bluuebunny/crossref_metadata_2025 huggingface dataset:
'Real' Epidemiology of Varicose Veins and Chronic Venous Diseases: The San Valentino Vascular Screening Project
Authors: Cesarone M.R. , Belcaro G. , Nicolaides A.N. , Geroulakos G. , Griffin M. , Incandela L. , De Sanctis M.T. , Sabetai M. , Geroulakos G. , Agus G. , Bavera P. , Ippolito E. , Leng G. , Di Renzo A. , Cazaubon M. , Vasdekis S. , Christopoulos D. , Veller M.
Published: July 2008

The aim of this study was to evaluate the prevalence and incidence of venous diseases and the role of concomitant/risk factors for varicose veins (VV) or chronic venous insufficiency (CVI). The study was based in San Valentino in Central Italy and was a real whole-population study. The study included 30,000 subjects in eight villages/towns evaluated with clinical assessment and duplex scanning. The global prevalence of VV was 7%; for CVI, the prevalence was 0.86% with 0.48% of ulcers. Incidence (new cases per year) was 0.22% for VV and 0.18% for CVI; 34% of patients with venous disease had never been seen or evaluated. The distribution of VV and CVI in comparison with duplex-detected incompetence (DI) indicates that 12% of subjects had only VV (no DI), 2% had DI but no VV, 7.5% had DI associated with VV, 2% apparent CVI without DI, 3% DI only (without CVI), and 1.6% both CVI and DI. VV associated with DI are rapidly progressive and CVI associated with DI often progresses to ulceration (22% in 6 years). VV without significant DI (3%) and venous dilatation without DI tend to remain at the same stage without progression for a lengthy time. New cases per year appear to have a greater increase in the working population (particularly CVI) possibly as a consequence of trauma during the working period. In older age (> 80 years), the incidence of CVI tends to decrease. Ulcers increase in number with age. Only 22% of ulcers can be defined as venous (due to venous hypertension, increased ambulatory venous pressure, shorter refilling time, obstruction and DI). Medical advice for VV or CVI is requested in 164 subjects of 1,000 in the population. In 39 of 1,000, there is a problem but no medical advice is requested and in only 61 of 1,000, the venous problem is real. In VV in 78% of limbs, there is only reflux, in 8% only obstruction, and in 14% both. In CVI, 58% of limbs have reflux, 23% obstruction, and 19% both. In conclu sion, VV and CVI are more common with increasing age. The increase with age is linear. There was no important difference between males and females. These results are the basis for future real, whole population studies to evaluate VV and CVI.
Elastic Fibers in Saphenous Varicose Veins
Authors: Cristóvão Porto Luís , Alves Azizi Marco Antônio , Pelajo-Machado Marcelo , da Silveira Paulo Roberto Matos , Lenzi Henrique Leonel
Published: July 2008

The purpose of this study is to describe the elastic fibers of varicose collateral saphenous veins. Sections were obtained from venous segments of patients with essential varices and stained with resorcin-fuchsin for elastic system fibers and analyzed with laser scanning microscopy after Evans blue staining. Vein portions (270 μm) were classified as without thick ening, with a cushion, or with a diffuse thickening. The elastic material density of the intima (Dei) and media (Dem) were tested for differences by the Kruskal-Wallis test. Diffuse thickening (87.1 ±8.6 μm) represents 54.5% of the segment. Cushion occupies 23.5% with 42.4 ±4.66 μm, The elastic network present in the cushion is formed by elastic fibers of different diameters that branch into delicate oxytalan fibers in association with the smooth muscle cells. The diffuse thickening elastic network varies from elastic lamellae and delicate oxytalan fibers related to the intima smooth muscle cell bundles to fragmented elastic fibers in the collagenous areas. Dei increases as the intima enlarges (10.19, 14.63, and 16.01, respectively to without thickening, cushion, diffuse thickening). In the media, the elastic network encircles the circular muscle bundles connecting them to the elastic internal lamina and to elastic fibers in the adven titia. Smooth muscle cells were coiled by numerous oxytalan fibers and the elastic fibers are irregular and fragmented. In the sclerotic portions, the elastic fibers are sparse. No correlation was found between Dei and Dem. The important thickening of varicose vein intima shows increasing quantities of elastic material formerly associated with smooth muscle cells. In the media, the elastic network around smooth muscle cell bundles is disrupted and the Dem dimin ishes as the media becomes sclerotic.
Fibrinolytic Parameters and Lipoprotein(a) in Young Women with Myocardial Infarction
Authors: Salobir Barbara , Šabovič Mišo , Peternel Polona , Stegnar Mojca
Published: July 2008

Impaired fibrinolysis and elevated lipoprotein(a) (Lp[a]) are possible nonclassic risk factors for myocardial infarction (MI) at young age. The fibrinolytic system in young women with MI has not been evaluated yet and the role of Lp(a) is still controversial. The authors determined fibrinolytic parameters and Lp(a) in premenopausal women (mean age 42 ±3 years, n = 22) 0.5 to 6 (mean 3.5) years after MI, who were all without severe classic risk factors and had an otherwise low risk for MI. Elevated levels of tissue type plasminogen activator (t-PA) (p < 0.05) were measured in comparison to 52 age-matched controls; no difference was found in plas minogen activator inhibitor, plasminogen, fibrinogen, euglobulin clotting time and D-dimers. Significantly more MI patients had Lp(a) levels greater than 300 mg/L compared to controls (36% vs 13.5%, p < 0.05). The combination of elevated Lp(a), mild hyperlipidemia, and nonsevere smoking was found in 62.5% of MI patients who had elevated levels of Lp(a), in 23% of all women with MI, and in none of the controls. Elevated t-PA is probably only a marker of increased risk of MI, whereas elevated Lp(a) probably has a causative role. A combination of elevated Lp(a), hyperlipidemia, and nonsevere smoking seems to be a high-risk profile, rela tively common in young women with MI.
The Chronic Effect of Rilmenidine on Heart Rate Variability in Patients with Mild Hypertension
Authors: Eryonucu Beyhan , Ulgen Mehmet S. , Bilge Mehmet , Güler Niyazi , Güneş Ahmet
Published: July 2008

