bluuebunny/crossref_metadata_2025_split huggingface dataset:
Treatment of hypertension with felodipine in patients with concomitant diseases
Authors: Gradman Alan H. 
Published: August 2009

AbstractCoexisting medical conditions often complicate the selection of antihypertensive drugs. Felodipine, a new vascular‐selective calcium antagonist with demonstrated antihypertensive efficacy, has not been found to alter lipid profiles in hypertensive patients. Studies in additional patient populations have yielded insights into the effects of the drug on other diseases that may coexist with hypertension. In individuals with stable angina pectoris or congestive heart failure, acute administration of felodipine reduces systemic vascular resistance and increases cardicac output and total coronary blood flow; myocardial contractility is not depressed at doses that produce a clinically significant reduction in vascular resistance. In patients with coronary stenoses, the drug increases vessel diameter in the vicinity of obstructive lesions. Single‐dose and long‐term studies in patients with exertional angian have found that felodipine reduces anginal frequency and improves exercise tolerance. In patients with congestive heart failure, chronic dosing with felodipine produces a persistent reduction in vascular resistance and an increase in cardiac output, both at rest and during exercise. Symptomatic improvement and increased exercise tolerance have been noted in some studies. In patients with Raynaud's phenomenon, felodipine has been assoicated with a dose‐dependent improvement in symptomatology. Among individuals with exercise‐induced bronchospasm, the drug has no effect on resting bronchial tone and may exert some positive effects during exercise. In hypertensive patients with Type II diabetes, felodipine has not been found to raise glucose levels significantly. The data obtained thus far suggest that felodipine is safe for use in hypertensive patients with a variety of concomitant diseases.
Dose‐ranging study with a new two‐chain rt‐PA in patients with acute myocardial infarction: A multicenter trial
Authors: Dewood Marcus A. , Kurnik Peter B. , Jolly Michael K. , Jain Abnash C. , Khaja Fareed , Gorfinkel H. Joel , Morris D. Lynn , Satler Lowell , Littlejohn Judith 
Published: August 2009

AbstractTissue‐type plasminogen activator (t‐PA) derived from a melanoma cell line was first used in patients with acute myocardial infarction in the early 1980s. Recombinant DNA technology then allowed production of large amounts of t‐PA. The TIMI‐I trial used a two‐chain recombinant (rt‐PA) product. A predominantly single‐chain rt‐PA (alteplase) was used in the majority of the TIMI II trial. The present study used a different form of two‐chain rt‐PA (duteplase) to determine the effective dose for thrombolysis at 60 min, and to evaluate time to reperfusion, reocclusion at 72‐96 h, coagulation profiles, and bleeding events. Duteplase was given intravenously to 75 patients a mean of 3.8±1 h after the onset of myocardial infarction. Following angiography demonstrating coronary occlusion, 23 patients received a low dose of duteplase [0.16‐0.29 million international units per kilogram (MIU/kg)] over 60 min followed by a 5‐h infusion in conjunction with heparin, 25 patients received a middle dose (0.30‐0.41 MIU/kg) and 23 patients received a high dose (0.43‐0.74 MIU/kg). Angiography was then performed every 15 min × 4. Progressive recanalization occurred over 60 min (median 45 min) with an overall success rate of 59% (mean 60‐min dose: 0.37 MIU/kg). No dose‐response relationship was observed. The reocclusion rate was 9% at 72‐96 h. Reductions in fibrinogen and plasminogen correlated with dose, but clinical events did not. These data are important because this form of rt‐PA was employed in the recently reported ISIS‐3 trial and the mean dose of duteplase in the present trial is the same as the 60‐min dose employed in ISIS‐3.
Single site experience with high‐speed coronary rotational atherectomy
Authors: Gilmore Paul S. , Bass Theodore A. , Conetta Donald A. , Percy Robert F. , Chami Youssef G. , Kircher Barbara J. , Miller Alan B. 
Published: August 2009

