
Blood Rheology Associated with Cardiovascular Risk Factors and Chronic Cardiovascular Diseases: Results of an Epidemiologic Cross-sectional Study
Authors: Koenig Wolfgang , Ernst Edzard , Matrai Arpad
Published: November 2007

As part of an epidemiologic cross- sectional study to determine cardio vascular (CV) risk factors in the population (total serum cholesterol, smoking, blood pressure, and body weight) hemoglobin (Hb) and plasma viscosity (PV) were measured. A two- stage cluster sample of 5,312 persons, aged twenty-five to sixty-four (availa ble 5,069) was selected from a mixed urban-rural target population of 282,279 inhabitants, from which 4,022 (79.3%) participated in the study. Patients with chronic myocar dial infarction (MI), cerebral infarc tion (CI), angina pectoris (AP), and peripheral arterial disease (PAD) were identified by questionnaire. The results show that there is no age or sex dependency of PV in healthy participants, while hemoglo bin shows the well-known sex differ ence. In contrast, PV increases continuously with age in the total population. In men, increased PV is found in untreated hypertension, in hypercholesterolemia, and in smok ers. In women, it is raised in hyper cholesterolemia and in gross obesity. Male MI patients and patients of both sexes after CI in particular show statistically significantly elevated PV. Finally, in male patients with chronic AP or patients of both sexes with PAD, PV is elevated and a tendency to higher Hb values is seen.

These results confirm smaller clinical trials suggesting that blood fluidity is pathologically altered in patients with CV risk factors or dis eases. Since impaired blood fluidity may worsen the hemodynamic situa tion, in particular in patients with limited vasomotor reserve, he morheologic parameters may be of prognostic relevance. Therapeutic implications of these findings should be considered.
No Metabolic Side Effects of Long-Term Treatment with Verapamil in Hypertension
Authors: Midtbø Kjell , Lauve Oddveig , Hals Ottar
Published: November 2007

In a prospective, open study 45 patients (mean age fifty-three years) with essential hypertension were treated with verapamil for four to eight years (mean 5.3 years). Blood pressure was satisfactorily controlled (from 160/104 to 145/91) and the side effects were infrequent, mild, and often transient. Verapamil did not exert any unfavorable metabolic or hematologic effects over the years. HDL-cholesterol was moderately increased (mean 24%) and the other plasma lipids were unaffected. These data suggest that the calcium channel blocker verapamil is a metabolically safe drug to use as monotherapy in essential hyper tension.
Prostanoid Production in Varicose Veins: Evidence for Decreased Prostacyclin with Increased Thromboxane A2 and Prostaglandin E2 Formation
Authors: Biagi Giovanna , Lapilli Aspero , Zendron Romeo , Piccinni Lucio , Coccheri Sergio
Published: November 2007

In this study, formation of arachidonic acid-derived prostanoids was investi gated in saphenous veins of varicosed and nonvaricosed patients, all undergoing saphenectomy respectively for varicosis or in preparation for coronary bypass operation. Venous production of prostacyclin (PGI 2), thromboxane A2 (TXA2) and prostaglandin E 2 (PGE2) was assessed by bioassay and/or radioimmunologic assays as appropriate. Fragments of saphenous veins from varicosed patients produced significantly less PGI2 and more TXA2 and PGE2 than those from the control patients. Addition of arachidonic acid to incubation mixtures dose de pendently increased release of these prostanoids, but the levels of PGI2 pro duced were consistently lower in veins from varicosed patients. No differences were found in varicosed patients between various segments of the same vein, no matter whether macroscopically affected or unaffected. These results demon strate that the cyclooxygenase pathway in the venous wall of subjects with vari cosis is shifted toward lesser formation of PGI2 and higher production of proaggregatory and proinflammatory prostanoids such as PGE2 and TXA2. These biochemical changes may be relevant to inflammation and thrombogene sis in varicosis.
Plasma Lipids as a Risk Factor in Peripheral Vascular Disease
Authors: Cardia Giuseppe , Grisorio Donato , Impedovo Giovanni , Lillo Antonio , Regina Guido
Published: November 2007

Plasma lipids were tested in 59 patients with symptomatic peripheral vascular disease (PVD) (confirmed by angiographic and, in many cases, operative examinations) and compared with the lipid balance in 47 nonarteriopathic subjects constituting the control group.

Of all the elements considered, only the hypertriglyceridemia and the fall in the HDL cholesterol/total cholesterol ratio showed a statistically significant difference between the two groups. In particular, there was a significant difference in the triglyceridemia present in the arteriopathic patients, as evidenced by the double check afforded by the frequency test (PVD: 25/59; control: 8/47; p < 0.01) and the averages test (PVD: 201 ± 131; control: 138 ± 98; p < 0.01).
Streptokinase in the Treatment of an Acute Cerebral Embolus—A Case Report
Authors: Frink Richard J. , Ostrach Louis H.
Published: November 2007