The purpose of this study was to evaluate the chronic effect of rilmenidine on time domain indexes of heart rate variability in patients with mild hypertension. Twenty patients (12 males, eight females; mean age, 47 yr; age range, 38-55 yr), with untreated and newly diagnosed mild hypertension were studied. There was no evidence of diseases other than hypertension. All patients received 1 mg of rilmenidine once daily. If the diastolic blood pressure was still greater than 90 mm Hg after 4 weeks of active treatment, the dose was increased to 2 mg once daily. Twenty-four hour ambulatory electrocardiograms were recorded before, and 4 and 12 weeks after the start of therapy. Time domain parameters of heart rate variability were calculated. Rilmenidine therapy determined a marked decrease in blood pressure. At 4 weeks, rilmenidine induced a significant reduction in systolic and diastolic blood pressure and a further reduction was observed after 12 weeks. At 4 and 12 weeks, time domain parameters of heart rate variability and heart rate were not significantly different in the data obtained before therapy. In conclusion, this study demonstrated that the administration of rilmenidine to patients with mild essential hypertension induced significant reductions in blood pressure, without any significant changes in time domain parameters of heart rate variability.
Irreversible Myocardial Damage After Coronary Air Embolism
Authors: Hung Ming-Jui , Kuo Li-Tang , Wang Chao-Hung , Cherng Wen-Jin
Published: July 2008

This case report describes the complication of an air embolism in the right coronary artery that developed during coronary angiography in a patient with acute anterior myocardial infarction. Follow-up left ventriculography, 4 months later, showed irreversible inferior wall damage. Incomplete aspiration of the angiographic catheter was the cause of this complication and should be avoided.
Ipsilateral Intracerebral Hemorrhage Following Carotid Stent-Assisted Angioplasty: A Manifestation of Hyperperfusion Syndrome
Authors: Nikolsky Eugenia , Patil Chandrashekhar V. , Beyar Rafael
Published: July 2008

A case of hyperperfusion syndrome manifested as intracerebral hemorrhage following carotid stent-assisted angioplasty while using intravenous abciximab is described. Review of literature regarding hyperperfusion syndrome in patients undergoing carotid artery revascularization is presented. Possible mechanisms of hyperperfusion and the role of arterial hypertension, anti coagulation, and antiplatelet treatment in the genesis of hyperperfusion syndrome are discussed. Widening use of percutaneous carotid revascularization necessitates physicians' awareness of early recognition of this complication.
Traumatic Tricuspid Insufficiency
Authors: RuDusky Basil M. , Cimochowski George
Published: July 2008

Traumatic tricuspid insufficiency following blunt chest trauma, although an uncommon entity, has been reported more frequently over the past 2 decades. Increased physician awareness of the possibility of myocardial trauma accompanied by proper clinical evaluation and follow-up are the keys to a successful outcome regardless of whether a medical or surgical approach to treatment is initially selected. Early surgical correction has become the preferred treatment in most instances and may be influenced by clinical status and other associated comorbid condi tions. A patient with a combination of myocardial contusion, valve laceration, and papillary muscle rupture is presented.
Oxerutins (Venoruton®): Efficacy in Chronic Venous Insufficiency
Authors: Petruzzellis Vincenzo , Troccoli Teresa , Candiani Carlo , Guarisco Raffaella , Lospalluti Mario , Belcaro Gianni , Dugall Mark
Published: July 2008

The aim of this study was to confirm the clinical efficacy of oxerutins by evaluation of venous parietal tone and microvascular perfusion in a double-blind, randomized, placebo-controlled study. The study included 60 patients. Venous tone was evaluated by air-plethysmography (APG) in patients with venous insufficiency (CVI). Forty patients were treated with oxerutins and 20 with placebo for 4 weeks. The dose of the first 2 weeks was higher than that of the following 2 weeks. The age range was between 18 and 65 years. Randomized patients received treatment (oxerutins or placebo) according to the grade of CVI. Patients with grade I CVI received 2 g/day in the first 2 weeks of treatment and 1 g/day in the following weeks. Patients with grade II CVI received 3 g/day in the first 2 weeks and 2 g/day in the following 2 weeks. Visits were scheduled at baseline time (visit 1), at 2 weeks (visit 2) and at 4 weeks (visit 3). They were assessed with the following: (1) APG; (2) light reflection rheography (LRR); (3) capillaroscopy; (4) liquid crystals thermography. CVI signs/symptoms-heavy legs, edema, paresthesia, and cramps-were evaluated following a 4-point rating scale (0 = no symptom; 3 = severe symptoms). At visit 3 a final opinion on efficacy was provided by both patients and investigators, based on a 4-point scale (none, fairly good, good, excellent). The two groups were homogeneous for age, sex, and clinical distribution. The changes in venous capacity, were significant (p< 0.01) in the oxerutins group at visits 2 and 3; values in the placebo group remained unchanged. The changes in LRR were significant in the treatment group at visits 2 (p < 0.05) and 3 (p < 0.01); values in the placebo group remained unchanged. Changes in temperature were significant in the oxerutins group at visits 2 (p < 0.05) and 3 (p < 0.01 ); changes in the placebo group were not significant at the end of the study. Capillaroscopy showed an improvement in patients treated with oxerutins. The results of the analysis of signs/symptoms favored active treatment. The overall effects of oxerutins were significantly better than the effects of placebo. Considering both noninvasive tests and clinical evaluation, oxerutins is effective in controlling chronic venous hypertension, without side effect, and with good tolerability.
Elevated Level of Plasma C-reactive Protein in Patients with Unstable Angina: Its Relations with Coronary Stenosis and Lipid Profile
Authors: Li Jian-Jun , Jiang Hong , Huang Cong-Xin , Fang Chun-Hong , Tang Qi-Zhu , Xia Hao , Liu Jun , Li Geng-Shan
Published: July 2008

