bluuebunny/crossref_metadata_2025 huggingface dataset:
Phosphodiesterase Type 5
Authors: Kass David A. , Champion Hunter C. , Beavo Joseph A.
Published: November 2007

Phosphodiesterase type 5A (PDE5A) selectively hydrolyzes cyclic GMP. Inhibitors of PDE5A such as sildenafil are widely used to treat erectile dysfunction, but growing evidence supports important roles for the enzyme in both the vasculature and heart. In disorders such as cardiac failure, PDE5A upregulation may contribute to a decline in cGMP and protein kinase G signaling, exacerbating dysfunction. PDE5A plays an important role in the pulmonary vasculature where its inhibition benefits patients with pulmonary hypertension. In the heart, PDE5A signaling appears compartmentalized, and its inhibition is cardioprotective against ischemia-reperfusion and antracycline toxicity, blunts acute adrenergic contractile stimulation, and can suppress chronic hypertrophy and dysfunction attributable to pressure-overload. In this review, we discuss the molecular biology, pharmacology, and physiology of PDE5A, mechanisms of vascular and cardiac regulation, and recent evidence supporting the utility of selective PDE5A inhibition for the treatment of cardiovascular disorders.
Editorial Comments
Authors: Emerson Edward C.
Published: November 2007

As a new policy of the Journal, the Board of Editors have decided to invite views of noted experts in the field of actual and controversial problems in vascular disease. These views will be presented as "special editorials."

These editorials do not necessarily reflect the consensus of the Board of Editors of the Journal, and the Board will make no efforts to impose its views on them. They are intended to present individual opinions from the leaders of our profession.

We will also invite and, if possible, provide a place in the Journal for the expression of opposite viewpoints.
The Treatment of Thrombophlebitis Without Anti Coagulation : Report of Five Cases
Authors: Grabois Martin
Published: November 2007

Five patients with active thrombophlebitis diagnosed by signs and symptoms, and confirmed by thermograms and venograms, were admitted to Moss Reha bilitation Hospital, Philadelphia, Pennsylvania. They all had relative or abso lute contraindications to anticoagulation (gastrointestinal and genitourinary bleeding, and deep decubitus ulcers). They were not treated by the conventional means of bed rest, warm soaks and elevation of the involved extremity. The treatment consisted of a full rehabilitation program, including range of motion, transfer and ambulation exercises. They were fitted with anti EM stockings, and the extremities were elevated when at rest.

The goal in treating thrombophlebitis should be early resolution of the condi tion, and prevention of pulmonary embolism. Bed rest leads to venous stasis, predisposes the patient to extension of the thrombus and increases the incidence of thromboembolism. Therefore, patients were mobilized immediately. Elastic stockings and elevation of the extremity have also been shown to increase venous flow, leading to a decrease in the formation and extension of the throm bus, and to a reduction of the threat of thromboembolism.

There was no evidence of thromboembolism in the five cases. Thus, an active program of exercise and ambulation, in addition to anti EM stockings and elevation of the extremity when at rest, is worth considering, even though thrombophlebitis has occurred and anticoagulation is contraindicated. This is especially true in a rehabilitation program where ambulation is a significant goal. Experiences with larger numbers of such patients would help to confirm this impression.
Aortic Insufficiency in Ehlers-Danlos Syndrome
Authors: Simon Armando P. , Stein Paul D.
Published: November 2007

A patient with Ehlers-Danlos syndrome (hypermobility of the joints, and hyperelasticity and fragility of the skin) associated with aortic regurgitation is reported. The aortic regurgitation appeared to be due to a combination of dilatation of the aortic ring and enlargement of the sinuses of Valsalva. Ehlers- Danlos syndrome is a rare cause of aortic regurgitation which occasionally, as in this patient, may be of clinical importance.
Cardiac Injuries
Authors: Tanga M.R. , Antani J.A. , Narasangi S.S. , Tanga M.R.
Published: November 2007

It is not always true to assume that all cardiac injuries have uniformly bad progno sis. If diagnosed early and treated properly, the results are rewarding. Four different types of cardiac injuries managed success fully are reported.
The Role of Angiography in the Management of Intestinal Carcinoid
Authors: Strasberg Z. , Hyland J. , Salem S. , Wilderspin K. , Tuttle R.J.
Published: November 2007

Carcinoid tumors of the intestine may present with bowel obstruction or with the carcinoid syndrome. Confirmation of the diagnosis by biochemical means is easy. Management is often surgical and a number of different procedures have been advocated, e.g. resection of the primary, hemicolectomy and lately, partial hepatectomy. The angiographic features of two cases are presented and discussed; the usefulness of the information so gleaned in the choice of management is stressed.
Deep Vein Thrombosis Treated With Streptokinase or Heparin
Authors: Seaman Arthur J. , Common Herbert H. , Rösch Josef , Dotter Charles T. , Porter John M. , Lindell Thomas D. , Lawler Lliam L. , Schlueter William J.
Published: November 2007

Randomly assigned streptokinase or heparin therapy was studied in 50 patients with deep vein thrombosis of less than 2 weeks' duration. Veno graphy was performed prior to therapy, after 3 days, and after 10 days. Two radiologists who were unaware of the patient's therapy compiled a single average lytic score for each patient at each time interval. Lysis of venous thrombi was significantly greater with streptokinase than with heparin after 3 days, but not after 10 days of treatment. Lytic scores achieved with streptokinase were significantly better than those achieved with heparin therapy (P < .01) in male patients who were symptomatic for 3 days or less. In females, regardless of the duration of symptoms, throm bolytic results obtained with streptokinase were not significantly different than results obtained with heparin.
Internal Bile Diversion—a New Model for the Study of Cholesterol Metabolism
Authors: Wilk P.J. , Karipineni R.C. , Danese C.A.
Published: November 2007