AbstractThis report describes a single site experience as part of a multicenter clinical trial with high‐speed rotational atherectomy in human coronary arteries. A total of 108 patients with 143 lesions had interventions, were grouped by success or failure, and were analyzed by patient, lesion, and procedural variables. Satisfactory results were achieved in 131 of 143 lesions (92%) and 99 of 108 (92%) patients. Neither patient‐related variables (age, gender, diabetes, hypertension, cigarette use, restenosis, previous myocardial infarction, and left ventricular function) nor lesion characteristics (length, ostial or bifurcation location, calcification, lesion classification, and coronary location) were predictive of poor outcome. Tears, acute closure, percentage stenosis after rotational atherectomy and after adjunctive balloon angioplasty were the procedural variables that were statistically associated with outcome by univariate methods. Multivariate analysis isolated postintervention residual stenosis as the only variable that was statistically different between groups. Serious complications included one death in the catheterization laboratory, one Q‐wave myocardial infarction, three non‐Q myocardial infarctions, and three emergency coronary bypass operations for sustained vessel closure. One patient required emergency surgery for a pacing wire perforation not related to the use of the device. The potential benefits of high‐speed rotational atherectomy include increased safety in complex lesions, the ability to address lesions not amenable to balloon techniques, and the possibility of reducing the incidence of restenosis.
Simvastatin in severe primary hypercholesterolemia: Efficacy, safety, and tolerability in 595 patients over 18 weeks
Authors: Simons Leon A. 
Published: August 2009

AbstractWe report the results of an open multicenter study which evaluated the efficacy, safety, and tolerability of simvastatin in a large cohort of patients with primary hypercholesterolemia. Against a background of standard dietary advice, the study enrolled 595 patients with total cholesterol ≥ 6.5 mmol/l and triglycerides < 6.0 mmol/l across 20 centers. After 4 weeks on placebo, treatment began with simvastatin 10 mg each night, titrating to 20 mg after 6 weeks, and then to 40 mg after 12 weeks if cholesterol levels still exceeded 5.5 mmol/l. By Week 18, 70% of patients were using 40 mg/day. After 18 weeks of treatment, the mean reductions (95% confidence interval) in total and low density lipoprotein (LDL) cholesterol were 30% (29‐31%) and 38% (37‐39%), respectively. There was a mean increase in high density lipoprotein (HDL) cholesterol of 12% (10‐13%), while triglycerides were reduced by a median 19% (16‐23%). From a mean entry total cholesterol of 9.31 ± 2.15 mmol/l, 52% of patients achieved cholesterol levels ± 6.2 mmol/l on treatment. The changes noted were essentially independent of gender, age, or lipid phenotype (IIa vs. IIb). Compliance with prescribed medication was very good and the drug was well tolerated; only 3% of patients manifested a clinical adverse experience requiring discontinuation or a clinical adverse experience described as serious (associated with hospitalization or serious disability). Isolated laboratory adverse experience required discontinuation in 0.2% of patients. One in 3 patients manifested a clinical adverse experience and 1 in 10 a laboratory adverse experience. Adverse experiences occurred in the digestive system (10% of patients), nervous system/psychiatric (6%), skin/appendages (5%), musculoskeletal (4%), elevated muscle enzymes (5%), and elevated transaminases (2%). In the absence of a parallel control group, the proportion of the events attributable to simvastatin could not be ascertained. Simvastatin appears to be a well tolerated and highly efficacious drug for the management of severe primary hypercholesterolemia.
Features of the hemodynamic response to amyl nitrite inhalation: Ew aspects of an old tool
Authors: Moody M. , Rubal Bernard J. , Balley Steven R. 
Published: August 2009

AbstractAlthough amyl nitrite inhalation (ANI) antedates current short acting vasodilators as a clinically useful pharcologic stressor, few clinicians are aware of the subtle hemonamic actions of this agent. This study examined transients left and right heart hemodynamics after ANI in seven men ages 44 ± 7 years) undergoing elective cardiac catheterization. ‐fidelity central aortic (AoP), left ventricular (LVP), pulonary artery (PAP), right ventricular (RVP), and right atrial (PAP) pressures were simultaneously recorded from left and right heart multisensor catheters. As expected, ANI caused an fall in Ao pressure (27%; p<0.01) and reflex (p<0.001). Little change was noted in PAP, RVP, RAP, or end‐diastolic pressures or the time constant of LV isovolnetric relaxation (tau). LV ejection time decreased 23 ± 10 (p<0.05) and RV ejection time did not change. Baroreflex was similar during pressure fall and recovery (6.4 ± vs. 6.1 ± 3.6 ms/mmHg), however hysteresis (p<0.05) was. Aortic pressure waveforms also changed following ANI. Changes were determined to be in part a consequence of the atanuation and delay in arterial wave reflections. This study the understanding of the complex nature of the hemodynamic response associated with ANI.
AAI pacing mode: When is it indicated and how should it be achieved?
Authors: Katritsis Demosthenes , Camm A. John 
Published: August 2009

