bluuebunny/crossref_metadata_2025 huggingface dataset:
Efficacy of Femoral Intra-arterial Administration of Teicoplanin in Gram-Positive Diabetic Foot Infections
Authors: Dorigo Bruno , Cameli Anna Maria , Trapani Maurizio , Raspanti Dinella , Torri Marco , Mosconi Giorgio
Published: July 2008

In this study the efficacy and safety femoral intra-arterial administration of teicoplanin in the treatment of diabetic foot infections caused by gram-positive bacteria were evaluated. Twenty-five hospitalized diabetic patients with foot ulcers or with foot ulcers and metatarsophalangeal osteomyelitis were included in the study.

In the ulcers Staphylococcus aureus was present alone in 16 patients and was associ ated with Pseudomonas aeruginosa in 2 patients, with Candida albicans in 2, and with coagulase-negative Staphylococcus in 1 patient. In 4 patients other gram-positive bacteria were isolated. All isolated strains were resistant to various antibiotics tested. Teicoplanin, 200 mg, was administered once a day by femoral intra-arterial injection for an average period of 14.72 ±7.16 days (range ten to thirty-six days). Six patients were treated with an additional antibiotic intramuscularly or intravenously because of a mixed infection. At the end of the therapy microbiological assessment confirmed that gram-positive infection was eliminated in all patients. Clinical outcome demonstrated that healing occurred in 18 patients (72%) and improvement in 7 patients (28%).

No adverse drug reactions were observed during the treatment. The results demon strate that femoral intra-arterial administration of teicoplanin was highly effective in skin- and bone-infected lesions in the diabetic foot. This method may represent a further advantage in management of this severe diabetic complication.
Power Spectral Analysis of Heart Rate in Elderly Hypertensive Subjects With or Without Silent Coronary Disease
Authors: Piccirillo Gianfranco , Fimognari Filippo L. , Santagada Elvira , Munizzi Maria Rita , Viola Emanuela , Monteforte Gabriella , Bucca Carmela , Durante Michele , Di Gioacchino Carlo , Tarantini Sabrina , Lo Verde Andrea , Cacciafesta Mauro , Marigliano Vincenzo
Published: July 2008

Much evidence indicates an involvement of the sympathetic nervous system in the genesis of silent myocardial ischemia. The authors assessed autonomic system activity by power spectrum analysis of heart rate variability in 21 elderly hypertensive men with and without angiographically confirmed coronary artery disease and compared the results with those from an age-matched control group.

In the analysis an autoregressive algorithm was used to determine the power spectrum from an electrocardiographic recording of 512 consecutive RR intervals. The autonomic nervous system induces two distinct sinusoids: a low-frequency signal attributable to sympathetic activity and a high-frequency vagal response. In the hypertensive patients with coronary disease the authors also evaluated sympathetic activation after double-blind, placebo-controlled administration of metoprolol (100 mg/day), followed by amlodipine (10 mg/day), quinapril (20 mg/day), and amlodipine (5 mg/day) plus quinapril (10 mg/day). (continued on next page)

Spectrum analysis showed significantly increased sympathetic activity in the hypertensive patients with coronary disease (low frequency: 58.4 ±2.0, P < 0.001) as compared with controls (36.21 ± 1.0, P < 0.001) and hypertensive subjects without coronary disease (low frequency: 25.2 ±0.6 , P < 0.001) but significantly reduced parasympathetic activity (39.4 ±2.0, P < 0.001) with respect to hypertensive patients without heart disease (42.5 ±2.0, P < 0.001) and controls (60.3 ±2.0). Treatment with metoprolol, quinapril, and amlodipine plus quinapril significantly reduced sympathetic tone (P < 0.05).
Clinical Science Review: Current Aspects of Thrombolytic Therapy in Women with Acute Myocardial Infarction
Authors: Hussain K.M.A. , Gould L. , Sosler B. , Bharathan T. , Reddy C.V.R.
Published: July 2008

Acute myocardial infarction (AMI) remains the greatest threat to health in our society and is the most common cause of death in the United States and in many other Western industrialized countries. Recent data demonstrate that mortality from MI is continuing to decline. In these days of more aggressive management of acute MI (AMI) there has been a resurgence of interest in advances in thrombolytic therapy. However, observational studies of patients with AMI have shown that women sustaining an AMI have a worse prognosis than men. AMI is the number-one killer of women in the United States; approximately 247,000 of more than 520,000 deaths due to AMI that occur each year are among women, and almost one-third of the women are younger than forty-five years old. While there have been great advances in thrombolytic therapy, these advances have benefited men to a more significant degree than they have benefited women. The purpose of this paper is to critically review the efficacy of thrombolytic therapy in women with AMI with consideration of some of the key components of its effectiveness: mortality, bleeding risk, infarct-artery patency, ventricular function, and cardiac arrhythmia.
Cerebrovascular Hemodynamic Inefficiency of Premature Ventricular Contractions
Authors: Malkoff Marc D. , Gomez Camilo R. , Myles Geraldine , Cruz-Flores Salvador
Published: July 2008

Transcranial Doppler (TCD) measurements of middle cerebral artery (MCA) blood flow velocities were recorded and synchronized with electrocardiographic (EKG) recordings in 52 EKG/TCD complexes in 4 patients. Thirty-seven normal sinus beats and 13 conductive and 2 nonconductive premature ventricular contractions (PVCs) were examined. Mean velocities averaged 45 ± 4 cm/sec for normal sinus rhythm (NSR) vs 26 ± 4 cm/sec in the PVC group (P = 0.007). Peak systolic velocities averaged 74 ± 6 cm/sec for the NSR and 45 ± 7 cm/sec in the PVC group (P = 0.016). The latency between the QRS complexes and corresponding TCD wave forms (QRS-SU) averaged 0.12 ± 0.03 sec in NSR and 0.17 ± 0.04 sec for the PVC group (P < 0.001). In addition, QRS-SU was inversely related to all velocities. PVCs appeared to be less hemodynamically efficient than NSR. The lower blood flow velocities and increased QRS-SU may result from lower stroke volume and delayed ventricular contraction associated with the aberrant QRS complex.
Idiopathic Dilatation of the Pulmonary Artery A Case Presentation
Authors: Chang Rei-Yeuh , Tsai Cheng-Ho , Chou Yu-San , Wu Tsai-Cheng
Published: July 2008