Biliary diversion in different ways has been studied as a prevention against induced hypercholesterolemia in experimental animals. A new model for the study of cholesterol metabolism is described in dogs in this paper. The technique consists in ligation and division of the common bile duct and interposition of an isoperistaltic loop of jejunum between the gallbladder and urinary bladder. This technique is free of complications such as diarrhea, infection, and peptic ulceration that are seen in other biliary diversion models, and it is tolerated well by the animals. This requires further study for its effectiveness in the prevention of experimental hy percholesterolemia and subsequent development of arteriosclerosis.
Isolated T Wave Alternans Progressing To QRS-T aLternation After Ventricular Defibrillation
Authors: Rowland Virginia , Lipschultz Ar-Thur , Benchimol Alberto , Desser Kenneth B.
Published: November 2007

A 54-year-old woman underwent re placement of a thrombosed Björk-Shi ley aortic valve prosthesis. Post oper ative electrical defibrillation resulted in isolated T wave alternation which progressed to total QRS-T electrical al ternans. This report represents the first description of such a phenomenon.
Double Mitral Valve
Authors: Ancalmo Nelson , Ochsner John L. , Mills Noel L. , King Terry D.
Published: November 2007

A case of double mitral valve orifice associated with atrioventricular canal was found at operation. These two anomalies are frequently associated. Double mitral valve is usually subclinical and does not necessarily need to be corrected, depending on the associated anomalies, the extent of the defect, and the personal experience of the surgeon. The embryology of double mitral valve is complicated and still needs to be clarified.
Arteriosclerotic Ulcer of Legs Without Occlusive Arterial Disease
Authors: Rosenberg Helmar G. , Müller Max V.
Published: November 2007

Twenty-one patients with arteriosclerotic ulcers of the legs are presented. All had normal blood pressure and had not a diabetic background, varicosities, or arteriosclerosis obliterans of the lower extremities. Histo logic examination is shown to be the best procedure for establishing the correct diagnosis. Changes in small arteries, between 100 and 300 microns in diameter, are characteristic. Two types of lesions were observed in these vessels: type I, consisting of hyperplasia of intima and media; and type II, consisting of enlargement and fibrosis of the intima and media. The type II lesion was found to be useful in separating arteriosclerotic ulcers from hypertensive ones, as well as from diabetic ulcers. The treatment consisted of local surgical resection and grafting. In five cases, because of multiple ulcers and/or severe dysthrophic skin changes, a sympatectomy was also performed.
Effect of Oral Contraceptives On Resting Blood Flow in the Leg
Authors: Gosling R.G. , Beasley M.G.
Published: November 2007

Resting blood flow in the leg was measured twice per week, by venous occlusion plethysmography, for two or more menstrual cycles in 11 nor mal female volunteers, 5 of whom were taking an oral contraceptive. Both groups showed a wide range of resting flow, with lowest values doubling or occasionally nearly trebling in any one menstrual cycle. In 1 subject a repeatable cyclic variation was found. The mean resting flow of the group taking oral contraceptives was found to be lower (0.1 < P < 0.2) and the range of flow values over the menstrual cycle smaller, than those of the subjects not using the pill. The lower flow values found for subjects on the pill suggests a possible mechanism linking use of oral contraceptives with the occurrence of venous thrombosis. However venous distensibilities estimated from plethysmographic observations indicate that the thrombo genic effect of low flow values may be offset by decreased distensibility, and hence it may be possible to maintain normal blood velocities.
Double-Outlet Right Ventricle With Long Survival
Authors: Skoulas Achilles , Franklin Robert , Cardelli Robert
Published: November 2007

A woman with an anomaly that fulfilled Lev's criteria for double-outlet right ventricle lived to the age of 51, an exceptionally long survival. This lesion is potentially amenable to surgical correction.
Reduction of Blood Flow Following Ischemia in Arteriopathic Patients: Reversion of the Phenomenon Induced By Propranolol
Authors: Rengo Franco , Chiariello Massimo , Paudice Giampaolo , Lavecchia Giuseppe , Condorelli Mario , Brevetti Gregorio
Published: November 2007

In most arteriopathic patients, the release of a transitory ischemia in the affected limb reduces blood flow, instead of increasing it as in normal subjects. In this study the effects of propranolol administration on this paradoxical response have been investigated. After rheographic tracings were recorded in 14 arteriopathic patients in the basal condition and in the postischemic period, 10 mg of propranolol was administered IV and the protocol was then repeated. The blood flow in the affected area, measured as Jantsch's index of the rheographic tracings, was 0.63 ± 0.04 in the basal condition and was reduced to 0.51 ± 0.05 (P < 0.001) in the postischemic period. When the ischemia was repeated after propranolol administration, Jantsch's index rose from 0.57 ± 0.04 to 0.85 ± 0.09 (P < 0.01). The reversion of the paradoxical response to the ischemia induced by pro pranolol administration suggests that the beta-adrenergic blockade can increase blood flow to the ischemic area, probably through a constrictive action on arterovenous connections.
Silent Coronary Artery-Left Ventricular Fistula: A Disorder of the Thebesian System?
Authors: Do Cha Se , Singer Edward , Maranhao Vladir , Goldberg Harry
Published: November 2007

