bluuebunny/crossref_metadata_2025 huggingface dataset:
Clinical Significance of Cerebral Aneurysm in Renovascular Hypertension due to Fibromuscular Dysplasia: Two Cases in Siblings
Authors: Ouchi Yasuyoshi , Tagawa Hitoshi , Yamakado Minoru , Takanashi Riichiro , Tanaka Shigeru
Published: July 2008

Two cases, in siblings, of renovascular hypertension caused by fibromuscu lar dysplasia (FMD) of the renal artery associated with cerebral aneurysms are reported. Both of the cases were found to have cerebral aneurysm, as well as multiple stenotic or occluded lesions in arteries such as renal, mesenteric, celiac, and internal carotid arteries. One case died of subarachnoid hemorrhage and the other case was successfully operated on for the aneurysm. This report sug gests that FMD should be considered to be a systemic angiopathy including the cerebral artery, as well as the renal artery. Thus, cerebral angiography is rec ommended to detect the association with cerebral aneurysm, at least, in cases with multiple lesions of FMD. Occurrence of FMD in siblings also indicates that a genetic factor might be involved in the pathogenesis of FMD.
Giant Cell Arteritis (Horton's Disease) of the Axillary Artery — Case Reports
Authors: Van Damme H. , Fourny J. , Zicot M. , Limet R.
Published: July 2008

The authors recently observed 2 elderly female patients with ischemic pain of the upper extremity as the first manifestation of giant cell arteri tis. They presented with rest pain of both upper extremities and even gan grene of the thumb in 1 case. Subcla vian and radial pulses were absent while peripheral pulses in the lower limbs were preserved. The angiogra phy was so typical that the diagnosis of inflammatory arteritis was made, despite negative temporal artery bi opsy.

The patient with thumb gangrene was successfully operated on, the oc clusive axillary lesions being by passed by a long venous carotidohu meral bypass graft. A biopsy of the axillary artery showed a granuloma tous lymphoplasmocellular infiltra tion.

A high-dose corticotherapy (24 mg daily) was begun in both cases, with dramatic improvements of gen eral state, lowering of the erythrocyte sedimentation rate, and even reappa rition of a reduced radial pulse in 1 patient.

The authors discuss the incidence, symptoms, diagnosis, and treatment of systemic giant cell arteritis, with special attention to extracranial in volvement. These case reports may broaden the knowledge of the diverse manifestations of giant cell arteritis and of its systemic character with widespread vascular involvement.
Coupling Between Cardiac and Locomotor Rhythms: The Phase Lag Between Heart Beats and Pedal Thrusts
Authors: Kirby R. Lee , MacLeod Donald A. , Marble Alan E.
Published: July 2008

During some rhythmic exercises, the heart and exercise rates may become coupled (be within 1% of each other). If the intraarterial and skeletal intramus cular pressure cycles were reciprocal, blood flow to exercising muscle should be maximized and cardiac load minimized. In this study the authors tested the hypothesis that, while coupling is present, the phase lag between the pedaling and cardiac contraction cycles is consistent and appropriate. Twenty-seven sub jects pedaled, at a frequency natural to them, on an electronically braked bicy cle ergometer that held the power output constant regardless of pedaling rate. To assess the phase lag between pedal thrust (two per revolution) and heart beat, pedal-gated plots of the electrocardiography signal were generated throughout the most coupled five-minute work load for each of the 9 subjects in whom the rates were within 1% of each other for at least two consecutive four- second samples taken every fifteen seconds. During this interval of thirty-sec onds in which the rates were within 1 % of each other, the phase lag of most subjects gradually lengthened and shortened and there was considerable varia tion among subjects, refuting the authors' hypothesis. The results of this study illustrate the importance of beat-by-beat analysis when studying coupling phe nomena. The preliminary assumption, that the coupling between cardiac and locomotor rhythms during cycling was on the basis of a single ischemic muscle group, has apparently been disproven.
Complementary Mechanisms of Atenolol and Diltiazem in the Clinical Improvement of Patients with Stable Angina
Authors: Merino A. , Alegría E. , Castelló R. , Fidalgo M. , Abecia A. , Martínez-Caro D.
Published: July 2008

The combination of atenolol with diltiazem has been shown to be useful in the treatment of patients with coronary artery disease. Eighteen patients with proven coronary artery disease, stable angina, and no previous myocardial in farction were studied before and after treatment with atenolol (100 mg/day) (9 patients) or diltiazem (180 mg/day) (9 patients). Ischemic threshold at stress test, pressure-rate product at ischemic threshold, direct oxygen consumption at ischemic threshold, and exercise ejection fraction were determined.

There was a slight increase in the duration of exercise, maximal oxygen con sumption, and ischemic threshold after treatment with each drug. Double prod uct at ischemic threshold decreased from 20.9 to 19.8 (p = NS) with atenolol but increased from 20.1 to 21.9 (p=NS) with diltiazem. Conversely oxygen con sumption at ischemic threshold increased with atenolol to nearly significant val ues from 17.2 to 23.6 (p = 0.067) but not with diltiazem (16.2 to 22.3; p = 0.16) .

Before treatment, exercise ejection fraction increased less than 10% or de creased from its resting values in all patients but 1 with atenolol and 1 with diltiazem, but exercise ejection fraction increased significantly after treatment with atenolol (60.6 to 67.5; p=0.02) but not with diltiazem. This improvement was due to a significant reduction in end systolic volume (103.8 to 78.6; p=0.019), despite a similar increase in heart rate and blood pressure in all patients.

