bluuebunny/crossref_metadata_2025 huggingface dataset:
Lidoflazine and Propranolol Combination Treatment in Chronic Stable Angina
Authors: Charlap Shlomo , Kimmel Bruce , Berezow Joel , Molinas Sharon , Strom Joel , Wexler John , Willens Howard , Klein Neal , Pollack Simcha , Frishman William H.
Published: November 2007

The short-term (1 month) and long-term (6 months) safety of combination lidoflazine-propranolol therapy was investigated in an open trial of 15 patients with stable angina of effort. The possible advantages of adding lidoflazine (ti trated to 360 mg daily) to patients having a therapeutic response to propranolol (80-400 mg daily) was also evaluated. Effects on non-invasive indexes of left ventricular function (echocardiography, systolic time intervals, radionuclide ventriculography) and exercise tolerance (treadmill exercise testing) were deter mined. There was no change in mean resting heart rate with the combination therapy, although one patient developed sinus bradycardia at a rate of 44 and had to have his propranolol dose reduced. Electrocardiographic analysis showed significant prolongation of the QTc intervals on lidoflazine-propranolol therapy compared to propranolol alone, with 3 patients having QTc interval prolongation to above .53 seconds, but there was no evidence of increased ar rhythmogenesis with the combination therapy compared to propranolol alone. Left ventricular end-diastolic volume index tended to rise with combination therapy. However, lidoflazine-propranolol therapy did not produce any signifi cant effects on resting ejection fraction determined by M-mode echocardio graphy or by radionuclide ventriculography. Radionuclide ventriculography determined peak exercise ejection fractions were also not significantly changed with combination therapy compared to propranolol alone. There were only small, insignificant improvements in exercise tolerance with the lidoflazine-pro pranolol combination treatment compared to propranolol alone. It is concluded that lidoflazine-propranolol combination therapy is generally safe but has the potential of causing serious adverse effects in certain patients, i.e. those with sick sinus disease, prolonged QTc intervals, and severe baseline left ventricular dysfunction, and that caution must be exercised in its use. Furthermore, it would appear that combination therapy provides only slight, if any, improve ments in exercise tolerance in patients with chronic stable angina having a ther apeutic response to oral propranolol.
Blood Flow Properties and Walking Performance in Chronic Arterial Occlusive Disease
Authors: Angelkort B. , Spürk P. , Habbaba A. , Mähder M.
Published: November 2007

Recent investigations suggest an interdependence between blood fluidity and walking performance in patients with peripheral arterial occlusive disease (PAOD). Therefore, various blood fluidity variables (erythrocyte aggregation, erythrocyte flexibility, plasma viscosity, plasma proteins) were studied in groups of healthy subjects and claudicants with severe PAOD (exhausted perfusion re serve) receiving intravenous treatment with Trental (600 mg Pentoxifylline b.i.d., 21 days).

Erythrocyte flexibility (expressed by filterability through micropore filters), red cell aggregation and plasma viscosity deteriorate with progression of disease especially in Stage IIb and III Fontaine classification, with walking distance below 150 m.

Trental treatment resulted in patients with advanced POAD stages in im provement of red cell filterability, red cell aggregation, decrease of plasma vis cosity, increase in absolute walking distance and relief from rest pain, suggesting that such patients are accessible to conservative treatment with he morheologically active agents.
The Prevention of Ca2+ Overload in Vascular Smooth Muscle by Flunarizine as Detected by Laser Microprobe Mass Analysis (LAMMA)
Authors: De Nollin Sonja , Borgers Marcel , Jacob Willem , Wellens Donald
Published: November 2007

In vitro exposure of depolarized caudal artery preparations of the rat to a high calcium concentration resulted in a strong contraction of the smooth mus cle cells. This muscle contraction was suppressed by flunarizine. It was shown cytochemically, using the combined oxalate-pyroantimonate method for the lo calization of calcium, that a considerable amount of electron-dense precipitate was seen over the depolarized muscle cells after incubation in a calcium contain ing medium. On the other hand this precipitate was not present on the smooth muscle cells when flunarizine was added to this incubation medium. The reac tion product was only present in the extracellular space.

These results were controlled by Laser Microprobe Mass Analysis. By evap orating and ionizing small parts of the smooth muscle cells ( ± 1 μm), it was confirmed that the cytochemical method indeed demonstrated calcium, with negligible interference of other cations.
Essential Hypertension: A Metabolic Cause? A Hypothesis
Authors: Macieira-Coelho Eduardo , Garcia-Alves Mario , Reis-Valle Antonio
Published: November 2007

Forty-five hypertensive patients, 28 women and 17 men, age range between 35 and 65 years (mean 50 years), with blood pressures which current therapy did not succeed to control, were submitted to several examinations in order to identify the cause of their hypertension. We found isolated or combinated ab normal values of aldosterone, renin, calcium and or potassium as the only alter ations in 19 patients. We distinguished 4 groups descretionarily classified according to biochemical alterations: renin and aldosterone increase, renin in crease, aldosterone increase, calcium and or potassium reduction.

The therapy used, intentionally aimed at the correction of the biochemical alterations found. Normal blood pressure was achieved in all patients and si multaneously the biochemical alterations also became normal in patients with isolated hyperreninemia, with combined hyperreninemia and hyperaldos teronemia and in those with hypocalcemia and or hypopotassemia. In patients were only isolated hyperaldosteronemia was found, this condition returned to normal in all except one.