During cerebral angiographic examination of a sixty-five-year-old white male, an acute right hemiplegia resulting from embolic occlusion of the left middle cerebral artery developed. Intravenous streptokinase therapy was initiated within forty-five minutes of symptom onset and the hemiplegia cleared in approximately one hour with no evidence of intracranial hemorrhage. This observation underscores the applicability and potential benefits of immediate intravenous thrombolytic therapy for selected patients presenting with acute cerebral thrombosis or embolism.
Homonymous Quadrantic Visual Field Defect Resulting from Vertebrobasilar Insufficiency: Report of a Case
Authors: Gomez Camilo R. , Bhat Madhav H. , Chung Hyung D.
Published: November 2007

A patient showing a congruous homonymous superior quadrantanopsia was found at autopsy to have infarction of the striate cortex. The lesion involved the inferior bank of the calcarine fissure almost entirely and approximately one fifth of the superior bank. Additionally, infarctions of the visual association cortex and the pontine tegmentum were found. No lesions in the corresponding temporal lobe were present. Two types of visual field defects have been described in association with occipital lobe lesions: a monocular temporal crescentic defect if the lesion is anterior and a congruous homonymous hemianopsia if it is posterior. This patient seems to represent a variant of the latter. The most prominent difference with respect to quadrantanopsias resulting from lesions of the optic radiation is the high degree of congruity, especially in the central portion of the field. Association with nonocclusive vascular events related to vertebrobasilar hypoperfusion rather than embolization is also more common.
Traumatic Coronary Arteriovenous Fistula Communicating the Left Main Coronary Artery to Pulmonary Artery, Associated with Pulmonary Valvular Insufficiency and Endocarditis: Case Report
Authors: Rangel Alberto , Badui Elias , Verduzco Cielo , Valdespino Aquiles , Enciso Roberto
Published: November 2007

The authors present a case of a seventeen-year-old white male who suffered from a knife chest wound and secondarily developed a traumatic coronary arteriovenous fistula communicating the left main coronary artery to the pulmonary artery, associated with pulmonary valvular insufficiency and endocarditis.
Skin Perfusion Pressure Assessed by Measuring the External Pressure Required To Stop Blood Cell Flux
Authors: Svensson Henry , Bornmyr Siv , Svedman Pal
Published: November 2007

Laser Doppler flowmetry (LDF) was used to determine the point at which blood flow cessation is achieved under circumferentially applied external counter pressure at the ankle level. In 13 individuals with a normal ankle index, the flow of cessation external pressure (FCEP) was, on average, 28 mmHg lower than the systolic ankle pressure (range: 7-62). In 19 patients with an ankle index below 1.0, FCEP correlated with the ankle pressure (rs=0.76) and even more closely with the ankle index (rs = 0.82) . In patients with a more pronounced degree of arterial occlusive disease, FCEP can be equal to or even higher than the ankle pressure. This may be due to a release of sympathetic vasoconstrictor tone and possibly to the presence of a collateral circulation supplying the skin. Individual LDF values from the skin at rest do not reflect the degree of peripheral circulatory insufficiency.
The ST Segment Axis as a Differential Diagnostic Feature Between Acute Pericarditis and Acute Inferior Myocardial Infarction
Authors: Kouvaras G. , Soufras G. , Chronopoulos G. , Giannopoulou A. , Pisimisis E. , Cokkinos D.V.
Published: November 2007

The ST segment electrical axis in the frontal plane was calculated in 20 patients with an acute inferior myocardial infarction (AIMI) and another 20 patients with the acute phase of pericarditis (AP). The ST segment axis of patients with AIMI ranged from 100° -120° (mean 114°). The ST segment axis of patients with AP ranged from 30°-60° (mean 45°). Thus, the ST segment axis can be used for the differential diagnosis in the early acute phase, especially when there are no other important distinguishing factors between these two conditions.
Management of Multiple Cholesterol Embolization Syndrome-A Case Report
Authors: Kawakami Yoshihide , Hirose Kunihiko , Watanabe Yutaka , Tomioka Nobuyoshi , Doyama Kiyoshi , Morikawa Masaru , Kosuga Kunihiko , Saiga Tatsuyoshi
Published: November 2007

A sixty-two-year-old man who underwent coronary angiography and received acute thrombolytic and anticoagulant therapy for acute myocardial infarction developed multisystemic injury, including renal insufficiency and cutaneous manifestations. Fundoscopic examination and skin biopsy specimen led to the diagnosis of multiple cholesterol embolization syndrome (MCES). Discontinuation of anticoagulants and administration of hemostatic (carbazochrome, tranexamic acid, reptilase, and vitamin K) and antihyperlipidemic (cholestyramine and probucol) drugs resulted in temporary improvement of cutaneous and renal disorders and extended survival for about one year. Besides severe aortic atherosclerosis, postmortem examination revealed numerous cholesterol emboli to multiple organs. MCES is a rare but serious complication of left heart catheterization and anticoagulant therapy, and the optimal treatment remains to be established. The authors suggest here that the above-mentioned therapy might be effective for management of MCES.
Comparison of Color Flow and 3D Image By Computer Graphics for the Evaluation of Carotid Disease
Authors: Houi K. , Mochio S. , Isogai Y. , Miyamoto Y. , Suzuki N.
Published: November 2007

