bluuebunny/crossref_metadata_2025 huggingface dataset:
Intracoronary Macrothrombus Formation During Percutaneous Coronary Intervention Despite Optimal Activated Clotting Time Using Bivalirudin
Authors: Tadros George M. , Broder Kevin , Bachour Fouad
Published: June 2007

The occurrence of intracoronary thrombus during percutaneous coronary intervention (PCI) is a well-known complication. It has been estimated that it complicates approximately 6% of all coronary procedures. Patients at highest risk for this complication include those with acute ischemic syndromes or with angiographically apparent thrombus. Since the development of PCI, intravenous unfractionated heparin (UFH) has remained the primary antithrombotic therapy for the prevention of periprocedural ischemic complications. The availability of a rapid “point of care” test for dose individualization (the activated clotting time [ACT]) has facilitated this process. Other forms of antithrombotic therapies such as direct thrombin inhibitors or low-molecular-weight heparin have been proposed as more effective anticoagulants during PCI. Bivalirudin is a direct thrombin inhibitor proven to decrease post-PCI ischemic complication rate compared with UFH and have a lower vascular complication rate compared with glycoprotein IIb/IIIa receptor antagonists. We herein report a case of acute macrothrombus formation during PCI despite adequate ACT achieved with bivalirudin.
Venous Hypertension and the Inflammatory Cascade: Major Manifestations and Trigger Mechanisms
Authors: Pascarella Luigi , Penn Alexander , Schmid-Schönbein Geert W.
Published: June 2007

Recent histologic and immunocytochemical evidence of venous leg ulcers supports the hypothesis that lesions observed at different stages of chronic venous insufficiency may be associated with, and possibly caused by, an inflammatory process. Evidence has been obtained that venous valve deficiency may be associated with leukocyte infiltration into valve leaflets; therefore, it is hypothesized that an essential event in the inflammatory cascade is the enzymatic degradation of the valve leaflets and venous wall. The metalloproteinases (MMP) in veins exposed to elevated pressures up to 6 weeks were examined in a rat femoral fistula model with venous hypertension. Zymography shows increased activity of pro-MMP-2 at 3 and 6 weeks. MMP-2 and MMP-9 activity was predominantly observed at days 7 and 21 after creation of the fistula. The degree of extracellular matrix remodeling correlates with the morphological finding of macroscopic lesions. Therefore, the MMP-2 and MMP-9 activation is already present in veins days after exposure to elevated blood pressure and coincides with periods of early alterations in the valve morphology and early forms of reflux.
Chronic Venous Insufficiency and the Therapeutic Effects of Daflon 500 mg
Authors: Bergan John J.
Published: June 2007

Chronic venous insufficiency is linked to venous hypertension and forces of shear stress on the endothelium. Venous hypertension depends upon two forces: the weight of a column of blood from the right atrium transmitted through the valveless vena cava and iliac veins to the femoral vein, and pressure generated by contracting skeletal muscles of the leg transmitted through failed perforating veins. When valve failure occurs in superficial axial veins and perforating veins, the venous pressure in the veins and venules of the skin and subcutaneous tissue is raised. The skin changes in chronic venous insufficiency are directly related to the severity of the venous hypertension. Also, pathologic changes in the valves are linked to venous hypertension and leukocyte infiltration and activation. It is hypothesized that acute venous pressure elevations cause a shift in the venous hemodynamics with changes in wall shear stress. This initiates the inflammatory cascade. Daflon 500 mg ameliorates the effects of chronic inflammation. In randomized trials, 60 days of therapy with Daflon at a dosage of 500 mg 2 tablets daily was effective, in addition to elastic compression, in accelerating venous ulcer healing. Because venous insufficiency is linked to venous hypertension and an inflammatory reaction, it appears that Daflon 500 mg 2 tablets daily shows a great potential for accomplishing blockade of the inflammatory cascade.
Effect of Propionylcarnitine on Changes in Endothelial Function and Plasma Levels of Adhesion Molecules Induced by Acute Exercise in Patients with Intermittent Claudication
Authors: Silvestro Antonio , Schiano Vittorio , Bucur Roxana , Brevetti Gregorio , Scopacasa Francesco , Chiariello Massimo
Published: June 2007

In patients with intermittent claudication, treadmill exercise may cause acute deterioration of endothelial function and increase in plasma concentrations of adhesion molecules. The authors evaluated the efficacy of intravenously administered propionylcarnitine (PLC) in preventing these phenomena. Thirty-six claudicants with postexercise decrease in brachial artery flow-mediated dilation (FMD) were randomized to either placebo or PLC (600 mg as a single bolus followed by 1 mg/kg/min for 60 minutes). In the 18 patients randomized to placebo, FMD markedly decreased with exercise before (from 6.8 ±0.4% to 4.0 ±0.4%; p<0.001) and after treatment (from 6.5 ±0.4% to 4.4 ±0.5%; p<0.001). By contrast, in the PLC group, FMD significantly decreased with exercise before treatment (from 8.0 ±0.7% to 4.4 ±0.4%; p<0.001), but not after active drug administration (from 7.1 ±0.7% to 6.0 ±0.6%; p=0.067). The difference between treatments was not significant (p=0.099; ANOVA). However, in the PLC group, the authors found that the greater the exercise-induced deterioration in endothelial function before treatment, the greater the capacity of PLC to prevent a postexercise decrease in FMD ( r = -0.50, p=0.034). Accordingly, they analyzed data in the 19 patients with a baseline exercise-induced decrease in FMD ≥45% (ie, the median FMD reduction in the entire group of 36 patients), and found that the exercise-induced FMD decrease was less after PLC than after placebo (p=0.046, ANOVA). In the same subgroup, the exercise-induced increase in plasma concentrations of soluble vascular cell adhesion molecule-1 (sVCAM-1) was significantly higher before than after treatment in patients randomized to PLC (23.4 ±5% vs 15.3 ±7%, p=0.007). In conclusion, in patients with intermittent claudication suffering from a greater endothelial derangement after treadmill, PLC administration provided a protective effect against deterioration of FMD and increase of sVCAM-1 induced by exercise
Identifying Unrecognized Peripheral Arterial Disease Among Asymptomatic Patients in the Primary Care Setting
Authors: Doubeni Chyke A. , Yood Robert A. , Emani Srinivas , Gurwitz Jerry H.
Published: June 2007

