bluuebunny/crossref_metadata_2025_split huggingface dataset:
Primary Raynaud's Phenomenon
Authors: Planchon Bernard , Pistorius Marc-Antoine , Beurrier Philippe , De Faucal Philippe 
Published: July 2008

Many authors consider that late onset is a suspect criterion for differentiating primary Raynaud's phenomenon (Raynaud's disease, RD) from Raynaud's syndrome (RS). However, many cases of late-onset Raynaud's phenomenon in patients over forty years of age remain without etiologic diagnosis and therefore deserve the designation "late- onset RD." One hundred and ninety-four patients with RD (143 women, 51 men) were selected among 424 patients with Raynaud's phenomenon, according to Allen and Brown's criteria with negative serologic investigations and normal capillaroscopy. The purpose of the study was to consider the possible discriminant value of age of onset in distinguishing between RD and RS. The following epidemiologic features were studied: age of onset, sex, family history of Raynaud's phenomenon and migraine, and smoking and working habits. Microcirculation was assessed by capillaroscopy and strain-gauge plethysmography. Maximal digital flow at 45°C and reactivity to cold were determined for each patient. Results were related to age of onset. The existence of true cases of late-onset RD in patients over forty years of age was confirmed (prevalence 27%), showing a correlation (continued on next page) with a family history of Raynaud's phenomenon inferior to that found in early-onset cases (p < 0.0001). Microcirculation studies generally indicated a strong correlation between reactivity to cold, familial RD, and early onset, whereas no correlation was found with migraine or smoking. Nor was there any clinical or plethysmographic evidence for arteritis as a possible pathogenetic factor in late-onset RD. These results indicate that late-onset RD is a valid designation and that its pathogenesis seems less dependent on genetic sensitivity to cold than that of early-onset cases. In the absence of underlying arteritis, neurovascular dysfunction or a hemorheologic mechanism may be suggested as plausible causes of late-onset RD.
Ace Inhibitors and Cough
Authors: Yesil Sena , Yesil Murat , Bayata Serdar , Postaci Nursen 
Published: July 2008

Probably the most common and irritating side effect of angiotensin-converting enzyme (ACE) inhibitors is cough. In this retrospective study the incidence of cough was investigated in 1113 patients with arterial hypertension who were receiving ACE inhibitors alone or in combination with other antihypertensive agents. Patients were treated with one of the following ACE inhibitors: enalapril 10-20 mg/day (n:668), captopril 25-75 mg/day (n:234), perindopril 2-8 mg/day (n:90), or lisinopril 5-20 mg/day (n:121). Mean follow-up periods were twenty-six months with enalapril, twenty-nine months with captopril, eleven months with perindopril, and thirteen months with lisinopril. Spontaneously declared cough incidence in enalapril, captopril, perindopril, and lisinopril groups were 7%, 5.1%, 2.2%, and 1.6%, respectively Cough was not dose related. Treatment was stopped in all patients with cough. In 59% of patients the onset of cough occurred after the first month of treatment (thirty to one hundred eighty days). Cough decreased by 50% within three days of drug cessation and disappeared in ten days. Mean age of patients with cough was 58.7 years and 79% of them were women. In patients without cough, mean age was 57.8 years and 56% of them were women. There was no significant difference between the two groups regarding mean age, but the sex difference between groups was statistically significant (P < 0.05). In conclusion, although cough may occur with all four types of ACE inhibitors, the incidence of this side effect was higher during enalapril and captopril treatment than during lisinopril and perindopril treatment. The incidence was also greater in women than in men.
Raised Leg Exercises for Leg Edema in the Elderly
Authors: Ciocon Jerry O. , Galindo-Ciocon Daisy , Galindo Diana J. 
Published: July 2008

