bluuebunny/crossref_metadata_2025 huggingface dataset:
Equine Laminitis: A Potential Model of Raynaud's Phenomenon
Authors: Hood David M. , Amoss Max S. , Grosenbaugh Deborah A.
Published: November 2007

Raynaud's phenomenon (RP) and equine laminitis in the horse are medical enigmas. Clinical and scientific data were compared to evaluate the degree of similarity that exists between these two peripheral vascular diseases. Data indicate that certain pathologic and pharmacologic aspects seem to have common features. Some of the correlations maybe due simply to both diseases having ischemia of the distal digits as a pathologic component. The exact etiology of the ischemia is not known for either disease.

The results of this study suggest the hypothesis that RP and laminitis are the same disease in different species. This hypothesis can be tested more efficiently when the pathophysiology of both conditions is better documented. It is possible that comparative studies will promote advances in the understanding of both RP and laminitis. The fact that equine laminitis can be experimentally induced is of potential value in such future studies.
Effects of Insulin on Vasoconstrictor Responses to Alpha Agonist and Tilting
Authors: Yamamoto Masakazu , Asayama Kunio , Kanai Masanobu , Sugimoto Tatsuho , Yagi Shinji , Takata Shigeo , Ikeda Takayuki , Hattori Nobu
Published: November 2007

The effects of insulin on vasoconstrictor response were studied in diabetics without autonomic neuropathy.

Vasoconstrictor response to phenylephrine was measured before and after insulin injection in 10 diabetics. Mean blood pressure, forearm blood flow, and forearm vascular resistance remained unchanged after insulin administration. But the increase in forearm vascular resistance to phenylephrine decreased significantly and heart rate increased significantly after insulin injection.

In 9 diabetics, vasoconstrictor response to tilting was measured before and after insulin injection. Mean blood pressure, cardiac index, and the total peripheral resistance index remained unchanged after insulin administration. However, the increase in the total peripheral resistance index to tilting decreased significantly and heart rate increased significantly after insulin injection. Furthermore, a significant fall in mean blood pressure following tilting was observed only after insulin administration.

Although blood glucose levels decreased significantly, no hypoglycemic symptoms occurred.

The present study suggests that insulin inhibits vasoconstrictor responses to both alpha agonist and tilting in diabetics.
Marfan's Syndrome and Coarctation. Coincidence or Association? A Case Report
Authors: Kouvaras George , Goudevenos John , Adams Peter
Published: November 2007

The case of a patient with coexisting Marfan's syndrome and coarctation of the aorta is presented. The relevant literature is reviewed and the possible association between the two lesions is discussed.
Vertebral Artery Injuries Following Chiropractic Cervical Spine Manipulation —Case Reports
Authors: Raskind Robert , North Charles M.
Published: November 2007

Four patients undergoing cervical spinal manipulations for nonneurologic diseases and with no previous neurologic signs or symptoms all developed significant neurologic deficits, one fatal, following manipulations of the cervical spine. Both the literature and the authors' series show that a number of patients have a prodrome prior to the onset of neurologic changes. There is no established therapy for the syndrome. Perhaps prevention is the best means of reducing neurologic injury.
Serum Zinc Concentration in Acute Myocardial Infaction
Authors: Katayama Tomoyuki , Honda Yukiharu , Yamasaki Hidefumi , Kitamura Shinichi , Okano Yoko
Published: November 2007

The serum zinc concentration was examined in 61 patients with acute myocardial infarction who were admitted within twenty-four hours after the onset. Forty-two of 61 patients were admitted within twelve hours. The zinc level fell sharply as early as within three hours after the onset. The minimum values were attained two or three days after infarction and then rose to normal values within five to ten days. There was a mild degree of change and early recovery in 9 patients who underwent major abdominal surgery. The pathologic factors that could influence these two conditions are discussed. In those patients whose serum zinc concentrations were remarkably lowered, clinically estimated severity was far graver, and prognosis seemed to be much worse. It should be asked whether zinc supplementation would be of therapeutic benefit to patients with acute infarction.
Stenosis in a Coronary Collateral Artery—A Case Report
Authors: Van den Heuvel Paul , Van den Branden Frank , D'Heer Herman , Vandewoude Michel , Parizel Gaston
Published: November 2007

The coronary cineangiography of a man with an inferoposterior myocardial infarction is reported. An occlusion of the proximal right coronary artery and an occlusion at the origin passing around the left atrial wall of the circumflex artery was observed. A large collateral artery connected the right coronary artery and the distal circumflex artery. This vessel showed a significant stenosis of 70%. This case suggests that collateral arteries are not protected from atherosclerotic degeneration. Alternatively, since the exact caliber of the anastomosis before the occlusion of the recipient artery is not known, an extrinsic compression or kinking may have generated the stenosis at the time of the flow-related dilatation of the vessel.
Characteristics of the Limb Circulation in Hypertension
Authors: Solti Francis , Váradi Andrew , Iskum Nicholas
Published: November 2007

The aim of this study was to investigate the effect of hypertension on the regulation of limb circulation. The study group consisted of 50 patients suffering from hypertension; in 21 cases the peripheral circulation was intact, while 29 patients had peripheral obliterative arterial disease (POAD) (clinical symptoms: intermittent claudication or rest pain). The control group consisted of 67 nor motensive patients. In 33 subjects of the control group the peripheral circulation was intact, while 34 patients suffered from POAD (clinical symptoms: intermit tent claudication or rest pain). The total limb blood flow (LBF) was measured by using venous isotope dilution technique.

