bluuebunny/crossref_metadata_2025_split huggingface dataset:
Thrombogenesis in Mitral Regurgitation and Aortic Stenosis
Authors: Lip Gregory Y. H. , Rumley Ann , Dunn Francis G. , Lowe Gordon D. O. 
Published: July 2008

The exact mechanisms for thrombus formation in patients with valvular heart disease have not been clearly defined. Abnormalities in plasma coagulation factors indicative of a prothrombotic state may in part account for the risk of stroke and thromboembolism in such patients. The aim of this study was, therefore, to determine the effects of mitral regurgitation (MR) and aortic stenosis (AS) on plasma fibrinogen or fibrin D-dimer levels as indices of a thrombogenic (or prothrombotic) state. A total of 25 patients with valve disease in sinus rhythm were studied: 12 patients (all women; mean age fifty-five years, sem 3.3) with MR; and 13 patients (7 men, 6 women; mean age fifty-seven years, sem 3.5) with AS were studied. Patients with MR had a median plasma fibrinogen that was significantly elevated when compared with female population values (median difference 0.62 g/L; 95% confidence intervals (CI) 0.27 to 1.05, P = 0.0016). However, these patients had a median plasma fibrin D-dimer that was lower than that for population controls (median difference 21 ng/mL; 95% CI 0 to 38, P = 0.05). Patients with aortic valve disease had a median plasma fibrinogen that was significantly increased when compared with population controls (median (continued on next page) difference 0.82 g/L; 95% CI 0.34 to 1.24, P = 0.001). These patients had a plasma fibrin D-dimer level that was similar to population values (median difference 3 ng/mL; 95% CI -25 to 22, P = 0.80). Patients with MR or AS have higher plasma fibrinogen levels when compared with "normal" population values, suggesting possible hemorheologic abnormalities in these patients. Subjects with MR had lower plasma fibrin D-dimer levels, suggesting lesser intravascular clotting, consistent with clinical echocardiographic studies. Subjects with AS had plasma fibrin D-dimer levels similar to the "normal" population values, suggestive of a different pathophysiological mechanism for thromboembolism. These findings add to an improved understanding of the relationship between clinical observations and the signif icance of plasma fibrinogen and fibrin D-dimer levels in thrombogenesis.
Efficacy of Daflon 500 mg in the Treatment of Lymphedema (Secondary to Conventional Therapy of Breast Cancer)
Authors: Pecking Alain P. , Fevrier Benoit , Wargon Caroline , Pillion Gérard 
Published: July 2008

To assess the activity of a purified, micronized, flavonoidic fraction (Dios; Daflon® 500 mg*) on upper limb lymphedema occurring after breast cancer therapy, a monocenter, randomized, double-blind, parallel group vs placebo (Plac) trial was carried out. One hundred and four women with lymphedema were included; 94 completed the study (46 Dios, 48 Plac). A subset of 24 patients with more severe lymphedema (10 Dios, 14 Plac) was subjected to a separate analysis. Treatment consisting of Dios or Plac was given two tablets daily over a six-month period. A radionuclide lymphoscintigraphy using technetium-99m was performed at inclusion and at the end of the treatment. The upper limb volume was measured every two months. In the overall population the evolution of parameters was not different between Dios and Plac. In the 24 patients with a more severe lymphedema, the lymphoscintigraphic parameters (m ±sd) were as follows: lymphatic migration speed was significantly improved by Dios in comparison with Plac (Δ Speed cm/minute: 0.84 ±0.6 vs 0.14 ± 0.26, P = 0.005). The half-life of the colloidal compound was significantly improved over time in the Dios group (Δ half-life = 10.3 ±13.07 minute, P = 0.034) but not in the Plac group (Δ half-life = 0.53 ±15.51 minute, P = 0.086). The change over time of colloidal clearance was close to significance in the Dios group (Δ clearance μL/minute: 2.18 ±3.10, P = 0.054) but not in the Plac group (0.11 ±2.26, P = 0.86). No significant difference was found for evolution of lymphedema volume, despite a tendency in favor of Dios. This can be related to wide distribution of volume values and small numbers of patients. ( continued on next page) In conclusion, these results suggest a beneficial therapeutic activity of Dios at the usual dose of two tablets/day in patients affected with more severe lymphedema. The clear improvement of the lymphatic speed illustrates its known lymphokinetic activity. Further studies with a higher dosage could confirm the beneficial activity of this drug in secondary lymphedema.
Is There Any Association Between Dissection After Successful Percutaneous Transluminal Coronary Angioplasty and Late Restenosis? An Angiographic Study
Authors: Övünç Kenan , Kabukçu Mehmet , Aksöyek Serdar , Kabakci Giray , Aytemir Kudret , Tokgözoğlu Lale , Özmen Ferhan , Ali Oto M. , Övünç Kenan 
Published: July 2008