Leg edema is a common problem in the elderly and requires further evaluation and management. Method: From October 1990 to July 1992, 245 patients presented to the Cleveland Clinic Florida with leg edema. All patients were counseled about the benefits of twenty-minute, three-times-a-day raised-leg exercises. Fifty seven (57) of the 245 patients were not compliant with this regimen (nonexercise group). Although not true controls, they formed a comparison group for those who performed the exercise regimen. The exercise group was composed of 188 patients with a mean age of 73 ±6.8 years, 25 (13%) men and 163 (87%) women; the nonexercise group was composed of 57 patients with a mean age of 71.9 ±4.3, 19 (33%) men and 38 (67%) women. Workup for leg edema included: comprehensive history, clinical examination including prostate or pelvic examination, complete blood count, chemistry profile, thyroid profile, electrocardiogram, chest radiograph, and, when indicated, pelvic or leg ultrasound and pelvic computed tomographic scan. The circumference of the leg with the maximum amount of edema was measured initially and on the fourth week. Results: In this study, the common causes of leg edema in the elderly population were venous stasis (63.2%), drug induced (13.8%), and heart failure (15.1%). Postphlebitic syndrome, cirrhosis, lymphedema, lipedema, prostate carcinoma (CA), and ovarian mass were the less frequent findings. Upon comparison of the circumference of leg edema on initial visit and four weeks after, both the exercise and nonexercise groups showed significant decreases in the measurement of the leg edema (P < .001) except those caused by lymphedema. The amount of change when compared between those who exercised and those who did not was significant only in venous stasis. Conclusion: Causes of leg edema in the elderly are multiple. Twenty-minute, three-times-a-day raised-leg exercises were significantly more effective in the management of leg edema due to venous stasis (P < 0.0001) but did not produce significant differences in other etiologies such as heart failure, drug induced, and other conditions, which include lymphedema, prostate and ovarian CA, and postphlebitic syndrome. Successful management of leg edema is based on adequate and thorough assessment to identify the cause.
Acute Effect of Glyceryl Trinitrate on Systolic Blood Pressure and Other Hemodynamic Variables
Authors: Kawakami Hideo , Sumimoto Takumi , Hamada Mareomi , Mukai Mikio , Shigematsu Yuji , Matsuoka Hiroshi , Abe Mitsunori , Hiwada Kunio 
Published: July 2008

The acute effect of glyceryl trinitrate (GTN) is mainly the reduction of systolic blood pressure (SBP) rather than diastolic blood pressure (DBP). To examine the mechanisms for decrease in SBP by GTN, the authors measured arterial compliance (AC), cardiac output (CO), stroke volume (SV), pulmonary capillary wedge pressure, right ventricular end-diastolic pressure, right atrial pressure, and left ventricular end-diastolic pressure before and after administration of GTN. Fourteen patients who underwent cardiac catheterization were included in this study The change of each variable was estimated by the differences between values just before and at three minutes after GTN. After administration of GTN, SBP was significantly decreased from 158 ±21 to 138 ±12 mmHg (P < 0.01). AC was significantly increased, and pulmonary capillary wedge pressure, CO, and SV were significantly decreased. The change in SBP was inversely correlated with the change in AC and positively correlated with the change in CO or SV The authors conclude that the mechanism for decrease in SBP by GTN is associated with both an increase in AC and a decrease in venous return.
Effect of Lipid-Lowering Treatment on Progression of Atherosclerotic Lesions—a Duplex Ultrasonographic Investigation
Authors: Caruzzo Carlo , Liboni William , Bonzano Alessandro , Bobbio Marco , Bongioanni Sergio , Caruzzo Enrico , Civaia Filippo 
Published: July 2008

The Prevenzione Aterosclerosi Studio Torino (P.A.S.T.) was a prospective, randomized trial testing the effect on carotid and femoral atherosclerotic lesions of lipid-lowering therapy, as assessed by duplex scanning (DS) technique, in 85 patients (12 women, 73 men), forty-five to fifty-five years old, with ischemic heart disease (IHD), and randomly assigned to a hypolipidemic diet or diet + 250 mg acipimox (a nicotinic acid compound) two to three times/day. Forty-one patients, without inclusion criteria, were compared with the randomized groups as a reference population. All three groups were submitted to DS and to hematic monitoring of lipid levels at the beginning and at the end of the study. During three years of treatment, there was a significant reduction (-6.5%) in total plasma cholesterol in the diet+drug group (P=0.04) and a simultaneous elevation of high-density lipoprotein cholesterol, significant in the treatment groups (respectively, + 15% P=0.02 in the diet and +16% P=0.016 in the diet+drug group). Every group showed a trend toward the increasing number of lesions in all explored areas and toward the progression in size of the already existing ones. Whereas in the initial DS the prevalence of lesions was significantly lower in the nonrandomized group in every site, at the end of the study the total number of lesions did not differ among groups, and there was a significant increase of plaques in carotid area in the nonran domized group in comparison with the treatment groups. (continued on next page) The final number of stable plaques was greater in the treatment groups as compared with the nonrandomized group (P=0.01 diet vs nonrandomized, P=0.03 diet+drug vs nonrandomized). In conclusion, lipid-lowering treatment, with diet and with diet+drug, was useful in slowing the natural progression of atherosclerosis; particularly, it reduced the develop ment of new lesions in the carotid and femoral arteries and increased the stability of the already existing ones. In these patients, diet was equivalent to diet+drug in regard to progression of lesions. The most favorable results in the treatment groups seem to correlate with high-density lipoprotein cholesterol, significantly increased in comparison with the nonrandomized group.
Functional Lymphatic Alterations in Patients Suffering from Lipedema
Authors: Bilancini Salvino , Lucchi Massimo , Tucci Sandro , Eleuteri Pietro 
Published: July 2008

