bluuebunny/crossref_metadata_2025 huggingface dataset:
The Relationship Between Exercise Performance and Peripheral Circulation in Patients with Peripheral Arterial Occlusive Disease
Authors: Chen Shiau-Yee , Wu Ying-Tai , Wang Shoei-Shen
Published: July 2008

The exercise performance of patients with peripheral arterial occlusive disease was often impaired. The relationship of exercise performance, daily physical activity, and peripheral circu lation was studied. Twenty-five patients with peripheral arterial occlusive disease were recruited; their exercise performance was evaluated with a maximal graded exercise test. A habitual physical activity questionnaire was used to quantify the physical activity level. Measurement of peripheral circulation included the assessment of macrocirculation (ankle- brachial pressure index, calf blood flow by impedance plethysmograph) and microcirculation (cutaneous blood flow, cutaneous temperature, transcutaneous oxygen tension, and cutaneous blood flow responses to iontophoresis). Pearson's product correlation coefficient and multiple linear regression were used in data analysis. Results showed that age, sports index in habitual physical activity questionnaire, and ankle-brachial pressure index were significantly correlated with maximal walking time. Age and sports index were the two major determinants for their exercise performance and accounted for a 61.5% variability.
Acute Anterior Myocardial Infarction Following a Mild Nonpenetrating Chest Trauma
Authors: Atalar Enver , Açil Tayfun , Aytemir Kudret , Özer Necla , Övünç Kenan , Aksöyek Serdar , Kes Sirri , Özmen Ferhan
Published: July 2008

Myocardial infarction in patients under age 45 years is a relatively unusual phenomenon; blunt chest trauma is one of the nonatherosclerotic mechanisms leading to acute myocardial infarc tion in young adults. The authors report a rare case of anterior myocardial infarction in a 22-year- old man following a mild nonpenetrating chest trauma whose left chest was elbowed during a soccer game.
Wolff-Parkinson-White Syndrome Mimicking Acute Anterior Myocardial Infarction in a Young Male Patient
Authors: Güler Niyazi , Eryonucu Beyhan , Bilge Mehmet , Erkoç Reha , Türkoğlu Cengizhan
Published: July 2008

A young male with Wolff-Parkinson-White syndrome whose electrocardiographic pattern was suggestive of acute anterior myocardial infarction is described. A 21-year-old male with a history of ventricular fibrillation after being successfully resuscitated was admitted to the coronary care unit. His electrocardiogram showed ST elevation in the precordial leads (V1-V6). This condition was erroneously interpreted as an acute myocardial infarction. At the fourth day, while ST elevations returned to baseline, short PR interval and delta waves were observed on the ECG. Myocardial infarction was excluded by biochemical tests, echocardiography, and coronary angiography. Electrophysiologic study confirmed Wolff-Parkinson-White syndrome with two accessory pathways.
Usefulness of Saturation Pulses in Magnetic Resonance Imaging of Partial Anomalous Pulmonary Venous Return
Authors: Kimura Keizo , Uemura Shigeru , Handa Satoshi , Terasaka Masako , Takeuchi Takeshi , Moriwaki Chizu , Hano Takuzo , Nishio Ichiro
Published: July 2008

The authors evaluated partial anomalous pulmonary venous return by magnetic resonance (MR) images. Seven patients with this congenital anomaly underwent MR imaging examination. Conventional spin-echo and gradient-echo imaging were performed. In addition, during acquisi tion of gradient-echo images, saturation pulses were imposed on the affected lung. Spin-echo images showed the anatomical situation of the anomalous veins, and gradient-echo images revealed the blood flow in the veins. With saturation technique, the direction and drainage of blood flow in the anomalous veins were well defined. The study suggests that MR imaging with spin-echo method and gradient-echo method with or without saturation pulses is a useful and noninvasive method of diagnosing partial anomalous pulmonary venous return. MR images with spin- and gradient-echo methods were useful in defining the anatomical situation and blood flow in the anomalous veins. By imposing saturation pulses on the affected lung field, the direction and drainage of blood flow in the anomalous veins were clearly demonstrated.
Paget-Schroetter Syndrome in Sports Activities
Authors: Zell Lothar , Kindermann Wilfried , Marschall Franz , Scheffler Peter , Gross Jörg , Buchter Axel
Published: July 2008

The authors report 7 patients with thromboses in the upper extremity resembling Paget- Schroetter syndrome. According to their case histories, all patients had a temporal and causal relationship between partially unusual sports activities and the genesis of the thrombosis. The cause of this condition is a strain on the subclavian and axillary veins by retroversion or hyper- abduction of the arm. This can entail microtraumatizations of the venous intima, consequently leading to a consecutive local activation of coagulation and to a possible thrombosis of the vessel. A mechanical compression of the vein by adjoining bone, ligament, and muscle struc tures can intensify the effects. Further primary diseases and risk factors as secondary causes for thromboses where taken into consideration when examining the patients. The Paget- Schroetter syndrome should be considered as a possible cause for unspecified trouble in the upper extremity reported by athletes. If such prolapses occur, they can be categorized as accidents by private and statutory insurance companies that cover accidents.
Rapid Clot Formation and Abnormal Fibrin Structure in a Symptomatic Patient Taking Fenfluramine
Authors: Carr Marcus E. , Carr Sheryl L. , Martin Erika J. , Johnson Betty Anne
Published: July 2008