Two cases with abnormal elec trocardiogram were found to have the unusual direct communication between the coronary artery and left ventricular chamber without any manifestations of the other reported coronary arterial fis tula.
Severe Cyanosis Due to Atrial Septal Defect and an Anomalous Inferior Vena Caval Valve
Authors: Laks Hillel , Ahmad Nasseer , Mudd J. Gerald
Published: November 2007

Uncomplicated atrial septal defect is often associated with mild arterial de saturation. A case is reported with severe cyanosis and life-threatening hypoxemia due to an atrial septal defect. Cardiac catheterization revealed normal right heart pressures and an atrial septal de fect with shunting of inferior vena caval blood into the left atrium. At surgery an anomalous inferior vena caval valve was found directing inferior vena caval blood into the left atrium. The embryologic basis for this association is discussed. The delayed onset of severe cyanosis may have been contributed to by the tho racic scoliosis.
Prognosis of Patients With Diabetes Mellitus After Endarterectomy of the Femoral Artery
Authors: Walter Paul , Parketta Peter , Heholein Fritz
Published: November 2007

The perioperative prognosis of 81 diabetic patients after endarterectomy of the femoral artery was analyzed by a computer program and compared to the prognosis of a control group of 83 nondiabetic patients. The percentage of fe male patients in the group with diabetes mellitus was 22% in comparison with 8% of the control group. Most of the diabetic patients in clinical degree II/III were approximately 10 years younger at the time of operation than the patients of the control group. Cardiac complications occurred in 16% of the diabetic patients and in 1% of the nondiabetic patients. The hospital mortality in the group with diabetes mellitus was 14%, significantly higher than the 6% mortality among patients of the control group (χ2 = 4.26). Clinical evaluation of the patients in both groups showed that the patency rate of the reconstructed vessels was 80%.
Accelerated Atrioventricular Conduction in Fabry's Disease: A Case Report
Authors: Rowe John W. , Caralis Dennis G.
Published: November 2007

Three unrelated men with Fabry's disease (angiokeratoma corporis diffu sum universale) and accelerated atrioventricular conduction are described. AQn His bundle electrogram in one patient who reported episodes of tachycardia demonstrated a prolonged deflection preceding the ventricular complex. This deflection is thought to represent an abnormal His bundle potential, possible resulting from glycolpid deposition. In the second patient the PR interval decreased from 0.18 to 0.11 second during 10 years, and in the third patient it decreased from 0.12 to 0.10 seconds during 13 years. Accelerated atrioventricu lar conduction may develop in Fabry's disease.
Diastolic Mitral Regurgitation in Patients With Hypertrophic Cardiomyopathy
Authors: Jamal Nasiruddin , Raizner Albert E. , Ishimori Tetsuo , Chahine Robert A.
Published: November 2007

An analysis of the left ventricular angiograms of 31 patients with hyper trophic cardiomyopathy revealed diastolic mitral regurgitation in 4, a preva lence of 12.9%. The clinical, echocardiographic, angiographic, and hemo dynamic data of these patients were reviewed. Diastolic mitral regurgitation could not be attributed to arrhythmia, PR interval prolongation, atrioventricu lar dissociation, aortic insufficiency, or aortic stenosis. Reduced left ventricular compliance was evidenced by elevated end-diastolic pressure following angiog raphy and reduced diastolic E-F slope on echocardiography. It is speculated that the rapid inflow of blood into a poorly compliant ventricle established a turbulent flow pattern that resulted in the "floating" of blood back into the left atrium.
Diastolic Flutter of Aortic Valves in Aortic Regurgitation: A Report of Seven Cases
Authors: Venkataraman Kalyanasundaram , Bornheimer J.F. , Pontius Steve , Sun June Kim  , Allen John W.
Published: November 2007

Seven patients with aortic regurgitation, manifesting diastolic flutter of the aortic valve cusps (DFAVC) in the echograms, are described. Five patients with infective endocarditis revealed coarse or fine, irregular DFAVC. Two patients with severe aortic regurgitation and a musical murmur manifested regular DFAVC with a frequency identical to that of a simultaneously recorded dias tolic murmur. Of the 5 patients with infective endocarditis, 4 required urgent aortic valve replacement and 1 died. The 2 patients with musical murmurs are clinically stable without surgery. This report extends the clinical spectrum of patients with DFAVC and describes the character of the flutter in patients with musical murmurs. Furthermore, it suggests that DFAVC is a sign of severe aortic regurgitation.
The Value of Exercise Stress Testing in Predicting Benefit From Aorto Coronary Bypass Surgery
Authors: Stuart Robert J. , Ziprick D.A. , Ellestad Myrvin H.
Published: November 2007

A total of 142 saphenous vein bypass patients who underwent pre- and postoperative treadmill stress tests were analyzed. The double product at the onset of ischemia improved in 15 of 25 females (68%) and 67 of 117 males (58%). In patients with a history of preoperative angina, 103 of 132 (78%) were relieved after operation, but only 81 of 132 (61%) improved their double product. In those with preoperative angina during treadmill stress testing, 48 of 79 (61%) improved. In patients without preoperative angina on treadmill stress testing, 40 of 65 (62%) improved their double product. When ST depression developed at a workload of 4 METS on the preoperative treadmill stress test, 54 of 87 (62%) improved. When ST depression developed at 6 METS, 20 of 34 (58%) improved their double product at the point of ischemia.