Morphologic characteristics and hemodynamics in the carotid artery were investigated in patients with stroke by use of Doppler color-flow analysis and three-dimensional (3D) analysis by computer graphics. The 3D imaging of the carotid bifurcation was reconstructed from a series of transverse B-mode images. Comparison of color-flow and 3D images demonstrated that wall configuration in vivo, dilation, and curvature play an important role in reversal of flow and stagnation at the carotid bifurcation. Furthermore, 3D analysis is very useful in mapping the distribution of the atheromatous plaques. The analyses suggest that it is important to investigate the wall configuration of the bifurcation in vivo on flow patterns, especially flow separation and stagnation, in relation to the development of atheromatous plaques.
Differential Effects of Vasodilators on Forearm and Calf Vessels
Authors: Colardyn F. , Clement D.L.
Published: November 2007

Because the literature comparing the effects of vasodilators on forearm and calf vessels is very scarce, the authors compared different vasodilators used in cardiovascular medicine in a group of volunteers. The peripheral effects were measured in the sitting position by plethysmography at the calf and at the forearm. At the forearm, comparable dilator effects were seen in arteries and veins. At the calf there was a trend for arterial flow to decrease as venous capacitance increased. Vascular response seen in one limb was not representative of the whole circulation. The changes observed were dependent not only on the vascular area investigated but also on the dose used.
Quantification of Left-Sided Valvular Stenoses by Color Doppler Imaging of Jets
Authors: Veyrat Colette , Beuve D. Sainte , Gourtchiglouian Cl. , Legeais Sylvie , Kalmanson D.
Published: November 2007

A new methodology for assessment of severity of stenosis employing color Doppler imaging and relying upon spatial and temporal studies of aortic and mitral stenotic jets is described. The spatial study consisted of the detection of the jet origin with respect to upstream and downstream trajectories in the long-axis view, with further identification of each of the three levels from characteristic single-gated Doppler flow recordings, when desired. For the temporal study, color images were gated in midsystole for aortic, and in early diastole for mitral, stenosis. The final step consisted of imaging the jet cross-sectional area in the short-axis view with planimetry. Measurements were compared with those obtained by the Gorlin formula.

The procedure was feasible in 43 of 48 studied cases and the correlation between hemodynamic and color Doppler data was satisfactory for both valvular lesions. The best agreement between both methods was for severe stenoses, where the standard error of estimate was the lowest. For large areas the variance in measurements was wider and the correlation coefficient decreased, but this did not cause errors in recognition.

This new method provides a convenient and rapid visualization of stenotic jets and is particularly recommended for assessment of severe stenoses, where accuracy was highest for all clinical conditions.
Efficacy of Betaxolol in the Treatment of Stable Exertional Angina Pectoris: A Dose-Ranging Study
Authors: Alpert Martin A. , Mukerji Vaskar , Villarreal Daniel , Singh Amolak , Flaker Greg C. , Sanfelippo John F. , Beach C.L. , Morgan Rebecca J.
Published: November 2007

To assess the efficacy of oral betaxolol in the treatment of stable exertional angina pectoris and to determine the relationship between betaxolol doses/serum concentrations and clinical/hemodynamic responses the authors studied 24 patients prior to and following stepwise administration of 5, 10, 20, 40, and 80 mg doses. The major endpoint for the study was the achievement of clinical beta blockade (heart rate 50-60 beats/min and ≤ 20% rise in treadmill stage I heart rate). Betaxolol produced a decrease in mean angina pectoris frequency from 6.6 ± 1.9 episodes/week with placebo to 0.2 ± 0.5 episode/week during clinical beta blockade (p < 0.00005). Mean treadmill exercise time increased from 3.1 ± 1.7 min with placebo to 7.3 ± 2.3 min with doses sufficient to reduce angina pectoris frequency ≥ 75% (p < 0.00005) and to 8.0 ± 2.3 min during clinical beta blockade (p < 0.00005). The mean doses of betaxolol required to produce a ≥ 75% decrease in angina pectoris frequency and clinical beta blockade were 12 ± 5 mg (range 5-40 mg) and 28 ± 29 mg (range 5-80 mg) respectively. Mean serum concentrations associated with these clinical endpoints were 23.8 ± 9.7 ng/mL and 59.7 ± 54.0 ng/mL respectively. The results indicate that betaxolol, in widely ranging doses, is highly effective in reducing angina pectoris frequency and improving exercise capacity in patients with stable exertional angina pectoris.
Assessment of Mitral Regurgitation Using Gated Radionuclide Ventriculography: Analysis of Left Atrial Time Activity Curve
Authors: Konishi Tokuji , Ichikawa Takehiko , Isaka Naoki , Sugawa Masahiro , Nakano Takeshi
Published: November 2007

The authors analyzed the left atrial (LA) time activity curve (TAC) in 18 normal subjects and 30 patients with mitral regurgitation (MR) to assess the usefulness of radionuclide ventriculography (RNV) in detecting MR. The LA TAC was generated from gated blood pool images using phase and amplitude images. The configuration of normal LA TAC was M shaped. The first peak and last peak of LA TAC were represented as points B and D, respectively. In addition, the trough following B was named point C. The presence and severity of MR was analyzed by use of three methods: (1) analysis of LA TAC, (2) analysis of left ventricular TAC, and (3) measurement of the stroke count ratio of left ventricle to right ventricle.