A 35-year-old woman experienced symptomatic calf pain while taking a combination of fenflu ramine and phentermine. All symptoms resolved when the medications were stopped, but pain returned when fenfluramine was restarted. Laboratory evaluation revealed mild elevations of aspartate aminotransferase and lactate dehydrogenase and a remarkably shortened prothrombin time (6.3 seconds). Additional studies revealed that the clots were composed of very thin fibrin fibers. All laboratory abnormalities, including the abnormal fibrin structure, completely resolved when fenfluramin was stopped. Direct addition of fenfluramine or phen termine to normal plasma did not alter either coagulation kinetics or fibrin structure, supporting the concept that the induced changes may have originated at the hepatic level. Clots composed of thin fibers are much more resistant to fibrinolysis, and could potentially put such patients at risk for thrombotic complications. This is the first report of clotting abnormalities associated with fenfluramine use. Subsequent to its use in this patient, fenfluramine was removed from clinical use due to reports of acquired valvular heart disease.
Improvement of Peripheral and Cardiopulmonary Performance After a Short-Term Exercise Program with Additive Prostaglandin E1
Authors: Cachovan Milan , Rogatti Waltraud
Published: July 2008

In patients with intermittent claudication, the walking distance can be increased, both by means of several months of intensive training and administration of IV prostaglandin E 1 (PGE1) for 4 weeks. The aim of this study was, therefore, to investigate whether the combination of intensive training and PGE 1 infusions during pedalergometry can increase peripheral and cardiopulmonary performance after 2 weeks. Ten patients with intermittent claudication received a once-daily intravenous infusion of 60 μg PGE1 over 2 hours during pedalergometry. In addition, a physical training program was carried out mornings and afternoons, as well as progressive treadmill training. Walking distance (3 km/h, 12%) and cardiopulmonary perfor mance were determined at the beginning and end of the 2-week treatment. Results were compared with those of a historical control group having received a similar training program without PGE1. The initial walking distance increased from 71 to 166 m (134%). At the same time, peak work load increased by 108%, and the physical work capacity by 100%. Cardiopulmonary function improvement was reflected in all the parameters investigated (peak VO2; peak VO2/peak work load ratio; slope of ΔVO2/Δt; RER). Compared with the historical control group, the difference between the two groups with regard to the increase in walking distance was significant in favor of the combined training program with PGE1.

The combination of short-term intensive training and PGE1 infusions during pedal ergometry significantly improves both the peripheral as well as the highly restricted functional capacity in patients with intermittent claudication.
Changes of Gut Barrier Function During Anesthesia and Cardiac Surgery
Authors: Bölke E. , Jehle P.M. , Orth K. , Steinbach G. , Hannekum A. , Storck M.
Published: July 2008

The aim of this clinical study was to investigate the time sequence between intraoperative and postoperative endotoxemia, changes in intramucosal pHI, mediator release, and acute phase proteins and their relationship to postoperative infections. In 60 patients (median age 61 [33-72] years, male/female: 50/10) plasma levels of endotoxin, endotoxin neutralizing capacity (ENC), leukotriene-C4 (LTC4), 6-ketoprostaglandin-F-1α (PGF), thromboxane-B 2 (TxB2), inter leukin-6 (IL-6), and C-reactive protein (CRP) were measured before, during, and after cardiac surgery. The intraluminal pHI of the stomach was assessed as a marker of splanchnic blood circulation. Patients were divided in one group with postoperative infections (group A, n=8) and another groups without infections (group B, n = 52). Among all measured parameters, endotoxin plasma levels showed the most rapid changes. A significant increase of endotoxin plasma levels and a decrease in ENC appeared after the induction of anesthesia, culminating in a peak after reperfusion. Endotoxin showed a significantly higher increase in group A (14fold) compared to group B (sixfold, p < 0.001 ), whereas ENC decreased by eightfold in both groups. The parameters of the arachidonic cascade increased and pHI decreased, however, there were no significant differences between both groups. The latest increase was observed for the acute phase proteins IL-6 and CRP. IL-6 levels peaked 6 hours postoperatively with a 20fold (group B) and 30fold (group A) increase (p < 0.001 vs baseline; no differences between groups), whereas CRP rose at the first postoperative day with a 21fold (group B) and 25fold (group A) increase at day 2 (p < 0.001 vs baseline, no difference between groups). Differences between both groups appeared at the second postoperative day for IL-6 (median values group A/B: 421/219 pg/mL; p < 0.05) and at the fifth postoperative day for CRP (median values group A/B: 321/81 mg/L; p < 0.05). In conclusion, endotoxin seems to be the earliest trigger of the mediator cascade in acute phase response and may indicate infections in the postoperative course.
Preferential Acetazolamide-Induced Vasodilation Based on Vessel Size and Organ: Confirmation of Peripheral Vasodilation with Use of Colored Microspheres
Authors: Taki Kenji , Oogushi Kazuhisa , Hirahara Kenji , Gai Xuefeng , Nagashima Futoshi , Tozuka Kazutoshi
Published: July 2008

