bluuebunny/crossref_metadata_2025_split huggingface dataset:
Quantitative Angiographic Analysis of PTCA-Induced Coronary Vasoconstriction in Single-Vessel Coronary Artery Disease
Authors: Altstidl Robert , Goth Claus , Lehmkuhl Hans , Bachmann Kurt , Altstidl Robert 
Published: July 2008

Quantitative coronary angiography was applied to investigate the degree and extent of coronary vasoconstriction following percutaneous transluminal coronary angioplasty (PTCA) in single-vessel disease of segments distal to the PTCA site (n=46) and of control segments in nonmanipulated vessels (n=33) before PTCA, 15 minutes after PTCA, and again 10 minutes after 10 mg sublingual isosonbide dinitrate (ISDN) in 46 patients receiving neither nitrates nor calcium channel blockers prior to PTCA. Furthermore, the degree of coronary vasoconstriction was compared with ergonovine-induced vasocon striction (n=8) as well as in patients with and without restenosis during follow-up angiography 4 months later. PTCA induced a moderate, but significant, vasoconstriction in both distal and control segments, with a reduction in coronary diameter from 2.34 ±0.58 to 2.26 ±0.55 mm (P=0.011) and from 2.70 ±0.62 to 2.60 ±0.65 mm (P=0.004), respectively. No corre lation between the degree of vasoconstriction on the one side and lesion severity and PTCA-induced mechanical stretch, judged by the sum of the products of inflation pressure and time, on the other side was found. Vasoconstriction was within the limits achiev able with the potent vasocontrictor ergonovine and did not differ in patients with or without restenosis. ISDN led to a significant vasodilatation in all segments. In conclusion, coronary vasoconstriction following PTCA is present in the coronary tree in a rather diffuse way. It is not associated with stenosis severity or PTCA-induced mechanical stretch, suggesting a complex underlying mechanism. ISDN-reversible vaso constriction was within the limits achievable with ergonovine and did not differ with regard to restenosis.
Stress/Rest Myocardial Perfusion SPET in Evaluation of the Hemodynamic Significance of a Fistula Between the Anterior Descending Branch of the Left Coronary and the Left Pulmonary Arteries
Authors: Rubini Giuseppe , Bovenzi Francesco , DiGiovine Giuseppe , D'Agostino Carlo 
Published: July 2008

This paper describes the use of Stress/Rest Tc-99m Sestamibi (MIBI) Single Photon Emission Tomography (SPET) to evaluate the hemodynamic significance of an unusual fistula between the descending anterior branch of the left coronary artery and the left pulmonary artery. Coronary arteriography in a patient with myocardial infarction of the inferior wall revealed subocclusive (greater than 90%) stenosis of the right coronary and an abnormal branch proceeding from the intermediate section of the left anterior descending (LAD) artery to the left pulmonary artery. Treatment of the stenosis by percutaneous transluminal coronary angioplasty gave a good angiographic result but failed to resolve the angina. Myocardial Stress/Rest Tc-99m MIBI SPET disclosed an irreversible defect corresponding to the previous infarc tion. The anterior wall and apex were marked by a reversible defect due to a flow steal via the abnormal branch running from the intermediate section of the LAD artery to the left pulmonary artery. The examination was thus able to reveal perfusion defects in two different sites and of different size and gravity. Its findings and the coronary angiog raphy data showed that these defects were caused by different coronary disorders (ather osclerosis of the right coronary artery and a coronary arteriovenous fistula of the LAD artery). It also demonstrated the functional importance of the LAD to the left pulmonary artery coronary fistula.
Pre-PTCA Detection of Chronic But Reversible Postischemic Myocardial Dysfunction by Nicardipine
Authors: Pust Borut , Surlan Milos 
Published: July 2008