We suggest that besides the disturbances in sodium distribution other elec trolytes or biochemical alterations may also play an equally important role in regulating, and sustaining essential hypertension.
The Noninvasive Laboratory — History and Future of Thermography
Authors: Winsor Travis , Winsor David
Published: November 2007

A brief history of thermography and recent developments in instrumenta tion have been reviewed. Important applications are related to thrombophle bitis, the cerebral circulation, peripheral arterial abnormalities and medical- legal situations.
Haemorheological Parameters in Hypertensive Nigerians With and Without Sickle-Cell Trait
Authors: Reid H.L. , Anah C.O.
Published: November 2007

Haemorheological parameters including whole blood (WBF) and erythrocyte filterability (EF), haematocrit (H'ct), haemoglobin levels (Hb) and plasma fi brinogen concentration (PFC) were measured in 61 adult Nigerians with un complicated essential hypertension during the course of their routine anti-hypertensive treatment. Results from these patients were compared to those of 39 age and sex-matched normotensive controls. Sixteen (26.2%) of the hypertensive patients and 6 (15.4%) of the controls had the sickle-cell trait (HbAS); the rest were normal homozygotes (HbAA).

Although there were no significant difference between WBF in the HbAA hypertensive and control groups, the former had a significantly lower EF than the latter (p < 0.025). Both WBF and EF were highly significantly decreased in the HbAS-hypertensives (p < 0.001). Significant differences in H'ct and Hb lev els between HbAA-hypertensives and controls were attributed to sex rather than to hypertension per se. Plasma fibrinogen concentration values were consist ently and significantly elevated in all hypertensives irrespective of sex or haemo globin genotype. In contrast to the HbAA-hypertensives, all 16 HbAS-hypertensives had a persistently raised diastolic blood pressure above 90 mm Hg, suggesting that these patients are either resistant or are less responsive to conventional anti-hypertensive therapy.

A more extensive follow-up study is in progress to assess the possible rela tionship of these parameters and blood pressure, particularly in hypertensive individuals with sickle-cell trait (HbAS).
CLS 2210, Hyaluronidase and the Cardiac Lymphatic System
Authors: Szlavy L. , Kubik S. , de Courten A. , Hachen H.J. , Solti F.
Published: November 2007

Earlier studies have shown that hyaluronidase exerts a potent influence upon the lymphatic system of the myocardium and that it reduces the size of myocar dial infarcts after coronary occlusion. In this study we compared, in mongrel dogs, the effect of intravenous hyaluronidase or CLS 2210 upon the cardiac lymphatic vessels. We observed that in CLS 2210-treated animals the number of visualized cardiac lymphatic vessels was significantly higher than in the hyal uronidase-treated control group. We have previously demonstrated a cardio- protective effect of hyaluronidase in the treatment of acute myocardial infarction. The present experimental data indicate that intravenous CLS 2210 may have a definite role in the management of acute coronary occlusion. Fur ther studies are needed to confirm these preliminary findings.
Embolization of a Sciatic Artery Aneurysm. An Alternative to Surgery: A Case Report
Authors: Fang Kum Loh
Published: November 2007

An elderly woman was admitted with a 2-day history of pain, numbness and coolness of the left lower limb. The left foot on examination was cool and blue with no palpable pulse nor motor or sensory function. An arteriogram demon strated a dilated persistent sciatic artery. The superficial femoral artery was hypoplastic and there was poor visualization of the distal circulation. At surgery an occluded popliteal artery was found. Attempts to open the occluded artery were unsuccessful and a left fibulectomy and fasciotomy was performed and the patient started on intravenous heparin. The patient's condition deteriorated and on the 4th hospital day an above-knee amputation was undertaken. The patient made an uneventful recovery and was subsequently discharged. At follow-up a month later the aneurysm was still patent and strongly pulsatile. She was read mitted to the hospital and the aneurysm was successfully embolized.
Serum Copper in Myocardial Infarction—Diagnostic and Prognostic Significance
Authors: Singh M.M. , Singh Ram , Khare Anukool , Gupta M.C. , Patney N.L. , Jain V.K. , Goyal S.P. , Prakash V. , Pandey D.N.
Published: November 2007

Serum copper estimations were carried out in 44 cases of acute myocardial infarction, 23 cases of angina and 40 age and sex matched healthy controls.

A highly significant degree of rise in serum copper levels was observed in patients with acute myocardial infarction as compared to cases of angina and controls. The levels showed a gradual rise with peak on 7th day followed by a gradual decline returning to normal on 28th day. The pattern was the same both in complicated and uncomplicated cases except that values were still higher on the 28th day in complicated cases of acute myocardial infarction.

Mean peak serum copper levels were significantly higher (p < .001) in com plicated cases of acute myocardial infarction as compared to uncomplicated cases. Significant correlation was found between serial serum copper changes and creatinine phosphokinase and lactic dehydrogenase levels.