There was a trend to increase ischemic threshold with both drugs that could have been produced by: (1) atenolol, by increasing oxygen consumption at the ischemic threshold, which suggests an improvement in ventricular perform ance; (2) diltiazem, by increasing double product at the ischemic threshold, which reflects an increase in myocardial oxygen consumption at the ischemic threshold and suggests a parallel improvement in myocardial flow. Atenolol produces a significant increase in exercise ejection fraction owing to a reduction in end systolic volume. This finding suggests a protective effect of atenolol in exercise-induced ischemia and agrees with the trends observed in stress tests.
Comparative Efficacy of Ketanserin and Pentoxiphylline in Treatment of Raynaud's Phenomenon
Authors: Arosio Enrico , Montesi Germana , Zannoni Massimo , Paluani Francesca , Lechi Alessandro
Published: July 2008

In a randomized, placebo-controlled, crossover study, 15 ambulatory pa tients with Raynaud's phenomenon, treated for three weeks with ketanserin 80 mg/day and pentoxiphylline 1,200 mg/day, were evaluated by subjective symp tom scores, daily frequency and duration of attacks, and photoplethysmog raphy, at room temperature and after cold test. Reduced subjective symptoms and duration of attacks, together with improved cold test plethysmography, were significant only after ketanserin. All subjective symptom scores also im proved after ketanserin but only for cyanosis and paresthesia after pentoxiphyl line. Excellent results were obtained in 4 cases after ketanserin and in 1 case with pentoxiphylline. The authors discuss the greater importance of antivaso spastic action over antiaggregating and hemorheologic effects in Raynaud's phenomenon therapy, as well as the pathogenetic role of serotonin.
Intravenous Treatment of Chronic Peripheral Occlusive Arterial Disease: A Double-Blind, Placebo-Controlled, Randomized, Multicenter Trial of Pentoxifylline
Authors: Rudofsky G. , Haussler K.F. , Künkel H.P. , Schneider-May H. , Spengel F. , Symann O. , Werner H.-J.
Published: July 2008

A multicenter, prospective, pla cebo-controlled, double-blind trial was conducted to investigate the effi cacy of intravenous infusion therapy with pentoxifylline over fourteen days in patients suffering from angio graphically confirmed chronic pe ripheral occlusive arterial disease, Fontaine stage II, with at least a six- month history. After a washout phase of one week, the patients received in accordance with a randomization scheme either an i.v. infusion of 300 mg of pentoxifylline (15 mL am poules) or 15 mL of a 0.9% NaCl so lution in 250 mL of 5% laevulose, administered over three hours twice daily. The main efficacy parameters were treadmill-assessed initial claudi cation distance (ICD) and absolute claudication distance (ACD). Base line testing revealed a mean ICD of 131 m in the pentoxifylline group and 126 m in the placebo cohort; mean ACD values were 239 m and 225 m respectively. The group of patients treated with pentoxifylline (n=75) displayed a significantly greater im provement (p < 0.0001) in ICD (+70%) and ACD (+60%) than the placebo group did (+33% and 32%, respectively) (n=79). The infusions were well tolerated in both groups.
Effect of Oral Pentoxifylline Therapy on Venous Lower Extremity Ulcers Due to Deep Venous Incompetence
Authors: Angelides N.S. , Weil von der Ahe C.A.
Published: July 2008

The effect of oral pentoxifylline, administered 1,200 mg/day (400 mg slow-release tablets tid) through six weeks, was studied in 10 patients with established deep venous incompetence and persisting venous ulcers. The following parameters were used for verification of the therapeutic result: venous patency (VP) and valvular competence (VC) assessed by means of Doppler ultrasound; venous refilling time (VRT) assessed by photoplethysmography; skin blood flow (SBF) at rest and after tiptoeing exercise, as well as skin perfusion pressure (SPP), both assessed by means of 99mtechnetium clearance technique. Finally, photo documentation of the tissue lesion was obtained, using a two-dimensional (max and min diameter = Dmax' Dmin) metered scale photo. There was an overall good response to the treatment, the studied parameters showing the following changes: VP and VC remained unchanged; VRT improved in 8 patients, SBF increased in 10; SPP slightly improved in 5; and Dmax and Dmin in all 10 patients. Removal or substantial diminution of the ulcers was obtained in 8 patients. These findings indicate that oral administration of pentoxifylline over a period of six weeks supports the conservative treatment and improves considerably the condition of patients with persisting venous ulcers.
Cavernous Lymphohemangioendothelioma of the Right Atrium — A Case Report
Authors: Palaniyandi Ravindran , Sing San Yang  , Eldredge W. Jay , Fernandez Javier , Ivan Gordon C. , Weiner Ronald , Kashnikow Constantine , Goldberg Harry , Maranhao Vladir
Published: July 2008

The authors report a successful resection of a rare cystic tumor in the right atrium, discovered in an asymptomatic patient with atrial fibrillation. The cystic nature of the tumor was characterized by two-dimensional echocardiogram preoperatively. The site of attachment and movement of the tumor were clearly shown by cine computed tomography preoperatively. The tumor contained numerous endothelium-lined cavernous channels and groups of red blood cells. These features are distinctly different from those of other cystic tumors.
Thoracic Outlet Syndromes— Application of Microcirculation Techniques and Clinical Review
Authors: Winsor Travis , Winsor David , Mikail Amani , Sibley A.E.
Published: July 2008