When carbonic anhydrase activity decreases, the regional blood flow (rBF) in organs increases as hypercapnia develops. However, the effects of acetazolamide (AZ)-induced vasodilation have not been estimated with respect to vessel size and organs. The aim of this study was to determine the diameter of the capillaries in various organs that respond to inhibition of carbonic anhydrase activity by AZ. White rabbits were anesthetized with urethane and ketamine and infused with AZ. While the systolic blood pressure (SBP), pH, hemoglobin concen tration, and base excess did not change, the partial pressure of arterial oxygen (PaO2) increased significantly and the partial pressure of arterial carbon dioxide (PaCO2) decreased significantly with AZ. The rBF was calculated by using 3 different sizes (15, 25, and 50 μm) of colored microspheres (CM). The rBF measured with 15μm CM in the brain, kidneys, and liver increased in response to AZ, and the rBF in these organs was different with the different sizes of CM. However, the rBF calculated by using the different sizes of CM in the stomach and abdominal muscle did not change after the administration of AZ. The AZ-induced vasodilation occurred in all sizes of vessels in the liver, in the small and medium-sized vessels in kidneys, and in the larger capillaries in the brain.
Hypotension and Functional Left Ventricular Obstruction During Dobutamine Stress Echocardiography
Authors: Ueda Takashi , Mizushige Katsufumi , Yukiiri Kazushi , Watanabe Kazufumi , Kohno Masakazu
Published: July 2008

Although hypotension during dobutamine stress echocardiography has been reported, the mechanism of this response is still controversial. In two patients, a 72-year-old woman and 64-year-old man, with exercise-induced ST-T change, continuous-wave Doppler examination of the left ventricular cavity was performed at baseline and peak dobutamine infusion. No echocar diographic abnormalities at rest or angiographic coronary lesions were observed in either patient. The intracavitary pressure gradient at peak dosage of dobutamine for both patients was 121 mm Hg and 100 mm Hg, and was reproducibly confirmed by cardiac catheterization. During dobutamine infusion, echocardiography or left ventriculography revealed that papillary muscle motion was dramatically augmented by dobutamine and mid-left ventricular obstruction was produced at the systolic phase. Although blood pressure response improved following β-blocker treatment, intracavitary pressure gradient during dobutamine infusion remained the same. A hypotensive response during dobutamine stress echocardiography may be produced by the development of dynamic intraventricular obstruction and a vasodepression reflex. The exercise-induced electrocardiographic changes may have been related to the systolic pressure augmentation in the mid-to-apical left ventricular cavity.
Predictive Value of Mitral Annular Calcification for the Diagnosis of Coronary Artery Disease in Patients with Dilated Cardiomyopathy
Authors: Dincer Irem , Ozdol Cagdas , Dandachi Rabih , Akyurek Omer , Atmaca Yusuf , Kiliçkap Mustafa , Erol Cetin , Oral Dervis
Published: July 2008

Mitral annulus calcification (MAC) is an independent predictor of coronary artery disease (CAD). The present study was designed to determine whether an association exists between MAC and CAD in patients with dilated cardiomyopathy. Among the 286 patients with MAC on echocardiographic examination who underwent coronary angiography, 55 patients with echocardiographic findings of dilated cardiomyopathy (group I) were compared to 60 age- matched controls without MAC and an echocardiographic diagnosis of dilated cardiomyopathy (group II) who underwent coronary angiography during the same time. There were no differ ences in echocardiographic findings between two groups. The prevalence of CAD was higher in group I when compared to group II (74% vs 28%, p<0.001). With regard to severity of CAD, two-vessel, three-vessel, and left main coronary artery disease were found to be significantly frequent in group I (p<0.001). Multivariate analysis revealed that MAC (p = 0.001 ), diabetes mellitus (p = 0.048), and history of anginal chest pain (p = 0.009) are the independent predictors for the presence of CAD in patients with dilated cardiomyopathy. In conclusion, MAC may be a marker for the presence of coronary artery disease in patients with dilated cardiomyopathy.
Dipyridamole-Induced ST-Segment Elevation Indicative of Transmural Myocardial Ischemia
Authors: Safi Arshad M. , Pillai Nisha , Rachko Maurice , Chaudhry Khalid , Stein Richard A.
Published: July 2008

Dipyridamole nuclear myocardial perfusion test is a safe and effective alternative to exercise nuclear perfusion testing for detecting myocardial ischemia. It is the procedure of choice in selected patients who are unable to exercise adequately. Intravenous dipyridamole causes coronary vasodilation with resultant maldistribution and heterogeneity of coronary flow in the presence of significant coronary artery disease. True ischemia, causing symptoms or ST-segment depression, is uncommon, in part because there is no increase in myocardial oxygen demand. A patient in whom myocardial ischemia developed, manifested by ST-segment elevation, during dipyridamole stress testing is described. Scintigraphic images illustrated a myocardial perfusion defect, which was consistent with coronary angiographic findings. This case report addresses the importance of dipyridamole-induced ST-segment elevation, its correlation with angiographic findings, and the need for continued hemodynamic and electrocardiographic monitoring in patients following dipyridamole infusion.
Coronary Artery Spasm-Induced Paroxysmal Atrial Fibrillation
Authors: Hung Ming-Jui , Wang Chao-Hung , Kuo Li-Tang , Cherng Wen-Jin
Published: July 2008

Paroxysmal atrial fibrillation is described in a patient that was consistent with the clinical history developed after induction of coronary artery spasm. The mechanism appeared to be sinus node artery spasm inducing sinus node ischemia. Coronary artery spasm can be a cause of paroxysmal atrial fibrillation.
Extent of Coronary Atherosclerosis and Homocysteine Affect Endothelial Markers
Authors: Yildirir Aylin , Tokgozoglu S. Lale , Haznedaroglu Ibrahim , Sinici Incilay , Kabakci Giray , Ovunc Kenan , Aksoyek Serdar , Oto Ali , Ozmen Ferhan , Kirazli Serafettin , Kes Sirri
Published: July 2008