The prognostic and diagnostic significance of serum copper has been dis cussed.
Complex Coronary Angioplasty: A Technique for Dilatation of Bifurcation Stenoses
Authors: Pinkerton Cass A. , Slack John D.
Published: November 2007

Bifurcation stenoses have been recognized to be at "high risk" for acute closure during percutaneous transluminal coronary angioplasty. Use of the tra ditional single balloon technique in such situations often results in acute closure or worsening of the stenosis in the other branch. A technique utilizing simulta neous inflation of two balloons, ("kissing balloon" technique) has been utilized to avoid this complication. A double balloon technique has been developed using sequential inflations rather than simultaneous inflations to preserve the integ rity of both branches while avoiding the arterial trauma produced by inflating two balloons in a small artery simultaneously. Twelve of 13 bifurcation stenoses were successfully treated with this sequential inflation double balloon tech nique. (Primary success rate = 92%).
Nailfold Capillary Microscopy in Essential Mixed Cryoglobulinemia: A Report of Several Cases
Authors: Wysenbeek Arjeh J. , Leibovici Leonard , Cohen Shimon , Weinberger Abraham
Published: November 2007

Nailfold capillaries were examined in eight patients with essential mixed cry oglobulinemia. Two patients disclosed marked abnormality. These patients had no Raynaud phenomenon. Four patients with Raynaud phenomenon disclosed normal capillary patterns. Thus, microvascular pathology in essential mixed cryoglobulinemia is not related to Raynaud phenomenon.
Percutaneous Transcatheter Embolization of Injuries to the Profunda Fernoris Artery: A Case Report
Authors: Stanton Paul E. , Rosenthal David , Clark Michael , Lamis Pano
Published: November 2007

Traumatic injury to the middle and distal thirds of the profunda femoris artery can be extremely difficult to surgically repair. The present article out lines an alternative form of treatment in which angiotherapeutic techniques of embolization are used in such an injury. A survey of the literature indicates that this may be the preferred method of therapy with lesions in this difficult area to surgically approach.
Therapy of Atherosclerotic Arteriopathy of Lower Limbs Aspects and Results
Authors: Tesi M. , Bronchi G.F. , Carini A. , Karavassili M.
Published: November 2007

As far as therapy is concerned, atherosclerotic arteriopathy may be divided into acute and chronic forms.

In acute embolic forms, therapy should be surgical. Only in cases of periph eral embolism or polyembolism, and in rare cases for which vascular surgery cannot be adopted, can thrombolysis be carried out with UK.

In acute thrombotic forms, therapy should be medical, because a thrombus of recent formation is rich in fibrin and may be lyzed by UK. Total recanaliza tion takes place in 61% of cases treated, partial recanalization in 23%. Subse quently perviousness is maintained by adequate antithrombotic therapy.

In chronic arteriopathy, the thrombus is lacking or almost lacking in fibrin and thrombolytic therapy is not indicated. Special therapeutic combinations are used containing platelet inhibitors (ticlopidine), antifibrin drugs (subcutaneous heparin), minor fibrinolytic agents (mesoglycan) and hemorheological drugs (pentoxyphylline). This therapy seems to give good results, as showed by the low percentage in amputation calculated on 2,565 patients treated and kept under observation for 5 years.

Finally let us consider chronic progressive arteriopathy. This term indicates a very advanced stage, characterized by a gradual irreversible change for the worse leading towards gangrene. As a last resort, before amputating, a throm bolytic therapy with UK was tried to see if with strong fibrinolysis continued for 3 days amputation might be avoided. In a pilot study carried out on 12 patients, the angiographic data showed only partial lysis in small arteries or arterial branches. Clinical data showed reduction or disappearance of pain at rest in 80% of cases. In 70% of cases gangrene disappeared if it was initial and superfi cial, it was delimited if already in progress.
Inhospital Prognosis of Patients with Their First Transmural or Subendocardial Infarction and Comparison of Their Coronary Arteriogram and Ventriculogram
Authors: Kouvaras George , Spyropoulou Mary , Bacoulas George
Published: November 2007

The inhospital clinical course and early prognosis were studied prospectively in 500 patients who suffered their first transmural or subendocardial myocar dial infarction, and were admitted in the coronary care unit of our hospital over the last four years. The coronary arteriogram and left ventriculogram of 300 patients out of the 500 was also compared. 434 patients developed transmural and 66 subendocardial infarction, as judged by electrocardiographic criteria. Both groups of patients had the same range of sex, age, coronary risk factors and history of previous angina. There was no statistical difference in in-hospital prognosis and early clinical course. There was no difference in prevalence of single, double or triple vessel coronary artery disease. The hemodynamic pa rameters (ejection fraction, left ventricular end-diastolic pressure), as well as the number of hypokinetic, akinetic or dyskinetic segments did not show any significant statistical difference between the two categories of patients. The same extent of coronary artery lesions and degree of left ventricular dysfunction may explain the similarity of early clinical course. 12% of patients who were admitted with subendocardial infarction developed transmural infarction dur ing their hospitalization.
Assessment of Venous Insufficiency using Photoplethysmography: A Comparison to Strain Gauge Plethysmography
Authors: Hirai Masafumi , Yoshinaga Mayumi , Nakayama Ryu
Published: November 2007

Simultaneous photoplethysmographic (PPG) and strain gauge plethysmo graphic (SPG) recordings were obtained in normal subjects and patients with venous insufficiency. In PPG tracings, a so called "negative segment," which represented a further fall below the baseline after exercising, was often ob served. This negative segment is produced by blood flow from the superficial to the deep veins during relaxation, which indicates that PPG can be used to assess the circulatory hemodynamics in the skin. PPG and SPG tracings from limbs with primary varicosis showed a shorter refilling time after exercise than those from normal limbs at the distal as well as the midcalf levels. The mean refilling time measured at the distal level by PPG was unaffected by tourniquets applied proximal to the transducer, indicating that the PPG tracings determined at the distal level were not always influenced by the reflux of blood through the incom petent saphenous system, but by altered cutaneous circulation. SPG was of greater diagnostic value for deep venous disease than PPG. From these results, it would be concluded that PPG in combination with SPG offers a rational ap proach to the assessment and the understanding of the pathophysiology of ve nous diseases.
Microangiographic Findings of Massive Intestinal Bleeding in a Patient with Crohn's Disease: A Case Report
Authors: Asakura Hitoshi , Takagi Toshikazu , Kobayashi Kensuke , Aiso Sadakazu , Hibi Toshifumi , Sugino Yoshinori , Hiramatsu Kyoichi , Teramoto Tatsuo , Tsuchiya Masaharu
Published: November 2007