AbstractAAI pacing offers better hemodynamic characterstics than dual‐chamber pacing and is the optimal mode for patents with sick sinus syndrome without AV conduction disorders. AAI pacing may be achieved by single‐chamber atrial, by programming a dual‐chamber pacemaker to the AAI mode, or by programming a dual‐chamber pacemaker to DDD mode with a long AV delay. The annual incidence of AV block development in patients with sick sinus syndrome is low, probably 1‐5%, but there is no method of detecting patients immune to future development of AV block. Chronotropic is often present in patients with sick sinus but the value of additional rate response is not yet established. Our recommendations for the choice of the method of pacing are discussed.
Anatomy, histology, and pathology of the cardiac conduction system: Part II
Authors: Waller Bruce F. , Gering Lawrence E. , Branyas Nancy A. , Slack John D. 
Published: August 2009

AbstractNormal anatomic and histologic features of the atrioventricular junction (transitional cell zone, atrioventricular node, penetrating portion of bundle) and the bifurcation of the penetrating portion into bundle branches are reviewed. Terminal ventricular Purkinje fibers are also discussed.
The postcardiac injury syndrome following percutaneous transluminal coronary angioplasty
Authors: Velander M. , Grip L. , Mogensen L. 
Published: August 2009

AbstractA 57‐year‐old man, who had suffered an anterior Q‐wave myocardial infarction complicated with typical postcardiac injury syndrome (PCIS) 9 years earlier, underwent percutaneous transluminal coronary angioplasty (PTCA) without any immediate clinical, laboratory, or radiological signs of complications. After 4 days he recognized the recurrence of the earlier symptoms of PCIS. The diagnosis was supported by slight fever, elevated inflammatory parameters, and improvement when oral corticosteroids were given. The observations suggest that milder cardiac injury than previously considered, that is, without demonstrated structural damage to pericardium or myocardium, may precipitate PCIS in predisposed individuals. The case adds a differential diagnosis to chest pain and malaise following PTCA.
Coronary artery rupture during transluminal coronary recanalization and angioplasty in a case of acute myocardial infarction and shock
Authors: Eeckhout E. , Beuret P. , Goy J. J. , Lobrinus A. , Genton C. Y. 
Published: August 2009

AbstractPercutaneous transluminal coronary angioplasty (PTCA) is a widely performed and effective therapy for coronary artery disease. Evolution of the dilatation instruments during the last decade has led to an increased success rate of PTCA and to the development of newer techniques such as recanalization of totally occluded coronary arteries. We report a case of coronary artery recanalization complicated by fatal coronary artery rupture.
Giant dissecting aortic aneurysm with concealed perforation in an 81‐year‐old female
Authors: Eber Bernd , Sarlay Holger , Dusleag Johann , Kullnig Peter , Ebner Franz 
Published: August 2009

AbstractThis paper describes the history of an 81‐year‐old female suffering from a giant dissecting aortic aneurysm with concealed perforation within the thorax. The patient had suffered from arterial hypertension for about 10 years and had been treated with thiazide. Nine months prior to admission the patient was in a state of collapse, and ultrasound examination revealed an intra‐abdominal aortic aneurysm. At this time thoracic x‐ray showed aortic sclerosis and elongation of the aorta but no signs of aneurysm formation. After this episode the patient was symptom‐free for the next 9 months. Following a further syncopal attack with severe thoracic pain, the patient was hospitalized at the intensive care unit. Both in thoracic x‐ray and computed tomography of the thorax, a pronounced dissecting aortic aneurysm with perforation of the thoracic aorta into the mediastinum could be established. Because of the patient's poor general condition and advanced age, as well as far reaching pathological findings, surgery was not advised by either the heart and vascular surgeon or the anesthetist. Following 1 week's intensive therapy, the patient's general condition improved greatly, with stabilization of thoracic pain, blood pressure, and respiratory action. On the other hand, thoracic x‐ray, computed tomography, and magnetic resonance imaging produced a distinct progression of the aneurysm with consequent mild displacement of mediastinum and left lung. Laboratory examinations for syphilis showed no evidence of that disease. After further improvement the patient was discharged 4 weeks after admission and has been symptom‐free for 6 months in spite of the extensive pathological findings described herein. This case demonstrates the efficacy of conventional therapy when surgery is not recommended.
Balloon dilatation of inferior vena cava obstruction in budd‐chiari syndrome
Authors: Short Sydney G. , Jian Liu , Ruijie Li 
Published: August 2009

