bluuebunny/crossref_metadata_2025 huggingface dataset:
Raised Leg Exercises for Leg Edema in the Elderly
Authors: Ciocon Jerry O. , Galindo-Ciocon Daisy , Galindo Diana J.
Published: July 2008

Leg edema is a common problem in the elderly and requires further evaluation and management. Method: From October 1990 to July 1992, 245 patients presented to the Cleveland Clinic Florida with leg edema. All patients were counseled about the benefits of twenty-minute, three-times-a-day raised-leg exercises. Fifty seven (57) of the 245 patients were not compliant with this regimen (nonexercise group). Although not true controls, they formed a comparison group for those who performed the exercise regimen. The exercise group was composed of 188 patients with a mean age of 73 ±6.8 years, 25 (13%) men and 163 (87%) women; the nonexercise group was composed of 57 patients with a mean age of 71.9 ±4.3, 19 (33%) men and 38 (67%) women. Workup for leg edema included: comprehensive history, clinical examination including prostate or pelvic examination, complete blood count, chemistry profile, thyroid profile, electrocardiogram, chest radiograph, and, when indicated, pelvic or leg ultrasound and pelvic computed tomographic scan. The circumference of the leg with the maximum amount of edema was measured initially and on the fourth week.

Results: In this study, the common causes of leg edema in the elderly population were venous stasis (63.2%), drug induced (13.8%), and heart failure (15.1%). Postphlebitic syndrome, cirrhosis, lymphedema, lipedema, prostate carcinoma (CA), and ovarian mass were the less frequent findings. Upon comparison of the circumference of leg edema on initial visit and four weeks after, both the exercise and nonexercise groups showed significant decreases in the measurement of the leg edema (P < .001) except those caused by lymphedema. The amount of change when compared between those who exercised and those who did not was significant only in venous stasis.

Conclusion: Causes of leg edema in the elderly are multiple. Twenty-minute, three-times-a-day raised-leg exercises were significantly more effective in the management of leg edema due to venous stasis (P < 0.0001) but did not produce significant differences in other etiologies such as heart failure, drug induced, and other conditions, which include lymphedema, prostate and ovarian CA, and postphlebitic syndrome. Successful management of leg edema is based on adequate and thorough assessment to identify the cause.
Mitral Valve and Left Ventricular Thrombi in an Infant with Acquired Protein C Deficiency
Authors: Atalay Semra , Imamoglu Ayten , Ikizler Coşkun , Uluoglu Omer , Öcal Burhan
Published: July 2008

The authors present an infant with left ventricular and mitral valve thrombi diagnosed by cross-sectional echocardiography. Thrombosis was due to acquired transient protein C deficiency, which was caused by impaired liver function due to sepsis. Because the thombi were very large and mobile, urgent surgery was performed. Eight weeks later, the patient's protein C level returned to normal ranges. The authors suggest that in all cases with intracardiac thrombosis, protein C deficiency should be investigated.
Acute Effect of Glyceryl Trinitrate on Systolic Blood Pressure and Other Hemodynamic Variables
Authors: Kawakami Hideo , Sumimoto Takumi , Hamada Mareomi , Mukai Mikio , Shigematsu Yuji , Matsuoka Hiroshi , Abe Mitsunori , Hiwada Kunio
Published: July 2008

The acute effect of glyceryl trinitrate (GTN) is mainly the reduction of systolic blood pressure (SBP) rather than diastolic blood pressure (DBP). To examine the mechanisms for decrease in SBP by GTN, the authors measured arterial compliance (AC), cardiac output (CO), stroke volume (SV), pulmonary capillary wedge pressure, right ventricular end-diastolic pressure, right atrial pressure, and left ventricular end-diastolic pressure before and after administration of GTN.

Fourteen patients who underwent cardiac catheterization were included in this study The change of each variable was estimated by the differences between values just before and at three minutes after GTN. After administration of GTN, SBP was significantly decreased from 158 ±21 to 138 ±12 mmHg (P < 0.01). AC was significantly increased, and pulmonary capillary wedge pressure, CO, and SV were significantly decreased. The change in SBP was inversely correlated with the change in AC and positively correlated with the change in CO or SV

The authors conclude that the mechanism for decrease in SBP by GTN is associated with both an increase in AC and a decrease in venous return.
Effect of Lipid-Lowering Treatment on Progression of Atherosclerotic Lesions—a Duplex Ultrasonographic Investigation
Authors: Caruzzo Carlo , Liboni William , Bonzano Alessandro , Bobbio Marco , Bongioanni Sergio , Caruzzo Enrico , Civaia Filippo
Published: July 2008

The Prevenzione Aterosclerosi Studio Torino (P.A.S.T.) was a prospective, randomized trial testing the effect on carotid and femoral atherosclerotic lesions of lipid-lowering therapy, as assessed by duplex scanning (DS) technique, in 85 patients (12 women, 73 men), forty-five to fifty-five years old, with ischemic heart disease (IHD), and randomly assigned to a hypolipidemic diet or diet + 250 mg acipimox (a nicotinic acid compound) two to three times/day.

Forty-one patients, without inclusion criteria, were compared with the randomized groups as a reference population. All three groups were submitted to DS and to hematic monitoring of lipid levels at the beginning and at the end of the study. During three years of treatment, there was a significant reduction (-6.5%) in total plasma cholesterol in the diet+drug group (P=0.04) and a simultaneous elevation of high-density lipoprotein cholesterol, significant in the treatment groups (respectively, + 15% P=0.02 in the diet and +16% P=0.016 in the diet+drug group).