National initiatives to enhance recognition of the detrimental impact of peripheral arterial disease on the health of adult Americans have been advocated. The objective of this study was to evaluate a strategy for identifying patients with unrecognized peripheral arterial disease from among persons without known atherosclerotic disease in the primary care setting. A cross-sectional design was used. Participants were patients receiving care from a multispecialty group practice in Massachusetts between July 2002 and July 2003, with a scheduled appointment with a primary care physician. Persons 70 years of age or older who were not already known to have atherosclerotic disease were enrolled. In addition, persons aged 50-69 with a diagnosis of diabetes mellitus, dyslipidemia, hypertension, and/or smoking based on information derived from administrative databases, and not known to have atherosclerotic disease, were enrolled. Before the scheduled appointment, potential study participants completed a telephone interview to ascertain their medical history. The ankle-brachial index (ABI) of eligible patients was measured at the time of the scheduled primary care office visit. Peripheral arterial disease was diagnosed if 1 or both legs had an ABI of ≤0.90. Also assessed was the time spent in performing ABI testing in a convenience sample of the study participants. ABI testing was performed on 717 patients. Among 359 study subjects aged ≥70 years, 45 (12.5%) were diagnosed with peripheral arterial disease. Nine (2.5%) of 358 subjects aged 50-69 years were diagnosed with peripheral arterial disease. The average total time (n=52) for ABI testing was 13.7 (SD: ±3.3) minutes. Patients aged ≥70 years required more time for ABI testing compared to those aged 50-69 (mean: 15.0 vs 13.0 minutes, p=0.04). Unrecognized asymptomatic peripheral arterial disease can be commonly detected among patients in the primary care setting who are not already known to have atherosclerotic disease. The yield from screening is substantially greater among unselected older patients compared with younger patients specifically identified as having risk factors for PAD. These findings should help inform the development and implementation of new initiatives to enhance the early detection of peripheral arterial disease among asymptomatic patients in the primary care setting.
Early Effects of Simvastatin versus Atorvastatin on Oxidative Stress and Proinflammatory Cytokines in Hyperlipidemic Subjects
Authors: Marketou Mary E. , Zacharis Evangelos A. , Nikitovic Dragana , Ganotakis Emmanuel S. , Parthenakis Frangiskos I. , Maliaraki Niki , Vardas Panos E.
Published: June 2007

The authors investigated the time-dependent action of atorvastatin and simvastatin on oxidative stress and cytokine levels immediately after the start of treatment. These factors play a role in endothelial dysfunction. Hyperlipidemic patients (n=132) were assigned to treatment with 40 mg atorvastatin, 40 mg simvastatin, or placebo. Blood samples were taken before, 2 hours, 24 hours, 7 days, and 3 weeks after the administration of the statin or placebo to evaluate serum concentrations of total peroxides (TP), interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-a) and soluble intercellular vascular adhesion molecule 1 (sICAM 1). In the atorvastatin group the TP changes were significantly different at 2 hours and 24 hours (p=0.005), whereas in the simvastatin group there was a gradual, more or less linear decline in TP until 7 days (p=0.006) and then a plateau. Simvastatin exhibited a faster statistically significant decrease over time in IL-6 and sICAM 1 levels (at 7 days, p=0.014 and p=0.001, respectively). TNF-a demonstrated a faster linear trend in the simvastatin group, but the significant effect appeared late (p=0.006). Both simvastatin and atorvastatin exerted early beneficial effects on oxidative stress, proinflammatory cytokines, and endothelial activation in hyperlipidemic subjects. These effects became significant 2 hours following the initiation of therapy.
Hypereosinophilic Syndrome Accompanying Gangrene of the Toes with Peripheral Arterial Occlusion
Authors: Funahashi Satoru , Masaki Ichiro , Furuyama Tadashi
Published: June 2007

The authors herein report the case of a teenage boy who presented with peripheral arterial occlusion of both upper and lower extremities associated with hypereosinophilia. During a 10-year follow-up, corticosteroid therapy was continued for the treatment of hypereosinophilia. The patient underwent bilateral lumbar sympathectomies because of severe ischemia of the bilateral lower extremities with gangrene of the toes. Based on the progress of his disease over the past 10 years, he was suspected to have idiopathic hypereosinophilic syndrome (HES) accompanied by peripheral arterial obstruction. Idiopathic HES is a disease characterized by unexpected hypereosinophilia, which may lead to organ damage. This is a very rare case of peripheral arterial occlusion associated with idiopathic HIS.
Marked Decrease of Plasma VEGF After Implantation of Autologous Bone Marrow Mononuclear Cells in a Patient with Critical Limb Ischemia
Authors: Ozawa Takuya , Kato Kiminori , Sanada Hirofumi , Makiyama Yashiro , Saigawa Takashi , Souda Satoru , Hashimoto Shigeo , Furukawa Tatsuo , Toba Ken , Kodama Makoto , Fujiwara Hiroshi , Namura Osamu , Hayashi Junichi , Yoshimura Nobuhiko , Aizawa Yoshifusa
Published: June 2007