The aim of the study was to evaluate the effects of the presence, extent, and clinical stability of coronary artery disease on endothelial function parameters, C-reactive protein and homo cysteine levels. Fifty-eight patients with angiographically documented coronary artery disease and 25 patients with normal coronary arteries were evaluated for risk factors, plasma homo cysteine, C-reactive protein, and soluble adhesion molecule levels. Vascular cell adhesion molecule-1 and sE-selectin were significantly higher in the group with coronary artery disease than in healthy subjects (p = 0.005 and p = 0.031, respectively). Patients with unstable angina had significantly higher C-reactive protein (p< 0.001), troponin I (p<0.01), and leukocyte counts (p < 0.05) than those with stable angina. sE-selectin levels were correlated with the extent of coronary atherosclerosis (r = 0.444, p < 0.05), and plasma homocysteine levels were associated with vascular cell adhesion molecule-1 (r= 0.479, p<0.05) in unstable cases. These results suggest that vascular cell adhesion molecule-1 and sE-selectin are useful for determining the presence of coronary atherosclerosis, whereas C-reactive protein, troponin I, and leukocyte count are predictors of clinical stability.
Effect of Blood Pressure Reduction on Abnormal Left Atrial Appendage Function in Untreated Systemic Hypertensive Patients with Sinus Rhythm
Authors: Bilge Mehmet , Güler Niyazi , Eryonucu Beyhan , Güntekin Ünal
Published: July 2008

To investigate whether reduction in blood pressure has a beneficial effect on left atrial appendage (LAA) function, the authors evaluated 24 untreated systemic hypertensive patients with normal left ventricular systolic function in sinus rhythm at baseline and at 3 months after initiation of antihypertensive therapy. They performed transthoracic and transesophageal echocardiographic examinations in hypertensive patients before and after treatment of hyper tension. Three of the 24 patients had blood pressure that failed to respond to the regimen of antihypertensive therapy and were removed from the analysis. Of the remaining 21 patients, mean systolic and diastolic blood pressures at baseline were 170 ± 18 and 104 ±6 mm Hg, respectively, and fell significantly at 3 months to 141 ±10 and 90 ±5 mm Hg, respectively, (p<0.001 ) after initiation of antihypertensive therapy. There was no significant change in heart rate with treatment (baseline 81 ±8 and at 3 months 84 ±9 beats/min). There was no signifi cant change in left ventricular end-diastolic diameter, left ventricular ejection fraction, left ventricular wall thickness, or left atrial diameter from baseline (49 ±4 mm, 58 ±5%, 12 ± 1 mm, and 41 ±4 mm, respectively) at 3 months (48 ±5 mm, 59 ±4%, 12 ± 1 mm, and 40 ±3 mm). The treatment caused a significant reduction in maximal LAA areas (6.3 ± 1.3 cm2 at baseline, 4.6 ±0.7 cm2 at 3 months, p<0.001), with a concomitant increase in LAA emptying velocity (44 ±7 cm/sec at baseline, 60 ±9 cm/sec at 3 months, p<0.001). In conclusion, these findings suggest that reduction in blood pressure with antihypertensive therapy could improve LAA function in hypertensive patients with normal left ventricular systolic function in sinus rhythm.
Recombinant Tissue Plasminogen Activator for the Treatment of Cutaneous Infarctions in Antiphospholipid Antibody Syndrome
Authors: Srinivasan Shashi K. , Pittelkow Mark R. , Cooper Leslie T.
Published: July 2008

Antiphospholipid antibody syndrome (APAS) commonly presents with cutaneous infarctions mimicking thromboembolic vaso-occlusive disease. Systemic anticoagulation is the standard of care for this disorder, but treatment failures can occur. The authors report the first successful treatment of cutaneous infarctions due to APAS with low-dose, intravenous tissue plas minogen activator (rTPA) in a patient who failed to improve with high-dose anticoagulation. Wound healing was associated with a marked improvement in blood flow as assessed by scanning laser Doppler. The authors recommend that patients presenting with cutaneous infarctions in the absence of atherosclerosis be evaluated for APAS, and that fibrinolytic therapy be considered if cutaneous infarction persists despite anticoagulant therapy.
Potential Use of a Low-Molecular-Weight Heparin to Prevent Restenosis in Patients with Extensive Wall Damage Following Peripheral Angioplasty
Authors: Schweizer Johannes , Müller Axel , Forkmann Lutz , Hellner Grit , Kirch Wilhelm
Published: July 2008

The long-term outcome of primary successful percutaneous transluminal angioplasty (PTA) for patients with peripheral occlusive arterial disease (POAD) is frequently compromised by the development of restenosis, especially when extensive dissections result from the angioplastic procedure. Unfortunately, prevention of the occlusive process by means of drugs such as antithrombotics, anticoagulants, thrombolytics, corticosteroids, lipid reducers, or cytostatics has not been demonstrated convincingly. The authors sought to clarify whether such patients could benefit from the postsurgical administration of low-molecular-weight heparin.

A total of 172 POAD patients with extensive dissections after PTA in the pelvic or upper leg regions were randomized for 7-day post-PTA intravenous treatment with either full heparinization or nadroparin calcium followed by adjunctive oral aspirin for 6 months. The primary outcome measure was the degree of stenosis (normal findings; stenosis <50%, > 50%, >80%, occlusion) before and after angioplasty, as well as 3 weeks and 3 and 6 months after dilation; secondary efficacy criteria included changes in the Fontaine stage and in the cruro brachial ratio.

