bluuebunny/crossref_metadata_2025 huggingface dataset:
Venous Elasticity After Treatment with Daflon 500 mg
Authors: Ibegbuna V. , Nicolaides A.N. , Sowade O. , Leon M. , Geroulakos G.
Published: July 2008

It has been demonstrated that patients predisposed to the development of varicose veins have an abnormal venous tone, and may have symptoms in the absence of obvious vari cosities. It has been suggested that venotonic drugs relieve the symptoms of chronic venous insufficiency by decreasing capillary leakage and improving venous tone. The aim of this study was to determine the effect of Daflon 500 mg in patients with abnormal venous elasticity without varicose veins. Twenty-five healthy female volunteers aged 18-35 were included in the study. They presented with symptomatic varicose veins in one leg and an abnormal elastic modulus without varicosities in the opposite leg. Treatment group: 12 patients received 2 tablets of Daflon 500 mg (1000 mg/day); control group: 13 patients received no treatment. The elastic modulus K was determined using the air plethysmograph. Simultaneous measurements of calf volume changes were made in response to different venous pressures produced by a thigh pneumatic cuff. In the control group K (mean ±sd) was 10.8 x 103 ±4.1 × 103 N/m2 at the beginning and 10.2 x 103 ±3.1 × 103 N/m2 at the end of the study (P > 0.1). In the treatment group the initial K was 10.2 × 10 3 ± 3.9 ×103 N/m2 and 14.2 x 103 ±5.1 x 103 N/m2 at the end (P < 0.02). The results of the Wilcoxon rank sum test indicated that 4 weeks' therapy with Daflon 500 mg is effective in improving venous tone in patients with symptoms but without varicose veins.
Measuring Health-Related Quality of Life in Venous Disease: Practical and Scientific Considerations
Authors: Lamping Donna L.
Published: July 2008

An important and often neglected aspect in the evaluation of patient outcomes in venous disease is quality of life. This paper addresses the why, what, and how of measuring health-related quality of life (HRQL) in venous disease by providing an overview of practical and scientific considerations in developing and using measures of HRQL in general. It begins with a brief overview of developments in the field of measuring HRQL and the definition of HRQL. This is followed by a consideration of issues relevant to the assessment of HRQL including generic and disease-specific measures, multiple compo nents of HRQL, different methods of measurement, measuring change, and cultural appropriateness of HRQL measures. In the next section, criteria for evaluating the scien tific credibility and practical utility of HRQL measures are outlined, followed by a descrip tion of some widely used generic and disease-specific measures of HRQL, including measures of HRQL in chronic venous disorders of the leg (CVDL).
The VEINES Study (VEnous INsufficiency Epidemiologic and Economic Study): An International Cohort Study on Chronic Venous Disorders of the Leg
Authors: Abenhaim L. , Kurz X.
Published: July 2008

The aim of the VEINES study is to address some gaps in knowledge regarding the multi dimensional repercussions of venous disorders and the measurement of outcomes. Its objectives are to describe and compare defined clinical presentations of venous-related leg disorders with regard to natural history, clinical outcome, functional capacity, quality of life, and economic impact. A secondary objective is to develop or identify and test standardized instruments for the evaluation of therapeutic effectiveness. This paper presents an overview of the design of the study and of the options chosen for the recruit ment process and the outcome measures.
Socioeconomic Impact of Chronic Venous Insufficiency and Leg Ulcers
Authors: Ruckley C.V.
Published: July 2008

Chronic venous insufficiency affects approximately 5% and chronic leg ulcer approxi mately 1% of the adult population of developed countries. Not only do recent quality of life studies highlight major disability and social impairment but, since this is a condition characterized by chronicity and relapse, it gives rise to massive health care expenditure amounting in the UK to around £400 million per annum. Venous disease consumes 1-2% of the health care budgets of European countries. Imprecise disease classifications and codings impede the acquisition of accurate data but there is a compelling need for better quality socioeconomic data concerning this long-neglected health care problem.
Efficacy of Daflon 500 mg in the Treatment of Lymphedema (Secondary to Conventional Therapy of Breast Cancer)
Authors: Pecking Alain P. , Fevrier Benoit , Wargon Caroline , Pillion Gérard
Published: July 2008

To assess the activity of a purified, micronized, flavonoidic fraction (Dios; Daflon® 500 mg*) on upper limb lymphedema occurring after breast cancer therapy, a monocenter, randomized, double-blind, parallel group vs placebo (Plac) trial was carried out.

One hundred and four women with lymphedema were included; 94 completed the study (46 Dios, 48 Plac). A subset of 24 patients with more severe lymphedema (10 Dios, 14 Plac) was subjected to a separate analysis. Treatment consisting of Dios or Plac was given two tablets daily over a six-month period. A radionuclide lymphoscintigraphy using technetium-99m was performed at inclusion and at the end of the treatment. The upper limb volume was measured every two months.