In hypertensive patients the limb vascular resistance (LVR) was markedly elevated, but the LBF remained in the normal range. In patients suffering from both hypertension and POAD the LVR was pathologically elevated and the LBF markedly diminished. After acute vasodilator therapy the LBF significantly increased, despite the drop in blood pressure owing to the extensive decrease of the LVR. It appears that in hypertension the elevation of the LVR is the most characteristic change of the limb circulation. The elevation of the arterial blood pressure has no favorable effect on the limb circulation, and the LBF compared with the blood pressure is relatively low.
Real-Time Ultrasound in the Diagnosis of Acute Deep Venous Thrombosis of the Lower Extremity
Authors: Habscheid Wolfgang , Höhmann Margarethe , Wilhelm Thomas , Epping Johannes
Published: November 2007

One hundred twenty-six patients with clinically suspected acute deep venous thrombosis of the lower extremity (DVT) were examined comparatively with ultrasound and venography. In total, 174 lower extremity venograms were obtained. Ultrasonic examinations were performed on patients in the supine position. The venous segments were evaluated almost exclusively with transversal scanning. In the thigh, the only criterion for DVT was the reduced or absent compressibility of the venous lumen when gently compressed with the transducer. In the calf, normal unobstructed veins can usually not be viewed in the supine patient, whereas thrombotic veins appear as sonolucent, incompressible channels.

Eight-three of the 174 lower extremity venograms were positive for DVT. In the majority of cases (53 of 83) the thrombotic process had involved two or more segments in combination. The sites of involvement of the different venous segments were distributed as follows: 24 occlusions of the common femoral vein, 52 of the superficial femoral vein, 56 of the popliteal vein, and 71 of the calf veins.

Ultrasound had a sensitivity of 100% for thrombosis of the common femoral vein, 96% for the superficial femoral veins, 98% for the popliteal vein, and 93% for the calf veins. For the entire lower extremity, in regard to the diagnosis of thrombosis, the overall sensitivity was 95%. In 90% the extension of the occlusion was foreseen correctly. In no cases were false-positive results reported. Thus the overall specificity was 100%.

The authors conclude that real-time ultrasound is a highly accurate method for the diagnosis of DVT of the lower extremity. It is the only indirect method capable of evaluating the venous system of the thigh, as well as that of the calf, with high accuracy. It should be the first choice of diagnostic imaging method in the diagnosis of deep venous thrombosis of the lower extremity.
Coronary Collateral Regression in Conscious Dogs
Authors: Fujita Masatoshi , McKown Daniel P. , McKown Michael D. , Franklin Dean
Published: November 2007

To study the effect of long-term coronary reperfusion on regression of newly developed collateral vessels, the authors reoccluded the coronary artery for ten minutes following one to fifteen weeks of reperfusion. They repeated one- or two-minute occlusions of the left circumflex coronary artery (LCCA) in 8 conscious dogs. After 401 ±202 (SD) minutes of total LCCA occlusion time (35 ± 19 days), the LCCA occlusion produced no sustained reduction in regional myocardial shortening and negligible reactive hyperemia. Upon reocclusion following a long-term reperfusion, the subendocardial segment shortening in the region at risk deteriorated markedly. At two minutes of occlusion, percent systolic shortening showed minimal values and thereafter gradually returned to the preocclusion resting levels within six to eight minutes of occlusion. In the presence of a resting heart rate similar to that at the time of functional recovery during the LCCA occlusion, long-term reperfusion did not modify the time course of regional functional response to the prolonged coronary occlusion. It is concluded that the newly developed collateral vessels still serve as significant blood-conveying conduits following a considerable period of reperfusion, and it requires approximately six to eight minutes to restore regional myocardial function in the collateral dependent zone following coronary reocclusion.
Underestimation of Treatment Effect in Crossover Trials
Authors: Cleophas Ton J. M.
Published: November 2007

In crossover trials each subject serves as his own control. For the study of cardiovascular diseases such as hypertension and angina pectoria, properly designed crossover studies are preferred to parallel studies. There is a consider able between-subject variability of symptoms in some of these conditions. Bias due to this is eliminated by the use of a crossover design. However, a problem is the so-called treatment-by-period interaction. The present study analyzes the potential influences of this on the outcome of the trial. Physical carryover effect, defined as a physical effect of the first treatment period carrying on into the second, tends to minimize differences between two consecutive treatment periods. So does the frustrating experience of an inactive agent in the first treatment period. Outside influences such as the change of the seasons may affect lengthy crossover trials in a similar way. The author concludes that the treatment effect in a crossover trial tends to be underestimated. The current concept that reports of clinical trials are generally biased toward an exaggeration of treatment effects does not seem to apply to crossover trials.
Does the Decrease in Heart Rate Prevent a Detrimental Decrease of the End-Systolic Volume during Central Hypovolemia in Man?
Authors: Sander-Jensen KÅre , Marving Jens , Secher Niels H. , Hansen Inge-Lis K. , Giese Jørn , Warberg Jørgen , Bie Peter
Published: November 2007