C-reactive protein (CRP) is a sensitive marker of inflammation, and elevated levels have been associated with future risk of cardiovascular events. To explore the role and relationship of CRP and coronary stenosis in the development of unstable angina (UA), plasma levels of CRP were determined on admission in 45 patients with UA, and in 42 patients with stable angina (SA) using high-sensitivity ELISA. Coronary angiography was performed in all patients with coronary heart disease (CHD), and severity of coronary stenosis was evaluated by a quanti tative analysis. Lipid measurement was performed using automatic biochemical analyzer. Data available from patients with CHD were compared with those of 41 control subjects. The results showed that plasma levels of CRP are significantly higher in patients with UA than those in patients with SA and control subjects (5.1 ± 1.4 mg/L vs 1.7 ±0.4 mg/L and 1.3 ±0.2 mg/L, p < 0.01, respectively) with no difference between the latter two groups (p > 0.05); the total incidence of clinical events during in-hospital follow-up was higher in the group A (p < 0.01 ); the scores of coronary stenosis are significantly higher in patients with SA than those in patients with UA (4.9 ±2.1 vs 3.4 ± 1.4, p < 0.05); there is no correlation between plasma levels of CRP and serum total cholesterol (TC) as well as high-density lipoprotein cholesterol (HDL-C) in both groups (p > 0.05 respectively); there was no correlation between plasma levels of CRP and severity of coronary stenosis was found in patients with UA (p > 0.05) but a significant positive association in patients with SA (p < 0.00 1 ); and the patients with persistent, severe, treatment-unresponsive UA had significantly higher CRP levels as well as incidence of clinical events than patients with treatment-responsive UA (7.4 ± 1.8 mg/L vs 2.6 ± 1.3 mg/L, p < 0.01; 0 vs 22.2%, p < 0.05). The present data suggested that inflammation may play an important role in the pathogenesis of UA, and the plasma levels of CRP might have a higher prognostic value than the severity of coronary stenosis correlated with the clinical outcome of insta bility despite of lipid profile status.
Effect of Ciprofibrate on C-Reactive Protein and Fibrinogen Levels
Authors: Rizos Evagelos , Kostoula Angeliki , Elisaf Moses , Mikhailidis Dimitri P.
Published: July 2008

Statins can lower the circulating levels of C reactive protein (CRP). This effect may be relevant because CRP is a predictor of vascular risk. In contrast, the evidence that fibrates lower CRP levels is very limited. The effect of treatment with ciprofibrate (100 mg once daily) was inves tigated for 8 weeks in 30 patients with primary dyslipidemia. There was a significant (p < 0.01) decrease in median (range) CRP levels by 36.8% from 1.9 mg/L (1.0-6.0 mg/L) to 1.2 mg/L (1.0-5.5 mg/L). Plasma fibrinogen levels were also significantly (p = 0.05) reduced. There was no correlation between the fall in CRP levels and the changes in lipid or fibrinogen levels. These findings support the concept that fibrates, like the statins, lower serum CRP levels. However, fibrates have a different mode of action. Fibrates (with the exception of gemfibrozil) also consistently lower plasma fibrinogen levels. In contrast, the effect of statins on the circulating levels of this coagulation factor remains to be defined. These differences may help in defining the mechanisms responsible for drug-induced changes in the circulating levels of CRP and fibrinogen. A favorable effect on CRP and fibrinogen levels may increase the clinical efficacy of statins and fibrates.
The Impact of Different Spectral Doppler Criteria on the Proportion of High-Grade Internal Carotid Artery Stenosis in Patients Undergoing Duplex Scanning
Authors: Logason Karl , Karacagil Sadettin , Tulga Ulus A. , Hardemark Hans-Göran
Published: July 2008

Aim: To investigate the impact of different spectral Doppler criteria on the proportion of high- grade ICA stenosis in patients undergoing carotid artery duplex scanning.

Material and methods: Duplex scans of 4,548 internal carotid arteries (ICA) in 2,349 patients were retrospectively analyzed. The following different criteria were applied for each scan for definition of ICA stenosis ≥ 70%: Criteria I = ICA peak systolic velocity (PSV) > 130 cm/sec and ICA end-diastolic (EDV) > 100 cm/sec, Criteria II = PSV ICA/common carotid artery (CCA) ratio > 4, Criteria III = ICA PSV ≥ 230 cm/sec, Criteria IV = ICA PSV > 230 cm/sec and/or ICA EDV ≥ 100 cm/sec and/or PSV ICA/CCA ratio ≥ 3.2.

Results: The frequency of detecting a ≥ 70% ICA stenosis with criteria I, II, III, and IV were 5.5%, 6.8%, 8.4%, and 9.6%, respectively (p < 0.05).

