bluuebunny/crossref_metadata_2025 huggingface dataset:
Atherosclerosis Vascular Damage in Elderly Athletes and Sedentary People
Authors: Galetta Fabio , Rossi Marco , Franzoni Ferdinando , Credidio Luigi , Vagheggini Guido , Galetta Fabio
Published: July 2008

The objective of this study was to determine the degree of vascular atherosclerotic damage at the carotid and femoral levels in a group of subjects over sixty years old prac ticing endurance sports. Using high-resolution Doppler-color flow ultrasonography the authors carried out a vascular screening, comparing two distinct groups of subjects, the first consisting of 20 elderly male subjects (age 65.6 ±5.6 years) practicing endurance sports (runners) and the second of 20 subjects of the same gender and age (63.5 ±4.5 years), clinically healthy, but leading a sedentary life. All subjects were nonsmokers, nondiabetics, with normal lipid values and normal blood pressure. The authors examined the internal, external, and common carotid arteries, bilaterally, as well as the common femoral, deep femoral, and superficial femoral arteries of both legs. For each vessel they documented: (1) presence of plaques, (2) position and quantity of the plaques, (3) stenosis percentage produced by the plaques, (4) echographic structure of the plaques. In the group of sportsmen they calculated a global score of atherosclerotic damage of 5.58 ± 2.21. This is statistically significant (P<0.001 ) as compared with the global score (continued on next page) observed in the sedentary group (9.24 ±3.9, range 6-14). The sportsmen exhibited small atherosclerotic plaques that were not hemodynamically significant; these plaques were present in 7 subjects (35%). In 4 of them (20%) the lesions were located in one carotid artery system. In the other 3 subjects (15%) the lesions were identified in one femoral artery system. In none of the sportsmen were they able to demonstrate simultaneous atherosclerosis of carotid and femoral arteries. In the sedentary subjects, atherosclerotic lesions were identified in 15 of them (75%). In 2 subjects hemodynamically significant plaques were located in one carotid artery system. In the other 13 subjects the plaques found were not hemodynamically significant; in 6 subjects this type of lesion was present in both femoral and carotid arteries; in 5 the lesions were located in one carotid artery system, and in 2 in one femoral artery system. In conclusion, endurance exercise appears to protect the elderly against atherosclerotic vascular damage.
Ambulatory Blood Pressure Monitoring in Diagnosing a Pheochromocytoma of the Urinary Bladder
Authors: Fujishima Shinichiro , Abe Isao , Kaseda Shigeru , Koga Tokushi , Hirano Haruka , Hamada Tetsuo , Oniki Hideo , Onoyama Kaoru , Fujishima Masatoshi
Published: July 2008

A patient is presented in whom the preoperative diagnosis of an intravesical pheochro mocytoma was facilitated by noninvasive ambulatory blood pressure monitoring. A fifty- two-year-old Japanese man suffered headache and palpitation after micturition. Cystoscopy revealed an intravesical tumor. To investigate whether his symptoms were associated with an elevation of blood pressure, the authors monitored his ambulatory blood pressure automatically for twenty-four hours. The patient was also instructed to activate the recording manually upon the onset of symptoms. As a result, elevations of blood pressure were apparent following micturition. The twenty-four-hour urinary excretion of norepinephrine was elevated on the day of the blood pressure monitoring. Pheochromocytoma was suspected and was confirmed by histopathologic studies following the operation. Thus, ambulatory blood pressure monitoring may be useful in detecting the transient hypertension induced by micturition, which can provide preop erative evidence of pheochromocytoma of the urinary bladder.
Cervical Aortic Arch
Authors: Açikel Ünal , Ugurlu Baran , Hazan Eyüp , Salman Ergun , Açikel Ünal
Published: July 2008

Cervical aortic arch is a rare type of aortic arch anomaly that is presumed to result from persistence of the third aortic arch and regression of the normal fourth arch. Most of the patients with this anomaly are asymptomatic, but symptoms of dysphagia and respira tory distress due to the compression by the vascular ring have been reported. Other findings such as a supraclavicular pulsatile mass, blood pressure discrepancies between the upper limbs, and loss of femoral or opposite-upper-limb pulses with compression of the cervical mass may also be present. In this article a twenty-two-year-old woman with symptomatic cervical aortic arch is presented. The patient had a left cervical pulsatile mass and elevated blood pressure on her right upper limb and was treated surgically with reanastomosis of the aorta.
Fibrinogen and Albuminuria are Related to the Presence and Severity of Peripheral Arterial Disease in Women with Type 2 Diabetes Mellitus
Authors: Tkáč Ivan , Molčányiová Angela , Tkáč Ivan
Published: July 2008

The relationship between the ultrasonographically determined presence and severity of peripheral arterial disease (PAD) and cardiovascular risk factors was studied in 30 post menopausal, nonsmoking women with type 2 diabetes mellitus. PAD was established on the basis of decreased ankle/arm index (AAI) of < 0.9 in 15 patients. The control group included 15 type 2 diabetic women with AAI > 1.0. There were no differences with respect to diabetes control and systolic blood pressure between the patients with PAD and controls. The patients with PAD had significantly higher mean fibrinogen concentrations (4.75 ±0.35 vs 3.53 ±0.36 g/L, P<0.01) and urinary albumin excretion (UAE) values (893 ±501 vs 57 ±24 mg/day, P<0.05) than the subjects in the control group. There was no significant difference between the study groups with respect to any lipid variables. Significant partial correlations adjusted for age were observed between AAI (which expressed the severity of PAD) and log UAE (r=-0.55, P<0.01), creatinine ( r=-0.48, P<0.01) and fibrinogen ( r=-0.45, P<0.01). In the multiple stepwise regression analysis with AAI as a dependent variable, only fibrinogen (P=0.033) and log UAE (P=0.029) were included into the best model. In conclusion, in nonsmoking women with type 2 diabetes mellitus, fibrinogen and albuminuria were the only risk factors associated with both the presence and severity of peripheral arterial disease.
Pulse Oximetry in the Evaluation of Peripheral Vascular Disease
Authors: Jawahar David , Rachamalla H.R. , Rafalowski Alicja , Ilkhani R. , Bharathan T. , Anandarao N. , Jawahar David
Published: July 2008