A 16 year old man with complaints of abdominal pain, diarrhea, high fever and loss of body weight was made a diagnosis of Crohn's disease. During the administration, he had intestinal obstruction and several episodes of massive intestinal bleeding. Selective angiography of the superior mesenteric artery demonstrated the bleeding site in the ileum. Microangiography of the surgical specimens revealed abrupt interruptions of arteriae rectae in the submucosa indicating the bleeding site from the diseased intestine.
Cystic Adventitial Degeneration as a Cause of Dynamic Stenosis of the Popliteal Artery: A Case Report
Authors: Schöllhorn J. , Arnolds B. , von Reutern G.M. , Schlosser V.
Published: November 2007

Cystic adventitial degeneration, which is generally localized in the popliteal artery, leads to a dynamic, exercise-dependent flow inhibition. The cysts of the adventitia, which increase in size with exercise, cause an increasing degree of stenosis which can be completely reversed after a longer period if rest. Angio graphic presentation may therefore be misleading. Functional examination with Doppler sonography is able to identify the obstruction in such cases. Resection of the involved vessel and restoration of flow by interposition of a vein graft is the therapy of first choice.
Strain Gauge Plethsymography in Ischemic Handsyndromes
Authors: van Rhede van der Kloot E.J.H. , Breslau P.J. , Jacobs M.J.H.M. , Greep J.M.
Published: November 2007

In sixteen patients with ischemic handsyndromes, strain gauge plethysmography was used as a noninvasive diagnostic test. Contrast-arteriography was available for comparison.

These patients demonstrate the role for a noninvasive test in selecting patients with Raynaud's phenomenon or asphyxia for arteriography.
The Carotid Pulse in Dissecting Aneurysm of the Aorta
Authors: Bensaid Julien , Dany François , Hammel Jean
Published: November 2007

In five patients with acute aortic type I dissection a deep early systolic notch was recorded on the carotid pulse tracing. This peculiar feature of the carotid pulse was quite comparable to the aspect of the continuous wave Doppler ultrasound recorded along the carotid arteries. It can be explained by the temporary interruption of blood flow caused by false lumen in the artery. Therefore the carotid pulse can provide to the clinician a good help to the diagnosis of aortic dissection especially in case of nontypical presentation.
Doppler Measurement of the Pressure Drop Caused by Arterial Stenosis: An Experimental Study: A Case Report
Authors: Faccenda Fulvio , Usui Yoshiyuki , Spencer Merrill P.
Published: November 2007

A stenotic arterial lesion which reduces the cross-sectional area of the artery causes an increased velocity and, as a consequence, a loss in kinetic energy and a pressure drop. A simplified formula, derived from the Bernoulli principle, relates the pressure drop to the maximum velocity of the blood flow in the stenotic segment: ΔP (mmHg) =4 Vmax2 (m/sec). This formula has been validated for stenosis of cardiac valves. Aim of our study was to test the hypothesis that this formula applies in the major arteries using Doppler ultrasound with spectrum analysis. In our experiments we created artificial graded stenoses of varied geometry in the thoracic aorta of dogs. Invasive pressure measurements were obtained using intra-arterial needles on both sides of the stenosis. A Doppler signal was obtained with a 2.5 MHz CW probe, insonating the stenotic area from a distance, with an almost parallel approach. In these conditions the maximum Doppler frequency shift is an accurate estimate of the maximum flow velocity, according to the Doppler equation. We compared the Doppler derived (ΔP=0.36 Fmax2) and the invasive measurements of pressure drops. Our results show a highly significant correlation between the intra-arterial and the Doppler measurements of the pressure drops caused by arterial stenoses and encourage efforts in applying similar techniques in the noninvasive evaluation of vascular patients.
Splenic Arteriovenous Fistula Causing Massive Ascites: A Case Report
Authors: Watson William D. , Bonta Marco J. , Bush Charles R.
Published: November 2007

A case of splenic arteriovenous fistula leading to portal hypertension and ascites is presented. The recognition of this vascular lesion is important. When portal hypertension is secondary to a splenic arteriovenous fistula, the complications of portal hypertension can be avoided by the resection of the lesion. The diagnosis can be suspected by clinical findings and confirmed by angiographic delineation of the fistula. Surgical resection of splenic arteriovenous fistulae must include the fistula and all dilated venous tributaries to prevent thrombosis and recurrent portal hypertension.
The Significance of a Persistent Precordial ST Segment ≥ 0.1 mV Depression in Acute Inferior Myocardial Infarction (Coronary Angiographic and Ventriculographic Findings)
Authors: Kouvaras George , Spyropoulou Mary , Bacoulas George
Published: November 2007

40 patients with acute inferior myocardial infarction (MI) associated with persistent precordial ST segment depression ≥ 0.1 mV underwent coronary arteriography and left ventriculography within 5-6 days of their admission. The inferior MI was the result of complete occlusion of the right coronary artery (RCA) in 38 patients and the result of complete occlusion of the posterior descending artery (PDA) coming off the cicrumflex artery (Cx) in two patients. 36 (90%) of the 40 patients showed one or more severe stenoses in the left anterior descending artery (LAD). 12 of the 36 patients had severe triple vessel disease. The 36 patients whose coronary arteriograms showed significant LAD stenosis had an emergency coronary artery by pass graft (CABG) operation. Soon afterwards the precordial leads were normal and the patients free of angina till their discharge from hospital.

