bluuebunny/crossref_metadata_2025 huggingface dataset:
Assessment of Clinical Laboratory Techniques in the Measurement of Oxygen Saturation in Whole Blood
Authors: Sarma Radha , Prickett Charles , Johnson John L.
Published: November 2007

The accuracy and advantages of determining percentage of hemoglobin oxygen saturation of whole blood by advanced instruments of oximetry, gas chromatography, and the computation of oxygen saturation from pO2 and pH data are compared with the Van Slyke-Neill manometric method. It was found that oximetry is extremely fast, less expensive, and more accurate than in the past, the apparatus requires little training to operate and has diminutive service maintenance. The gas chromatograph proved to be highly accurate and could serve as a standard calibration check method in place of the more time-consuming Van Slyke-Neill apparatus for oximetry and pO2 and pH electrode instrumentation. Computation of O2 saturation from pO2 and pH data also proved to be accurate, confirming that this method is more useful during cardiac surgery because it can provide additional acid-base information. In the low oxygen saturation range (<60%), all three methods proved to be of similar sensitivity.
Aneurysms of the Pulmonary Arteries
Authors: Gould Lawrence , Ramana Reddy C.V. , Chang Sing Yang
Published: November 2007

A case of bilateral pulmonary artery aneurysms is presented. Serial car diac catheterizations over an 8-year period showed remarkably little he modynamic change. Thus there may be a long period of clinical and hemodynamic stability in this condition.
The Value of Thermography in Peripheral Vascular Disease
Authors: Henderson H.P. , Hackett M.E.J.
Published: November 2007

The value of thermography as a reliable, noninvasive, and rapid method of investigating patients with peripheral vascular disease is discussed. Thermography has great value in managing deep venous thrombosis, in estimating the optimal site of amputation, in evaluating vasoactive drugs, and correctly timing the division of pedicled skin flaps. Its use in localizing incompetent perforating veins of the leg and in monitoring patients with cerebrovascular disease after surgery to the carotid arteries is also briefly described.
Acute Effects of Furosemide on Blood Electrolytes and Hemodynamics in Dogs
Authors: Koob Ronald , Prasad Kailash
Published: November 2007

The effects of furosemide on the hemodynamics, blood electrolytes, and urinary output in 5 anesthetized dogs were studied. There were no significant changes in blood Na+ or Ca++ levels, but K+ decreased significantly after 15 minutes of furosemide treatment. There were no significant changes in the blood pressure, heart rate, left ventricular systolic pressure, index of left ventricular contractility [(dp/dt)/IIP], or systemic vascular resistance. Left ventricular dp/dt decreased for 30 to 60 minutes. Later the dp/dt and (dp/dt)/IIP of left ventricular pressure exceeded control values, although increases were not signif icant. Left ventricular work index and stroke volume decreased significantly between 30 and 90 minutes. The cardiac output and cardiac index also de creased. Left ventricular end-diastolic pressure decreased significantly only at 30 minutes. Cardiac function remained unchanged and consistent with the elec trolytes changes. Although there was a marked diuresis, which normally must have significantly decreased the effective blood volume and hence the myo cardial contractility, the cardiac function remained unchanged. These results suggests that furosemide might have a direct effect on the myocardium. Clinical improvement in patients might be the result of a direct effect on the myo cardium aside from its effect due to diuresis.
Complete Heart Block Complicating Acute Myocardial Infarction
Authors: Gupta M.C. , Singh M.M. , Wahal P.K. , Mehrotra M.P. , Gupta S.K.
Published: November 2007

Complete heart block (CHB) developed in 10.3% of patients with acute myocardial infarction (MI). It was more frequent among patients with inferior myocardial infarction compared to anterior myocardial infarction, but the mortality was significantly high among patients with anterior MI who devel oped CHB.

A new classification into primary (P) and secondary (S) CHB is suggested by the sequence of events. The incidence and mortality of SCHB was significantly high when compared to the incidence and mortality of PCHB.

Wide QRS complexes, a heart rate of less than 60/min, and syncopal attacks were the grave prognostic signs. Progression from a lesser degree of AV block and regression of CHB to a lesser degree of AV Block were both observed in 25.8% cases. Circulatory failure in the form of shock, hypotension, congestive heart failure, and left ventricular failure, alone or in combination was a factor in 17 of the 22 patients who died. Four of 5 patients who underwent transvenous pacing also died.
Study of Respiratory Influence on the Intensity of Heart Sound in Normal Subjects
Authors: Ishikawa Kyozo , Tamura Takeshi
Published: November 2007

The amplitudes of the first and second heart sounds were recorded during quiet natural breathing in 31 normal subjects. A total of 3,656 and 3,016 heart beats were available at the apex and pulmonic areas respectively. The in tensities of the first and second heart sounds were found to be increased during expiration. This respiratory tendency in the heart sounds was less prominent during the transitional phase between expiration and inspiration. Therefore we suggest that respiratory changes in heart sounds should be evaluated with a heart beat located at or close to the center of each inspiration and expiration. Respiratory alteration in the intensity of heart sounds is one of the commonest auscultatory pitfalls. Auscultatory evaluation of the intensity of heart sounds should thus be performed carefully, with the respiratory changes kept in mind.
Aortobronchial Fistula: Keys to Successful Management
Authors: Demeter Stephen L. , Cordasco Edward M.
Published: November 2007

Aortobronchial fistula is a rare but highly lethal condition. If diagnosed, its survival rates are greater than 80%; if not, the condi tion is uniformly fatal with death most com monly due to massive hemoptysis. A review of the world's literature and an illustrated case are presented. A total of 30 cases have been described, but the published incidence may be low.