In the overall population the evolution of parameters was not different between Dios and Plac. In the 24 patients with a more severe lymphedema, the lymphoscintigraphic parameters (m ±sd) were as follows: lymphatic migration speed was significantly improved by Dios in comparison with Plac (Δ Speed cm/minute: 0.84 ±0.6 vs 0.14 ± 0.26, P = 0.005). The half-life of the colloidal compound was significantly improved over time in the Dios group (Δ half-life = 10.3 ±13.07 minute, P = 0.034) but not in the Plac group (Δ half-life = 0.53 ±15.51 minute, P = 0.086). The change over time of colloidal clearance was close to significance in the Dios group (Δ clearance μL/minute: 2.18 ±3.10, P = 0.054) but not in the Plac group (0.11 ±2.26, P = 0.86). No significant difference was found for evolution of lymphedema volume, despite a tendency in favor of Dios. This can be related to wide distribution of volume values and small numbers of patients. ( continued on next page)

In conclusion, these results suggest a beneficial therapeutic activity of Dios at the usual dose of two tablets/day in patients affected with more severe lymphedema. The clear improvement of the lymphatic speed illustrates its known lymphokinetic activity. Further studies with a higher dosage could confirm the beneficial activity of this drug in secondary lymphedema.
Is There Any Association Between Dissection After Successful Percutaneous Transluminal Coronary Angioplasty and Late Restenosis? An Angiographic Study
Authors: Övünç Kenan , Kabukçu Mehmet , Aksöyek Serdar , Kabakci Giray , Aytemir Kudret , Tokgözoğlu Lale , Özmen Ferhan , Ali Oto M. , Övünç Kenan
Published: July 2008

Restenosis continues to be the most important limitation of percutaneous transluminal coronary angioplasty (PTCA). Many clinical, angiographic, and procedural variables are thought to be related to the development of restenosis. This study was aimed at investi gating the effects of no dissection, minor dissections, and major dissections on the long- term outcome of lesions after successful PTCA. The study group comprised 91 patients with 100 lesions who underwent successful PTCA and in whom follow-up coronary angiography was performed at 8.8 ± 7.2 (two to twenty-three) months after dilation. Dissections were classified according to the National Heart, Lung, and Blood Institute criteria. Restenosis was defined as more than 50% stenosis at follow-up angiography. Restenosis rates were found to be 22% in the no-dissection group (10 restenoses in 46 patients), 27% in the minor dissection group (11 restenoses in 40 patients), and 36% in the major dissection group (5 restenoses in 14 patients). The authors applied corrected Yates Chi-square test and no difference was observed in the restenosis rate between the group without any dissections and that with minor dissections (P > 0.05). However, a statistically significant difference was observed in the restenosis rate between the major dissection group and the other two groups (P < 0.05).

The authors conclude that the occurrence of major dissections after successful PTCA may adversely affect the long-term outcome and may increase the restenosis rate.
Catheter Fragments Embolization
Authors: Monsuez Jean-Jacques , Douard Marie-Cécile , Martin-Bouyer Yves , Monsuez J.J.
Published: July 2008

Although the use of central venous silicone catheters is widespread, little is known about the incidence of catheter rupture and embolization. Over a three-year period, 3916 silicone catheters were inserted in 3672 patients in the authors' hospital. Catheter or catheter fragments embolism occurred in 4 patients (1.2 embolizations per 1000 patients treated). Inappropriate mechanical deobstruction attempts resulted in 2 embolizations, and hence, these should be avoided. Chest roentgenography failed to detect the small fragments within the heart silhouette in 2 cases. Two-dimensional echocardiography showed the separated catheter fragment in all 4 cases. All four catheter fragments were subsequently removed from the right-heart chambers.
Use of a Collagen Plug Versus Manual Compression for Sealing Arterial Puncture Site After Cardiac Catheterization
Authors: Gwechenberger Marianne , Katzenschlager Reinhold , Heinz Gottfried , Gottsauner-Wolf Michael , Probst Peter , Gwechenberger Marianne
Published: July 2008

The aim of the study was to investigate (1) the safety and efficacy of the application of a collagen plug (Vasoseal®) at arterial puncture sites, (2) the hemostasis time, and (3) the comfort for the patient of a collagen plug (Vasoseal®) when compared with manual compression. Sixty-two patients were randomized either for application of a collagen plug (Vasoseal®, group A, n=33) or manual compression (group B, n=29) after cardiac catheterization. All patients were evaluated for subjective pain score ranging from 1 to 5 (1= no pain up to 5 =very strong pain). In addition the authors measured the time until hemostasis could be achieved. The patients were evaluated by duplex sonography for complications at days 1 and 7 after the procedure. The pain score demonstrated a signif icantly lower score in group A when compared with group B (P=0.01). The mean time for hemostasis was significantly lower in group A (mean 9.6 minutes) when compared with group B (mean 23.6 minutes) (P=0.0001). Regarding the complication rate there was no significant difference between the groups (group A vs group B, P=0.82). The authors conclude that the application of a collagen plug at the arterial puncture site is a safe and time-saving method. In addition it is less painful and therefore better tolerated than manual compression.
Determinants of Exercise-Induced ST Segment Depression in Patients with Coronary Artery Disease: A Multivariate Approach
Authors: Papazoglou Nicolaos , Kalpoyiannakis Ioannis , Papazoglou Spyros , Papazoglou N.M.
Published: July 2008

The purpose of this study was to delineate among the usually gathered parameters in an electrocardiographic exercise test the determinants of its positive outcome (ΔST↓≥ 1 mm measured at 80 msec from the J point). The authors studied 832 patients investigated with Bruce's exercise testing and with diagnostic coronary arteriography, all of whom were shown to have significant coronary artery disease (diameter stenosis ≥ 50%). Twenty-five demographic, clinical, electrocardiographic, exercise, and anatomic/hemo dynamic parameters were analyzed. The stepwise forward logistic regression analysis retained seven among them as significant independent predictors: four as positive contributors: (1) three-vessel and/or left main disease (P=0.0000), (2) Gensini's angio graphic score for disease extent (P=0.0025), (3) anginal pain during the test (P=0.0000), and (4) age (P=0.0031) and three as negative contributors: (1) resting heart rate (P=0.0004), (2) history of old myocardial infarction (P=0.0019), and (3) pathological Q waves at the resting ECG (P=0.0018).