No significant treatment-related differences were found at the 3 post-PTA follow-up exam inations with regard to the degree of stenosis. This was also the case for the subgroup of patients (n = 62) who had undergone angioplasty in the pelvic region. By contrast, when angio plasty was performed in the superficial femoral artery (n = 110), the degree of restenosis was significantly lower (p<0.01) among patients receiving nadroparin calcium compared to those given heparin at week 3, month 3, and month 6. No intergroup differences emerged for secondary outcome measures in the long term or for safety parameters. These preliminary results indicate that patients with extensive dissections after PTA treatment for POAD in the upper leg region might benefit from a reduction in the rate of restenosis by administration of 7-day weight-adjusted nadroparin calcium.
Flow-Dependent Vasomotor Dysfunction of the Popliteal Artery Related to Common Carotid Artery Intima-Media Thickness
Authors: Spáčil Jiří , Češka Richard , Haas Tomáš
Published: July 2008

This study was designed to assess a possible correlation between flow-mediated endothe lium-dependent vasodilation in the popliteal artery and the intima-media thickness of the common carotid artery. Impaired vasodilation is one of early markers of atherosclerosis that has not been studied on the popliteal artery. An increase in intima-media thickness of the common carotid artery is also considered to be an indication of early stages of atherosclerosis. With use of ultrasound, the diameter of the popliteal artery was measured at rest and during reactive hyperemia after 5-minute arterial occlusion. Subsequently, the intima-media thickness was measured in left common carotid arteries in 27 patients with hyperlipidemia, in 10 patients with confirmed coronary artery disease, and in 20 healthy individuals. In healthy individuals, popliteal artery diameter increased by mean of 6.6 ±3.5% (p<0.01) in relation to hyperemia. In patients with hyperlipidemia before therapy and in patients with coronary disease, no increase in diameter occurred (mean, 0.44% and -1.6%, respectively). The difference between healthy individuals and patients was statistically significant at p<0.001. The popliteal artery seems to respond similarly to the brachial artery. When comparing the change in popliteal artery diameter and intima-media thickness of common carotid arteries, a strong negative correlation (r = -0.5713, p < 0.001) was observed in all subjects.
Deep Vein Thrombosis Caused by Congenial Interruption of the Inferior Vena Cava
Authors: Tsuji Yoshihiko , Inoue Takeshi , Murakami Hirohisa , Hino Yutaka , Matsuda Hitoshi , Okita Yutaka
Published: July 2008

Congenital interruption of the inferior vena cava is an uncommon vascular anomaly. In this setting, the appearance of deep vein thrombosis is very rare because associated azygous or portal continuation develops as a collateral system for venous return. The authors present a case of infrahepatic interruption of the inferior vena cava in a 21-year-old man who presented with symptoms of deep vein thrombosis. Clinical features and prognosis of this entity are discussed.
Clinical Logistics in Treadmill Exercise Stress Testing
Authors: RuDusky Basil M.
Published: July 2008

The predictability as to a positive or negative outcome of treadmill exercise stress testing in 341 consecutively studied patients referred for diagnostic purposes is presented. A clinical decision as to the result was derived by asking 2 simple questions and reviewing the pretest ECG. Additional clinical logistics included the type of physician ordering the study, smoking history, symptoms, and basic patient history. The predictable accuracy was 77.7% for the total patient group and 81.5% when the questionable cases (reflecting a neutral or ambivalent cardi ologist's opinion) were eliminated.
Importance of Left Anterior Hemiblock Development in Inferior Wall Acute Myocardial Infarction
Authors: Özdemir Kurtuluş , Uluca Yavuz , Daniş Gülizar , Tokaç Mehmet , Altunkeser Bülent Behlül , Telli Hasan Hüseyin , Gök Hasan
Published: July 2008

The aim of this study was to investigate the clinical and angiographic importance of left anterior hemiblock (LAHB) during acute inferior myocardial infarction (AIMI) by comparing patient groups with and without LAHB after AIMI.

One hundred seventy-two patients (141 men and 31 women) between 28 and 84 years of age (mean 55 ± 10 years) with AIMI were included in the study. Patients were divided into 2 groups according to electrocardiogram (ECG) criteria: group I comprised 25 patients in whom ECG pattern characteristic of LAHB developed, group II comprised 147 patients without this pattern. According to the electrocardiogram, patients were placed in group I if the mean QRS axis was deviated to the left <30° in the frontal plane with the following pattern: increased S- wave voltage and decreased R-wave voltage in leads II, the appearance of a deep S-wave in lead II, and a terminal positive R-wave in lead aVR. Coronary angiography was performed within 2 weeks. A coronary stenosis was considered if the vessel diameter was narrowed by > 50%. The dominant coronary artery was classified as right or left or balanced. The left ventricular ejection fraction (LVEF) was calculated from left ventriculography.

The mean age of the patients in group I was significantly higher (58 vs 54 years, p = 0.007), while the risk factors were similar in both groups. Left anterior descending (LAD) and multi vessel coronary artery disease (CAD) were found to be significantly higher in group I compared with group II (80% vs 38%, p = 0.0001; 84% vs 52%, p = 0.001, respectively). The mean LVEF was found to be lower in group I (51% vs 56%, p = 0.04). Peak creatine phosphokinase MB (CKMB) values were not different (216 vs 162 IU/L, p = 0.09). The frequency of left dominant or balanced coronary artery was determined to be higher in group I (44% vs 17%, p = 0.018).