Every group showed a trend toward the increasing number of lesions in all explored areas and toward the progression in size of the already existing ones. Whereas in the initial DS the prevalence of lesions was significantly lower in the nonrandomized group in every site, at the end of the study the total number of lesions did not differ among groups, and there was a significant increase of plaques in carotid area in the nonran domized group in comparison with the treatment groups. (continued on next page)

The final number of stable plaques was greater in the treatment groups as compared with the nonrandomized group (P=0.01 diet vs nonrandomized, P=0.03 diet+drug vs nonrandomized).

In conclusion, lipid-lowering treatment, with diet and with diet+drug, was useful in slowing the natural progression of atherosclerosis; particularly, it reduced the develop ment of new lesions in the carotid and femoral arteries and increased the stability of the already existing ones. In these patients, diet was equivalent to diet+drug in regard to progression of lesions. The most favorable results in the treatment groups seem to correlate with high-density lipoprotein cholesterol, significantly increased in comparison with the nonrandomized group.
Multiple Cerebral Infarcts Associated with an Atrial Septal Aneurysm
Authors: Chammas Elie , Trinca Manuel , Goullard Luc , Leys Didier , Houdas Yvon
Published: July 2008

The authors describe the case of a patient referred for evaluation of multiinfarct dementia. Conventional echocardiography revealed an aneurysm of the interatrial septum. A transesophageal echocardiogram demonstrated surimposed thrombus. This rare cause of systemic emboli can be diagnosed only by transesophageal echocardiog raphy and is of major interest to avoid recurrence of ischemic strokes.
Functional Lymphatic Alterations in Patients Suffering from Lipedema
Authors: Bilancini Salvino , Lucchi Massimo , Tucci Sandro , Eleuteri Pietro
Published: July 2008

Lipedema is a chronic vascular disease almost exclusively of female sex, characterized by the deposit of fat on the legs, with an "Egyptian column" shape, orthostatic edema, hypothermia of the skin, alteration of the plantar support, and negativity of Stemmer's sign.

The etiology and pathogenesis of this disease are still the object of study, and therapy is very difficult.

Various authors have described morphologic and functional alterations of prelym phatic structures and of lymphatic vessels.

The big veins remain untouched in the phlebograms and an alteration of the skin elasticity is demonstrated.

The present authors have studied by dynamic lymphoscintigraphy 12 women patients suffering from lipedema, and compared the results with those of 5 normal subjects and 5 patients suffering from idiopathic lymphedema who were sex and age matched with the patients suffering from lipedema.

The patients suffering from lipedema showed an abnormal lymphoscintigraphic pattern with a slowing of the lymphatic flow that presented some analogies to the alter ations found in the patients suffering from lymphedema.

A frequent asymmetry was also noticed in the lymphoscintigraphic findings that is in contrast to the symmetry of the clinical profile.
Percutaneous Transluminal Coronary Angioplasty for Culprit Lesions in Patients with Post Myocardial Infarction Angina Based on Dextrocardia and Anomalous Coronary Arteries
Authors: Yabe Yoshimasa , Tsukahara Reiko
Published: July 2008

Four cases of successful coronary angioplasty for anomalous coronary arteries, including dextrocardia associated with three-vessel disease, single left coronary artery with proximal left anterior descending lesion, anomalous right coronary artery (RCA) from adjacent left coronary sinus of Valsalva associated with proximal RCA lesion, and anomalous left circumflex angulated lesion bifurcated from the RCA, were encountered. Four cases with 8 target lesions who had a mean age of 63.5 ±11.5 years old are presented. All the targets lesions were completely dilated through balloon angioplasty, including use of a newly developed support device for cases with large jeopardized myocardium. The factors for complete revascularization were appropriate selection of catheters and originality and ingenuity of procedural technique based on the anatomic characteristics.
Contraction of Isolated Porcine Coronary Arteries is Inhibited by High Concentrations of Propranolol
Authors: Carey Edmund L. , Robertson David , Wells Jack N. , Robertson Rose Marie
Published: July 2008

Isometric tension responses of isolated porcine coronary artery rings were studied in the presence of concentrations of propranolol higher than those necessary to block effects mediated by β-adrenergic receptors. Propranolol (50-300 μM) inhibited contractions induced by 30mM KCl and by histamine, norepinephrine, and acetylcholine in a concen tration-dependent, noncompetitive fashion. The (+) propranolol isomer and the racemic mixture were equipotent inhibitors of contraction. Propranolol inhibition was partly reversed by increased extracellular Ca++. These effects of propranolol thus appeared to be independent of β-blockade and could be relevant to some of the drug's observed but still unexplained in vivo actions.
Acute Myocardial Infarction Shortly After a Normal Exercise Stress Test
Authors: Capezzuto Aldo , Achilli Augusto , Pontillo Daniele , Sassara Massimo , De Spirito Stefano , Guerra Roberto
Published: July 2008

The authors describe 3 cases of AMI occurring shortly after a negative bicycle ergometer stress test. These cases represent an unfortunate but extremely rare complication of a relatively safe diagnostic procedure.