Restenosis continues to be the most important limitation of percutaneous transluminal coronary angioplasty (PTCA). Many clinical, angiographic, and procedural variables are thought to be related to the development of restenosis. This study was aimed at investi gating the effects of no dissection, minor dissections, and major dissections on the long- term outcome of lesions after successful PTCA. The study group comprised 91 patients with 100 lesions who underwent successful PTCA and in whom follow-up coronary angiography was performed at 8.8 ± 7.2 (two to twenty-three) months after dilation. Dissections were classified according to the National Heart, Lung, and Blood Institute criteria. Restenosis was defined as more than 50% stenosis at follow-up angiography. Restenosis rates were found to be 22% in the no-dissection group (10 restenoses in 46 patients), 27% in the minor dissection group (11 restenoses in 40 patients), and 36% in the major dissection group (5 restenoses in 14 patients). The authors applied corrected Yates Chi-square test and no difference was observed in the restenosis rate between the group without any dissections and that with minor dissections (P > 0.05). However, a statistically significant difference was observed in the restenosis rate between the major dissection group and the other two groups (P < 0.05). The authors conclude that the occurrence of major dissections after successful PTCA may adversely affect the long-term outcome and may increase the restenosis rate.
Determinants of Exercise-Induced ST Segment Depression in Patients with Coronary Artery Disease: A Multivariate Approach
Authors: Papazoglou Nicolaos , Kalpoyiannakis Ioannis , Papazoglou Spyros , Papazoglou N.M. 
Published: July 2008

The purpose of this study was to delineate among the usually gathered parameters in an electrocardiographic exercise test the determinants of its positive outcome (ΔST↓≥ 1 mm measured at 80 msec from the J point). The authors studied 832 patients investigated with Bruce's exercise testing and with diagnostic coronary arteriography, all of whom were shown to have significant coronary artery disease (diameter stenosis ≥ 50%). Twenty-five demographic, clinical, electrocardiographic, exercise, and anatomic/hemo dynamic parameters were analyzed. The stepwise forward logistic regression analysis retained seven among them as significant independent predictors: four as positive contributors: (1) three-vessel and/or left main disease (P=0.0000), (2) Gensini's angio graphic score for disease extent (P=0.0025), (3) anginal pain during the test (P=0.0000), and (4) age (P=0.0031) and three as negative contributors: (1) resting heart rate (P=0.0004), (2) history of old myocardial infarction (P=0.0019), and (3) pathological Q waves at the resting ECG (P=0.0018). These findings establish standards that permit the prediction of the positive electro cardiographic exercise outcome in patients with significant coronary disease.
Postischemic Hyperemia in Subjects with Lower Limbs Obstructive Arteriopathy: Role of PGI2 and Endothelin
Authors: Pancera Paolo , Minuz Pietro , Rossi Luca , Ribul Mirco , Arosio Enrico , Lechi Alessandro , Pancera Paolo 
Published: July 2008

The physiological basis of postischemic hyperemia is not yet fully understood. The present study investigated the effects of pharmacologic manipulation of the prostaglandin system on local hemodynamics. Strain-gauge plethysmography was used to study 8 normal subjects and 9 patients with obliterating arterial disease of the lower limbs. Hemo dynamic evaluations were performed before treatment, after seven days of low-dose acetylsalicylic acid (100 mg/day) to inhibit platelet thromboxane synthesis, and after acute infusion of 1 g of acetylsalicylic acid to inhibit endothelial prostacyclin synthesis. In patients with arterial disease, the hemodynamic study was also carried out after infusion of iloprost, a synthetic prostacyclin analogue. Acute infusion of acetylsalicylic acid significantly reduced basal blood flow in normal subjects, but not in patients with arterial disease. In the latter group, iloprost affected neither basal nor maximal postischemic flow. The study also evaluated the role of endothelin in musculocutaneous hemodynamic regulation, both in physiological conditions and in atherosclerosis. This part of the study addressed the possibility that the hemodynamic effects of vasodilator prostanoids like prostacyclin might affect endothelin release in vivo. During reactive hyperemia, plasma endothelin was reduced in normal subjects (-1.02 pg/mL, 95% CI: -2.23, 0.08), but not in patients with atherosclerosis (-0.35 pg/mL, 95% CI: -1.45, 0.75). In both groups, plasma endothelin was not affected by aspirin. These findings confirm the role of prostacyclin in local hemodynamic regulation. In the normal subject, musculocutaneous blood flow seems to depend at least in part on the action of vasodilator prostanoids and endothelin. This is not the case in patients with arterial disease, in whom plasma endothelin does not seem to be affected by postischemic changes in blood flow. A possible explanation for this difference could be alteration of the endothelial function in patients with arterial disease, related to the functional and struc tural characteristics of the artery wall in atherosclerosis.
Physical Therapy Improves Venous Hemodynamics in Cases of Primary Varicosity: Results of a Controlled Study
Authors: Hartmann Bernd R. , Drews Bernadette , Kayser Thomas , Hartmann Bernd R. 
Published: July 2008