The role of pulse oximetry in the evaluation of peripheral vascular disease (PVD) was investigated. In addition, the value of elevating the limb to improve the sensitivity of detection of PVD by the pulse oximeter was also determined. Pulse oximetry reading in the toes were obtained in 40 young, healthy volunteers and in 40 randomly selected patients referred to the vascular investigation laboratory over a period of two months. All 40 healthy volunteers had normal pulse oximetry readings. Normal pulse oximetry reading in the toes was defined as >95% O 2 Sat and ±2 of finger pulse oximetry reading. In all 40 patients, pulse oximetry readings were either normal or not detected at all. Since there was no gradation in decrease in the pulse oximetry reading with severity of disease or with elevation of the patient's lower extremity, an absent or no reading was considered as an abnormal result from the test. The frequency of abnormal pulse oximetry readings increased significantly in groups with abnormal ankle-brachial pressure index (ABPI) and also varied significantly with elevation of the patients' lower limbs. In patients with no PVD detected by Doppler (ABPI >0.9), pulse oximetry readings were normal in all. However, in patients with moderate PVD (ABPI, 0.5-0.9), 84% of the patients' lower limbs had normal pulse oximetry readings and 16% had an abnormal reading at baseline level (flat). An additional 12% of the lower limbs in this group had an abnormal reading on elevation of the limb to 12 inches. In patients with severe PVD (ABPI < 0.5), 54% of the patients' lower limbs had an abnormal reading at baseline and an additional 23% had an abnormal reading at elevation of the limb to 12 inches. In conclusion, pulse oximetry was not a sensitive test for detecting early PVD.
Color Doppler Echocardiographic Evaluation of Tricuspid Regurgitation and Systolic Pulmonary Artery Pressure in the Full-Term and Preterm Newborn
Authors: Schmitz A.J. , Weinzheimer H.R. , Fahnenstich H. , Lê T.P. , Redel D.A. , Kowalewski S. , Schmitz Achim J.
Published: July 2008

Color Doppler echocardiography of tricuspid valve regurgitation (TR) is a valid, nonin vasive method of determining systolic pulmonary artery pressure (SPAP). In a prospec tive study the authors examined 56 healthy full-term newborns (group I), 36 healthy preterm newborns (group II), and 10 preterm newborns with severe respiratory distress syndrome requiring surfactant replacement therapy (group III). Doppler studies were repeated until the transtricuspid gradient was <20 mm Hg.

In 83.3% of children a reproducible spectral curve was recorded at least once. The authors estimated the transtricuspid gradient Δp(RV-RA) by using the modified Bernoulli equation. Within the first twenty-four hours p(RV-RA) was <20 mm Hg in 72.7%, 50%, and 25% of children with measurable TR in groups I, II, and III, respectively, increasing to 91.1%, 78.6%, and 55.6% within forty-eight hours. There was no significant correla tion between SPAP and gestational age, birth weight, mode of delivery, and ductal closing time. Continuous holosystolic envelope tracing of TR was recorded in 16.6%. In these patients Δp(RV-RA) was measured markedly higher (mean of 30.1 mm Hg) than in the others (mean 17.3 mm Hg).

The authors conclude that there is a high prevalence of TR in neonates, which allows estimation of SPAP in >80% of newborns without considerable impairment. Normalization of SPAP takes place within four days in most patients, but there is a delay in preterm infants with severe respiratory distress syndrome.
Excessive Arterial Thrombus in Spherocytosis
Authors: Nikol Sigrid , Huehns Tanya Y. , Kiefmann Rainer , Höfling Berthold , Nikol Sigrid
Published: July 2008

Spherocytosis is the most common of the hereditary hemolytic anemias, with character istically shaped erythrocytes. An unusually large amount of arterial thrombus was docu mented in a dissected artery after angioplasty in a patient with spherocytosis. It is hypoth esized that the excessive arterial thrombus may have been linked to the spherocytosis.
Enhanced Angiogenesis and Unfavorable Remodeling in Injured Porcine Coronary Artery Lesions: Effects of Local Basic Fibroblast Growth Factor Delivery
Authors: Staab Michael E. , Simari Robert D. , Srivatsa Sanjay S. , Hasdai David , Pompili Vincent J. , Holmes David R. , Schwartz Robert S. , Schwartz Robert S.
Published: July 2008

There is interest in the role of growth factors in the genesis of arterial remodeling. We studied local administration of basic fibroblast growth factor (bFGF) to coronary lesions to determine whether there is a difference in remodeling and whether neovascularization could be induced in such stenoses and distal myocardium. Pigs were randomized to balloon infusion of either saline or bFGF at each thermally injured arterial site. After the animals were killed, their internal elastic lamina, neointima, and lumen areas were measured. Capillaries were counted in the arteries and myocardium. There was a greater loss of lumen and internal elastic lamina in the bFGF group. The neointima, media, and myocardium in the bFGF treated arteries had statistically more capillaries. This study showed that local intracoronary bFGF, at a dose that results in arterial luminal revascu larization in injured segments, adversely affects arterial remodeling. Thus, the angio genic response to exogenous bFGF may be offset by concomitant shrinkage of injured arterial segments.
Decreasing Common Carotid Artery Intimal Thickness During Hypolipidemic Therapy
Authors: Spáčil Jiří , Ceška Richard , Sobra Josef , Petrášek Jan , Spáčil Jiří
Published: July 2008

It has been demonstrated in recent years that ultrasound can be used to measure common carotid artery intimal thickness; an increase in intimal thickness is regarded as an early stage of atherosclerosis. This study was designed to establish whether or not intimal thickness can be modulated by therapy.