The thoracic outlet syndromes of the upper extremities consist of many disorders. The most important two are the costoclavicular syndrome (compres sion of neurovascular structures between the clavicle and the first rib) and the scalenus anticus syndrome (compression of these structures within the scalene triangle). Congenital abnormalities of the clavicle, congenital small thoracic outlet, high first rib, cervical ribs of all configurations, pectoralis minor and pectoralis major syndromes, and others may occur. The costoclavicular syn drome and scalenus anticus syndrome have been considered the most prevalent compression syndromes and are amenable to surgical or medical treatment. Quantitative measurements of the microcirculation of the fingertip were ex amined with the shoulders and head in various positions to provide quantitative information relative to the costoclavicular and scalenus anticus syndromes. A laser instrument was ideal for this purpose, for results were quantitative and no counterpressure was applied during the measurement. The technic applied was highly successful in separating quantitatively the normal individuals from those with either costoclavicular syndrome or scalenus anticus syndrome.
Segmental Early Relaxation of the Left Ventricle
Authors: Teplitsky I. , Wurzel M. , Artul S. , Aygen M.
Published: July 2008

The clinical, electrocardiographic, and angiographic findings of 90 patients, whose RAO 30° left ventriculograms showed segmental early relaxation (SER), were compared with those of 100 patients without SER. There were no signifi cant differences in age and sex distribution or in clinical and coronary angio graphic findings between the two groups. There was, however, a significantly lower prevalence of pathologic Q or QS patterns in the anterior leads of the ECG in the group with SER. SER occurred more frequently in segments with well-preserved systolic contraction and was confined to the anterolateral seg ments in the great majority of the patients (80%). An inverse correlation was found between SER and geographically related critical coronary artery stenosis.
Usefulness of Angiography in Studying Carcinoma of the Bladder
Authors: Kanaan Zuhair Ashoor
Published: July 2008

Angiography of the pelvic vasculature can be quite helpful in assessing blad der tumors, for it provides useful results both when used alone and when used in combination with other methods. It is especially useful when there is doubt about the results of simpler methods, particularly in younger patients.
Occult Pulmonary Artery Associated with Failure to Thrive and Recurrent Pneumonia—A Case Report
Authors: Lax Daniela , Butto Fouad , Leonard Stanley A. , Ring W. Steves , Dunnigan Ann
Published: July 2008

Occult pulmonary artery is an uncommon cardiovascular defect. Associated symptoms include recurrent pulmonary infections and congestive heart failure. The authors describe a one-year-old boy initially diagnosed as having broncho- pulmonary dysplasia who developed severe failure to thrive, recurrent pneumo nias, and pulmonary hypertension. The presence of an occult right pulmonary artery was suspected by lung perfusion scan and diagnosed by cardiac catheteri zation and angiography. After surgical repair, his clinical course improved and his growth and development were normal. This case demonstrates the impor tance of including occult pulmonary artery in the differential diagnosis of in fants with failure to thrive associated with recurrent pulmonary infection.
Effect of L-Carnitine on the Reactive Hyperemia in Patients Affected by Peripheral Vascular Disease: A Double-Blind, Crossover Study
Authors: Brevetti Gregorio , Attisano Tiziana , Perna Sergio , Rossini Arturo , Policicchio Antonio , Corsi Marco
Published: July 2008

A double-blind, crossover study was designed to evaluate the effect of L- carnitine on the reactive hyperemia in patients with peripheral vascular disease. After drug washout, 18 patients were randomly assigned to receive placebo or L-carnitine, 3 g IV as a bolus, followed by continuous intravenous infusion of 2 mg/kg/min for thirty minutes. Blood flow in the affected limb was measured by impedance plethysmography, under resting conditions and every two minutes for ten minutes after a five-minute ischemia induced in the affected limb. As compared with placebo, L-carnitine did not modify blood flow at rest. On the contrary, the hyperemic response with carnitine was higher than that observed with placebo. A significant increase in blood flow was found two, four, and six minutes after the release of ischemia with placebo, whereas the blood perfusion to the affected limb rose significantly at all times of recording after carnitine administration. Moreover, the values of the blood flow at two and ten minutes with carnitine were significantly higher than those recorded after placebo at the same times of recording. After the release of ischemia, the mean maximum value of blood flow observed after carnitine was 3.1 ± 1.4 mL/min/100 mL, a value significantly higher than that recorded after placebo, which was 2.7 ±1.3 mL/min/100 mL (p < 0.05). In conclusion, this study demonstrates that L-carni tine, although not affecting blood flow and ankle/arm systolic blood pressure ratio under resting conditions, improves the functional circulatory reserve in patients with peripheral vascular disease.
Viscoelasticity and Red Blood Cell Aggregation in Patients with Coronary Heart Disease
Authors: Hahn R. , Müller-Seydlitz P.M. , Jöckel K.H. , Hubert H. , Heimburg P.
Published: July 2008

Viscoelastic parameters were evaluated in 169 consecutive male pa tients with clinical signs of coronary heart disease. The patients were clas sified according to the extent of coro nary artery stenosis. Levels of blood viscosity, erythrocyte aggregation, and plasma viscosity were elevated in patients with extensive coronary ves sel disease. However, the differences between the several groups were not statistically significant. The increase of hemorheologic parameters was mainly due to high hematocrit, fibrin ogen, and cholesterol concentrations. There was a significant correlation be tween plasma fibrinogen values and plasma viscosity levels. Blood viscos ity and erythrocyte aggregation can be described by multiple linear re gression as a function of the sum of log hematocrit, fibrinogen, choles terol, and α2-macroglobulin.
Late Results of Local Thrombolytic Treatment of Peripheral Arterial Occlusions
Authors: Poredoš Pavel , Keber Dušan , Videčnik Viktor
Published: July 2008