The authors performed autologous bone marrow mononuclear cells implantation (BMI) in a 79-year-old man with critical limb ischemia. After BMI, the resting pain of the ischemic leg improved gradually. They measured the plasma concentrations of vascular endothelial growth factor (VEGF), basic fibroblast growth factor (bFGF), and serum hepatocyte growth factor (HGF) in the blood from bilateral femoral veins. Before BMI, the plasma VEGF and bFGF concentrations were much greater in the ischemic leg than in the other lower limb, but decreased to the same concentrations as those in the contralateral lower extremity after BMI. The large concentrations of the angiogenic factors VEGF and bFGF in plasma indicate the severity and extent of the leg ischemia. BMI resulted in lower levels of VEGF and bFGF, and this fall is the hallmark of the effectiveness of BMI in the treatment of peripheral artery disease.
Transcatheter Retrieval of Different Types of Central Venous Catheter Fragment: Experience in 13 Cases
Authors: Yen Hsiu-Ju , Hwang Betau , Lee Pi-Chang , Meng C. C. Laura
Published: June 2007

In total, 13 patients, from April 1992 to November 2002 at this institution, had embolization caused by central venous catheter fragments including 4 peripherally-inserted central catheters (PICCs), 1 Hickman catheter, 1 Swan-Ganz catheter, and 7 port-A catheters. These dislodged fragments were percutaneously retrieved successfully in 12 patients. As each type of the central venous catheter has its distinct properties, the locations of embolization, detection, and retrieval methods differed.
Foot Gangrene in Patients with End-Stage Renal Disease: A Case Control Study
Authors: Boufi Mourad , Ghaffari Parinaz , Allaire Eric , Fessi Hafedh , Ronco Pierre , Vayssairat Michel
Published: June 2007

The prevalence of peripheral arterial disease (PAD) in patients with end-stage renal disease (ESRD) is high, with an annual risk of amputation estimated at 13%, and indications for limb revascularization in patients combining ESRD with stage IV PAD (foot gangrene) are still controversial. This case-controlled study compared survival, limb salvage, and quality of life in a group of patients hospitalized for foot gangrene according to their renal status (ESRD versus no renal insufficiency). All patients with ESRD hospitalized for foot gangrene (n=16) from 1996 to 2002 were compared with a control group with normal creatininemia (n=24) hospitalized for foot gangrene due to peripheral atherosclerotic arterial disease. The 2 groups were matched for age, sex ratio, and number with diabetes mellitus. After a mean follow-up of 467 ±410 days, patients with ESRD had a more severe prognosis as regards mortality (68.7% vs 12.5%, p=0.0005) and major amputation (31% versus 8%, p=0.09). The ESRD group was characterized by more frequent extensive arterial calcifications (16/16 vs 13/24, p=0.002), owing to a higher level of the calcium phosphorus product (3.54 ±1.2 vs 2.4 ±0.6, p=0.0023), and by impaired microcirculatory perfusion, as indicated by a lower oxygen pressure (TcPO2) (15.6 ±12 mm Hg vs 26 ±16, p=0.07). ESRD implies a poor prognosis in patients with stage IV peripheral arterial disease.
LDL Apheresis for Cholesterol Embolism Following Coronary Artery Bypass Graft Surgery
Authors: Sanai Toru , Matsui Rei , Hirano Tadashi
Published: June 2007

A 76-year-old man without any prior history of abnormal urinalysis findings or renal insufficiency demonstrated mild renal dysfunction after coronary bypass graft surgery (CABG). Two months after CABG, pain and blueness in the toes (blue toe syndrome) appeared and, the serum creatinine level (S-Cr) increased from 1.2 to 2.0 mg/dL. On admission (3 months later), the urinary protein level was 0.5 g/day, white blood cell count 8,300/μL with eosinophils (Eo) 10.5%, S-Cr 2.1 mg/dL, and low-density lipoprotein (LDL) 106 mg/dL. Acute renal failure and blue toe syndrome due to a cholesterol embolism (CE) were diagnosed. Alprostadil 40 μg/day orally for 2 weeks and alprostadil 40 μg/day intravenously were used for 5 weeks, and Eo were 250/μL, S-Cr 2.5 mg/dL; however, blue toe syndrome gradually developed. At 8 weeks after admission, limaprost alfadex 30 μg/day orally was used for 3 weeks. However, the Eo gradually rose to 1,520/μL, S-Cr to 3.0 mg/dL, and LDL to 135 mg/dL, and LDL apheresis was therefore performed 20 times for CE. The data just after LDL apheresis was performed 10 times were as follows: Eo 1,120/μL, S-Cr 4.0 mg/dL, and LDL 89 mg/dL, and blue toe syndrome had disappeared. At 10 months after the first LDL apheresis, the Eo were 630/μL, S-Cr 2.9 mg/dL, and LDL 109 mg/dL. As a result, LDL apheresis was found to be beneficial for the treatment of CE with acute renal failure and blue toe syndrome after CABG.
Postural Compression of Subclavian Vein in Droopy Shoulder Syndrome
Authors: Lan Min-Yu , Chang Yung-Yee , Liu Jia-Shou
Published: June 2007

A patient with droopy shoulder syndrome (DSS) presented postural symptoms of venous compression of the left upper limb, in addition to those of traction at the brachial plexus. An antegrade phlebography clearly demonstrated impaired patency of the subclavian vein on neck extension. Recognition and management of the compromised venous drainage in patients with DSS is important in preventing vascular complications of the upper limbs.
Rhythm Disturbances in the Form of Atrial Tachycardia in a Female Patient with Polymyositis
Authors: Peregud-Pogorzelska Malgorzata , Kazmierczak Jaroslaw , Brzosko Marek
Published: June 2007