Conclusion: The use of various duplex criteria significantly affected the number of scans receiving a diagnosis of ICA stenosis of ≥ 70%.
Peristent Tissue Proliferation of Multilink Stents Is Dependent on Preprocedural Plaque Area: A Serial Intravascular Ultrasound Analysis
Authors: Yoshitomi Yuji , Kojima Shunichi , Yano Michiko , Matsumoto Yuji , Sugi Toshihiko , Saotome Masao , Tanaka Kyo-e , Endo Michiko , Kuramochi Morio
Published: July 2008

It is not known whether any factors are related to tissue proliferation within and surrounding stents in humans. The authors used serial intravascular ultrasound (IVUS) to evaluate the relationship between IVUS parameters and tissue proliferation within and surrounding Multilink stents. They were able to analyze preinterventional and postinterventional and follow-up IVUS studies in 33 native vessel lesions in 33 patients with stable angina pectoris. Quantitative coronary angiography and IVUS measurements were performed before and after intervention and at follow-up. IVUS imaging using an automatic transducer pullback device allowed follow- up analysis of the same lesion site. The vessel area at the lesion site increased from 17.1 ±4.5 mm2 after intervention to 18.5 ±5.9 mm2 at follow-up (p < 0.01). The in-stent tissue growth (after intervention to follow-up) in-stent plaque area (PA) was 1.6 ±1.1 mm2, and the peristent tissue growth (after intervention to follow-up) peristent PA was 0.8 ±2.3 mm2. In multivariate analysis, the preprocedural PA at the lesion site was the best predictor of the peristent tissue growth, whereas no factors predicted the in-stent tissue growth. Risk factors, clinical charac teristics, and quantitative coronary angiographic parameters showed no relation to the peristent tissue growth or the in-stent tissue growth. The peristent tissue growth was closely related to the preprocedural plaque size, while the factors that affect the in-stent tissue growth were not identified.
A Tête-à-Tête Comparison of Ejection Fraction and Regional Wall Motion Abnormalities as Measured by Echocardiography and Gated Sestamibi SPECT
Authors: Fleming Richard M.
Published: July 2008

Determination of ejection fraction and regional wall motion abnormalities (RWMAs) consistent with stunned, hibernating, or infarcted myocardium can be noninvasively determined by both echocardiography and nuclear cardiac imaging. Prior comparisons between the 2 methods have been limited to Tc 99m pertechnetate or to stress images with attention to RWMAs only. To determine the relationship between results seen with echocardiography and gated single photon emission computed tomography (SPECT) using sestamibi, 26 individuals with varying degrees of coronary artery disease were prospectively studied with both techniques. Five indi viduals had single-vessel disease, 10 had 2-vessel disease, and 11 had triple-vessel disease. Each individual underwent 2-D, M-mode, and Doppler echocardiography (echo) as well as gated SPECT imaging using rest and stress (high-dose dipyridamole/HDD) sestamibi imaging. The results were statistically different when ejection fractions (EFs) and RWMAs were compared. There were no statistical differences between EFs determined at rest when either echo or nuclear imaging was used. However, patients with EFs <70-80% were overestimated by echo, with echo underestimating EFs > 70-80% (p = 0.001). There was a high correlation (r = 0.76) between resting echocardiographic EFs and SPECT resting gated sestamibi images in patients with single-vessel disease, and a moderate correlation ( r=0.68 and r=0.68) in patients with 2- and 3-vessel disease, respectively. Differences in the detection of RWMAs were statistically different for patients with 2-vessel disease (p = 0.04) and approached significance in 3-vessel disease (p = 0.56) with more RWMA being detected by resting gated SPECT imaging than by echo. Greater differences in RWMAs were seen in patients with 1-, 2-, and 3-vessel disease when resting echo was compared with HDD gated SPECT sestamibi imaging. These differ ences were statistically greater in 2- (p=0.0027) and 3- (p=0.0003) vessel disease. Differences between stress and resting images are expected in individuals with severe coronary artery disease. Comparison of noninvasive assessment of EFs and RWMAs by gated SPECT sestamibi and echocardiography showed different results when looking at EFs, with echo reporting greater EFs for people with EFs < 70-80%. Patients with two and 3-vessel disease were statis tically more likely to have RWMAs detected by gated SPECT sestamibi than by echo.
Complete Heart Block in a Patient with Wegener's Granulomatosis in Remission
Authors: Suleymenlar Gultekin , Sarikaya Metin , Sari Ramazan , Tuncer Murat , Sevinc Alper
Published: July 2008

Wegener's granulomatosis is a systemic inflammatory disorder of unknown cause that usually affects the upper and lower respiratory tracts as well as the kidney. Cardiac involvement is rare, although electrocardiographic abnormalities, coronary artery vasculitis, cardiac arrhyth mias, and myocardial infarction have been reported in the literature. A 27-year-old female patient with Wegener's granulomatosis in remission is described in whom complete heart block developed in the 13th month of treatment with cyclophosphamide. A temporary pacing was applied and pulse methylprednisolone and cyclophosphamide were commenced. On the ninth day of treatment, normal sinus rhythm was achieved. In conclusion, cardiac rhythm abnormalities should always be kept in mind both in the diagnosis and follow-up of Wegener's granulomatosis.
Myocardial Ischemia Secondary to a Large Coronary-Pulmonary Fistula
Authors: Umaña Ernesto , Massey Clara V. , Painter Jack A.
Published: July 2008

Coronary-pulmonary fistulas are rare. The majority of these fistulas arise from the left anterior descending or the right coronary arteries; the circumflex coronary artery is rarely involved. The majority of patients are asymptomatic, but heart failure, angina, myocardial infarction, endo carditis, and dyspnea have rarely been reported. The management is controversial and recom mendations are based on anecdotal cases or very small retrospective series. A case of a 62- year-old female is reported who presented with chest pain and was found to have myocardial ischemia on SPECT sestamibi. Cardiac catheterization revealed no obstructive coronary artery disease and a large coronary pulmonary fistula communicating from the left circumflex coronary artery to the left pulmonary artery.
Bilateral Iliac Vein Thrombosis After Seat Belt-Related Trauma Revealing Hypoplasia of the Inferior Vena Cava
Authors: Granel Brigitte , Serratrice Jacques , Bartoli Jean Michel , Disdier Patrick , Piquet Philippe , Weiller Pierre-Jean
Published: July 2008