These findings establish standards that permit the prediction of the positive electro cardiographic exercise outcome in patients with significant coronary disease.
Postischemic Hyperemia in Subjects with Lower Limbs Obstructive Arteriopathy: Role of PGI2 and Endothelin
Authors: Pancera Paolo , Minuz Pietro , Rossi Luca , Ribul Mirco , Arosio Enrico , Lechi Alessandro , Pancera Paolo
Published: July 2008

The physiological basis of postischemic hyperemia is not yet fully understood. The present study investigated the effects of pharmacologic manipulation of the prostaglandin system on local hemodynamics. Strain-gauge plethysmography was used to study 8 normal subjects and 9 patients with obliterating arterial disease of the lower limbs. Hemo dynamic evaluations were performed before treatment, after seven days of low-dose acetylsalicylic acid (100 mg/day) to inhibit platelet thromboxane synthesis, and after acute infusion of 1 g of acetylsalicylic acid to inhibit endothelial prostacyclin synthesis. In patients with arterial disease, the hemodynamic study was also carried out after infusion of iloprost, a synthetic prostacyclin analogue.

Acute infusion of acetylsalicylic acid significantly reduced basal blood flow in normal subjects, but not in patients with arterial disease. In the latter group, iloprost affected neither basal nor maximal postischemic flow.

The study also evaluated the role of endothelin in musculocutaneous hemodynamic regulation, both in physiological conditions and in atherosclerosis. This part of the study addressed the possibility that the hemodynamic effects of vasodilator prostanoids like prostacyclin might affect endothelin release in vivo. During reactive hyperemia, plasma endothelin was reduced in normal subjects (-1.02 pg/mL, 95% CI: -2.23, 0.08), but not in patients with atherosclerosis (-0.35 pg/mL, 95% CI: -1.45, 0.75). In both groups, plasma endothelin was not affected by aspirin.

These findings confirm the role of prostacyclin in local hemodynamic regulation. In the normal subject, musculocutaneous blood flow seems to depend at least in part on the action of vasodilator prostanoids and endothelin. This is not the case in patients with arterial disease, in whom plasma endothelin does not seem to be affected by postischemic changes in blood flow. A possible explanation for this difference could be alteration of the endothelial function in patients with arterial disease, related to the functional and struc tural characteristics of the artery wall in atherosclerosis.
Physical Therapy Improves Venous Hemodynamics in Cases of Primary Varicosity: Results of a Controlled Study
Authors: Hartmann Bernd R. , Drews Bernadette , Kayser Thomas , Hartmann Bernd R.
Published: July 2008

Physical factors are known to influence hemodynamics in the veins of the lower extrem ities. In a controlled, randomized study the authors investigated the effects of combined physical therapy on varicose veins.

Over a twenty-four-week period a treatment group consisting of 12 persons exercised under the supervision of a therapist twice a week for sixty minutes. This included muscle and joint activation by means of externally applied compression and cold-temperature stimuli (ie, thermosteresis). They also exercised once a day without supervision for fifteen minutes. During the same period a control group of 12 persons underwent the same measurements but no treatment.

In the treatment group venous capacity decreased by an average of 16% from 4.9 ± 0.3 (sd) mL/100 mL tissue to 4.1 ±0.4 (P < 0.005, U-test) while in the control group it remained practically unchanged at 4.8 ±0.4 vs 5.0 ±0.3. Venous refilling time in the lower extremities also increased in the treatment group, half refilling time rising from 7.8 ±1.0 to 11.3 ±0.9 seconds (P < 0.001) and total refilling time from 17.0 ±1.4 to 25.7 ±2.1 seconds (P < 0.001); these parameters remained virtually unchanged in the control group, with half refilling time dropping slightly from 7.7 ± 1.1 to 7.1 ± 1.3 seconds and total refilling time from 18.3 ± 1.7 to 16.3 ± 1.9 seconds. Patient self-rating scores obtained by use of a standardized questionnaire administered at baseline and at the end of week 24 improved in the treatment group only.

The combined physical therapy was thus shown to be of long-term therapeutic value, improving venous function and reducing patients' symptoms. These findings indicate that for the further development of this combined treatment regimen it would be useful to identify the individual factors contributing to its efficacy and evaluate them separately.
Left Ventricular Pseudoaneurysm Presenting Twenty-eight Months After Myocardial Infarction
Authors: Martin Raquel , Tegtmeier Terry , Smith Alison S. , Ognibene André , Ognibene André
Published: July 2008

The authors report an unusually late presentation of a ventricular pseudoaneurysm more than two years after an inferior lateral myocardial infarction and the first case evaluated by Cine loop magnetic resonance imaging.
Primary Antiphospholipid Syndrome and Pulmonary Hypertension with Prolonged Survival
Authors: Nagai Hideo , Yasuma Keiichi , Katsuki Tatsuo , Shimakura Atsuhiro , Usuda Kazuo , Nakamura Yukio , Takata Shigeo , Kobayashi Ken-ichi , Nagai Hideo
Published: July 2008