The presented case report describes a female patient suffering from polymyositis, in whom atrial tachycardia and depressed left ventricular function were diagnosed. Atrial tachycardia was confirmed by electrophysiological study, and the radiofrequency ablation failed to restore sinus rhythm. This case is an example of the tachy phase in brady-tachy syndrome. The patient is evaluated cardiologically on a regular basis with emphasis on bradycardia and asystole episodes because she was symptomatic for many years.
Improvement of Diabetic Microangiopathy With Pycnogenol®: A Prospective, Controlled Study
Authors: Cesarone M. R. , Belcaro G. , Rohdewald P. , Pellegrini L. , Ledda A. , Vinciguerra G. , Ricci A. , Gizzi G. , Ippolito E. , Fano F. , Dugall M. , Cipollone G. , Acerbi G. , Cacchio M. , Del Boccio G. , Di Renzo A. , Stuard S. , Corsi M.
Published: June 2007

The aim of this study was to investigate the clinical efficacy of oral Pycnogenol® (Horphag Research Ltd, United Kingdom) in patients with diabetic microangiopathy. Patients without a history of diabetic ulcerations were treated with Pycnogenol. Patients received oral Pycnogenol (50 mg capsules, 3 times daily for a total of 150 mg daily for 4 weeks). A group of 30 patients was included (severe microangiopathy); 30 comparable patients were observed as controls (no treatment during the observation period). All patients (age, 59 years; range, 55-68 years; male:female = 18:12) included in the treatment group completed the 4-week study. Also, all controls completed the follow-up period. There were no drop-outs. All included subjects had signs and symptoms of diabetic microangiopathy. The duration of diabetes—from the first signs/symptoms—was on average 7.5 years (SD = 3). After 4 weeks, microcirculatory and clinical evaluations showed a progressive decrease in skin flux at rest in the foot (indicating an improvement in the level of microangiopathy), a significant decrease in capillary filtration, and a significant improvement in the venoarteriolar response in all treated subjects. There were no visible effects in controls except a slight reduction in skin flux at rest in the foot. Treatment was well tolerated in both groups. In conclusion, this study confirms the clinical efficacy of Pycnogenol in patients with diabetic microangiopathy. The study indicates the clinical role of Pycnogenol in the management, treatment, and control of this common clinical problem. The treatment may be also useful to prevent diabetic ulcerations by controlling the level of microangiopathy.
Cutting Balloon Angioplasty for the Treatment of In-Stent Restenosis in Diabetics: A Matched Comparison of 6 Months' Outcome With Conventional Balloon Angioplasty
Authors: Cin Veli Gokhan , Pekdemir Hasan , Akkus Mehmet Necdet , Camsari Ahmet , Doven Oben , Yenihan Senay
Published: June 2007

Ranging from 24% to 55%, angiographic in-stent restenosis (ISR) rates in diabetics are higher than the 17% to 28% rates observed in nondiabetics. There are controversies regarding optimal treatment for ISR. Recently, cutting balloon angioplasty (CBA) emerged as a tool in management. The authors assessed the hypothesis that CBA has advantages over conventional percutaneous transluminal balloon angioplasty (PTCA) in treatment of ISR in diabetics. CBA or PTCA was applied to 165 diabetics (267 ISR lesions) in their institution. With a computer algorithm, an attempt was made to match each lesion in the CBA group with a corresponding lesion in the PTCA group. The lesion pairs should match with respect to the patients' age and gender, type of target vessel and stent, reference vessel diameter, and baseline minimal lumen diameter (MLD). Following the matching process, 55 ISR lesion pairs were identified. Baseline patient characteristics were similar among the groups (p=NS). There was no difference in the in-hospital major adverse cardiac events (MACE) between the groups, whereas MACE at follow up was significantly lower in the CBA group compared to the PTCA group (CBA, 20.0% vs PTCA, 43.6%, p<0.05). The recurrent ISR rate was significantly lower in the CBA group compared to the PTCA group (CBA, 27.3% vs PTCA, 49.1%; p<0.05). Also, a diffuse pattern of recurrence was more common in lesions treated with PTCA, whereas a focal pattern of recur- rence was more common in the CBA group. The minimal luminal diameter at follow-up, the acute gain, and net gain were significantly higher in the group of lesions treated with CBA than in the PTCA group. In addition, a significantly higher late loss and loss index at follow-up were observed in the PTCA group compared to the CBA group. CBA has advantages over PTCA in treatment of diabetic patients with ISR, with better immediate and follow-up angiographic outcomes, and better follow-up clinical outcome.
Lipoma of the Interatrial Septum in a Patient With Chronic Atrial Fibrillation
Authors: Korantzopoulos Panagiotis , Patsouras Dimitrios , Kountouris Evaggelos , Voukelatou Maria , Charaktsis Ioannis , Zakkas Fotios , Siogas Konstantinos
Published: June 2007

The authors report on a 70-year-old woman with chronic atrial fibrillation that was hospitalized for digitalis intoxication and incidentally was found to have an interatrial lipoma. The diagnosis was established by transesophageal echocardiography, computed tomography (CT) scanning, and magnetic resonance imaging (MRI). Owing to the asymptomatic character and the benign nature of the tumor, a decision for conservative management was made.
Isolated and Significant Left Main Coronary Artery Disease: Demographics, Hemodynamics and Angiographic Features
Authors: Mahajan Nitin , Hollander Gerald , Malik Bilal , Temple Brian , Thekkoott Deepak , Abrol Sunil , Schulhoff Nancy , Ghosh Joydeep , Shani Jacob , Lichstein Edgar
Published: June 2007