Hypoplasia of the inferior vena cava can be revealed by a deep venous thrombosis of the lower limbs. Associated precipitating factors or clotting defects leading to thrombosis are frequently observed. A case of bilateral iliac veins thrombosis occurring after a motor vehicle accident with seat belt injury is reported, revealing hypoplasia of the inferior vena cava. This young man was totally asymptomatic up to the crash, and did not have coagulation abnormalities. The patient had a very good outcome after anticoagulant treatment with complete regression of venous thromboses. Hypoplasia of the inferior vena cava was a predisposing anatomic abnor mality that led to thrombosis, but seat belt trauma was probably the precipitating factor. This observation should be kept in mind in the evaluation of a deep venous lower limb thrombosis.
Limb Salvage Instead of Amputation in 10 Cases of Nonreconstructible "End-Point Ischemia" Treated with IV Hydroxyethylrutosides Plus Oral Anticoagulation
Authors: Lund Fredrik , Zhaomei Qian  , Schiötz Jörn , Tillgren Carl
Published: July 2008

The authors report on limb salvage in 10 cases of "end-point ischemia," already scheduled for urgent amputation, selected from a group of 42 atherosclerotic cases with critical limb ischemia according to the definition of the Second European Consensus Document on Critical Limb Ischemia.(1) Patients were treated for 3 to 4 weeks with intravenous infusions of the rheologic, antioxidant and endotheliumprotective flavonoid mixture 0-(beta-hydroxyethyl)- rutosides (HR) (Venoruton; Zyma, now Novartis) which improves microvascular blood perfusion and possesses antiedematous effects. The infusions were combined with oral anticoagulation (Waran ®) which was continued afterwards as long-term treatment for at least 2 years. In some cases anticoagulation was later replaced by low-dose aspirin. A statistically significant favorable effect was found for both limb salvage and survival—the 10 selected cases of limb salvage in spite of "end-point ischemia" also included 1 uremic case on hemodialysis with very severe rest pain and toe necrotization. Improved microcirculation following soon after the start of treatment was observed in all 10 cases as well as an often very rapid alleviation of rest pain and beginning healing of ischemic lesions. The follow-up showed a preservation of the threatened limb for a mean time of 7.9 years in the atherosclerotic group and, in spite of high age at start of treatment (mean age 72 years), an apparently long survival of those patients who had died, on average 7.7 years. Because side effects are rare and there is a rapid allevia tion of rest pain, it may be possible to give the HR infusions safely on an ambulatory basis in the out-patient department.
High-Dose Dipyridamole and Gated Sestamibi SPECT Imaging Provide Diagnostic Resting and Stress Ejection Fractions Useful for Predicting Extent of Coronary Artery Disease
Authors: Fleming Richard M. , Boyd Larry D.
Published: July 2008

A decline in ejection fraction at stress compared with rest images has been associated with increased severity of coronary artery disease (CAD) and suggests a poorer prognosis. Myocardial perfusion imaging (MPI) using high-dose dipyridamole (HDD) has been shown to more accurately detect CAD than either standard dose dipyridamole (SDD) or exercise-induced stress (EST), but has not been looked at to determine its usefulness in detecting changes in stress and rest ejection fractions. To determine the relationship between changes in left ventricular ejection fraction (LVEF) and the severity of CAD, 36 individuals underwent gated single photon emission computed tomography (SPECT) MPI using HDD. In each case resting and stress LVEFs were determined along with MPI results. Subjects with single-vessel CAD demonstrated an increase in LVEF from 77.8% (sd ±8.8%) to 85.6% (sd ±8.4%) resulting in a statistically significant increase in LVEF of 7.8% (p = 0.009). Patients with two-vessel disease showed a smaller increase from 73.2% (sd + 8.3%) to 79.8% (sd + 9.8%) following HDD stress. This increase was statistically (p=0.008) significant. Patients with triple-vessel CAD showed a reduction in LVEF from 67.4% (sd ± 14.07) to 65.1 % (sd ± 16.5%) which represented a decrease in LVEF of 2.7% and approached (p=0.25) but did not reach statistical significance. Both the resting and stress LVEFs were statistically lower (p<0.05) in patients with triple- vessel CAD. Changes in resting LVEF (REF) and HDD pharmacologically induced stress LVEF (SEF) provide a valuable diagnostic marker as to the number of significantly diseased coronary arteries and can be acquired from gated SPECT sestamibi images.
Elevated Prothrombin and Activated Protein C Resistance in Patients with Thoracic Aortic Atheroma
Authors: Lochow Peter , Schwartzbard Arthur , Guest Judy , Ripps Carolyn , Matalon Daniel , Gambetta Rosemary , Tunick Paul A. , Sedlis Steven
Published: July 2008

Patients with protruding aortic atheroma containing mobile emboli are at risk for peripheral emboli and stroke. This risk may possibly be reduced by anticoagulation, but whether or not such patients have an increased prevalence of thrombotic risk factors has not been previ ously determined. Twenty-two patients were studied (11 with protruding thoracic aortic atheromas and superimposed mobile thrombi on transesophageal echocardiography were compared to 11 age-matched controls). The authors evaluated activated protein C resistance (APC-R) by measuring the prolongation of the partial thromboplastin time (PTT) in response to activated protein C (APC). Concentrations of fibrinogen, antithrombin III (AT III), factor II, factor V, and D-dimer were also determined in all patients. There was significant resistance to APC (a smaller prolongation in PTT) in patients with atheromas and thrombi. They also had signifi cantly higher concentrations of factor II. Factor V and fibrinogen were higher, and AT III lower, in patients than in controls; however, these latter differences did not reach statistical signifi cance. Patients with aortic atheroma and mobile thrombi may have an increased prevalence of thrombotic risk factors. There is significantly increased resistance to activated protein C in patients with protruding atheroma and mobile thrombi in their thoracic aorta. There was also a trend toward elevated fibrinogen, homocysteine, and apo (a) concentrations as well as lower antithrombin III concentrations in these patients.
Giant Cell Arteritis in China: A Prospective Investigation
Authors: Zhiping Hu  , Qidong Yang  , Shan Zeng  , Jinghe Li  , Xiaoyin Wu  , Li Cao  , Li Yang  , Xinwang Song
Published: July 2008