Idiopathic dilatation of the pulmonary artery is an uncommon, but not rare, congenital anomaly that is diagnosed by exclusion and generally has a benign clinical course. A left hilar mass on the chest x-ray film is the major presentation. The authors present a case of idiopathic dilatation of the pulmonary artery with posttraumatic chest pain clinically. After serial examinations, idiopathic dilatation of the pulmonary artery was diagnosed. They discuss the phenomenon of transpulmonary valvular pressure gradient and noninvasive tools for long-term follow-up, including transesophageal echocardiography and magnetic resonance imaging.
Budd-Chiari Syndrome as a Complication of Behqet's Syndrome A Case Report
Authors: Danaci Mehmet , Gül Sabahattin , Yazgan Yusuf , Hülagü Saadeddin , Üskent Necdet
Published: July 2008

Budd-Chiari syndrome (BCS) is a very infrequent complication of Behçet's syndrome. The authors report a young, male patient with Behçet's syndrome presenting with BCS. He underwent emergency surgery for thrombectomy but unfortunately died during the operation.
Buerger's Disease in a Middle-Aged Woman with Diabetes Mellitus A Case Report
Authors: Fujii Yoichi , Ohmura Yasuyuki , Takeuchi Ryuzo , Morimoto Setsuo , Uchida Hatsuzo , Hayashi Kazuhiko , Sano Shunji
Published: July 2008

Buerger's disease or thromboangiitis obliterans with involvement of small arteries of the upper and lower extremities usually afflicts young male smokers, but this report presents a middle-aged female nonsmoker with diabetes mellitus who satisfied clinical, angiographic, and histologic criteria for the diagnosis of Buerger's disease.
Aortic Coarctation with Two Intercostal Aneurysms, Appearing Radiographically as a Subclavian Aneurysm A Case Report
Authors: Kelsay Damon E. , Ribeiro Paulo
Published: July 2008

The authors present a case of adult aortic coarctation with two associated intercostal aneurysms and poor left ventricular function. The intercostal aneurysms appear, radiographically, as a subclavian aneurysm. The case illustrates, in aortic coarctation, the potential difficulty in defining the anatomy of the associated vascular aneurysms. The authors also demonstrate that the left ventricular function markedly improves after resection of the aortic coarctation.
An Evaluation of Streptokinase Therapy in Early Coronary Reperfusion in a Primate Model
Authors: Premaratne Shyamal , Siu Benjamin , Wei Zhang  , McNamara J. Judson
Published: July 2008

Efficacy of streptokinase (SK) administered beyond the period of coronary occlusion with regard to ultimate infarct size and the extent of hemorrhagic infarction was assessed in primates. Eleven macaques underwent coronary occlusion for two hours and were then reperfused. Five of them were given a 2,000 U IV bolus of SK followed by a 10,000 U IV infusion over ninety minutes. The remaining 6 served as controls. Macaques were sacrificed seven days postocclusion. The left ventricle was sectioned parallel to the minor axis, and these were examined histologically for infarct size and hemorrhage. Multiplying the planimetric values by the thickness of the sections yielded the total volumes of left ventricle, infarction, and hemorrhage. The mean percentage of left ventricle involved in infarction in the treated group was not significantly different from the controls (14.06 ± 6.35 versus 16.50 ± 4.67, P > 0.10). SK-treated animals had a significantly greater volume of infarct involved with hemorrhage as compared with controls (27.1 ± 10.8 versus 4.0 ± 1.4, P < 0.05). SK infusions done concurrently with reperfusion following a two-hour occlusion did not result in a significant reduction or increase in the size of infarct. However, SK infusions resulted in a significant increase in the amount of hemorrhagic infarction.
Optimizing External Cardiac-Assist Compressions in Patients with Atrial Fibrillation by Anticipating the Next Beat
Authors: Dillon Richard S.
Published: July 2008

Multiple empirical formulas predicting the next RR interval in centiseconds (CS) were tested on EKG strips obtained from 30 patients with atrial fibrillation (AF). The benefits of the formulas were related to the percentages of leg pulsations determined by computer to be effective when the formulas were utilized to initiate compressions in an external end-diastolic pneumatic compression boot. The use of averages of variable numbers of preceding RRs was found to be increasingly beneficial as the number of preceding beats averaged was increased from 1,2,3,5 to the 10th preceding beat with little additional benefit beyond the 10th beat. The following empiric method was the most effective (P < 0.001): the next RR equals the average of the last 10 RRs minus 4 cs if the last RR is within 10% of the average; if the last RR is < 90% of the average, the next RR is 110% of the average minus 4 cs; and if the last RR is greater than 110% of the average, the next beat is 88% of the average minus 4 cs. It was concluded that a computer-controlled monitor may improve the efficiency of external end-diastolic cardiac assist in patients with AF.
Orthostatic Vasoconstrictor Response in Patients with Occlusive Arterial Disease Assessed by Laser Doppler Flux and Transcutaneous Oximetry
Authors: Caspary Ludwig A. , Creutzig Andreas , Alexander Klaus
Published: July 2008

Posturally induced microvascular constriction normally causes a decrease of transcutaneous oxygen pressure (tCPO2) and laser Doppler flux (LDF) measured on the forefoot at 37°C. The authors used both methods to assess the vasoconstrictor response (VCR) in 31 patients with various degrees of peripheral arterial occlusive disease (PAOD) and analyzed factors that could have influenced the response.