LAHB development during AIMI can be an indicator of LAD lesions, multivessel coronary artery disease, and impaired left ventricular systolic function.
Spontaneous Echo Contrast in Descending Aorta Correlates with Low Blood-Flow Velocity in Carotid Arteries and Hemostatic Abnormalities
Authors: Yamamura Osamu , Miyoshi Yoshimitsu , Hiraki Seiichi , Ono Hiromi , Ootaki Hideho , Fujiyama Jiro , Kuriyama Masaru
Published: July 2008

Spontaneous echo contrast in the descending aorta (DA-SEC) was examined as a possible risk factor for cerebral thromboembolism. In 19 patients (10 males, 9 females) in the chronic stage of cerebral infarction, abnormal findings by transesophageal echocardiography, flow dynamics of the common carotid artery (CCA), and hemostatic factors including blood coagulation and fibrinolysis were investigated. In nine patients, DA-SEC was detected, and SEC in left atrium (LA-SEC) was detected in nine patients. The DA-SEC positive group showed decreased blood- flow velocity (BFV) in bilateral CCA, high levels of thrombin-antithrombin III complex (TAT) and prothrombin fragment 1.2 (F1+2), a decrease in platelet count and a slight increase in D- dimer, which means an activated state of thrombin generation and resulting fibrinolysis, compared to the DA-SEC negative group. On the other hand, the LA-SEC positive group showed normal BFV in CCA and only a slight increase in D-dimer. We conclude that the condition producing DA-SEC is a stronger risk factor for cerebral infarction than that producing LA-SEC.
MR Angiography of the Hand Arteries
Authors: Krause Ulrich , Pabst Thomas , Kenn Werner , Wittenberg Günther , Hahn Dietbert
Published: July 2008

The aim of this study was to optimize different magnetic resonance angiography (MRA) tech niques and to evaluate MRA of the hand arteries compared to intraarterial digital subtraction angiography (IA-DSA). The MRA examinations were performed on a 1.5-T system equipped with a flexible surface coil. The protocol contained time-of-flight (TOF), rephased/dephased (Re/De), and contrast enhanced (CE) techniques. Maximum intensity projection (MIP) was used for postprocessing. The IA-DSA procedure was performed as pharmaco-angiography (after intraarterial injection of a vasodilatator) via a transbrachial approach. Nine patients suffering from peripheral vascular disease were examined with IA-DSA, TOF-MRA, and Re/De- MRA; six patients were examined with CE-MRA and IA-DSA. Best overall image quality was attained with IA-DSA, followed by TOF-MRA, Re/De-MRA, and CE-MRA. Selective arterial visu alization of digital arteries was possible with IA-DSA and TOF-MRA. Rephased/dephased MRA showed venous overlay. Contrast-enhanced MRA was limited by inconstant quality of bolus timing. Appropriate arterial bolus timing was achieved in four of six patients; one examination showed venous overlay, one examination incomplete arterial enhancement. Time-of-flight MRA detected 96% of the digital artery segments that were identified with IA-DSA and revealed 34 segments that were failed on IA-DSA. Rephased/dephased MRA and CE-MRA were inferior to IA-DSA and TOF-MRA regarding detection of digital arteries. Magnetic resonance angiography with optimized protocols is a noninvasive procedure to visualize hand arteries in patients with ischemic disease. With TOF-MRA it is possible to detect angiographically occluded arterial segments of digital arteries.
Pulmonary Arterial Aneurysm with CATCH 22 Syndrome
Authors: Kinoshita Osamu , Mizoue Tetsuro , Kusama Akitoshi , Gomi Eiichi , Sato Shinobu , Hongo Minoru , Kubo Keishi
Published: July 2008

An adult case of CATCH 22 syndrome with a pulmonary arterial aneurysm is presented. The chest radiograph showed a large massive lesion, which should be differentiated from lung cancer, mediastinal tumor, or aortic aneurysm. CATCH 22 syndrome is a developmental malfor mation caused by hemizygous deletion of 22q11 chromosome, which usually presents with cardiac malformation including tetralogy of Fallot, truncus arteriosus, patent arterial duct, and ventricular septal defect. Most patients with this syndrome usually die early in life.
Value of Echocardiographic Findings in Predicting Cardiovascular Complications in Infective Endocarditis
Authors: Mathew James , Anand Aswini , Addai Theodore , Freels Sally
Published: July 2008

Echocardiography allows the detection of vegetations and estimation of valvular dysfunction in patients with infective endocarditis. The value of echocardiographic findings in predicting cardiac and other vascular complications in infective endocarditis is not well understood. Identification of high-risk patients and early surgery may improve their prognosis. The authors reviewed echocardiographic findings and related them to the development of congestive heart failure, systemic embolism, and the need for surgery or the risk of death without surgery in patients with infective endocarditis.

There were 125 episodes of endocarditis in 114 patients (84 episodes [67%] in men) with a mean age ± standard deviation of 37 ±7 years. Vegetations were detected by echocardiog raphy on at least 1 valve in 87 episodes (70%); on the mitral valve in 36 episodes (29%); on the aortic valve in 21 episodes (17%); and on the tricuspid valve in 45 episodes (36%). Severe aortic regurgitation was present in 9 episodes (7%) and severe mitral regurgitation in 4 instances (3%). In 12 of 21 episodes (57%) of vegetations on the aortic valve compared with 15 of 104 patients (14%) without vegetations on the aortic valve (p < 0.00 1), and in 8 of 9 instances (89%) of severe aortic regurgitation compared with 19 of 116 episodes (16%) without severe aortic regurgitation (p < 0.00001), the patients developed congestive heart failure. In 18 of 55 episodes (33%) of vegetations on the aortic/mitral valve compared with 17 of 70 episodes (25%) without vegetations on the aortic valve/mitral valve (p=NS), the patients developed systemic embolism. In 13 of 21 episodes (62%) of vegetations on the aortic valve compared with 19 of 104 episodes (19%) without vegetations on the aortic valve (p < 0.001 ), and in 8 of 9 episodes (89%) of severe aortic regurgitation compared with 24 of 116 episodes (21%) without severe aortic regurgitation (p < 0.00001), the patients either had surgery or died without surgery.