The authors also focus on the pathogenesis of the ischemic event, which may be attributed either to intraplaque hemorrhage or to platelet aggregation, both exercise- induced. The prevalence of AMI in this paper (0.06%) is similar to the data described in literature.
Analytic Isocenter Calibration
Authors: Wunderlich Werner , Fischer Frank , Linderer Thomas , Kirkeeide Richard L.
Published: July 2008

Isocenter calibration transforms cardiac structures in digitized biplane angiograms to absolute dimensions, calculating their radiological magnification and video transforma tion. Since a scaling device is not required, isocenter calibration yields to more accurate measurements than the widely used reference object calibration.

Both isocenter methods reported so far, regarding geometrically inaccurate x-ray gantries, yield to different and complex computational formulas. Since these formulas are hard to understand, isocenter calibration is less widely used.

To facilitate the implementation of the isocenter calibration, the basic formulas for accurate x-ray gantries are derived. Shifting virtually one x-ray system onto the other, basic isocenter calibration is derived geometrically in three simple steps. The radiological magnification of an object is illustrated as a ratio of planes. The calculation of all para- meters entering the computations is demonstrated geometrically, by use of the isocenter of the x-ray gantry.

The derivation gives a clear idea of isocenter calibration. It is simple to derive and facilitates the understanding of the error regarding developments. When geometrical inaccuracies vanish, all formulas become equivalent. However, even if the inaccuracies increase, all methods provide nearly identical results, indicating the robustness of isocenter calibration.
Results of Transcutaneous Electrical Stimulation (TES) in Cure of Lower Extremity Arterial Disease
Authors: Debreceni László , Gyulai Magdolna , Debreceni András , Szabó Kázmér
Published: July 2008

The results of the treatment of 24 subjects—10 of them diabetic—with peripheral obstructive arterial disease of the lower limbs by transcutaneous electrical stimulation (TES) have been studied. The chronic ischemia of the lower extremities was complicated with ulceration in 12 and initial or advanced gangrene in 6 patients. All patients had been treated with antiplatelet drugs, pentoxifylline, and vasodilating drugs for many years. The drug therapy was continued, and TES was given daily for twenty minutes. The results were estimated after four to eight weeks of hospitalization and during a one- year follow-up in numerous cases. Except for 4 patients the improvement was very signif icant in all cases: the pain disappeared, the gangrenous process of the toes stopped, regression or complete healing of the ulceration could be observed, and the painfree walking distance increased. The oxygen saturation measured on the toes increased signif icantly during electrical stimulation. The blood pressure measured in the tibial artery showed very different changes. According to these observations TES appears to be a useful method superior to drug therapy in curing arterial circulatory disturbances of the lower extremities.
Ischemic Cardiomyopathy Without Significant Coronary Stenosis
Authors: Ishizaka Nobukazu , Isshiki Takaaki , Saeki Fumihiko , Ishizaka Yuko , Takanashi Riichilo , Yamaguchi Tetsu
Published: July 2008

The authors present a rare case of myocardial infarction in a fifty-eight-year-old man without significant coronary artery stenosis apparent on the emergency coronary angiogram. However, a second angiogram two days later revealed a total occlusion of the left anterior descending artery. Intracoronary thrombolytic therapy was performed with a successful outcome. The patient was subsequently readmitted with an acute myocardial infarction, and the coronary angiogram again failed to demonstrate significant stenosis. Thereafter, the patient's left ventricular function deteriorated progressively, with the occurrence of another myocardial infarction and frequent bouts of symptoms related to congestive heart failure. He died of ischemic cardiomyopathy about seven years later. Findings including an autopsy report showed that myocardial ischemia was involved in the pathogenesis of what initially appeared to be primary dilated cardiomyopathy, based on emergency angiograms.
In Vivo Ultrasonic Parametric Imaging of Carotid Atherosclerotic Plaque by Videodensitometric Technique
Authors: Mazzone A.M. , Urbani M.P. , Picano E. , Paterni M. , Borgatti E. , De Fabritiis A. , Landini L.
Published: July 2008

Extensive experimental and clinical data show that the ultrasonic image conveys infor mation on the biochemical composition of the atherosclerotic plaque, ie, the relative content of lipids (hypoechoic), fibrous tissue (hyperechoic), and calcific deposits (very echogenic with shadowing). A more dishomogeneous echo structure of the plaque is also more often associated with clinically complicated carotid plaques. To date, however, the assessment of plaque density and homogeneity by transcutaneous B-mode imaging remains subjective and qualitative.

The aim of this study was to assess whether plaque echodensity and homogeneity might be established on a more objective and quantitative basis by description of the spatial distribution of echo amplitude (referred to as tissue texture) applied to digitized images, obtained with commercially available B-mode transcutaneous imaging systems. A total of 47 B-mode images derived from echotomographic studies in 10 patients were digitized off line. For each region of interest, a set of first-order (mean gray level, standard deviation, skewness, kurtosis: mathematical descriptors of the shape of the frequency distribution of gray-level histogram) and of second-order (entropy, angular moment: mathematical descriptors of the spatial distribution of gray levels within the region of interest) textural parameters were evaluated. The visual, concordant reading by two independent, experienced observers assigned the plaques on the basis of qualita tively assessed echodensity to three groups: "soft" (n = 18), "fibrotic" (n = 20), "calcific" (n = 9). Regarding spatial gray-level distribution, 46 plaques would be separated into "homogeneous" (n = 17) and "dishomogeneous" (n = 29). On digitized images, the normalized mean gray level was the most effective first-order textural parameter for distinguishing soft (24.2 ± 12.4 arbitrary units in a zero to 255 scale) from fibrotic (64.5 ±16.4) and calcific plaques (125.3 ±24.5), P<0.01 for all intergroup differences. "Homogeneous" plaques were separated from "heterogeneous" ones on the basis of entropy (5 ±1 vs 7.9 ±9.7; P<0.01), whereas the values of angular second moment overlapped (1.542E-3 + 1.334E-3 vs 5.181E-4 ±2.5615E-4, P = ns).