Disturbed VCR was indicated by a signal increase following leg dependency, which occurred significantly more often in tCPO2 than in LDF measurements (69% vs 32%, P < 0.001). Correspondingly the median sitting/supine ratio was 2.4 for tcPO 2 and 0.7 for LDF (P < 0.0001). Age and clinical stage had no influence on the VCR. With ankle artery pressures below 50 mmHg an increase of LDF was more probable. TcPO2 predominantly increased with ankle artery pressures up to 100 mmHg, though the sitting/supine ratio of tcPO2 was correlated with ankle artery pressure. In nondiabetics the response of tcPO2 but not of LDF was influenced by the values at rest.

Differences between the two methods may be explained in part by their different sample volumes. The authors assume that tcPO2 is predominantly monitoring a local myogenic response while LDF is reflecting venoarteriolar response.
Subacute Cardiac Rupture Complicating Myocardial Infarction
Authors: Rosato Giuseppe , Santomauro Maurizio , Stanco Giovanni , Petillo Fiorenzo , Sauro Rosario , Chiariello Massimo , Spampinato Nicola , Rotiroti Domenico
Published: July 2008

The authors have focused this study on the emergence of subacute ventricular free wall rupture in a seventy-six-year-old patient admitted to hospital for inferior acute myocardial infarction. After six days he showed clinical symptoms of bradycardia and hypotension evolving to electromechanical dissociation. Given an adequate pharmacologic therapy, the patient was submitted to echocardiography, which was believed to be consistent with myocardial rupture, showing a moderate to large pericardial effusion. Pericardiocentesis of 150 mL of bloody fluid resulted in a further improvement in his hemodynamics. The patient underwent cardiac surgery with repair of the myocardial rupture through a large diaphragmatic infarction by a Dacron polyester fiber graft and pacemaker placement. In conclusion the authors confirm the relevant role of clinical data such as persistent chest pain and hemodynamic instability and the value of echocardiography in identifying subacute myocardial free wall rupture after an episode of acute myocardial infarction.
Coronary Artery Fistula to Bronchial Artery on Contralateral Side of Coronary Atherosclerosis and Myocardial Insufficiency
Authors: Wandwi W.B.C. , Mitsui Norimasa , Sueda Taijiro , Orihashi Kazumasa , Sueshiro Masafumi , Azuma Kazuyoshi , Matsuura Yuichiro
Published: July 2008

Among coronary vessels anomalies is the rare coronary artery fistula. Myocardial insufficiency resulting from fistula steal phenomenon can not be clinically distinguished from that of coronary atherosclerosis, if these conditions coexists in the same patient. The authors present a case of extracardiac left coronary artery fistula connecting the circumflex branch and left bronchial artery, with inferior wall myocardial insufficiency attributable to the right coronary artery atherosclerosis.
ACE Inhibition with Spirapril Improves Diastolic Function at Rest Independent of Vasodilation During Treatment with Spirapril in Mild to Moderate Hypertension
Authors: Petersen Jan Roland , Drabaek Hans , Gleerup Gitte , Mehlsen Jesper , Juhl Petersen Lars , Winther Kaj
Published: July 2008

The effects of the ACE inhibitor spirapril and of hydrochlorothiazide on left ventricular diastolic function were studied. Thirteen patients with mild to moderate essential hypertension completed this randomized, double-blinded, placebo-controlled, crossover study. After a three-week run-in period the patients entered three periods lasting four weeks each, wherein they were treated with placebo, spirapril, or hydrochlorothiazide. Blood pressure, hemodynamic variables (stroke volume, heart rate, cardiac output, index of contractility, and systemic vascular resistance), echocardiography (left ventricular mass), and Doppler-derived atrial to early (A/E)-ratio velocity time integrals (VTI) were measured at the end of each of the four periods.

Spirapril lowered the A/E-ratio VTIs (0.57, 0.12-1.00) (P < 0.02) as compared with both placebo (0.80, 0.50-2.67) and hydrochlorothiazide (0.83, 0.44-1.25), and the drug normalized the A/E-ratio VTI in those patients with elevated values. The hemodynamic variables, left ventricular mass, and end-systolic wall stress were unchanged during all three treatments. There were no significant changes in mean blood pressure during the treatment periods.

These results indicate that spirapril lowers A/E ratio within four weeks in patients with mild to moderate essential hypertension. It thereby seems able to improve left ventricular diastolic function. The effect is not dependent upon changes in hemodynamic variables, blood pressure, left ventricular mass, or end-systolic wall stress.
Quality of Life in a Group of Patients with Intermittent Claudication
Authors: Ponte Euro , Cattinelli Sergio
Published: July 2008

In view of the increasing importance of chronic diseases in recent years, not only quantity but also quality of life has been taken into consideration.

The aim of this study was to verify the quality of life in patients with peripheral obstructive arteriopathies of second degree according to the Leriche-Fontaine classification. Therefore, the authors administrated three different questionnaires to patients selected among those who came to the Angiology Ambulatory Care of the Medical Clinic of the University of Trieste. The questionnaires used were the following: McMaster Health Index Questionnaire (MHIQ), "Squibb" Quality of Life, General Health Index Questionnaire (GHIQ).

The analysis of the results of the questionnaires shows the severe limitation of physical capacities of this kind of patients (overall mean functional limitation of 69% of the maximum value of 1, corresponding to an ideal state of well-being, with negative peaks of 50%). A negative tendency regarding social life and relationship is represented by different scores (from 52% to 66% of ideal maximum) from different items and questionnaires.

