bluuebunny/crossref_metadata_2025_split huggingface dataset:
Referral Pattern and Outcome in Men and Women Undergoing Coronary Artery Bypass Surgery
Authors: Hussain K.M.A. , Kogan A. , Estrada A.Q. , Kostandy G. , Foschi A. 
Published: July 2008

Women with coronary artery disease are less likely to undergo coronary artery bypass surgery, and this may represent a potential referral bias in favor of men. A higher in- hospital mortality rate in women compared with men has been reported earlier. Accumulating evidence currently suggests, however, that variables other than gender, such as advanced age, late referral, angina classification, diabetes mellitus, concurrent medical conditions, the number of diseased vessels, the caliber of coronary arteries, and the decreased body surface area in women may have accounted for this difference. In fact, when these variables are taken into account, female gender is no longer a statisti cally significant predictor of operative mortality. Women appear to have comparable immediate and late survival rates. Recurrent angina, perioperative myocardial infarc tion, congestive heart failure, incomplete revascularization, and early and late graft reoc clusion following surgery are, however, more prevalent in women. Men and women show differences in recovery experiences after discharge following bypass surgery. When coronary bypass surgery is offered to women, the decision should be individ ualized, based on the patients' perioperative baseline clinical risk factors and coronary anatomy. Coronary artery bypass surgery should not be withheld in women who are considered to be appropriate candidates for fear of a reduced success rate.
Acute Mesenteric Ischemia After Open Heart Surgery
Authors: Schütz A. , Eichinger W. , Breuer M. , Gansera B. , Kemkes B.M. 
Published: July 2008

Acute mesenteric ischemia is a rare but severe complication after open heart surgery. Its incidence (0.2-0.4%) is quite low, but mortality rates are ranging between 70% and 100%. From October 1992 to December 1996, 4,640 patients underwent open heart surgery with cardiopulmonary bypass: 74.6% coronary artery bypass graft (CABG) operations, 23.2% valve replacement including aortic repairs, and 2.2% corrections of congenital heart diseases or tumors of the heart. The overall mortality rate (30 days) was 3.4%, and after CABG, 2.9%. Twelve patients (0.26%), following CABG (one combined with aortic valve replace ment, one with mitral reconstruction, and one with carotid disobliteration) developed signs of acute mesenteric ischemia in the early postoperative period (day 1 to 5). In all patients various abdominal symptoms, leukocytosis, acidosis, hyperlactatemia, hyperos molality, renal failure, and, finally, hemodynamic instability were observed. Eleven patients underwent emergency laparotomy. Mesenteric angiography was done if possible in still stable patients (n=7); it showed severe stenosis or occlusion prior to the operation in each case. Other diagnostic methods were not reliable. In six patients (55%) during the first look, extensive bowel necrosis was found and in five patients an ischemic intestine but no necrosis was detected. Of these, three patients were affected by extensive bowel gangrene at the second look. In the fourth patient a disseminated peripheral ischemia of the entire small intestine was found intraoperatively. After mechanical release and stim ulation normal bowel function could be reestablished. One patient underwent percuta neous transluminal angioplasty prior to the laparotomy. Bowel perfusion was still dete riorated but no necrosis was found intraoperatively. These patients were the only survivors in the investigated group; 10 of 12 patients (83.3%) died in the early postop erative period (day 1 to day 6). Predisposing factors for mesenteric ischemia are: arte riosclerotic patients after CABG (100%), age >70 years (91.7%), hyperosmotic dehy dration (100%), and cardiac ischemia in 25%. Mesenteric ischemia is a fatal complication with high mortality rates after open heart surgery, especially in older, dehydrated patients with generalized atherosclerotic vessel disease. As the acute mesenteric ischemia usually starts during anesthesia or in the early postoperative period, setting of immediate diagnosis is very difficult. With the occur rence of typical symptoms diagnostic and therapeutic procedures (angiography and laparotomy) must be done very urgently owing to the life-threatening mesenteric process. When mesenteric gangrene already has taken place, the prognosis is very poor, despite extensive resection. Prevention can be exercised by avoiding perioperative hyperosmotic dehydration of patients at high risk.
The Determination of Metabolite M 17 and Its Meaning for Immunosuppressive Cyclosporin Therapy
Authors: Khoschsorur G. , Auer T. , Lanzer G. , Petritsch P. , Holzer H. , Tscheliessnigg K.H. 
Published: July 2008