One hundred thirty-four patients, in whom acute and subacute arterial oc clusions of lower limbs were treated with low dose intraarterial streptokinase, were observed for periods of up to five years. Primary recanalization of occluded vessels was achieved in 66 patients, but in the remaining 68 patients recanaliza tion was not observed. In 45% of the patients with successful thrombolytic treatment, percutaneous dilatation (PTA) of remnant stenosis was performed. In patients with successful recanalization the reocclusion rate was greatest in the first year (17.4%); the first two weeks after therapy were most critical in this respect. The reocclusion rate during the succeeding years ranged from 4% to 9% per year. The cumulative patency rate after five years was 63.4%. Late results were better in patients in whom more proximal vascular segments were affected. The preservation of vessel patency was highly dependent on the severity and extent of the previous atherosclerotic process and especially on the state of peripheral (runoff) arteries. Presence of diabetes mellitus increased the reoc elusion rate of recanalized vessels. Of the patients with unsuccessful recanaliza tion, only 5 reported some symptomatic improvement during the observation period, 39 (57%) needed immediate amputation, and an additional 8 (4.7%) were amputated later on. Considering the fact that all patients were previously refused for bypass surgery owing to unsuitable runoff vessels or bad general condition, the long-term results were surprisingly good, suggesting that throm bolytic treatment, combined in remnant stenosis with PTA, was an efficient method in patients with acute or subacute arterial occlusions.
Monoclonal Antibody—Defined Lymphocyte Subsets in Normal Nigerians
Authors: Adedeji M.O.
Published: July 2008

Lymphocyte subsets using monoclonal antibodies have hitherto not been re ported in normal Nigerian subjects. In all 8 subjects, the average number of lymphocytes showed a clear rhythmicity with higher values in the morning (8 AM) than in the afternoon (2 PM). The time of day variation in circulating lymphocytes appears to affect T cells rather than B cells. The absolute numbers of 0KT4+ cells at 8 AM was significantly higher than at 2 PM (p < 0.05).

It would appear that the 0KT4+ cells are largely responsible for the time of day variation in peripheral blood lymphocytes, owing probably to a greater sensitivity to changes in plasma cortisol levels.
Therapeutic, Hemodynamic, and Metabolic Effects of Hyperbaric Oxygenation in Peripheral Vascular Disease
Authors: Visonà Adriana , Lusiani Luigi , Rusca Fabrizio , Barbiero Damiano , Ursini Fulvio , Pagnan Antonio
Published: July 2008

Hyperbaric oxygen therapy (HBT) consists of inhaling 100% oxy gen under pressure exceeding atmos pheric pressure.

Patients with various degrees of peripheral vascular disease (stages II, III, and IV according to Fontaine's classification) were treated with HBT. Clinical symptoms improved in 70%. Ankle/brachial index increased by more than 0.10 in 47%. Photo plethysmographic pulse appearance has been detected in roughly one third of patients. Transcutaneous ox ygen tension did not, however, im prove significantly. Plasma malon dialdehyde (MDA) was evaluated as a marker of lipid peroxidation, possi bly influenced by hyperbaric oxygen. Surprisingly, the authors found that MDA levels decreased after HBT, probably as a result of the activation of antioxidant systems. These results show that HBT represents a useful approach in the treatment of periph eral vascular disease, since it im proves clinical and hemodynamic parameters, with no potentially harmful side effects, such as en hanced lipid peroxidation, at least in the short term.
S-Mg Does Not Change Inversely to S-FFA During Acute Stress Situations
Authors: Hansen Ole , Johansson Bengt W.
Published: July 2008

The apparently divergent changes in serum magnesium (S-Mg) and serum free fatty acids (S-FFA) in stress situations associated with ele vated levels of circulating adrenaline were studied experimentally in 12 healthy volunteers, who were each given three adrenaline infusions (0.05 μg/kg bw/min over one hundred twenty minutes). Before the adrena line infusions the volunteers were treated for three days with either a non-selective beta-blocking agent (propranolol) or a beta-1-selective agent (atenolol) or with placebo.

Six of the volunteers underwent a fourth adrenaline infusion after pretreatment with a beta-2-selective beta-blocking agent (ICI 118551). S- Mg and S-FFA were determined every fifteen minutes. After pretreatment with placebo, adrenaline infusion caused an increase in S-FFA from 0.22 ± 0.20 mmol/L (mean ± SD) to max 0.59 ± 0.39 mmol/L after thirty minutes of adrenaline infusion (p < 0.001). At one hundred twenty minutes S-FFA had decreased to 0.35 ± 0.26 mmol/L. Thirty minutes after cessation of the adrenaline infusion, S-FFA had returned to the same level as before the infusion. S-Mg before the adrenaline infusion was 0.83 ± 0.05 mmol/L, rose to 0.85 ± 0.05 at fifteen minutes, and then decreased to 0.78 ± 0.05 at one hundred thirty- five minutes (p < 0.05). Pretreat ment with atenolol did not change this pattern, although the changes in S-FFA and S-Mg were of a smaller magnitude but still statistically sig nificant. No statistically significant changes in S-FFA or S-Mg were seen after pretreatment with either pro pranolol or ICI 118551.