The patient's sex, angina during treadmill stress testing, and the workload associated with ischemia did not help identify those who would benefit from bypass surgery. Treadmill stress testing does demonstrate the disparity be tween symptomatic and functional improvement and provides an important parameter for evaluation of aortocoronary bypass.
Measurement of Arterial and Venous Reactivity by an Advanced Strain Gauge Plethysmograph
Authors: Hellige Gerhard , Baller Ensink D. , Prennschütz-Schützenau H. , Sigmund-Duchanova H. , Zipfel J.
Published: November 2007

The problems of applying mercury strain gauge venous occlusion plethys mography in quantitative measurements of high blood flow rates were studied in the extremities of humans and animals. The fast-acting ECG-controlled pneumatic Periflow system opens the possibility of measurements with reduced restriction of arterial inflow. In animal experiments the arterial inflow rate (about 0.25 vol%/min) during the arterial occlusion period was estimated by an indicator dilution technique. The accuracy of the perfusion rate estimation of a limb by plethysmography was tested in controlled perfused extremities of large dogs weighing about 60 kg. Strain gauges with different positions showed dif ferent—but for each filament quite proportional—relations to real values. The nonuniform venous capacities of the different segments of a limb, which have been shown by injections of a known volume and recording of pressure volume curves, may complicate blood flow measurements by volume displacements from low-compliance regions to high-compliance regions of the vein system. Estimations of the length resistance relation of mercury strain gauges agreed well with the theoretically expected function. If an inextensible part is inserted into the circumferential arrangement of the filament, a correcting calculation of volume changes is necessary.
Hypertension Detection and Compliance: Permanent Site Hypertensive Evaluation—A New Method of Increasing Patient Compliance
Authors: Hutchison James C.
Published: November 2007

Screening is successful in detecting hypertension, but reducing morbidity and mortality depends on achieving patient compliance. Cardiovascular disease has declined significantly since the thiazide diuretics have become generally available and provided effective and safe treatment of hypertension. More people are now aware of their blood pressure, and more hypertensive people are under treatment than ever before. Unfortunately many are not being treated— or if treated, they are not receiving adequate therapy.

After several years of experimentation in screening, the concept of per manent site hypertension evaluation with an automatic recording device was instituted in a pharmacy. Detection during the first year in 926 people revealed that 51 % were hypertensives. There were 17% with mild hypertension, 9% with moderate hypertension, and 25% under treatment. Those under treatment were assumed to be hypertensive—normal being considered 140/90, and hyperten sive 160/100. Those between were considered mild hypertensives. After the second year, 1726 people had been screened and hypertension was detected in 48%; 18% had mild hypertension, 10% had more severe hypertension, and 20% were being treated.

Compliance was measured in two groups of patients. Short-term compliance (up to 6 months) was measured in 441 patient revisits: initially 16% were normotensive, but on revisit after 6 months, 37% were normotensive—a reduc tion in mild hypertension from 52% to 33%. Long-term compliance (6 months to 2 years) was measured in 402 patient revisits: initially 19% were normotensive, and on revisit 32%—an increase in compliance with a reduction from 48% to 35% in mild hypertension.

A new method, permanent site hypertension evaluation with patient revisits, is suggested as a new way of increasing patient compliance. The presence of normotension is assumed to mean compliance. The easy availability of per manent sites may induce the patient to return regularly, or the patient may be testing the medication or his physician. Whatever the case, normotension is the aim of compliance.
The Usefulness of Theophylline in Nonasthmatic Airway Obstruction
Authors: Schmidt R. , Altschuler S.
Published: November 2007

This study evaluated the effectiveness of oral bronchodilator therapy using theophylline in patients with nonreversible chronic obstructive pulmonary dis ease. Twelve chronic obstructive pulmonary disease patients were entered into a doubleblind crossover study using either active drug theophylline in 200 mg capsules (Elixophyllin) or placebo for 3 months, followed by 3 months of the alternate capsule. At baseline and monthly visits, data were recorded, including history, physical examination, and pulmonary function testing.

Clinically, 7 of 11 patients responded favorably to theophylline, 3 were unchanged, and 1 improved on placebo. Comparison of each sign and symptom individually revealed no statistically significant differences. Pulmonary function (FEV1 and FVC) showed slight deterioration with placebo, but not with active drug therapy.

These findings suggest that nonasthmatic patients may improve clinically during theophylline therapy whereas their pulmonary function may deteriorate during placebo therapy.
Connective Tissue in Varicose Veins
Authors: Andreotti Lupo , Cammelli Daniele
Published: November 2007

The collagen, elastin, total sugar, and nonscleroprotein content was eval uated in 32 samples of saphenous varicose vein and in 34 controls. A signifi cantly lower collagen and elastin content was found in the varicose samples without correlation with the degree of pathologic broadening. Otherwise the total sugars and the soluble nonscleroproteins were found to be increased in varicose samples. The results are more significant when expressed as milligrams per surface unit of endothelium. Our data support the hypothesis that the decrease in collagen and elastin content is a primary rather than secondary change.
Serial Hemodynamic Studies During the Treatment of Congestive Heart Failure With Isolated Low-Dose Oral Prazosin Therapy
Authors: Reyns Philippe , Romney David , Desser Kenneth B. , Benchimol Alberto
Published: November 2007