Of the cases presented in sufficient detail for analysis, 92% (23 of 25) were associated with an aneurysm of the thoracic aorta. The most consistent symptom was hemoptysis (22 of 23, 96%), especially massive he moptysis (15 of 19, 79%). Plain chest radio graphs demonstrated an aneurysm in 46% (6 of 13 evaluable cases). Either an aneurysm on the chest x-ray or massive hemoptysis, or both were seen in 94% of cases (16 of 17). The most rewarding test (in 5 of 7, 71 %) was the thoracic aortogram. Surgical correction was followed by an 82% survival rate (9 of 11). Untreated, the eventual mortality was 100%, although one patient died as late as 6 months after the initial presentation with massive hemoptysis.
Focal Arteritis of the Breast
Authors: Chaitin Barbara , Kohout Nevea Donell , Goldman Ronald L.
Published: November 2007

The fourth case of focal (isolated) arteritis of the breast is reported. The lesion, which may be unilateral or bilateral, presents as a painful or tender mass and has been confused clinically with carcinoma. Arteritis, either necrotizing or granulomatous, may occur as an isolated phenomenon re stricted to a solitary organ; it does not necessarily imply concurrent or subsequent systemic vasculitis.
Cardiomyopathy with Cardiomegaly: A Diagnostic Dilemma
Authors: Gupta Satyendra C.
Published: November 2007

The clinical, angiographic, and available autopsy data of 32 patients with cardiomyopathy with cardiomegaly were reviewed. Twenty-six patients had alcoholic cardiomyopathy. Of these, 20 patients had patent coronary arteries, and 6 had significant occlusive coronary artery disease. Six patients denied any history of excessive alcohol intake, had significant occlusive coronary artery'disease, and were grouped as ischemic cardiomyopathic. A total of 12 patients (37.5%) had significant occlusive coronary artery disease.

The clinical separation of patients with cardiomegaly due to alcoholic cardiomyopathy from those with occlusive coronary artery disease is ex tremely difficult. Clinical parameters, including history of chest pain and presence or absence of abnormal Q waves on electrocardiograms, are of little value in individual cases. It seems likely that many patients with ischemic cardiomyopathy may present clinically and electrocardiographically as pa tients with silent occlusive coronary artery disease. This study underlines the importance of coronary angiography in making a precise diagnosis. The mortality rate during the 5-year follow-up period was 56%. The patients with alcoholic cardiomyopathy with occlusive coronary artery disease carried the worst prognosis. The outlook for patients with cardiomyopathy and cardio megaly becomes grave once they develop left ventricular end diastolic pressure over 24 mm Hg.
Noninvasive Versus Invasive Evaluation of the Extracranial Circulation in Patients With Suspected Cerebral Vascular Disease
Authors: Alves Angelo M. , Sterensis Joseph B. , Alves Angelo M.
Published: November 2007

This is the second in an ongoing series of evaluations in an attempt to find a combined system of noninvasive cerebral vascular evaluation of the extracra nial circulation reliable enough so that decisions can be made, utilizing this system regarding further diagnostic studies and management. The current study evaluates a system of combined doppler arterial scanning of the extra cranial circulation with Real Time B-Mode imaging of the territory of the carotid bifurcations and show that such a system, in skilled hands, is capable of very high levels of accuracy both quantitatively and qualitatively regarding the status of the carotid bifurcations as well as giving much indirect information about the cerebral vascular and subclavian circulations. The paper ends with a strong statement supporting the routine utilization of noninvasive screening of patients with suspected cerebral vascular disease. This conclusion is reached after comparing 59 patients representing 118 carotid bifurcations studied; first by physical examination and noninvasive evaluation and subsequently by angiography.
Thrombolytic Therapy for Thromboembolism of Vertebrobasilar Artery
Authors: Nenci G.G. , Gresele P. , Taramelli M. , Agnelli G. , Signorini E.
Published: November 2007

Thrombolytic therapy was carried out on four patients with brain stem stroke due to thromboembolism of the vertebrobasilar system. Diagnosis was confirmed by angiography. Clinical and instrumental findings indicated a very poor prognosis. Two of these patients were treated with urokinase and the other two with streptokinase for periods ranging from 16 to 44 hours. The interval between onset of symptoms and start of therapy was less than 10 hours for three of these patients. All made a gradual and almost complete recovery after only a few hours of treatment, and only one presented minimal residual neurological disability. The conditionof the fourth patient, who started therapy four days after the first episode, remained unchanged until he died 16 hours later.