Twenty-nine patients with familial hyperlipoproteinemias had follow-up ultrasound of the common carotid artery after twenty-nine months of comprehensive therapy. In 21 patients with familial hypercholesterolemia, intimal thickness decreased from 0.83 to 0.68 mm (P<0.01), in 9 with familial combined hyperlipoproteinemia, the decrease was from 0.77 to 0.74 mm (a decrease was seen in only 50% of patients). With the group taken as a whole, the larger decrease was observed in patients treated with statins while the reduction was less marked in those administered fibrates.

The authors found a decrease in common carotid artery intimal thickness following hypolipidemic therapy in patients with hyperlipoproteinemias. Their impression is that this was a manifestation of atherosclerosis regression.
Plasma Endothelin-1 Release in Normal and Varicose Saphenous Veins
Authors: Mangiafico Roberto Antonio , Malatino Lorenzo Salvatore , Santonocito Maurizio , Spada Rosario Sebastiano , Benedetto Francesco Antonio , Mangiafico R.A.
Published: July 2008

The aim of the study was to investigate the release of endothelin-1 (ET-1) in normal and varicose saphenous veins at baseline and after venous stasis test. Ten patients (eight women and two men, mean age 43 ±4) with primarily varicose great saphenous veins and ten controls (eight women and two men, mean age 42 ±6) were recruited. After 30 minutes of resting in supine position, venous occlusion in a leg was performed with a sphygmomanometer provided to keep the pressure in the cuff intermediate between systolic and diastolic blood pressure for 10 minutes. Blood samples were taken from the great saphenous vein just above the medial malleolus at baseline and 10 minutes after venous stasis was begun. Plasma ET-1 was determined by a radioimmunoassay system. Results are expressed as mean ±SD.

Plasma ET-1 concentration was higher in varicose than in normal saphenous veins (4 ±0.1 pmol/L vs 2.6 ±0.1 pmol/L, P<0.001), and it significantly increased (P<0.001) in both groups after venous stasis when compared with baseline (6.8 ±0.9 pmol/L and 3.6 ±0.1 pmol/L in varicose and normal saphenous veins, respectively). Absolute increase in plasma ET-1 was significantly greater in varicose than in normal saphenous veins (2.8 ±0.9 pmol/L vs 1.0 ±0.2 pmol/L, P<0.01).

In conclusion, increased local ET-1 release in varicose saphenous veins could be a marker for venous endothelial activation/damage and/or contribute to promote the morphologic alterations of the varicose vein wall by stimulating smooth muscle cell prolif eration. On the other hand, increased ET-1 release could contribute to counterbalancing the varicose venous relaxation and to increasing preload in varicose patients via ET-1- induced venoconstriction.
Evaluation of Successful PTCA by Transstenotic Flow Velocity Ratios
Authors: Altstidl Robert , Regenfus Matthias , Lehmkuhl Hans , Dill Harald , Bachmann Kurt , Altstidl Robert
Published: July 2008

Doppler probes mounted on the tip of a guidewire allow the measurement of coronary blood flow velocities, not only proximal but also distal to stenoses eligible for percuta neous transluminal coronary angioplasty (PTCA). The objective of this study was to determine the improvement of transstenotic Doppler flow velocity ratios following PTCA and to investigate the possible impact on restenosis during follow-up control angiog raphy three months later.

Doppler flow velocity measurements were performed in 29 patients with 29 stenoses eligible for PTCA. Results of PTCA were morphologically evaluated by computer-assisted quantitative coronary angiography (QCA) and measured hemodynamically by deter mining transstenotic Doppler flow velocity ratios.

Successful PTCA according to QCA was present in all cases with a reduction of mean diameter stenosis from 66 ±8% to 35 ±7%. Resting spectral peak velocities and velocity integrals were markedly reduced distal to lesions (all P<0.001), resulting in mean transstenotic flow velocity and velocity integral ratios of less than 0.60 prior to PTCA. Owing to endoluminal enlargement, significant improvement of transstenotic Doppler ratios was observed in mean ratios greater than 0.90 (all P < 0.0001 ) . In patients with restenosis, transstenotic ratios following PTCA demonstrated a tendency to be smaller than in patients without restenosis.

Transstenotic Doppler flow velocity ratios are diminished in severe coronary stenoses. Improvement of these ratios provides information on hemodynamic success of interven tional procedures. Thus, the determination of intracoronary Doppler flow velocity ratios contributes, in additon to angiographic estimation, to the evaluation of stenoses severity and success of interventional procedures.
The Hemorheologic Effects of Hand-Transmitted Vibration
Authors: Greenstein D. , Kester R.C. , Greenstein D. , Kester R.C.
Published: July 2008

