bluuebunny/crossref_metadata_2025 huggingface dataset:
Isoxsuprine in Nonproliferative Diabetic Retinopathy: Effect on Human Retinal Circulation Assessed by Fluorescein Angiography—A Pilot Study
Authors: Dandrieu Maurice R. , Brood-van Zanten Monique M.A.
Published: November 2007

The retinal vessel filling time of 10 patients with early nonproliferative diabetic retinography was measured by fluorescein angiography. Initially, the reproduc ibility of the authors' standardized fluorescein angiography was assessed by control angiograms on two different dates in each patient. Thereafter, prolonged use (six months) of isoxsuprine sustained release (80 mg/day) led to a nearly 50 % reduction of the arterial filling time and a nearly 25 % reduction of the arteriove nous filling time, whereas no changes were seen in control patients.

This effect of isoxsuprine might be explained by an increase of red cell deformability and, concomitantly, a decrease of platelet adherence in the micro circulation of patients with diabetic mellitus.
Occult Inferior Vena Cava Thrombosis: Diagnosis by Sonography—Case Reports
Authors: Khurana Bhupinder K. , Friedman Sandor A.
Published: November 2007

Ultrasound has become an effective tool for evaluating the inferior vena cava. The authors report 3 cases that illustrate the difficulty in diagnosing partially adherant clots, which may have a high propensity for pulmonary embolism.
The Use of Ionic and Nonionic Contrast Agents and the Effects of Hydration in the Post Cardiac Transplant Patient with Moderate Renal Insufficiency
Authors: Denys Bart G. , Sudhakar Reddy P. , Urestsky Barry F.
Published: November 2007

To determine the effects of ionic (diatrizoate) and nonionic (iopamidol) con trast and of hydration, 90 asymptomatic cyclosporine-treated cardiac transplant patients with moderate renal insufficiency (serum creatinine ≥1.5 mg/dL) under going cardiac catheterization were evaluated. All patients were hydrated with intravenous fluid (5% dextrose and 0.5 normal saline) over a twelve-hour period prior to catheterization and with oral fluids thereafter. Thirty patients received iopamidol (Group I) and 60 were given diatrizoate (Group II). Renal function was determined the day before and after catheterization in all patients of Group I and in 30 patients of Group II (Group IIa). In the remaining 30 patients of Group II renal function was also determined before contrast administration (Group IIb). The dose of dye was similar in all groups (I: 139±55 mL, IIa: 140±58 mL, IIb: 128 ± 38 mL). There was a significant decrease in BUN (I: 41±10 to 33±8 mg/dL [p<0.005], IIa: 42±9 to 33±8 mg/dL mg/dL [p<0.001], IIb: (44±12 to 34±10 mg/dL [p<0.005]) and a small decrease in serum cratinine after catheterization (I:2.0±0.3 to 1.9±0.3 mg/dL, IId:2.0±0.3 to 1.9±0.3 mg/dL, IIb:2.1±0.4 to 1.8±0.4 mg/dL [p<0.005]. In Group IIb patients there was a significant decrease in BUN (44±12 to 36 ± 12 mg/dL [p<0.01]) and creatinine (2.1 ± 0.4 to 1.8±0.4 mg/dL [p<0.005]) after hydration. There were no additional changes twenty-four hours after receipt of contrast in this group. When adequately hydrated, cyclosporine-treated cardiac transplant patients do not exhibit worsening of renal insufficiency with either contrast agent and therefore either can be used safely in this setting.
Intercostal-to-Pulmonary Arterial Anastomosis, Complicated by High-Output Heart Failure: Case Report
Authors: Chino Masao , Kawaguchi Tatsuhito , Sakai Takashi , Okuno Tetsuji
Published: November 2007

A patient who had high-output heart failure resulting from anastomosis of the intercostal and bronchial arteries to the right pulmonary artery is reported. The patient was a fifty-one year-old man who was admitted to our hospital with left heart failure. A radionuclide angiocardiogram revealed blood flow from the aorta to the right pulmonary artery. A descending aortogram revealed abnormally dilated right intercostal and bronchial arteries, which formed the anastomosis. The right pulmonary artery was visualized via that anastomosis. Tuberculous pleurisy in the patient's history was considered to be the cause of the aanastomosis. The therapeutic procedure used was embolization via a catheter for the anastomosis, but most anatomoses could not be embolized. The present report is considered the first on anastomosis of the intercostal artery to the pulmonary artery to the extent that high-output heart failure occurs.
Importance of RAA System and the Treatment of Patients with ACE Inhibition After Myocardial Infarction
Authors: Ray S.G. , McAlpine H.M. , Morton J.J. , Leckie B. , Dargie H.J.
Published: November 2007

There is activation of the renin angiotensin system after both complicated and uncomplicated myocardial infarction. Angiotensin II increases myocardial oxy gen consumption whilst reducing coronary flow and is also directly toxic to the myocardium. Angiotensin converting enzyme inhibitors produce beneficial haemodynamic and neuroendocrine changes in patients with acute left ventricular failure, and may have a role in selected patients with cardiogenic shock. There is evidence to suggest that they might prevent the development of late cardiac failure by limiting the extent of post infarction ventricular dilation. Further research is necessary to define their role in the treatment of acute myocardial infarction.
Incidence of Aneurysms in Takayasu's Arteritis
Authors: Matsumura Kaname , Hirano Tadanori , Takeda Kan , Matsuda Akira , Nakagawa Tsuyoshi , Yamaguchi Nobuo , Yuasa Hiroshi , Kusakawa Minoru , Nakano Takeshi
Published: November 2007