Also the items concerning somatic disorders, sleeplessness, and states of anxiety gave results near the percentage of 70% and for this reason were indicative of a state of unwell-being.

The data obtained from the items regarding the presence of a state of depression gave a result less predictable: a score of 87% with peaks over 90% could be indicative of a positive tendency. This last result, consistent with others of analogous studies in the literature, seems to indicate that peripheral arterial disease, even if physically restricting, does not have a strong impact on the psychological and emotional equilibrium of the patients.
Recurrent Myocardial Infarction Provoked by Multiple Giant Coronary Aneurysms A Case Report
Authors: Nakaike Ryuichi , Urabe Yoshitoshi , Shimokawa Hiroaki , Kinjoh Mitsuru , Takeshita Akira
Published: July 2008

A case of multiple coronary aneurysms, complicated with repeated myocardial infarction, is presented. The cine-coronary angiogram and autopsy disclosed marked dilatation of epicardial coronary arteries associated with multiple giant thrombosed aneurysms, which is rare in patients with atherosclerosis.
Training Physicians and Health Care Providers to Accurately Read Coronary Arteriograms A Training Program
Authors: Fleming Richard M. , Fleming Diane M. , Gaede Ruth
Published: July 2008

Patterns in visual interpretation of coronary arteriograms (CAs) frequently cause incorrect assessment of percent diameter stenosis (%DS). These errors result in overestimating the results of angioplasty as well as of the number of arteries significantly affected by coronary artery (CAD) disease.

Methods. Forty-one physicians, nurses, and students participated in the standardization of 45 Kodachromes (39 arteries, 6 phantoms) and 5 photographic reproductions. Eleven of the 41 participated in a three-part training program designed to eliminate errors and improve accuracy of interpreting %DS from CAs.

Results. Improvement in reading %DS was seen in 69% of CAs with statistical (P ≤ 0.05) improvement in one third of these cases, whose narrowings ranged from 4% to 84%DS. Variability of reporting was reduced in 26% of the cases. Skewing, representing an over-estimation of "severe" disease and underestimation of "less severe" disease, was reduced with statistical improvement (P ≤ 0.05) in reported %DS noted after training. Similar improvement was seen with phantoms but not in photographic images where the arterial edges were outlined. (Continued on next page)

(Abstract continued)

Conclusion. The outcomes of clinical management, invasive and interventional (mechanical, thrombolytic) procedures, as well as research studies depend in part upon the accuracy of reading %DS from CAs. Most studies to date have been completed using extremely unreliable estimates of %DS with resultant problems in data interpretation. The use of this standardized training program has led to significant improvement in accurately assessing CAD.

CONDENSED ABSTRACT

Visual interpretation of percent diameter stenosis (%DS) from coronary arteriograms results in underestimating stenosis severity for "mild" disease and overestimating "severe" disease. These patterns in reading stenosis severity yield misinterpretation of angioplasty results as well as of the number of vessels significantly diseased. Forty-one physicians, nurses, and students participated in a training program designed to reduce errors made while reading %DS from coronary arteriograms. Following the three-part training program, participants demonstrated improvement in 69% of the arteries, with statistical (P < 0.05) improvement in one third of these. The improved interpretation resulted in more accurate assessment of the severity of coronary artery disease present, both before and after interventions. Utilization of this training program in cardiology fellowship programs would result in better interpretation of disease severity by cardiologists.
Unusual Presentation of Takayasu Arteritis with Cardiac Involvement and Imitation of Juvenile Arteriosclerosis A Case Report
Authors: Jung E.M. , Baumann R. , Rauh G. , Müller-Höcker J.
Published: July 2008

A twenty-five-year-old Caucasian man with Takayasu arteritis, who was formerly diagnosed as suffering from premature arteriosclerosis, is described. Necropsy disclosed involvement of the entire aorta and its major branches, the pulmonary arteries, the coronary arteries, the intramyocardial arteries, and the heart valves, a combination hitherto not described. Literature concerning heart involvement in Takayasu arteritis is reviewed, and the differential diagnosis is discussed.
Heparin-Induced Thrombocytopenia with Multiple Cerebral Infarctions Simulating Thrombotic Thrombocytopenic Purpura A Case Report
Authors: Boon D.M.S. , Michiels J.J. , Tanghe H.L.J. , Kappers-Klunne M.C.
Published: July 2008

The authors describe a patient with stroke, treated with heparin for unstable angina, whose clinical features mimicked those of thrombotic thrombocytopenic purpura (TTP). His condition eventually proved to be caused by heparin-induced thrombocytopenia (HIT), complicated by thrombosis (HITT). The absence of microangiopathic hemolytic anemia should question the diagnosis in a presumed TTP patient. Early diagnosis of HITT is possible since recently two highly sensitive and specific tests have become available. Heparin treatment has to be stopped immediately if HITT is diagnosed. First-choice antithrombotic treatment in HITT patients is danaparoid.
Multiple Organ Manifestations in Thromboangiitis Obliterans (Buerger's Disease) A Case Report
Authors: Harten Pontus , Müller-Huelsbeck Stefan , Regensburger Dieter , Loeffler Helmut
Published: July 2008

Thromboangiitis obliterans (TAO) occurs almost exclusively in young male smokers. Its involvement of the small and medium-sized arteries and veins leads to ischemic complaints and/or changes in the extremities. The possibility of organ involvement is a matter of controversy. The authors report a case of TAO with multiple organ involvement, including myocardial, splenic, and cerebral infarctions; pulmonary embolisms; and probable intestinal ischemia during a twenty-three-year course.
Identification of Viable Myocardium by Nitrate Echocardiography After Myocardial Infarction: Comparison with Planar Thallium Reinjection Scintigraphy
Authors: Pontillo Daniele , Carboni Gian Piero , Capezzuto Aldo , Alessi Claudio , Achilli Augusto , Piccini Francesca , Guerra Roberto
Published: July 2008

Background: The aim of this study was to validate a new diagnostic tool, nitrate echocar diography (NE), for the identification of viable noncontracting myocardium in patients with a history of prior myocardial infarction (MI). Nitroglycerin (NTG) may be useful for this purpose for its peculiar pharmacodynamic action and may represent an option other than dobutamine echocardiography for the detection of hibernating segments in the presence of severely reduced coronary reserve.