Echocardiographic findings do not reliably predict the risk of systemic embolism in patients with infective endocarditis. Vegetations on the aortic valve and severe aortic regurgitation detected by echocardiography predict a high risk of developing congestive heart failure, and for the combined outcome of requiring surgery, or dying without surgery in infective endocarditis. Early surgery may improve the outlook for survival of these patients.
tPA via Infusion Catheters Followed by Continuous IV Infusion for 3 Days Prevents Intimal Hyperplasia After Balloon Injury
Authors: Kanamasa Ken , Inoue Yoshikazu , Otani Narutaka , Naito Norikatsu , Morii Hideki , Ikeda Akiko , Taniguchi Mitsugu , Ishida Norihiro , Hayashi Takahiro , Ishikawa Kinji
Published: July 2008

A rabbit model was used to examine the effects of tissue plasminogen activator (tPA) on development of intimal hyperplasia following balloon injury. Thirty-two hereditary hypercho lesterolemic (KHC) rabbits underwent percutaneous transluminal coronary artery balloon catheterization and injury to the common iliac artery, after which they were divided into four groups: untreated (control); Dispatch catheterized-30 minutes local saline delivery [D(+)- tPA(-)]; D(+)-30 minutes local tPA delivery (0.6 mg/kg) [D(+)-tPA(30 min)]; and D(+)-30 minutes local tPA + 3 days intravenous infusion (0.6 mg/kg/24 h) [(D(+)-tPA(30 min + 3 d)]. Twenty-eight days later, the intimal cross-sectional areas of all three Dispatch catheterized groups were significantly smaller than those of control groups, as were the intimal/medial area ratios. Moreover, the intima/media ratios of the D(+)-tPA(30 min + 3 d) group were significantly smaller than those of the D(+)-tPA(-) group. Thus, local delivery of tPA via Dispatch catheters followed by continuous intravenous infusion of tPA for 3 days prevented intimal hyperplasia after angioplasty.
Suppression of Fatty Acid Metabolism After Exercise Stress in Patients with No Electrocardiographic ST Segment Shift During Balloon Angioplasty
Authors: Iwado Yasuyoshi , Mizushige Katsufumi , Manabe Kimiteru , Wada Yoshihiro , Kondo Isao , Ohmori Koji , Kohno Masakazu
Published: July 2008

Although ST segment shift is a marker of myocardial ischemia, some patients have no ST segment shift during percutaneous transluminal coronary angioplasty (PTCA). The aim of this study is to investigate myocardial perfusion and metabolism in adaptation for ischemia using 201TI and 123I-BMIPP dual exercise stress myocardial single photon emission computed tomog raphy (SPECT) (dual stress SPECT). In 28 patients with coronary artery disease, dual stress SPECT was performed 3 weeks before PTCA. Early and delayed images were obtained at 5 minutes and at 3 hours after termination of ergometer stress, respectively. During PTCA, 12- lead ECG was recorded, and a significant ST segment shift was defined as more than 1 mm elevation or a depression of the J-point at the first ballooning. No collateral circulation on the coronary angiogram or 201TI filling on the delayed images were observed on any of the target regions of PTCA. Patients were divided into 2 groups: with (Group A: n = 15) and without (Group B: n = 13) significant ST segment shift during PTCA. A redistribution of TI was observed in 14 (93%) of Group A and 10 (77%) of Group B patients. Incidence of BMIPP redistribution was significantly higher in Group B (11 [85%]) than in Group A (3 [20%]) (p < 0.05). Redistribution of BMIPP means suppression of fatty acid metabolism during exercise stress. Augmentation of glucose metabolism is speculated to be an energy source in ischemic preconditioning.
Occlusive Thromboaortopathy (Takayasu Disease): Clinical and Angiographic Features and A Brief Review of Literature
Authors: Sheikhzadeh A. , Tettenborn I. , Noohi F. , Eftekharzadeh M. , Schnabel A.
Published: July 2008

The aim of this study was to evaluate the diagnostic criteria and angiographic classifications of Takayasu arteritis by presenting the clinical, angiographic, and prognostic findings and a prospective follow-up of 78 patients. Occlusive thromboaortopathy or Takayasu arteritis is a large vessel vasculitis. The disease is systemic with an autoimmune and genetic etiology. The complete clinical and angiographic manifestations are reported for 78 cases based on diag nostic criteria of the American College of Rheumatology with a mean 6 ±3.2 years follow-up. The mean age was 34.7 and female:male ratio was 3.6:1. According to National Institute of Health criteria, 61.5% of patients were in the acute phase of disease with systemic symptoms such as fever, weight loss, malaise, and elevated C-reactive protein levels. Immunologic markers, such as antinuclear antibody and antineutrophil cytoplasmic antibodies, were negative. The tuberculin test result was positive in 47%. Vascular bruit was present in 89%. Almost all patients had stenoses, occlusions, or aneurysmatic changes of the aorta and its main branches. Hypertension was detected in 58% and left ventricular hypertrophy was initially present in 22 (28%) patients. The angiographic manifestations were classified as type I, cervi cobrachial type with 20 cases (25.6%); type II, thoracoabdominal type with 13 cases (16.6%); type III, peripheral type with 10 cases (12.8%); and type IV, generalized type with 35 cases (44.8%). The coronary arteries were involved in 6 cases, pulmonary arteries in 11 initially 5 in follow-up (16 cases), and renal arteries in 28 cases, respectively. A good correlation of the clinical manifestations and the prognosis was observed. During follow-up, five patients suffered from myocardial infarction, six had cerebrovascular accident, seven patients underwent aortic valve replacement, and six patients died (mortality rate, 7.6%). The specificity and sensitivity of diagnostic criteria were 94% and 76%, respectively. In contrast to ours and Nasu's classifi cation in the new classification of Numano, some angiographic types and subtypes of Takayasu arteritis are not present in our patients.
A New Technique for the Quantification of Peripheral Edema with Application in Both Unilateral and Bilateral Cases
Authors: Cornish Bruce H. , Thomas Brian J. , Ward Leigh C. , Hirst Cherrell , Bunce Ian H.
Published: July 2008