Lipedema is a chronic vascular disease almost exclusively of female sex, characterized by the deposit of fat on the legs, with an "Egyptian column" shape, orthostatic edema, hypothermia of the skin, alteration of the plantar support, and negativity of Stemmer's sign. The etiology and pathogenesis of this disease are still the object of study, and therapy is very difficult. Various authors have described morphologic and functional alterations of prelym phatic structures and of lymphatic vessels. The big veins remain untouched in the phlebograms and an alteration of the skin elasticity is demonstrated. The present authors have studied by dynamic lymphoscintigraphy 12 women patients suffering from lipedema, and compared the results with those of 5 normal subjects and 5 patients suffering from idiopathic lymphedema who were sex and age matched with the patients suffering from lipedema. The patients suffering from lipedema showed an abnormal lymphoscintigraphic pattern with a slowing of the lymphatic flow that presented some analogies to the alter ations found in the patients suffering from lymphedema. A frequent asymmetry was also noticed in the lymphoscintigraphic findings that is in contrast to the symmetry of the clinical profile.
Acute Myocardial Infarction Shortly After a Normal Exercise Stress Test
Authors: Capezzuto Aldo , Achilli Augusto , Pontillo Daniele , Sassara Massimo , De Spirito Stefano , Guerra Roberto 
Published: July 2008

The authors describe 3 cases of AMI occurring shortly after a negative bicycle ergometer stress test. These cases represent an unfortunate but extremely rare complication of a relatively safe diagnostic procedure. The authors also focus on the pathogenesis of the ischemic event, which may be attributed either to intraplaque hemorrhage or to platelet aggregation, both exercise- induced. The prevalence of AMI in this paper (0.06%) is similar to the data described in literature.
Analytic Isocenter Calibration
Authors: Wunderlich Werner , Fischer Frank , Linderer Thomas , Kirkeeide Richard L. 
Published: July 2008

Isocenter calibration transforms cardiac structures in digitized biplane angiograms to absolute dimensions, calculating their radiological magnification and video transforma tion. Since a scaling device is not required, isocenter calibration yields to more accurate measurements than the widely used reference object calibration. Both isocenter methods reported so far, regarding geometrically inaccurate x-ray gantries, yield to different and complex computational formulas. Since these formulas are hard to understand, isocenter calibration is less widely used. To facilitate the implementation of the isocenter calibration, the basic formulas for accurate x-ray gantries are derived. Shifting virtually one x-ray system onto the other, basic isocenter calibration is derived geometrically in three simple steps. The radiological magnification of an object is illustrated as a ratio of planes. The calculation of all para- meters entering the computations is demonstrated geometrically, by use of the isocenter of the x-ray gantry. The derivation gives a clear idea of isocenter calibration. It is simple to derive and facilitates the understanding of the error regarding developments. When geometrical inaccuracies vanish, all formulas become equivalent. However, even if the inaccuracies increase, all methods provide nearly identical results, indicating the robustness of isocenter calibration.
In Vivo Ultrasonic Parametric Imaging of Carotid Atherosclerotic Plaque by Videodensitometric Technique
Authors: Mazzone A.M. , Urbani M.P. , Picano E. , Paterni M. , Borgatti E. , De Fabritiis A. , Landini L. 
Published: July 2008