Methods: Twenty selected patients (pts) with an old MI were studied with NE and planar thallium scintigraphy with reinjection. NE was performed by administering IV NTG starting at 0.4 mcg/kg/minute with equal increments every five minutes up to 2 mcg/kg/minute or to early interruption of the test (decrease of systolic blood pressure ≥ 20% or improvement of previously akinetic segments). Left ventricular wall motion was analyzed by dividing the left ventricle (LV) into 16 segments, and a wall motion score index (WMSI) was calculated. Thallium images were obtained at peak exercise, at four hours, and after reinjection. Myocardial viability was defined as an improvement in thallium uptake after reinjection in fixed defects. (continued on next page)

Results: Basal echo demonstrated 74 akinetic segments; of these 21 (28%, 11 pts) showed improved contractility during NTG infusion at a mean dose of 0.87 ±0.33 mcg/kg/minute. WMSI decreased from 1.69 ±0.29 to 1.46 ±0.31 (P=.001). The only hemodynamic response was a drop in systolic blood pressure (136 mmHg to 124; P=.02). Thallium studies showed 29 segments with a four-hour reversible defect and 79 segments with a four-hour fixed defect; of the latter, 14 regions demonstrated improvement in tracer uptake after reinjection (17.7%; 10 pts). Nine pts had a positive echo and thallium study, while 8 showed no improvement either during NE or after thallium reinjection. Two pts had a false-positive nitrate echocardiogram. Therefore, according to an echo/thallium study match, sensitivity, specificity, and accuracy are 90%, 80%, 85%, respectively.

Conclusion: NE is a reliable and low-cost method for the detection of viable noncon tracting myocardium in selected patients with CAD but needs further validation for wide spread application.
Doppler Echocardiographic Assessment of Normally Functioning Starr-Edwards, Carbomedics and Carpentier-Edwards Valves in Aortic Position
Authors: Chakraborty Barendra , Quek Susan , Ding Zee Pin  , Chee Tek Siong  , Tan Lay Kheng
Published: July 2008

Doppler echocardiography was performed in 168 normally functioning aortic prostheses to determine acceptable pressure gradients across the commonly used valves and to establish the relationship between valve size and gradients. There were 82 Carbomedics (C), 63 Starr-Edwards (SE), and 23 Carpentier-Edwards (CE) valves. Peak and mean gradients across the prostheses were measured by use of the simplified Bernoulli equation. CarboMedics valve had a lower peak and mean gradient than Starr-Edwards and Carpentier-Edwards valve (P < 0.05 when compared with Starr-Edwards). The authors observed a weak inverse correlation between valve size and peak and mean gradients in CarboMedics and Carpentier-Edwards valves but not in the Starr-Edwards valve. For the CarboMedics valve the peak pressure gradient (PPG) was 26.1 ±8.2 mm Hg and the mean pressure gradient (MPG) was 14.7 ± 5.1 mm Hg; in Starr-Edwards valve the PPG was 32.8 ±9.1 mm Hg and the MPG was 19.5 ±5.6 mm Hg; in the Carpentier-Edwards valve the PPG was 28.7 ± 10.1 mm Hg and the MPG was 16.1 ± 5.2 mm Hg when size was not specified. The CarboMedics valves were noted to have a better hemodynamic profile in comparison with Starr-Edwards and Carpentier-Edwards prostheses.
The Effect of Low Molecular Weight Heparin (Fragmin) on Myocardial Neutrophil Accumulation and Infarct Size in a Rat Model of Myocardial Infarction
Authors: Hasdai David , Varda-Bloom Nira , Blumberg Nehemia , Ohad Dan , Kornowski Ran , Battler Alexander
Published: July 2008

Background: Heparin molecules possess immunomodulating properties, which are thought to complement their established antithrombotic activity. The purpose of this study was to evaluate whether the antiinflammatory properties of low molecular weight heparin (LMWH) can attenuate polymorphonuclear neutrophil accumulation and infarct size in a rat model of myocardial infarction.

Methods: Myocardial infarction was induced by ligating the left main coronary artery. LMWH (fragmin 500 anti-FXa u/kg) or vehicle (saline) were administered subcuta neously thirty minutes prior to coronary artery occlusion. Significant anticoagulant activity was attained with LMWH for more than eight hours. Twenty-four hours later, neutrophil accumulation and infarct size were determined by measuring left ventricular free wall myeloperoxidase and residual creatine kinase activity, respectively.

Results: As compared with rats administered vehicle, myeloperoxidase activity was insignificantly decreased in rats treated with LMWH (1.24 ±0.28 u/g vs 1.66 ±0.15 u/g, P=0.16). Infarct size was also not significantly different between the groups (62.48 ±3.5% and 50.67 ±7.2% of left ventricular free wall with vehicle and LMWH, respec tively, P=0.1).

Conclusion: The authors conclude that LMWH does not significantly reduce myocar dial neutrophil accumulation and infarct size twenty-four hours after myocardial infarc tion in the rat.
Peripheral Neuropathy Associated with Ischemic Vascular Disease of the Lower Limbs
Authors: Pasini F. Laghi , Pastorelli M. , Beermann U. , de Candia S. , Gallo S. , Blardi P. , Di Perri T.
Published: July 2008

This paper deals with the possible identification of somatic and autonomic nerve damage in patients with peripheral obliterative arterial disease (POAD) at different stages of the disease, with a well-reproducible technique like electroneurographic evaluation of nerve conduction.