In conclusion, quantitative texture analysis of ultrasonic images derived from tran scutaneous, high-resolution, commercially available B-scan systems is feasible in man and provides a quantitative operator-independent assessment of plaque echodensity and homogeneity.
Coronary Artery Aneurysms Develop in Weanling Rabbits with Serum Sickness But Not in Mature Rabbits
Authors: Onouchi Zenshiro , Ikuta Kouji , Nagamatsu Kazukiyo , Tamiya Hiroshi , Sakakibara Yoshimine , Ando Mineko
Published: July 2008

The involvement of the cardiovascular system in rabbits with serum sickness is similar of that in Kawasaki disease, both with respect to the histologic changes of the myocardium, the valves, the coronary arteries, and the aorta and to the sequence with which they appear. Although coronary arteritis appears the same histologically, aneurysms did not occur in mature rabbits, even in case of necrosis of an arterial segment with deletion of muscle and elastic tissue. On the other hand, weanling rabbits with serum sickness had a tendency to develop aneurysms of coronary arteries, despite little cellular infiltration and reactive fibrocellular hyperplasia.

The age factor thus appears to play an important role in the development of coronary aneurysms in Kawasaki disease, irrespective of the underlying mechanism, be it a markedly increased permeability to mediators through degenerated endothelial cells, or primary degenerated muscle cells with marked thinning of the media without much inflammatory cellular reaction.

Furthermore, this study provides an insight into the long-term prognosis of transient dilatation of coronary arteries in the acute stage of Kawasaki disease.
Relation of Hematocrit Values to Coronary Heart Disease, Arterial Hypertension, and Respiratory Impairment in Occupational and Population Groups of the Athens Area
Authors: Goubali A. , Voukiklaris G. , Kritsikis Sp. , Viliotou F. , Stamatis D.
Published: July 2008

Hematocrit values (Hct) were studied in relation to clinical and electrocardiographic (ECG) manifestations of coronary heart disease (CHD), arterial hypertension (AH), and respiratory impairment (RI) in 2901 adults (2033 men, 868 women) thirty to seventy years old, who comprised selected groups of large occupational (8611 workers) and population (5573 individuals) samples of the Athens area. The results of this study were as follows:

1. The women of the population sample with high Hct values had a significantly greater frequency of CHD (14.6%) as compared with women of the same sample with low Hct values (7.4%) (χ2=12.778 P < 0.005).

2. Subjects of both sexes in the population sample with high Hct values had signifi cantly higher mean levels of systolic and diastolic blood pressure as compared with subjects of the same population sample with low Hct values (F:4.61, P < 0.01).

3. In the women of the population sample with RI, the mean Hct values were signif icantly higher than those in the normal population (t:1.994, P < 0.05).

It is concluded that high Hct values as an indirect measure of increased blood viscosity seem to be related to CHD and AH. Moreover, RI is correlated with high Hct values.
Pseudo-alternans of Left Ventricular End Diastolic Pressure
Authors: Kwan Tak , Feit Alan
Published: July 2008

The authors report a case of left ventricular end diastolic pressure alternans without systolic alternans in a patient with bradycardia and tachypnea. This is an artifact due to the heart rate falling in a 2:1 ratio to the respiratory cycle. Alternation of left ventricular end diastolic pressure should be interpreted carefully in patients with bradycardia.
Vasomotor Effects of Transcutaneous CO2 in Stage II Peripheral Occlusive Arterial Disease
Authors: Savin Etienne , Bailliart Olivier , Bonnin Philippe , Bedu Mario , Cheynel Jean , Coudert Jean , Martineaud Jean-Paul
Published: July 2008

Vasomotor effects of skin exposure to carbon dioxide (CO2) have been described in normal subjects. It was of interest, therefore, to determine whether percutaneous CO2 is of therapeutic benefit. In a randomized, double-blind study, 10 patients with lower limb arteriopathy (stage II) were investigated before and after local exposure for twenty minutes to CO2-rich spa gas or to water-vapor-saturated air at the same temperature as that CO2 -rich spa gas.

Brachial and femoral blood flows, brachial and posterior tibial artery pressures, heart rate, and chest and foot transcutaneous oxygen tensions (tcPO2) were determined. Femoral blood flow, tibial pressure, and foot tcPO2 were significantly increased after exposure of the skin to CO2-rich spa gas. This effect was not accompanied with systemic hemodynamic modifications. Water-vapor-saturated air had no effect.

These results suggest that transfer of CO2 across the skin can have beneficial local vasomotor effects in patients with lower limb stage II arteriopathy.
Wall Thickening of Common Carotid Arteries in Patients Affected by Noninsulin-Dependent Diabetes Mellitus: Relationship to Microvascular Complications
Authors: Visonà Adriana , Lusiani Luigi , Bonanome Andrea , Beltramello Gianpietro , Confortin Loris , Papesso Barbara , Costa Franco , Pagnan Antonio
Published: July 2008

This study evaluates the wall thickness of common carotid arteries and the atherosclerotic involvement of the carotid bifurcations in patients with noninsulin-dependent diabetes mellitus (NIDDM), with and without microvascular complications. Seventy subjects affected by NIDDM, and 17 healthy controls were evaluated by means of high-resolu tion echo-Doppler scan. Twenty-six diabetics (Group A) had complications (overnight proteinuria > 500 mg, background retinopathy, sensory neuropathy), while 44 (Group B) had no complications. The two groups were comparable for age, sex, plasma lipid profile, and smoking habit. Arterial hypertension was present in 15 of 26 (58%) complicated patients (Group A) and in 18 of 44 (41%) uncomplicated patients (Group B). None of the patients had a history of cerebrovascular disease.