The aim of the study was to find out whether in patients (n = 24) with one-vessel coronary artery disease, reversibility of related left ventricular (LV) wall motion abnor malities after successful percutaneous transluminal coronary angioplasty (PTCA) can be predicted by the immediate effect of calcium antagonist nicardipine. Dynamic quantitative left cineventriculography performed four times successively (as the control, 30 minutes after oral nicardipine, 10 minutes after PTCA, and 6 months after PTCA) and hemiaxis method (mean relative hemiaxis shortening or Xδr %) were used for wall motion analysis of 48 poststenotic LV myocardial segments divided into three groups: hypokinetic noninfarcted (PNHS, n = 25), infarcted (PIS, n = 12), and normokinetic noninfarcted (PNNS, n =11) and of 24 normal LV myocardial segments (NS). In PNHS and PIS close correlation (r = 0.75, P < 0.0001 and r = 0.71, P < 0.005) was demonstrated between postnicardipine improvement (21 ±4% to 37 ±9%, P < 0.0001, and 16 ±7% to 20 ±8%, P < 0.0005) and 6 months after PTCA improvement (21 ±4% to 33 ± 7%, P < 0.0001, and 16 ± 7% to 19 ± 9%, P < 0.0005) of wall motion. It was loose in PNNS and absent in all three groups immediately after PTCA. The sensitivity of the nicardipine test for 6 months after PTCA reversible LV segmental hypokinesia was high in PNHS (95%) and lower in PIS and PNNS (67% and 60%, respectively). The speci- ficity was 100% in PIS, lower in PNNS (67%), and absent in PNHS (owing to lack of true nonresponders). Immediately after PTCA, contraction significantly improved only in PNHS; the nicardipine test was 100% sensitive but nonspecific. Significant improvement of contraction of all groups of poststenotic LV wall segments is expected 6 months after successful PTCA of related artery stenosis, being well predictable by the pre-PTCA effect of nicardipine, at least in PNHS and in PIS. Immediate ly after PTCA, only in PNHS can significant improvement of contraction be expected.
Pyoderma Gangrenosum and Extensive Caval Thrombosis Associated with the Antiphospholipid Syndrome
Authors: Chacek Samuel , MacGregor-Gooch Julian , Halabe-Cherem Jose , Nellen-Hummel Haiko , Quiñones-Galvan Alfredo 
Published: July 2008

Pyoderma gangrenosum is a rare cutaneous disorder frequently associated with systemic diseases. The authors report the case of a 28-year-old man with pyoderma gangrenosum and inferior cava vein syndrome due to thrombosis. The search for pyoderma gangrenosum-associated conditions (gastrointestinal, rheumatic, neoplasic, and infec tious diseases) was negative. A prolonged partial thromboplastin time and a positive test for circulating anticardiolipin antibodies strongly suggested the diagnosis of the antiphos pholipid syndrome. There are reports of at least three other cases of pyoderma gangrenosum associated with the antiphospholipid syndrome. This clinical case adds further evidence to the possible link between these disorders and warrants a search for anticardiolipin antibodies in patients with pyoderma gangrenosum.
Carotid-Subclavian Bypass for Subclavian Artery Revascularization: Long-term Follow-up and Effect of Antiplatelet Therapy
Authors: Wittwer Thorsten , Wahlers Thorsten , Dresler Christoph , Haverich Axel 
Published: July 2008

Subclavian artery stenosis is found in up to 25% of supraaortic lesions. Bypass grafting is the procedure of choice but controversies exist concerning the optimal technique and the effect of postoperative antithrombotic therapy on long-term patency. The authors retrospectively analyzed 40 patients with carotid-subclavian bypasses. Stenoses were documented preoperatively by arteriography. Patency was determined by clinical, ultrasound, or arteriographic examinations. Cumulative patency rates were calcu lated by Kaplan-Meier method and analyzed by Tarone-Ware test. Graft materials were Dacron (32), polytetrafluoroethylene (seven) or saphenous vein (one). Indications for surgery included vertebrobasilar insufficiency (22.5%), upper extremity ischemia (22.5%), and the combination of both (55.0%). Perioperative mortality and morbidity were 2.5% and 10.0%, respectively. Patients were followed up from 0 to 134 months (mean 61 ±39 months). Cumulative 5-year patency rate was 83.3%. Anticoagulation with acetylsalicylic acid (ASA) led to significantly better 5-year patency rates (100%) as compared with the combination of ASA and dipyridamole (64.0%, p=0.013) or no anticoagulation (70.0%, p=0.016). Carotid-subclavian bypass led to excellent long-term patency rates and can provide durable relief of symptoms with minimal perioperative morbidity and mortality. Therefore, it is a worthwile procedure to correct proximal subclavian artery stenosis. Postoperative medication with ASA seems to increase long-term bypass function significantly.
Plasma Soluble P-Selectin in Acute Myocardial Infarction: Effects of Coronary Recanalization Therapy
Authors: Aoki Naoto , Tomoda Haruo 
Published: July 2008