The angiographic findings of Takayasu's arteritis in a series of 113 patients were reviewed. Predominant findings were stenotic or occlusive changes, but fusiform or saccular aneurysms were also found in 36 patients (31.9%) in the various sites of aorta and its major branches. Multiple aneurysms were found in 15 patients. The most common site of aneurysms was the ascending aorta (16 patients); in 7 of the patients these were complicated by aortic regurgitation. Aneurysms developed in the aortic arch in 3 patients, in the descending aorta in 11, in the abdominal aorta in 7, and in the major branches of the aortic arch in 9 patients. In 2 patients, follow-up angiograms showed enlargement of the aneu rysms, and rupture of the aneurysm occurred in 1 patient. Aneuryms were found even in young patients. A fifteen-year-old female showed a huge aneurysm in the ascending aorta as the initial manifestation of this disease. Thickening of the walls of aneurysms was common and characteristic. This study revealed the moderately high incidence of aneurysms of various sites of arteries in patients with Takayasu's arteritis. The authors conclude that aneurysm, as well as occlusive changes, can be a primary lesion.
Heterozygous Protein C Deficiency Associated with Multiple Congenital Hemangiomas—A Case Report
Authors: Simioni P. , Zanon G. , Lazzaro A.R. , Patrassi G.M. , Girolami A.
Published: November 2007

Congenital protein C deficiency is described as associated with recurrent thrombotic manifestations. The proband, a fourteen-year-old female, has a history of severe and frequent thrombotic disease, moreover, she presents con genital multiple hemangiomas. Family history was positive for protein C defi ciency since the mother of the proposita is also affected and has manifested deep venous thrombophlebitis. Two additional relatives on the maternal side were not available for study but were reported to be symptomatic. None of the family members presented angiomatosis. This case report represents the first description of the association of protein C deficiency with multiple hemangiomas.
Cardiac Pacemaking in Hong Kong: Report of a Survey of General Practitioners and Internists
Authors: Lau Chu-Pak , Cheng Chun-Ho , Munro Clark , Tse Maxwell , Wong Cheuk-Kit , Leung Wing-Hung
Published: November 2007

A questionnaire study was carried out among cardiologists, internists, general practitioners, and final year medical students in Hong Kong concerning cardiac pacemaking. The response rate was 11.2%. Salient results include the misconception on the part of 40% and 12% of physicians, that general anesthesia and thoracotomy respectively, are commonly required for permanent pacing and that the procedure is associated with significant mortality (14.2% of physicians). Most would offer permanent pacing to patients with symptomatic complete atrioventricular block, but advanced age appeared to be considered as a barrier to permanent pacemaking. There was confusion about the need to pace asymptomatic sick sinus syndrome and bundle branch conduction diseases. Oral isoprenaline was still used to treat bradycardia by 16.6 % of physicians. A similar deficiency in knowledge was found among the students. It is suggested that misunderstanding of cardiac pacing is common and may be a reflection of the lack of emphasis in undergraduate teaching. This deficiency may have prevented some patients from receiving the benefits of permanent pacing.
Bacterial Infection and Peripheral Vascular Disease
Authors: Ciuffetti Giovanni , Mercuri Michele , Lupattelli Graziana , Maccari Adriana , Lombardini Rita , Pasqualini Leonella , Ott Christian , Mannarino Elmo
Published: November 2007

Whole blood filterability was monitored in 16 nondiabetic peripheral vascular disease (PVD) patients within forty-eight hours of onset of bacterial infection, after ten to seventeen days antibiotic therapy and again, ten days later, after convalescence. The whole blood filterability rate was constantly disturbed before infection in these patients; the impairment worsened significantly (as was expected during infection), but after convalescence the whole blood filterability rate did not return to preinfection levels. This further significant impairment in whole blood filterability was inversely correlated with a reduction in the patients' pain-free walking time as determined by a standard treadmell test performed after convalescence and compared with their average times before infection.
Regional Intravenous Ketanserin and Guanethidine Therapy in Raynaud's Phenomenon
Authors: Caputi C.A. , De Carolis G. , Tomasetti C.
Published: November 2007

The authors report the results of a study of 25 patients with Raynaud's phenomenon (primary, posttraumatic, and secondary to diffuse connective tissue deseases) treated with regional intravenous injections of guanethidine or ketanserin. These two drugs were chosen because of the different etiopathologic profiles of the conditions.

All the patients showed a substantial clinical improvement with a remission of trophic lesions.

Conditions secondary to connective tissue disorders did not demonstrate much improvement based on instrumental data alone, possibly because of the intrinsic limitations of the techniques used for evaluating peripheral blood flow.

This specific type of pharmaceutical treatment appeared to be especially suitable for this disease owing to a combination of therapeutic efficacy and a substantial reduction in the total dosage for each patient.
Venous Thrombosis After Long-Term Transvenous Pacing in the Chinese
Authors: Chow Wing-Hing , Yip Alex S.B. , Tai Yau-Ting , Cheung King-Loong
Published: November 2007

To determine the incidence of venous thrombosis after long-term transvenous pacing in the Chinese, venograms were performed in 50 consecutive Chinese pa tients seen at the pacemaker clinic. There were 25 women and 25 men. The mean age was sixty-six years (range thirty-two to eighty-one). The indications for pac ing were complete heart block in 16 patients and sick sinus syndrome in the re mainder. All pacemakers were of the single-chamber ventricular pacing type and had been implanted for a mean period of four years (range two to seven). In 27 patients the route of entry for the pacing electrode was through the cephalic vein and in the other 23 patients the subclavian veins were used. Of the 50 veno grams, 1 showed partial and 1 showed total obstruction at the subclavian vein. Both patients (4%) were asymptomatic. All others (96%) were normal. The in cidence of venous thrombosis was not related to the routes of entry of the pac ing electrodes. All patients tolerated the procedure well and had no complications.