Physical factors are known to influence hemodynamics in the veins of the lower extrem ities. In a controlled, randomized study the authors investigated the effects of combined physical therapy on varicose veins. Over a twenty-four-week period a treatment group consisting of 12 persons exercised under the supervision of a therapist twice a week for sixty minutes. This included muscle and joint activation by means of externally applied compression and cold-temperature stimuli (ie, thermosteresis). They also exercised once a day without supervision for fifteen minutes. During the same period a control group of 12 persons underwent the same measurements but no treatment. In the treatment group venous capacity decreased by an average of 16% from 4.9 ± 0.3 (sd) mL/100 mL tissue to 4.1 ±0.4 (P < 0.005, U-test) while in the control group it remained practically unchanged at 4.8 ±0.4 vs 5.0 ±0.3. Venous refilling time in the lower extremities also increased in the treatment group, half refilling time rising from 7.8 ±1.0 to 11.3 ±0.9 seconds (P < 0.001) and total refilling time from 17.0 ±1.4 to 25.7 ±2.1 seconds (P < 0.001); these parameters remained virtually unchanged in the control group, with half refilling time dropping slightly from 7.7 ± 1.1 to 7.1 ± 1.3 seconds and total refilling time from 18.3 ± 1.7 to 16.3 ± 1.9 seconds. Patient self-rating scores obtained by use of a standardized questionnaire administered at baseline and at the end of week 24 improved in the treatment group only. The combined physical therapy was thus shown to be of long-term therapeutic value, improving venous function and reducing patients' symptoms. These findings indicate that for the further development of this combined treatment regimen it would be useful to identify the individual factors contributing to its efficacy and evaluate them separately.
Hypertension and Peripheral Arterial Disease: A Plethysmographic Study
Authors: Milio Glauco , Cospite Valentina , Cospite Michele , Milio Glauco 
Published: July 2008

Sixty patients suffering from arterial hypertension and/or obliterative arteriopathy of the lower limbs (20 hypertensive uncomplicated [H group], 20 normotensive affected by obliterative arteriopathy [A group], 20 suffering from both hypertension and peripheral arterial disease [HA group]) were studied, by strain gauge plethysmography, in compar ison with 20 healthy subjects (N group). The aims were to evaluate the arterial and venous hemodynamics of the lower limbs in such conditions and also to determine whether the vascular damage is primary or represents a consequence of the hypertensive pathology in the patients affected by both hypertension and peripheral arterial disease. The resting blood flow did not show significant differences in the mean values, even if lightly decreased in hypertensive patients (with or without peripheral arteriopathy). The peak flow was reduced significantly both in the H group and in the A and HA groups. The half-time (t½) and total time (tT), which indicate vascular reactivity, were signifi cantly decreased in the H group, but they were increased in the A and HA groups. Finally, the venous compliance was decreased in the H group, did not vary significantly in the A group, and showed an intermediate behavior in the HA group. These results suggest that hypertensive and arteriopathic patients develop similar arterial structural changes. However, they show a different behavior with regard to vascular reactivity and venous hemodynamics, as demonstrated by venous plethysmography.
Dipyridamole-Induced Angina Pectoris During Sestamibi Stress Test in Patients with Significant Coronary Artery Disease: Clinical, Angiographic, and Nuclear Determinants
Authors: Rosseel M. , Dendale P. , De Sadeleer C. , Schoors D. , Block P. , Franken P.R. , Rosseel M. 
Published: July 2008