The authors found that the wall thickness of the common carotid artery was greater and atherosclerotic lesions of the carotid bifurcation were more frequent in diabetic patients with microvascular complications than in uncomplicated diabetics (who had a similar distribution of other risk factors for atherosclerosis) and in nondiabetic controls. These data on the one hand confirm the role of diabetes as an independent risk factor for carotid atherosclerosis and, on the other hand, indicate a correlation between microvas cular lesions and early atherosclerosis in diabetes.
Vertebral Artery Injury Presenting with Signs of Middle Cerebral Artery Occlusion
Authors: Sternbach George , Cohen Michael , Goldschmid David
Published: July 2008

Therapeutic manipulation of the neck has been shown to produce injury to the vertebral artery. The clinical syndromes produced by this arterial insufficiency generally reflect dysfunction of the brainstem or cerebellum. The authors present a case of such injury that presented with clinical findings, namely, hemiparesis and aphasia, suggestive of involve ment of the dominant middle cerebral artery. These findings may have been the result of disruption of flow through the posterior cerebral artery to the thalamus, internal capsule, and cerebral peduncles.
Lipomatous Hypertrophy of the Interatrial Septum: Diagnosis by Echocardiography and Magnetic Resonance Imaging
Authors: Koželj Mirta , Angelski Risto , Pavčnik Dušan
Published: July 2008

Lipomatous hypertrophy of the interatrial septum is generally a benign abnormality char acterized by deposition of adipose tissue in the interatrial septum, usually extending to the atrial wall and interventricular septum. It is most often detected as an incidental echocardiographic finding. Transesophageal echocardiography can provide additional details, but in this case magnetic resonance imaging proved superior to it in assessing the involvement of other cardiac structures.
Effect of Methylprednisolone on Metabolism and Contractility in the Stunned Myocardium
Authors: Kawabata Hitoshi , Takada Kozo , Katori Ryo
Published: July 2008

The effect of glucocorticoid on the metabolism and contractility in the stunned myocardium was examined by phosphorus 31 nuclear magnetic resonance (31P-NMR) in Langendorff rabbit hearts by use of an artificial blood substitute, perfluorochemical emulsion Fluosol-43. After normothermic global ischemia of fifteen minutes, postischemic reperfusion of sixty-five minutes was carried out. Methylprednisolone sodium succinate (MPSS) was administered either prior to global ischemia or during postischemic reper fusion. Adenosine triphosphate (ATP), creatine phosphate (CrP), inorganic phosphate (Pi), pH, left ventricular systolic developed pressure (LV DevP) and coronary flow were continuously measured. Thirty-six hearts were divided into three experimental groups consisting of 12 hearts each; CONT consisted of controls, Pre-MPSS perfusion with MPSS containing solution (10-4M) from forty-five minutes prior to global ischemia, and Post- MPSS with the same MPSS solution immediately after postischemic reperfusion. Pre- MPSS showed a significant inhibition of the increase in Pi and of the decrease in ATP and pH during global ischemia, in comparison with the other groups, and a suppression of the overshoot of CrP observed immediately after postischemic reperfusion. LV DevP of Pre- MPSS showed a marked improvement during the postischemic reperfusion as compared with CONT. In Post-MPSS, Pi was significantly increased and ATP decreased during the postischemic reperfusion as compared with the other two groups. There were no differ ences in coronary flow during postischemic reperfusion among the three groups. In conclusion MPSS has a beneficial effect on metabolism and contractility of the stunned myocardium when it is administered prior to ischemia.
Urine C-Peptide and Atherogenic Risk Factors in Diabetes Mellitus: Relevance to "Syndrome X"
Authors: Kato Hiroyuki , Takashima Toshinobu , Ohmori Keizo , Sunaga Toshiaki
Published: July 2008

The relation between the C-peptide concentration in twenty-four-hour urine specimens and atherogenic risk factors was investigated in 38 patients with noninsulin-dependent diabetes mellitus in an attempt to determine the significance of urine C-peptide in diag nosing "syndrome X," which is characterized by insulin resistance. Weak positive corre lations between twenty-four-hour urine C-peptide concentration and body mass index, systolic blood pressure (BP), diastolic BP, serum total cholesterol, and serum triglyceride were detected. A weak negative correlation was also apparent between urine C-peptide and serum high-density lipoprotein (HDL). The body mass index and serum triglyceride of patients with urine C-peptide excretion of > 100 μg/day were significantly higher than those in patients with normal urine C-peptide excretion (< 100 μg/day) (P < 0.01 and P < 0.02, respectively). Systolic BP, diastolic BP, serum total cholesterol, and serum HDL did not differ significantly between the two groups of patients. Results indicate that twenty-four-hour urine C-peptide concentration is of significance in determining whether a patient has a tendency to insulin resistance but has only limited value as a quantitative measure of endogenous insulin secretion.
The Effect of Streptokinase on Return to Work 18 Months After a First Myocardial Infarction
Authors: Christensen Jeppe Hagstrup , Ravn Lene , Rasmussen Søren Elkjaer , Sørensen Henrik Toft
Published: July 2008