It is concluded that the incidence of venous thrombosis after long-term trans venous pacing is extremely low in the Chinese (4%), and venograms are both safe and useful for identifying venous thrombosis related to transvenous pacing.
The Role of Two-Dimensional Echocardiography in the Diagnosis of Ineffective Endocarditis
Authors: Burger Andrew J. , Peart Brenda , Jabi Haytham , Touchon Robert C.
Published: November 2007

Two-dimensional echocardiography has had a significant impact on and is considered the technique of choice for the diagnosis and management of infec tive endocarditis. Over a thirty-six month period, 106 patients were evaluated by echocardiography for the possibility of endocarditis. The diagnosis of en docarditis was determined by strict clinical and laboratory criteria. All clinical histories, blood cultures, echocardiograms, and autopsy results were reviewed. Five echocardiograms were technically inadequate, resulting in a study popula tion of 101 patients.

The age of the patients ranged from forty-five days to eighty-eight years (mean fifty-seven years). The clinical manifestations of endocarditis included fever (83%), chills (60%), congestive heart failure (25%), and splenomegaly (18%). Twelve patients had preexisting valvular or congenital heart disease. Gram-positive cocci were the most common microorganisms. Complications included mitral regurgitation, subarachnoid hemorrhage, renal infarction, stroke, and a pulmo nary embolus.

The patients were divided into two groups: Group I consisted of 36 patients with definite vegetations by echocardiography, and Group II had 65 patients with no vegetations. In Group I, acute infective endocarditis was present in 35 patients, whereas only 4 patients had endocarditis in Group II. The sensitivity of two-dimensional echocardiography for detecting endocarditis was 90%. The specificity was 98%. The predictive accuracy for a positive test was 97%, and the predictive accuracy for a negative test was 94%. Thus, two-dimensional echocardiography appears to have a high sensitivity, specificity, and predictive value in the evaluation of patients with suspected endocarditis.
Effects of Cocaine on Canines' Coronary Arteries
Authors: Valentine Jimmie L. , Yamanashi William S. , Leak David , Saksanen Seppo , Wagner Benny D. , Phillips Steven W.
Published: November 2007

Nine canines were anesthetized with pentobarbital and studied by both selective and semiselective coronary artery angiography following intravenous bolus doses of 1,3,5,8, or 10 mg/kg of cocaine. Catheterization was accomplished with a 5 Fr catheter over a 0.035 inch guidewire under fluoroscopic control, and angio grams were obtained by injection of a diatrizoate solution. Digital subtraction angiography (DSA) was performed prior to cocaine administration and at minutes 0.5, 1,1.5, 3, 5, and, in some cases, minutes 10 and 15 after cocaine administra tion. The 1 and 3 mg/kg doses of cocaine had no effect on the coronary arter ies. The 5 mg/kg dose significantly dilated the coronary arteries. The 8 mg/kg dose produced significant dilation at 30 seconds after cocaine but nonsignifi cant dilation of the coronary arteries at all other times. The 10 mg/kg dose produced significant dilation at 30 seconds, nonsignificant dilation at 60 seconds followed by significant constriction at 90 seconds after cocaine, which led to immediate death in most animals. The coronary dilation and constriction produced by 10 mg/kg of cocaine could be prevented by either preadministra tion or postadministration of naloxone, but this did not prevent subsequent death.
Laser-Assisted Angioplasty in the Treatment of Prosthetic Graft Stenosis
Authors: Diethrich Edward B. , Santiago Osvaldo , Bahadir Ilhan
Published: November 2007

Late failure of peripheral bypass grafts has been treated primarily by secon dary reconstruction. Laser-assisted angioplasty is an optional therapy that the authors investigated in 28 prosthetic grafts over a two-year period.

Twenty-five symptomatic patients with 28 peripheral prosthetic arterial bypass grafts (25 polytetrafluoroethylene [PTFE] grafts and 1 each of knitted Dacron, Teflon, and umbilical vein) demonstrated graft occlusion (25) or high-grade stenoses (3). All patients underwent standard laser-assisted angioplasty using a continuous wave Nd:YAG laser source and hybrid probe.

Twenty-one grafts (75%) were successfully recanalized with adequate resto ration of flow through the conduit. All 7 failures were in occluded PTFE grafts that presented with either recalcitrant lesions (5) or perforations (2) at the distal anastomoses.

There have been 3 long-term failures (14%) to date in the successfully treat ed group, all in PTFE grafts. Two patients suffered recurrent thrombosis and 1 developed an inexplicable graft infection five months after laser treatment.

Laser-assisted angioplasty appears to be a clinically viable alternative treat ment for prosthetic graft stenosis and recanalization of grafts occluded at their distal anastomosis.
Mycotic Aortic Aneurysm Infected by Clostridium septicum — A Case History
Authors: Hurley Liam , Howe Kenneth
Published: November 2007

The authors describe a sixty-seven-year-old hypertensive, diabetic man with a mycotic abdominal aortic aneurysm infected with Clostridium septicum. The patient had colonic polyps but no malignant disease. They could find only one other report of a mycotic aneurysm infected with C. septicum. In that case, as in most other cases of C. septicum bacteremia, the patient had gastrointestinal cancer. Their case suggests that treatment for a clostridial infection should be considered in patients with known gastrointestinal disease, signs and symptoms of sepsis, and abdominal pain. Conversely, patients known to have a C. septi cum infection should be evaluated for gastrointestinal lesions.
Effects of Nifedipine GITS and Atenolol Monotherapy on Serum Lipids, Blood Pressure, Heart Rate, and Weight in Mild to Moderate Hypertension
Authors: Houston M.C. , Olafsson L. , Burger M.C.
Published: November 2007