Our observations suggest that thrombolytic therapy may be useful in treat ing recent acute life-threatening brain stem stroke.
Intrapericardial Instillation of Sodium Hydroxide: Failure to Produce Pericardial Symphysis
Authors: Srinivasan Venkatraman , Berdoff Russell L. , Goldberg Emanuel , Gallerstein Peter E. , Ehya Hormoz , Berger Marvin
Published: November 2007

Previously reported clinical studies have suggested sodium hydroxide as an effective agent in causing pleural symphysis. To explore the sclerosing poten tial of this agent, we instilled 0.5% sodium hydroxide into the pericardium of four dogs. Normal saline was instilled into the pericardium of one control dog. Echocardiograms, 24 hour EKG monitoring and intracardiac pressures were recorded. One dog was sacrificed at the end of 24 hours, another at the end of seven days and three other dogs were sacrificed at the end of 28 days. ST elevations and prolonged episodes of supra-ventricular and ventricular tachycardia were noted during and within 24 hours after the intrapericardial instillation of sodium hydroxide in all the dogs. No arrhythmias were noted in the control dog. None of the dogs showed pericardial symphysis. These results suggest that sodium hydroxide causes serious cardiac arrhythmias when in stilled intrapericardially and is of limited value in causing pericardial sym physis.
Diffuse Dilatation of Autogenous Saphenous Vein Grafts Used to Replace the Renal and Superior Mesenteric Arteries. A Case Report
Authors: Robicsek Francis , Vajtai Peter
Published: November 2007

Of the many different materials used to replace diseased arteries, autogenous saphenous vein grafts are among the most favored.1 This view is also explicitly expressed regarding patients who suffer from occlusive arterial disease of the abdominal viscera, particularly the renal vessels.2-4 There is, however, recent information which suggests that for reasons unknown saphenous vein grafts in the renal position are likely to be subject to both diffuse and aneurysmatic dilatation,3,5 a complication seen only seldom in the femoral1,6 and practically never in the coronary7-8 position.

The purpose of this paper is to present the case of a young woman with fibromuscular stenosis of both her abdominal renal and the mesenteric arteries whose condition was surgically corrected using autogenous vein grafts. Despite the fact that at the time of her surgery her saphenous vein appeared to be both macroscopically and microscopically intact and postoperatively her blood pressure returned to normal, she developed diffuse, aneurysmatic dilatation of all of her vein grafts.
Discrepancy in the Thrombolytic Effect of UK Between Angiographic and Circulatory Evaluations
Authors: Matsuo Osamu , Mihara Hisashi , Motomatsu Kenichi
Published: November 2007

A clinical case in which angiographic and circulatory evaluations of the thrombolytic effect of urokinase (UK) were not correlated, is described. Circu latory improvement distal to the thrombosis was recognized on the basis of a rise in skin temperature and increased palpability of the pulse at the distal artery. However, angiography revealed the development of thrombosis. This discrepancy may have arisen from the hypotensive action of UK preparations due to increased flow in the collateral circulation. The significance of angiogra phy in providing direct evidence for assessing the thrombolytic effect of UK is emphasized.
Value of Doppler Multi-Level Segmental Pressure Index in the Diagnosis and Hemodynamic Characterization of Totally Occlusive Aorto-Iliac-Femoro-Popliteal Lesions
Authors: Giulini Stefano M. , Bonardelli Stefano , Bartoli Andrea , Floriani Marco , Tiberio Giorgio
Published: November 2007

Four-level lower limb Doppler S.P.I. (upper thigh; above knee; below knee; above ankle) were evaluated in 275 limbs, 110 of which showed totally occlusive lesions at one or more levels of the aorto-iliac-femoro-popliteal axis on angiographic examination, 65 showed stenosis < 50% (sclerotic controls) and 100 did not undergo arteriographic examination since they apparently had no lesions (healthy controls) . Analysis of the results - carried out using the Student's t statistical method - showed a drop in the S.P.I. close to or over 0.30 between two adjacent levels and was indicative of the presence of an occlusion in the intermediate area. This method therefore allowed the presence and the position of an isolated lesion to be detected. In the case of multiple lesions in series, the proximal one is detected with certainty, whereas the more distal ones can be recognized but not their exact position and extension. Multiple lesions in series are more hemodynamically significant than isolated ones, and proximal lesions more than distal ones.
Aortic Valvular Malformation Associated With Coincident Cardiovascular Anomalies: Morphologic Considerations
Authors: Folger Gordon M. , Stein Paul D.
Published: November 2007

The association of a bicuspid aortic valve with other congenital cardiac mal formations, prominently coarctation of the aorta, is widely accepted with esti mates of frequency reported to be 20% overall1 and ranging between 25-50% to as high as 85% when there is coarctation. 2-5 The anatomic configuration of the valve has received little comment and, excepting those individuals requiring aortic valve surgery coincident with repair of other malformations, has been limited to postmortem examination. Recently, however, an angiographic tech nique for accurately evaluating the morphology of the aortic valve has been utilized allowing for the determination of aortic valvular appearance at routine evaluation by cardiac catheterization. 6

We have currently examined 17 individuals with various forms of congenital cardiac malformations in whom an aortic valvular abnormality was suspected as a coexistent abnormality employing the technique of orifice-view aortogra phy. The present report concentrates on the aortic valvular anatomy of these patients.
Hemodynamic Effects of Intravenous PGE1 on Patients with Arterial Occlusive Disease of the Leg
Authors: Hirai Masafumi , Nanki Michio , Nakayama Ryu
Published: November 2007