Vibration white finger (VWF) is an ischemic condition of the hands that is associated with long-term exposure to hand-held vibration tools. The pathophysiology of VWF remains unknown. The aim of this study was to assess the hemorheologic effect of acute hand-transmitted vibration. This study investigated 52 men divided into two groups: VWF=29, mean age 46.9 years (range twenty-two to sixty-six); Controls=23, mean age 42.8 years (range twenty to sixty-four). Each subject gripped a vibrating handle for seven minutes thirty seconds at a vibration frequency of 120 Hz with an amplitude of displace ment of 0.25 mm. Venous blood was analyzed before and after acute vibration to determine the hematocrit, the plasma hemoglobin concentration, plasma viscosity, and red cell deformability, expressed as red cell transit time (RCTT). At rest, there was no significant difference in RCTT, plasma viscosity, hematocrit, and plasma hemoglobin concentration between the VWF group and controls. Acute vibration did, however, signif icantly increase the red cell transit time in the VWF group but not in the control group. In both groups vibration resulted in a significant increase in plasma viscosity, hemat ocrit, and plasma hemoglobin concentration in hand venous blood. Moreover, in each group there was a highly significant correlation between the change in plasma viscosity and the change in the hemoglobin concentration and the hematocrit. The authors conclude that hand-transmitted vibration is associated with hemoconcentration.
A Review of Erythromycin-Induced Malignant Tachyarrhythmia— Torsade de Pointes
Authors: Katapadi K. , Kostandy G. , Katapadi M. , Hussain K.M.A. , Schifter D. , Kostandy G.
Published: July 2008

The term torsade de pointes refers to a ventricular tachycardia characterized by QRS complexes of changing amplitude that appears to twist around the isoelectric line and occurs at rates of 200-250/minute. Most cases of torsade de pointes are iatrogenically induced by drugs or electrolyte abnormalities. The most important feature is QT interval prolongation. Torsade de pointes was first described in 1966 in France by Dessertenne.

The authors report a case of a fifty-year-old woman with medical history of corrective surgery for tetralogy of Fallot who was admitted to the hospital with pneumonia and atrial fibrillation and later developed recurrent episodes of polymorphic ventricular tachy cardia with QT interval prolongation after IV administration of erythromycin. The episodes did not recur after discontinuation of erythromycin, and the QT interval returned to normal. The association of erythromycin with torsade de pointes has been reported in 18 cases to date. Erythromycin has been shown to produce electrophysio logic effects similar to those of class Ia and class III antiarrhythmic drugs on the cardiac muscle.

This potentially fatal complication of a commonly used antibiotic is rare, but increased physician awareness is important, especially in patients with predisposing factors like electrolytes abnormalities, use of class Ia and Class III antiarrhythmic drugs, and presence of prolonged QT interval (congenital prolonged QT syndromes). This is the second case reported in a patient with previous cardiac surgery and erythromycin administration.
Left Ventricular Diastolic Filling Dynamics During Isometric Exertion in Syndrome X Assessed with Doppler Flowmetry
Authors: Mizushige Katsufumi , Masugata Hisashi , Morita Hisaki , Senda Shoichi , Matsuo Hirohide , Mizushige Katsufumi
Published: July 2008

To study left ventricular diastolic properties in syndrome X, we analyzed transmitral filling dynamics during handgrip exertion. In 14 normal subjects (N), 17 with syndrome X (Syn X), 16 with single-vessel disease (SVD), and 8 with multiple-vessel disease (MVD), transmitral inflow was recorded at baseline and during handgrip (50% of maximal effort for one minute) using pulsed Doppler echocardiography. We measured early diastolic (E) and late atrial (A) inflow velocities, A/E ratio and percent change of A/E from baseline (%A/E).

Blood pressure and heart rate increased to the same degree in each group during handgrip. In normal subjects, E did not change with handgrip; A (51 ± 10 vs 54 ±11 cm/sec, P<0.05) and A/E (1.16 ±0.22 vs 1.25 ±0.33, P<0.05) increased minimally. In Syn X subjects, E decreased (51 ± 10 vs 38 ± 10 cm/sec, P<0.0001), A increased (52 ±11 vs 60 ±14 cm/sec, P<0.005), and A/E increased markedly (1.07 ±0.31 vs 1.68 ±0.51, P< 0.0001). The %A/E in Syn X and MVD were significantly larger than that in SVD and N (Syn X: 58 ±29%; MVD: 45 ±25%; SVD: 22 ±21%; N: 8 ±13%).

Handgrip-induced changes in diastolic filling in syndrome X and are similar to those in MVD and more marked than in SVD. These changes are consistent with impaired ventricular relaxation and support a generalized left ventricular (LV) abnormality in syndrome X.
Coronary Wallstent Implantation by the Transradial Artery Approach
Authors: Herz Itzhak , Assali Abid , Shor Nurit , Solodky Alejandro , Sclarovsky Samuel , Herz Itzhak
Published: July 2008

The authors report the implantation of two wallstents in a patient by use of the transra dial artery approach. This approach for coronary wallstent implantation allows for intensive anticoagulation therapy with less risk of bleeding.
Right Ventricular Electrode Lead Implantation via a Persistent Left Superior Vena Cava
Authors: Hsiang Chiang Hsiao  , Chi Woon Kong  , Jiann Jong Wang  , Wan Leong Chan  , Shin Pu Wang  , Mau Song Chang  , Chiang Benjamin N. , Chi Woon Kong
Published: July 2008

Persistent left superior vena cava occurs in approximately 0.5% of the population. This may complicate pacemaker implantation by making lead insertion difficult and causing lead instability through the left cephalic vein and the subclavian vein approach. We used a wide loop technique in the right atrium and successfully advanced the lead in the right ventricle apex. A persistent left superior vena cava does not preclude successful lead placement.
Symptomatic Improvement After AV Nodal Ablation and Pacemaker Implantation for Refractory Atrial Fibrillation and Atrial Flutter
Authors: Kim Soo G. , Sompalli Vineel , Rameneni Anuradha , Gadde Murali K. , Pamidi Madhavi , Pathapati Raja , Ferrick Kevin J. , Gross Jay , Ben-Zur Uri , Furman Seymour , Fisher John D. , Kim Soo G.
Published: July 2008