P-selectin is translocated from platelets and endothelial cells to initiate the first step in a sequence of events leading to the adherence of leukocytes, possibly inducing reperfu sion injury and the no-reflow phenomenon in acute myocardial infarction (AMI). This study was undertaken to investigate plasma P-selectin in AMI patients undergoing coronary recanalization therapy. A total of 40 patients were studied: 20 patients with AMI who underwent coronary recanalization by direct percutaneous transluminal coronary angioplasty (PTCA), 10 patients with AMI who underwent thrombolytic therapy by tissue-type plasminogen activator (TPA), and 10 patients with stable angina pectoris who underwent elective PTCA. Blood samples were obtained from systemic arteries before and immediately after PTCA or thrombolytic therapy. Plasma-soluble P-selectin was measured by enzyme immunoassay. Plasma P-selectin was significantly higher in AMI than in stable angina pectoris (176.6 ± 12.9 ng/mL vs 91.4 ± 9.5 ng/mL, p<0.001). Plasma P-selectin did not change significantly as a result of elective PTCA in patients with stable angina (from 91.4 ± 9.5 ng/mL to 87.9 ± 7.9 ng/mL). Plasma P-selectin was decreased by direct PTCA in all of the 20 patients with AMI (from 176.2 ±17.7 ng/mL to 141.7 ±12.6 ng/mL; p<0.001, paired t-test), whereas it was increased by thrombolysis using TPA in nine of the 10 AMI patients (from 177.4 ±17.2 ng/mL to 248.8 ±17.3 ng/mL, p<0.005). Increased P-selectin activity in AMI appeared to be attenuated by direct PTCA, but augmented by thrombolysis, possibly due to direct stimulatory effects of TPA on P-selectin expression. This may lead to less favorable results in salvaging the ischemic myocardium by thrombolytic than mechanical coronary recanalization therapy in AMI.
Detection of Coronary Artery Disease in Patients with Severe Aortic Stenosis with Noninvasive Methods
Authors: Patsilinakos Sotirios P. , Antonelis Ioannis P. , Filippatos Gerasimos , Houssianakou Irene K. , Zamanis Nikolaos I. , Sioras Elias , Tsiotika Theodora , Kardaras Fotios , Anthopoulos Lambros P. , Kranidis Athanasios 
Published: July 2008

Exercise stress ECG testing is not generally recommended in patients with severe aortic stenosis. Analysis of the utility of exercise testing, both with and without the use of myocardial thallium-201 scintigraphy for the diagnosis of coronary artery disease (CAD), yielded low specificity. A noninvasive, safe, and accurate diagnostic modality to ascertain the presence of CAD is not available to date for patients with severe aortic stenosis. The aim of this study was to assess the safety and diagnostic accuracy of adenosine stress echocardiography (A-Stress-Echo) and of adenosine stress myocardial perfusion scintig raphy (A-SPECT), for the detection of CAD in patients with severe aortic stenosis. The study included 50 patients with severe aortic stenosis (maximal instantaneous aortic valve gradient > 80 mmHg, range 81 to 144 mmHg, and aortic valve area < 0.75 cm2). All patients were submitted to A-Stress-Echo, after a 6-minute infusion of adenosine (140 μg/kg body weight/min), and then (>3 days later) A-SPECT with the same dosage of adenosine as above. Coronary angiography was performed in all patients. No major complications were observed. The unpleasant symptoms were brief and did not necessitate cessation of the test. Both modalities showed the same sensitivity (85% for A-SPECT and 85% for A-Stress-Echo) angiographically diagnosed CAD while A-Stress-Echo yielded much higher specificity (96.7% vs 76.7%). Concordance of the two methods was found in 40 cases and the specificity for those patients was 100%. A-Stress-Echo and A-SPECT, either separately or in combination, constitute excellent and safe noninvasive diagnostic methods in detecting CAD in patients with severe aortic stenosis.
Upper Extremity Vein Thrombosis: Etiologic Categories, Precipitating Causes, and Management
Authors: Sakakibara Yuzuru , Shigeta Osamu , Ishikawa Shigemi , Hiramatsu Yuji , Jikuya Tomoaki , Onizuka Masataka , Mitsui Toshio , Sakakibara Yuzuru 
Published: July 2008