AbstractBudd‐Chiari syndrome is a well described entity which can easily be confused with congestive hepatomegaly. The syndrome usually is caused by thrombosis of the hepatic veins, however it also can be caused by congenital fibrous webs that occlude hepatic vessels in the inferior vena cava. It leads to an enlarged liver with ascites, peripheral edema, and portal hypertension.
The toxic oil syndrome
Authors: James Thomas N. 
Published: August 2009

AbstractHundreds died and thousands were poisoned by rapeseed oil adulterated with aniline and sold illegally in Spain in 1981. The clinical manifestations, now known as the toxic oil syndrome, include pulmonary hypertension and right ventricular hypertrophy plus widespread vascular and neural lesions in other organs. Many of the late deaths ended with a scleroderma‐like illness. Because scleroderma involves the heart, an examination was made of the small and large coronary arteries, the neural structures, and the conduction system from 11 victims dying with the toxic oil syndrome. Dense fibrosis, atrionodal junctional hemorrhages, and cystic degeneration of the sinus nodes were present. Small and large coronary arteries exhibited focal fibromuscular dysplasia and a proliferative cystic myointimal degeneration. This latter abnormality was associated with sloughing of the inner wall and embolization of the detached fragment downstream in the same coronary artery. Every heart had many degenerative lesions within nerves, ganglia, and the coronary chemoreceptor. Based upon observations by others with experimental feeding of rapeseed oil containing either high or low erucic acid, it is suggested that this oil must remain a major suspected cause of the toxic oil syndrome, particularly in conjunction with some as yet unexplained facilitative influence by oleoanilids. If this is so, it is important to reexamine the widely recommended use of any rapeseed oil product as a suitable food for humans or animals.
The effect of successful angioplasty on variables of signal‐averaged electrocardiogram and ventricular wall motion in patients with a first myocardial infarction
Authors: Masui Akira , Tsuji Hisako , Tamura Koji , Kamihata Hiroshi , Karakawa Masahiro , Sugiura Tetsuro , Iwasaka Toshiji , Inada Mitsuo 
Published: August 2009

AbstractThe correlation among three variables of late potentials (LPs) obtained by signal‐averaged electrocardiography (SAECG) and improvement of ventricular wall motion estimated by echocardiography were studied in 66 patients with a first acute myocardial infarction (MI). Patients with bundle‐branch block, intraventricular conduction delay, multi‐vessel disease, previous MI, repeat percutaneous transluminal coronary angioplasty (PTCA), or evidence of reinfarction during a 6‐month follow‐up were excluded. A total of 66 patients was divided into two groups, with (Group 1: n = 27, age 56 ± 11) or without (Group 2: n = 39, age 61 ± 10) improvement of ventricular wall motion. Three variables of LPs and ventricular wall motion index (WMI) estimated and scored by echocardiography at admission (WMI 1) and at 6 months after MI (WMI 2) were compared in each group. In Group 1 (WMI 1 vs. WMI 2, p < 0.002), 20 of 27 patients underwent successful angioplasty; in Group 2 (WMI 1 vs. WMI 2, p = NS), 7 of 39 patients had successful emergency angioplasty. There were significant differences in three variables of LPs between the time of admission and at 6 months after MI in Group 1 but not in Group 2. Higher incidence of LPs and greater frequency of successful emergency PTCA were found in Group 1 compared with Group 2. These results suggest that because myocardial ischemia is reversed by successful angioplasty, ventricular wall motion is improved and the arrythmogenic substrate that generates LPs is stabilized electrically. Stunned or hibernating myocardium may be the arrhythmogenic substrate that generates LPs.
Conversion from immediate‐release to extended‐relase diltiazem in angina pectoris
Authors: Pool Peter E. , Thadani Udho , Miller Alan B. , Fromell Gregg J. , Eff Jack 
Published: August 2009