In the diagnosis of MR using RNV, the rapid emptying fraction [REF:(B-C)/ (B-A)] of LA TAC was the most sensitive index compared with the other two methods. The sensitivity and specificity of MR with Sellers' II° or more were 0.84 and 0.90 in LA TAC but were 0.42 and 0.90 in the count method.
Assessment of Deep Venous Incompetence: A Prospective Study Comparing Duplex Scanning with Descending Phlebography
Authors: Rosfors Stefan , Bygdeman Stellan , Nordström Eva
Published: November 2007

In this prospective study duplex scanning was performed in 21 consecutive patients (23 lower extremities) referred for descending phlebography. The grade of deep venous insufficiency (Grades 1-4) was estimated in a blinded fashion with phlebography and duplex technique. Agreement occurred in 15 of 23 lower extremities. Discrepancies were found particularly in patients with minor degrees of reflux. The patients with reflux below the knee according to phlebography were also identified with ultrasonography. The authors found duplex scanning to be an accurate method of evaluating deep venous valvular function. With duplex—but not with phlebography—it was also possible to diagnose isolated lower extremity valvular insufficiency.
Correlates of Atherosclerosis in Coronary Arteries of Patients Undergoing Angiographic Evaluation
Authors: Perez Guido O. , Mendez Armando J. , Goldberg Ronald B. , Duncan Robert , Palomo Andres , DeMarchena Eduardo , Hsia S.L.
Published: November 2007

The correlations between lipid and lipoprotein measurements and other risk factors of coronary artery disease were evaluated in 101 men undergoing coro nary angiography. Clinically significant disease was present in 75 patients, whereas 24 had no observable lesions and 2 had minimal lesions. Comparisons of individual lipid and lipoprotein levels were nearly all significantly different between patients with and patients without clinically significant disease; how ever, no single variable could predict the presence of disease among patients. Logistic regression analysis identified five factors: apolipoprotein A-I, apolipo protein B, diabetes, age, and family history of heart disease, which account for most of the differences between the two patient groups. These results could have important implications for the evaluation and management of patients sus pected of having coronary atherosclerosis.
Improvement of Capillary Permeability in Patients with Venous Hypertension After Treatment with TTFCA
Authors: Belcaro Giovanni V. , Grimaldi Roberto , Guidi Guido
Published: November 2007

The VSC (vacuum suction chamber) device, a new system to evaluate local capillary permeability, was used with laser Doppler flowmetry to study varia tions of permeability and of the microcirculation in 10 normal subjects; in 22 patients with moderate, superficial venous hypertension; and in 12 patients with postphlebitic limbs and severe venous hypertension. All these patients had distal (ankle and foot edema) in the evening.

After a first assessment these subjects were studied again after two weeks without treatment and after two weeks' treatment with total triterpenic fraction of centella asiatica (TTFCA), tablets, 60 mg, tid.

The VSC produces a wheal on the skin of the perimalleolar region that dis appears (in average) in less than sixty minutes in normal subjects. The disap pearance time (DT) is greater in conditions of increased capillary filtration and permeability.

The three groups of subjects (normal and those with superficial and severe venous hypertension) had significantly different, increasing disappearance time of the wheals at the first observation.

There were no significant changes after two weeks' observation, but after 2 weeks' treatment with TTFCA, there was a significant decrease of DT both in limbs with superficial and with deep venous incompetence.

The improvement (decrease) of the abnormally increased capillary permea bility was associated with a significant improvement of the microcirculation and symptoms (studied by an analogue scale line).

In conclusion this study showed a combined improvement of the microcircu lation and capillary permeability after treatment with TTFCA and the possibil ity of using the VSC to evaluate the effects of drugs (or other treatment) on local capillary permeability in patients with venous hypertension.
Transcutaneous Oximetry Monitoring During the Early Phase of Exercise in Patients with Peripheral Artery Disease
Authors: Modesti Pietro Amedeo , Boddi Maria , Gensini Gian Franco , Neri Serneri Gian Gastone
Published: November 2007

The present work was performed to test the sensitivity of transcutaneous oximetry in evaluating the first stage of peripheral artery disease in patients with few symptoms.

Eighteen nondiabetic patients, stage II according to Fontaine and classified according to their walking capability and Doppler examination, were investi gated. Ten healthy subjects served as controls. Measurements were performed with the subjects standing and during exercise on a treadmill. Postischemic hyperemia was also evaluated with strain-guage plethysmography.