In 64 patients with intermittent claudication, 19 patients with pain at rest, and 7 patients with trophic ulcers, electroneurographic evaluation of motor (tibial and peroneal) and sensory (superficial peroneal and sural) nerve conduction was performed. The median nerve (motor and sensory) was used as control.

A severe impairment of sural and superficial peroneal nerve velocities was evident in many claudicant patients and in all patients with pain at rest and trophic ulcers, with a progression in the conduction abnormalities in advanced stages of the disease.

Motor nerve conduction showed only minor reductions in patients with claudica tion and pain at rest, although some of them did show very poor velocity values. In 21 patients with intermittent claudication and sensory nerve abnormalities, the autonomic fibers activity, evaluated by the skin sympathetic response (SSR) test, was significantly depressed, thus suggesting an involvement of the local autonomic system in the ischemic disease.

A correlation exists between the severity of the somatic nerve damage and the stage of the vascular insufficiency. However, in the group of claudicant patients, the evidence of similar ischemic threshold (claudication distance) may be associated with a marked difference in the amount of somatic nerve damage. The somatic and autonomic nerve alterations may play a relevant role in the progression of the disease toward critical limb ischemia.
Successful Application of Hypothermia Combined with Intra-Aortic Balloon Pump Support to Low-Cardiac-Output State After Open Heart Surgery
Authors: Moriyama Yukinori , Iguro Yoshihumi , Shimokawa Shinji , Saigenji Hideaki , Toyohira Hitosi , Taira Akira
Published: July 2008

The authors report a successful application of hypothermia, along with intra-aortic balloon pump (IABP) support, to postcardiotomy ventricular failure. Surface-cooling hypothermia was applied in 8 patients after open heart surgery. The original cardiac procedure consisted of 3 aortocoronary bypass graftings (ACBGs), 2 aortic valve replace ments (AVRs), 1 repair for left ventricular (LV) rupture after mitral valve replacement (MVR), 1 MVR+ACBG, and 1 MVR+AVR+tricuspid valve annuloplasty (TAP). Their ages ranged from fifty-two to sixty-eight years with a mean of sixty-one years. Hemodynamic criteria for induction of hypothermia included cardiac index (CI) less than 2.0 L/min/m2 with left atrial pressure greater than 18 mmHg despite the use of IABP and maximum pharmacologic support. Blood temperature was maintained at around 33°C. By six hours after induction of hypothermia the tissue oxygen consumption decreased significantly with no hemodynamic deterioration as compared with that before cooling. The duration of hypothermia ranged from thirty-six to one hundred fifty-nine hours with a mean of seventy-eight hours. All 8 patients finally discontinued IABP support with a mean driving time of one hundred thirty-two hours. Five of them were ultimately discharged from the hospital and returned to their previous life-style. The authors believe that, from the perspective of monetary and personal resources, the use of hypothermia with IABP support could be a therapeutic option for patients with postcardiotomy ventricular failure.
The Influence of Angiographic Endpoints on the Outcome of Lipid Intervention Studies
Authors: Wouter Jukema J. , van Boven Ad J. , Zwinderman Aeilko H. , Bal Egbert T. , Reiber Johan H. C. , Bruschke Albert V. G.
Published: July 2008

The aims of this study were to evaluate the influence of different coronary angiographic endpoints on the outcome of lipid intervention studies and to formulate a proposal for angiographic endpoint standardization.

In recent angiographic intervention studies a confusing diversity in angiographic endpoints has been used to determine the outcome. In addition, differences in study populations (eg, bypass patients included or not) could influence results. This makes comparisons between studies cumbersome and raises the question to what extent the results of various studies may be subject to the selection of angiographic endpoints.

The investigators compared three frequently used endpoints (mean segment diameter, minimum obstruction diameter, and % stenosis) in a group of 505 patients who had just finished a trial designed to assess the effect of cholesterol lowering by pravastatin. To exclude a potential bias this analysis was carried out at the time that the study was still blinded. (continued on next page)

They found poor intercorrelation coefficients for mean segment diameter calculated in different ways, ranging from 0.55 to 0.95, dependent on inclusion or exclusion of segments influenced by coronary angioplasty or bypass grafting and on whether or not a value of 0 was assumed for occluded segments and segments distal to occlusions. The correlation between mean segment diameter and minimum obstruction diameter was 0.79; between minimum obstruction diameter and % stenosis, 0.85; and between mean segment diameter and % stenosis, only 0.64.

Different endpoints sometimes correlate poorly. This may lead to differences in results of angiographic intervention trials. The authors propose standardization by (1) using both mean segment diameter and minimum obstruction diameter as endpoints and (2) excluding from the primary analysis segments influenced by mechanical interven tions.
Angiotensin-Converting Enzyme Gene Polymorphism in Essential Hypertensive Patients in Japanese Population
Authors: Maguchi Motofumi , Kohara Katsuhiko , Okura Takafumi , Shimin Li  , Takezaki Masayuki , Nishida Wataru , Hiwada Kunio
Published: July 2008

Association between angiotensin-converting enzyme (ACE) gene polymorphism and essential hypertension in a Japanese population with the same socioeconomic back ground was investigated. Insertion-deletion (I/D) polymorphism of the ACE gene located on intron 16 was detected by polymerase chain reaction. Association between ACE gene polymorphism and family history of essential hypertension as well as the development of vascular damage in eye fundi were also investigated. Variation at ACE loci did not contribute to essential hypertension and the vascular damages in eye fundi. These results suggested that the ACE gene was not directly responsible for essential hypertension in this particular Japanese population with the same socioeconomic background.
Arachidonic Acid Metabolites in Acute Myocardial Infarction
Authors: Takase Bonpei , Maruyama Toshiharu , Kurita Akira , Uehata Akimi , Nishioka Toshihiko , Mizuno Kyoichi , Nakamura Haruo , Katsura Kenichiro , Kanda Yoshikazu
Published: July 2008