AbstractThis multicenter, open‐label, single crossover study examined 195 patients taking an immediate‐release diltiazem tablet as chronic stable angina therapy to determine if apparently logical methods of converting them to an extended‐release, once‐daily formulation were effective. Patients were converted from the immediate‐release (Phase I) to an extendedrelease (Phases II) formulation of diltiazem on a mg‐for‐mg basis or, when a similar dose was not available, to the next higher 120mg dose. Weekly angina occurrences and nitroglycerin use, exercise testing at the end of each phase, and ambulatory electrocardiographic monitoring (AEM) during the week prior to the exercise study were evaluated. There was a statistically significant decrease in angina frequency and nitroglycerin consumption during Phase II. In the exercise studies, there was an insignificant increase in time to 1 mm ST‐segment depression and total exercise time associated with a statistically significantly lower end‐exercise blood pressure and heart rate in Phase II. In those patients who had ischemia during either phase on AEM, total ischemic duration and ischemic episodes were insignificantly lower in Phase II. All observations were similar in the subgroup of patients who were converted mg‐for‐mg. Adverse reactions were equal. Thus, in converting patients from an immediate‐to an extended‐release diltiazem formulation for the treatment of symptomatic coronary artery disease, it is reasonable to convert directly to the same or, if not available, the next higher available dose of the extended‐release preparation.
Factors associated with the development of persistently depressed cardiac output during the first year after cardiac transplantation
Authors: Glazier James J. , Mullen G. Martin , Johnson Maryl R. , Ching‐Tung  , Heroux Alain L. , Kao Walter G. , Koch Dorothea , Khatib Yazan , Fisher Susan G. , Costanzo Maria Rosa 
Published: August 2009

AbstractThe purpose of this study was to determine factors associated with the development of a persistently depressed cardiac output during the first year after cardiac transplantation. With this aim in mind, the records of 133 consecutive patients undergoing orthotopic cardiac transplantation and surviving for ≥1 year after transplantation were reviewed. For each patient, the mean cardiac index for each of the 3‐month periods, 0‐3, 4‐6, 7‐9, and 10‐12 months after transplantation was calculated. of the 133 patients, 19 (14%) had a mean cardiac index < 2.41/min/m2 during ≥3 of these 3‐month periods. The pre‐ and post‐transplantation clinical, immunologic, and hemodynamic data of these 19 patients (study group) were compared with the remaining 114 patients (control group). Compared with the control group, the patients in the study group were older (56±5 vs. 46±15 years; p = 0.0001), more frequently had ischemic heart disease as the original diagnosis (58 vs. 37%; p < 0.05), had a lower preoperative cardiac index (1.91 ± 0.53 vs. 2.71 ± 1.0 1/min/m2; p = 0.0001), more frequently did not receive perioperative anti‐T cell therapy (47 vs. 25%; p=0.046), and had a greater median number of infections during the first year after transplantation (5 vs. 3; p = 0.027). However, only one factor—a low preoperative cardiac index—emerged as an independent predictor of the development of a persistently depressed cardiac index during the first year after transplantation. Of note, mean systemic vascular resistance was higher in the study group than in the control group at every 3‐month period following cardiac transplantation. One possible although largely speculative explanation of the latter observation is that heart transplantation does not entirely reverse the neurohumoral abnormalities of chronic heart failure. Furthermore, this persistently elevated systemic vascular resistance may impact negatively on long‐term allograft function.
Pacing for sinus node disease: A therapeutic rationale
Authors: Brandt Johan , Schüller Hans 
Published: August 2009

AbstractSymptomatic sinus node disease is a common indication for permanent pacemaker implantation. Single‐chamber ventricular (VVI) pacing, single‐chamber atrial (AAI) stimulation, and dual‐chamber (DDD or DDI) systems are used to a varying extent at different implanting centers. Hemodynamic and clinical studies relevant to the choice of pacing mode in these patients are reviewed. The data currently available strongly support the use of pacing systems providing atrial stimulation. The choice between single‐chamber atrial or dual‐chamber pacing can be based on the relative importance assigned to a number of factors: Hemodynamic aspects, the risk of ventricular lead problems, cost, and complexity aspects favor AAI pacing, whereas patients with a substantial risk of developing atrioventricular block should receive a DDD or DDI unit.