Symptomatic Improvement was evaluated in 64 patients with drug-refractory atrial fibril lation or atrial flutter who underwent atrioventricular (AV) nodal ablation and permanent pacemaker implantation. The arrhythmias were chronic in 40 patients and paroxysmal in 24 patients. All were refractory to multiple drugs (3.7 ±1.5) and had severe symptoms: palpitations (58 patients), dyspnea (n=58), dizziness (n=38), asthenia (n=37), and chest pain (n=20). All underwent AV nodal ablation and single- (n=39) or dual-chamber (n=25) pacemaker implantation. During follow-up of 20.4 ± 17.8 months, palpitations improved in 100% of 58 patients who had palpitations before the ablation, dyspnea improved in 75% of 58 patients, chest pain in 95% of 20 patients, asthenia in 75% of 37 patients, and dizziness in 93% of 38 patients. Moderate to significant improve ment in these symptoms was reported in 83% of patients and mild improvement in 5%. Before ablation, 77% of patients were in New York Heart Association functional class III or IV. After ablation, 19% of patients were in the same functional classes (P<0.05). Thus, AV nodal ablation and pacemaker implantation in patients with drug-refractory atrial fibrillation or flutter was associated with significant improvement in presenting symptoms and functional capacity. A randomized, controlled study is needed to compare this form of therapy with other therapeutic modalities.
The Effect of Cigarette Smoking on Free-Living Daily Physical Activity in Older Claudication Patients
Authors: Gardner Andrew W. , Sieminski Debra J. , Killewich Lois A. , Gardner Andrew W.
Published: July 2008

The purposes of this study were (1) to determine whether peripheral arterial occlusive disease (PAOD) patients who smoke have a lower free-living daily physical activity than nonsmoking patients and (2) to determine whether the difference in physical activity persisted after controlling for potential confounders such as PAOD severity, age, body composition, and peripheral circulation. Thirty-four smokers (45.5 ±9.8 years of smoking) and 43 nonsmokers (former smokers who had a smoking history of 35.0 ± 13.1 years who quit 12.2 ± 10.5 years prior to investigation) were studied. Patients wore a Caltrac accelerometer and a pedometer on each hip over two consecutive weekdays to assess free-living daily physical activity. Patients were also characterized on age, weight, body mass index (BMI), percent body fat, ankle/brachial index (ABI), calf blood flow, and exercise capacity. The smoking and nonsmoking claudication patients had a similar level of PAOD severity, for no group differences were noted in ABI (P=0.287) and treadmill time to maximal claudication pain (P=0.201). However, the smokers were 35% less physically active than the nonsmokers (264 ± 123 vs 407 ±272 kcal/day; P<0.006), and they took 23% fewer steps (4,116 ± 2,199 vs 5,329 ±2,924 steps/day; P<0.034). After adjustment for group differences in age, weight, BMI, percent body fat, and calf blood flow, the lower activity level of the smokers persisted. The adjusted daily energy expen diture was 27% lower (292 ± 105 vs 400 ±214 kcal/day; P=0.021), and the adjusted amount of daily walking was 29% lower (4,039 ±1,760 vs 5,684 ±2,235 steps /day; P=0.003). Smoking PAOD patients had a less physically active lifestyle than nonsmoking patients, and the lower activity level of the smokers was independent of PAOD severity, age, body composition, and peripheral circulation.
Antihypertensive and Renal Effects of Isradipine in Essential Hypertension: Focus on Renin System Activity
Authors: Allikmets Kristina , Parik Triin , Teesalu Rein , Allikmets Kristina
Published: July 2008

Calcium antagonists are known to exert various effects on the kidney that might modulate their antihypertensive potential. This study evaluated the renal effects, along with the efficacy, of isradipine in two subgroups of patients with mild to moderate essential hyper tension (EH), defined according to plasma renin activity (PRA). Twenty-six patients were randomly assigned to receive 12-week treatment with slow-release isradipine (2.5-5 mg) or placebo. Assessment of PRA related to concurrent 24-hour sodium excretion was used to define patients with high/medium (n=16) and low renin profile (n=10). Urinary albumin excretion (UAE), serum creatinine and glomerular filtration rate (GFR, as endogenous creatinine clearance) were measured. Blood pressure (BP) decrease with isradipine was greater in the low PRA group as compared with the high/medium PRA group (P<0.05), and normalization of BP was achieved in all low-renin patients compared with 57% in the high/medium PRA group. BP reduction in the placebo group was statistically not significant. Isradipine, but not placebo, induced significant reduction in UAE (P<0.05); the decrease was similar in both PRA groups. Treatment did not cause any significant changes in GFR, PRA, urinary sodium or creatinine excretion, or serum aldosterone or creatinine concentrations. The decrease of BP in the whole isradipine- treated group was inversely correlated with pretreatment serum creatinine as well as with basal urinary creatinine excretion. In conclusion, the antihypertensive effect of isradipine was more pronounced in low-renin EH patients, despite similar effects on renal function and UAE in both PRA groups.
Aortic Dissection Decades Following Internal Carotid Artery Dissection
Authors: Schievink Wouter I. , Mokri Bahram , Schievink Wouter I.
Published: July 2008

Recurrent dissections involving carotid, vertebral, or renal arteries have been described in patients with spontaneous cervical artery dissections, with a maximal interval between dissections of fourteen years. The authors describe 2 patients in whom aortic dissections developed twenty-five and forty years, respectively, following carotid artery dissections. These 2 patients constituted 8% of the total number of patients from Rochester, Minnesota, who were diagnosed with aortic dissection between 1987 and 1992.