Left main coronary artery disease carries a poor prognosis. The etiology of isolated and significant left main coronary artery (ILMCA) disease is not well understood. Studies so far were limited by small numbers. The authors identified 46 patients with ILMCA disease from their database over 10 years (group I) and compared them with 83 consecutive patients undergoing catheterization (group II). They also compared patients with ostial vs distal ILMCA disease. Group I represented 0.1% of catheterization patients. The demographic profile and atherosclerotic risk factor profile of the 2 groups as well as ostial and distal ILMCA disease were compared. This is the largest study of ILMCA disease. Risk factors for atherosclerosis were commonly seen. Nonatherosclerotic causes of ILMCA disease were not seen. This study suggests coronary atherosclerosis as the predominant cause of ILMCA disease. ILMCA disease is more common in women. Diabetes is more commonly associated with distal ILMCA lesion. There is a trend suggesting that ostial ILMCA lesion is more common in smokers and women.
Predicting the Risk of Rupture of Abdominal Aortic Aneurysms by Utilizing Various Geometrical Parameters: Revisiting the Diameter Criterion
Authors: Giannoglou G. , Giannakoulas G. , Soulis J. , Chatzizisis Y. , Perdikides T. , Melas N. , Parcharidis G. , Louridas G.
Published: June 2007

The authors estimated noninvasively the wall stress distribution for actual abdominal aortic aneurysms (AAAs) in vivo on a patient-to-patient basis and correlated the peak wall stress (PWS) with various geometrical parameters. They studied 39 patients (37 men, mean age 73.7 ± 8.2 years) with an intact AAA (mean diameter 6.3 ± 1.7 cm) undergoing preoperative evaluation with spiral computed tomography (CT). Real 3-dimensional AAA geometry was obtained from image processing. Wall stress was determined by using a finite-element analysis. The aorta was considered isotropic with linear material properties and was loaded with a static pressure of 120.0 mm Hg. Various geometrical parameters were used to characterize the AAAs. PWS and each of the geometrical characteristics were correlated by use of Pearson's rank correlation coefficients. PWS varied from 10.2 to 65.8 N/cm2 (mean value 37.1 ± 9.9 N/cm2). Among the geometrical parameters, the PWS was well correlated with the mean centerline curvature, the maximum centerline curvature, and the maximum centerline torsion of the AAAs. The correlation of PWS with maximum diameter was nonsignificant. Multiple regression analysis revealed that the mean centerline curvature of the AAA was the only significant predictor of PWS and subsequent rupture risk. This noninvasive computational approach showed that geometrical parameters other than the maximum diameter are better indicators of AAA rupture.
Cardiac Function, Inflammatory Mediators and Mortality in Critical Limb Ischemia
Authors: Barani Jamal , Mattiasson Ingrid , Lindblad Bengt , Gottsäter Anders
Published: June 2007

Patients with critical limb ischemia (CLI) have a high frequency of concomitant coronary heart disease and congestive heart failure. The aim of the study was to evaluate cardiac function in relation to inflammatory markers and 1-year mortality rate among patients with CLI. The authors investigated 232 consecutive patients with CLI by means of electrocardiogram (ECG), and measurements of endothelin (ET)-1, tumor necrosis factor alpha (TNF)a, interleukin (IL)-6, neopterin, CD40 ligand, and 8-epi-prostaglandin (PG)F2a in plasma. Echocardiography (echo) was performed in 88 (38%) patients. One-year mortality rate was assessed after prospective follow-up. One hundred and eighty-six (80%) patients had sinus rhythm (SR), 36 (16%) had atrial fibrillation or flutter (AF), and 10 (4%) pacemaker rhythm. Ischemic ECG changes occurred in 143 (62%) patients. Patients with AF showed higher IL-6 (p=0.0296) and neopterin (p=0.0494) concentrations. Patients with ischemic ECG changes showed higher ET-1 (p=0.0303), 8-epi-PGF2a (p=0.0027), neopterin (p=0.0004) concentrations and 1-year mortality rate (p=0.0105). The difference in ET-1 remained in logistic regression (p=0.0152). Internal diameter of the left ventricle on echo correlated with IL-6 (r =0.345, p=0.0017), TNFa (r =0.240, p=0.0273), and neopterin (r =0.327, p=0.0028). Internal diameter of the left atrium correlated with TNFa (r =0.384, p=0.0092) and neopterin (r =0.526, p=0.0004), and ejection fraction (EF) correlated inversely with IL-6 (r =-0.380, p=0.0015) and neopterin (r =-0.346, p=0.0038). Patients with EF <40% showed higher (p=0.0462) 1-year mortality rate than patients with EF >40%. In conclusion, in critical limb ischemia, cardiac rhythm disturbances and ischemic ECG changes were related to inflammatory mediators and predicted 1-year mortality rate. The inflammatory mediators correlated with echocardiographic signs of congestive heart failure.
Thromboangiitis Obliterans (Buerger’s Disease): Searching for a Therapeutic Strategy
Authors: Paraskevas Kosmas I. , Liapis Christos D. , Briana Despina D. , Mikhailidis Dimitri P.
Published: June 2007

Treatment of thromboangiitis obliterans (Buerger’s disease) includes both surgical and nonsurgical approaches, or a combination of both. A definite therapeutic approach has not yet been set. This article reviews the proposed therapeutic strategies and considers the advantages and disadvantages of each treatment. Cessation of smoking seems to be the only globally accepted therapeutic measure to prevent disease progression. A number of promising novel therapeutic strategies may prove useful for the treatment of this physically and socially mutilating disease.
Rapid Relief of Signs/Symptoms in Chronic Venous Microangiopathy With Pycnogenol®: A Prospective, Controlled Study
Authors: Cesarone M. R. , Belcaro G. , Rohdewald P. , Pellegrini L. , Ledda A. , Vinciguerra G. , Ricci A. , Gizzi G. , Ippolito E. , Fano F. , Dugall M. , Acerbi G. , Cacchio M. , Di Renzo A. , Hosoi M. , Stuard S. , Corsi M.
Published: June 2007