Cyclosporin A (CyA) is intensively metabolized by the hepatic cytochrome p450 III monooxygenase A system in the human liver, the most important metabolites being M1, M17, and M21. Because CyA and its metabolites have nephrotoxic, hepatotoxic, and neurotoxic side effects, CyA dosage must be calculated to avoid the risk of organ rejection through underdosage and toxic organ damage through overdosage or accumulation of metabolites. In this study, we determined the whole-blood concentrations of cyclosporin and metabolite M17 by high-pressure liquid chromatography (HPLC) and by monoclonal specific and polyclonal nonspecific fluorescence polarization immunoassay (Abbott) in patients after immunosuppressive treatment. Patients with different resorption and metabolization rates showed high individual variations. CyA concentrations in patients with good liver function and low concentra tions of CyA metabolites showed a good correlation between the HPLC and the FPIA (TDx-monoclonal assay) methods in ranges between 25 and 180 ng/mL. TDx-mono clonal was not always as precise as HPLC. In cases of metabolic disorders, we found false high CyA concentrations assayed with the immunologic method, caused by a cross- reaction of the elevated metabolite concentration. We found that HPLC rendered more information about the extent of immunosuppressive activity and the metabolization rate and showed a good correlation with the concentration of metabolite M17 and total metabolites measured with the Abbott CyA polyclonal kit.
Effect of Felodipine on Arterial Blood Flow and Venous Function at Rest in Patients with Mild Essential Hypertension
Authors: Bicchi Maurizio , Vedovini Giovanni , Cappelli Roberto , Arrigucci Stefano , Righi Giovanni Andrea , Forconi Sandro 
Published: July 2008

Felodipine is a second-generation dihydropyridine calcium antagonist used to treat mild to moderate arterial hypertension. The authors used venous occlusion plethysmography to study the effect of this drug on lower limb arterial inflow and venous outflow in 10 at rest patients with mild essential hypertension. They also sought correlations between changes in district blood flow and blood pressure. Plethysmography was carried out at 8 AM and 4, 8, and 24 hours later at baseline (after washout), on the first day of treatment with a single daily administration of 10 mg felodipine ER, and after 7 and 30 days of treatment. The drug was given after the 8 AM evaluation. The authors determined rest flow, maximal venous incremental volume (MVIV) at 40 mmHg and 60 mmHg, and gradient of venous volume between 60 and 40 mmHg divided by the pressure difference (DV/DP) as index of venous distensibility. On the days of plethysmographic evaluation, arterial blood pressure and heart rate were measured continuously over 24 hours by the ABPM (Ambulatory Blood Pressure Monitoring). The results were analyzed by ANOVA. Rest flow, MVIV, and DV/DP were stable at the baseline evaluation. On days 1, 7, and 30 of treatment the rest flow after 4 and 8 hours was significantly greater than at 8 AM but had always returned to normal after 24 hours. No other plethysmographic parame ters changed significantly; in particular venous outflow remained unchanged. Mean arterial, systolic, and diastolic blood pressure were significantly reduced, compared with baseline, following treatment on the first day and after 7 and 30 days' treatment. There was no effect on heart rate. The authors conclude that felodipine is useful for the treatment of mild essential hypertension, since it reduces arterial resistance without altering venous capacitance or distensibility.
Cerebral Vascular Accidents in Young Patients with Essential Thrombocythemia: Relation with Other Known Cardiovascular Risk Factors
Authors: Randi Maria Luigia , Fabris Fabrizio , Cella Giuseppe , Rossi Carla , Girolami Antonio 
Published: July 2008