Standing values did not discriminate between patients and controls; on the contrary the pattern of the early phase of trancutaneous oximetry curves ob tained during exercise allowed the investigators to distinguish the symptomatic patients with minimal symptoms. Accuracy and sensitivity of the method fur ther increased when regional perfusion index was considered.
Diagnostic Accuracy of Computerized Impedance Plethysmography in the Diagnosis of Symptomatic Deep Vein Thrombosis: A Controlled Venographic Study
Authors: Agnelli Giancarlo , Longetti Mauro , Cosmi Benilde , Lupattelli Luciano , Barzi Francesco , Levi Marcel , Nenci Giuseppe G.
Published: November 2007

The aim of our study was to evaluate the sensitivity, the specificity, and the positive and negative predictive values of a recently developed computerized impedance plethysmography (CIP) in the diagnosis of deep vein thrombosis (DVT); 117 consecutive outpatients with a clinical suspicion of DVT were evalu ated. After informed consent was obtained, a CIP and, within twenty-four hours, a venography of the symptomatic lower limb were performed in each patient. The results of CIP were compared with the results of contrast veno graphy, which was considered as the gold standard. As far as the diagnosis of both proximal and distal DVT was concerned, the accuracy of CIP was 88.5%; the sensitivity and specificity were 95.1% and 83.6%, respectively; the positive and negative predictive values were 81.2% and 95.8%, respectively. When the diagnosis of only proximal deep vein thrombosis was considered, the accuracy of CIP was 88.8%; the sensitivity and specificity were 97.1% and 83.6%, respec tively ; the positive and negative predictive values were 79.0% and 97.8%, re spectively.

The authors conclude that the newly developed CIP has a diagnostic accu racy similar to that of traditional impedance plethysmography. Moreover, being completely automated and portable, CIP can play an important role in the bed side diagnosis of DVT.
Isolated Pulmonary Artery Stenosis: Four-Year Follow-Up: Case Report
Authors: Lesser Barry A. , Quaday James , Shetty P.C. , Bower George C. , Khaja Fareed
Published: November 2007

The authors present a four-year follow-up of a patient with a single isolated right main pulmonary artery stenosis without an associated cardiac anomaly. This is an extremely uncommon lesion thought to be congenital. This case illustrates the stability of isolated lesions of the pulmonary vasculature without associated cardiac defects.
Thrombolytic Versus Fibrinogenolytic Activity of rt-PA and Streptokinase in Patients with Acute Myocardial Infarction
Authors: Prisco Domenico , Bonechi Francesco , Scarti Luca , Tramontana Manuela , Abbate Rosanna , Gensini Gian Franco
Published: November 2007

In this study the concentration of plasma breakdown products of cross-linked fibrin (XDP), serum fibrinogen-fibrin degradation products (FDP), and plasma fibrinogen were measured before and at the end of the administration of single-chain recombinant tissue-type plasminogen activator (rt-PA, 100 mg IV over three hours) or streptokinase (1.5 million units over one hour), respectively, in two groups, each composed of 22 patients with acute myocardial infarction. The XDP concentration was not statistically different between the two groups at the end of thrombolytic treatment, whereas FDP and fibrinogen concentrations were significantly different (FDP: streptokinase 396 ± 287 vs rt-PA 177 ± 222 μg/mL, p < 0.01; fibrinogen: streptokinase 71 ± 43 vs rt-PA 181 ± 49 mg/dL, p < 0.001). These results indicate that the two drugs have equipotent thrombolytic activity at this administration regimen but that rt-PA causes a markedly more selective lysis of fibrin in comparison with streptokinase.
Prognostic Value of Hyponatremia in Patients with Severe Chronic Heart Failure
Authors: Panciroli Claudio , Galloni Gianfranca , Oddone Alessandro , Marangoni Egidio , Masa Antonella , Cominesi Walter Raimondi , Caizzi Vincenzo , Pezzi Carlo , Belletti Sebastian , Comalba Carlo , Orlandi Mario
Published: November 2007

In order to evaluate the incidence and the prognostic value of hyponatremia (hypoNa) in patients (pts) with severe chronic heart failure (SCHF), the authors studied 161 consecutive pts (113M, 48F ages sixty-seven ± ten) with SCHF in NYHA class III-IV. The cause of SCHF was ischemic in 64 pts, hypertensive in 39, valvular in 14, alcohol-related in 3, and idiopathic in 41. Pretreatment hypoNa (<135 mmol/L) was found in 64/161 pts (40%) (Group I); Na+ was < 125 in 10 pts, 125-130 in 19, and 131-135 mmol/L in 35; 42/64 pts (66%) of Group I were in NYHA class IV at admission. In the pts with pretreatment Na+ < 125 mmol/L, hypoNa was persistent and refractory to high-dose furosemide (<500 mg/day) and water restriction. Cardiovascular mortality of Group I pts was 69% within twenty-four months (34 pts died of low-output syndrom and 10 suddenly). All pts with Na+ < 130 mmol/L died within six months. The 20 pts who normalized Na+ are alive, and in NYHA class II-III (follow-up: twenty-six ± fifteen, six to sixty months). Pts without hypoNa were 97/161 (Group II), and 58/97 (60%) are alive (follow-up: thirty ± eighteen, five to fifty-eight months), whereas 39 pts died (27 suddenly, 9 of low-output syndrome, and 3 of extracardiac disease) within twenty-four months. The mortality rate of Group II was significantly lower (40% vs 69%, p < 0.001) compared with Group I. The two groups were similar for age, sex, and cause and duration of SCHF.

