bluuebunny/crossref_metadata_2025_split huggingface dataset:
Current Therapy of Peripheral Obstructive Arterial Disease. The Non-Surgical Approach
Authors: De Felice Maria , Gallo Pasquale , Masotti Giulio 
Published: November 2007

In recent years double-blind trials have proved the effectiveness of nonsurgical therapy in the treatment of peripheral obstructive arterial disease (POAD). Among the non-pharmacologic measures taken, walking distance was increased by 40% in subjects who stopped smoking and by more than 100% in those who undertook physical exercise. Drug treatment reduces the atherosclerotic process and brings about an improvement in the symptoms of the disease. In subjects given hypolipidemic treatment the progression of the disease was reduced by two thirds. Two separate studies suggest that antiplatelet drugs, taken over a period of two to four years, significantly slow the progression of atherosclerosis in lower extremity arteries. In the treatment of claudication, two vasodilating drugs, naftidrofuryl and buflomedil, have shown a significant improvement in painfree walking distance and/or total walking distance, compared with treatment with placebo. Another effective approach is in the treatment of blood rheology through drugs such as pentoxifylline or by hemodilution. Double-blind trials with pentoxifylline demonstrated an average increase of 66% in maximum walking distance as compared with 22% with placebo. The effectiveness of hemodilution was demonstrated by two controlled trials, during which the reduction of the hematocrit to values of 40-42 for periods of four to six weeks increased both walking distance and resting blood flow. When introduced intraarterially in low doses in the vicinity of the occluding thrombus, thrombolytic agents have been found to be helpful in the treatment of acute and chronic POAD. This therapy should, however, be regarded as a substitute for surgical treatment only in highrisk patients. Further, after having produced the lysis of thrombi, the treatment permits the underlying parietal lesions to be accurately identified; at this point the appropriate therapy can be decided upon, either an operative procedure or a balloon dilation. In conclusion the many controlled clinical trials carried out over the past few years have clearly demonstrated that conservative treatment can alleviate clinical signs and symptoms in patients with claudication and pain at rest.
Calcium Antagonists: Pharmacologic Agents in Search of New Clinical Indications
Authors: Gasser Robert 
Published: November 2007

The broad availability of new pharmacologic agents is usually followed by both the search for similar compounds with more specific and refined actions and the expansion of clinical applicability for these agents. During the last twenty years extensive investigations have revealed that calcium (Ca) antagonists hold a multifaceted pharmacodynamic potential that includes not only the antiarrhythmic and antihypertensive effects of the drug but also the protection against excessive Ca entry into the cells of the cardiovascular system and subsequent cell damage. The physiologic age-dependent Ca accumulation in the arterial wall, which inevitably appears after the second decade, reaches maximal values in the age group of eighty-one to ninety years when the aortic wall exhibits a total Ca content that is 100 times higher than in arteries of infants. In animals we also find age-dependent accumulation of Ca in the arterial wall that is severely aggravated by uncontrolled diabetes or hypertension. Fleckenstein has shown that this arterial calcinosis can be prevented by chronic administration of Ca antagonists. Furthermore, Fleckenstein has demonstrated that excessive Ca overload of myocardial tissue constitutes a basic pathologic process in the development of cardiac necroses—brought about by extreme beta-adrenergic drive (overdoses of catecholamines), high doses of vitamin D3, dihydrotachysterol, alimentary factors such as K or Mg deficiency, or genetic defects (hereditary cardiomyopathy). Even cardiac hypertrophy, either idiopathic or as a consequence of hypertension, can be prevented by the action of Ca antagonists. In addition, the uncontrolled Ca entry into the cell constitutes an important etiologic factor in microstructural impairment of the myocytes due to ischemia—hence Ca antagonists are successfully used as cardio-protective agents in cardioplegic solutions. More recently the tissue-protection action of Ca antagonists has also been proven to be effective in renal transplantation and inhibition of toxic liver injury. It can be concluded that Ca antagonists have an antiatherosclerotic, anticalcinotic, and tissue-protective potential that opens a wide spectrum of applications both prophylactic and therapeutic, especially in the cardiovascular field.
Hyperbaric Oxygen Therapy in Chronic Vascular Wound Management
Authors: Wattel F. , Mathieu D. , Coget J.-M. , Billard V. 
Published: November 2007