We conclude that a persistent precordial ST segment ≥ 0.1 mV depression in acute inferior MI is highly predictive of significant LAD disease.
Platelet Half-Life, Plasma Thromboxane B2 and Circulating Endothelial-Cells in Peripheral Vascular Disease
Authors: Sinzinger Helmut , Fitscha Peter , Peskar Bernhard A.
Published: November 2007

We studied platelet half-life (T/2), plasma thromboxane B2-levels (TXB2) and circulating endothelial cells in 107 patients with a mean age of 63 ± 6.8 years and angiographically proven peripheral vascular disease (PVD). Patients were divided into 4 groups according to Fontaine but also according to additional clinical manifestations of atherosclerosis like coronary heart disease (CHD) and cerebrovascular disease (CVD). Furthermore, the influence of sex and smoking was investigated.

Compared to patients without atherosclerotic manifestations we could detect an enhanced platelet consumption measured as shortended platelet half-life time (79.2 ± 9.1 vs 100.9 ± 5.6 hours, p < 0.001 and an increased platelet activity measured as increased TXB2-plasma levels (51.6 ± 20.9 vs 23.2 ± 11.2 ng/ml, p < 0.001). Correspondingly, the amount of circulating endothelial cells was increased 45.2 ± 25.7 vs 20.3 ± 23.4, p < 0.001). Patients with PVD who smoked had the shortest actual platelet half-life, the highest TXB2 plasma levels and the greatest amount of circulating endothelial cells compared to non-smok ing patients and controls.

Patients with clinical stage IV according to Fontaine had the shortest platelet half-life, the highest TXB2 plasma levels and the greatest amount of circulating endothelial cells compared to the other clinical stages. Analyzing the influence of additional clinical manifestations of atherosclerosis we could detect only in patients with PVD and CHD significant differences compared to the other groups.
The Short Foot Syndrome—An Unfortunate Consequence of Neglected Raised Intracompartmental Pressure in a Severe Hemophilic Child: A Case Report
Authors: Martinowitz Uri , Horoszowski Henri , Heim Michael
Published: November 2007

The vast majority of bleeding episodes in hemophilia occur in the muscu loskeletal system. When bleeding occurs, within a closed compartment, the pos sibility of neurovascular compromise must be suspected. We present an interesting case where this danger was overlooked in a young hemophiliac boy and resulted in bone growth retardation and permanent deformity.
The Effect of β-Blockade on Leg Blood Flow in Hypertensive Patients with Intermittent Claudication
Authors: Boström Per-Åke , Janzon Lars , Ohlsson Ola , Westergren Anita
Published: November 2007

The present study was designed to assess the short-term effects of β-blocking antihypertensive treatment on leg blood flow in patients with peripheral artery disease. Seven patients with intermittent claudication were randomly allocated to treatment with atenolol 100 mg or pindolol 10 mg. Patients switched therapy after one month of treatment. Venous occlusion plethysmography on the calves was used to assess the effects on leg blood flow after one and two months of treatment. The average 10% reduction of the systolic and diastolic blood pres sures was not associated with any reduction of blood flow at rest. There was on average 3.4 ml reduction of peak flow which had no influence on the painfree or total walking distance.
Improvement of Subcutaneous Nutritional Blood Flow in the Forefoot by Hydroxyethylrutosides in Patients with Arterial Insufficiency: Case Studies
Authors: Jelnes Rolf , Gaardsting Ole , Holm Axel
Published: November 2007

Four patients with bilateral arterial insufficiency were treated with i.v. hy droxyethylrutoside for three days (1.5 grs twice a day).

All patients experienced relief of symptoms. By continuous registration of subcutaneous nutritional blood flow in the forefoot (by 133Xenon clearance tech nique) a significant increase in nutritional blood flow of 33% on the average during the second and third hour after medication could be demonstrated. The drug seems to be of use in treating subacute occlusions and thrombosis of arter ies in the lower extremity.
Paraneoplastic Digital Thrombosis: A Case Report
Authors: Albin Glenn , Lapeyre Andre C. , Click Roger L. , Callahan Mark J.
Published: November 2007

Persistent digital ischemia is an uncommon paraneoplastic syndrome. We describe a 71-year-old man whose only manifestation of an underlying adeno carcinoma was digital ischemia. His symptoms responded dramatically to bilat eral dorsal sympathectomies. A thorough search for the mechanism producing the ischemia failed to provide an explanation. We assume that unknown neuro- humoral factors produced by the tumor were responsible.
Effectiveness of Bevantolol in the Treatment of Angina — A Placebo-Controlled Study
Authors: Farnham D. John
Published: November 2007