Prazosin was administered orally at a maximal dose of 2 mg every 6 hours to 4 patients with congestive heart failure (CHF) who had not received either digitalis or diuretics for 72 hours before therapy. Three of the 4 patients had hypertensive and arteriosclerotic heart disease. Hemodynamic monitoring in dicated a significant reduction of preload and afterload with a concomitant rise in the cardiac index. We concluded that isolated low-dose oral prazosin has salutary effects on indices of hemodynamic function in selected patients.
Complication Rate of Power Coronary Angiography Injection
Authors: Koppes Gerald M.
Published: November 2007

From 1970 to 1975, 1,498 patients underwent coronary angiography at Wilford Hall USAF Medical Center via the same injection technique utilizing a Viamonte Hobbs automatic volume injector. Most institutions now perform coronary angiography by hand injections of contrast medium, and automatic power injection angiography is reserved for ventriculograms. The Sones technique was used in 822 patients (55%) and the Judkins technique in 676 (45%). Saphenous vein grafts were studied in 12% or 180 cases. The amounts of contrast medium usually used were 4 cc for right coronary artery injection and 6 cc for left coronary artery and saphenous vein graft injections over 2 seconds. No acute coronary artery dissections, one coronary occlusion (0.067%), one death (0.067%) in a patient with greater than 90% left main coronary obstruction, and three (0.20%) acute myocardial infarctions occurred. We conclude that power injection is a safe technique for coronary angiography. This technique is easier to use, could improve the quality of coronary angiography, and may actually be safer than hand contrast medium injection.
Coronary Ostial Stenosis
Authors: Mautner Richard K. , Phillips John H.
Published: November 2007

Coronary ostial stenosis as a complication of atherosclerosis is a rarely emphasized angiographic finding. Its recognition is important because of the adverse prognosis of left main stenosis and the inherent risks during catheterization of these patients. Recently 3 patients were identified with left coronary ostial stenosis. A clinical picture emerged during coronary angiography characterized by an abrupt fall in catheter tip pressure associated with symptoms of dyspnea and chest pain. Contrast media injections into the sinus of Valsalva, in right anterior oblique and left anterior oblique projections, revealed characteristic angiographic changes.
Recurrent Pericarditis Due to Cystic Teratoma of the Mediastinum: A Case Report
Authors: Aravanis Christ , Papasteriades E. , Steriotis J.
Published: November 2007

A case of a benign cystic teratoma of the anterior mediastinum and recurrent peri carditis is presented. The clinical, angiocar diographic, surgical, and pathologic findings are described. The cardinal clinical picture of long-standing recurrent pericarditis and the excellent surgical results make this case noteworthy.
Thoracic Outlet Arterial Compression: Prevalence in Normal Persons
Authors: Gergoudis R. , Barnes Robert W.
Published: November 2007

The prevalence of thoracic outlet compression of the subclavian or axillary artery was determined in both upper extremities of 130 normal individuals. Photoplethysmographic (PPG) recordings were made simultaneously in each index finger during performance of Adson, costoclavicular, and hyperabduc tion maneuvers. Significant arterial obstruction resulted from one or more of these maneuvers in 78 subjects (60%) and was bilateral in 43 individuals (33%). Thoracic outlet arterial compression is common in normal persons and thus has little diagnostic value in symptomatic patients.
Myocardial Infarction in a Young Woman With Systemic Lupus Erythematosus
Authors: Rosenthal Talma , Neufeld Henri , Kishon Yehezkiel , Yelin Oded , Many Amira
Published: November 2007

We describe the case of a young woman with systemic lupus erythematosus (SLE) who suffered an acute myocardial infarction (MI). The patient was treated by corticoste roids in addition to the usual management for acute MI. The role of arteritis in produc ing the infarction is also discussed.
Echocardiographic Determination of Septal and Left Ventricular Wall Motion in the Early Hours of Acute Myocardial Infarction
Authors: Kounis Nicholas G.
Published: November 2007

Interventricular septal and left ventricular posterior wall excursions and ve locities were determined by M-mode echocardiography in the early hours of acute myocardial infarction in 43 patients. In the group with anterior in farction, including 24 patients, the systolic septal excursion (SSE), systolic sep tal velocity (SSV), diastolic septal excursion (DSE), and diastolic septal velocity (DSV) were decreased ( P < 0.001). The posterior wall excursion during iso- volumetric contraction (B-C) and the mean systolic posterior wall velocity (PWVmean) were also decreased ( P < 0.02). The posterior wall excursion dur ing ejection (PWE) was not affected significantly.

In the group with inferior infarction, including 19 patients, the B-C excur sion was not significantly affected, but the PWE and PWVmean were dimin ished ( P < 0.001). The opposing healthy interventricular septum showed an in creased movement-compensatory hyperactivity.

These findings indicate that the acute myocardial ischemia which grossly af fects the mobility of the myocardium can be detected and determined in the early hours by M-mode echocardiography.
Plethysmographic Registration of Volume Changes in a Hand Vein Effects of Serotonin and of a Specific Antagonist
Authors: Jageneau A.H.M. , Hörig Ch. , Loots W. , Symoens J.
Published: November 2007

The influence of serotonin on a selected dorsal hand vein can be evaluated by changes in tangential wall tension, volume, and pressure. A plethysmo graphic method has been used to record the changes in venous capacitance at constant pressure after IV injection of small doses of serotonin.