In 42 patients with arterial occlusive disease of the leg, the hemodynamic effects of prostaglandin E1 (PGE1) given intravenously were studied. Blood pres sure of the leg and crest time of the pulse wave did not change significantly, while increases in blood flow at the calf and foot, amplitude of the pulse wave, velocity, and skin temperature at the foot and toes were significant. Skin tem perature of the calf dropped significantly. The increase in blood flow, velocity, and skin temperature was significantly more dominant in the distal part of the leg than that in the proximal part. In separate observation of individuals, 12 of the 66 legs with arterial occlusive disease (18%) showed a decrease in skin tem perature at the toes. The steal phenomenon was observed most frequently in limbs with rest pain, gangrene, or both.
Effort Angina Without Coronary Obstruction in a Patient with Takayasu's Aortitis: A Case Report
Authors: Ochiai Jun , Kanaide Hideo , Okamatsu Shuichi , Yamada Akira , Nakamura Motoomi
Published: November 2007

Angina occurring in patients with Takayasu's aortitis is attributed to the narrowing of the coronary ostium and/or aortic regurgitation. We treated a patient with Takayasu's aortitis with effort angina, in whom there was no ob struction of the ostium or aortic regurgitation. Treadmill exercise stress test revealed significant ST depression in leads V4-6, II, III and aVF with chest pain. Examinations of lactate in coronary sinus as well as arterial blood suggested the occurrence of myocardial ischemia during atrial pacing. The DPTI/TTI index was decreased and the left ventricular end-diastolic pressure was increased dur ing angina. It is considered that the reduced coronary perfusion pressure re sulted from a low diastolic aortic pressure and the elevated left ventricular end-diastolic pressure decreased the DPTI/TTI index and contributed to the development of subendocardial ischemia.
Influences of Ca2+ : Antagonist and Cyclic AMP on Vascular Smooth Muscle Cells in Culture
Authors: Kuzuya Fumio , Naito Michitaka , Asai Kan-ichi , Shibata Kazuaki
Published: November 2007

When cultured with a Ca2+ antagonist diltiazem, fetal bovine aortic smooth muscle cells showed a cobblestone-like monolayer and a positive factor VIII related antigen in culture, which are supposed to be specific to the endothelial cells in general. Similar change was produced by addition of a cyclic AMP ana logue, dibutyryl cyclic AMP or a phosphodiesterase inhibitor, theophylline. All of these changes were reversible. Both smooth muscle cells and endothelial cells are derived from mesenchymal cells embryologically and it is of great interest to presume the differentiation process of both cells.
Pentoxifylline Treatment in Patients with Occlusive Peripheral Arterial Disease. Circulatory Changes and Effects on Prostaglandin Synthesis
Authors: Poggesi Loredana , Scarti Luca , Boddi Maria , Masotti Giulio , Serneri Gian Gastone Neri
Published: November 2007

Pentoxifylline has recently been reported to stimulate in vitro the synthesis of prostacyclin. However it is not known so far whether the drug is able to stimulate prostacyclin synthesis in man also in vivo. In the present study the effects of pentoxifylline on prostaglandin synthesis and several circulatory pa rameters were studied in 10 controls and 10 patients with occlusive arterial disease after acute i.v. and medium term oral treatment. Prostacyclin (as 6- keto-PGF1alpha) and PGE 2 plasma concentrations have been measured together with arterial blood flow, peripheral vascular resistance, platelet aggregation and red blood cell deformability. Pentoxifylline was found both in healthy sub jects and patients to significantly increase prostacyclin plasma concentration after i.v. treatment. In medium term oral treatment prostacyclin concentration was found to increase only two hours after administration and not 8 hours after. No significant variations in PGE2 plasma concentration were found at any time in both groups. Pentoxifylline significantly enhanced resting and post-ischemic blood flow of the lower limbs and simultaneously decreased peripheral vascular resistance both in healthy subjects and patients. Different grades of delayed platelet aggregation and increased red blood cell deformability were also ob served.

In conclusion results of the present placebo controlled study show that pen toxifylline increases arterial blood flow in patients with occlusive arterial dis ease. Moreover pentoxifylline induces a temporary stimulation of prostacyclin synthesis which can be suggested to contribute to the clinical activity of the drug as far as an antithrombotic effect in terms of inhibition of platelet aggregation is concerned.
Two Pumps and One Heart: Studies and Theoretic Considerations
Authors: Burch George E. , Cronvich James A.
Published: November 2007

Using 2 pumps specially constructed to simulate the right and left ventricles of the heart of man, it was shown that very small differences in output per stroke of the 2 pumps will result in a significant change in the volume of the "pulmonary" circulatory system and could become "pathophysiologically" im portant with time. These studies demonstrate that both ventricles must be well synchronized and regulated to maintain good health and to prevent dyspnea and other manifestations of CHF. They also indicate the inadequacy of the conven tional methods used for measuring cardiac output in man and the need to mea sure stroke volume or cardiac output of both ventricles separately and simultaneously. It must not be assumed that the cardiac output is always equal for both ventricles even in the presence of myocardial disease.