The outcome of patients with pulmonary hypertension (PHT) and antiphospholipid syndrome (APS) is usually fatal. The authors report the rare case of a patient with primary APS and nonthrombotic PHT who has survived for twenty years after the onset of PHT. In this case, the patient's PHT resembled the primary idiopathic variety with clear lung fields and normal perfusion on the lung scan, and the combination therapy with nitrate, digoxin, and diuretics had been performed. During her clinical course over twenty years, she had not experienced any critical pulmonary thrombosis that influenced the progression of nonthrombotic PHT or any other severe systemic involvement of APS.
Patency and Reinfarction in Late-Entry Myocardial Infarct Patients Treated with Reperfusion Therapy
Authors: van't Hof Arnoud W. , Zijlstra Felix , de Boer Menko-Jan , Ay Lee Liem  , Hoorntje Jan C. , Suryapranata Harry , Suryapranata Harry
Published: July 2008

Patency of the infarct-related vessel is associated with a more favorable long-term prognosis after acute myocardial infarction (AMI). High infarct vessel patency is reported for early reperfusion therapy, but data on patency and its possible effect on clinical outcome are less abundant for patients presenting late after the acute event. The aim of this study was to investigate whether time to reperfusion is related to infarct-vessel patency and clinical outcome. This study compares 268 patients who presented with symptoms of AMI within six hours after the onset of symptoms (Early) with 33 patients who had reperfusion therapy for signs of ongoing ischemia more than six hours after the start of chest pain (Late). At follow-up coronary angiography, flow through the infarct- related vessel was assessed according to the thrombolysis in myocardial infarction (TIMI) classification. Vessels were considered occluded if TIMI flow grade 0 or 1 was present. Follow-up angiography was performed in 95% of patients after a mean of forty-eight days. The infarct-related vessel was occluded in 41% of the late-entry patients (13 of 32), and in 17% of those presenting early (44 of 252), (P=0.01; relative risk [RR] : 2.50; 95% confidence interval [CI]: 1.26 to 6.83). This was associated with a higher rate of recurrent myocardial infarction in late-entry patients: 27% (9 of 33), compared with 9% (25 of 268) in the early group (P=0.005; RR: 2.94; 95% CI: 1.50 to 5.81). Thus, in the present study, late reperfusion therapy (after six hours) was associated with a higher recurrent myocardial infarction rate and a lower infarct vessel patency rate, compared with early treatment of patients.
Volume of Infarction and Blood Flow in Cerebral Embolism
Authors: Ayada Yoshihide , Tsuda Yoshiyasu , Takahashi Tsutomu , Kitadai Masaya , Ohkawa Motoomi , Matsuo Hirohide , Tsuda Yoshiyasu
Published: July 2008

The value of measuring asymmetry of cerebral perfusion semiquantitatively by single- photon emission computed tomography (SPECT) correlated with measuring the volume of infarction on computed tomography (CT) was evaluated in cerebral embolism. Eighteen patients with acute cerebral embolism (mean age: sixty-nine years) were evaluated. Ten were diagnosed as having middle cerebral artery (MCA) occlusion, 3 as having MCA branch occlusion, and 4 as having unilateral and 1 as having bilateral internal carotid occlusion. The infarct volume was measured, summing up the area of infarction on CT, at 8.5 days, mean time after onset. Outcomes of the patients were clas sified into three groups: good, fair, or dead, judged by the consequences one month after onset. Regional cerebral blood flow (rCBF) was measured in 9 of 10 surviving patients at one month, mean time after onset, by 123Iodine N-isopropyl-p-iodoamphetamine (IMP) SPECT. Semiquantitative rCBF index of asymmetry (AI) was evaluated from four regions of brain cortex. Eleven patients with <300 mL infarct and 7 with ≥300 mL infarct showed a significant difference of outcome with infarct volumes (P < 0.01). The mean AI value in patients with < 150 mL infarct was 31% while it was 52% with ≥150 mL infarct (P < 0.039). There were significant linear correlations between mean AI values and the volumes of infarction or infarct/brain volume ratios (P < 0.034 or P < 0.018). The signif icant correlations of the AI values with the volumes of infarction suggest that the measured asymmetry of perfusion evaluated by SPECT could reflect the ultimate tissue damage and residual intact brain volume after cerebral embolism.
Hypertension and Peripheral Arterial Disease: A Plethysmographic Study
Authors: Milio Glauco , Cospite Valentina , Cospite Michele , Milio Glauco
Published: July 2008

Sixty patients suffering from arterial hypertension and/or obliterative arteriopathy of the lower limbs (20 hypertensive uncomplicated [H group], 20 normotensive affected by obliterative arteriopathy [A group], 20 suffering from both hypertension and peripheral arterial disease [HA group]) were studied, by strain gauge plethysmography, in compar ison with 20 healthy subjects (N group). The aims were to evaluate the arterial and venous hemodynamics of the lower limbs in such conditions and also to determine whether the vascular damage is primary or represents a consequence of the hypertensive pathology in the patients affected by both hypertension and peripheral arterial disease.

The resting blood flow did not show significant differences in the mean values, even if lightly decreased in hypertensive patients (with or without peripheral arteriopathy). The peak flow was reduced significantly both in the H group and in the A and HA groups. The half-time (t½) and total time (tT), which indicate vascular reactivity, were signifi cantly decreased in the H group, but they were increased in the A and HA groups. Finally, the venous compliance was decreased in the H group, did not vary significantly in the A group, and showed an intermediate behavior in the HA group.