Central hypovolemia occurring with epidural anesthesia was investigated by measurement of hemodynamic and endocrine variables in 10 patients. Responses fell into two categories. Four patients experienced a hypotensive bradycardic episode after seventeen ± four minutes. In this group epidural anesthesia initially induced a tendency toward an increase in heart rate from 65 ± 4 to 73 ± 5 beats/min concomitantly with decreases in end-diastolic (172 ± 22 to 138 ± 16 mL), end-systolic (67 ± 12 to 51 ± 9 mL), and stroke (105 ± 10 to 85 ± 7 mL) volumes (radionuclide cardiography). A subsequent decrease in mean arterial pressure from 76 ± 3 to 67 ± 4 mmHg was associated with a decrease in venous return as reflected by the decrease in cardiac output from 6.1 ± 0.4 to 4.7 ± 0.7 L/min. In this situation when the venous return was critically reduced, the heart rate was 49 ± 4 beats/min and no further reduction in end-diastolic and end-systolic volumes was observed. The observed endocrine changes were compatible with a response to central hypovolemia. In the other 6 patients the reaction to epidural anesthesia did not induce statistically signif icant changes in hemodynamic and endocrine variables.

It is concluded (1) that the decrease in heart rate associated with central hypovolemia during epidural anesthesia seems to be elicited when the left ven tricular end-systolic volume is decreased by about 25% and (2) that a further decrease in end-systolic volume during progressive central hypovolemia is avoided possibly as a direct consequence of the slowing of the heart.
Chronic Arterial Occlusion with PGE1-Resistant Skin Lesions Treated by Glycosaminoglycan Compound—Case Reports
Authors: Nakashima Yasuhide , Segawa Jun , Kawashima Takashi , Fukuchi Yasunori , Kuroiwa Akio
Published: November 2007

The authors report on 2 patients with chronic arterial occlusion in whom the intravenous administration of the glycosaminoglycan compound FPFD 101 was markedly effective. One patient suffered from thromboembolic episodes of the left hand, and the other had peripheral circulatory impairment related to colla gen disease. In these patients, the oral administration of anticoagulants and antiplatelet agents in combination with intravenous infusion of prostaglandin E1 was not adequately effective. However, the addition of intravenous injection of FPFD 101 resulted in a marked improvement in their symptoms. FPFD 101, which has an anticoagulant effect and also inhibits platelet aggregation, seems to be useful for the treatment and prevention of chronic arterial occlusion when combined with drugs such as anticoagulants, antiplatelet agents, and vasodila tors.
Optimizing Heparin Utilization in Angiographic Flush Solutions
Authors: Glickstein Marc F. , McLean Gordon K. , Sussman Steven K.
Published: November 2007

Various concentrations of heparin in angiographic flush solutions are em ployed during angiography. In an effort to determine whether differences in outcome are seen when either high or low concentrations of heparin in an giographic flush solutions are utilized, two groups of patients were evaluated. There was no difference in outcome and a small systemic effect from heparin was seen in both groups. Use of a low concentration of heparin is suggested for routine angiography.
Simultaneous Measurement of All Thrombosis Parameters from Native Human Blood: Usefulness in Monitoring Efficacy and Complications of Thrombolytic Therapy
Authors: Kovacs Iren B. , Görög Peter
Published: November 2007

The sequelae of thrombus formation, both by shear forces and by collagen fiber, the subsequent coagulation, and the dislodgement of thrombi (thromboly sis) were measured from a small volume of nonanticoagulated blood sample, by a new instrument. Addition of streptokinase (SK) or tissue-type plasminogen activator (rt-PA) to the blood sample eliminated the need for anticoagulation for thrombolysis measurement: clot lysis preceded and allowed thrombolysis to occur. The test revealed activation of platelets and coagulation by SK and rt-PA. Apart from this general trend, platelet reactivity in response to plasminogen activator showed great individual variation. Whether the greatly enhanced (42 %) or prolonged hemostasis (13%), observed in different blood samples with rt-PA, could be used as a predictor of reocclusion or bleeding complications remains to be established. Thrombolysis did not occur in 12 % of the samples tested. These thrombolysis models may be useful for developing new agents for the dissolution of platelet-rich thrombi. It is suggested that this technique be used for monitoring thrombolytic therapy.
Circumferential Quantitative Analysis of Planar 201T1 Myocardial Scintigraphy in the Diagnosis of Coronary Artery Disease
Authors: Hung Guo-Long , Siegel Michael E. , McKay Charles , Chen David C.P. , Ansari A.N. , Arnstein Nelson B. , Lee Kai H. , Stewart Charles A. , Rahimtoola S.H.
Published: November 2007

Methodology for the computer analysis of 201T1 myocardial perfusion images has been developed by several laboratories. Substantial evidence of the advantage of this approach over visual inspection alone has been reported. The currently available computer analyses use different algorithms to analyze 201T1 kinetics in the myocardium. The authors evaluated and compared two widely used software programs, Medical Data System (MDS): a mean-count profile, and the Cedars Sinai (CS): a maximal-count profile, of planar 201T1 scintigraphy for their ability to detect coronary artery disease (CAD).
Conduction System Injury After Aortic Valve Dilation in the Dog Single- Versus Double-Balloon Catheters
Authors: Plack Raymond H. , Hutchins Grover M. , Brinker Jeffrey A.
Published: November 2007