In order to assess the impact of thrombolytic therapy on return to work eighteen months after a first myocardial infarction, 32 patients treated with streptokinase were compared with 30 patients not treated with streptokinase. The study was designed as a historical cohort study. The patients in both groups had continuous chest pain of less than six hours prior to admission and electrocardiographic changes consistent with acute myocardial infarction (MI). The two groups were comparable with respect to medical variables related to their myocardial infarction and to educational level. A total of 17 patients (53%) in the streptokinase group and 16 (53%) among controls had stopped working eighteen months after their MI. An association between the treatment and the working status could not be found (relative risk=1.0) nor could it be found if the figures were corrected for deaths and retirements because of age. In conclusion, this study could not demonstrate any beneficial effect of thrombolytic therapy on the return to work eighteen months after an initial myocardial infarction.
Normal-Appearing Captopril MAG-3 Renal Scintigraphy in Hemodynamically Significant Renal Artery Stenosis
Authors: Mansoor George A. , White William B. , Friedman Nicholas C.
Published: July 2008

The finding from a normal-appearing angiotensin converting enzyme (ACE)-inhibitor renal scan is generally reassuring to the physician screening for renovascular hyperten sion. In fact, the false-negative rate for captopril scintigraphy is very low. Possible reasons for false-negative scans have not been well documented. A fifty-two-year-old man was evaluated and found to have renovascular hypertension on two occasions, at initial presentation and again eight months later (restenosis had occurred). Renovascular hyper tension was present on both occasions as judged by decline of blood pressure following angioplasty of right renal artery stenosis (∼80% and ∼70% stenosis on the two occasions, respectively). However, ACE-inhibitor renal scanning with 99mTc MAG-3 gave disparate results on the two occasions. The first study using oral captopril (25 mg) indicated a low probability of renal artery stenosis, whereas the second study done with the patient regularly taking lisinopril (10 mg daily) was markedly positive. Possible reasons for the initial negative study include poor absorption of oral captopril or inade quate inhibition of the renin-angiotensin system by the 25 mg dose.
Portal Vein Thrombosis Due To Antithrombin III Deficiency
Authors: Yonemitsu Yoshikazu , Yanaga Katsuhiko , Matsumata Takashi , Sugimachi Keizo
Published: July 2008

The authors report a case of intrahepatic portal vein thrombosis in a sixty-four-year-old Japanese man with antithrombin III deficiency who successfully underwent cholecystec tomy and common bile duct exploration. To their knowledge, this is the first report of portal vein thrombosis due to primary antithrombin III deficiency.
Drug Injection in Jugular Veins: A New Risk Factor for Vascular Diseases in HIV-Infected Patients?
Authors: Maggi Paolo , Fullone Martina , Federico Maria , Angarano Gioacchino , Pastore Giuseppe , Regina Guido
Published: July 2008

The authors describe a rare case of diffused thrombosis of the superficial veins in the whole body and periphlebitis with perivascular abscesses in an human immunodeficiency virus (HIV)-infected drug abuser who was using neck veins to inject cocaine and heroin. In addition the patient presented oral candidiasis, hepatitis C virus infection, bronchop neumonitis, and endocarditis of the tricuspid valve with valvular failure. The conditions of the patient needed repeated vascular catheterizations for therapy administration. Similar pathologies, in HIV-infected patients, highly increase the risk of opportunistic infections, especially in the encephalic territory; in addition the need for vascular catheterizations represents a further risk factor for bacterial infections.
Four-Barrel Aortic Dissection Involving the Ascending Aorta
Authors: Ohte Nobuyuki , Takase Rie , Hashimoto Takeshi , Suzuki Kenji , Narita Hitomi , Fujinami Takao
Published: July 2008

A fifty-four-year-old woman was evaluated at the authors' hospital for symptoms of repeated chest and back pain. The symptoms had recurred for five months prior to admission. A dynamic computed tomographic scan was performed on admission and demonstrated an enlarged ascending aorta with four barrels secondary to split intimal flaps. This case is an extremely rare example of a patient with a four-barrel aortic dissec tion involving the ascending aorta.
Transesophageal Echocardiographic Evaluation of Left Main Coronary Artery
Authors: Alam M. , Gabriel F. , Khaja F. , Paone G.
Published: July 2008

Transesophageal echocardiography (TEE) demonstrated the left main coronary trunk in 30 of 32 patients. Of these 30 patients, 10 had angiographically normal and 20 stenotic left main coronary arteries. The TEE study revealed no stenosis in 9 of 10 patients with normal left main trunks and atherosclerotic lesions in all 20 patients with stenotic left main trunks. TEE demonstrated additional areas of stenosis in the left main coronary artery in 3 patients, which included ostial lesions in 2 patients. These features were not observed by angiography. Furthermore, when compared with angiography, TEE overes timated severity of stenosis in 4 patients. In conclusion, TEE is a useful test in demon strating normal as well as stenotic left main coronary trunks.
Isolated Cortical Venous Thrombosis— Discrepancy Between Clinical Features and Neuroradiologic Findings
Authors: Chang Yeu-Jhy , Huang Chin-Chang , Wai Yau-Yau
Published: July 2008