Many nonhealing tissues are hypoxic, with oxygen tensions frequently ranging from 5 to 15 mmHg. In such an environment, the normal wound healing sequence is disrupted or halted and phagocytic killing activity depressed. So the adjunctive use of hyperbaric oxygen (HBO), based on physiologic data and clinical observations, can provide the substrate necessary to initiate and sustain the healing process. During a twelve-month period, 20 patients with a nonhealing wound were referred to the hyperbaric center : chronic arterial insufficiency ulcers in 9 cases, diabetic wounds (foot lesions) in 11 cases. Adjunctive HBO therapy, initiated twice a day, consisted of pure oxygen, 2.5 ATA, 90 min. The average length of sessions was 46 (15-108). Complete healing was observed in 15 of 20 cases. The wound management can be helped with the transcutaneous oxygen measurements under hyperbaric oxygen. The distal TCPO2 at 2.5 ATA pure oxygen is a reliable test to predict final outcome (healing or no change), when these values were not different in normal air and in normobaric oxygen: Distal No TCPO2 Healing Change air 32 ± 31 NS 12 ± 4 1 ATA O2 75 ± 70 NS 18 ± 10 2 ATA O2 635 ± 388 p = 0.003 45 ± 20 In hyperbaric oxygen therapy, when the distal TCPO2 value was inferior to 100 mmHg, all patients showed either no improvement or aggravation, and when the value was higher than 100mmHg, wound healing was achieved with all patients.
Transcranial Doppler Monitoring During Percutaneous Transluminal Aortic Valvuloplasty
Authors: Karnik Ronald , Valentin Andreas , Bonner Gerhard , Ziegler Bert , Slany Jörg 
Published: November 2007

Cerebral blood flow was studied in 12 elderly patients with severe calcific aortic stenosis by means of transcranial Doppler sonography (TCD) during percutaneous transluminal aortic valvuloplasty (PTAV). In 8 of these 12 patients duplex sonography revealed a stenosis of the internal carotid artery (ICA) exceeding 50%. Frequency spectra of 10 patients showed a satisfactory quality and were analyzed. In 7 subjects balloon inflation was well tolerated and systolic blood pressure did not drop below 75 mmHg. In these patients, whether they had a stenosis of the ICA or not, blood flow velocity in the middle cerebral artery (MCA) did not decrease to a critical level. The authors defined "critical" as a reduction of mean blood flow velocity in the MCA exceeding 50% or a decrease below 35 cm/sec. Three patients showed a rapid decrease of systolic aortic pressure below 75 mmHg. In these subjects mean blood flow velocity in the MCA dropped to levels below 35 cm/sec. Deflation and retraction of the balloon resulted in a rapid increase of systemic blood pressure and flow velocity in the MCA. This report demonstrates TCD to be a useful monitoring method of determining residual perfusion in patients with aortic stenosis during PTAV.
Detection of the Spatial Distribution of Late Potentials by Body Surface Mapping Using Forty-Five Unipolar, Leads
Authors: Nakai Kenji , Syobuzawa Minoru , Itoh Chuichi , Miyakawa Tomohisa , Kato Masataka , Onishi Tetsu , Kasanuki Hiroshi , Hosoda Saichi 
Published: November 2007

For evaluating the spatial location of late potentials (LPs), the authors designed a new system for the body surface mapping of signal-averaged, filtered ECGs using forty-five thoracic unipolar leads (5 x 9 array). The signals from patients with old myocardial infarction (MI,N = 7) and arrhythmogenic right ventricular dysplasia (ARVD, N = 1) were amplified and passed through a bandpass (100-300 Hz) filter. The departure maps, LP isopotential maps, and LP30 area maps were generated and superimposed. The LP30 duration was determined as the section between the filtered QRS endpoints and points thirty milliseconds (ms) before. Isopotential maps of the LPs showed distinct positive and negative regions. In 7 cases with MI, the extreme was related to the zones indicated by the departure maps, and the LP30 area maps also corresponded to the departure areas. In 1 case of ARVD, endocardial fragmented activity directly recorded at the right ventricle closely corresponded with the region on the LP30 area map. In conclusion, body surface LP isopotential maps and LP30 area maps may provide useful information concerning the spatial distribution of endocardial fragmentation.
Use of IV Radionuclide Total Body Arteriography To Evaluate Arterial Bypass Shunts—A New Method— A Review of Several Cases
Authors: Yang David C. , Uday Jain Chandra , Patel Devayani , Gould Lawrence , Schaefer Harold , Maghazeh Paul , Giovanniello Joseph 
Published: November 2007