The results show that the adrena line-induced changes in S-FFA and S-Mg disappear after blockade of the beta-2-adrenoceptor. The changes in S-FFA were not opposite to the changes in S-Mg, and although the changes in S-Mg could be explained in part by a binding of Mg to FFA in serum, there are probably other mechanisms at work too, such as a transport from the extracellular to the intracellular compartment.
Impending Myocardial Infarction in a Patient with Marked Left Ventricular Hypertrophy and Normal Coronary Arteriogram—A Case Report
Authors: Bestetti Reinaldo B. , Pinto Lucimara Z. , Finzi Luiz A. , Secches Antonio L.
Published: July 2008

A middle-aged woman with long-term uncontrolled arterial hypertension de veloped a clinical picture of impending myocardial infarction. A normal coro nary arteriogram was obtained. However, left heart catheterization showed a marked increase in left ventricular end-diastolic pressure, while left angiocardi ography revealed marked left ventricular hypertrophy. She was successfully treated with a beta-blocking and calcium-antagonist agent. The present case shows that an impending myocardial infarction may occur in patients having normal coronary arteriogram but with left ventricular hypertrophy secondary to arterial hypertension.
Precordial ECG Mapping in Acute Myocardial Infarction (AMI) After Intravenous Infusion of Streptokinase (s)
Authors: Babalis Dimitris C. , Boutos Georges N. , Iliodromitis Eystathios K. , Trovas Alexandros K. , Vorides Eytychios M.
Published: July 2008

Repeated precordial ECG map ping (42 leads) and CK-MB serum measurements were done in 40 pa tients with anterior and/or antero lateral acute myocardial infarction. Twenty patients serving as controls, were treated with routine anticoagu lant therapy. In 20 patients (the s group), randomly selected, a short- term IV infusion of 1,500,000 IU streptokinase was administered and followed by the same anticoagulant treatment as in controls. Ten subjects from each group underwent coronary arteriography one month later.

From the analysis of ECG map ping the number of leads (N) and the sum of measurements (Σ) for each parameter were calculated. Before treatment there were no significant differences for all measured parame ters between the two groups of pa tients. Seven days later, ST elevations were statistically different for NST and ΣST with lower values for the s group. Higher values for NR and ΣR were also noted in this group. No sta tistically significant difference was found for NQ and ΣQ. CK-MB curve showed an earlier peak in the s group than in the control group. Five pa tients from the s group showed a pa tency of the infarct-related vessel.

In conclusion, the results of this study show that patients receiving s have a significant benefit with ECG improvement. On the other hand, the CK-MB curve indicates an eventual recanalization to a certain degree in the obstructed coronary artery, which is the final goal.
Hypotensive Effects of Nifedipine in Patients with Primary Hyperparathyroidism: Case Reports
Authors: Takata Yutaka , Takishita Shuichi , Koga Tokushi , Nakao Yae , Okamura Ken , Yao Takashi , Takemura Ken , Fujishima Masatoshi
Published: July 2008

Nifedipine was administered orally to 2 patients with primary hyperparathy roidism before and after parathyroidectomy. The operation lowered serum cal cium concentration and parathyroid hormone but did not alter plasma renin activity, plasma aldosterone concentration, and serum magnesium. The hypo tensive effects of nifedipine were markedly enhanced with the decrease in serum calcium concentration following parathyroidectomy. Thus, the level of serum calcium concentration may modulate the hypotensive effect of nifedipine in hu mans.
Beneficial Effects of Intermittent Suction and Pressure Treatment in Intermittent Claudication
Authors: Mehlsen Jesper , Himmelstrup Holger , Himmelstrup Bodil , Winther Kaj , Trap-Jensen Jens
Published: July 2008

The present study reports on the effects of a physical treatment modality in patients with intermittent claudication. During this treatment a major part of the skin surface is subjected to intermittent suction and pressure. In a previous, preliminary study the authors found a beneficial effect of this treatment in intermittent claudication.

The study included 34 patients with moderate, stable intermittent claudication. Twenty-two patients participated in a double-blinded, randomized trial comparing the effects of 25 treatments to 25 placebo applications given over a period of two months. Twelve patients participated in an open trial investigating the possible effects of the treatment on platelet aggregation and fibrinolysis. Pain-free and maximal walking distances were measured on a treadmill, and systolic blood pressure was measured on the upper limb, the ankle, and the first toe bilaterally. The threshold for adenosine diphosphate (ADP)-induced platelet aggregation was tested, and the fibrinolytic activity was estimated from the euglobulin clot lysis time.

Active treatment resulted in significant improvements in pain-free and maximal walking distances, whereas no changes could be found during placebo administration. The treatment caused significant increments in the ADP thresholds for platelet aggregation, while the effects on fibrinolysis were uncertain.

It is concluded that intermittent suction and pressure treatment offers a new approach for conservative treatment of intermittent claudication.
Noninvasive Ultrasonic Biopsy: Evaluation of Early Arteriosclerotic Lesions Progression in Normal Asymptomatic, Hyperlipidemic, and Diabetic Subjects
Authors: Belcaro G. , Laurora G. , Cesarone M.R. , Barsotti A. , Trevi G.P. , Renton S. , Veller M. , Fisher C. , Gerulakos G. , Nicolaides A.N.
Published: July 2008

Noninvasive ultrasonic biopsy (UB) is a method of detecting early arteriosclerotic changes by high-resolution ultrasound scanning of the carotid and femoral bifurcation. Six UB classes (scoring 0 to 10) have been identified in 2000 asymptomatic subjects and 600 vascular patients followed up for four years. The incidence of silent coronary ischemia (tested by effort test) and the occurrence of symptomatic events in four years are increased in advanced classes and with increasing UB score.

The rate of progression (ROP) in four years to the next UB class has been defined in normal subjects (1.4% in class I, 3.1% in II, 10.7% in III, 17.9% in IV, and 79.2% in class V). In a group of 305 asymptomatic hyperlipidemic subjects and in a group of 269 diabetics the ROP (in four years) was significantly higher.