R 41 468, a specific serotonin antagonist, has been given orally (10, 20, or 40 mg) or intravenously (2.5 or 10 mg) to healthy volunteers. A reduction or a complete blockade of activity of serotonin was observed after all doses of R 41 468. Duration and strength of the antagonism were dose-dependent.

This pharmacologic in vivo model allows investigations into substances with an effect on vascular smooth muscles.
Surgical Treatment of Aorto-Iliac Artery Disease
Authors: Chang John B.
Published: November 2007

In a period of 6 years, up to January, 1980, the author has treated 248 cases of aorto-iliac artery disease. There were 109 cases of abdominal aortic aneurysm, and the remainder was obstructive aorto-iliac artery disease. All but 20% of elective abdominal aortic aneurysms were asymptomatic. There were 100 cases of elective abdominal aortic aneurysm resection with operative mortality of 2%. There were 19 cases of ruptured aortic aneurysm with hospital mortality of 47%. There were 49 cases of aorto-femoral artery bypasses with 6th year cumulative patency rate of 89% in aorto-femoral bypass with Dacron graft, and 69% in aorto-iliac artery bypass with Dacron graft, and 2 year cumulative patency rate of 75% in descending thoracic aorto-femoral artery bypass with Poly Tetra Fluoro Ethylene graft. There were 32 cases of axillo-femoral artery bypasses and 48 cases of femoral- femoral artery bypasses. The 3 year cumulative patency rate of axillo-femoral artery bypass with PTFE graft was 89%, and that of femoral-femoral artery bypass with PTFE was 85%. However, axillo-femoral artery bypass with Dacron graft had 3-year patency rate of 67% and femoral-femoral artery bypass with Dacron graft was 62%. The 4 year cumulative patency rate of axillo-femoral artery bypass with Dacron graft was 39%. The 5 year cumu lative patency rate of femoral-femoral artery bypass with Dacron graft was 62%.
Effect of Manual Lymphdrainage Massage on Blood Components and Urinary Neurogormones in Chronic Lymphedema
Authors: Kurz W. , Kurz R. , Litmanovitch Y.I. , Romanoff H. , Pfeifer Y. , Sulman F.G.
Published: November 2007

In an earlier paper we have shown that manual lymph drainage massage of edematous limbs can result in the excretion of up to 1 liter urine derived from reabsorption and transport from the interstitial fluid, simultaneously with significant changes in the excretion of urinary neurohormones.1 These findings indicated that histamine and serotonin were released from the edematous tissue and that circulation improved through increased output of adrenaline and noradrenaline. The results achieved led us to assume that similar changes may have occurred in the blood during treatment, and induced us to study the effect of manual lymphdrainage on various blood constituents and urinary neurohormones.
The Antihypertensive Effects of a Pure and Selective Serotonin-Receptor Blocking Agent (R 41 468) in Elderly Patients
Authors: De Cree J. , Leempoels J. , De Cock W. , Geukens H. , Verhaegen H.
Published: November 2007

In a first experiment, an acute intravenous administration of 10 mg R 41 468, a pure serotonin-receptor blocking agent with high selectivity for blood vessels and thrombocytes and devoid of central effects, dramatically reduced systolic and diastolic blood pressure in 23 elderly hypertensive patients. Heart rate and cardiac output remained virtually unchanged.

In a second double-blind placebo-controlled cross-over study a highly significant decrease of systolic and diastolic blood pressure was obtained in 14 elderly hypertensive patients during an 8-day oral treatment with 40 mg t.i.d. of R 41 468. No serious side-effects were observed. An oral maintenance therapy with R 41 468 for 3 weeks showed a further reduction of blood pressure, resulting in a normalization of blood pressure, taking into account the advanced age of the patients.

R 41 468 most probably acts by decreasing the venous capacitance bed constriction. Essential hypertension might be causally related to an impair ment of venous function, in which serotonin might be an important pressor factor.
Correction and Monitoring of Postoperative Cerebral Vasospasm
Authors: Dalessandri Kathie , John James N. St. , Carson Stanley N.
Published: November 2007

There have been several case reports in which various hypertension-inducing regimens have been used in the treat ment of postoperative cerebral vaso spasm. Regimens have included the use of metaraminal bitarate, norepineph rine with intravascular volume expan sion, and high-dose dopamine with mannitol and volume expansion. Clini cal response has been very favorable. Our patient improved markedly after administration of dopamine and intra vascular volume expansion.

Little work has been done to docu ment vasospasm as the cause of the ischemia or to demonstrate increased cerebral blood flow following treat ment. We suggest that noninvasive Doppler flow velocity studies may be an ideal tool for the further assessment of these patients.
Protection by Flunarizine against Endothelial Cell Injury in vivo
Authors: Hladovec J. , De Clerck F.
Published: November 2007

Flunarizine in vivo protects against endothelial cell damage induced by intravenous injection of citrate, CaCl2, or lactate in rats. Its effect is optimal at the low oral dose of 0.1 mg/kg, corresponding to the clinically used one. It lasts for at least 8 hours. Edema formation, platelet activation, and venostatic thrombosis subsequent to endothelial cell injury consequently are also in hibited by flunarizine. The compound does not affect platelet function, plasma coagulation or generation of PGI2 by vascular tissue and does not impair normal haemostasis at effective doses. As for its vascular and hemor rheological effects, the protection by flunarizine against endothelial injury may be related to its Ca2+-antagonistic properties.
Platelet Aggregation in Patients With Moyamoya Disease
Authors: Maki Yutaka , Nose Tadao , Tanoue Kenjiro , Abe Tsukasa
Published: November 2007