Currently, Doppler ultrasound and contrast angiography are the main imaging procedues being used to evaluate arterial bypass shunts. IV radionuclide total body arteriogra phy (TBA) is another useful imaging procedure for evaluation of bypass shunts. The authors reviewed 33 patients, 19 women and 14 men, ranging in age from forty-three to eighty-five, who had TBA done after arterial bypass surgery. Ten patients had multiple shunts and 5 had multiple follow-up studies. In total there were 80 shunts, including 43 femoropopliteal, 16 axil lofemoral, 1 axillopopliteal, 13 cross over femorofemoral, and 7 aortofe moral shunts. Sixty-two of the 80 shunts were patent, 14 were oc cluded, and 4 had partial occlusion. The results were confirmed by Dop per studies, contrast angiograms, an d/or surgical exploration without false positives or false negatives. Since the radiotracer used was 99mTc labeled red blood cells, a MUGA study can also be performed immedi ately following TBA in the same in jection. Twenty-eight patients had gated cardiac blood pool studies (MUGA) done; 16 had abnormal wall motion and diminished ventricular function. TBA requires only a single IV in jection of radiotracer (less than 1 cc) in the upper limb. The imaging times for total body arterial and perfusion images are seventy seconds and five minutes respectively. Both total body arterial and per fusion images clearly demonstrated the entire course of shunts (single or multiple); underlying and coexisting arterial abnormalities, e g, occlusive disease (27 patients), or aneurysm (3 patients); and related perfusion changes in the extremities. TBA has unique features. It permits a com plete, excellent visualization of the bypass graft without the hazard of contrast media injection. It is a sim ple and a virtually noninvasive proce dure, particularly useful for preoperative workups and post operative follow-ups.
Use of Doppler Flow Velocity Waveform Analysis in Detection of Initial Diabetic Microangiopathy
Authors: Bernardi Daniele , Ferreri Andrea , Bartoli Paolo , Ieri Aldo , Russo Paolo Lo , Teloni Paolo , Bonechi Igino 
Published: November 2007

Doppler flow velocity waveform analysis (FVWFA), recorded from the dorsalis pedis artery (DPA) and the radial artery (RA), was performed on 36 women in attempting to detect an initial diabetic microangiopathy (DM). The study comprised two groups of women affected by non-insulin-depen dent diabetes mellitus, 6 patients (pts) of reproductive age (1), 12 pts in meno pause (II), and two groups of age-matched healthy controls (C) (III and IV). Clinical signs of initial DM were present in group I. All the examined pts were nonsmokers and normotensive and without cardiopathy, signs of diabetic macroangiopathy, collagen vascular disease and/or Raynaud's phenomenon, and renal failure. Four waveform dimensions capable of separating different degrees of periph eral obstructive arteriolar disease were determinated on velocity tracing and the results used in a single best discriminant equation. The resultant discriminant score (DS), derived by FVWFA on DPA, showed a highly accurate rate of separating the young pts with DM from both C and the pts in menopause without DM. Furthermore, the resultant DS was statistically not different in groups II, III, and IV. In conclusion, FVWFA on DPA, in this experience, has proved to be an accurate and sensitive method in the detection of initial DM.
Long-Term Evaluation of Indobufen in Peripheral Vascular Disease
Authors: Belcaro G. , De Simone P. 
Published: November 2007

Indobufen—an inhibitor of platelets aggregation—has been used in 306 pa tients with intermittent claudication due to peripheral vascular disease. Patients were treated and followed up for one year. One patient of every 3 treated with indobufen was treated with ASA, and a control group of patients receiving no treatment was also followed up. The authors studied by means of a treadmill exercise test the pain-free walking distance (PFWD), the global walking distance (GWD), and the recovery time after exercise. The treatment period was com pleted by 290 patients: 204 claudicants, 51 claudicants with diabetes, and 35 with a short PFWD and GWD (>150 m). Indobufen was more effective than ASA in improving the PFWD and GWD in all groups. There were also fewer side effects with indobufen, and cardiac morbidity and mortality was also reduced. In conclusion indobufen showed its activity and safety in chronic treatment of patients with peripheral disease, and we suggest that it may be used for long periods without side effects.
Circadian Blood Pressure Pattern in Patients with Treated Hypertension and Left Ventricular Hypertrophy
Authors: Klein Werner , Zweiker Robert , Eber Bernd , Dusleag Johann , Brussee Helmut , Rotman Brigitte 
Published: November 2007