The first patient, a forty-five-year-old woman, presented in 1948 with right neck pain and headache, associated with several episodes of transient numbness of the right face and numbness and clumsiness of the left upper and lower extremities. Examination showed right miosis. Angiography showed a stenosis of the extracranial right internal carotid artery beginning several centimeters from the bifurcation. She died at age eighty- five from an aortic dissection. The second patient, a thirty-eight-year-old man, noted left orbital and frontotemporal headaches and drooping of the left eyelid in 1962. Examination showed left oculosympathetic palsy. Angiography showed stenosis and an aneurysm in the midportion of the extracranial left internal carotid artery. He died at age sixty-three from an aortic dissection.

These cases suggest that following a carotid artery dissection the risk of a recurrent arterial dissection may remain elevated for a prolonged period of time and the recurrent dissection may involve the aorta.
Transesophageal Echocardiographic Doppler Study of Coronary Flow in a Patient with Myocardial Bridging
Authors: Kranidis Athanasios J. , Salachas Anastasios J. , Antonellis Ioannis P. , Kappos Konstantinos G. , Patsilinakos Sotirios P. , Zamanis Nikolaos J. , Margaris Nikolaos G. , Tavernarakis Antonios G. , Anthopoulos Lambros P. , Kranidis Athanasios J.
Published: July 2008

A case report of myocardial bridging of the left anterior descending artery is described. Coronary flow proximal to the myocardial bridge was studied with transesophageal echo Doppler. The patient, a 62-year-old farmer who sustained an anterior myocardial infarc tion, underwent thrombolysis and was admitted. He subsequently underwent coronary angiography and left ventriculography, which showed a severe myocardial bridge of the midshaft of the left anterior descending artery. The ejection fraction improved from 25 to 48% after thrombolysis, as measured by using echocardiography. Transesophageal Doppler study proximal to the myocardial bridge revealed a relative increase of the diastolic coronary flow velocity (increased acceleration), which reached its peak value in early diastole. Despite the presence of severe myocardial bridging, coronary flow reserve increased substantially two minutes after the infusion of dipyridamole (0.56 mg/kg iv for 4 minutes). Transesophageal Doppler study of coronary blood flow proximal to the myocardial bridge in the left anterior descending artery showed a characteristic waveform that may prove to be indicative of this condition.
Sustained Dapsone-Induced Remission of Hypocomplementemic Urticarial Vasculitis
Authors: Eiser Arnold R. , Singh Parikshit , Shanies Harvey M. , Shanies Harvey M.
Published: July 2008

Hypocomplementemic urticarial vasculitis (HUV) is often misdiagnosed. The response to drug therapy may be unsatisfactory, and immunosuppressive therapy may be associ ated with significant side effects. A 35-year-old patient whose condition was resistant to cyclophosphamide, corticosteroids, pentoxyphylline, cyproheptadine, sulindac, and colchicine was maintained in remission with dapsone, which may be the drug of choice for HUV. Emphysema has been reported to complicate HUV, but this is the first account of vasculitis-related emphysema with no confounding history of tobacco smoke exposure. The relationship of proteolytic injury to the pulmonary and other manifestations is considered, as is the possible role for dapsone in reducing it.
Raynaud's Phenomenon in Vibration Syndrome: The Impact of Cold Feet on Skin Temperature and Vasomotion of the Hand After Immersion in Cold Water
Authors: Falkenbach A. , Watanabe I. , Hartmann B. , Agishi Y. , Falkenbach Med Albrecht
Published: July 2008

Patients with vibration syndrome, suffering from Raynaud's phenomenon, are sensitive to cold. Rewarming time, after local cooling, is delayed. The present study evaluated whether rewarming of the hand after cooling is influenced by the temperature of the feet. In five Japanese patients (former forest workers) with vibration syndrome, suffering from Raynaud's phenomenon, and in five healthy controls, temperature changes of the hand after cooling were registered under the two test situations (on different days) with the feet immersed in water of 35°C or 20°C, respectively. In both patients and controls (in both groups, in four of five cases) rewarming of the hand after cooling was faster when the feet were immersed in cold water, compared with when the feet were immersed in warm water. In this test situation, the systemic thermoregulative counterreaction appears to be more important for rewarming of the hand after cooling than a possible synchro nous passive reaction accompanying warming of the feet. A deliberate training of the systemic counterreaction may prove beneficial for patients with Raynaud's phenomenon.
Aortic Dissection in a Patient Receiving Chemotherapy for Hodgkin's Disease
Authors: Golden Michael A. , Vaughn David J. , Crooks Gary W. , Holland George A. , Bavaria Joseph E. , Golden Michael A.
Published: July 2008

Cancer chemotherapy is associated with a wide range of vascular toxicities, which may be related to endothelial cell damage by these agents. The authors describe a patient with Hodgkin's disease who developed an atypical aortic dissection while receiving MOPP/ABV chemotherapy (nitrogen mustard, vincristine, procarbazine, prednisone, doxorubicin, bleomycin, and vinblastine). They would place aortic dissection on the list of potential vascular complications associated with antineoplastic agents.
Giant Coronary Artery Pseudoaneurysm Causing Pulmonary Artery Obstruction: A Rare Complication of Coronary Bypass Surgery
Authors: Sebastian Cherian , Knott-Craig Christopher J. , Chandrasekaran Krishnaswamy , Sivaram Chittur A. , Kugelmass Aaron D. , Lazzara Ralph , Chandrasekaran K.
Published: July 2008

The authors report the diagnosis and successful management of a 57-year-old man with right ventricular outflow tract obstruction from a large pseudoaneurysm of the left anterior descending coronary artery 5 years after he had undergone redo coronary artery bypass grafting.
Pulsus Alternans in Diastolic Left Ventricular Dysfunction
Authors: Kwan Tak , Feit Alan , Alam Mahmood , Mandawat Mahendra K. , Clark Luther T. , Kwan Tak
Published: July 2008