Background and purpose: Since the advent of routine automated blood cell counts, an increased platelet count often is detected fortuitously in asymptomatic individuals. In the past, essential thrombocythemia (ET) was thought to be linked to an increase incidence of hemorrhagic complications, whereas thrombosis is now considered more frequently. Actually, the risk of thrombosis cannot be predicted in an asymptomatic patient with essential thrombocythemia. Patients and methods: A total of 41 young patients (age range, 18 to 45 years) affected by ET and diagnosed in agreement with the Polycythemia Vera Study Group criteria are reported. Common risk factors, such as hypertension, smoke, obesity, dyslipidemia, and diabetes, have been registered. Particular attention has been given to cerebral vascular accidents (CVA) both of the arterial and venous systems. Platelet number, platelet serotonin content, and platelet aggregation under collagen, adenosine diphosphate (ADP), and adrenalin stimuli were evaluated. Results: Nine out of the 41 patients affected by ET had CVAs, four of which occurred in the venous system. No difference in platelet function tests has been observed between patients with or without CVA. Six out of the 9 patients with ET and CVA had at least one atherosclerotic risk factor: four were heavy smokers, one had hypertension, and one had hypertension and obesity. (continued on next page) Conclusions: Cerebral vascular accidents are confirmed to be frequent in patients with essential thrombocythemia, even at a young age. However, the presence of at least one atherosclerotic risk factor associated with increased platelet number seems to favor thrombotic complications. In particular, cigarette smoking seems to be related to arterial CVAs in essential thrombocythemia.
An Unusual Presentation of Simultaneous Bilateral Popliteal Artery Embolism
Authors: Fernandez Bernardo B. , Grove Mark , Carman Teresa L. 
Published: July 2008

We present what we believe is the first case in the literature of carcinoma of the lung presenting de novo as an intracardiac mass with bilateral, simultaneous popliteal artery embolization. Arterial thromboembolism of cardiac origin and in situ thrombosis of a preexisting atherosclerotic lesion or aneurysm account for the majority of cases of acute lower extremity ischemia. Less common causes include trauma, aortic dissection, venous ischemia, and foreign body or tissue embolization. Although the history, physical exam ination, and electrocardiographic findings may provide a likely explanation in many cases, noninvasive studies such as echocardiography may help further elucidate the embolic source.
99mTc SESTAMIBI Scintigraphic Evaluation of Skeletal Muscle Disease in Patients with Systemic Sclerosis: Diagnostic Reliability and Comparison with Cardiac Function and Perfusion
Authors: Rinaldi E. , Ierardi M. , Tiberio N.S. , Boccabella G. Luca , Barbieri C. , Scopinaro F. , Morelli Sergio , DeSantis Marcello , Banci Maria 
Published: July 2008

The diagnosis of skeletal muscle involvement in patients with systemic sclerosis (SSc) is usually based on clinical, laboratory, electromyographic, and bioptic evidence of muscle disorder, whereas SSc cardiac disease is well established by nuclear medicine techniques (radionuclide ventriculography and myocardial scintigraphy). Previous reports have retrospectively hypothesized a possible relationship between cardiac and muscle involvement in scleroderma patients. In order to improve overall diagnostic accuracy in the qualitative/quantitative assess ment of skeletal muscle involvement in these patients and to compare these results with those obtained at the cardiac level, diethylenetriaminepentaacetic acid (DTPA)-99mTc radionuclide ventriculography and 99mTc SESTAMIBI myocardial and muscular scinti graphic examinations were performed in 10 SSc patients and in five healthy subjects. Muscular radioactivity, as assessed at thigh and calf levels by means of a segmental score, was significantly decreased in SSc patients in comparison with healthy subjects (global score value 15.6 ±2.2 vs 22.7 ± 1.6, p < 0.001), as well as right ventricular ejection fraction (RVEF, 34.3% ±5.3 vs 53.6% ±4.2, p<0.001) and myocardial segmental perfusion (global score value, 19.6 ± 2 vs 25.9 ± 1.1, p < 0.01 ) . The results show a high frequency of skeletal muscle involvement in patients with SSc. Moreover, scleroderma patients with muscle disorders, as evidenced by scintigraphy, show a comparable occurrence of cardiac involvement, even in the absence of clinical signs of cardiac dysfunction.
Shock Waves in Vascular Diseases An in-Vitro Study
Authors: Nicolaides A.N. , Marlinghaus E.H. , Cesarone M.R. , Incandela L. , De Sanctis M.T. , Dhanjil S. , Laurora G. , Ramaswami G. , Artese L. , Ferrero G. , Ricci A. , Barsotti A. , Ledda A. , Steigerwalt R. , Griffin M. , Belcaro G. 
Published: July 2008