Left ventricular hypertrophy in hypertensives is an important determinant of prognosis. In the present study 45 patients with treated essential hypertension were divided into two groups: 23 patients had normal left ventricular dimension and 22 patients had echocardiographic signs of left ventricular hypertrophy (LVH). All patients were adequately treated during daytime, but ambulatory blood pressure monitoring showed a distinct abnormal pattern in the LVH group characterized by a lack of blood pressure reduction during the night; 16 of 22 patients with LVH had no blood pressure decline during the night, whereas 17 of 23 patients without hypertrophy showed this reduction (P < 0.01). In conclusion, patients with hypertension and LVH often reveal a lack of blood pressure decline during the night, which may be the reason for the development of left ventricular hypertrophy (and thus should be managed by a different circadian blood pressure therapy) or which may be the consequence of progressive structural changes in the resistance vessels, along with the development of left ventricular hypertrophy. It is suggested that patients with hypertension and left ventricular hypertrophy should have ambulatory twenty-four hour blood pressure monitoring.
Transient Myocardial Ischemia During Holter Registration Before and After Coronary Angioplasty
Authors: Johansson Sten R. , Sánez Miguel , Emanuelsson HÅkan 
Published: November 2007

Purpose: Revascularizing procedures like percutaneous transluminal coro nary angioplasty (PTCA) aim at reducing the incidence and severity of myocardial ischemia. To evaluate this, continuous Holter ST analysis is a possible method. Design: 41 patients (35 men, 6 women) with stable angina pectoris had continuous twenty-four-hour two-channel Holter registration (V5/aVF -analogous leads) recorded before and after PTCA. Transient myocardial ischemia (TM) was defined as 0.1 mV ST depression or more 80 msec after the J point for one minute or more. Findings: PTCA was successful for 37 patients (90%). Eleven of these had a total of 53 episodes of TM, 36 (68%) before and 17 (32%) after PTCA (p<0.05). Fifteen episodes (28%) were symptomatic, and 38 (72%) were asymptomatic. Six patients had TM after successful PTCA, 5 of whom had one-vessel disease and a clinically uncomplicated course. One patient had multivessel disease, with only one vessel dilated. Follow-up angiograms for 9 of the 11 patients with TM revealed 5 restenoses. There was no significant correlation between TM after PTCA and subsequent restenosis (p>0.05). Implications: TM is common in patients with stable angina pectoris. The incidence significantly decreases after successful PTCA, but TM is seen also with a clinically uncomplicated course. In multivessel disease this is consistent with incomplete revascularization, whereas in single-vessel disease the most likely cause is intermittent spasm or thrombosis. TM after successful PTCA does not seem to be a predictor of restenosis.
Effect of Blood Glucose Level in Acute Cerebral Ischemia in Spontaneously Hypertensive Rats — Survival and Brain Pathology
Authors: Ibayashi Setsuro , Sadoshima Seizo , Ogata Jun , Yao Hiroshi , Okada Yasushi , Fujishima Masatoshi 
Published: November 2007

The present study was designed to examine the effect of blood glucose level on survival and pathologic changes of the cortical neuronal cells during and af ter three-hour incomplete cerebral ischemia, which was induced by bilateral carotid artery ligation in spontaneously hypertensive rats (SHRs). Blood glu cose levels were varied by intraperitoneal infusion of 50% glucose (hyperglyce mia) or insulin with hypertonic saline (hypoglycemia) or hypertonic saline (normoglycemia).None of the hyperglycemic or normoglycemic animals died during three-hour ischemia, whereas 45% of hypoglycemic animals died (p > 0.001). The survival rate for twenty-four hours after recirculation was in the following ascending order: hypoglycemia, normoglycemia, and hyperglycemia.Neither hypoglycemia nor hyperglycemia (38-392 mg/dL) in nonischemic animals developed any morphologic changes in the cerebral cortex. However, both the ischemic and recirculated brains showed various degrees of histologic changes such as shrinkage of the neuronal cells with cytoplasmic vacuoles, perineuronal edema, and swelling of neuropils. Such ischemic damage of the brain was more marked in hypoglycemic animals than in hyperglycemic or nor moglycemic ones during ischemia, as well as one hour after recirculation.The results suggest that cerebral ischemia and its outcome become more deleterious in hypoglycemic than in normoglycemic and hyperglycemic states. On the other hand, hyperglycemia is not necessarily a disadvantage in acute cerebral ischemia with or without reperfusion in this model.
The Influence of CLS 2210 on the Course of Myocardial Infarction: A Pilot Study in Man
Authors: Szlavy Laszlo , Repa Imre , Hachen Hans Jürg 
Published: November 2007