Isolated cortical venous thrombosis (CVT) is rare, and the discrepancy between clinical features and neuroradiologic findings has not been adequately emphasized. A thirty-one- year-old woman presented with focal seizures and occasionally secondary generaliza tion. There was no focal neurologic deficit except for Todd's paralysis. Electroencephalog raphy showed intermittent theta waves at the left frontoparietal area. Brain computed tomography (CT) and magnetic resonance imaging (MRI) disclosed a large lesion in the left frontoparietal area. An extensive occlusion of the superior cerebral veins of the left hemisphere with a patency of the dural sinuses was noted in the cerebral angiography. Eight months later, the CT hypodense lesion disappeared. Her neurologic status was stationary, but the seizures, mostly focal, still occurred occasionally. In this report, the authors emphasize the dissociation between minor clinical features and larger CT and MRI lesions in isolated CVT.
Ischemic Stroke Following an Intramuscular Injection of Diclofenac
Authors: Kornowski Ran , Pines Amos , Levo Yoram
Published: July 2008

Nonsteroidal antiinflammatory drugs (NSAIDs) have arterial vasospastic properties. The authors report a stroke that occurred within minutes following an intramuscular injection of diclofenac. A sixty-one-year-old man, a heavy smoker, was admitted for an acute onset of mild hemiparesis thirty minutes after a single intramuscular injection of diclofenac. The neurologic deficit was resolved at one month of follow-up. The authors suggest a temporal causal relationship between the cerebrovascular event and the injection of diclofenac. The mechanism of stroke might be related to a synergistic vasospastic property shared by the use of an NSAID and heavy smoking.
Alteration of Left Ventricular Filling Evaluated by Doppler Echocardiography as a Potential Marker of Acute Rejection in Orthotopic Heart Transplant
Authors: Pellicelli Adriano Maria , Barba Cosial Joaquin , Ferranti Edoardo , Gomez Arturo , Borgia Maria Clotilde
Published: July 2008

To evaluate the changes in left ventricular (LV) filling associated with acute cardiac rejection, serial Doppler echocardiographic (ED) examinations were performed on the same day as endomyocardial biopsy (EMB) in 40 patients who underwent orthotopic transplantation. The diameters and wall thickness of the left ventricle were measured. The indexes of LV filling in the following parameters were measured by pulsed Doppler: isovolumic relaxation time (IRT), peak early mitral flow velocity (V max E), and pressure half-time (PHT). The patients were classified into three groups on the basis of EMB: Group I (19 patients without rejection), Group II (11 patients with mild or moderate rejection), and Group III (10 patients with severe rejection).

In Group III rejection was associated with a significant increase of posterior wall thickness (P < 0.05), with a decrease of IRT (P < 0.05), and an increase of V max E velocity (P < 0.01) in comparison with Group I. In Group II, Doppler indexes were not statistically significant in comparison with Groups I and III.

In conclusion, in transplant patients, a diagnosis of acute cardiac rejection can be suspected in severe rejection by use of echocardiography when the diagnosis is based on a multiparametric evaluation of different ED indexes (m-mode and Doppler indexes). Doppler echocardiography is a method with an excellent specificity but insufficient sensitivity ; this is due to the influence of recipient atrial contraction timing on Doppler indexes of LV filling.
Inoue Balloon Pericardiotomy for Patients with Recurrent Pericardial Effusion
Authors: Chow Wing-Hing , Chow Tsun-Cheung , Yip Alex S.B. , Cheung King-Loong
Published: July 2008

The results and follow-up data for 11 patients with recurrent pericardial effusion due to various etiologies who underwent balloon pericardiotomy with the Inoue balloon catheter between May 1992 and July 1994 are described. Inoue balloon pericardiotomy was successful in 10 patients (91%), who remained free of pericardial effusion at a mean follow-up duration of 4.2 months. All patients tolerated the procedure well with minimal discomfort and with no complications. Despite good symptomatic relief, 9 patients (82%) eventually succumbed to disease dissemination, with a mean survival time of 1.4 months. It is concluded that Inoue balloon pericardiotomy is a safe and useful alternative to surgical pericardial windowing for the symptomatic treatment of recurrent pericardial effusion.
Isolated Corrected Transposition of Great Arteries and Double Left Anterior Descending Artery Originating from the Left and Right Coronary Artery A Rare Combination of Coronary Artery Anomaly and Congenital Heart Disease
Authors: Salachas Anastassios , Achenbach Kerstin , Liberatos Grigorios , Hatzioannidis Vassilios , Goudevenos Ioannis , Sideris Dimitrios
Published: July 2008

A case of double left anterior descending coronary artery in a patient with isolated corrected transposition of great arteries is presented. The double artery originated from the left main stem and the right coronary artery. There were no stenoses on these two arteries. This anomaly seems to be very rare.
The Postmyocardial Infarction Syndrome Vanished or Vanquished? A Twenty-Five-Year Follow-up A Case Report
Authors: Kossowsky Warren A. , Lyon Alan F.
Published: July 2008

Although the existence of the postmyocardial infarction syndrome has now long been questioned, the Dressler symptom complex remains widely accepted as a distinct clinical entity. A patient is described whose twenty-five-year follow-up adds to our argument that there is no late or separate multisystem autoimmune disease following acute myocardial infarction. It is suggested that the Dressler complex is an entity that has neither vanished nor been vanquished but one that may never have existed.
Criticism of Cardiovascular Studies with Negative Results Due to a Negative Correlation
Authors: Cleophas Ton J. M.
Published: July 2008

Background. Trials that do not allow rejection of the null hypothesis of no treatment effect may have had an inappropriate design. Self-controlled trials, although routinely used for the study of cardiovascular diseases, are virtually never assessed for correlation between treatment modalities.