Extensive experimental and clinical data show that the ultrasonic image conveys infor mation on the biochemical composition of the atherosclerotic plaque, ie, the relative content of lipids (hypoechoic), fibrous tissue (hyperechoic), and calcific deposits (very echogenic with shadowing). A more dishomogeneous echo structure of the plaque is also more often associated with clinically complicated carotid plaques. To date, however, the assessment of plaque density and homogeneity by transcutaneous B-mode imaging remains subjective and qualitative. The aim of this study was to assess whether plaque echodensity and homogeneity might be established on a more objective and quantitative basis by description of the spatial distribution of echo amplitude (referred to as tissue texture) applied to digitized images, obtained with commercially available B-mode transcutaneous imaging systems. A total of 47 B-mode images derived from echotomographic studies in 10 patients were digitized off line. For each region of interest, a set of first-order (mean gray level, standard deviation, skewness, kurtosis: mathematical descriptors of the shape of the frequency distribution of gray-level histogram) and of second-order (entropy, angular moment: mathematical descriptors of the spatial distribution of gray levels within the region of interest) textural parameters were evaluated. The visual, concordant reading by two independent, experienced observers assigned the plaques on the basis of qualita tively assessed echodensity to three groups: "soft" (n = 18), "fibrotic" (n = 20), "calcific" (n = 9). Regarding spatial gray-level distribution, 46 plaques would be separated into "homogeneous" (n = 17) and "dishomogeneous" (n = 29). On digitized images, the normalized mean gray level was the most effective first-order textural parameter for distinguishing soft (24.2 ± 12.4 arbitrary units in a zero to 255 scale) from fibrotic (64.5 ±16.4) and calcific plaques (125.3 ±24.5), P<0.01 for all intergroup differences. "Homogeneous" plaques were separated from "heterogeneous" ones on the basis of entropy (5 ±1 vs 7.9 ±9.7; P<0.01), whereas the values of angular second moment overlapped (1.542E-3 + 1.334E-3 vs 5.181E-4 ±2.5615E-4, P = ns). In conclusion, quantitative texture analysis of ultrasonic images derived from tran scutaneous, high-resolution, commercially available B-scan systems is feasible in man and provides a quantitative operator-independent assessment of plaque echodensity and homogeneity.
Coronary Artery Aneurysms Develop in Weanling Rabbits with Serum Sickness But Not in Mature Rabbits
Authors: Onouchi Zenshiro , Ikuta Kouji , Nagamatsu Kazukiyo , Tamiya Hiroshi , Sakakibara Yoshimine , Ando Mineko 
Published: July 2008

The involvement of the cardiovascular system in rabbits with serum sickness is similar of that in Kawasaki disease, both with respect to the histologic changes of the myocardium, the valves, the coronary arteries, and the aorta and to the sequence with which they appear. Although coronary arteritis appears the same histologically, aneurysms did not occur in mature rabbits, even in case of necrosis of an arterial segment with deletion of muscle and elastic tissue. On the other hand, weanling rabbits with serum sickness had a tendency to develop aneurysms of coronary arteries, despite little cellular infiltration and reactive fibrocellular hyperplasia. The age factor thus appears to play an important role in the development of coronary aneurysms in Kawasaki disease, irrespective of the underlying mechanism, be it a markedly increased permeability to mediators through degenerated endothelial cells, or primary degenerated muscle cells with marked thinning of the media without much inflammatory cellular reaction. Furthermore, this study provides an insight into the long-term prognosis of transient dilatation of coronary arteries in the acute stage of Kawasaki disease.
Relation of Hematocrit Values to Coronary Heart Disease, Arterial Hypertension, and Respiratory Impairment in Occupational and Population Groups of the Athens Area
Authors: Goubali A. , Voukiklaris G. , Kritsikis Sp. , Viliotou F. , Stamatis D. 
Published: July 2008

Hematocrit values (Hct) were studied in relation to clinical and electrocardiographic (ECG) manifestations of coronary heart disease (CHD), arterial hypertension (AH), and respiratory impairment (RI) in 2901 adults (2033 men, 868 women) thirty to seventy years old, who comprised selected groups of large occupational (8611 workers) and population (5573 individuals) samples of the Athens area. The results of this study were as follows: 1. The women of the population sample with high Hct values had a significantly greater frequency of CHD (14.6%) as compared with women of the same sample with low Hct values (7.4%) (χ2=12.778 P < 0.005). 2. Subjects of both sexes in the population sample with high Hct values had signifi cantly higher mean levels of systolic and diastolic blood pressure as compared with subjects of the same population sample with low Hct values (F:4.61, P < 0.01). 3. In the women of the population sample with RI, the mean Hct values were signif icantly higher than those in the normal population (t:1.994, P < 0.05). It is concluded that high Hct values as an indirect measure of increased blood viscosity seem to be related to CHD and AH. Moreover, RI is correlated with high Hct values.
Vasomotor Effects of Transcutaneous CO2 in Stage II Peripheral Occlusive Arterial Disease
Authors: Savin Etienne , Bailliart Olivier , Bonnin Philippe , Bedu Mario , Cheynel Jean , Coudert Jean , Martineaud Jean-Paul 
Published: July 2008