The aim of this study was to investigate the clinical efficacy of oral Pycnogenol® (Horphag Research Ltd, UK) in patients with severe chronic venous insufficiency. Patients with severe venous hypertension (chronic venous insufficiency, ankle swelling) and history of venous ulcerations were treated with Pycnogenol. Patients received oral Pycnogenol (50 mg capsules, 3 times daily for a total of 150 mg daily) for 8 weeks. A group of 21 patients was included in the treatment group and 18 equivalent patients were observed as controls (no treatment during the observation period). All 21 patients (age 53 years; range, 42-60 years; M:F=11:10) in the treatment group completed the 8-week study. Also the 18 controls completed the follow-up period. There were no drop-outs. The average ambulatory venous pressure was 59.3 (SD 7.2; range 50-68) with a refilling time shorter than 10 seconds (average 7.6; SD 3). There were no differences in ambulatory venous pressure or refilling time between the treatment and control patients. The duration of the disease—from the first signs/symptoms—was on average 5.7 years (SD 2.1). At 4 and 8 weeks, in all Pycnogenol-treated subjects, microcirculatory and clinical evaluations indicated a progressive decrease in skin flux, indicating an improvement in the level of microangiopathy; a significant decrease in capillary filtration; a significant improvement in the symptomatic score; and a reduction in edema. There were no visible effects in controls. In conclusion, this study confirms the fast clinical efficacy of Pycnogenol in patients with chronic venous insufficiency and venous microangiopathy. The study indicates the significant clinical role of Pycnogenol in the management, treatment and control of this common clinical problem. The treatment may be also useful to prevent ulcerations by controlling the level of venous microangiopathy.
Use of Gadolinium-Based Angiography for Renal Artery Stenting in a Patient With Renal Insufficiency
Authors: Mannebach Patrick C. , Dieter Robert S. , Marks David Scott
Published: June 2007

The number of percutaneous diagnostic and interventional procedures performed continues to increase. Despite the use of various methods to reduce the incidence of contrast-induced nephropathy, the development of renal failure remains a significant problem with iodinatedbased contrast agents. Patients with a baseline renal insufficiency are at considerably higher risk of permanent renal deterioration following exposure to iodinated contrast. The authors report a successful case of percutaneous stenting of the renal artery using a gadolinium-based contrast agent in a high-risk patient with renal insufficiency.
Conception of the Venous Hemodynamics in the Lower Extremity
Authors: Reček Č.
Published: June 2007

Contradictory reports on the significance of several hemodynamic phenomena, such as femoral vein incompetence and incompetent calf perforators, impede orientation in venous hemodynamics. Venous pressure difference arising between the popliteal and the posterior tibial vein during the activity of the calf muscle venous pump was reported for the first time about 50 years ago, but regrettably, this important discovery continues to be unrespected. The venous pressure difference has since been termed ambulatory pressure gradient and seems to be the key factor triggering the venous reflux in the lower limb as well as the process leading to varicose vein recurrence. On the other hand, simultaneous recordings of the mean venous pressure in the posterior tibial and long saphenous veins demonstrated that the pressure curves have been identical at rest, during ambulation, and in the recovery period, a finding typical of conjoined vessels. Bidirectional flow within calf perforators taking place both in healthy subjects and in patients with varicose veins enables a quick equilibration of pressure changes between deep and superficial veins of the lower leg. Reflux disturbing the venous hemodynamics is in various degrees dependent on the quantity of retrograde flow; abolition of reflux restores normal venous hemodynamics. Reflux in superficial veins, if large enough, may cause the most severe form of chronic venous insufficiency. Femoral vein incompetence and incompetent calf perforators per se do not produce ambulatory venous hypertension and do not cause hemodynamic disturbance. This study discusses the controversial issues, tries to define and appraise the principal hemodynamic phenomena (ambulatory venous hypertension, ambulatory pressure gradient, venous reflux, superficial and deep vein incompetence, incompetent perforators), mentions a possible relation between deep vein incompetence and varicose veins, and attempts to present, based on proved facts, a comprehensive picture of the venous hemodynamics in the lower extremity.
The Influence of Smoking Cessation on Hemodynamics and Arterial Compliance
Authors: Oren Shmuel , Isakov Irina , Golzman Boris , Kogan Jacob , Turkot Svetlana , Peled Ronit , Yosefy Chaim
Published: June 2007

Cigarette smoking is associated with consistent changes in small arteries and arterioles. Recently, arterial compliance was determined in smokers; however, the effect of smoking cessation on arterial compliance has not yet been investigated. The objective of the study was to assess how smoking cessation, achieved with use of behavioral and pharmacologic therapy, influences vascular compliance and arterial stiffness in smokers. In an open-label study, 60 habitual smokers were treated for 2 months with buproprion 300 mg per day and personal and group conversations in order to facilitate smoking cessation. Hemodynamic variables, including vascular compliance and augmentation index (AI), were measured twice, at the beginning of the study and after 6 months. Of the 60 smokers, 35 stopped smoking and 25 failed at the end of the 2-month treatment period. Of the 35 who were initially successful, 12 went back to smoking, and thus only 23 remained nonsmokers at the end of 6 months. Smoking cessation was accompanied by significantly lower arterial pressure and heart rate but by weight gain. Among the 23 subjects who stopped smoking for 6 months capacitive compliance (C1) did not change but oscillatory compliance (C2) rose significantly (from 5.1 ±2.3 to 6.3 ±3.0 p<0.01), and AI decreased significantly (from 63.1 ±22 to 50.6 ±17 p<0.05), whereas in smokers who still smoked after this period, both C1 and C2 and augmentation index did not change significantly from their basal values. The authors conclude that smoking cessation improves arterial stiffness as assessed by the augmentation index, owing mainly to increasing the small artery compliance, which is known to be an early index of endothelial damage.
Nailfold Videocapillaroscopy in Primary Sjögren’s Syndrome
Authors: Aguiar Thula , Furtado Eliane , Dorigo David , Bottino Daniel , Bouskela Eliete
Published: June 2007