Methods. Using three models and a series of published studies as examples, the author studies the influence of correlation levels on the statistical power of self-controlled studies.

Results. Between-subject variation as estimated by SD is largely dependent on the level of correlation, and so is the power of testing. The assessment of paired data as though they are unpaired can be used as a simple test to estimate correlation levels.

Conclusion. It is extremely relevant to assess correlation levels in a paired comparison a priori. With a presumably negative correlation a self-controlled design is likely to lack power.
Severe Raynaud's Syndrome Associated with Interferon Therapy
Authors: Creutzig Andreas , Freund Mathias
Published: July 2008

Side effects of long-term interferon (IFN) therapy for myeloproliferative disorders may be vasospastic Raynaud's attacks and lupus-like illness. The authors report on a woman with chronic myelogenous leukemia who experienced severe trophic lesions of the fingers after forty-nine months of IFN therapy. Digital artery occlusions could be proven arteriographically.
Postinfarction Ventricular Septal Rupture Following Thrombolysis: Long-Term Survival in the Presence of Normal Coronary Arteries A Case Report
Authors: Alexopoulos Dimitrios , Olympios Christoforos , Hahalis Georgios
Published: July 2008

A case of postinfarction ventricular septal rupture in a thrombolyzed patient is described. Coronary angiography revealed normal coronary arteries. The interrelations of long-term survival of postinfarction ventricular septal rupture, thrombolysis, and normal coronary arteries are discussed.
Guide Wire-Induced Coronary Artery Spasm During Percutaneous Transluminal Coronary Angioplasty A Case Report
Authors: Takahashi Masafumi , Ikeda Uichi , Sekiguchi Hiromichi , Fujikawa Hideyuki , Shimada Kazuyuki , Ri Takeshi
Published: July 2008

Coronary artery spasm induced by a guide wire is a very rare complication of percutaneous transluminal coronary angioplasty (PTCA). The authors describe a patient who developed coronary vasoconstriction distal to the dilated lesion during PTCA, which was refractory to intracoronary nitroglycerin and intravenous calcium antagonist injection and balloon angioplasty but responded promptly and completely to withdrawal of the guide wire from the coronary artery, suggesting that the spasm had been induced by the guide wire.
Takayasu's Arteritis Associated with Antiphospholipid Antibodies Report of Two Cases
Authors: Yokoi Kenji , Hosoi Emiko , Akaike Masashi , Shigekiyo Toshio , Saito Shiro
Published: July 2008

The authors describe 2 patients with Takayasu's arteritis in whom lupus anticoagulant was positive and the titer of anticardiolipin antibody was elevated. One patient developed diffusely stenotic and occlusive changes in the multiple larger arteries. Histology of the small-sized arteries in another patient showed occlusive vasculitis without thrombosis, in addition to the findings in large-sized arteries compatible with Takayasu's disease. These findings are uncommon in Takayasu's arteritis. These findings suggest that antiphospholipid antibodies may have contributed to the pathogenesis of the extensive vasculopathy and may have triggered vasculitis in these patients.
Morphologic Changes in Pulmonary Vasculature with Arteriographic Correlation
Authors: Basu Sabita , Datta B.N. , Khandelwal N.
Published: July 2008

During fetal life the pulmonary circulation is one of high resistance. Soon after birth with the onset of breathing and thereafter, sequential structural changes in the pulmonary vasculature take place. Several authors have reported differently on this structural remodeling.

This study describes the changes in the pulmonary vasculature occurring following birth. Twenty-five cases submitted to autopsy with ages ranging from newborns up to fourteen years were studied. Postmortem arteriography was undertaken in most of the cases and arterial morphology was quantitated by histomorphometry. It was found that the thick-walled pulmonary arteries of the newborn show a reduction in medial thickness over a period of one month, the reduction being most rapid in the first three days. After one month there is no significant change in medial thickness until fourteen years of age.
Effects of a Single Heparin Bolus on Neointimal Growth After Arterial Injury in Intact Rabbits
Authors: Janiszewski Mariano , Laurindo Francisco R. M. , Pasqualucci Carlos A. , da Luz Protásio L. , Pileggi Fúlvio
Published: July 2008

Heparinization is a routine procedure during angioplasty; however, its consequences on the late vascular response to a severe injury are unclear. The authors' objective was to explore the effect of a single heparin bolus at the time of a severe vascular injury on late intimal proliferation and neointimal thickening. The iliac artery of 57 normolipemic rabbits was overdistended with a balloon catheter. Heparin (250 IU/kg IV) was given to 29 rabbits ten minutes before angioplasty, whereas 28 rabbits served as untreated controls. Neointimal thickening was prominent at fourteen days after injury and reached near-maximal values at day 28. The intimal/medial area ratio was reduced by an average 28.3% with heparin (at day 28: 2.19 ± 0.51 vs 1.57 ± 0.59, control vs heparin, P = 0.02). Neointimal cells stained positively for HHF-35 antibody, directed against smooth muscle cell antigens. Neointimal proliferation, quantified through the number of cell nuclei peroxidase-stained for PCNA/cyclin antigen, was significantly decreased by 43% and 49% with heparin, respectively, at days 7 and 14 after injury. These data suggest that early exposure even to low doses of heparin accounts for much of its inhibitory effect in vascular response to injury; such an effect might prove important in interpreting results of human trials of interventions against restenosis.