The objective of this prospective study was to investigate further the clinical features of patients with giant cell (temporal) arteritis (GCA). All patients diagnosed from July 1999 to March 2001 at the Department of Neurology of the Second Xiangya Hospital in China were included. The final diagnosis was based on clinical manifestations, a temporal artery biopsy, response to steroid, and follow-up. The American College of Rheumatology (ACR) criteria for the classification of GCA were tested in the patients identified. Sixteen patients with GCA were identified; 13 (81.25%) patients fulfilled the 1990 ACR criteria for the classification of GCA. Clinical findings included the following: mean age at disease onset 43.13 years (range 28-60) and 81.25% of the patients under the age of 50 when the disease began; men 93.75%; the common initial symptoms including new headache 62.50% and visual symptoms 18.75%; the common clinical findings at presentation including new headache 93.75%, temporal artery abnormality 81.25%, visual abnormality 56.25%, and fever 25.00%; raised erythrocyte sedi mentation rate (ESR) 68.75%; and uncommon findings including jaw claudication, ptosis, fatigue, syncope, hemiparesis; all 16 patients underwent a temporal artery biopsy; inflamma tory cell infiltration 68.75% in arterial wall, fragmented internal elastica 100.00%, fibrinoid necrosis 18.75%, smooth muscle cell changes 62.50%, and thrombosis in the lumen 31.25%. The mean time from symptom onset to suspicion of GCA or biopsy was 5.52 months (range 0.25-24.33); the initial diagnosis was wrong in 87.50% of patients. These examples are too small a number to permit definite conclusion. But the results suggest that GCA may not be a rare disorder in China, mean age at disease onset was relatively young, males may be more susceptible, the clinical features of GCA have not been widely appreciated yet, there was a delay between diagnosis and treatment, and initial diagnosis was wrong in many patients.
Mönckeberg's Sclerosis: An Unusual Presentation
Authors: Top Cihan , Çankir Zeki , Şilit Emir , Yildirim Şükrü , Danaci Mehmet
Published: July 2008

Calcification of the media of peripheral arteries is referred to as Mönckeberg's sclerosis and occurs commonly in aged individuals. However, it also occurs in younger patients with diabetes mellitus and chronic renal failure. In diabetic patients, medial calcification appears to be a strong independent predictor of cardiovascular mortality. In this report, we have presented a 20 year-old-patient with extensive peripheral artery calcification. The etiology of calcification was not identified. It has been suggested that this was an unusual form of Mönckeberg's sclerosis.
Failure of Pentoxifylline or Cilostazol to Improve Blood and Plasma Viscosity, Fibrinogen, and Erythrocyte Deformability in Claudication
Authors: Dawson David L. , Qintian Zheng  , Worthy Sue A. , Charles Brandie , Bradley Donald V.
Published: July 2008

Peripheral artery disease is associated with altered blood rheologic properties, including increased viscosity and decreased red blood cell (RBC) deformability. Pentoxifylline and cilostazol are available therapies for intermittent claudication. Improvement of blood viscosity and erythrocyte deformability have been cited as potential mechanisms of action for pentox ifylline. Cilostazol is a new drug with antiplatelet and vasodilating activity, but the mechanism by which it promotes an improvement in walking is not known. This study was performed to evaluate and compare the hemorheologic effects of pentoxifylline and cilostazol on viscosity, fibrinogen levels, and erythrocyte deformability when administered to adults with moderate to severe claudication. A double-blind, controlled study was conducted and included 59 patients (46 male, 13 female; mean age 65 yr) randomized to pentoxifylline 400 mg orally thrice daily (n=20), cilostazol 100 mg orally twice daily (n=19), or placebo (n=20); all subjects were observed for 24 weeks. Walking ability was assessed before, during, and at the conclusion of treatment by standard constant speed, variable grade treadmill testing. Erythrocyte deforma bility was measured by passage of washed RBCs, 10% hematocrit in phosphate buffered saline (PBS), through a polycarbonate membrane with 4.7 to 5.0 μm pores. Whole blood and plasma viscosity were measured using a cone/plate viscometer at variable shear rates (from 4.5 to 450 sec -1). Erythrocyte sedimentation rate was measured by a modified Westergren technique. Fibrinogen was assayed by a commercial reference laboratory. Plasma viscosities did not change significantly in any treatment group. Within-group comparisons demonstrated a significant (p<0.01) drop in whole blood viscosity (week 24 compared with week 0) for cilostazol-treated subjects (at shear rates of 45, 90, 225, and 450 sec-1), but these changes were not significantly different from those in the placebo group. There were no significant changes in whole blood viscosity for subjects treated with pentoxifylline or placebo. There were no significant changes in erythrocyte deformability, fibrinogen, or erythrocyte sedimen tation rate. A trend toward improved walking distances was noted for both pentoxifylline and cilostazol in comparison with placebo. This trend was not correlated with changes in any underlying rheologic parameter. Ex vivo rheologic characteristics of blood from patients with
Is It Safe to Withhold Anticoagulation Based on a Single Negative Color Duplex Examination in Patients with Suspected Deep Venous Thrombosis? A Prospective 3-Month Follow-up Study
Authors: Norén Anders , Ottosson Eva , Rosfors Stefan
Published: July 2008