Nailfold videocapillaroscopy was performed in 2 groups of subjects: 14 healthy volunteers (C) and 15 patients with primary Sjögren’s syndrome (PSS). This was a controlled clinical trial, matched by age and sex. The aims of this study were to evaluate (1) functional capillary density (number of capillaries with flowing red blood cells per mm2, FCD); (2) capillary red blood cell velocity at rest (RBV), maximum capillary red blood cell velocity (RBVmax) after 1 minute ischemia, and the time to reach it (TRBVmax), taking into account the presence or absence of Raynaud’s phenomenon (RP) in the analysis; (3) nailfold capillary morphology; and (4) afferent (AFD), apical (APD), and efferent (EFD) capillary diameters. The mean values obtained for controls versus patients, respectively, were (mean ± SD): FCD (per mm2) 8.0 ±1.6 and 10.1 ±3.6; RBV (mm/s) 0.9 ±0.4 and 0.7 ±0.2; RBVmax (mm/s) 1.7 ±0.9 and 1.3 ±0.3; TRBVmax (s) 4.5 ±0.8 and 5.8 ±1.6 (p=0.02); and TRBVmax (s) in patients with RP=6.7 ±1.6 and without RP=5.6 ±1.6 (p=0.52). The correlation between RBV and RBVmax for each group, using the Pearson’s coefficient, was significant only for the control group (p=0.007), estimated correlation coefficient = 0.68. Controls and patients showed, in the majority of fields examined, normal morphologic patterns of capillaries. The capillary diameters were AFD (μm) 10.8 ±1.5 and 11.3 ±1.8; APD (μm) 16.3 ±2.4 and 16.8 ±2.9; and EFD (μm) 12.3 ±1.4 and 13.7 ±1.9. These results indicate that these patients have longer time to reach RBVmax, suggesting an impairment of the reactive hyperemia response, which could correlate with clinical features of the disease, ie, abnormal macrovascular and microvascular reactivity.
Hyperthyroidism as a Cause of Pulmonary Arterial Hypertension: A Prospective Study
Authors: Armigliato Michela , Paolini Rossella , Aggio Silvio , Zamboni Sergio , Galasso Maria Paola , Zonzin Pietro , Cella Giuseppe
Published: June 2007

The authors assessed the prevalence of pulmonary arterial hypertension (PAH) in patients with hyperthyroidism and evaluated the response to treatment of the thyrotoxicosis. They assessed the pulmonary artery systolic pressure (PASP) at rest (estimated by echocardiography) in 23 consecutive patients diagnosed with hyperthyroidism due to Graves’ disease or toxic multinodular goiter. Twelve of 23 patients (52%) did not show antithyroglobulin and antithyroperoxidase antibodies. Seventeen patients were followed up for at least 9 months after achieving a stable euthyroid status. Fifteen (65%) patients demonstrated PAH at admission. Four patients were lost to follow-up; therefore they were able to evaluate 17 patients serially with echocardiography. Sixteen patients normalized their PASP value: 13 after methimazole, 2 after total thyroidectomy, and 1 after 131I treatment. In 1 patient no significant change in PASP was observed. This patient experienced an acute myocardial reinfarction during follow-up. They found a higher prevalence than that previously reported in observational studies. In addition, they demonstrated that the PAH reverses after correction of hyperthyroidism. Elevated PASP at rest on echocardiography may be considered a frequent finding of thyrotoxicosis. Moreover, the data seem not to support an autoimmune pathogenesis for PAH.
Stent Explantation From an Arteriovenous Fistula for Hemodialysis: A Case Report
Authors: Nano Giovanni , Dalainas Ilias , Casana Renato , Bianchi Paolo , Lupattelli Tommaso , Malacrida Giovanni , Tealdi Domenico G.
Published: June 2007

Percutaneous transluminal angioplasty is the first treatment of a dysfunctional vascular access for hemodialysis. A case of stenting of a native arteriovenous hemodialysis fistula is reported that was treated with a stent placement at the anastomosis level, with explantation of the stent after complete thrombosis of the fistula 48 hours after the procedure. It is preferable to treat arteriovenous fistulas with simple balloon dilatation, avoiding stenting of the fistula, especially in the anastomosis site.
Iliac Arteries Injury Secondary to Extracorporeal Shock Wave Lithotripsy: A Case Report
Authors: Filho José Dalmo de Araújo , Ciorlin Emerson , de Araújo José Dalmo , Mauad Thais , Saldiva Paulo Hilário N.
Published: June 2007

The authors report a case of a 40-year-old woman who developed claudication of the right limb 3 months after extracorporeal shock wave lithotripsy (ESWL) owing to a pyelic calculus. Patient had no previous vascular disease. Arteriography revealed a 12-cm-long 80% stenosis of the right common, external, and internal iliac arteries; the rest of the arterial tree had no detectable pathology. Arterial complications related to ESWL have been reported before in patients with aortic aneurysms or very intense calcifications. To the authors’ knowledge this is the first report of ESWL-induced injury in a patient without previous arterial pathology.
Admission Plasma Leptin Level Strongly Correlates With the Success of Thrombolytic Therapy in Patients With Acute Myocardial Infarction
Authors: Amasyali Basri , Aytemir Kudret , Kose Sedat , Kilic Ayhan , Abali Gulcan , Iyisoy Atila , Kursaklioglu Hurkan , Turan Mustafa , Bingol Necati , Isik Ersoy , Demirtas Ertan
Published: June 2007