The range of morbidity induced by valvuloplasty is not fully known, but transient conduction disturbances are common. The authors performed aortic valve balloon dilatation on 10 closed-chest dogs with normal aortic valves, using a femoral cutdown approach and fluoroscopic guidance. Four were done with a single 15 mm balloon catheter, and in the other 6 two 12 mm balloon catheters were used. Balloons were inflated to 5 to 12 atms pressure with contrast solution. After several inflations the dogs were sacrificed, the hearts removed and exam ined. Gross examination revealed subendocardial hemorrhage in the outflow tract in 5 of the 6 in which double balloons had been used. Microscopically, all aortic valve areas showed hemorrahage, mostly in loose connective tissues of the valve leaflets. The severity of injury appeared greater when two ballons had been used. Histologic examination showed definite injury to the myocytes of the left bundle branch in all 6 of the double-ballooned dogs, but in none of those subjected to the single-balloon procedure. During aortic valve dilation the only manifestation of conduction system injury was prolongation of the QRS complex in 3 of the 6 dogs in which a double-balloon catheter had been used. The results suggest that electrocardiographic conduction disturbances observed in patients undergoing aortic valvuloplasty may be the result of direct injury of conduction tissue and may be more likely to occur when larger balloons are used.
Coronary Artery Calcification Detected by CT: Clinical Significance and Angiographic Correlates
Authors: Masuda Yoshiaki , Naito Shigenori , Aoyagi Yutaka , Yamada Zenjyu , Uda Takehiko , Morooka Nobuhiro , Watanabe Shigeru , Inagaki Yoshiaki
Published: November 2007

Cardiac computed tomography (CT) to detect coronary calcification was performed on 161 patients undergoing coronary angiography for proven or suspected coronary artery disease. Among 108 patients in whom coronary calci fications was identified, 90% had significant coronary stenosis angiographically (>75% stenosis), and 80% of 121 patients with significant coronary stenosis showed calcification by CT.

The relationship between the calcification site and the significance in stenosis of each vessel was determined. Calcification was present in 133 arteries among 205 stenotic coronary arteries (sensitivity = 65%) as compared with 59 of 439 entire arteries with normal coronary angiograms (specificity = 87%). In the younger age group the sensitivity of calcification for stenosis of each coronary artery was lower and the specificity and predictive value were generally higher than those in the elderly group.

These results demonstrate that CT is a valuable procedure for detecting coronary arterial disease, since this examination is easy to conduct, noninvasive, and widely applicable for screeening a large population.
Microcirculation and Hemorheology in NIDDM Patients
Authors: Catalano Maria , Tomasini Maurizio , Annoni Massimo , Gherardi Elia , Scandale Giovanni , Galimberti Paolo , Porro Tomaso , Milanese Franco , Libretti Arnaldo
Published: November 2007

The authors studied 10 patients with non-insulin-dependent diabetes mellitus and 5 controls matched for age, sex, blood lipids, and smoking habit. The two groups were also comparable for hemorheologic characteristics as evaluated by viscosimetry on whole blood, plasma and serum, erythrocyte filtration and aggregation. The microcirculation was studied in the subjects of both groups by microalbuminuria determination, retinal fluorangiography, and capillaroscopic examination of the bulbar conjunctive and nail folds. None of the patients presented microalbuminuria values higher than the upper limit of normal (20mg/24h).

Fluorangiographic alterations were observed in 4 patients, and all 10 pre sented capillaroscopic alterations at the bulbar conjunctiva (microaneurysms, erythrocyte aggregates) and nail folds (more frequently of the fingers than toes). Similar alterations were detected in controls. Thus these abnormalities seem independent of hemorheologic values.
Efficacy of Low-Molecular-Weight Heparin in the Management of Intermittent Claudication
Authors: Mannarino Elmo , Pasqualini Leonella , Innocente Salvatore , Orlandi Ugo , Scricciolo Vito , Lombardini Rita , Ciuffetti Giovanni
Published: November 2007

Treating chronic arterial occlu sive disease with heparin is contro versial because of the risks associated with long-term anticoagulant ther apy. Low molecular weight (LMW) heparin (mw about 5000 Dalton), which selectively inhibits the Xa fac tor with minimal risk of hemorrhage, seems to offer new possibilities in the prevention and treatment of both ve nous and acute arterial thromboem bolism.

Therefore, 44 patients with inter mittent claudication were recruited to a randomized, double-blind, con trolled study. Twenty-two were treated for six months with a single daily subcutaneous dose (15,000 UaXa) of LMW heparin and 22 with placebo administered in the same way over the same period of time.

After six months, LMW heparin treatment not only improved walking capacity (by lengthening the pain- free walking time by 25 %) but also significantly modified the hemor rheologic pattern (by reducing fibrin ogen concentrations and whole blood viscosity at low shear rates). LMW heparin also exerted an anti thrombotic and profibrinolytic effect by significantly increasing both the anti-Xa factor and plasminogen ac tivity without markedly modifying activated partial thromboplastin time ( + 20 %). No LMW heparin- treated patient hemorrhaged or re ported other noteworthy side effects.