The aim of this study was to evaluate prospectively the clinical short-term outcome of patients with suspected deep venous thrombosis (DVT) and negative duplex investigation and to assess whether it is clinically safe to withhold anticoagulant therapy on the basis of a single negative color duplex examination including the calf veins. The study included a consecutive series of patients with suspected DVT referred for color duplex examination over 1 year. Patients with negative duplex findings (n=341) were followed up for 3 months clinically and/or by reviewing hospital charts and the official registry of health care and causes of death. In only 1 of the patients was DVT diagnosed following a negative duplex examination. This patient had accentuated symptoms and a thrombus in the peroneal vein was detected at subsequent phlebography. None of the other patients with a negative duplex finding developed signs of, or had treatment initiated for, DVT or pulmonary embolism during the 3-month period after the duplex investigation. Five patients died, but none of the deaths was related to thromboem bolism. The results indicate that it is clinically safe to rely on a single negative color duplex examination in patients without any progressing symptoms from the affected limb.
Dyslipoproteinemia and Coronary Disease
Authors: Raos Vjekoslava , Strujić Branka Jeren
Published: July 2008

Dyslipoproteinemia is involved in the origin of arteriosclerosis by changing the architecture of the coronary artery wall and therefore represents an important factor in the development of coronary artery disease (CAD). High-density lipoprotein (HDL) and apolipoprotein-A1 (Apo A1) serve as protection against the origin and development of coronary obstructive disease. The aims of this study were to evaluate the relations among the plasma lipids, their fraction Apo A1, HDL, and positive coronary arteriography, and to estimate their importance as markers of the degree of coronary lesions. The study included 101 subjects, 77 men and 24 women, aged 35 to 75 years, mean age = 55.7 years. The subjects were divided into 2 groups: 1 group-CAD with positive coronary arteriography (n=70), and the other group—CAD with negative coronary arteriography (n=31). According to the anatomic localization of atherosclerotic lesion, the first group of subjects was divided into 1-vessel (n = 26), 2-vessel (n = 20), and multiple- vessel lesion (n = 24) subgroups. The results show a significant difference in Apo A1 and Apo A1/Apo B (p < 0.005) in the 2- and multiple-vessel disease in relation to the control group, while subject significance was not proved for 1-vessel disease. A positive correlation and signifi cance for HDL as well as cholesterol ratio/HDL (p<0.05) was noted for 1- and multiple-vessel disease, while a negative correlation was noted for 2-vessel disease in relation to the control group. This study stressed the diagnostic significance in determining Apo A 1 and Apo A1/Apo B1 as better predictors than HDL cholesterol in evaluating coronary lesion severity. Dyslipoproteinemia, namely, the level of lipoproteins of low density, plays an important role in the pathogenesis of arteriosclerosis and the development of CAD.
Carbon Coating of Stents Has No Effect on Inflammatory Response to Primary Stent Deployment
Authors: Korkmaz Mehmet Emin , Tayfun Egemen , Müderrisoglu Haldun , Yildirir Aylin , Özin Bülent , Uluçam Melek , Turan Münire
Published: July 2008

The aim of this study was to investigate the effects of stent carbon coating on inflammatory response. The authors serially measured plasma concentrations of C-reactive protein (CRP), fibrinogen, and several cytokines (tumor necrosis factor, interleukin [IL]-1-β, IL-6, and IL-8) in patients with single-vessel coronary stenosis who underwent primary stent implantation. None of the subjects had inflammatory or infectious disease at the time of the procedure. Forty-six patients (38 males; mean age 55 ±9 years) were studied. Blood samples were collected before and at 2, 4, 6, 24, and 48 hours after stent implantation. Patients were randomly assigned 1 of 2 different stent types, an uncoated MAC (AMG® Raesfeld-Erle, Germany) (UC-MAC) or a carbon-coated MAC (CC-MAC) stent. Implantations were performed without predilatation, and stents were deployed at a maximum pressure of 6 atmospheres for 90 seconds. Of the 46 patients, 14 had stable, 27 had unstable, and 5 had atypical angina. According to ACC/AHA classification, 35 lesions (76.1 %) were type A, 10 (21.7%) were type B, and 1 (2.2%) was type C. Single stenosis of 28 left anterior descending, 12 circumflex, and 6 right coronary arteries were treated. Serum IL-6 increased in both the UC-MAC and CC-MAC groups, with concentra tions significantly elevated above baseline at 6 hours, and then decreasing after 24 hours (baseline, 6-hour, and 24-hour values = 3.1 ±2.3, 5.7 ±3.8, and 6.3 ±4.6 pg/mL, respectively, in UC-MAC; 3.7 ±2.6, 6.2 ±6.0, and 4.6 ±3.7 pg/mL, respectively, in CC-MAC [p=0.002]). Plasma fibrinogen, CRP, and leukocyte concentrations also increased in both groups over the 24 hours (p < 0.05). The elevations of IL-6, CRP, and fibrinogen were similar in the 2 groups. The percent increases in IL-6, fibrinogen, and CRP were not associated with stent length, size, or clinical presentation (all p>0.05). The results showed that stent implantation increases plasma IL-6, fibrinogen, and CRP concentrations, but carbon coating of the stent does not seem to affect this inflammatory response.
Intima-Media Thickness of the Common Carotid Arteries Is Related to Coronary Atherosclerosis and left Ventricular Hypertrophy in Older Adults
Authors: Raso Francesco Mattace , van Popele Nicole M. , Schalekamp Maarten A. D. H. , van der Cammen Tischa J. M.
Published: July 2008