Abnormalities of arachidonic acid metabolism are implicated in spasm and thrombosis in coronary arteries. Therefore, arachidonic acid metabolites were examined in patients with acute myocardial infarction (AMI). Plasma levels of thromboxane B2 (TXB 2), 6-keto prostaglandin F1α (6KPGF1α), leukotriene B4 (LTB4), and slow reacting substance of anaphylaxis (SRS-A) composed of leukotriene C4 (LTC4), leukotriene D4 (LTD4) and leukotriene E4 (LTE4), were measured in 19 AMI patients. Plasma levels of TXB2, LTB4, and SRS-A in systemic artery blood were significantly elevated during the acute stage (within twenty-four hours after the onset of chest pain) of AMI (TXB2, 0.36 ng/mL; LTB4, 0.75 ng/mL; and SRS-A [LTC4+LTD4+LTE 4], 0.96 ng/mL) compared with those of normal controls (TXB2, 0.18 ng/mL; LTB4, 0.44 ng/mL; and SRS-A [LTC4+LTD4+LTE 4], 0.31 ng/mL). These values decreased to near-normal control levels by one month after the AMI attack. The findings in this study suggest that abnormalities of arachidonic acid metabolism accompany, and may play a role in the pathogenesis of, AMI.
Common Carotid Artery Wall Properties in Takayasu's Arteritis
Authors: Wada Takashi , Kodaira Kuniyasu , Fujishiro Kentaro , Maie Ken-ichi , Tsukiyama Eiji , Fukumoto Tsutomu , Uchida Tomoko , Yamazaki Sayaka
Published: July 2008

The vessel wall properties of the common carotid artery have been noninvasively and quantitatively assessed with an ultrasonic instrument. Stiffness parameter β, which repre sents the mechanical properties of the vessel, was calculated from the relationship between blood pressure and the diameter of the artery. There are no reports that quan titatively assess wall properties in Takayasu's arteritis.

The authors compared, in vivo, the vessel wall properties of the common carotid artery in 14 patients with Takayasu's arteritis versus those in 60 normal subjects (controls). They measured changes in the inner diameter of the artery between systole and diastole with an ultrasonic, phase-locked, echo-tracking system. β was significantly higher in Takayasu's arteritis than in normal subjects (better than a 99% confidence interval). The findings for each decade were as follows: 3rd decade (20s): 35.7 ±28.9 vs 5.01-6.46, P=0.0001; 4th decade (30s): 19.5 ±9.71 vs 6.09-7.80, P=0.02; 5th decade (40s): 26.2 ±11.3 vs 7.26-9.28, P=0.0001; 6th decade (50s): 19.1 ±4.27 vs 8.66-11.25, P=0.0001.

Takayasu's arteritis significantly impaired the mechanical performance of the common carotid artery. Thus, β shows promise as a useful diagnostic indicator of Takayasu's arteritis.
Nitrate-Induced Headache in Patients with Stable Angina Pectoris: Beneficial Effect of Starting on a Low Dosage
Authors: Cleophas Ton J. M. , Niemeyer Menco G. , van der Wall Ernst E. , van der Meulen Jan
Published: July 2008

Background: Nitrates, although important for the management of angina pectoris, cause significant headache in many patients.

Methods: In a randomized, double-blind, crossover study, 89 patients with stable angina pectoris were studied to compare two different dosage strategies of isosorbide-5-monon itrate (5-ISMN). Patients were randomized to either 60 mg 5-ISMN once daily (od) for two weeks or to 30 mg 5-ISMN od for one week followed by 60 mg 5-ISMN od for one week. Then, there was a two-week placebo washout, after which the alternative treatment was given. The authors assessed the occurrence of angina pectoris and headache by diary cards while taking into account the numbers of isosorbide dinitrate sublingual puffs and paracetamole tablets required. Data were assessed for carryover and time effects.

Results: The two dosage regimens were equally efficient for the relief of angina pectoris without development of tolerance. Thirty percent of the patients never experienced headache from the given dosages. In the remainder of them there was a highly significant time effect: the overall numbers of headache attacks in the first period of active treatment versus the second were 2,380 vs 1,400 (P < 0.003). Yet significantly fewer patients had headache on low dosage than on high dosage (45 vs 57, P < 0.02).

Conclusions: (1) Starting on a low dosage was associated with a reduced frequency and severity of headache and did not notably influence the beneficial effect on angina pectoris. (2) One in 3 patients never experienced headache from the given dosages. (3) The overall number of headache attacks in the first period of active treatment was signif icantly higher than in the second period irrespective of the dosages given.
Reverse Jugular Flow in a Case of Thrombosis of the Brachiocephalic Vein with an Artificial Arteriovenous Fistula A Case Report
Authors: Chen Yu-Wei , Yip Ping-Keung , Jeng Jiann-Shing , Hwang Bao-Show , Chang Yang-Chyuan , Lin Win-Hwan
Published: July 2008

Thrombosis of the thoracic inlet veins following placement of a central venous catheter is a well-known complication, and several findings have been reported by color Doppler sonography. However, reverse jugular flow resulting from this complication is rarely mentioned and should be differentiated from another complication of iatrogenic arteri ovenous fistula between neck vessels. The authors here describe a uremic patient with an artificial arteriovenous fistula in the forearm complicated with thrombosis of the ipsilat eral brachiocephalic vein. Factors permitting the differential diagnosis by color Doppler sonography and clinical conditions are proposed.
Paroxysmal Atrial Tachycardia Recorded by Holter Monitoring During an Episode of Fear A Case Report
Authors: Badui Elias , Lepe Luis , Van Wielink Gullermo , Espinosa Rafael
Published: July 2008