These results suggest LMW hepa rin might be a useful drug in the long- term treatment of chronic arterial occlusive disease of the limbs.
Human Atherosclerotic Coronary Artery Xenografts: A Model for Investigation of Transluminal Recanalization
Authors: Weber Helmut , Ruprecht Lutz , Enders Susanne
Published: November 2007

A model for testing transluminal recanalization techniques was developed. Fragments of human atherosclerotic coronary arteries were transplanted into carotid arteries of dogs and evaluated by angiographic, angioscopic, and histo logic study within a three-month period. An inflammatory response was most intense within the first week. By two weeks no inflammation was noted. Total occlusion (n = 13) and stenosis (n = 11) of the carotid arteries were achieved without complications. The model is easy to produce within a short period and the arterial occlusion resembles human vascular disease. This model has been used to evaluate laser recanalization of vascular obstructions.
Neuropeptide Y- and Vasoactive Intestinal Polypeptide-Containing Nerve Fibers in the Human Cerebral Arteries: Characteristics of Distribution
Authors: Kawamura Koji , Sakata Noriyuki , Takebayashi Shigeo
Published: November 2007

Perivascular innervation in cerebral arteries from 28 human fetuses at twelve to twenty-eight weeks' gestational age was studied histochemically. Neuropeptide Y (NPY)- and vasoactive intestinal polypeptide (VIP)- containing nerve fibers were densely distributed along with adrenergic and cholinergic nerve fibers in the major pial arteries at the base of the brain, an area that forms the circle of Willis, and in the lenticulostriate arteries. In contrast, distribution was sparse in the cortical circumflex branches of the middle cerebral artery, as compared with findings in the lenticulostriate artery of the same diameter.

Densely distributed perivascular nerve fibers in the lenticulostriate arteries may play an important role in the pathogenesis of intracerebral hemorrhage.
The Role of Intracaval Filters in Patients with COPD and DVT
Authors: Pomper Stuart R. , Lutchman Gordon
Published: November 2007

A retrospective study of the Coney Island Hospital experience with Greenfield filters over a five-year period was undertaken. During this period, a total of 78 intracaval filters were placed in 76 patients. The patients' charts were reviewed for (1) indication for Greenfield filter placement, (2) complications of the proce dure, (3) associated medical problems, and (4) follow-up information.

The data revealed one statistically significant subpopulation within the group that had particularly poor survival statistics after intracaval filter insertion. These were patients who had a pulmonary embolism and also had chronic obstructive pulmonary disease (COPD). Considering the low morbidity associ ated with this procedure, it is the author's feeling that prophylactic intracaval filters in patients with deep vein thrombosis and COPD may be warranted.
Pheochromocytoma with Electrocardiographic Change Mimicking Angina Pectoris, and Cyclic Change in Direct Arterial Pressure—A Case Report
Authors: Murai Kayoko , Hirota Kazuyoshi , Niskikimi Toshio , Kawarabayashi Takahiko , Yoshiyama Minoru , Yasuda Mitsutaka , Teragaki Masakazu , Akioka Kaname , Oku Hisao , Takeuchi Kazuhide , Takeda Tadanao
Published: November 2007

A forty-two-year-old man was admitted because of chest pain. Electrocardio grams at admission showed horizontal ST depression in leads, II, III, aVF, V4, V5, and V 6. Direct blood pressure monitoring revealed cyclic change between 160/100 mmHg and 70/50 mmHg and heart rate between 80/sec and 120/sec at fifteen minute intervals. The plasma norepinephrine and epinephrine concentrations were elevated during the episodes of hypertension. Pheochromocytoma was found in the right adrenal gland. These cyclic changes in blood pressure and heart rate are an aid for diagnosis.
Downslope Claudication in Eosinophilic Fasciitis: A Fourth Type of Claudication—Case Presentations
Authors: Naschitz J.E. , Yeshurun D. , Misselevitch Ines , Boss J.H.
Published: November 2007

Two patients who presented with discomfort in the calves while walking down a slope were diagnosed as suffering from eosinophilic fasciitis of the lower limbs. Following therapy of the underlying disease, this peculiar discomfort remitted concomitantly with the disappearance of the subcutaneous abnormalities. The authors posit that downslope claudication of the calves in eosinophilic fasciitis constitutes an additional variant of claudication of the lower limbs.
Diabetes Mellitus and Localizations of Obliterating Arterial Disease of the Lower Limbs
Authors: Rubba Paolo , Leccia Giovanni , Faccenda Fulvio , De Simone Biagio , Carbone Luciano , Pauciullo Paolo , Vaccaro Olga , Mancini Mario
Published: November 2007

Thirty patients with intermittent claudication (IC) and treated diabetes melllitus and 30 age- and gender-matched nondiabetic claudicants underwent a vascular examination by noninvasive ultrasound methods (continuous-wave Doppler, duplex scanner).

The ankle/arm systolic pressure index did not differ in the two groups. Diabetic patients with IC had more (p < .001) non-flow-reducing stenoses (lumen reduction < 50%) and fewer (p <.002) flow-reducing obstructions (lumen reduc tion > 50 % ) of the iliac arteries than nondiabetics had. These data are consistent with a preferentially distal (below the inguinal ligament) localization of arterial stenoses in diabetic patients, whereas iliac artery diseases are relatively more severe in nondiabetics.
Age-Related Changes in Red Blood Cell Lipids
Authors: Prisco Domenico , Rogasi Pier Giorgio , Paniccia Rita , Abbate Rosanna , Gensini Gian Franco
Published: November 2007

Red blood cell (RBC) lipid composition was investigated in 81 healthy subjects aged twenty to sixty-nine years, having similar dietary habits, and living in the same geographic area in order to search for changes referable to aging. A significant increase in RBC cholesterol and total phospholipid content with aging was found (p<0.001), whereas no differences were observed in cholesterol/phos pholipid molar ratio. Significant increases in palmitic acid 16:0 esterified in phosphatidylcholine and in stearic acid 18:0 esterified in phosphatidylethanolam ine (p<0.001) were observed with aging. Moreover, a decrease in 18:2 n6 was observed in all three phosphoglyceride fractions investigated (p<0.001). These results suggest that modifications in RBC lipid composition occur with aging, possibly causing a reduction of membrane fluidity.
Efficacy of Ketanserin in the Therapy of Raynaud's Phenomenon: Thermometric Data
Authors: Arosio Enrico , Montesi Germana , Zannoni Massimo , Perbellini Luigi , Paluani Francesca , Lechi Alessandro
Published: November 2007