The antianginal efficacy and safety of bevantolol was compared with placebo in 107 patients with angina pectoris of effort. The median frequency of angina attacks in these patients was 6 per week. Following a 6-week placebo-baseline phase, the patients were randomly assigned to groups receiving either 150 or 300 mg/day bevantolol (75 or 150 mg b.i.d.) or placebo for 6 weeks of double- blind treatment. During exercise tolerance testing at 2 hours postdose, the higher dose of bevantolol produced a marked increase in total work performed. Double product (HR × Systolic BP) at maximum common work load decreased significantly (p < 0.001) in both bevantolol groups compared with the placebo group. In patients receiving 300 mg/day bevantolol, the proportion who stopped exercising because of angina or S-T depression decreased from 97% to 65%; the frequency of angina attacks decreased by one-half or more in 77% of those with 3 or more attacks per week; and 90% had an improvement in capacity to per form usual daily and occupational activities. A significant therapeutic effect was still present 12 hours postdose. Bevantolol was safe; fewer adverse reactions occurred in either drug group than in the placebo group. Bevantolol appeared to be an effective, well-tolerated drug in the management of angina pectoris.
Effectiveness of Bevantolol in the Treatment of Hypertension: Once-Daily Versus Twice-Daily Evaluation of Home Blood Pressure Measurements
Authors: Jain Adesh
Published: November 2007

Two multicenter, double-blind, placebo-controlled studies were conducted to determine in patients with hypertension the oral dose of bevantolol that would effectively reduce home diastolic blood pressure to less than 95 mm Hg. The two studies differed only in once-daily or twice-daily dose administration. In the 125 patients evaluated, the mean decreases in home diastolic blood pressure were significantly greater in patients receiving 100 to 400 mg/day of bevantolol (8 to 10 mm Hg) than in patients receiving placebo (2 to 3mm Hg) (p < 0.05). Bevan tolol administered once daily or twice daily was equally effective in the manage ment of hypertension and was well tolerated in the doses studied.
Bevantolol Hydrochloride — Preclinical Pharmacologic Profile
Authors: Kaplan Harvey R.
Published: November 2007

Bevantolol hydrochloride, a beta adrenoceptor antagonist, can be catego rized using conventional schemes as being cardioselective, devoid of intrinsic sympathomimetic activity and having weak membrane-stabilizing and local an esthetic properties. The cardioselectivity of bevantolol was conferred by the incorporation of a 3,4-dimethoxyphenyl moiety into the terminal amino portion of the molecule. This portion of the molecule also appears to account for bevan tolol's in vitro binding affinity at alpha-adrenoceptor sites; the in vivo signifi cance of which remains unclear. In the various cardiovascular disease-state models, bevantolol's profile differed from that of propranolol, i.e., there was no initial pressor response in spontaneously hypertensive or renal hypertensive rats. In a myocardial ischemia model, bevantolol, unlike propranolol, increased contractile function in the ischemic myocardium. A ring hydroxylated urinary metabolite, which occured only in trace amounts in human urine, had an inter esting profile when studied in animals at pharmacologic doses. It ranked high in cardioselectivity (like bevantolol), but unlike bevantolol showed significant in trinsic beta sympathomimetic activity. The clinical significance of this metabo lite, if any, remains to be established. Collectively the preclinical profile of bevantolol showed it to have an interesting profile for a beta adrenoceptor an tagonist in a variety of pharmacologic test systems.
Development of Pulmonary Aneurysm in Primary Pulmonary Hypertension: A Case Report
Authors: Nienaber Christoph A. , Spielmann Rolf P. , Montz Ricardo , Bleifeld Walter , Mathey Detlef G.
Published: November 2007

Selected cases of severe primary pulmonary arterial hypertension and asso ciated pulmonary vascular disease have been related to the oral ingestion of aminorex fumarate, an anorexigen obviously responsible for an epidemic of primary pulmonary hypertension in Western Europe between 1967 and 1970. This report describes a fifteen year follow-up of a female patient with aminorex fumarate related pulmonary hypertension and the uncommon finding of the formation of an excessive fusiform pulmonary trunk aneurysm in the late stage of the disease process. The progressive clinical course was followed by serial chest x-ray films and repeat right heart catheterization. The diagnosis of a main stem pulmonary artery aneurysm was noninvasively established by two-dimen sional echocardiography and confirmed by contrast-enhanced computed tomo graphy and radionuclide blood pool imaging. The patient is alive, thus no histologic correlate of this entity is available at present.
Influence of Transdermal Nitrates on Exercise Capacity in Patients with Stable Angina
Authors: Thompson Richard
Published: November 2007

Twenty patients completed a double-blind cross-over study to determine the influence of a transdermal preparation of Nitroglycerin on exercise perform ance in stable angina. Angiographically proven two or three vessel coronary disease was present in all. After a base-line exercise test the active device was titrated to efficacy or side effects and the number of patches thereafter re mained constant (2-6 patches per day; mean 3.5). Patients were randomly allo cated to active treatment or placebo, and further exercise tests were performed at 2 hours and 26 hours after application of the device. Patients were then crossed over after one days rest to the opposite treatment group, and exercise studies repeated. Two hours after application of transdermal nitroglycerin total exercise duration increased (mean 14.0 minutes) compared to placebo (12.5 minutes) and control (12.0 minutes) (p < 0.05). This effect was maintained at 26 hours. Exercise time to anginal threshold (angina + 1.5 mm ST segment depression) was increased at 2 hours and 26 hours with active drug by 11 % compared to placebo and by 22% in comparison to control. Double product of heart rate and blood pressure was not significantly different in treated and placebo groups. Oral nitroglycerin consumption assessed during the titration phase was reduced by 71%. It is concluded that transdermal nitroglycerin sig nificantly increases exercise capacity in patients with stable angina, with an effect that is maintained over a 24-hour period using a single dose application.
Therapeutic Embolization for Delayed Rectal Hemorrhage Following Episiotomy: A Case Report
Authors: Kellum Charles D. , Tegtmeyer Charles J. , Dombrowski Phillip J. , Rudolf Leslie E.
Published: November 2007