Three human aortic specimens were used for this in-vitro study on the effects of shock waves on the arterial wall. Specimen one was from a normal (for age) healthy aorta. The full abdominal lengh was used (including mesenteric and renal arteries and the aortoiliac bifurcation), divided into six pieces (3 cm). The pieces were placed and fixed into degassed water. Shock waves (SW) were focused onto the aortic wall by means of a B-mode ultrasound imager. An SW generator (Minilith SL1, Storz Medical AG, Kreuzlingen, Switzerland) was used for setting of energy flux density between 0.03 and 0.5 mJ/mm2. The six aortic pieces (excluding piece 1, placed in water and left untreated as control) were treated with SW at increasing energy levels. A second aortic specimen of a man with arteriosclerotic plaques was also used and the experiment repeated at energy levels 1, 5, and 8. Another specimen of normal thoracic aorta was exposed at energy levels 1 and 8 only. Energy levels delivered onto the aortic walls were selected from theoretically destructive levels to minimal levels known not to alter vascular tissues. High-resolution ultrasounds of the aortic segments were performed with a 10 MHz high- resolution, broad-band (ATL 3000, USA) probe in water before and after SW applica tion to detect structural changes in the wall after SW. Histology was performed with a standard hematoxylin-eosin staining. (Abstract continued) Results: The aortic pieces did not show macroscopic damages at visual examination, and at the ultrasound examination no visible changes were observed even at higher levels of SW energy. Also no effects were seen by histology. In conclusion, no damaging effects were observed, visually, by ultrasound, or by histology. At these energy levels SW appear to be safe and do not produce any damage to the aortic wall. Therefore, SW could be considered a safe, nondamaging procedure for potential treatment (ie, thrombolysis) in which vessel walls could be involved. Theoretically it is possible that functional changes could be observed in vivo including cell permeability modifications and other alterations (including changes in the potential of the cells in SW fields to modify themselves and to divide). At the energy levels described in this study SW could, theoretically be, safely used for vascular applications (ie, treating venous and arterial thrombi or in arterial plaques modification) without altering major, structural, arterial wall characteristics. Lesions or alterations that have a different density from the normal wall (thrombi or plaques) could be differently sensitive to the same dosage of SW. These differences in acoustic impedance characteristics could be used for potential treatments with SW without damaging the arterial wall.
Present Status of HMG Reductase Inhibitors in Treatment of Dyslipidemia
Authors: Kalmansohn Richard W. , Schiff David L. , Kalmansohn Robert B. 
Published: July 2008

HMG reductase inhibitors have significant desirable effects on patients with dyslipidemia. Multiple factors are involved in these desirable effects. Other factors that might play a role in the risk of coronary artery disease are fibrinogen concentration, homocysteine, Lp (a), small dense LDL, insulin resistance, and infection with chlamydia. High-dose reductase inhibitors may be indicated in select patients. The ideal end point may be 150 mg/dL for adults.
Venoarteriolar Response to Experimental Venous Hypertension in Legs with Chronic Venous Insufficiency and in Healthy Legs, Measured Using a Double-Wavelength Laser Doppler Technique
Authors: Malanin Ken , Vilkko Pekka , Kolari Pertti J. 
Published: July 2008

The venoarteriolar response (VAR) of the skin in legs caused by experimental venous hypertension was measured using a new, double-wavelength laser Doppler probe technique (543 nm and 780 nm). This enables the measurement of the laser Doppler flux in the superficial and deep layers of the skin simultaneously. The recordings were obtained from the leg with the patient in a recumbent position with a sphygmo manometer cuff around the thigh. The VAR was recorded at the cuff pressures of 30 mmHg and 60 mmHg. Ten patients with chronic venous insufficiency (CVI) and 20 control subjects with healthy legs were investigated. The VAR increased in relation to the increase of cuff pressure at both wavelengths. There were no significant differences in the VAR between the cuff pressures within or between the legs with CVI and healthy legs. The VAR measured at 780 nm was very significantly greater than the VAR measured at 543 nm in legs with CVI (p<0.005), as well as in healthy legs (p<0.001). The VAR depends both on the wavelength of the laser Doppler light used and on the degree of venous hypertension. The VAR is not impaired in legs with CVI compared with healthy legs.
Vasodilatory Capacity of Forearm Resistance Vessels Is Augmented in Hypercholesterolemic Patients After Treatment with Fluvastatin
Authors: Schobel Hans P. , Schmieder Roland E. 
Published: July 2008