Obesity-associated alterations in coagulation and fibrinolytic factors in favor of thrombosis are well known. Observations suggest that leptin, a recently discovered obesity gene product, in addition to being a satiety factor, induces platelet aggregation, accelerates formation of firm thrombi, and is associated with abnormal fibrinolysis. The authors studied the influence of plasma leptin concentrations on admission within 6 hours of acute myocardial infarction (MI) on the outcome of thrombolytic therapy (TT). Forty-one patients with acute MI who underwent TT were enrolled into the study. Levels of plasma leptin were determined with radioimmunoassay method in samples obtained just before initiation of TT. Patients were initially classified according to the admission plasma leptin concentrations, and it was observed that failure of reperfusion therapy with streptokinase was significantly higher in patients with admission plasma leptin concentrations ≥14 ng/mL (group 2) as compared to patients with admission plasma leptin concentrations <14 ng/mL (group 1). Final failure of TT, identified both by reinfarction and absence of early reperfusion as assessed noninvasively, was observed in 11 patients (39%) in group 1 and in 10 patients (77%) in group 2 (p=0.025). Left ventricular ejection fraction was slightly but significantly higher in group 1 than in group 2 (p=0.031). High plasma leptin concentrations on admission in patients within 6 hours after the onset of acute MI are associated with less TT efficacy. The authors suggest that admission leptin levels may play a role in the management of patients with acute MI.
Wine, Diet, and Arterial Hypertension
Authors: Carollo Caterina , Presti Rosalia Lo , Caimi Gregorio
Published: June 2007

Hypertension is one of the leading causes of death in developed countries, and the number of prehypertensive patients is increasing. The beneficial effects of moderate wine consumption on cardiovascular diseases have been demonstrated, along with the healthy influence of a Mediterranean dietary pattern. The association of these 2 factors on hypertension and its complications is considered here. As wine polyphenols exert a vasorelaxing action, they might positively influence the hemodynamic situation of these patients. These effects could be enhanced by dietary constituents, such as garlic, onions, and olive oil, which are widely employed in Mediterranean cooking. By evaluating many studies performed in animal models and in humans, the authors conclude that moderate wine consumption, if associated with a healthy dietary pattern, such as the Mediterranean one, could help hypertensive patients to ameliorate their arterial pressure and quality of life by reducing cardiovascular morbidity and mortality rates.
Automatic Implantable Cardioverter Defibrillator for the Treatment of Ventricular Fibrillation Following Coronary Artery Spasm
Authors: Al-Sayegh Ali , Shukkur Abdul Mohammed , Akbar Moussa
Published: June 2007

Coronary artery spasm is an infrequently recognized condition that causes Prinzmetal’s angina and specific electrocardiographic changes. A 50-year-old man who suffered a spontaneously aborted acute inferior myocardial infarction is presented. He underwent cardiac catheterization, which initially showed a normal coronary artery. The coronary angiogram was repeated shortly after a second presentation of acute coronary syndrome and ventricular fibrillation. Coronary spasm of very proximal right coronary artery was present, which was reversed completely with intracoronary nitroglycerin. The spasm segment was first stented. Subsequently, an automatic implantable cardioverter defibrillator was inserted because of the uncertainty of future spasm recurrence. The patient was discharged with oral isosorbide dinitrate and Amlodipine. In further follow-up, the patient had two separate shocks within 4 months of implantation. Ventricular fibrillation was the trigger for the shock therapy in both occasions.
A Sequential Approach to the Management of a Massive Intracoronary Thrombus in ST Elevation Myocardial Infarction
Authors: Carey Brian C. , Blankenship James C.
Published: June 2007

Thrombus-laden coronary lesions present a particular challenge to the interventional cardiolo-gist. Despite the development of multiple strategies to attack this problem, lesions with angio-graphically visible thrombus still carry a high risk of complications when coronary intervention is attempted. The authors present a case of acute inferior ST elevation myocardial infarction with a massive thrombus in an ectatic right coronary artery. Sequential treatment with intra-coronary glycoprotein IIb/IIIa inhibitor, rheolytic thrombectomy with 2 different-sized catheters, and transcatheter thrombus aspiration with a Pronto aspiration catheter was required to achieve a satisfactory result. This case illustrates the potential benefit of combining various mechanical strategies to treat intracoronary thrombus.
Impact of the Metabolic Syndrome on Atrial Size in Patients With New-Onset Atrial Fibrillation
Authors: Nicolaou Vasilios N. , Papadakis John E. , Karatzis Emmanouil N. , Dermitzaki Sofia I. , Tsakiris Alexandros K. , Skoufas Panagiotis D.
Published: June 2007

Atrial fibrillation (AF) is the most common arrhythmia, and it is strongly related to atrial enlargement. Metabolic syndrome (MetSyn) is associated with increased cardiovascular morbility and mortality. However, the impact of the MetSyn on cardiac arrhythmias is poorly elucidated. The aim of this study was to compare atrial dimensions in patients suffering from nonvalvular paroxysmal AF, with and without MetSyn, trying to identify structural differences that could favor the occurrence of this arrhythmia. The study population consisted of 60 patients who presented with at least 1 episode of paroxysmal AF. From these, 26 patients fulfilled the criteria of the National Cholesterol Education Program Adult Treatment Panel III (NCEP-ATP III) definition of MetSyn, while the remaining 34 patients did not. Left atrial size was assessed by 2-dimensional echocardiography. Patients with MetSyn had a mean atrial size of 46.2 ∓4.3 mm and those without MetSyn had a mean atrial size of 41.6 ∓1.9 mm, p<0.011. MetSyn may favor the occurrence of paroxysmal AF by increasing atrial size. This concept deserves more research.