An explanation is introduced for the acute onset of dyspnea associated with angina pectoris and with exercise. Also, the concept that the ventricles fill, at least in part, by "sucking" action is presented, with support from these and other theoretic considerations.
Economic Impact of Transluminal Angioplasty
Authors: Freiman David B. , Freiman Marc P. , Spence Richard K. , McLean Gordon K. , Berkowitz Henry D.
Published: November 2007

Using actual bills and follow-up records we attempted to determine the eco nomic impact of percutaneous transluminal angioplasty. The patients selected included forty angioplasties performed early in our experience as well as forty comparable patients who had operations in the same period of time. Clinical follow-up was obtained over four years. The statistics obtained demonstrate the hospital bills for angioplasty were only 24% that of surgical treatment for femo ral lesions ($1,329.00 versus $6,112.00) and 16% for iliac lesions ($1,353.00 versus $7,732.00). Using this patient sample and readily available statistical data, we calculated direct national savings for using angioplasty on all patients suitable and used a standard value of life analysis to estimate the value of lives saved by doing the less dangerous procedure. The sum total savings in the United States from using angioplasty in all suitable candidates as opposed to surgery would be $180 million per year for femoral lesions and $117 million for iliac lesions. This could produce a significant savings in medical costs over the coming years.
Spiral Saphenous Vein Graft for Replacement of Internal Jugular Vein: A Series of Case Reports
Authors: Leafstedt Stuart W. , Rubenstein Richard B. , Pallanch John F. , Wilder William H.
Published: November 2007

Bilateral radical neck dissection with internal jugular vein extirpation, be it simultaneous or staged, results in severe cephalic venous hypertension. Symp toms remit with time, however, acutely contribute to the morbidity of the proce dure. Internal jugular vein replacement using autogenous saphenous vein that is fashioned into a spiral conduit has been used in three patients undergoing bilat eral or second side radical neck dissection.

The technique entails construction of a large vein conduit by wrapping saphenous vein around a chest tube in a spiral fashion. Patients treated had objective relief of the acute venous hypertension based on cephalic venous pres sure measurements. The three patients undergoing the spiral vein grafting were notable for the lack of any expected symptoms derived from venous hyperten sion, and postoperative venograms demonstrate graft patency at one to two weeks.
Lymph Cysts or Lymphocoele: A Case Report
Authors: Fisher Martin M. , Halpern Gary J. , Wilkins Robert M.
Published: November 2007

A patient wth a lymph cyst of the thigh following sulfuric acid burns of both feet is presented. It was diagnosed by percutaneous lymphangiography with Ethiodal. Omentopexy was performed with success. A complication of hernia of small intestine into the thigh was corrected by herniorraphy. Omentopexy is an excellent modality to improve lymph flow. Awareness of hernia post operatively may limit its use.
Tissue Damage in Sickle Cell Disease as Assessed by Serum Acid Phosphatase
Authors: Okafor L.A. , Obi J.O.
Published: November 2007

The extent of tissue damage caused by vaso-occlusion in sickle cell disease in those organs rich in acid phosphatase was assessed by measuring serum acid phosphatase in 33 patients with homozygous sickle cell disease Hb-SS (sicklers) and comparing the result with that of 31 persons with normal haemoglobin— AA (non-sicklers) matched for age and sex. The result showed a decrease in the level of total, labile and tartrate-resistant serum acid phosphatase in sicklers compared to non-sicklers, though the decrease is not statistically significant (p > 0.1). Though serum acid phosphatase is unlikely to be a useful index for the assessment of organ damage, the result is in consonance with reported decreases in other body secretions such as serum testosterone or aldosterone due to organ damage by vaso-occlusion of the micro-circulation by sickled red cells in sickle cell disease.
Acute Congestive Heart Failure Due to the Arteritis of Rheumatoid Arthritis: Early Diagnosis by Endomyocardial Biopsy
Authors: Slack John D. , Waller Bruce
Published: November 2007

A 49-year-old man with rheumatoid arthritis presented with acute conges tive heart failure. Acute viral myocarditis was suspected clinically as a Gallium- 67 myocardial scan was positive. Percutaneous catheter-directed biopsy of the right ventricular endomyocardium, however, revealed heavy endothelial de posits of I gM in the small blood vessels of the myocardium. Prednisone therapy resulted in normalization of both the myocardial Gallium-67 scan and left ven tricular ejection fraction with resolution of the symptoms of congestive heart failure. This is the first report documenting rheumatoid arteritis antemortem by myocardial biopsy.
Panic Disorder: A Frequent Occurrence in Patients with Chest Pain and Normal Coronary Arteries
Authors: Mukerji Vaskar , Beitman Bernard D. , Alpert Martin A. , Lamberti Joseph W. , DeRosear Lori , Basha Imad M.
Published: November 2007

From 10% to 20% of patients undergoing coronary arteriography for chest pain are subsequently found to have normal coronary arteries. We investigated the prevalence of panic disorder in these patients in a two-stage study. Our results indicate that approximately one third of patients with chest pain and angiographically normal coronary arteries have panic disorder. Proper diagnosis and treatment of these patients with panic disorder may be expected to substantially reduce their psychosocial morbidity.
Bedside Computers in the Surgical Intensive Care Unit
Authors: Seiver Adam , Kohatsu Shoichi , Rowles Donald
Published: November 2007

User "friendly" computers are becoming available for increased usage in the medical arena. The Surgical Intensive Care Unit (SICU) has a large number of items to identify, quantify, manage, and record frequently, often on a continuing basis. At the Palo Alto Veterans Hospital, a program has been developed (A.S.) to change ventilator requirements as an aid to medical staff. Fewer laboratory studies such as blood gas determinations are required. Trending of information is critical in making appropriate plans of care. Twenty patients with a variety of surgical problems have been evaluated by utilizing a bedside computer.
Transcutaneous Oximetry in Evaluation of the Initial Peripheral Artery Disease in Diabetics
Authors: Modesti Pietro Amedeo , Boddi Maria , Poggesi Loredana , Gensini Gian Franco , Neri Serneri Gian Gastone
Published: November 2007

This study was performed to evaluate the reliability of transcutaneous ox imetry as compared with strain gauge plethysmography and with Doppler in the assessment of the initial peripheral vascular disease in diabetics who are still asymptomatic.