To assess the effect of CLS 2210 (a new formulation of calcium dobesilate) on the evolution of acute myocardial infarction, 100 patients presenting their first infarct were distributed, according to their sequential admissions to the hospital, into CLS 2210-treated group (50 patients) or a comparison group (50 patients not receiving CLS 2210). The two groups were similar in age, sex, predisposing factors, and site of infarction. Intravenous infusion of CLS 2210 was begun within six hours of onset of chest pain and continued for seventy-two hours. Thereafter, it was given, as oral capsules, in a dose of 1,000 mg every eight hours throughout the hospitalization. Before and during the trial, blood samples were drawn for the measurements of serum concentrations of creatine kinase (CK), and twelve-lead electrocardiograms (ECGs) were obtained serially in each patient. All objective data were analyzed on a coded basis without reference to the treatment. In the comparison group, thirty-six to forty-eight hours was required for CK to fall to 50% of the baseline value, whereas in the CLS 2210-treated group it reached 50% of the baseline in eighteen to twenty-four hours. For each infarction site, a statistically significant fall was reached earlier in the CLS 2210 group. CK, the ECG index, and the sum of the ST segments showed earlier and more rapid improvement in the CLS 2210 group than in the comparison group. The consumption of narcotic analgesic agents and nitroglycerin was substantially less in the CLS 2210 group than in the comparison group. Similarly, lidocaine infusion was employed for 1.2 ± 0.03 days in the CLS 2210-treated patients, whereas the comparison group received lidocaine for 5.7 ± 0.23 days because of continuing cardiac arrhythmias. The agent was well tolerated and no untoward side effects were recorded during the trial. The findings so obtained with CLS 2210, in this pilot study, could have important clinical implications in designing protocols for further trials.
Impedance Cardiography for Repeated Determination of Stroke Volume in Elderly Hypertensives: Correlation with Pulsed Doppler Echocardiography
Authors: Antonicelli Roberto , Savonitto Stefano , Gambini Claudio , Tomassini Pia F. , Sardina Marco , Paciaroni Enrico 
Published: November 2007

In this double-blind, crossover study the authors have validated stroke volume determination by impedance cardiography against the pulsed Doppler echocardiographic method in elderly hypertensives. They found a good correlation between the stroke volume values obtained by the two methods over a range of values from 30 to 130 mL. The coefficient of linear regression was about .95 at each visit. The mean of the differences was -0.73 mL with a standard deviation of 8.46. Given that individual differences are normally distributed, the values corresponding to 2 standard deviations of the mean define a range covering 95% of the observed differences. From the distribution of the data around the mean plot it appears that, in comparison with pulsed Doppler, impedance cardiography tends to slightly underestimate stroke volumes of >90 mL and to overestimate values of <50 mL. The results of this study indicate that impedance cardiography may represent a reliable alternative to pulsed Doppler echocardiography for the noninvasive estimation of cardiac output at rest in elderly patients.
Hemodynamic and Hemorheologic Effects of IV Dilevalol in Hypertensive Patients
Authors: Laghi Pasini F. , Pecchi S. , Guideri F. , DeFranco V. , Damiani P. , Galigani C. , Saletti M. , Verzuri M.S. , Blardi P. , Di Perri T. 
Published: November 2007

The authors evaluated the effect of Dilevalol infusion on blood pressure, heart rate, central hemodynamics, and rheologic parameters in hospitalized inpatients affected with mild or moderate hypertension. After a dose-finding phase and a washout period of one week, 10 patients aged fifty to seventy-two-years (median 61.5) were given either a single dose of Dilevalol 60 mg or placebo, and seven days later they underwent the other treatment, according to a single-blind, crossover design. Central hemodynamic measurements were performed by means of M-mode echocardiography, and hemorheologic parameters were evaluated by means of strain-gauge plethysmography. The maximal increase in lower extremity flow at rest had been obtained with the infusion of 60 mg Dilevalol during dose-finding, and so this dose was chosen for the second part of the study. The infusion of Dilevalol significantly increased rest flow and decreased blood viscosity, but the changes in central, parameters were not considered clinically relevant, although statistically significant. Blood pressure decreased without significant changes in heart rate. Thus, the acute administration of Dilevalol reduced blood pressure, without affecting heart rate and central hemodynamics, confirming the vasodilating effect of the drug. A significant improvement was also shown on blood viscosity in these hypertensive patients.