These results suggest that hypertensive and arteriopathic patients develop similar arterial structural changes. However, they show a different behavior with regard to vascular reactivity and venous hemodynamics, as demonstrated by venous plethysmography.
Effects of Indobufen and Pentoxifylline on Walking Capacity and Hemostasis in Patients with Intermittent Claudication: Results of Six Months of Treatment
Authors: Panchenko E. , Eshkeeva A. , Dobrovolsky A. , Titaeva E. , Podinovskaya Ya. , Hussain K.M.A. , Karpov Yu. , Panchenko Elizaveta
Published: July 2008

Seventy-one patients with peripheral arterial occlusive disease (PAOD) were random ized into two groups of different treatment modalities. The diagnosis of PAOD was estab lished by history of intermittent claudication, clinical examination, and by Doppler pressure assessment or lower extremity arteriography. After a three-month washout period, 35 patients (Group 1) started treatment with indobufen (400 mg per day) and 36 patients (Group 2) with pentoxifylline (600 mg per day). Twenty-nine patients from each group completed six months of treatment. Both of the drugs significantly improved maximal and pain-free walking distances, but the effect of indobufen was more pronounced than that of pentoxifylline. Patients with PAOD exhibited signs of hyperco agulation. Fibrinogen, D-dimer, and b-thromboglobulin concentrations did not change significantly following treatment in both of the groups. The authors observed a decrease of platelet aggregation after treatment with indobufen and a decrease of F1+2 fragment and PAI-1 antigen after treatment with pentoxifylline.
Hospital vs Home-Based Exercise Rehabilitation for Patients with Peripheral Arterial Occlusive Disease
Authors: Regensteiner Judith G. , Meyer Thomas J. , Krupski William C. , Cranford Linda S. , Hiatt William R. , Regensteiner Judith G.
Published: July 2008

Supervised, hospital-based exercise rehabilitation programs are effective for improving functional status for patients with claudication due to peripheral arterial occlusive disease. However, it has been suggested that unsupervised, home-based exercise programs, which have been relatively little evaluated, would be equally efficacious as compared with hospital-based programs. The authors tested the hypothesis that a hospital-based exercise rehabilitation program would improve treadmill exercise perfor mance more than a home-based program. Of 20 consecutively enrolled patients with claudication, 10 were randomly placed into a supervised, hospital-based program and 10 into an unsupervised, home-based program for a three-month period. Exercise perfor mance was evaluated by treadmill testing using a graded protocol. In addition, func tional status was evaluated by the Walking Impairment Questionnaire (WIQ) and the Medical Outcomes Study SF-20 questionnaire (MOS). Patients in the hospital-based program were treated with treadmill walking three times a week for one hour/visit. Patients in the home-based program were instructed to walk at least three times a week and were contacted weekly to provide encouragement and to record compliance with (continued on next page) the program. Patients in the hospital-based group improved peak walking time by 137%, pain-free walking time by 150%, and peak oxygen consumption by 19% (all P<0.05). Patients reported an improved walking distance and speed according to WIQ data (both P<0.05). In addition, the MOS physical functioning score in the hospital-based group improved by 20 percentage points (P<0.05). In contrast, patients in the home-based program did not improve exercise performance measured on the treadmill. Improvement in the ability to walk on the treadmill was greater in the hospital-based than the home- based program (P<0.05). The ability to walk distances was the only questionnaire measure that improved in persons who received the home-based program (P<0.05). Preliminary results suggest that a supervised, hospital-based program is more effective for improving treadmill exercise performance than an unsupervised, home-based program.
Dipyridamole-Induced Angina Pectoris During Sestamibi Stress Test in Patients with Significant Coronary Artery Disease: Clinical, Angiographic, and Nuclear Determinants
Authors: Rosseel M. , Dendale P. , De Sadeleer C. , Schoors D. , Block P. , Franken P.R. , Rosseel M.
Published: July 2008

Intravenous dipyridamole induces angina pectoris (AP) in some patients with significant coronary artery disease (CAD). The aim of this prospective study was to identify the angiographic, nuclear, and clinical determinants. The authors examined 50 patients consecutively with significant CAD on coronary angiography. All antiischemic medica tions were stopped twenty-four hours (nitrates only 6 hours) before injection of dipyri damole (0.84 mg/kg). ECGs were taken before, during, and after this injection. The regional myocardial activity of Tc-99m-Sestamibi at rest and after dipyridamole injection was measured with single-photon emission computed tomography (SPECT).

During dipyridamole injection 20 patients had AP, of whom 15 had ST segment depression on ECG (P < 0.001). The only significant difference on coronary angiography between patients with dipyridamole-induced AP and those without AP was the presence of collaterals (P < 0.05). In patients with AP and collaterals, ECG and SPECT changes were always noted in the collateralized territory. Subgroup analysis showed that patients without previous myocardial infarction (MI, n=17, P < 0.05) or nontransmural MI (n=17, P < 0.05) had a good correlation between collaterals and AP, whereas patients with a history of transmural MI (n=16) did not. No further significant variables could be found as a predictor of AP after dipyridamole injection.

These findings suggest that AP during dipyridamole stress test is due to ischemia, which is not related to the severity of CAD. Ischemia is probably due to coronary steal to the collateralized territory in patients without transmural MI. Dipyridamole-induced angina pectoris is predictive for collaterals and may indicate viability in patients with MI.
Viability After Myocardial Infarction: Can It Be Assessed Within Five Minutes by Low-Dose Dynamic Iodine-123-Iodophenylpentadecanoic Acid Imaging with a Multicrystal Gamma Camera?
Authors: Murray Gary L. , Schad Nikolaus , Bush Andrew J. , Murray Gary L.
Published: July 2008