Vasomotor effects of skin exposure to carbon dioxide (CO2) have been described in normal subjects. It was of interest, therefore, to determine whether percutaneous CO2 is of therapeutic benefit. In a randomized, double-blind study, 10 patients with lower limb arteriopathy (stage II) were investigated before and after local exposure for twenty minutes to CO2-rich spa gas or to water-vapor-saturated air at the same temperature as that CO2 -rich spa gas. Brachial and femoral blood flows, brachial and posterior tibial artery pressures, heart rate, and chest and foot transcutaneous oxygen tensions (tcPO2) were determined. Femoral blood flow, tibial pressure, and foot tcPO2 were significantly increased after exposure of the skin to CO2-rich spa gas. This effect was not accompanied with systemic hemodynamic modifications. Water-vapor-saturated air had no effect. These results suggest that transfer of CO2 across the skin can have beneficial local vasomotor effects in patients with lower limb stage II arteriopathy.
Wall Thickening of Common Carotid Arteries in Patients Affected by Noninsulin-Dependent Diabetes Mellitus: Relationship to Microvascular Complications
Authors: Visonà Adriana , Lusiani Luigi , Bonanome Andrea , Beltramello Gianpietro , Confortin Loris , Papesso Barbara , Costa Franco , Pagnan Antonio 
Published: July 2008

This study evaluates the wall thickness of common carotid arteries and the atherosclerotic involvement of the carotid bifurcations in patients with noninsulin-dependent diabetes mellitus (NIDDM), with and without microvascular complications. Seventy subjects affected by NIDDM, and 17 healthy controls were evaluated by means of high-resolu tion echo-Doppler scan. Twenty-six diabetics (Group A) had complications (overnight proteinuria > 500 mg, background retinopathy, sensory neuropathy), while 44 (Group B) had no complications. The two groups were comparable for age, sex, plasma lipid profile, and smoking habit. Arterial hypertension was present in 15 of 26 (58%) complicated patients (Group A) and in 18 of 44 (41%) uncomplicated patients (Group B). None of the patients had a history of cerebrovascular disease. The authors found that the wall thickness of the common carotid artery was greater and atherosclerotic lesions of the carotid bifurcation were more frequent in diabetic patients with microvascular complications than in uncomplicated diabetics (who had a similar distribution of other risk factors for atherosclerosis) and in nondiabetic controls. These data on the one hand confirm the role of diabetes as an independent risk factor for carotid atherosclerosis and, on the other hand, indicate a correlation between microvas cular lesions and early atherosclerosis in diabetes.
Alteration of Left Ventricular Filling Evaluated by Doppler Echocardiography as a Potential Marker of Acute Rejection in Orthotopic Heart Transplant
Authors: Pellicelli Adriano Maria , Barba Cosial Joaquin , Ferranti Edoardo , Gomez Arturo , Borgia Maria Clotilde 
Published: July 2008

To evaluate the changes in left ventricular (LV) filling associated with acute cardiac rejection, serial Doppler echocardiographic (ED) examinations were performed on the same day as endomyocardial biopsy (EMB) in 40 patients who underwent orthotopic transplantation. The diameters and wall thickness of the left ventricle were measured. The indexes of LV filling in the following parameters were measured by pulsed Doppler: isovolumic relaxation time (IRT), peak early mitral flow velocity (V max E), and pressure half-time (PHT). The patients were classified into three groups on the basis of EMB: Group I (19 patients without rejection), Group II (11 patients with mild or moderate rejection), and Group III (10 patients with severe rejection).In Group III rejection was associated with a significant increase of posterior wall thickness (P < 0.05), with a decrease of IRT (P < 0.05), and an increase of V max E velocity (P < 0.01) in comparison with Group I. In Group II, Doppler indexes were not statistically significant in comparison with Groups I and III.In conclusion, in transplant patients, a diagnosis of acute cardiac rejection can be suspected in severe rejection by use of echocardiography when the diagnosis is based on a multiparametric evaluation of different ED indexes (m-mode and Doppler indexes). Doppler echocardiography is a method with an excellent specificity but insufficient sensitivity ; this is due to the influence of recipient atrial contraction timing on Doppler indexes of LV filling.