Platelet aggregation was studied by giving ADP or adrenalin to 28 patients with Moyamoya disease. There were 7 males and 21 females, and 27 normal controls, 11 males and 16 females. We found that 2 μM of ADP, and 9.1 and 22.7 μM of adrenalin induced statistically significant increases in nondisso ciative patterns of platelet aggregation in the patient group. Maximum aggregation was significantly increased in the patient group compared with the controls by the addition of ADP (2 and 4 μM) or adrenalin (9.1 and 22.7 μM). When patients were divided into two groups under and over 20 years of age, there was no discernible difference of platelet aggregation in either group.
Persistent Left Superior Vena Cava and Associated Structural and Functional Considerations
Authors: Bunger Paul C. , Neufeld Daniel A. , Moore Josephine C. , Carter Guy A.
Published: November 2007

Potentially significant associations are presented between anomalous sys temic venous return (including both left superior vena cava and left hepatic venous drainage to the coronary sinus), a history of atrial fibrillation and a forme fruste of cor triatriatum in an elderly woman. Lack of associated structural defects or functional deficits makes it difficult to assess the frequency of occurrence in the general population of bilateral superior venae cavae in association with a persistent left hepatic vein draining into the coronary sinus. However, the potential for these systemic venous anomalies needs to be considered when unexplained arrhythmias are encountered. More specifically, the size of the coronary sinus needs to be assessed in patients with arrhythmia.
An Experimental Overview of a New Vasoactive Drug: Buflomedil HCl
Authors: Dubourg Alain , Scamuffa Robin F.
Published: November 2007

A brief review of the pharmacology, pharmacokinetics, and metabolism of buf lomedil-HCl is presented providing a phar macologic basis for buflomedil therapy of ischemia associated with peripheral vascu lar disease. Buflomedil is readily absorbed in the gastrointestinal tract and has a plasma half-life of approximately 2-3 hours. The para-desmethyl derivative of buflo medil has been identified as a urinary me tabolite. Pharmacologically, buflomedil in creases perfusion to impaired vascular beds of the microcirculation, increases arterial perfusion with minimal effects on central hemodynamics, exhibits apparent oxygen "sparing" effects in animal experiments, demonstrates inhibitory effects on platelet aggregation, and, in preliminary experi ments, appears to improve deformability of erythrocytes with abnormal fluidity. A non specific α-receptor blocking activity ap pears to be involved, at least in part, in these pharmacologic effects. The relative importance of these mechanisms/effects in the treatment of symptoms of vascular dis ease is unknown.
Fibrodysplasia of the Popliteal Arteries
Authors: Tisnado Jaime , Barnes Robert W. , Beachley Michael C. , Vines Frederick S. , Amendola Marco A.
Published: November 2007

Fibrodysplasia is a generalized arterial dysplasia of unknown etiology. We report a case involving both popliteal arteries. The patient presented with microemboli of the toes of both feet originating in the dysplastic popliteal arteries. The clinical significance of popliteal artery fibrodysplasia is briefly discussed.
Intracoronary Nitroglycerin Reversal of Life-Threatening Ergonovine Maleate- Induced Coronary Artery Spasm
Authors: Tanser P.H. , Stanton E. , Stolberg H.O.
Published: November 2007

Ergonovine maleate was given to a patient suspected as a case of Prinz metal's variant angina following dem onstration of normal coronary arteries by angiography. Profound shock, heart block, and severe pain accompanied marked spasm of the left coronary ar tery. Direct infusion of nitroglycerin into the left coronary artery reversed the spasm when sublingual and intra- aortic nitroglycerin failed to prevent further hemodynamic and clinical de terioration.
Small Arteries Supplying the Trabeculae Carneae Cordis
Authors: Burch George , Koepke Ronald
Published: November 2007

The arterial supply to the trabeculae carneae cordis in 13 randomly collected hearts was studied in detail by means of stereoroentgenograms of radiopaque-injected coronary arteries. Certain anatomic peculiarities of the small arterial vessels that supply the trabeculae carneae cordis are described. The concept that these small blood vessels may play a role in providing collateral circulation to the subendocardial myocardium is presented. Also, the possible contribution of these small trabecular arteries to the production of angina pectoris clinically in patients in whom angiocardiography reveals normal main coronary arteries is suggested.
Pitfall of Venous Occlusion Plethysmography
Authors: Knox R. , Cramer M. , Fell G. , Breslau P. , Beach K. , Strandness D.E.
Published: November 2007

The supposition that the lower limb expands uniformly in circumference during venous occlusion has been investigated. The 3 compartments of the calf were found to expand to differing degrees depending on the volume of muscle within the compartment. The effect of this phenomenon on the measurement of venous outflow and capacitance using an overlapping strain gauge was assessed. When using an overlapping strain gauge, the anatomical site of overlap was found to alter the measured values of outflow and capacitance by as much as 50%. These errors do not arise with strain gauges designed to fit a small range of limb circumferences, so that no overlap occurs.