A case of severe, delayed rectal bleeding following an episiotomy was treated with selective pelvic arteriography and embolization after surgery failed to con trol the hemorrhage.
Nitrendipine vs. Long-Acting Nifedipine in Mild, Moderate and Severe Hypertension
Authors: Guazzi Maurizio D. , De Cesare Nicoletta , Galli Claudia , Tamborini Gloria , Salvioni Alessandro
Published: November 2007

Long-acting nifedipine and nitrendipine, a nifedipine analogue, have been proposed for single-drug therapy of hypertension. In this study we compared the two preparations in three groups (10 subjects in each group) of mild (group 1), moderate (group 2), and severe (group 3) hypertensives. Drugs were admin istered for seven days (20 mg every 8 hr), according to a randomized, double- blind, crossover design. Blood pressure and heart rate readings were taken hourly, from 8 A.M. to 7 P.M., for the duration of the trial.

In group 1, pressure was lowered to normal levels by both compounds and did not recover in the interval between one dose and the other, so that it re mained normal throughout the day. In group 2, from an average of 170/109, values were reduced by the two preparations to 140/90 mm Hg within two hours, and then they tended to recover. This tendency was interrupted by the next dose. Because of this pattern, compared with the placebo period, pressure was substantially reduced during the twelve hours of the day; however, for a certain span it remained higher than normal. In group 3, the immediate re sponses to the two drugs were similar (from an average of 208/130, pressure was lowered to an average of 170/95 mm Hg), and then it tended to rise again and recovery was faster with nifedipine. Although pressure was significantly re duced throughout the day by both preparations, normotension was never achieved in this group.

Neither drug induced a tachycardia reaction, altered renal or cardiac func tion, or affected body weight or plasma renin activity. The tendency to produce dependent edema was less pronounced with nitrendipine.

In conclusion, these calcium channel antagonists were equally effective in mild and moderate hypertension, while in the severe form the action of nitrendi pine was more persistent. Within the limits of the drug regimens used in this study, it seems that both preparations as monotherapy may be satisfactory in mild, questionable in moderate, and inadequate for severe hypertension, al though the action of nitrendipine is more lasting.
Transcatheter Embolization of Multiple Mycotic Splenic Artery Aneurysms: A Case Report
Authors: Tihansky Dennis P. , Lluncor Edgar
Published: November 2007

Embolization of splenic artery aneurysms is recommended in young women to prevent likely rupture and exsanguination during pregnancy. This report describes the successful coil occlusion of multiple mycotic aneurysms in such a patient, who was also treated interventionally for gastric hemorrhage and hy persplenism. Although infection or sepsis is a rare cause of visceral aneurysms, it is associated with a high incidence of rupture and peritonitis. Complications from elective embolization include abscess formation within the spleen and focal infarction in the upper alimentary tract. However, such risks should be mini mized by appropriate selection of embolic materials and prophylactic care of the patient.
Continuous Infusion Treatment with Pentoxifylline in Patients with Severe Peripheral Vascular Occlusive Disease
Authors: Angelides Nicos S.
Published: November 2007

The effect of continuous i.v. infusion of pentoxifylline, administering 1,200 mg/24 hours through 15 days, was studied in 22 patients (19 m, 3 f) with arterio graphically confirmed extensive occlusion in the femoro-popliteal segment, as sociated with marked intermittent claudication and rest pain of varying sever ity.

The following parameters were used for the verification of the therapeutic response: Flow resistance factor (RF), pressure indices at rest (RPI) and after exercise (PPI and recovery time (RT) assessed by means of ultrasonic Doppler technique; muscle and skin blood flow at rest and after exercise using 99m Technetium Clearance Technique (TC); toe skin temperature (TST) by electric thermometer; painfree walking distance (WD) assessed on treadmill (horizon tal, 4 km/h); rest pain (RP) was assessed by a 4-step-relief-scale.

There was an overall good response to treatment, the studied parameters showing the following changes: RF improved in 12/17 patients (= 70%); RT decreased in 14/22 patients (= 63%) RPI and PPI showed no change; TC (mus cle) increased after exercise in 17/22 patients (= 77%); TC (skin) increased after exercise in 20/22 patients (= 90%); WD increased on average by 80% (from 115 m to 206 m); TS increased in 16 limbs; RP showed an overall relief.

The results of this study indicate that the continuous infusion of pentoxifyl line is safe and effective in improving the condition of patients with severe pe ripheral vascular disease.
Circulating Platelet Aggregate Size in Ischemic Heart Disease
Authors: Weinberger Itzhak , Fuchs Jacob , Rotenberg Zvi , Almozlino Avi , Joshua Henry , Agmon Jacob
Published: November 2007