Twenty-five diabetics (38 lower extremities) with different degrees of periph eral vascular disease, classified according to Fontaine, were investigated. Ten healthy subjects (16 lower extremities) served as controls.

In the first group of patients (still asymptomatic) it was possible to select by transcutaneous oximetry and by plethysmography a subpopulation that pre sented a significant reduction in the arterial flow of the limbs. Moreover, a significant correlation between data obtained by strain gauge plethysmography and transcutaneous oximetry was found (p < 0.001), whereas correlation with data from Doppler was lacking.
Transcatheter Embolization of Hepatic Arteriovenous Fistula in Osler-Weber-Rendu Disease — A Case Report
Authors: Roman Cecelia F. , Se Do Cha  , Incarvito John , Cope Constantin , Maranhao Vladir
Published: November 2007

Hereditary hemorrhagic telangiectasia (Osler-Weber-Rendu disease) is asso ciated with arteriovenous fistulas throughout the body that can cause hemody namic abnormalities. Owing to their size and extent, surgical repair is often not feasible.

A patient referred for presumed valvular heart disease is described. On the basis of oximetry data at cardiac catheterization, a large intrahepatic arterio venous fistula was discovered by aortography. This finding and a history of recurrent epistaxis were consistent with Osler-Weber-Rendu disease. Owing to the size of the fistula, embolization of the right hepatic artery with Gianturco coils was chosen as treatment, with resultant symptomatic improvement and decreased arteriovenous shunting.
31P in-Vivo Spectroscopic Study by High-Field Whole-Body MR System—An Application to a Case with Arteriosclerosis Obliterans
Authors: Nishimura Tsunehiko , Imakita Satoshi , Naito Hiroaki , Takamiya Makoto , Matsuo Hiroshi , Nakayama Ryu
Published: November 2007

31P in-vivo spectroscopy was performed by a 1.5-tesla whole-body MR sys tem. The 31P spectrum for the calf muscle in a patient with arteriosclerosis obli terans having intermittent claudication was obtained every two minutes. When the spectrum after the workload was compared with that at rest, an increase in inorganic phosphate (Pi) and a decrease in phosphocreatine (PCr) were ob served, resulting in a strong decrease in the PCr/Pi ratio. This method can measure the ischemic and recovery stages of energy metabolism in skeletal mus cle noninvasively and continuously in addition to magnetic resonance imaging.
IV Radionuclide Total-Body Arteriography: A New Noninvasive Whole-Body Screening Procedure— A Case Report
Authors: Yang David Chang-Sing , Gould Lawrence , Yee Wyman K. , Patel Devayani , Giovanniello Joseph
Published: November 2007

Recently the authors introduced a new technique of intravenous (IV) radionuclide total-body arteriography. The major arterial system, multiple organs of the whole body, and cardiac function can be evaluated with one small IV injection in the arm. After analyzing more than 1000 cases, they have found that many pathologies can be detected and/or confirmed in this procedure.

This new technique may be used as a general whole-body screening test for those patients at high risk for disease.
Hemodynamic Effects of Prostacyclin Infusions in Healthy Volunteers
Authors: Wollersheim Hub , Thien Theo
Published: November 2007

The selective hemodynamic effects of an intravenous infusion of prostacyclin on skin and on forearm blood flow during inceasing doses up to 6 ng.kg. - 1min. -1 were evaluated in 12 healthy volunteers. The highest dose raised total skin blood flow (p=0.0001) as measured by laser Doppler with a concomitant rise in finger skin temperature (p=0.02). Capillary perfusion as measured by transcutaneous oxygen monitoring remained relatively unaffected (p=0.25). Cold-induced vasoconstriction and the recovery thereafter were not influenced. Diastolic blood pressure tended to decrease (p=0.06), but there was no change in systolic blood pressure, forearm blood flow, and calculated fore arm vascular resistance.

The authors conclude that prostacyclin may have dissimilar vasoactive po tencies in different vascular beds as shown by a pronounced increase in total skin blood flow, owing to vasodilation of shunt vessels, simultaneously with an insignificant change in nutritional skin blood flow and forearm muscle blood flow.
Pressor Responses from Noncardioselective Beta-Blockers
Authors: Cleophas Ton J. M. , Kauw Frans H. W.
Published: November 2007

This study reviews more than fifty papers dealing with pressor responses from noncardioselective beta-blockers. It is concluded that the responses are usually mild. They occur mainly in situations of increased sympathetic activity. Therefore some patients seem to be at risk, eg, patients with unstable diabetes type 1, sportsmen performing isometric exercise, and heavy smokers. In orthostatic hypotension, noncardioselective beta-blockers may be beneficial. Cardiac output tends, however, to decrease, and patients with orthostatic hypotension will probably not benefit from this effect.
Transient Encephalopathy Related to Rapidly and Markedly Elevated Blood Pressure in Acute Stage of Hypertensive Cerebral Hemorrhage — Relationship to Hypertensive Encephalopathy — A Case Report
Authors: Shiokawa Osamu , Lau Alan H. C. , Sadoshima Seizo , Fujishima Masatoshi
Published: November 2007