The reproducibility of plethysmography may be enhanced by attention to the site and degree of overlap of gauges which are designed to fit all sizes of limb. Technicians performing venous occlusion plethysmography should be aware of these variations, so that the examination technique can be stan dardized.
The Use of Injectable Nitroglycerin in the Cardiac Catheterization Laboratory
Authors: Esente Paolo , Giambartolomei Alessandro , Gensini Goffredo G.
Published: November 2007

At our institution, injectable nitroglycerin (TNG) has been employed dur ing cardiac catheterization since 1976. Initially, it was primarily used in pa tients undergoing a provocative test for coronary spasm with ergonovine maleate. After the initial favorable experience, the use of injectable TNG became routine. 1,2
Automated Blood Pressure Recording: The Phenomenon of Blood Pressure Elevations During Speech
Authors: Malinow Kenneth L. , Lynch James J. , Thomas Sue A. , Friedmann Erika , Long Jack M.
Published: November 2007

The recent development of automatic non-invasive blood pressure devices has allowed the rapid and repeated assessment of both the blood pressure and pulse rate in the clinical setting. The development of this technology has allowed us to observe a striking relationship between human communication and blood pressure. Talking produces rapid increases in their systolic, diastolic and mean arterial pressures as well as pulse rate in both normotensive and hypertensive subjects. This phenomenon has been obscured by the conven tional assessment techniques of blood pressure measurement. Ignoring the pattern of verbal communication during the assessment of blood pressure can result in marked differences in recorded blood pressure and its interpretation.
Pharmacologic Effects of a Nitrate Coronary Vasodilator on Cardiac Perfusion and Function, Measured Semiquantitatively
Authors: Winsor David W. , Winsor Travis , Krohn Bernard G. , Bernett Jorge R.
Published: November 2007

The effects of a nitrate coronary vasodilator, Pentaerythritol Tetranitrate (Peritrate®), on perfusion and function of ischemic heart muscle were studied in six patients. Coronary angiograms were performed on all subjects, and a high degree of triple-vessel disease was present in all. Our studies were performed semiquantitatively by means of an image-processing computer [A2] and a gamma cammera. Perfusion of the myocardium was determined by thallium201 imaging after exercise. Selected areas of ischemic myocardium were chosen for study. Function of the myocardium was determined by technetium99 imaging with determination of total and segmental wall motion after exercise. A single-blind study with a placebo was performed. Significant increases in perfusion and function of ischemic areas occurred with Peritrate. For the perfusion studies for each patient observed, the myocardium was divided into four segments, A-B, B-C, C-D, and D-A. The two segments that had the poorest perfusion were chosen for study for each patient. For the function studies, the myocardium was again divided into the same four segments, A-B, B-C, C-D, and D-A. Two segments that were deficient in wall motion were chosen for each patient. In the perfusion study, of the twelve segments chosen from the six patients (two segments per patient) and in the function study, of the twelve segments chosen from the six patients (two segments per patient), nine segments of the perfusion study were similar to nine segments of the function study. An increase of perfusion and wall motion occurred with Peritrate in 8 out of 9 segments of similarity.
The Usefulness of Naftidrofuryl in Severe Peripheral Ischaemia—A Symptomatic Assessment Using Linear Analogue Scales
Authors: Meehan S.E. , Preece P.E. , Walker W.F.
Published: November 2007

The effect of **Naftidrofuryl (Nafronyl) on the symptoms of severe peripheral vascular disease has been studied in 40 hospital inpatients. Assess ment of ischaemic symptoms and of symptoms which may occur with any type of chronic pain was made using a linear analogue system. Patients treated with naftidrofuryl showed a significant symptomatic improvement compared to patients treated without vasoactive drug therapy. These results show that this drug has a useful place in the treatment of severe ischaemic symptoms during assessment for vascular reconstruction and in those patients found to be unsuitable for limb-salvage operations.
Coincidence of Cerebrovascular Accident and Silent Myocardial Infarction
Authors: Badui Elias , Estanol Bruno , Garcia-Rubi David
Published: November 2007

Although it is well known that a myocardial and a cerebral infarction may be coincident, the nature of this association is not clear. The problem is further complicated because the myocardial infarction may be silent. This is a report of 3 patients with cerebral infarct in whom a silent recent myocardial infarction was found. All patients with cerebrovascular disease should be screened for a possible myocardial lesion.
Anomalous Chordae Tendinae
Authors: Choo Maurice H. , Chia B.L. , Wu D.C. , Tan Arthur T. , Ee Bernard K.
Published: November 2007

A unique instance of an anomalous chorda tendinae visualized in the left ventricular outflow tract during M-Mode and two-dimensional echocardiog raphy, and subsequently confirmed during surgery for concomitant severe rheumatic valvular disease, is described. The M-Mode appearance can be confused with more serious forms of heart disease manifesting extraneous echoes in the outflow tract, and an approach to these echoes is described, based on a review of the literature.
Late Survival of a Patient With Ventricular Septal Defect and Eisenmenger Syndrome
Authors: Gould Lawrence , Gopalaswamy Chitra
Published: November 2007

A case of a 57 year old female with a large ventricular septal defect and delayed onset of Eisenmenger syndrome is presented. Possible explanations for the delayed onset of the Eisenmenger syndrome are discussed.
Hypoplasia of Descending Aorta As A Rare Cause of Hypertension A Report of 5 Cases
Authors: Bashour Tali , Jokhadar Moufid , Cheng Tsung O. , Nasri Marwan , Kabbani Sami
Published: November 2007

Five cases of hypoplasia of the descending thoracic and/or abdominal aorta as a rare cause of hypertension are presented. Similarities and dissimilarities between this lesion and classical coarctation of the aorta are discussed. Man agement of the resulting hypertension is usually medical, as surgical therapy is extremely difficult due to the diffuse involvement of the entire aorta and its branches.