After a two-week washout (WO) period with placebo 1 capsule/ bid, 12 patients suffering from stable Raynaud's phenomenon were treated with ketanserin (K) 40 mg/ bid for fifteen days. Blood pressure, heart rate, and laboratory parameters were evaluated at the end of each period. Patients used diary cards to record the number, duration, and intensity of attacks. Computerized thermometry of the fingers was evaluated at basal temperature after acclimatization, 23°C for thirty minutes; after cold test, 10°C for five minutes; and after thermal recovery, 23°C for eighteen minutes. Results were analyzed statistically by use of Student's t-test for paired data (p<0.05). No marked changes were observed in the symptoms of the attacks, but K proved effective in significantly reducing the number and duration of daily attacks and in promoting their spontaneous regression. Thermometry revealed a parallel increase in temperatures, particularly basal and recovery values. The data suggest increased flow and decreased vasospasm following 5-HT2 receptor blockade.
Pentoxifylline in the Treatment of Vascular Impotence— Case Reports
Authors: Allenby Kent S. , Burris James F. , Mroczek William J.
Published: November 2007

Vascular impotence is a common medical problem for which available therapies are limited. Three impotent patients observed in the authors' practice who were receiving pentoxifylline for treatment of claudication of the lower extremities spontaneously reported improved sexual function. A controlled trial of pentoxifylline for vascular impotence may be warranted.
Cervical Bruits: Clinical Correlates of Stenosis
Authors: Goldman Linda , Koller Richard L. , Lebow Steven S. , Loewenson Ruth B. , Anderson David C.
Published: November 2007

To analyze the relationship among characteristics of buits, degree of under lying stenosis, and neurologic symptom complexes, the authors studied 157 patients with bruits undergoing digital subtraction angiography. Symptom status assignment (definite lateralizing, possible lateralizing, vertebrobasilar, diffuse, and asymptomatic) and cervical auscultation for location, duration, and other bruit characteristics were performed independently. Bruit occurrence was asso ciated with stenosis of ≥50% of the underlying vessel with the association being no stronger at higher levels of stenosis (≥80%). No relationship existed between the side of bruit and side of symptoms in those with lateralized symptoms. The authors found more severe degrees of carotid stenosis in two symptomatic groups (vertebrobasilar insufficiency [VBI] and definite lateralized) compared with asymptomatic patients. Those with VBI had more high-grade stenosis, whereas those with lateralized symptoms had more occlusions, which tended to be ipsilat eral to the symptoms.
Physical Training and Antiplatelet Treatment in Stage II Peripheral Arterial Occlusive Disease: Alone or Combined?
Authors: Mannarino Elmo , Pasqualini Leonella , Innocente Salvatore , Scricciolo Vito , Rignanese Antonio , Ciuffetti Giovanni
Published: November 2007

The efficacy of physical training alone or combined with antiplatelet thera py (dipyridamole and aspirin) was studied in 30 patients with stage II peripheral arterial occlusive disease (PAOD).

Patients were randomly allocated to one of the following groups: Group A— dipyridamole 75 mg three times daily and aspirin 330 mg once daily: Group B— physical exercise; Group C—physical exercise and dipyridamole 75 mg three time daily and aspirin 330 mg once daily.

After six months' treatment the pain-free walking time (PFWT) and the max imum walking time (MWT) improved significantly (p < 0.05) in all three groups. In group A the PFWT lengthened by 35% (from 101.00 ± 34.56 to 137.32 ± 40.50 s) and the MWT by 38% (from 150.34 ± 55.60 to 207.26 ± 60.67 s); in group B the PFWT lengthened by 90% (from 90.65 ± 40.54 to 171.45 ± 55.60 s) and the MWT by 86% (from 145.39 ± 60.50 to 270.63 ± 63.61 s). When physical exer cise was associated with drugs as in group C, the PFWT lengthened by 120% (from 89.51 ± 43.89 to 196.72 ±51.73 s) and the MWT by 105% (from 160.43 ± 59.84 to 329.05 ± 63.96 s). No significant variations were observed at any stage of the study in the ankle/arm pressure ratio at rest and after standard treadmill exercise, in the plethysmographic rest and peak flows, or in the trans cutaneous oxygen pressure in basal conditions and in its half recovery time after an induced ischemia.

The results confirm the benefits of regular exercise in stage II PAOD pa tients but suggest they may be enhanced by antiplatelet therapy.
Quantitation of Early Myocardial Ischemia Using Acridine Orange Fluorescence — an Experimental Study
Authors: Sabherwal U. , Chopra P.
Published: November 2007

It has been observed in the present investigation that ischemic myocardium consistently produces bright green fluorescence after Acridine Orange (AO) staining. The area of ischemia in the left ventricular myocardium at different time intervals after onset of experimental ischemia has been calculated by us of this AO fluorescence technique. Zonal distribution of ischemia in the epicardial, middle, and endocardial zones has also been evaluated quantitatively from ten minutes to six hours after ligation of the anterior descending branch of the left coronary artery in the Wistar strain of albino rats. No similar study was available for comparison from the literature reviewed.