Although an increasing incidence of upper extremity venous thrombosis (U/E-DVT) has been reported, a relative paucity of information regarding the etiologic categories, precipitating causes, and proper management for this disorder is available. To settle on a strategy for the management of U/E-DVT, retrospective analyses were performed using records from the authors' hospital. In 12 patients (seven men, five women), 61 (mean) years of age, diagnosed as having symptomatic venography-proved U/E-DVT and followed up for 41 (mean) months, etiologic factors, precipitating causes, treatments, and outcomes were retrospectively analyzed. As etiologic factors, five of the patients had neoplastic disease, one had hemodialysis, and two had transvenous pacemaker implan tations. Among various precipitating causes of U/E-DVT, hypoproteinemia was most frequently noted (67%). Various types of therapeutic management were selected: from thrombolysis with urokinase in six, balloon angioplasty in two, thrombectomy in two, and venous bypass surgery in one patient. Pulmonary embolism did not occur in any of the patients and only three of them complained of mild intermittent arm swelling during the follow-up period. Four patients died of neoplastic disease or heart failure (three within the first 6 months). This study, though limited, suggests that the rate of mortality depends on multiple underlying medical problems in U/E-DVT patients. Low incidences of late postthrom botic sequelae and pulmonary embolism were noted in this series. Symptomatic U/E- DVT patients could be managed conservatively with a revised supplementary therapy for their precipitating causes of U/E-DVT.
Adoption Planning for Handicapped Children
Authors: Davis Joseph H. , Montgomery Patricia A. 
Published: July 2008

Major changes are taking place in the field of adoption. Once concerned primarily with the placement of newborn infants, the field has broadened, with a major emphasis on the adoption of older children, often from foster care and many times with major handicaps or problems. These children require special families who are willing to adopt them. They require the services of skilled social workers to effectively place them, and they require the understanding of the physician who may be involved either with their placement examination or with their subsequent management as an adoptee. A new objective approach to the problem is necessary.
Rapid Glucose Disappearance in Infants with Infection
Authors: Leake Rosemary D. , Fiser Robert H. , Oh William 
Published: July 2008

Altered carbohydrate metabolism has been reported during episodes of neo natal infection. To document that there is more rapid glucose disappearance during infection, intravenous glucose tolerance tests (IVGTT) and serial plasma growth hormone and insulin levels were determined in eight full-term neonates during the first three days of an acute episode of infection and during convalescence, 5 to 15 days later. Eight healthy infants were each studied once using the same study protocol. Glucose disappearance rates, measured as Kt of glucose, were increased (p < 0.01) during both the acute septic period (3.7 ± 0.3% disappearance/min; mean ± S.E.M.) and convalescent period (2.5 ± 0.2%/min) when compared with values in control infants (1.3 ± 0.3%/min). Gram-negative, gram-positive, and viral infections were all associated with rapid glucose disposal. The ab normality in carbohydrate homeostasis persisted for at least 5 to 15 days after treatment was begun. Baseline and stimulated (20-minutes post bolus glucose infusion) plasma insulin and growth hormone levels did not differ among the groups. Thus, there is no evidence that hyperinsulinism produced the rapid glucose disappearance rate and enhanced glucose utilization. The reason for the disturbed carbohydrate metabolism in neonatal infections remains un known.
Physiotherapy benefits patients with Parkinson's disease
Authors: Banks Moira A , Caird FI 
Published: July 2008

Thirty-six patients with Parkinson's disease, of Hoehn and Yahr grade I-IV, on optimal unchanging drug therapy, were taught physiotherapeutic exercises in their own homes. They were assessed by timed tests twice before and once after a fortnight's exercises. A postal follow-up was conducted at three months. There were statistically significant improvements in walking (17%), turning over in bed, sitting from lying, and standing from sitting (each approximately 30%). Improvement was irrespective of the duration of disease, and was seen with all degrees of initial impairment of mobility. After three months, half the patients were still doing their exercises daily. Intercurrent illness, tiredness, and lack of perceived benefitwere the main reasons for discontinuance.
The stroke patient in an urban environment
Authors: Kettle Melvyn , Chamberlain M Anne 
Published: July 2008