A seventy-two-year-old man with hypertensive cerebral hemorrhage acutely developed severe headache, nausea, vomiting, agitation, and disorientation with abrupt rise in blood pressure on the sixth day after the onset. At that time, there were no remarkable changes in focal neurologic deficits, and repeated brain CT scans revealed a small hematoma located in the right basal ganglia without further enlargement or herniation. Blood chemistry and arterial gas analysis were within the normal ranges except for a slight rise in blood urea nitrogen. Similar episodes occurred three times within two days, and each time the cere bral symptoms disappeared in accordance with lowering of blood pressure by antihypertensive therapy. Complication of hypertensive encephalopathy was strongly suggested. The authors discuss the pathophysiology of this encephalo pathy in relation to cerebral hemorrhage.
Cardiac Lymphoma Associated with Superior Vena Caval Syndrome and Cardiac Tamponade: Case History
Authors: Hwang Ming H. , Brown Alan , Zhen En Piao  , Scanlon Patrick J.
Published: November 2007

A sixty-three-year-old patient with malignant histiocytic lymphoma of the heart presented with both superior vena cava syndrome and cardiac tamponade. A two-dimensional echocardiogram showed a large tumor mass in the right atrium and pericardial effusion with right ventricular compression. Superior and inferior vena cavagrams disclosed a lobulated tumor located in the right atrium that extended into and obstructed the superior vena cava. After the pericardial effusion was drained and the diagnosis was established, the patient was irradiated and given chemotherapy with resolution of the tamponade and superior vena cava obstruction.
Cyanosis and Raynaud's Phenomenon: The Relation to Underlying Disease and Venous Abnormalities
Authors: Engelhart Merete , Seibold James R.
Published: November 2007

Matched groups of 7 to 8 patients with primary Raynaud's phenomenon, systemic sclerosis, and undifferentiated connective tissue disease and cold tolerant normal control subjects were studied by simultaneous digital strain gauge plethysmography and laser Doppler capillary velocimetry during two controlled cycles of hand warming and cooling. Nailfold capillaroscopic assessments and measures of in vivo platelet activation were performed. Triphasic color changes were present in all patients with systemic sclerosis, in 6 of 8 with undifferentiated connective tissue disease, but in only 1 of 7 with primary Raynaud's phenomenon. The occurrence of cyanosis correlated with evidence of impaired venous volume by strain gauge plethysmography and with higher degrees of capillary loop architectural abnormalities. The authors conclude that the presence of digital cyanosis is indicative of connective tissue disease and related to evidence of impaired digital venous capacitance. This may underlie the frequent presence of edema in these patients and may be implicated in the pathogenesis of capillary loop abnormalities.
Large Arteries Involvement in Scleroderma—A Case Report
Authors: Alušík Štefan , Kováč Jozef , Peregrin Ján
Published: November 2007

The authors describe a thirty-nine-year-old woman patient presenting with progressive systemic sclerosis and an unusual angiographic picture of an impair ment of large arteries, which in their opinion is due to the primary disease. The review literature reports about similar arterial involvement in scleroderma.
Aortic Dissection with a Fistulous Communication into the Right Atrium: A Case Report
Authors: Vaidiyanathan D. , Meenakshi K. , Elangovan S. , Jayachandran J. , Chokalingam V. , Tajamul Hussain A. , Alagesan R.
Published: November 2007

A case of aortic dissection (type 1, De Bakey) with a rent into the right atrium (RA), diagnosed by echocardiography (echo) and confirmed by aortography, is reported. The patient presented with cardiac failure and a continuous murmur in the right second and third intercostal spaces. The patient has survived for two years with medical treatment.
Plethysmographic Evaluation of the Vascular Effects of Human Calcitonin Gene-Related Peptide in Man
Authors: Gennari Carlo , Nami Renato , Pecchi Silvio , De Franco Vincenzo , Panza Filomena , Pavese Giovanni
Published: November 2007

Calcitonin gene-related peptide (CGRP) is a neuropeptide with potent cardio vascular effects that include positive inotropic and chronotropic actions systemic vasodilation, and hypotension in animals and in man. The mechanism of action of CGRP is still, however, not clear, and in particular it is not known whether vasodilation by CGRP occurs by changes in cutaneous or in muscular blood flow, or both. The aim of the study was, therefore, to evaluate the cutaneous and muscular blood flow, at rest and after ischemic test, induced by an IV bolus 25 μg human CGRP infusion in 5 healthy normotensive volunteers, using a strain gauge plethysmographic procedure with venous occlusion. Human CGRP pro voked a transient but significant decrease in sistolic and diastolic blood pressure, associated with tachycardia, marked flushing, a significant increase in plasma noradrenaline, adrenaline, and cyclic AMP levels, and a slight, but significant, decrease in serum total calcium. Moreover, a significant increase in the carpal cutaneous blood flow at rest was observed, with no significant change in the lower extremity muscular blood flow at rest and after ischemic test. Finally human CGRP produced a significant increase in the venous partial 02 pressure and in the hematocrit and a significant decrease in the venous partial CO2 pressure.

The results of the present study confirm the acute cardiovascular and meta bolic effects of CGRP. In fact, hypotension, tachycardia, flushing, and the increased cutaneous blood flow indicate a systemic vasodilation by the neuropep tide, with a secondary sympathetic response, as documented by the augmented catecholamine and cyclic AMP plasma levels. Moreover, the plethysmographic study suggests a blood flow redistribution, from the muscular tissues to the cutaneous surface, with a relative lower oxygen uptake and CO2 release and a partial hemoconcentration phenomenon.