In conclusion: pretreatment Na+ seems to be a significant predictor of cardiovascular mortality in pts with SCHF; persistent hypoNa seems to indicate pts with SCHF refractory to conventional medical therapy. On the contrary, normalization of Na + indicates a subgroup of pts with a more favorable clinical outcome.
Carotid-Cavernous Sinus Thrombosis Caused by Aspergillus Fumigatus: Magnetic Resonance Imaging with Pathologic Correlation—A Case Report
Authors: Dyken Mark E. , Biller José , Yuh William T. C. , Fincham Richard , Moore Steven A. , Justin Eric
Published: November 2007

The authors describe a case of aspergillosis with carotid-cavernous sinus thrombosis diagnosed by use of magnetic resonance imaging (MRI). MRI may aid in early detection of intracranial fungal infection and potentially help decrease morbidity and mortality through the institution of early medical and surgical therapy.
Fibromuscular Dysplasia of the Basilar Artery: A Case with Brain Stem Stroke
Authors: Saygi Serap , Bolay Hayrunnisa , Tekkok Ismail H. , Cila Aysenur , Zileli Turgut
Published: November 2007

Fibromuscular dysplasia of the basilar artery is a rare and usually asymptomatic vascular disease with only 5 cases reported in the literature. A thirty-eight-year-old man who developed ischemic neurologic symptoms of the brain stem due to dysplasia of the basilar artery is presented, and the clinical features, radiology, treatment, and prognosis of this disease are discussed in correlation with the current data.
Hemodynamic Effects of Nebivolol at Rest and on Exertion in Patients with Heart Failure
Authors: Brune Stephan , Schmidt Thomas , Tebbe Ulrich , Kreuzer Heinrich
Published: November 2007

Nebivolol is a novel B-1-adrenoceptor-blocking drug with an unusual hemo dynamic profile unlike classical B-blockers. In dogs and in healthy volunteers it decreases blood pressure and heart rate but improves left ventricular function. The authors studied 10 male patients with coronary artery disease and heart failure (ejection fraction mean = 46%). A Swan-Ganz catheter was placed into the pulmonary artery, and the mean blood pressure, the heart rate, the pulmo nary artery pressure, the pulmonary wedge pressure, the right atrial pressure, the cardiac output, and the stroke volume were measured at rest and on exer tion before and after seven days' treatment with oral nebivolol (5 mg/day). While the blood pressure and the heart rate decreased significantly, the pulmo nary artery and wedge pressures, as well as the right atrial pressure and the cardiac output, did not change during treatment. The stroke volume increased significantly. The maintained cardiac output cannot be explained by any changes in preload or afterload; instead a positive inotropic mechanism must be assumed. Unlike other B-blockers it seems to be possible to treat patients with heart failure with nebivolol without causing the hemodynamic situation to dete riorate.
Effects of Diltiazem on the Functional Recovery of the Myocardium at Organ and Cellular Level During Prolonged Hypothermic Ischemic Cardiac Arrest
Authors: Chan W.P. , Bharadwaj B. , Prasad K.
Published: November 2007

The effectiveness of diltiazem on the functional recovery of the heart, cal cium (Ca++) uptake and binding, Ca++ ATPase of cardiac sarcoplasmic reticu lum (SR), and MB fraction of creatine kinase (MBCK) of coronary sinus blood was investigated after one and a half hours of reperfusion following three hours of ischemic cardiac arrest. The dogs were divided into three groups: group I, sham bypass; group II, cold crystalloid cardioplegia; and group III, cold crys talloid cardioplegia with diltiazem. There was a decrease in aortic pressures left ventricular pressure development (dp/dt), left ventricular work index (LVWI), total systemic vascular resistance (TSVR), and left ventricular systolic pressure (LVSP) in the sham bypass group. There was a decrease in cardiac index (CI), LVWI, and mean right atrial pressure (mRAP) and an increase in TSVR and pulmonary vascular resistance (PVR) in group II as compared with group I. Although there was a tendency for a decrease in the indices of myocardial con tractility in group II, they were not significantly different from those in group I. The indices of myocardial contractility, CI, and LVWI in group III were slightly higher than in group II, but they were not significantly different from each other. The values for calcium uptake by SR in groups II and III were similar but significantly lower than those in group I. Calcium binding in group III was significantly lower than that in group I. Calcium ATPase of SR in the three groups were similar. Although MBCK increased in all the groups, the increases were not significantly different among the three groups. The results of this study indicate that cold crystalloid cardioplegia with diltiazem was not better than cold crystalloid alone in preserving the cardiac contractility and cellular function during prolonged ischemic cardiac arrest. However, the cardiac func tion in terms of cardiac index was better preserved with diltiazem.
Separation of a Ruptured Angioplasty Balloon with Successful Percutaneous Retrieval—A Case Report
Authors: Sharma Rajinder P. , Shetty P.C. , Burke Thomas H. , Burke Matthew W.
Published: November 2007

A case of ruptured angioplasty balloon with complete separation from the catheter is presented. Successful percutaneous retrieval of the balloon with endoscopic biopsy forceps was performed.
Timing of Data Acquisition Determines Image Quality in Femoropopliteal Phase-Sensitive MR Angiography
Authors: Lanzer P. , Gross G. , Nanda N. , Pohost G.
Published: November 2007

To study the effects of timing of data acquisition on quality of femoropopli teal magnetic resonance (MR) angiograms, the authors studied 16 healthy men, mean age 34.3 ± 6 years, by color Doppler imaging and by phase-sensitive (PS) MR angiography. PS MR imaging was performed at 1.5T using a flow adjusta ble gradient (FLAG) pulse sequence. The images were graded in a blinded fash ion by two independent observers.