The total area of left ventricular ischemia showed an increase with the prolongation of duration of coronary ligation from 13.39 ± 2.69 mm2 at ten to twenty-five minutes to 32.99 ± 5.69 mm2 at six hours after ligation.

Statistical analysis of the zonal area of ischemia has shown that ischemia in the middle and endocardial zones was greater than that in the epicardial zone at all time intervals recorded. Middle zone ischemia extended over a larger area than that over the endocardial zone at all intervals except at intervals II (30-45 min), IV (2-2½ hrs) and V (3-4 hrs).

The results of this experimental investigation are significant for these point to the value of Acridine Orange fluorescence in detecting early myocardial ischemia and in demarcating zonal differences in ischemia. The authors have successfully utilized the method in a few human cases of clinically suspected myocardial infarction and recommend the technique for routine use to detect early human myocardial ischemia.
Striking CT Scan Findings in a Case of Unilateral Moyamoya Disease—A Case Report
Authors: Shin In-Sook J. , Cheng Raymond , Pordell Gholam R.
Published: November 2007

The authors report striking CT scan findings in a young woman with unilateral Moyamoya disease. Serial CT scans showed features that paralleled the clinical and pathophysiologic evolution of the disorder, in much the same way as has been reported in studies using serial angiograms.
Effect of Variation in Heart Size on Quantitative Thallium SPECT
Authors: Quint Roger I. , Rehr Roger B. , Pippin John J. , Tatum James L.
Published: November 2007

Quantitative single-photon emission tomographic (SPECT) thallium 201 (201Tl) cardiac studies are frequently used to improve test accuracy. One common technique uses polar mapping of relative tracer distribution to compare patient data to emplates from "normal" patient data. Commercial software does not correct for cardiac size variations. This study's purpose was to determine the effect of uncorrected variations in heart size on the variance of the normal population, which is the basis of template significance levels. Twenty-one male volunteers with low probability (< 5%) for coronary disease underwent SPECT-Tl stress test. Data analysis with and without size correction was performed. Data were corrected for size by use of a three-dimensional compression/expansion algorithm. Quantitative data were generated by radial search to maximum activity in short-axis reconstructions. The mean activity and its variance was calculated from 288 points encompassing the myocardium. Mean and variance differences were analyzed by paired t test. There was no difference in activity means (pT > .9), indicating that size correction does not distort the data. The corrected data had, however, significantly lower variance (pT < .0001). This shows that ventricular size variation contributes significantly to "normal" template variance and may adversely affect diagnostic accuracy in the absence of volume correction.
Detection of Deep Vein Thrombosis: Combined Flow and Blood Pool Radionuclide Venography vs Contrast Venography
Authors: Caner Biray , Ozmen Mustafa , Dincer Alp , Kapucu Ozlem , Bekdik Coskun
Published: November 2007

This study was performed to validate the combined study of flow radionuclide venography (FRV) with subsequent 99m Tc-red blood cell(RBC) blood pool ra dionuclide venography(BRV) for the detection of deep vein thrombosis (DVT). Findings in 32 patients with suspected DVT of lower extremities (n = 52) were compared with those of corresponding contrast venograms (CV) serving as a refer ence method. FRV was performed by using three separate doses of a large 99mTc04-bolus (10-12 cc) injection. The findings were as follows: concerning the detection of DVT in calf veins, agreement between FRV and CV, FRV $BRV and CV, and BRV and CV were 67%, 73% and 60%, respectively. For femoral veins, agreement between FRV and CV was 96%, while it was 87% between BRV and CV. When FRV and BRV of femoral veins were evaluated in combination, 100% agreement between radionuclide and radiologic methods was observed. For ili ac veins there was no disagreement in comparison of the methods either singly or in combination. In 7.6% of the extremities, collaterals not demonstrated by CV and BRV were visualized only by FRV. Although the radioactive agent was injected in a relatively large volume, all of the calf veins could not be filled even when they were completely patent. It was concluded that a combined study of FRV with BRV improved the diagnostic value of radionuclide venography for the detection of DVT in calf and femoral veins.
Ventricular Tachycardia as a First Manifestation of Right Ventricular Myxoma—A Case Presentation
Authors: Badui Elias , Cruz Humberto , Almazan Arturo , Enciso Roberto , Soberanis Napoleon , Garcia Romeo
Published: November 2007

The authors present a case of a thirty-nine-year-old white man in good health who developed episodes of ventricular tachycardia as a first manifestation of a right ventricular myxoma, which was diagnosed by two-dimensional echocardio gram and then resected with no complications and total disappearance of the cardiac arrhythmia.

After reviewing the literature they consider the present case as a rare manifesta tion of an infrequent location of an uncommon disease.
Angioscopy in Endovascular Surgery: Recent Technical Advances to Enhance Intervention Selection and Failure Analysis
Authors: Diethrich Edward B. , Yoffe Boris , Kiessling J.J. , Santiago Osvaldo , Bahadir Ilhan , Stern Larry A. , Lavine Daniel
Published: November 2007

Recent technical and procedural modifications have greatly enhanced the usefulness of angioscopy during angioplasty. A pulsed irrigation system, proximal and distal blood flow control by pressure, and attention to sheath/vessel diameter ratio were incorporated into a study in which angioscopy was used for pretreatment assessment in 23 patients with symptomatic peripheral vascular disease presenting for initial (8 patients) evaluation or repeat treatment (15 patients) following a previous vascular procedure. Twenty-five lesions were examined with a 2.3 mm flexible angioscope equipped with an irrigating lumen; there were no complications attributable to angioscopy.