Although positron emission tomography (PET) assesses myocardial viability (V) accu rately, a rapid, inexpensive substitute is needed. Therefore, the authors developed a low- dose (1 mCi) Iodine-123-Iodophenylpentadecanoic Acid (IPPA) myocardial viability scan requiring analysis of only the first three minutes of data acquired at rest with a standard multicrystal gamma camera. Twenty-one patients > 2 weeks after myocardial infarction (MI) (24 MIs, 10 anterior, 14 inferoposterior, 21 akinetic or dyskinetic) had cardiac catheterization and resting IPPA imaging. V was determined by either transmural myocar dial biopsy during coronary bypass surgery (12 patients, 14 MIs) or reinjection tomo graphic thallium scan (9 patients, 10 MIs), and 50% of MIs were viable. The IPPA variables analyzed were: time to initial left ventricular (LV) uptake in the region of interest (ROI), the ratio of three-minute uptake in the ROI to three-minute LV uptake, three-minute clearing (counts/pixel) in the ROI (decrease in IPPA after initial uptake), and three-minute accumulation (increase in IPPA after initial uptake) in the ROI. Rules for detecting V were generated and applied to 10 healthy volunteers to determine normalcy. While three-minute uptake in nonviable MIs was only 67% of volunteers (P < 0.0001) and 75% of viable MIs, uptake alone identified only 50% of viable MIs and 75% of nonviable MIs. IPPA clearing, however, was ≥ 13.5 counts/pixel in 10/12 (83%) of viable MIs, and IPPA accumulation ≥ 6.75 counts/pixel identified one more viable MI, for a sensitivity for V of 11/12 (92%), with a specificity of 11/12 (92%), and a 100% normalcy rate.

The authors conclude low-dose IPPA (five-minute acquisition with analysis of the first three minutes of data) has potential for providing rapid, inexpensive V data after MI. Since newer multicrystal cameras are mobile, IPPA scans can be done in emergency rooms or coronary care units, generating information that might be useful in decisions regarding thrombolysis, angioplasty, or bypass surgery.
Effect of Carbon Dioxide-Enriched Water and Fresh Water on the Cutaneous Microcirculation and Oxygen Tension in the Skin of the Foot
Authors: Hartmann Bernd R. , Bassenge Eberhard , Pittler Max , Hartmann Bernd R.
Published: July 2008

The effects of immersion of the lower leg and foot in fresh water and in carbon dioxide (CO2 )-enriched water (1200 mg CO2 per kg water; succinate + sodium bicarbonate: Actibath®, KAO Tokyo) on cutaneous circulation, vasomotion and oxygen tension (PO2) were measured by laser Doppler flowmetry and transcutaneous oximetry. On the first of two consecutive days patients were randomly assigned to have the lower extremities immersed in either fresh water or CO2-enriched water under standardized conditions (temperature, 34°C; depth, 35 cm; immersion time, twenty minutes) with concurrent measurement. On the second day patients were switched to the other bath type. For both sets of measurements probes were attached symmetrically to the dorsum of each foot. Included in the study were 18 patients with mild, bilateral, peripheral, occlusive arterial disease (intermittent claudication, femoral or iliac type). During immersion in CO2 enriched water the Doppler laser signal and vasomotion amplitude rose by 300%, while PO2 increased by 10%. These increases were still apparent during the latter part of the measurement period, following withdrawal of the limbs from the bath, while patients were seated and supine. During immersion in fresh water and thereafter the Doppler laser signal was unchanged and the PO2 increase was considerably less marked. The authors were thus able to demonstrate vasodilation and increased oxygen utilization (Bohr effect) resulting from topical CO2 application, and hence, that the use of topical CO2 has an objective basis.
Cold-Induced Acral Vasospasm in Migraine as Assessed by Nailfold Video-Microscopy: Prevalence and Response to Migraine Prophylaxis
Authors: Hegyalijai T. , Meienberg O. , Dubler B. , Gasser P. , Gasser Paul
Published: July 2008

In order to learn the prevalence of cold-induced vasospasm in migraine patients, blood cell velocity measurements of finger nailfold capillaries were performed in 58 consecutive patients suffering from migraine with and without aura. In 5 (8.6%) patients capil laroscopy could not be performed because of reduced nailfold transparency; 21 of the remaining 53 patients (39.6%) showed blood flow stop due to vasospasm under cold provocation. There was no significant difference (P=0.69) in the occurrence of vasospastic reaction between migraine with (12 of 32 patients = 37.5%) and without (9 of 21 patients = 42.9%) aura.

The clinical and capillaroscopic course under migraine prophylaxis was observed in 18 vasospastic patients. After sixteen weeks 14 patients showed good clinical improve ment of their migraine. The vasospastic reaction persisted in only 1 patient. This patient and 3 others with abolished vasospasm were still suffering from migraine.

These findings suggest that observing blood cell velocity noninvasively in nailfold capillaries under cold provocation could be useful for objectively monitoring the response to prophylactic treatment in migraine patients or for testing new potentially antimigraine drugs.
Superior Vena Cava Syndrome as a Primary Manifestation of Behçet's Disease
Authors: Roguin Ariel , Edelstein Shimon , Edoute Yeouda , Edute Yeouda
Published: July 2008

Superficial thrombophlebitis is a common finding in Behçet's disease. However, the potential life-threatening complication of superior vena cava (SVC) syndrome due to thrombotic occlusion is a rare manifestation and usually occurs several years after the onset of the diagnosis. The authors describe a twenty-nine-year-old Arab man who had an acute thrombosis of the SVC as the presenting manifestation of his Behçet' s disease. The patient was successfully treated with thrombolytic and anticoagulant therapy, and during follow-up no relapse was observed. Behçet's disease should be suspected in young patients presenting with thrombosis of the SVC and without evidence of a hypercoagu lable state.
Comparative Effects of Volume Loading on Pulmonary Venous Flow in Dogs with Normal Heart and with Myocardial Ischemia
Authors: Akita Sachie , Ohte Nobuyuki , Hashimoto Takeshi , Narita Hitomi , Kobayashi Kenji , Fujinami Takao
Published: July 2008