Of 16 MR angiograms consisting of 141 angiographic images (AI), 45 (31.9%) were diagnostic. At least 1 diagnostic AI was obtained in each subject, and 38 (84.4%) of the diagnostic images were acquired within the first 120 milli seconds (ms) of the systolic flow pulse. The highest yield of diagnostic images (90.9%) was obtained in the interval of thirty to sixty ms before the peak flow velocity.

In healthy man diagnostic PS MR angiography requires triggering to the femoropopliteal systolic flow pulse. The highest yield of diagnostic images is acquired during the flow pulse acceleration.
Clinical Evaluation of a Novel Ambulatory Automatic Blood Pressure Monitoring System
Authors: Modesti P.A. , Gensini G.F. , Brogi E. , Neri Semeri G.G.
Published: November 2007

Reliability and reproducibility of a new automatic ambulatory blood pressure recorder were tested on 31 subjects (18 normotensives and 13 hypertensives). Of 3688 recordings, 1424 measurements were cross-checked with a sphygmomanom eter in standing or sitting position at the beginning and at the end of a twenty-four hour monitoring period. In the normotensive subjects cross-checkings were performed also during a treadmill exercise stress test.

Analysis of variance did not indicate statistical differences between the two types of measurement (p>0.09 for systolic and p>0.62 for diastolic), and a significant linear correlation was found at rest (r = 0.99, p<0.001 for systolic and r = 0.98, p<0.001 for diastolic pressure).

During the effort test the device was unable to correctly measure blood pressure values after the first step. During the twenty-four hour monitoring period only 1.1 % of the preprogrammed measurements were lost for each subject.

The recorder seems to be a suitable and reliable tool for automatic blood pressure monitoring.
A Forme Fruste of Marfan's Syndrome: Case History
Authors: Lamers R.J.S. , Janevski B.K.
Published: November 2007

A thirty nine year old woman presented with multiple aneurysms and dissec tions of the arterial system secondary to cystic medial necrosis is presented. After assessment of the family history a diagnosis of a forme fruste of Marfan's syndrome was made. Preoperative consideration of this rare diagnosis is impor tant for treatment and surgical management.
Cardiogenic Hepatorenal Syndrome
Authors: Naschitz Johanan E. , Yeshurun Daniel , Shahar Julio
Published: November 2007

A variant of hepatorenal syndrome occurring in patients with chronic conges tive heart failure following an episode of cardiogenic pulmonary edema, and in the absence of hypotension, is described. This was observed in 13 patients during an eleven-year period. The clinical picture is characterized by hepatic injury and functional renal impairment. Increase of serum glutamic oxaloacetic transami nase levels as high as 2100 IU; prolongation of prothrombin time; elevation of serum bilirubin, creatinine, blood urea nitrogen, and potassium levels; decrease in urinary sodium excretion; and a normal urinary sediment are the salient laboratory abnormalities of this entity. Treated with convential medication, the patients' course was fatal in 4 cases. When the splanchnic vasodilator dopamine was added to the patients' management, 5 of 9 patients recovered. Cardiogenic hepatorenal syndrome is a severe but potentially reversible complication of heart failure. The apparently beneficial effect of low-dose dopamine needs further evaluation.
Treatment of Angiomas with Sclerosing Injection of Hydroxypolyethoxydodecan
Authors: Seccia Antonio , Salgarello Marzia
Published: November 2007

The authors discuss the indications for hydroxypolyethoxydodecan in the sclerosing treatment of angiomas, with particular reference to cavernous, ve nous, and evolutive angiomas (ie, immature angiomas that fail to involute by eight to ten months). Moreover, the sclerosing agent may be employed, in connection with embolization and subsequent surgery, in arteriovenous angio mas with a relevant cutaneous-subcutaneous development. The authors have successfully used the "interstitial" sclerosing technique, according to Andrews' method. This technique involves interstitial injections to obtain the sclerosis of the thin threads of fibrous tissue stroma between the blood vessels.