Therefore ultrasonic biopsy is useful to identify subjects at risk of coronary ischemia and cardiovascular events and to follow up noninvasively the progression of arteriosclerosis.
Increased Risk of Coronary Artery Dissection During Coronary Angiography with 6F Catheters
Authors: Prewitt Kerry C. , Zen Bujung , Wortham Dale C. , Pearson Clarence
Published: July 2008

The use of smaller sized catheters for coronary angiography (CA) is increasing, but little is known about the safety of CA with 6F catheters. The authors reviewed all cases of CA in which 6F and 8F catheters were used in adult patients between 1988 and June, 1990. There were 597 patients in the 6F group and 2,409 patients in the 8F group. Cases of CA with 6F catheters were more likely to be elective (95% vs 87%), to have no coronary disease (35% vs 24%), and to be performed by nonfirst-year fellows (70% vs 54%) when compared with CA with 8F catheters. There were 5 cases of coronary artery dissection. The incidence of dissections was significantly higher (p=.007) in the 6F group (0.67%) than in the 8F group (0.04%). The incidence of dissections was highest for first-year fellows using 6F catheters (1.7%), which was significantly higher (p = .008) than for first-year fellows using 8F catheters. The incidence of major vascular complications tended to be lower (p=.068) in the 6F group (0.17%) than in the 8F group (0.95%). In summary, CA with 6F catheters is associated with an increased risk of coronary artery dissection, particularly with less experienced operators, but tends to be associated with a lower risk of major vascular complications.
Blood Pressure and Heart Rate Relationship in Normotensive and Hypertensive Subjects
Authors: Vannucchi P.L. , Cipriani M. , Montigiani A. , Lagi A.
Published: July 2008

A twenty-four-hour blood pressure (BP) monitoring was performed in 20 normotensive and 20 hypertensive subjects, matched by sex and age. Blood pressure and heart rate (HR) variability were evaluated both as absolute and percent standard deviation. In agreement with the literature no significant difference in HR and BP variability was observed between the two groups. The linear regression between HR and BP values was evaluated in both groups. The authors observed a significant difference in the relationship between these two cardiovascular variables between the two groups. In the hypertensive group the cardiovascular control of HR and BP showed a different relationship than in normotensive subjects, suggesting a different neurovegetative modulation.
Acute Fatality Following Pulmonary Angiography in a Patient on an Amiodarone Regimen—A Case Report
Authors: Malden Eric S. , Tartar V. Marie , Gutierrez Fernando R.
Published: July 2008

A patient being treated with amiodarone experienced acute respiratory failure and death immediately following pulmonary angiography. Physicians must be aware of the potential catastrophic complication of both ionic and nonionic contrast angiography in this setting.
Intracerebral Hemorrhage Associated with Migrainous Headache—A Case Report
Authors: Furui Tomoo , Iwata Kinjiro
Published: July 2008

A case of intracerebral hemorrhage that developed some time after severe headache is reported in a relatively young woman. It is proposed that hemorrhage may also be included among the causes of so-called migraine-related stroke, which has generally been known to result from infarction.
Comparison of Duplex Ultrasonography and Ascending Contrast Venography in the Diagnosis of Venous Thrombosis
Authors: Montefusco-von Kleist Cheryl M. , Bakal Curtis , Sprayregen Seymour , Rhodes Barbara A. , Veith Frank J.
Published: July 2008

The application of duplex ultrasonography to the diagnosis of venous throm bosis requires validation by comparison of the duplex findings with the results of ascending contrast venography. In this study, 2534 veins were examined by both methods with contrast venography results serving as the standard for com parison. In this setting, duplex ultrasonography proved to be 100% sensitive and 99% specific for venous thrombosis. Duplex ultrasonography is as reliable as venography in the diagnosis of venous thrombosis and has no associated risks or known complication. In addition, duplex ultrasonography provides informa tion regarding pathologic anatomy that is comparable to the detail provided by high-quality venography. The authors conclude that duplex ultrasonography should be the diagnostic method of choice for evaluating patients with suspected venous thrombosis.
Clinical Assessment of Low Molecular Weight Heparin Effects in Peripheral Vascular Disease
Authors: Calabrò Alessio , Piarulli Francesco , Milan Daniele , Rossi Alberto , Coscetti Giovanna , Crepaldi Gaetano
Published: July 2008

This study was carried out, using the double-blind method vs placebo, on 36 patients suffering from stage II peripheral vascular disease (PVD) according to Leriche, to check the clinical and hemorrheologic effects of the administration of a new low molecular weight heparin (LMWH). After a one-month washout period, the patients were randomly assigned either to the group treated with the LMWH (15,000 aXaU/day sc) or to the group treated with indistinguishable placebo.

At the start of the study and after three and six months of treatment, clini cal, instrumental, and laboratory tests were performed to assess local and sys temic efficacy and tolerance.