Forty-nine patients, with ages ranging from eighteen to seventy years and with mild to moderate primary hypertension (sitting diastolic blood pressure of > 95 mmgH and < 115 mmHg) were randomized into a twenty-one-week, double-blind, prospective study to determine the effects of monotherapy of nifedipine GITS (gastrointestinal therapeutic system) versus atenolol on serum lipids, lipid subfractions, apolipoproteins, (apo), and blood pressure (BP). Nifedipine GITS and atenolol significantly reduced blood pressure, but nifedipine GITS reduced sitting and standing systolic BP significantly more than atenolol (p = .001). Sitting and standing heart rate decreased significantly (p = 0.001) during atenolol therapy but did not change significantly during nifedipine GITS therapy. Atenolol increased weight (mean change + 2.2 lb; p = 0.011), but nifedipine GITS decreased weight (mean change - 2.4 lb; p = 0.07).

Nifedipine GITS had a more favorable effect on the lipid profile. High density lipoprotein cholesterol (HDL-C) and HDL2 subfractions were increased significantly (p = .001) as were apo A1 (p = 0.037) and apo A2 (p = 0.025). Nifedipine GITS increased HDL3 (NS), reduced triglycerides (TG) (NS), and had no significant effect on total cholesterol (TC) low density lipoprotein cholesterol (LDL-C) and apo B.

Atenolol significantly increased serum total cholesterol (p = 0.039) and HDL-C and HDL2 (p = 0.049 and 0.048 respectively). Atenolol increased TG (NS) and apo B (NS) with little change in apo A1 and apo A2. It is concluded that nifedipine GITS had equal or better antihypertensive efficacy than atenolol and had a more favorable effect on the lipid profile. These effects may offer advantages in reducing CHD risk.
Early Exercise Test in Acute Myocardial Infarction Treated with Intravenous Streptokinase
Authors: Hamouratidis Nikolaos , Katsaliakis Nikolaos , Manoudis Floros , Lazaridis Kyriakos , Tselegaridis Theophilos , Stravelas Vasilios , Simeonidou Eftihia , Roussis Stefanos
Published: November 2007

The aim of this study was to assess the value of the early exercise test (ET) in patients with acute myocardial infarction (AMI) treated with IV streptokinase (SK). The authors studied 70 patients with first AMI; 31 were treated with SK and 39 were not. Before discharge everyone was given early exercise up to 5-6 METs and catheterized within 22.9 ± 7.2 days. There was no significant difference in the number of positive ETs between the two groups (11/31 and 14/39 respectively). There was significant difference in favor of: (1) the recanalization of the infarct-related artery in the SK group, (2) the negative ET in patients with recanalized vessels in both groups, (3) the positive ET in patients with multi-vessel coronary disease.

It is concluded that the results of early ET in patients with AMI are related to the recanalization of the infarct-related artery and the coexistence of multi-vessel coronary artery disease, regardless of SK treatment. Patients with successful thrombolysis have negative ET more frequently.
Role of Cholinergic Nervous System in Healing Neuropathic Lesions: Preliminary Studies and Prospective, Double-Blinded, Placebo-Controlled Studies
Authors: Dillon Richard S.
Published: November 2007

The amplitudes of photoelectricplethysmography (PPG) tracings were sig nificantly increased by subcutaneous injections of methacholine (MC) and diminished by injections of atropine (AT) as compared with placebo injections of multielectrolyte solution (MES) both in 8 normal subjects and 11 patients with diabetic peripheral neuropathy. AT-containing lotion delayed healing compared with placebo in the forearms of 6 normal subjects. MC-containing lotion sped healing compared with placebo in the forearms of 6 subjects with diabetic neu ropathy. Thigh incisions in 6 neuropathic patients were shown to heal faster if soaked in MES rather than saline. Healing with the MES solution was shown to be further increased by the addition of MC to the solution and to be decreased by the addition of AT. The addition of MC produced erythrema and an increase in the amplitude of PPG tracings. AT solutions produced blanching and a decrease in the PPG amplitude. It was concluded that (1) the slow healing charac teristic of neuropathic ulcers is associated with a loss of cholinergic nerve func tion ; (2) cholinergic stimulation will increase capillary blood flow and promote healing while cholinergic blockade has opposite effects; (3) secondary ischemia makes the ulcers susceptible to the deleterious effects of therapeutic agents such as saline; (4) the ischemic tissue will heal faster with a balanced MES than with saline; and (5) the benefits of MES on healing are augmented in patients with diabetic neuropathy by the addition of cholinergic agents to the solution.
Comparison of Various Noninvasive Techniques for Evaluating Deep Venous Thrombosis
Authors: Winsor David , Sibley A.E. , Winsor Travis , Mikail Amani
Published: November 2007

A series of noninvasive vascular tests was performed on groups of normal individuals (Group I) and on patients with chronic deep vein thrombophlebitis (Group II) to determine the relative specificity and sensitivity of the tests.1-10 Results indicate that the simpler tests, requiring a minimum of equipment and technique are as effective as certain of the more sophisticated procedures.
The Venoarteriolar Response in Diabetics
Authors: Belcaro G. , Nicolaides A.N.
Published: November 2007

Resting skin blood flow and the venoarteriolar response (VAR) were studied in 40 patients with diabetic microangiopathy and neuropathy, in 40 diabetics with microangiopathy, and in 30 normal subjects by means of laser-Doppler flowmetry.