In conclusion, these results are in agreement with the hypothesis that the vasodilative action of human CGRP is stronger on the skin than on the muscles of the lower extremities, even if a concomitant involvement of other vascular beds such as the splanchnic territory, by CGRP, cannot be excluded.
Chronic Venous Insufficiency in Primary varicose Veins Evaluated by Plethysmographic Technique
Authors: Hirai Masafumi , Naiki Kenichi , Nakayama Ryu
Published: November 2007

Venous hemodynamics were evaluated by plethysmography in normal sub jects and patients with venous disorders of the lower extremity, to clarify the pathophysiology of chronic venous insufficiency (CVI) due to primary varicose veins. Expelled volume during five active dorsiflexions of the feet and venous recovery time were calculated to evaluate muscle pump efficiency and valvular competence. Limbs with CVI due to primary varicose veins showed a higher expelled volume and a more shortened refilling time than limbs with simple varicosities. With application of tourniquets, the refilling time normalized in limbs with CVI, as well as in limbs with simple varicosities. These results indicate that a high degree of venous congestion in the distal part of the calf and valvular incompetence of the superficial vein system might cause CVI due to primary varicose veins.
Emergency Arteriography in the Assessment of Penetrating Trauma to the Lower Limbs
Authors: Jebara Victor A. , Haddad Soha N. , Ghossain Michel A. , Nehmé Dolly , Aoun Noël , Tabet Georges , Ashoush Ramzi , Atallah Nagi G. , Boustany Fouad N. , Saade Bachir
Published: November 2007

One hundred emergency arteriographies (EA) were performed in 87 patients with lower limb trauma due to high-velocity missiles. Thirteen patients had bilateral injuries. In 79 cases, EA findings were positive and led to emergency surgery. In 76 cases an arterial injury was found and treated, a positive predic tive value of 96% (76/79). In the other 3 cases, no arterial lesion was found (3 false positives). Among the 21 patients with normal findings from angiography, 10 had surgical exploration because of high clinical suspicion of vascular injury. Arterial injury was found in 2 cases (2 false negatives). In 8 patients, arteriogra phy modified the surgical procedure. In the 11 remaining patients, clinical and echo Doppler follow-up results were normal, a negative predictive value of 90% (19/21). Sensitivity was 97%, specificity 86%, and accuracy 95%.

These data show that arteriography in stable patients is a safe and accurate procedure. It permits avoidance of unnecessary surgical exploration in selected patients and helps modify the surgical procedure.
Effects of Nitroglycerin and Diltiazem on Well-Developed Coronary Collateral Circulation in Conscious Dogs
Authors: Fujita Masatoshi , Mikuniya Atsushi , McKown Daniel P. , McKown Michael D. , Franklin Dean
Published: November 2007

The purpose of the present study was to compare the effects of nitroglycerin and diltiazem on coronary collateral circulation. Studies were conducted in 8 conscious dogs instrumented for the measurement of left circumflex coronary artery (LCCA) flow, subendocardial segment lengths in areas perfused by the LCCA, and left anterior descending coronary artery (LAD). Brief, repeated LCCA occlusions sufficiently developed collateral vessels for the resting metabolic requirement in the LCCA region. One week following the cessation of repeated LCCA occlusions, two-minute coronary occlusions with and without drug pretreatment were performed on separate days. The ischemic responses to coronary occlusions were not altered by diltiazem (50 μg/kg, IV), but nitroglycerin (5 μg/kg, IV) attenuated myocardial ischemia definitely. The authors conclude that nitroglycerin produces greater effects than diltiazem in attenuating myocardial ischemia in the collateral dependent zone when effects of each drug on systemic and coronary circulation were minimized by pretreatment with small doses.
Assessment of Flow and Oxygen Delivery to the Lower Extremity in Arterial Insufficiency: A PET-Scan Study Comparison with Other Methods
Authors: Depairon Michèle , Depresseux Jean-Claude , Petermans Jean , Zicot Michel
Published: November 2007

The authors studied muscular blood flow (F), oxygen consumption rate (R), and oxygen extraction fraction (E) in 5 patients suffering from severe intermit tent claudication (stage II). They applied the bolus technique of H2150 and 1502 with a detection by positron emission tomography (PET).

Tomograms were recorded at the greatest diameter of the calfs, at rest and ten minutes after a treadmill walk test leading to the development of ischemic pain in the affected extremity.

F and E data were compared with the values obtained by more usual methods, namely occlusive venous strain gauge plethysmography and femoral venous blood sampling.

During the study, these patients received naftidrofuryl, a vasodilatator drug, in an intravenous dose of 600 mg diluted in 250 mL saline infused over a six- hour period in a placebo-controlled, double-blind, crossover protocol (two con secutive experiments, a week apart).

The results showed that all blood flow values measured at rest and after ex ercise by PET were in close correlation (r = 0.71) with the plethysmographic findings. The agreement between the two methods of measuring blood flow was less obvious with an Altman's presentation of the data: there was a tendency to measure higher values with PET scan.

Concerning E, the correlation was poor at rest. After exercise, the values were more elevated with PET and no correlation was found with blood samples.

The authors found no significant effect of naftidrofuryl either on flow or metabolic data.