A twenty-four-year-old, white, athletic woman, free of heart disease, experienced an episode of fear when she was assaulted in the street without physical injury while under going twenty-four-hour Holter monitoring. She developed an important sympathetic response in which, besides the symptoms characterized by palpitations, chest pain, dyspnea, asthenia, dizziness, nausea, and profuse cold sweating, she had an episode of paroxysmal atrial tachycardia. The causes and mechanism of this not well-documented event in humans are discussed.
Pulmonary Valvular Stenosis Associated with Takayasu's Disease. Favorable Response to Corticosteroids A Case Report
Authors: Rangel Alberto , Badui Elias , Jara Luis J. , Chavez Eduardo , Solorio Sergio , Enciso Roberto , Verdin Raul , Marin Guadalupe
Published: July 2008

The authors describe the first reported case of type IV Takayasu's arteritis with pulmonary valve stenosis. After thirty months under corticosteroid therapy the disappearance of the pulmonary valve stenosis signs was observed in the patient. In the same patient coarcta tion of the aorta, aortic insufficiency, stenosis of both pulmonary arteries, and left coronary artery stenosis were observed. This case illustrates the extensive cardiovascular involvement that can occur in Takayasu's arteritis and suggests that pulmonary valvular stenosis could be secondary to the same inflammatory process.
Persisting Effect of Ca2+-Channel Blockers on Left Ventricular Function in Hypertrophic Cardiomyopathy After 14 Years' Treatment
Authors: Hartmann Andreas , Schnell Joachim , Hopf Rüdiger , Kneissl Georg
Published: July 2008

Ca2+-channel blockers of the verapamil type have been reported to exert a beneficial effect on clinical symptoms and survival rates in hypertrophic cardiomyopathy. The effects of verapamil have been attributed predominantly to an improved diastolic filling. It is unknown whether an effect on diastolic filling persists in these patients after long-term treatment. Fourteen patients (12 men, 2 women, median age fifty-one [thirty-two to fifty-five] years) with hypertrophic cardiomyopathy were included in the study. Patients had been treated with verapamil 240-480 mg/d or gallopamil 150-200 mg/d for fourteen (seven to seventeen) years. The effect of a withdrawal of Ca2+-channel blockers on parameters of left ventricular diastolic function was evaluated at rest and during exercise in patients with hypertrophic cardiomyopathy after long-term therapy. Investigations were performed at rest and during supine ergo metric exercise during ongoing Ca2+-channel blocking therapy and after five (four to nine) days' withdrawal (control). Pulsed Doppler echocardiography was used to record diastolic mitral flow profiles from an apical four-chamber view.

Withdrawal of Ca2+-channel blockers of the phenylalkylamine type after long-term treatment of hypertrophic cardiomyopathy resulted in a significant reduction of early diastolic inflow velocity at rest and during exercise. In conclusion, these results indicate a persistent improvement of early diastolic filling by Ca2+-channel blockers even after long-term treatment.
Acute Myocardial Infarction with Normal Coronary Arteries in a Patient with Dermatomyositis
Authors: Badui Elias , Valdespino Aquiles , Lepe Luis , Rangel Alberto , Campos Arturo , Leon Francisco
Published: July 2008

The authors present a forty-year-old man, with a history of dermatomyositis for the past twelve years, managed intermittently with prednisone. During an exacerbation of his illness he developed an acute anterior wall myocardial infarction with normal coronary arteries. A literature review indicates this represents a rare association.
Geometry of the Carotid Arteries and Tilt-up Hypotension in Subjects with Essential Arterial Hypertension
Authors: Ciccone Marco , Antonelli Gianfranco , Di Venere Nicola , Campaniello Maurizio , di Noia Domenico , Rizzon Paolo
Published: July 2008

Dysfunction of the baroreceptor structures located in the carotid bulb is considered responsible for hypotensive responses to orthostatic posture in hypertensive subjects.

Because of a recurrent vascular impairment in essential hypertensives, the authors hypothesized that in these cases the baroreceptive dysfunction could be related to some peculiar vascular disarrangement of the carotid arteries, at the level of the bulb. To test this, they compared two groups of mild essential hypertensives, divided into group A— 15 subjects considered hyporeacting because of a decrease in mean blood pressure ≥ 10 mmHg at the first minute of a passive orthostatic stress—and group B—15 subjects considered normoreacting because of an increase in mean blood pressure ≥ 5 mmHg. They evaluated by high definition echo Doppler ultrasonography: (1) an arterial compli ance index, (2) the volume of the carotid bulb, and (3) a score expressing the degree of arteriopathy at the level of the carotid arteries.

In group A, results demonstrated a significant impairment of the carotid artery structure, expressed by an increase in volume of the carotid bulb (389.4 ± 134.7 vs 233.2 ± 116.5 mm3, P < 0.05) and a higher vascular score (2.7 vs 1, P < 0.001), while the index of arterial compliance was similar in the two groups.

In conclusion, in mild essential hypertension a baroreceptor dysfunction could be strictly linked to a derangement of the carotid artery structure, while arterial compli ance does not seem to involve the baroreceptor function.
Digital Infarction in a Patient with Raynaud's Phenomenon Associated with Treatment with a Specific Serotonin Reuptake Inhibitor
Authors: Bell Caroline , Coupland Nicholas , Creamer Paul
Published: July 2008

The authors report the worsening of preexisting Raynaud's phenomenon during treatment of depression with a selective serotonin reuptake inhibitor, fluvoxamine.