In patients with microangiopathy and neuropathy, resting flow (RF) was in creased and the VAR was impaired to a greater extent than in patients without neuropathy. There was also a significant delay in the VAR in diabetics, particu larly in patients with neuropathy.

The microangiopathy index (VAR/RF) was on the average 71.3 in normal subjects, significantly lower (p<0.05) in diabetics without neuropathy (34.8), and even lower in those with neuropathy (13.6). The VAR was evaluated with different postural changes; The authors observed that in the passage from su pine to standing the VAR is more evident.

In conclusion these results confirm that the postural control of blood flow in the skin of the foot is impaired in diabetic microangiopathy, particularly in patients with neuropathy. The increased skin blood flow and the impaired VAR are causes of edema and may contribute to the thickening of capillary basement membranes observed in diabetics.
Atrial Pacing with Two-Dimensional Echocardiography for Evaluation of Chest Pain: Comparison with Thallium 201 Scintigraphy
Authors: Stratmann Henry G. , Janosik Denise L. , Mezei Leslie E. , Mark Alexander L. , Williams George A.
Published: November 2007

Atrial pacing was performed with two-dimensional (2-D) echocardiography and thallium 201 scintigraphy in 40 men with stable chest pain. Coronary an giography showed significant (one or more lesions ≥ 50%) coronary artery dis ease (CAD) in 36 patients and no or insignificant CAD in 4. Two dimensional echocardiography showed a left ventricular wall motion abnormality (WMA) either at rest or with pacing in 28 (78%) patients with CAD, with 17 (47%) show ing a new or worsened WMA with pacing. A thallium scan showing abnormali ty (reversible or fixed perfusion defect) was seen in 26 (72%) patients with CAD; 18 (50%) had a reversible defect. In all, 34 of the 36 patients with CAD (94%) had a WMA, a perfusion defect, or both (specificity 50%). Occurrence of both a WMA and a perfusion defect in individual segments ranged from 10 of 25 pa tients with septal abnormalities to 0 of 12 with abnormalities of the lateral seg ment. Sensitivity of 2-D echocardiography for identifying CAD in specific vessels was 81% for the left anterior descending (LAD) artery, 30% for the right coro nary artery, and 20% for the circumflex artery (both p < .001 compared with the LAD artery). Corresponding sensitivities for thallium 201 imaging were 54% (p<.05 compared with 2-D echocardiography), 27%, and 8% (both p<.05 com pared with the LAD artery). When combined with atrial pacing, 2-D echocar diography and thallium 201 perfusion imaging are of similar value for diagnos ing the presence of CAD in patients with stable chest pain. Two-dimensional echocardiography is superior to thallium 201 imaging for identifying the presence of significant CAD in the LAD artery, but both tests are limited in their ability to detect lesions of the right coronary or circumflex arteries
Single-Dose Sublingual Nifedipine as the Only Treatment in Hypertensive Urgencies and Emergencies
Authors: Gonzalez-Carmona Victor M. , Ibarra-Perez Carlos , Jerjes-Sanchez Carlos
Published: November 2007

One hundred and eighteen patients with hypertensive urgencies and emer gencies and diastolic blood pressure (DBP) at least 120 mm Hg by the cuff method were seen at the Emergency Care Department; none had received calcium chan nel blockers during the previous twelve hours.

Patients with DBP of 120 to 139 mm Hg received 10 mg of sublingual nifedi pine; patients with left ventricular hypertrophy or failure, renal disease, hyper tensive encephalopathy, angina, papilledema, or a DBP over 140 mm Hg received 20 mg of the drug. The criterion for control was the achievement of a DBP of 100 mm Hg or less within sixty minutes of receiving sublingual nifedipine and maintenance of the effect until discharge.

Control was achieved in all patients; a sixty-three-year-old man died of a brain hemorrhage after pulmonary edema and a DBP of 210 had been controlled; the other 117 were discharged to their attending physicians, either as outpatients or to a hospital ward. No patient developed hypotension, clinical or electrocardio graphic signs of myocardial ischemia, or clinical signs of neurologic dysfunction.

Practical, fast, safe, and dependable control of hypertensive urgencies and emergencies has made sublingual nifedipine the treatment of choice of such pa tients in the Emergency Care Department.
Single Administration of Captopril and Combined Use with Beta-Blocker and/or Thiazide Diuretic in the Treatment of Essential Hypertension
Authors: Yoneda Shunki , Kako Toshio , Koketsu Masaaki , Hayano Junichiro , Asakawa Takeshi , Fujinami Takao , Kato Tadashi
Published: November 2007

Thirty-four patients with essential hypertension at WHO stage I or II were divided into three groups. Group I consisted of 22 cases who displayed normal renin activity (NR) or low renin activity (LR) and who received a single adminis tration of captopril. Group II consisted of 6 cases given beta-blockers after ad ministration of captopril. Group III consisted of 6 cases in whom beta-blocker was replaced with thiazide diuretics after administration of captopril alone. Blood pressure decreased significantly by captopril treatment alone in group I of the NR and LR subgroups (except for the diastolic blood pressure [DBP] of the NR subgroup) and fell below the target blood pressure (SBP of 165 mmHg and DBP of 95 mmHg) in 86% of the NR subgroup and 73% of the LR subgroup. Com bined treatment with captopril and beta-blocker in Group II did not decrease blood pressure any lower than with captopril alone treatment and achieved the target blood pressure in only 50% of the patients. In group III, combined treat ment with catopril and thiazide achieved the target blood pressure in 100% of the patients. Plasma renin activity (PRA) was increased by captopril but reduced by captopril in combination with beta-blocker. However, when beta-blocker was replaced with thiazide, PRA increased. The serum sodium concentration was significantly reduced in the LR subgroup after a single administration of cap topril, but there was no other variation.
Clinical and Instrumental Evaluation of the Family of a Patient with Arrhythmogenic Right Ventricle Dysplasia
Authors: Mocchegiani Roberto , Mazzanti Marco , Gili Alberto , Purcaro Augusto
Published: November 2007