The sclerosing therapy may cause the complete regression of "low flow" angiomas or, at least, a partial reduction that simplifies the ensuing surgical excision. In the case of partial regression of the angioma obtained with the sclerosing therapy, the surgery of the remaining angioma causes a lesser degree of bleeding (especially in areas that do not particularly lend themselves to surgical exploration, ie, the oral cavity); an increased reliability in the radicality of the intervention (due also to the reduced size of the lesion); and better results from an aesthetic-functional point of view.
Coronary Artery Aneurysm Without Stenosis in Association with Osler-Weber-Rendu Disease—A Case Report
Authors: Tsuiki Kai , Tamada Yoshiaki , Yasui Shoji
Published: November 2007

A fifty-three-year-old woman presented with coronary artery aneurysm in association with Osler-Weber-Rendu disease (hereditary hemorrhagic telangiec tasia) manifested also by large pulmonary arteriovenous fistulas. The arterial dye dilution curves were unusually distorted owing to the right-to-left shunts. The coronary artery aneurysm was located in multiple sites but was not accom panied by stenotic lesions. Coronary artery aneurysm without stenosis is a rare pathologic state and has not been previously reported in association with heredi tary telangiectasia.
A Rheolytic System for Percutaneous Coronary and Peripheral Plaque Removal
Authors: Drasler William J. , Jenson Mark L. , Wilson Gregory J. , Thielen Joseph M. , Protonotarios Emmanuil I. , Dutcher Robert G. , Possis Zinon C.
Published: November 2007

A method for plaque dissolution has been identified that percutaneously delivers a pulsatile high-velocity stream of saline to the site of an atheromatous lesion within a coronary or peripheral artery. In vitro evaluation and in vivo canine and porcine testing were performed using this 'rheolytic' system to deter mine its feasibility in ablating calcified plaque and soft thrombotic tissue.

A prototype rheolytic guidewire capable of providing 30,000 psi of internal pressure was designed to fit within the guidewire lumen of a standard percutane ous transluminal coronary angioplasty catheter. An additional over-the-wire rheolytic catheter was fabricated to follow a standard .014-inch guidewire. The rheolytic devices were tested in vitro with simulated atheromatous and thrombotic lesions to evaluate the size and quantity of the particulate effluent. The particulate was then sterilized, mixed with saline, and introduced percutaneously into the animal kidney and heart for evaluation.

The in vitro studies demonstrated that the rheolytic catheter and guidewire were able to follow both a coronary and femoral arterial model and successfully ablate the simulated lesions. The particle size for osseous, muscular, and car tilagenous tissue. ranged from 2 to 6 micrometers; for fresh human plaque the particles ranged from 2 to 15 micrometers. Injection of cartilagenous and plaque particles into the animal model caused very slight regions of necrosis but no clinical sequelae . Applications of the rheolytic devices to the animal femoral artery demonstrated that both devices could ablate and cross calified or soft thrombosed lesions without damage to the vessel wall; the rheolytic catheter provided a debulking of the plaque.

The ability to cut through calcified and soft lesions with the rheolytic devices without thermal damage may provide this system with advantages over current atherectomy methods. Its flexibility suggests that it may have applications in the coronary position.
Perivascular Innervation of the Cerebral Arteries in Spontaneously Hypertensive Rats—An Immunohistochemical Study
Authors: Kawamura Koji , Takebayashi Shigeo
Published: November 2007

Perivascular innervation in cerebral arteries of spontaneously hypertensive rats and of normotensive Wistar-Kyoto rats was studied. Adrenergic nerve fibers and neuropeptide Y-containing nerve fibers, indicative of vasoconstrictor nerves, were denser in all cerebral arteries of spontaneously hypertensive rats than those of Wistar-Kyoto rats. In contrast, cholinergic nerve fibers and vasoactive intes tinal polypeptide, substance P-containing nerve fibers, indicative of vasodilator nerves, remained unchanged in all cerebral arteries of spontaneously hyperten sive rats, as compared with findings in the Wistar-Kyoto rats. Thus, not only adrenergic nerve fibers but also neuropeptide Y-containing nerve fibers may play an important role in preventing the disruption of the blood-brain barrier and the development of hypertensive encephalopathy in spontaneously hypertensive rats.
Impaired Inotropic Responses to Adrenergic Stimulation Following Aortic Constriction: Role of Oxidation Product of Catecholamines
Authors: Ganguly Pallab K.
Published: November 2007

In order to support the hypothesis that oxygen free radicals derived from persistent sympathetic drive play an important role in the modulation of recep tor-mediated effect in cardiac hypertrophy, rat hearts subjected to aortic band ing-induced pressure overload were assessed on postoperative days 3, 14, and 28 . Sham-operated rats without aortic banding were used as a control group . Cardiac alpha-adrenoceptors were increased at day 3 whereas beta-adrenoceptors were increased at postoperative days 14 and 28; these results were associated with increased amount of circulating norepinephrine and adrenolutin, one of the oxidation products of catecholamines. The hearts of these animals were also perfused by Langendorff technique in the presence and absence of adrenergic agonists. Banded animals had a diminished inotropic response to alpha agonists in addition to their reduced inotropic responsiveness to beta-adrenergic stimuli. These changes were however, reversible in animals pretreated with alpha-tocoph erol, a powerful antioxidant. Furthermore, the circulating level of adrenolutin was normalized by such treatment. These results indicate that an oxidation product of catecholamines may be responsible for impaired inotropic responses to adrenergic stimulation following aortic constriction.