The influences of cardiac loading conditions and left ventricular performance on pulmonary venous flow are poorly understood. The authors studied the effects of volume loading on the pattern of pulmonary venous flow in normal and ischemic hearts. Thirteen anesthetized dogs were equipped with a transit-time ultrasonic flow probe around the left upper pulmonary vein. In 6 of the dogs, the left anterior descending artery was ligated to induce myocardial ischemia. The remaining 7 dogs had normal hearts. Heart rate was fixed at 110 beats/minute by right atrial pacing. Dextran was infused from the femoral vein until mean left atrial pressure increased 3 mm Hg above the baseline value in both groups.

In normal heart, systolic pulmonary venous flow volume (SI) increased significantly, but early diastolic flow volume (DI) did not show a significant change during volume loading. The ratio of SI/DI increased significantly (1.12 ±0.34 vs 2.11 ±0.49, P<0.05). After ligation of the left anterior descending artery, the SI and DI decreased significantly. The ratio of SI/DI did not show a significant change (0.88 ±0.32 vs 0.87 ±0.30, ns). In dogs with myocardial ischemia, volume loading caused increases in the SI and DI. However, no significant change was observed in the ratio of SI/DI (0.87 ±0.30 vs 0.97 ±0.36, ns).

These findings demonstrate that left ventricular performance influences the alter ation in pulmonary venous flow pattern that is caused by systemic volume loading.
Percutaneous Transluminal Coronary Angioplasty for Morphologic Left Anterior Descending Artery Lesion in a Patient with Dextrocardia
Authors: Yamazaki Tatsuo , Tomaru Akihisa , Wagatsuma Kenji , Kudo Makoto , Baba Jun , Takikawa Kazutoshi , Miho Otoya , Yoshikawa Makoto
Published: July 2008

A case report of percutaneous transluminal coronary angioplasty (PTCA) to treat coronary atherosclerotic lesions in a patient with dextrocardia associated with situs inversus totalis is presented. The patient was a sixty-two-year-old man who was admitted with a diagnosis of congestive heart failure. Cardiac catheterization was performed. Left ventriculography showed mild hypokinesis in segments 2 and 3 with ejection fraction of 63%. Coronary arteriography revealed 74% stenosis in segment 7 of the left anterior descending (LAD) artery. PTCA for this lesion was performed. Successful dilation was achieved with the residual stenosis in the LAD reduced from 74% to 34%. Performance of PTCA in patients with dextrocardia is extremely rare, and only 8 cases have been reported to date. However, by visualizing the procedure as a mirror image and choosing a guide catheter that permits good engagement, it appears possible to perform it like ordinary PTCA.
Experimental Model of Short-Time Exercise-Induced Preconditioning in POAD Patients
Authors: Capecchi Pier Leopoldo , Pasini Franco Laghi , Cati Graziella , Colafati Marcella , Acciavatti Angela , Ceccatelli Linda , Petri Silvia , de Lalla Arianna , Di Perri Tullio , Capecchi Pier Leopoldo
Published: July 2008

Regular physical exercise improves walking performance in patients affected with periph eral obliterative arterial disease (POAD). The mechanisms underlying the phenomenon are still controversial. In order to verify the hypothesis that physical conditioning of lower limbs on a treadmill and ischemic preconditioning of the heart could share some biolog ical aspects, 14 POAD subjects underwent a training program on the treadmill consisting of five repeated submaximal exercises at five-minute and two-hour intervals preceding the maximal tolerance test. Moreover, a protocol with two daily submaximal walking exercises over one week was also performed. Pain-free and total walking distance were measured before and after they performed the program. Moreover, plasma levels of adenosine and adenosine triphosphate (ATP) were measured and polymorphonuclear (PMN) leukocyte activity was studied together with rheologic parameters.

Pain-free distance was prolonged by 15.4% and 14.3%, and total distance was prolonged by 23.1% and 26.9%, in the exercises with five-minute and two-hour intervals, respectively. After one week of daily exercises, the onset of pain and the end of the test were delayed by 24% and 43.7%, respectively. An improvement in blood rheology and a reduced PMN reactivity were also observed with the three protocols, associated with an increase in plasma levels of adenosine and ATP.

Similarly to ischemic preconditioning in the heart, the possibility is suggested that an adenosine-mediated mechanism may contribute to the development of physical condi tioning in treadmill-trained POAD patients.
Effects of Nisoldipine on Cytosolic Calcium, Platelet Aggregation, and Coagulation/Fibrinolysis in Patients with Coronary Artery Disease
Authors: Fujinishi Akiko , Takahara Kazuo , Ohba Chizuko , Nakashima Yasuhide , Kuroiwa Akio , Takahara Kazuo
Published: July 2008