A cohort of 70 patients who had had a stroke a median of 19 months, for males, and 23 months, for females, beforehand and had been treated intensively in a rehabilitation unit, was compared with an age matched control group (25) of normal people living in the same city. Two thirds of patients were moderately or severely limited in their independence on the Barthel Scale; only4% had a normal level of social activities (Frenchay Index) and half were depressed (Wakefield Scale). Mobility was severely impaired, only 15% being able to walk more than 440 yards. Only one subject drove a car, few could use public transport, and only two people returned to work full time. Use of health services and social services was low. No control subjects had any such problems. Therefore, the social effects of stroke are severe; they persist for many years and they are not addressed by current inpatient treatment. New models of treatment must be devised and evaluated to reduce social isolation and depression in the patient and carer.
Effectiveness of a rehabilitation programme in chronic bronchitis and emphysema
Authors: Prince KL , Helm M. 
Published: July 2008

Thirty-nine patients with stable chronic bronchitis and emphysema were randomly allocated into two groups. Eight withdrew before the study and six during the study. One group received six weeks active outpatient rehabilitation, the other (control) group six weeks attendance without rehabilitation. Before entry, patients were examined to assess stability and measure arterial blood gases. On both entry and completion the following were recorded: smoking history; carboxyhaemoglobin; FEVI; six minute walking distance (6MD); the General Health Questionnaire (GHQ) and visual analogue scale (VAS) of breathlessness. The treatment group showed a significant (p > 0.01) reduction in GHQ score after rehabilitation, suggesting a decrease in psychiatric symptoms. In the control group, the GHQ score reduction was not statistically significant. The control group, but not the treatment group, showed a significant (p > 0.05) increase in 6MD. No significant difference was found in FEV1, VAS score, or the number of patients smoking after rehabilitation. Our rehabilitation programme appeared to benefit patients' psychological wellbeing, but this may be due to attendance at the groups rather than the rehabilitation programme per se. Underlying disease severity or perception of disability did not change.
Hemiplegic shoulder pain: a study of two methods of physiotherapy treatment
Authors: Partridge CJ , Edwards SM , Mee R. , van Langenberghe Hvk 
Published: July 2008

A study was undertaken to examine the effectiveness of two methods of physiotherapy treatment for hemiplegic shoulder pain. Sixty-five patients were randomly allocated to receive either cryotherapy or the Bobath approach. Patients were assessed before and after a four-week period of treatment. The differences between the scores of the two groups on exit were not found to reach statistically significant levels for severity of pain at rest, on movement, or for reported distress; however the proportion of patients who reported no pain after the four weeks' treatment was greater in those who received the Bobath approach. The differences in reported frequency of occurrence of pain reached a significant level (p < .05), those in the Bobath group reporting less frequent pain. It is suggested that reasons forthe lack of expected differences in outcome between the two groups may be in part due to the diversity of underlying pathology, and to further trauma which occurred in the study period. The difference between before and after ratings for all pain variables was significant; for reported severity and frequency p < .05, and for reported distress p < .001. These findings suggest that physiotherapy may have a role to play in the treatment and management of hemiplegic shoulder pain, but further investigations are needed. It may be appropriate to set up and monitor programmes of careful handling to see if shoulder pain can be avoided, and it is also suggested that those with severe pain at rest and on movement may be considered as a separate group for study.
The Bradford community stroke trial: eight week results
Authors: Young John B , Forster Anne 
Published: July 2008

To evaluate two commonly practised methods of stroke aftercare we have conducted a randomized comparison trial of day hospital (DH) and home physiotherapy (HPT). Patients over 60 years discharged from hospital following a new stroke event were eligible. One hundred and twenty-four patients were recruited, stratified by disability measured on the Barthel Index and by length of time since stroke onset, then randomized to attend a DH twice weekly or to receive HPT. Outcome measurements included the Barthel Index, Motor Club Assessment, Frenchay Activities Index, Nottingham Health Profile and the General Health Questionnaire. One hundred and seven patients completed an eight week course of treatment. Both the DH and the HPT treated patients showed a significant but small further improvement in functional abilities with the HPT patients being significantly more able on stairs. Social function of both groups was poor but the HPT treated patients were significantly less so. More than a third of patients in each treatment group were depressed and more than a quarter of the carers were 'stressed'. The HPT patients received significantly less physiotherapy and virtually no occupational therapy compared to the DH group. The findings suggest that HPT is slightly more effective for stroke aftercare than DH attendance and is considerably more resource efficient.