The aim of the present study is a clinical and instrumental evaluation of the family of a patient with arrhythmogenic right ventricle dysplasia (ARVD), ini tially complicated by recurrent ventricular tachycardia and later by congestive cardiac failure. Because the probability of familial involvement is very high in those cases described in the literature, the authors evaluated the patient's 3 chil dren : 2 daughters. twenty-four and twenty years old, respectively, and a twenty- one-year-old son; his niece, thirty-one years old; and her sons three and eight years old. The authors did not evaluate his fifty-six-year-old sister, because she was affected by rheumatic mitral valve disease. All in the study were asympto matic, and clinical examination did not show any pathologic findings. Rest ECG was normal in all cases, and the exercise stress test (Bruce protocol) showed nor mal functional capacity. Holter recordings were normal without arrhythmias; chest x rays showed normal cardiothoracic ratio and cardiac morphologic volume. Two-dimensional echocardiography and pulsed and continuous wave Doppler demonstrated normal sizes of cardiac chambers and normal function and mor phology of cardiac valves. Nevertheless, in 4 cases (66.5%) the right ventricles showed an apical bulging with normal systolic thickness, without hypokinetic or akinetic areas or diverticular outpouchings. The authors did not find those abnormalities in 5 control subjects who were studied in the same way.

Conclusions: In 4 family members (66.5%) of a patient with ARVD pro gressed to cardiac congestive failure, the authors found anomalies of right ven tricle morphology: apical bulging, not revealed in a control group, and an ab sence of symptoms. They believe that these minor anomalies of the right ventricle need further investigation in suspicion of the initial signs of right ventricular dysplasia.
Survival from Acute Occlusion of the Left Main Coronary Artery with Preexisting Collateral Vessels—A Case Report
Authors: Takayanagi Kan , Satoh Tsutomu , Inoue Teruo , Sakai Yoshihiko , Morooka Shigenori , Takabatake Yutaka
Published: November 2007

A thirty-two-year-old man suffered from evolving acute myocardial infarc tion caused by total occlusion of the left main coronary artery, which was 95% stenosed before the onset. Nevertheless, he had a good clinical course. The myo cardium may have been protected by well-developed preexisting collateral ves sels as evidenced by serial coronary angiograms.
Defibrotide Inhibits Ca2+ Dependent Neutrophil Activation: Implications for its Pharmacological Activity in Vascular Disorders
Authors: Di Perri Tullio , Pasini Franco Laghi , Ceccatelli Linda , Pasqui Anna Laura , Capecchi Pier Leopoldo
Published: November 2007

Defibrotide (DEF) is a polydeoxyribonucleotide agent provided with profibrinolytic and antithrombotic properties. Moreover, an antiischemic, cardi oprotective effect of the drug has recently been demonstrated in experimental animals. Increasing evidence exists of the important role played by neutrophils in the development of tissue damage during chronic and acute ischemia and in the early phases of reperfusion. In order to evaluate whether the overall cytoprotective effect of DEF could be based, at least in part, on a neutrophil- involving mechanism, the authors studied the in vitro effects of the drug on hu man neutrophil activation triggered by several specific stimuli.

The drug dose-dependently (10-100 μM) inhibited enzyme release, superoxide anion generation, and chemiluminescence induced in neutrophils by the chemoat tractant oligopeptide fMLP and by the divalent cation ionophores A23187 and ionomycin. The increase of extracellular calcium concentration from 0.5 to 2.0 mM antagonized the inhibitory effect of DEF. The use of the fluorescent probe Fura 2/AM led them to show that DEF is able to reduce the cytosolic free calci um increase following specific stimulation by affecting extracellular calcium en trance. Such a behavior resembles that of calcium-antagonistic drugs, thus suggesting that DEF works, at least in part, similarly to calcium entry blockers. Such an activity on cell calcium translocation could represent the underlying molecular mechanism of cytoprotection. Finally, the inhibitory action on neu trophil functions may play a role in tissue protection during ischemic injury.
Influence of Short Atrioventricular Delay on Late Diastolic Transmitral Flow and Stroke Volume
Authors: Ronaszeki Aladar , Denef Boudewijn , Ector Hugo , Aubert Andre E. , Van de Werf Frans , De Geest Hilaire
Published: November 2007

Atrial transport function and the corresponding transmitral flow and stroke volume depend on the timing of atrial contraction. To study the influence of short atrioventricular delay (AVD) on these hemodynamic parameters, transmitral flow velocity (by pulsed wave Doppler) and aortic flow (by electromagnetic technique) were studied and compared (paired t test) during normal and short AVD at fixed rate DDD pacing (80 bpm) in AV-blocked, open-chest canine preparations (n:16).