Pulsus alternans is usually found in patients with reduced systolic ventricular function. We describe a patient with recurrent pulmonary edema, hypertension, bilateral renal artery stenosis, but with normal systolic function. Pulsus alternans was demonstrated in both pulmonary artery, right ventricle, and left ventricle pressures. After successful renal artery revascularization, the pulsus alternans disappeared. This case illustrates that pulsus alternans can be present with diastolic dysfunction of the left ventricle in the absence of systolic dysfunction.
Differentiating Syndrome X from Coronary Artery Disease by Treadmill Exercise Test in Patients with Chest Pain and Exercise-Induced Myocardial Ischemia
Authors: Hsu Nai-Wei , Chen Jaw-Wen , Jen Shu-Long , Kuo Benjamin Ing-Tiau , Lee Wen-Lieng , Mar Guang-Yuan , Lin Shing-Jong , Wang Shih-Pu , Chang Mau-Song , Chen Jaw-Wen
Published: July 2008

Even though the underlying mechanisms of myocardial ischemia may be different, it is difficult to differentiate syndrome X from coronary artery disease (CAD) by means of the treadmill exercise test in elderly patients with chest pain and exercise-induced myocar dial ischemia.

One hundred sex- and age-matched patients—42 with syndrome X and 58 with CAD—were studied. Another 10 subjects with atypical chest pain, negative treadmill exercise test, and normal-appearing coronary angiograms served as controls. We evaluated the difference in exercise performance between patients with syndrome X and CAD, and the treadmill exercise test was undertaken with modified Bruce protocol within 2 weeks before coronary angiography. Parameters including time to 1 mm ST segment depression (STD), exercise duration (ED), heart rate (HR), systolic blood pressure, rate- pressure product (RPP), and percentage of age-predicted maximum HR (% HR) at different stages of the test were measured and then compared among the three groups of patients.

Compared with CAD patients, syndrome X patients had significantly higher HR, % HR, and RPP at the time of 1 mm STD and at peak exercise. The time to 1 mm STD and ED were longer in syndrome X than in CAD patients. However, ED was shorter and HR, % HR, and RPP at peak exercise were similar in syndrome X patients as compared with control subjects. The new criterion of combined ED (≥315 seconds) and RPP at peak exercise (≥24,000 beats x mmHg/min) was found to be highly specific (86%) and moder ately sensitive (64%) in differentiating syndrome X from CAD patients. The positive like lihood ratio for this criterion was 4.57 and negative likelihood ratio was 0.42.

In conclusion, syndrome X patients had better exercise performance than CAD patients, but less ED and similar workload when compared with control subjects. The new criterion proposed in this study may provide a quick and simple way to differentiate syndrome X from CAD in a group of aged and predominantly male patients with chest pain and positive treadmill exercise test.
Clinical Importance of AaDO2 and Pulmonary Artery Pressure as Predicted by Pulsed Doppler Echocardiography at Bedside in Diagnosing Pulmonary Embolism
Authors: Shioya Takanobu , Kagaya Manabu , Sasaki Masahiro , Hasegawa Hitoshi , Kibira Satoshi , Miura Mamoru , Shioya Takanobu
Published: July 2008

The authors evaluated clinical importance of alveolar-arterial PO2 difference (AaDO2) and pulmonary artery pressure (PAP) estimated by pulsed Doppler echocardiography in 31 patients with pulmonary embolism (PE). Echocardiographic estimates from flow velocity patterns in the right ventricular outflow tract showed significant correlation with actual measurements obtained by right cardiac catheterization. Furthermore, PAP as obtained by pulsed echocardiography was significantly higher in acute massive and recurrent multiple groups in comparison with the acute submassive group. AaDO2 was greatest in the acute massive group, followed by the recurrent multiple group, and then by the acute submassive group. These results suggest that analyses of AaDO2 and the echocardiographic estimation of PAP at bedside are successful in the diagnosis and classification of PE.
The Antiatherogenic Effect of Nifedipine on Intramural Small Coronary Arterial Lesions in Cholesterol-Fed Rabbits
Authors: Kato Hiroyuki , Okada Ryuuichirou , Enoki Masafumi , Oogushi Kazuhisa , Emura Sei , Takashima Toshinobu , Ohmori Keizo , Kato Hiroyuki
Published: July 2008

The objective of this study was to examine the suppressive effect of nifedipine on intra mural coronary arterial lesions in cholesterol-fed rabbits. Each rabbit in Groups A (n=6) and B (n=5) was fed a 0.3% cholesterol diet and was orally administered nifedipine (40 mg/day) or placebo. Each rabbit in Groups C (n=5) and D (n=6) was fed a 0.5% choles terol diet and was orally administered nifedipine (40 mg/day) or placebo. The serum concentrations of total cholesterol (TC) were determined at 1-week intervals to calculate the integrated values. The lesion induction ratio was defined as the ratio of intramural coronary arteries 50-150 μm in diameter with arterial lipoidosis to the total number of arteries of the same diameter. There were no significant differences between the nifedipine-treated and placebo groups in either the integrated TC or lesion induction ratio in either the 0.3% and 0.5% cholesterol-fed rabbits. This study demonstrates that nifedipine does not suppress atherogenesis in the intramural small coronary arteries of cholesterol-fed rabbits.
Successful Stenting of Bilateral Renal Artery Stenosis Due to Fibromuscular Dysplasia Assessed by Use of Pressure Guidewire Technique
Authors: Isobe Mitsuaki , Takenaka Hiroaki , Kinoshita Osamu , Sekiguchi Morie , Ohta Masayoshi , Imamura Hiroshi
Published: July 2008