Platelet aggregate size was measured in 178 patients with ischemic heart disease, among whom 56 had stable angina, 42 suffered from unstable angina, and 80 had had uncomplicated acute myocardial infarction. A group of 50 healthy volunteers and 20 hospitalized noncardiac patients served as controls. Venous blood (0.5 cc) was introduced into a solution containing 11.7 mM EDTA and 1.0 g formaldehyde. Platelet aggregate size was determined by microscopic reading as the number of platelets forming aggregates (per 1000 counted platelets) divided by the number of aggregates. Mean aggregate size was found not significantly different in both control groups, as well as in patients with stable angina and acute myocardial infarction (2.21±0.36 platelets, 2.20±0.58 platelets, 2.28±0.19 platelets, 2.76±1.07 platelets, respectively, p=NS). The highest value was found in the unstable angina group: 4.00±1.40 platelets (p < 0.001 vs other studied groups). Platelet aggregate size was found not to be related to sex, age, medication, or coronary risk factors. Unstable angina may thus be a unique entity in ischemic heart disease concerning its platelet behavior, demonstrated in this study by the increased size of peripheral platelet aggregates, which may have pathogenetic, diagnostic, and eventual therapeutic implications.
Aortic Connective Tissue in Atherosclerotic Aorta— A Biochemical Study
Authors: Andreotti Lupo , Bussotti Alessandro , Cammelli Daniele , di Giovine Francesco , Sterrantino Gaetana , Varcasia Giuseppe , Arcangeli Paolo
Published: November 2007

Biochemical analysis of the extracellular matrix of human aortas was per formed on samples of ascending and descending aortas affected by atherosclero sis in comparison with a control group of nonatherosclerotic aortas.

Ulcerated or heavily calcified atheromas were excised and excluded from the analysis in order to differentiate biochemical alterations leading to the forma tion of atheromas from those due to complications of already formed athero mas.

Our results show that the development of atheromas brings about an exten sive destruction of elastic fibers and muscular cells, and their place is occupied by other components of the extracellular matrix, most notably, collagen, non uronic sugars, water, and lipids, which were found significantly increased.
Angina Pectoris and Acute Myocardial Infarction Due to "Slow-Flow Phenomenon" in Nonatherosclerotic Coronary Arteries: A Case Report
Authors: Przybojewski Jerzy Z. , Becker Peter H.
Published: November 2007

A 51 year-old White woman with angina pectoris and nonatheromatous cor onary artery disease is presented. Cardiac catheterization demonstrated a "slow-flow phenomenon" in the left coronary artery accompanied by severe angina pectoris and anterolateral ST-segment elevation and culminating in an acute nontransmural myocardial infarction. At repeat coronary arteriography, ergonovine maleate provocation proved negative.

This patient is unique, since the previously documented 6 cases with this coronary cineangiographic response did not exhibit angina pectoris or ECG evidence of myocardial ischemia during the "slow-flow phenomenon," and none was complicated by an acute myocardial infarction. Various aspects of the pathophysiology of angina pectoris in this patient, including the recently de scribed "reduced vasodilator reserve" concept, are briefly outlined.
Arteriosclerotic Carotid Lesions in Hyperlipoproteinemia
Authors: Mannarino E. , Susta A. , Tazza D. , Pistola L. , Senin U.
Published: November 2007

An ultrasonographic study was performed in 187 hyperlipoproteinemia pa tients to evaluate the incidence of atheromatous lesions in the extracranial ca rotid tract.

A high-resolution, real-time, B-mode instrument with two probes (4- and 8- MHz) was used. Fifty-five subjects had high blood cholesterol levels, 70 high triglyceride values, and 62 both. Arteriosclerotic disease was present at other sites in 39% of the patients.

Atheromatous carotid lesions were revealed in 37% of the patients, and there seemed to be no significant correlation with the type of hyperlipoproteinemia. There was also no correlation between blood cholesterol levels and the presence or absence of atheromatous lesions.

Increasing age and arteriosclerotic disease at other sites were the factors most frequently associated with atheromatous lesions in the extracranial carotid tract.
Influence of Sublingual Nitroglycerin on the Digital Circulation of Man
Authors: Burch George E.
Published: November 2007

By means of the digital rheoplethysmographic (RPG) method, the effect of sublingually administered nitroglycerin (NTG), 1/200 gr (0.3 mg), on the digital circulation was studied in 17 normal subjects and 5 patients with ischemic heart disease and angina pectoris. NTG produced dilatation of all digital vessels, re flected especially by increases in total digital volume. NTG produced marked changes in the dicrotic notch of the pulse wave, noted also in inflow volume curves but not in outflow volume curves. The dicrotic notch was displaced later on the descending limb of the digital pulse wave and became deeper and more prominent after NTG. It is suggested that NTG produces disproportionate dila tation of the arterial system, having its greatest effect on arteries near the heart, including the coronaries and great vessels branching off the aorta, and on left intraventricular cavity pressure. This greater regional vasodilatation of vessels near the heart could delay closure of the aortic valve, producing a delayed and prominent dicrotic notch of the pulse wave.
Laser-Doppler Examinations in Persons with Healthy vasculature and in Patients with Peripheral Arterial Occlusive Disease
Authors: Ranft J. , Heidrich H. , Peters A. , Trampisch H.
Published: November 2007

Recently, a new procedure for noninvasive measurement of the microcircu lation has been developed in the form of a helium-neon-laser Doppler apparatus with which the total erythrocyte flow through a cubic millimeter of skin is quan tifiable.

The authors used the procedure to examine 17 persons with healthy vessels, 36 patients with a degenerative occlusive disease of the peripheral arteries in Fontaine stages II-IV, and 5 patients with endangiitis obliterans.

It is concluded that single measurements do not permit an assessment of microcirculatory conditions but that provocative tests (which are described), especially occlusion tests, make possible valid and reproducible statements and have a high selectivity with respect to the different stages of disease. By repeated measurements followed by calculation of mean values, a further reduction in intraindividual variability among the measurement results can be obtained.

Laser-Doppler examinations of the skin constitute a new procedure with which quantitative statements on the blood flow through skin are feasible and from which interesting results can be expected, especially when used as an acute test.