The effect of nisoldipine, a dihydropyridine Ca2+ antagonist, on the platelet cytosolic Ca 2+ concentration ( [Ca2+] i), platelet aggregation, and various coagulation and fibri nolysis parameters was assessed in normotensive patients with coronary artery disease (CAD). Eleven patients with angiographically confirmed CAD (4 men, 7 women aged 67.3 ±5.4 years) were administered nisoldipine at 10 mg/day for two weeks. The [Ca2+]i was determined by use of fura2-loaded platelets, platelet aggregation was measured with an aggregometer, and coagulation/fibrinolysis parameters were measured by standard methods. Nisoldipine did not significantly affect blood pressure or heart rate. However, the [Ca2+] decreased significantly (P<0.05) and platelet aggregation was also signifi cantly inhibited. Plasma D-dimer levels decreased significantly (P<0.01). Thus, nisol dipine not only suppressed platelet activation but also affected the coagulation system, suggesting that it is not only a vasodilator and platelet inhibitor but also an antithrom botic agent.
Duplex Sonography of Venous Stasis
Authors: Kröger K. , Rudofsky G.
Published: July 2008

The major reasons for venous thrombosis are inflammation, increased blood coagula bility, and blood stasis. Investigation of these processes in vivo in a particular vein is difficult. Blood stasis in the peripheral veins is assumed to increase the risk of thrombosis during immobilization. By duplex sonography the authors were able to demonstrate different echogenicity in single veins of the lower limb in healthy subjects in a sitting position. Of 25 subjects, 7 presented a high echogenicity of the venous blood similar to that of the surrounding tissue. An additional 5 subjects presented this phenomenon after venous blood flow was stopped by a pressure cuff. The remaining 13 subjects still presented a dark lumen of the veins. Duplex sonography can discriminate different compositions of resting venous blood associated with venous stasis. Whether these findings correlate with an increased risk of thrombosis is not known.
Venous Disease: From Pathophysiology to Quality of Life
Authors: Vanhoutte P.M. , Corcaud S. , de Montrion C. , Vanhoutte Paul M.
Published: July 2008

Venous insufficiency is a multifactorial pathology that has an important impact on the quality of life of the patients. The primary factor of venous disease is an abnormal wall distensibility, which seems to be correlated with genetic factors. Facilitating factors include hormonal impregnation and prolonged hydrostatic load, particularly under condi tions where the control of the sympathetic nervous system is reduced by an increase in local temperature. The resulting valvular incompetence, combined with the augmented hydrostatic load, leads to varicosis and venous stasis. The ensuing tissue hypoxia and local edema favor inflammation and infection, which ultimately favor the occurrence of ulcers. The available data on the impact of the disease suggest a relation between the physiopathological phenomena and some parameters of health-related quality of life.
Epidemiology of Chronic Venous Insufficiency
Authors: De Backer G. , De Backer G.
Published: July 2008

In contrast to the knowledge on the frequency and determinants of arterial diseases, little epidemiologic research has been carried out on venous diseases; this may be partly due to methodological problems in defining chronic venous insufficiency and in measuring these conditions with sufficient validity.

Epidemiologic studies that were published after 1965 and that are not based on clinical series are reviewed; prevalence and incidence rates are reported. Studies of risk factors for varicose veins have largely resulted in inconsistent results; the sex difference is universal while the large geographical differences suggest strong environmental influ ences. For all other determinants much of the variation between studies is probably related to differences in definition, in population-sampling techniques, and in assess ment methods. Several plausible etiologic theories on the causes and development of chronic venous insufficiency are supported or refuted by the epidemiologic studies. Further research is needed, whenever possible cross-cultural, with particular emphasis on clear definitions, valid methods, and a prospective study design.
The Socioeconomic Profile of Patients Treated by Phlebotropic Drugs in Germany
Authors: Uber Andrea , Uber Andrea
Published: July 2008

Conservative treatment of venous disease is difficult. There is much skepticism concerning the efficacy of drugs in venous diseases. Nevertheless, in Germany, these drugs have obtained a substantial market share with a tendency to increase. The objective of this empirical study is to evaluate the socioeconomic characteristics of consumers of venous medications and to explore the demand elasticity with respect to health insurance coverage.

In a first set of inquiries 12,500 households were asked from July to September 1993 if they had purchased prescribed venous medication during the past 12 months. About 10,000 households with 19,750 persons aged fifteen years and older responded; 2,080 (11%) of those persons had consumed prescribed medications against venous disease over the past twelve months.

In the second part of the study a detailed questionnaire was sent to the 2,080 purchasers and to 3,000 randomly selected nonpurchasers; 1,930 (92.8%) purchasers and 2,291 (76.4%) nonpurchasers returned their questionnaire. The key findings can be summarized as follows: The percentage of women is much higher in the group of purchasers (80%) than in the group of nonpurchasers. Most of the purchasers are over fifty years old. Only one quarter of the purchasers are under fifty. One third of the purchasers are retired, and only 29% are working. In the group of nonpurchasers 56% are working and only 17% are retired. A comparison of the distribution of purchasers and nonpurchasers over income classes and education levels shows that higher income and higher education are less prevalent in the group of consumers of venous medica tions. Varicose veins (58%) and various leg complications (30%) and pain in the legs (30%) play a dominant role for applying venous medications. The analysis shows that pregnancy and chronic diseases are risk factors for venous diseases and are more prevalent in the purchasers group. We did not, however, discover a significant difference in the share of smokers, and it is quite low in the group of purchasers (14%). Only 45% of the purchasers feel that their venous disease has a negative influence on their spare- time activities, their family life, or their work. Purchasers consult a physician on the average 3.7 times a year; 40% of the managers, merchants, and self-employed craftsmen have no physician consultation at all.

Owing to the pain and trouble of some complications of venous disease, only a rela tively low percentage of purchasers would react to a reduction of health insurance coverage of venous medications; 5% would stop buying these drugs and 22% would reduce consumption if they would have to pay the cost out-of-pocket.