The short AVD resulted in a shorter acceleration (difference 4.1 ± 4.9 msec, mean ± SD, p<0.05), a lower peak velocity (difference: 7.1 ± 3.2 cm/sec, p < 0.001), a shorter (difference: 26.9 ± 16.2 msec, p<0.001) and more rapid deceleration (difference: 220.7 ± 291.7 cm/sec2, p < 0.005) of the late diastolic transmitral flow elicited by atrial systole. Stroke volume decreased (7.8 ± 5.2%, p < 0.001) during short AVD as a consequence of a reduced left ventricular filling due to the interruption of the active atrial transport by the onset of the ventricular contraction.
Differential Effects of Nifedipine on Plasma Atrial Natriuretic Peptide in Normal Subjects and Hypertensive Patients
Authors: Shigematsu Satoshi , Yamada Takashi , Aizawa Toru , Takasu Nobuyuki , Shimizu Zenji
Published: November 2007

The physiology of atrial naturiuretic peptide (ANP) secretion was studied in normotensive subjects and hypertensive patients both young and old. Basal plasma ANP concentration was least in young normotensives, intermediate in old normotensives and young hypertensives, and highest in old hypertensives. Nifedipine, a known stimulator of ANP secretion, acutely increased plasma ANP in young and old normotensive subjects but not in young hypertensive patients and half of the old hypertensive patients. Increase in serum ANP level in response to nifedipine did not augment its hypotensive effect. However, the increase of aldosterone in response to nifedipine-induced rise in plasma renin activity (PRA) seemed to be suppressed by elevated ANP.
Immunoscintigraphy of Infections Using 123I and 99mTc-Labeled Monoclonal Antibodies. Advanced Experiences in 230 Patients
Authors: Seybold K. , Frey L.D. , Locher J.
Published: November 2007

Advanced experiences show an extremely high diagnostic potential in im munoscintigraphy of infections using monoclonal antigranulocytes antibodies (Mab). There was no hampering of the biological properties of the granulocytes after in vivo labeling with123I or99mTc-tagged Mabs. There were mostly identi cal findings and an equal functional behavior of the granulocytes observed with the use of different agents. Diagnosis of infections was made mostly within four to six hours p.i.99mTc labeling is more advantageous than123 I because of better image quality, constant availability, and lower costs.123I Mab 47 seems to be recommended in some cases of chronic osteomyelitis and spondylitis. No rele vant antigenicity was observed in follow-up studies of testing HAMA serum levels. Only a few short-time reactions were seen after repeated administration of99mTc Mab. There were no side effects and no allergic or adverse reactions.

Despite these methodical advantages of the immunoscintigraphic detection of infectious and inflammatory lesions, this method should be further restricted to severe cases or patients in whom other methods would not be practicable or have failed. HAMA controls are continued in all our patients undergoing im munoscintigraphy.
Calcium Utilization Associated with U-46619 and PGF2a Vascular Responses in Rat Lungs
Authors: Santoian Edward C. , Angerio Allan D. , Schneidkraut Marlowe J. , Ramwell Peter W. , Kot Peter A.
Published: November 2007

The pulmonary vasoconstrictor responses to U-46619 and PGF2aare calcium dependent. The purpose of this investigation was to determine to what extent extracellular and intracellular calcium pools are utilized during the dose-de pendent pulmonary vasopressor responses induced by multiple doses of U- 46619 and PGF2a. Increasing doses of these agonists were administered to isolated rat lungs perfused with Krebs-Ringer bicarbonate (KRB) or KRB not containing CaCL 2. The data indicate that U-46619 uses predominantly extracel lular calcium at low doses (0.1 μg) and depends solely on intracellular calcium at the highest dose (0.4 μg). In contrast PGF 2aappears to use depletable intracellu lar calcium stores to achieve contraction.
Duplex Ultrasonography of Vertebral Arteries: Examination, Technique, Normal Values, and Clinical Applications
Authors: Bartels Eva , Fuchs H.-H. , Flügel K.A.
Published: November 2007

A technique for the imaging of vertebral arteries at their origins and along the longitudinal extracranial course is described. The results of the examination of 108 normal vertebral arteries are shown. The vertebral artery could be distin guished in the pretransverse and intertransverse segment C5-C6 in 100%. The average diameter of the vessel was 3.81 ± 0.46 mm on the right and 3.88 + 0.47 on the left side. The average maximal systolic velocity was 43.0 ± 8.9 cm/s on the right and 43.3 ± 9.6 on the left side. In 81% of the cases the vertebral origin could be located on the right and in 65% of the cases on the left side. The technical quality of visualization, especially of the vertebral origin, was greatly influenced by the depth of the examined structure. Examples of pathologic find ings, such as hypoplasia, stenosis, and occlusion, demonstrate the practical pos sibilities of this noninvasive method.
Fine Structures Around the Orifice of the Intercostal Artery of the Rabbit Thoracic Aorta
Authors: Emura Sei , Masuko Sadahiko , Sunaga Toshiaki
Published: November 2007

In hypercholesterolemic rabbits, atherosclerotic lesions easily occur in the thoracic aorta, especially at the distal and lateral sides of the walls around the orifices of the dorsal intercostal arteries. In order to examine whether some spe cial structures that lead to atherosclerotic lesions are present even in normal con ditions, the authors investigated the morphologic features around the orifice of the intercostal artery of 20 normal rabbit aortae under electron microscopy.

The endothelial cells were generally fusiform but tended to be round and have a cobblestone-like appearance at the lateral side. There was intimal protrusion at the distal and lateral sides of the orifice, where the distribution and arrange ment of elastic fibers and smooth muscle cells were different from those at the proximal side. At the proximal edge of the orifice, elastic fibers formed a thick plate-like internal elastic lamina beneath the endothelial cells. On the other hand, at the distal and lateral sides, elastic fibers formed close-meshed structures over the proper plate-like internal elastic lamina.