An 18-year-old woman with renovascular hypertension had stenosis due to fibromus cular dysplasia (FMD) of the bilateral renal arteries, and this did not respond to conven tional balloon angioplasty owing to marked elastic recoil. Implantation of Palmaz-Schatz stents resulted in successful dilation of the stenosis and remission of hypertension. Transstenotic pressure gradients were measured by use of a pressure-monitoring guidewire. It is suggested that stenting is a very useful adjunct to balloon angioplasty in the treatment of renal artery stenosis due to FMD.
Factor V Leiden Mutation in a Case with Ischemic Stroke: which Relationship?
Authors: Orlandi Giovanni , Pellegrinetti Alberto , Fioretti Cristina , Martini Antonio , Murri Luigi
Published: July 2008

A 50-year-old man presented spontaneous internal carotid artery dissection with ischemic stroke. He had a history of deep venous thrombosis, and an activated protein C resistance due to factor V Leiden mutation was documented. He showed no other vascular risk factor. This unusual case puts the question whether this coagulation defect may be related to the stroke occurrence.
Circumferential Spontaneous Coronary Artery . Dissection in an Elderly Man
Authors: Koga Tokushi , Sakamoto Akira , Nakamura Yoshito , Kawazoe Nobuyuki , Sadoshima Seizo , Onoyama Kaoru , Fujishima Masatoshi
Published: July 2008

An 82-year-old man developed acute inferior myocardial infarction. Emergent coronary angiography demonstrated thrombotic occlusion in the right coronary artery. Intracoronary thrombolytic therapy was performed with successful recanalization. However, circumferential dissection with luminal stenosis was revealed at the point of thrombus formation. Repeat angiography 6 months later showed resolution of the dissec tion. This is the first description of circumferential spontaneous coronary artery dissec tion. In addition, the present patient is older than any previous patients.
Beat-to-Beat Variation of the ST Segment in a Patient with Right Bundle Branch Block, Persistent ST Segment Elevation, and Ventricular Fibrillation
Authors: Hirata Kazuhito , Takagi Yousuke , Nakada Misao , Kyushima Masahiro , Asato Hiroaki
Published: July 2008

The authors describe a patient with ventricular fibrillation associated with right bundle branch block-like QRS morphology and persisting ST segment elevation in the precordial leads, in whom the morphology of the ST segment changed from the coved type to the saddle-back type or vice versa on a beat-to-beat basis. Such an observation has never been reported in the previous literature.
Ventricular Arrhythmias in Normotensive Subjects and in Mild Hypertensive Patients
Authors: Fariello Raffaele , Crippa Massimo , Damiani Gianpaolo , Notaristefano Ilaria , Costa Raffaella , Boni Enrico , Corda Luciano , Chiari Ermanna , Zaninelli Augusto
Published: July 2008

Twenty-five normotensive subjects (14 men, 11 women) aged from 25 to 60 years (mean 36) and 30 untreated patients with mild hypertension (stages 1 and 2, JNC V) without target organ damage (16 men, 14 women), aged 26-59 years (mean 35.8) underwent continuous 24-hour ECG Holter monitoring with a Fukuda Denshi SM-40 ambulatory recorder and SCM-400 ECG analyzer. During 24-hour ambulatory ECG recording, mean heart rate was slightly but not significantly higher in hypertensive patients (73.3 ± 10 beats per minute [bpm]) in comparison with normotensive subjects (71.2 ± 12 bpm). The prevalence of premature atrial contractions was similar in the two groups. Total ventricular arrhythmias were more prevalent in the group of mild hypertensive patients (P<0.05), who also had a higher prevalence in complex forms of ectopy (r=0.81 for bigeminy; r=0.83 for trigeminy; r=0.83 for couplets). Holter recordings did not show abnormalities of ST-T wave or episodes of silent ischemia.
A Placebo-Controlled Study of the Effects of Intravenous Buflomedil on Foot Skin Microcirculation in Patients with Severe Intermittent Claudication
Authors: Van den Brande P. , Maurel A.
Published: July 2008

Buflomedil hydrochloride (Buflomedil), a vasoactive drug, has been proven to improve pain-free walking distance in patients with peripheral arterial occlusive disease stage II of the lower extremities.

In the present double-blind, randomized study, resting skin flux motion activity and skin flux response to a local heat stress at the hallux were assessed by laser Doppler fluxmetry (LDF) in claudicants. Twenty of 39 enrolled patients with severe intermittent claudication received a daily intravenous dose of 400 mg Buflomedil, and the other 19 patients received 0.9% NaCl as placebo over a 5-day period.

Before treatment mean LDF skin resting flux, flux frequency, and flux amplitude were 2 ±0.8 Arbitrary Units (AU), 8.4 ±0.5 cycles per minute (c/min), and 0.12 ±0.01 AU, respectively in the Buflomedil group, and 2.3 ±0.3 AU, 8.7 ±0.7 c/min, and 0.13 ±0.02 AU in the placebo group (NS). Also the response to heat stress was identical in both groups: a slow initial increase of skin flux, followed by a reflex reduction, with a maximal initial flux increase to 138 ± 12% of the resting value in the Buflomedil group, and 155 ± 16% in the placebo group (NS). (continued on next page)

After 5 days of treatment the mean LDF skin resting flux, flux frequency, and flux amplitude were unchanged in both patient groups. The response to heating on the contrary was dramatically enhanced in the Buflomedil group (226 ±33%), against that in the placebo group, which remained unchanged (144 ±13%) after 3 minutes (P<0.05), while after reflex reduction the flux in the Buflomedil group remained stable at 200% of resting value during further heating and was only approximately 140% in the placebo group (P<0.05).

It is concluded that Buflomedil, administered in a daily intravenous dose of 400 mg, does not alter the mean LDF skin flux and flux motion at the hallux in claudicants in resting conditions. Local skin heating on the contrary provokes a significant LDF monitored skin flux increase, suggesting an improved capacity of cutaneous microvessel perfusion in stressed conditions.