The angioscope was useful in the characterization of lesions for selection of the recanalization technique. Lesions more amenable to initial atherectomy were visualized in 12 patients; 7 occlusions were successfully treated with laser/balloon angioplasty, with angioscopy assisting in probe and/or wire passage in 4 cases. Three late reocclusions were identified angioscopically as due solely to thrombosis, indicating the need for thrombolytic therapy. Angioscopy also identified 4 cases of incomplete recanalization despite a satisfactory arteriographic image.

Angioscopy was also used to evaluate stenotic lesions unaccompanied by thrombus formation in patients previously treated with laser-assisted angioplasty. Histologic evaluation of the biopsied plaques identified intimal hyperplasia as the etiology, matching identically similar specimens harvested from a lesion treated with balloon dilation only.
Cerebral Ischemia Due to Congenital Malformations of Brachiocephalic Arteries—Case Reports
Authors: Savastano Sergio , Feltrin Gian Piero , Chiesura-Corona Matteo , Miotta Diego
Published: November 2007

Seven cases of congenital anomalies of brachiocephalic arteries are presented ; malformations include unilateral absence of the internal carotid artery (ICA) (n = 3), unilateral hypoplasia of the ICA (n = 2), agenesis of the innominate artery (n =1), and atresia of the subclavian artery (n =1). All patients but 1 exhibited symptoms of cerebrovascular insufficiency at the time of radiologic investigation; they were not affected by other cardiovascular malformations, except right aortic arch in 2 cases and left cervical arch in another case. Two patients suffering from congenital subclavian steal syndrome underwent surgery to correct the vascular malformations. Embryogenesis and natural history of such malformations are briefly discussed.
A Serial Observation of Coronary Thrombi in Vivo by a New Percutaneous Transluminal Coronary Angioscope
Authors: Mizuno Kyoichi , Miyamoto Akira , Isojima Kazushige , Kurita Akira , Senoo Akira , Arai Tsunenori , Kikuchi Makoto , Nakamura Haruo
Published: November 2007

This study was undertaken to observe coronary thrombus formation serially from an antegrade perspective by means of a new thin flexible angioscope that has an inflatable balloon at the distal tip and an angulation mechanism.

To test its capabilities, thrombi were induced in the left anterior descending coronary artery of 11 dogs by copper coils, and the thrombi were then observed through this angioscope, which had been introduced into the coronary artery by a guide catheter. Five minutes after insertion of the copper coil, fibrin-like material and white components of the thrombi were seen massing around the copper coil. Then, thin, mixed thrombotic white and red components formed around the copper coil. At fifteen minutes after the copper coil insertion, the thrombi grew in size. Ten minutes later, the thrombi finally obstructed the coro nary lumen in most dogs.

The red and white appearance of these thrombi was confirmed macroscopi cally, and the microscopic findings of these occluding thrombi revealed a fibrinous network with platelet aggregates and blood cell coagulation. Though ordinary angiography cannot reveal the precise features of the various coronary thrombi, this new angioscope was able to discern them from the antegrade perspective.

The capabilities of this angioscope, which enabled these findings, should prove helpful in evaluating the stages of human coronary thrombosis. Of additional benefit, this angioscope can be used clinically for cardiac catheterization.
Examination of Raynaud's Phenomenon in Traumatic Vasopastic Disorders
Authors: Duprez D. , De Buyzere M. , Vandenbroeck P. , De Meester M. , Lamon M.C. , Clement D.L.
Published: November 2007

Certain types of occupation-related vibrations can cause traumatic vasospastic disorders. Findings from clinical examination are often normal at the office con sultation. Measurements of finger blood flow using plethysmography while the local ambient temperature is changed can give important information about the severity of traumatic vasospastic disorder and the concomitant disability. This technique can also be used for follow-up of the finger blood flow after with drawal from vibrations.
The Role of Blood Perfusion and Tissue Oxygenation in the Postischemic Transcutaneous pO2 Response
Authors: Slagsvold Carl-Erik , Stranden Einar , Rosén Leif , Kroese Andries J.
Published: November 2007

The transcutaneous pO2 (TCpO2) response following release of tourniquet cuff occlusion is expressed as oxygen reappearance time (ORT) and oxygen recov ery index (ORI). In the present study the effects of blood perfusion and tissue oxygenation on ORT and ORI in healthy control subjects and two patient groups with peripheral arterial insufficiency were assessed.

In control subjects, ORT reflects diffusion time for O2molecules from capil laries to the TCpO2sensor. In patients with claudication, ORT was prolonged probably because of delayed postischemic reperfusion and reduced tissue oxy genation. In patients with critical ischemia, prolonged ORT seems to be attributed more to reduced tissue oxygenation than to delayed postischemic reperfusion.

ORI in control subjects and patients with claudication apparently depends more on capillary pO2than on magnitude and duration of the postischemic reper fusion. In patients with critical ischemia, ORI is more related to decreased O2delivery subsequent to reduced or absent reactive hyperemia response.

In addition, increased O2extraction ("O2steal") and extensive countercur rent O2exchange during low flow states may reduce ORT and ORI in severely ischemic skin.