These results indicate that the aortic walls at the distal and lateral sides of the orifice are structurally different from those at other regions even in normal conditions and suggest the involvement of special structures at the distal and lateral sides of the orifice in atherogenesis.
Microcirculatory Characteristics in Patients with Buerger's Disease
Authors: Nishikimi Naomichi , Sakurai Tsunehisa , Shionoya Shigehiko , Oshima Motoo
Published: November 2007

The most characteristic pathophysiologic change in Buerger's disease or thromboangiitis obliterans (TAO) is considered the breakdown of microcircula tion in the extremity, but this has not yet been proven. The purpose of this study is to examine the damage of microcirculation in TAO objectively, by means of intra-arterial injection of two kinds of radioisotope. In 7 TAO and 4 infraingui nal arteriosclerosis obliterans (ASO) patients, thallium 201 chloride (201 Tl) and 99mTc macroaggregated human serum albumin ( 99mTc-MAA) were administered through bilateral common femoral artery injections. In the planar image of the foot, rectangular regions of interest (ROIs) were placed on the foot muscles and toes. Normalized counts of 99m Tc-MAA in each ROI were divided by that of 201Tl, and the result was defined as the microcirculation damage index, based on their different kinetics. The damage index of the foot muscle was not differ ent between ASO and TAO, but that of the toe was lower in TAO than ASO patients. Lumbar sympathectomy was performed in 5 TAO patients, but it did not improve the damage index. It is concluded that there is breakdown of the microvascular defense system from the beginning of the disease, and critical ische mia make the regional cell function deteriorate as if a precursor to a trophic lesion. Lumbar sympathectomy did not immediately improve microcirculation.
Relationship between Chronic Hypoxia and In Vitro Pulmonary Relaxation Mediated by Endothelium-Derived Relaxing Factors in Human Chronic Obstructive Lung Disease
Authors: Dinh-Xuan A. Tuan , Higenbottam Timothy W. , Wallwork John
Published: November 2007

Endothelium-derived relaxing factors (EDRF) are paracrine vasodilator sub stances released by endothelial cells. There is compelling evidence to suggest that EDRF may play an important role in the modulation of vascular tone in the systemic circulation. However, the role of EDRF-mediated pulmonary relaxa tion in chronic lung disease is unknown. The authors have, therefore, investigated endothelium-dependent relaxation of isolated pulmonary arteries (PAs) obtained from 18 patients undergoing heart-lung transplantation for end-stage chronic hypoxic cor pulmonale (HCP). Control PAs were obtained from 10 patients, none of whom had evidence of HCP, and who underwent lobectomy for lung carcinoma.

All vascular rings were studied immediately after lung excision. PA rings from control patients dose-dependently relaxed to cumulative doses of acetylcholine (ACh, 10-10 to 10 -5 M), achieving a maximal relaxation of 73.2±4.4% from precontraction to phenylephrine. By contrast, PA rings from HCP patients achieved only 42.1 ±6.7% of maximal relaxation (p<0.01). Sodium nitroprus side (10-4 M) relaxed all PA rings, with and without endothelium (carefully re moved before study), obtained from both control and HCP patients.

The endothelium-dependent maximal relaxation to ACh was positively related to pretransplant values of PaO2 (r = 0.59; p< 0.01), but no relationship was found with either PaCO2 (r = -0.41) or FEV1 (r = -0.14).

The authors conclude that pulmonary relaxation mediated by EDRF is im paired in human HCP and suggest that such impairment may be related to severity of the preexisting chronic hypoxemia.
Bacteriology of 100 Consecutive Diabetic Foot Infections and In Vitro Susceptibility to Ampicillin/Sulbactam Versus Cefoxitin
Authors: Borrero Edgar , Rossini Michael
Published: November 2007

One of the major complications of diabetes mellitus is the occurrence of diabetic foot infection. The polymicrobial nature of diabetic foot infection has been well documented in the literature.

In order to avoid amputation of the tissue affected, the ulceration and infec tion must be appropriately diagnosed and treated. This paper describes the microbiologic and clinical features obtained from 100 consecutive diabetic in fected foot patients treated with either cefoxitin or ampicillin/sulbactam.
Clinical Significance of the Calcification of Coronary Arteries in Patients with Angiographically Normal Coronary Arteries
Authors: Sekiya Michihito , Mukai Mikio , Suzuki Makoto , Ohtani Takashi , Abe Mitsunori , Matsuoka Hiroshi , Sumimoto Takumi , Fujiwara Yasushi , Hamada Mareomi , Hiwada Kunio
Published: November 2007

In order to clarify the clinical significance of coronary calcification in pa tients with angiographically normal coronary arteries, exercise electrocardiog raphy was used and left ventricular function was examined noninvasively and invasively. The patient groups were as follows: (1) patients with coronary artery calcification on only the left anterior descending artery but no narrowing lesion on any other arteries (calcified group), (2) patients with a significant stenosis on only the left anterior descending artery (stenotic group), and (3) the control group.

The left ventricular function in the calcified group, as indicated by systolic time intervals and invasive parameters such as ejection fraction and mean sys tolic ejection rate, showed a depression similar to that in the stenotic group, compared with the control group. The incidence of electrocardiographically is chemic responses to exercise testing was significantly higher in the calcified group (75%, p < 0.01) and the stenotic group (68%, p < 0.01) than in the control group (25%). Exercise tolerance time and the maximum double product were markedly smaller in the calcified and the stenotic groups as compared with the control group.

These results indicate that the left ventricular function and coronary reserve in the calcified group were reduced and almost identical with those in the stenotic group. The authors conclude that a calcified coronary artery, even if patent, cannot supply an adequate blood flow for the myocardium, resulting in impaired left ventricular function.