The LMWH under study caused a statistically significant increase in claudi cation time, with a parallel increase in the absolute claudication distance and in the interval free of pain. The drug also led to a significant increase in activated partial thromboplastin time, the values of which, however, remained within the normal limits, and to a marked reduction in blood viscosity. No significant vari ation was observed in the tolerability parameters in the two treatment groups, and no local or systemic adverse reactions occurred.
Atrial Septal Defect After Balloon Mitral Valvuloplasty: A Transesophageal Echocardiographic Study
Authors: Arora R. , Jolly N. , Kalra G.S. , Khalilullah M.
Published: July 2008

Fifty patients with rheumatic mitral stenosis aged twelve to thirty-six (twen ty ± six) years were studied by two-dimensional, pulsed and color Doppler echo cardiography during, seventy-two hours after, and biweekly for three months after balloon mitral valvuloplasty (BMV). Transesophageal echocardiography (TEE) done immediately after BMV (in the catheterization laboratory) detected a new atrial septal defect (ASD) in 46 (92%) patients. These measured 1 to 2 (mean 1.2±0.3) mm in diameter. Doppler color flow mapping guided the loca tion of the ASD in most of the cases. A narrow jet of left-to-right shunt could be evaluated by pulsed Doppler studies. Velocity time integral (VTI) of the jet across one cardiac cycle and the diameter of the ASD were used to calculate the left-to-right shunt (shunt = VTI x π (D/2)2 x heart rate). The estimated shunt was 0.04-0.39 (mean 0.20 ±0.10) L/minute. A repeat study at seventy-two hours revealed the defect in 40 (80%) patients.

At three months, the defect persisted in only 5 (10%) cases. The mean inter val of closure of ASD was 4.6± 2.2 weeks. The authors conclude: (1) ASD occurs commonly after BMV, (2) the septal defect and the resultant left-to-right shunt are insignificant, and (3) ASD disappears in the majority of cases by three months after BMV.
Clinical Case Reports
Authors: Wagner D.R. , Spengel F. , Middeke M.
Published: July 2008

A thirty-eight-year-old woman presented with typical signs of erythromelal gia : burning, redness, and warm congestion of the extremities. These symptoms occurred after cessation of obesity drug therapy with norephedrine (250 mg/ day) continuously over six years. The condition was refractory to treatment with acetylsalicylic acid. It is suggested that erythromelalgia in this case was unmasked by the vasoactive properties of norephedrine. Continuous drug ther apy with norephedrine may have led to adaptive adrenergic subsensitivity of vascular smooth muscles. The pathomechanism of primary erythromelalgia is still unknown. Their observations suggest that an enhanced vasodilatation due to an abnormal adrenergic sensitivity may play an important role in the patho genesis of primary erythromelalgia.
Determination of Arterial Diameters, Length and Mass of the Plaque, and Theoretical Volume in the Internal Carotid Artery by Quantitative Vascular Echography
Authors: Ciccone Marco , di Noia Domenico , Liquori Maurizio , di Michele Liliana , Novo Salvatore , Rizzon Paolo
Published: July 2008

To study the evolution of atherosclerosis, the consensual changes that occur in the arterial wall, lumen, and atheroma must be evaluated.

The authors propose a new, noninvasive method of obtaining arterial diame ters, length and mass of plaque, and theoretical volume in the internal carotid artery.

The study was performed in 37 patients with different degrees of athero sclerosis (from 20% to 50%). All patients underwent echo examination. Long- axis tomographic planes were recorded with the same angle of incidence by placing a goniometer around the neck. Furthermore, the arterial diameters and the plaque length were measured from photorecordings, and theoretical arterial volume (sum of two bitruncated semiellipsoids), residual volume (Simpson's in tegral rule), and plaque mass (difference between theoretical vascular volume and residual volume) were calculated. Intraobserver and interobserver variabil ity and reproducibility were tested in all the measurements and calculations.

Intraobserver/interobserver variability and reproducibility were found to be less than 8% according to all measurements and calculations.

These results indicate that the method is reproducible and allows noninva sive, quantitative assessments of vascular geometry in evolving atherosclerosis.
Prevention of Recurrent Deep Venous Thrombosis with Indobufen. A 3-Year Follow-up Study Using Color Duplex Scanning
Authors: Belcaro G. , Errichi B.M. , De Simone P.
Published: July 2008

After an episode of deep venous thrombosis (DVT) 123 patients were ran domized into two groups: one was prophylactically treated with indobufen (60 patients), an oral antiplatelet agent, and one had no treatment (63) and acted as a control group. They were followed up for three years and scanned with color duplex scanning (CDS) every three months and any time that signs and symp toms suggested a new episode.

In patients receiving indobufen the incidence of thrombosis was 5% in three years while it was significantly higher (46%) in the control group. Also 62% of the new episodes in the control group were asymptomatic (33.3% in the treated group).

Results suggest that recurrent DVT is common, often asymptomatic, and confused with sequelae of the initial episode. The prophylaxis with indobufen is an effective measure in preventing recurrent thrombosis and avoiding the pro gressive deterioration of the deep venous system observed after deep venous thrombosis.
Serum Tumor Necrosis Factor Levels in Acute Myocardial Infarction and Unstable Angina Pectoris
Authors: Başaran Y. , Başaran M.M. , Babacan K.F. , Ener B. , Okay T. , Gök H. , Özdemir M.
Published: July 2008

Tumor necrosis factor (TNF) enhances leukocyte adherence to vascular en dothelium and increases procoagulant activity in the endothelial cells. Thus it may be implicated in the pathogenesis of acute vascular occlusions. To study the role of TNF in the early stages of acute myocardial infarction (MI), the authors measured circulating TNF levels in the sera of patients with acute MI and unsta ble angina pectoris.

Blood samples were obtained within six hours after onset of chest pain and stored at -70 degrees until tested. A sensitive sandwich enzyme-linked im munosorbent assay (ELISA) test was used for TNF measurement. C-reactive protein (CRP) levels were determined semiquantitatively. Immediate complica tions such as heart failure, arrhythmia, and shock were also noted. Twenty-four patients with electrocardiographically and biochemically confirmed acute MI and 14 patients with unstable angina pectoris were included in the study. TNF levels were serially assessed at the time of admission and at hours 6, 24, 48, 72, and 96 after onset of chest pain in 2 patients with acute MI. Detectable TNF was found in 13 sera of the acute MI group (range; 10-1510 pg/mL) and 4 sera of the angina pectoris group (range; 15-240 pg/mL). There was no correlation between the serum TNF levels and the occurrence of complications and the extent of myocardial damage. CRP response was unrelated to TNF levels.