Increased intima-media thickness (IMT) of the common carotid arteries is related to generalized atherosclerosis and increased risk of future myocardial infarction and cerebrovascular disease. An association between IMT and the presence of coronary artery disease (CAD) has been documented, but controversial data have been found about the relation between increased IMT and the extent of CAD. An association between carotid atherosclerosis and cardiac remodeling has also been reported. It is still unclear whether increased IMT of the common carotid arteries might be associated with prevalent cardiovascular disease in older adults. This study included 70 patients, 37 with CAD and 33 matched for age and gender without CAD. All patients underwent a baseline clinical examination, B-mode ultrasound of the carotid arteries, and echocardiography. The authors evaluated the possible association between increased IMT with the presence and extent of CAD and the presence of left ventricular hypertrophy (LVH). The patients with CAD had significantly increased IMT compared to patients without CAD. IMT was found to increase with the number of coronary vessels affected, after adjustment for age, gender, hypertension, hypercholesterolemia, diabetes mellitus, and smoking habits. The test for trend was highly significant (p<0.001). Patients with LVH had significantly increased IMT as compared with patients without LVH. IMT of the common carotid arteries was increased in the presence of CAD and increased with the number of coronary vessels diseased. Second, the authors found that IMT of the common carotid arteries was significantly increased in patients with LVH. Increased IMT, as an indicator of subclinical cardiovascular disease, may help to identify patients who would benefit from aggressive therapeutic measures.
Reliability and Efficacy of Metoprolol and Diltiazem in Patients Having Mild to Moderate Mitral Stenosis with Sinus Rhythm
Authors: Alan Sait , Ulgen Mehmet S. , Ozdemir Kurtulus , Keles Telat , Toprak Nizamettin
Published: July 2008

The authors evaluated the effects of beta blockers (metoprolol) and calcium channel blockers (diltiazem) in patients having mild to moderate mitral stenosis (MS) with sinus rhythm. Eighty patients with a complaint of dyspnea with diagnosed MS were included in this study. Patients were randomized into metoprolol and diltiazem groups. The first group received oral diltiazem treatment for 3 months following an IV dose of 25 mg diltiazem. The second group received oral metoprolol for 3 months following an IV dose of 5 mg metoprolol. All patients performed a treadmill exercise test at the beginning of and after 3 months of treatment. Transthoracic echocardiographic studies were also performed following the IV drug administration and after 3 months of treatment. In addition, oxygen uptakes of patients were measured before and after the stress and after 3 months of treatment. Decreases in peak gradient (PG) and mean transmitral gradient (MG) were observed in the metoprolol group after IV and oral metoprolol treatment. A prolongation of exercise time in treadmill exercise test (TET) and a decrease in the maximum heart rate after oral metoprolol treatment were noted. Eighteen patients in the metoprolol group had benefited symptomatically from this treatment and complaints of dyspnea were alleviated, whereas no symptomatic relief was seen in the diltiazem group. No significant prolongation was observed in effort times (p>0.05) of the diltiazem group. Transmitral gradients measured via echocardiographic examination did not change (p>0.05). With respect to oxygen uptake rates, a statistically significant decrease was determined in the metoprolol group, whereas no difference was found in diltiazem group. The authors conclude that metoprolol may be useful in patients with MS and can provide symptomatic relief. They did not observe any beneficial effect of diltiazem in these patients.
Diagnostic Utility of Cardiac Troponin-I Levels in Patients with Suspected Pulmonary Embolism
Authors: Dieter Robert S. , Ernst Eric , Ende David J. , Stein James H.
Published: July 2008

Although positive troponin-I (TnI) assays have been reported in patients with pulmonary embolism (PE), Tnl levels in patients with suspected PE have not been evaluated systemati cally. The purpose of this study was to evaluate the diagnostic utility of Tnl measurements in patients with suspected PE. Consecutive patients with suspected PE were identified in whom nuclear ventilation/perfusion (V/Q) scans were performed and Tnl levels were measured. Tnl levels in patients with and without positive V/Q scans were compared by use of t tests. After categorizing Tnl levels as positive (Tnl-pos, ≥ 0.40 ng/mL) or negative, chi-square tests were used to relate these values to V/Q scan results. Separate comparisons were made for subjects with high-probability V/Q scans (V/Q-high, ≥90% likelihood of PE) and intermediate- or high- probability V/Q scans (V/Q-pos, ≥50% likelihood of PE). The mean Tnl level in the 10 subjects with V/Q-high scans was 0.39 ±0.79 ng/mL. The mean Tnl level in the 81 subjects without V/Q- high scans was 0.36 ±0.66 ng/mL (p = 0.89). Tnl levels did not differ between the 22 V/Q-pos subjects and the 69 subjects with negative V/Q scans (p = 0.86). A positive Tnl in the setting of V/Q-pos had a sensitivity of 32%, specificity of 71 %, positive predictive value of 26%, and a negative predictive value = 77% (chi-square = 0.06, p = 0.80). Elevated Tnl levels are not associated with positive V/Q scans. The Tnl assay is not a useful test in patients suspected of having PE, unless used to exclude myocardial ischemia or infarction.
Polycythemia Vera
Authors: Gumina Richard J. , Foley David A. , Tefferi Ayalew , Rooke Thom W. , Shields Raymond C.
Published: July 2008

Polycythemia vera is a myeloproliferative disorder characterized by increased red cell mass and frequently complicated by venous and arterial thrombosis. The mechanism underlying the increased incidence of thrombotic events remains illusive. Presented in this report are a case of a 77-year-old man diagnosed with polycythemia vera and a review of the current literature on the mechanisms underlying the increased incidence of thrombotic events in polycythemia vera.