Atherosclerotic vessels are characterized by endothelial and structural abnormalities as indicated by an impaired vasodilation to metabolic requirements. To determine whether effective treatment of hypercholesterolemia may improve vasodilatory capacity of resis tance vessels, the authors examined the impact of 12 and 24 weeks of lipid-lowering therapy with the hepatic hydroxymethylglutaryl coenzyme A (HMG-CoA)-reductase inhibitor fluvastatin (40 to 80 mg/day) on the increment in forearm blood flow during reactive hyperemia in 24 hypercholesterolemic patients (mean age: 56 ±11 years; 15 men/9 women). Changes in forearm blood flow in response to reactive hyperemia were measured by venous occlusion plethysmography. Serum low-density lipoprotein (LDL)-cholesterol fell from 213 ±32 to 125 ±27 mg/dL (P<0.001) after 12 weeks and remained stable at a level of 125 ± 18 mg/dL after 24 weeks of treatment. Baseline forearm blood flow was similar before and after 12 and 24 weeks of therapy. In contrast, forearm blood flow at peak reactive hyperemia was greater at week 12 (37.0 ±22.9 mL/min/100 mL; P<0.05), and at week 24 (47.1 ±33.5 mL/min/100 mL; P<0.05) than at week 0 (30.5 ± 18.1 mL/min/100 mL). Compared with week 0 (defined as 100%), the percent change in forearm blood flow in response to reactive hyperemia was augmented at week 12 (171 ± 144%; P<0.05 vs week 0) and at week 24 (218 ±228%; P<0.05 vs week 0). Thus, the lowering of high serum LDL choles terol after short-term treatment with fluvastatin increased the blood flow responses during reactive hyperemia in forearm resistance vessels. These data indicate a beneficial effect of HMG-CoA reductase inhibition on structural wall properties of peripheral arteries in human atherosclerosis.
The Role of Leukocytes in the Pathogenesis of Vibration-Induced White Finger
Authors: Greenstein D. , Kester R.C. 
Published: July 2008

Vibration white finger (VWF) is an occupational disorder associated with long-term exposure to hand-transmitted vibration. The condition exhibits features of secondary Raynaud's phenomenon. The etiology is unknown. The aim of this study was to examine the role of leukocyte rheology in the pathogenesis of VWF.Fifty-two male subjects divided into two groups were exposed to controlled acute hand-transmitted vibration. One group consisted of 29 workers who have all had occu pational exposure to handheld vibration and all suffered from VWF (mean age 46.9 years, range 22-66) . The second group consisted of 23 controls. Venous blood was analyzed from the dorsum of the hand before and after vibration to determine granulocyte deformability, granulocyte morphology, and white blood cell count with differential. There was a subpopulation of hard and poorly deformable granulocytes in the VWF group when compared with controls (p < 0.05). Acute hand-transmitted vibration had no in vitro effect on leukocyte rheology in either group.Leukocyte rheology may play a role in the pathogenesis of microvascular disease and tissue ischemia in VWF, although whether this is a cause or an effect of the disorder is not clear.
Impaired Response of the Forearm Resistance but not Conductance Vessels to Reactive Hyperemia in Hypertrophic Cardiomyopathy
Authors: Krzanowski Marek , Surdacki Andrzej , Nizankowski Rafal , Szczeklik Andrzej , Dubiel Jacek S. , Petkow Dimitrow P. 
Published: July 2008

It has been suggested that in hypertrophic cardiomyopathy (HC), vascular abnormali ties are not restricted to the heart. Flow-mediated dilation of peripheral conductance arteries (reflecting their endothelial function) has not yet been studied in HC. Our aim was to assess both flow-dependent dilation of the brachial artery and flow responses (dependent on resistance vessels) during forearm reactive hyperemia (RH) in nontreated HC patients. The authors studied 13 HC patients and 14 age- and sex-matched healthy controls. None of them exhibited any factors known to be associated with endothelial dysfunc tion. Using 7 MHz ultrasound, brachial artery diameter and Doppler flow velocity were measured continuously at baseline and throughout 1 min of RH following 5 min of forearm ischemia induced by inflation of a blood pressure cuff. Arterial diameter and RH flow are expressed as percent changes with respect to the baseline. Flow-dependent dilation was similar in the HC patients and control subjects (7.2 ±9.5% vs 9.9 ± 10.4%, p>0.05). Compared to the control group, RH flow in HC was decreased; however, differences did not reach statistical significance until 60 sec of RH (112 ±102% vs 261 ±217%, p<0.05; HC vs controls). In HC patients, endothelial function of peripheral conductance arteries is preserved. Hence, a defect in the forearm arterial bed in HC seems to be limited to mechanisms maintaining the dilation of resistance vessels during decreasing RH flow.