Contrary to previous reports, serial measurement of TNF revealed that peak values were reached within six hours and disappeared after twenty-four hours.

The authors concluded that TNF may contribute to the development of acute coronary artery occlusion by changing vascular endothelial cell characteristics instead of being a late consequence of myocardial infarction.
Types of Basilar Artery Syndrome: Clinicoradiologic Correlation
Authors: Thajeb Peterus , Lie Sian-King , Chiang Tsuey-Ru
Published: July 2008

Twenty-two patients with ischemic stroke, as a single event, in the territory of basilar artery (BA) are reported. On the basis of the findings from computerized tomography (CT) and clinico-radiologic features, the authors propose that this heterogeneous entity—the basilar artery (BA) syndrome—can be divided into five subtypes. Type 1 (complete type), characterized by infarctions in the whole territory of BA, is incompatible with life; type 2, with extensive brain stem infarct, may result in a locked-in state; and type 3, with infarctions in part of the BA territory (incomplete form or "partial syndrome") may have a more variable clinical outcome. However, type 4, with a top of the BA syndrome, and type 5, with negative CT BA syndrome (angiographically verified), are often more benign. Although initial CT scanning may infrequently be unrevealing, serial and follow-up CT scannings have proven their usefulness in the majority of cases as a noninvasive tool, in contrast to cerebral angiography, for predicting the short-term prognosis of BA syndrome.
Giant Congenital Left Ventricular Aneurysm in an Adult— A Case Report
Authors: Chandrashekhar Y. , Anand I.S. , Dutta B.N. , Gujral J.S. , Anand I.S.
Published: July 2008

Congenital cardiac aneurysms are extremely rare. The echocardiographic features of this condition have never been described. The authors report a case of giant congenital left ventricular aneurysm wherein the diagnosis was made by echocardiography and confirmed at cardiac catheterization. The aneurysm was surgically removed. The histologic examination showed that the aneurysmal wall was only 1.5 to 2 mm thick but contained all the layers of the heart.
Risk Factors for Carotid Atherosclerosis and Silent Cerebral Infarction in Patients with Coronary Heart Disease
Authors: Nishino Masami , Sueyoshi Kenji , Yasuno Masao , Yamada Yoshio , Abe Hiroshi , Hori Masatsugu , Kamada Takenobu
Published: July 2008

In this study, the authors examined relations between coronary and carotid atherosclerosis and between coronary atherosclerosis and silent cerebral infarc tion. They ascertained the risk factors for carotid atherosclerosis and silent cerebral infarction complicating coronary heart disease (CHD) in 77 Japanese subjects. As coronary atherosclerosis progressed, the carotid ultrasonographic score and the brain computed tomographic score increased. Multivariate analy ses showed that the significant and independent risk factors for carotid athero sclerosis in patients with CHD were age (p < 0.01) and apolipoprotein (apo) B (p < 0.05) and the factors for silent cerebral infarction were age (p < 0.05) and hypertension (p < 0.05).

Their study confirms a positive relation between coronary atherosclerosis and carotid atherosclerosis and between coronary atherosclerosis and silent ce rebral infarction in patients with CHD. Their data suggest that carotid athero sclerosis should be looked for in patients with CHD who are old and have a high value of apo B, and silent cerebral infarction should be looked for in those who are old and have hypertension, to prevent complicating symptomatic cerebral vascular disease (CVD). If severe carotid atherosclerosis or silent cerebral in farction are detected, antithrombotic medication should be given.
Coronary Thrombolysis and Endothelin-1 Release
Authors: Tomoda Haruo
Published: July 2008

The relation between intracoronary thrombus and endothelin-1 (ET-1) was studied. In a canine model, acute myocardial infarction (MI) was induced by coronary occlusive thrombus produced at a mock atheromatous plaque. Blood samples were collected from the aorta (A) and coronary vein (V). Twenty-eight open-chest dogs divided into three groups were studied. Group I (n=15): acute MI was induced by coronary occlusive thrombus, and thrombolysis was ob tained by urokinase two hours after MI. Group II (n=8): nonocclusive throm bus was produced without inducing MI. Group III (n = 5) : coronary artery was ligated for two hours and reperfused by release of ligation.

In Group I, ET-1 was significantly increased after MI in A and V, and ET-1 in V was significantly more elevated than in A during thrombolysis, suggesting ET-1 production in the coronary vessels by thrombolysis. In Group II, ET-1 increased slightly during thrombus formation, but there was no difference in A and V. In Group III, ET-1 was elevated significantly after MI without A and V difference.

These results indicate that there is no detectable ET-1 production with coro nary thrombus formation, whereas coronary ET-1 production is detected dur ing thrombolysis, most probably because resolved thrombus releases a more potent stimulus to ET-1 production.
Extraaortic Intimomedial Mucoid Degeneration: A Clinicopathological Study
Authors: Cooper Kumarasen
Published: July 2008

Six black patients with extraaortic intimomedial mucoid degeneration of the major arterial branches of the aorta are reported. Five patients presented with aneurysmal dilatation of the arterial wall as a result of the intimomedial mucoid degeneration, and the sixth patient had superimposed occlusive thrombosis. The ages ranged from twenty to fifty years. Five patients were female. Two were hypertensive. All patients in this study underwent reconstructive vascular surgery. The clinical and histopathologic findings are discussed.