Current noninvasive techniques for the routine and frequent quantification of peripheral lymphedema in patients are total limb volume measurement (by water immersion or by circumferential measurements) and bioelectrical impedance analysis (BIA). However both of these techniques require standardizing the measurement using a contralateral measurement from the unaffected limb. Hence these techniques are essentially restricted to unilateral lymphedema. This paper describes the results from a preliminary study to investigate an alter native approach to the analysis of the data from multiple frequency BIA to produce an index of lymphedema without the need for normalization to another body segment. Twenty patients receiving surgical treatment for breast cancer were monitored prior to surgery and again after diagnosis with unilateral lymphedema. The data recorded were total limb volume, by circumferential measurements; and BIA measurements of both limbs. From these measure ments total limb volumes and extracellular fluid volumes were calculated and expressed as ratios of the affected limb to that of the unaffected limb. An index of the ratio of the extra cellular fluid volume to the intracellular fluid volume was determined. This ECW/ICW index was calculated for both the affected and unaffected limbs at both measurement times. Results confirmed that the established techniques of total limb volume and extracellular fluid volume normalized to the unaffected contralateral limb were accurate in the detection of lymphedema (p < 10-6). Comparison of the ECW/ICW index from the affected limb after diagnosis with that from the pre-surgery measurement revealed a significant (p < 10-6) and considerable (75%) increase. The results of this pilot study suggest that by using multiple frequency bioelectrical impedance analysis, an index of the ECW/ICW ratio can be obtained and this index appears to have an equal, or better, sensitivity than the other techniques in detecting lymphedema. More importantly, this index does not require normalization to another body segment and can be used to detect all types of peripheral edema including both unilateral and bilateral lymphedema.
Long-Term Effect of Lipid-Lowering Therapy on Atherosclerosis of Abdominal Aorta in Patients with Hypercholesterolemia: Noninvasive Evaluation by a New Image Analysis Program
Authors: Arai Yasumichi , Hirose Nobuyoshi , Yamamura Ken , Kimura Mitsuru , Murayama Akira , Fujii Isamu , Tsushima Motoo
Published: July 2008

Recent clinical studies have demonstrated that 3-hydroxy-3-methylglutaryl coenzyme A (HMG- CoA) reductase inhibitors are effective in the prevention of cardiovascular events and regres sion of atherosclerotic lesions evaluated by angiography. In this study, the authors investigated how lipid-lowering therapy effects on the progression of aortic atherosclerosis by using plain and enhanced computed tomography (CT) of the lower abdominal aorta. Twenty-nine hyper lipidemic patients (mean age 61.4 ±7.2 yr) were enrolled in a prospective open-labeled study. All patients underwent baseline CT scanning of abdominal aorta, screening for serum lipid profile and coagulation-fibrinolysis measurement, then treatment with simvastatin was begun. After 2 years, a follow-up CT scan was done and atherosclerotic lesions were compared between baseline and on-treatment scan. In spite of significant improvement of lipid and fibri nolytic profiles by simvastatin administration, mean aortic wall thickening volume (AWV) was increased during observation period. When patients were divided into subgroups by the levels of on-treatment LDL cholesterol (LDL-C), development rate of AWV was more potently suppressed in patients whose on-treatment LDL-C were below 125 mg/dL (median LDL-C). We could not find any associations of coagulation-fibrinolysis measurements with atheroscle rotic lesions. In regard to aortic calcification volume (ACV), low levels of total and HDL choles terol and higher age were associated with aortic calcification at baseline. These results suggest that aggressive treatment with LDL-C below 125 mg/dL may suppress the progres sion of wall thickening and factors that promote arterial calcifications and those for wall thick ening may be different.
Endothelial Functions in Pathophysiology of Thrombosis and Fibrinolysis: Late Spontaneous Recanalization of an Occluded Internal Carotid Artery
Authors: Manganaro Agatino , Ruggeri Marinella , Ando Giuseppe , Longo Marcello , Vita Giuseppe
Published: July 2008

The use of oral contraceptives is a potential cause of ischemic stroke in young women. The risk of stroke is higher when contraceptives contain high levels of estrogens. A thrombotic occlusion of the right internal carotid artery, seen on ultrasound, developed in a patient who was taking high-dose estrogen contraception. Recanalization occurred several months later by spontaneous thrombolysis and was confirmed by cerebral angiography. This case suggests that the activation of endothelial spontaneous antithrombotic mechanisms may allow the dissolution of a thrombus, once the cause of the thrombosis has been identified and removed and when the endothelium has maintained its functional integrity.