Intravenous dipyridamole induces angina pectoris (AP) in some patients with significant coronary artery disease (CAD). The aim of this prospective study was to identify the angiographic, nuclear, and clinical determinants. The authors examined 50 patients consecutively with significant CAD on coronary angiography. All antiischemic medica tions were stopped twenty-four hours (nitrates only 6 hours) before injection of dipyri damole (0.84 mg/kg). ECGs were taken before, during, and after this injection. The regional myocardial activity of Tc-99m-Sestamibi at rest and after dipyridamole injection was measured with single-photon emission computed tomography (SPECT). During dipyridamole injection 20 patients had AP, of whom 15 had ST segment depression on ECG (P < 0.001). The only significant difference on coronary angiography between patients with dipyridamole-induced AP and those without AP was the presence of collaterals (P < 0.05). In patients with AP and collaterals, ECG and SPECT changes were always noted in the collateralized territory. Subgroup analysis showed that patients without previous myocardial infarction (MI, n=17, P < 0.05) or nontransmural MI (n=17, P < 0.05) had a good correlation between collaterals and AP, whereas patients with a history of transmural MI (n=16) did not. No further significant variables could be found as a predictor of AP after dipyridamole injection. These findings suggest that AP during dipyridamole stress test is due to ischemia, which is not related to the severity of CAD. Ischemia is probably due to coronary steal to the collateralized territory in patients without transmural MI. Dipyridamole-induced angina pectoris is predictive for collaterals and may indicate viability in patients with MI.
Viability After Myocardial Infarction: Can It Be Assessed Within Five Minutes by Low-Dose Dynamic Iodine-123-Iodophenylpentadecanoic Acid Imaging with a Multicrystal Gamma Camera?
Authors: Murray Gary L. , Schad Nikolaus , Bush Andrew J. , Murray Gary L. 
Published: July 2008

Although positron emission tomography (PET) assesses myocardial viability (V) accu rately, a rapid, inexpensive substitute is needed. Therefore, the authors developed a low- dose (1 mCi) Iodine-123-Iodophenylpentadecanoic Acid (IPPA) myocardial viability scan requiring analysis of only the first three minutes of data acquired at rest with a standard multicrystal gamma camera. Twenty-one patients > 2 weeks after myocardial infarction (MI) (24 MIs, 10 anterior, 14 inferoposterior, 21 akinetic or dyskinetic) had cardiac catheterization and resting IPPA imaging. V was determined by either transmural myocar dial biopsy during coronary bypass surgery (12 patients, 14 MIs) or reinjection tomo graphic thallium scan (9 patients, 10 MIs), and 50% of MIs were viable. The IPPA variables analyzed were: time to initial left ventricular (LV) uptake in the region of interest (ROI), the ratio of three-minute uptake in the ROI to three-minute LV uptake, three-minute clearing (counts/pixel) in the ROI (decrease in IPPA after initial uptake), and three-minute accumulation (increase in IPPA after initial uptake) in the ROI. Rules for detecting V were generated and applied to 10 healthy volunteers to determine normalcy. While three-minute uptake in nonviable MIs was only 67% of volunteers (P < 0.0001) and 75% of viable MIs, uptake alone identified only 50% of viable MIs and 75% of nonviable MIs. IPPA clearing, however, was ≥ 13.5 counts/pixel in 10/12 (83%) of viable MIs, and IPPA accumulation ≥ 6.75 counts/pixel identified one more viable MI, for a sensitivity for V of 11/12 (92%), with a specificity of 11/12 (92%), and a 100% normalcy rate. The authors conclude low-dose IPPA (five-minute acquisition with analysis of the first three minutes of data) has potential for providing rapid, inexpensive V data after MI. Since newer multicrystal cameras are mobile, IPPA scans can be done in emergency rooms or coronary care units, generating information that might be useful in decisions regarding thrombolysis, angioplasty, or bypass surgery.
Cold-Induced Acral Vasospasm in Migraine as Assessed by Nailfold Video-Microscopy: Prevalence and Response to Migraine Prophylaxis
Authors: Hegyalijai T. , Meienberg O. , Dubler B. , Gasser P. , Gasser Paul 
Published: July 2008

In order to learn the prevalence of cold-induced vasospasm in migraine patients, blood cell velocity measurements of finger nailfold capillaries were performed in 58 consecutive patients suffering from migraine with and without aura. In 5 (8.6%) patients capil laroscopy could not be performed because of reduced nailfold transparency; 21 of the remaining 53 patients (39.6%) showed blood flow stop due to vasospasm under cold provocation. There was no significant difference (P=0.69) in the occurrence of vasospastic reaction between migraine with (12 of 32 patients = 37.5%) and without (9 of 21 patients = 42.9%) aura. The clinical and capillaroscopic course under migraine prophylaxis was observed in 18 vasospastic patients. After sixteen weeks 14 patients showed good clinical improve ment of their migraine. The vasospastic reaction persisted in only 1 patient. This patient and 3 others with abolished vasospasm were still suffering from migraine. These findings suggest that observing blood cell velocity noninvasively in nailfold capillaries under cold provocation could be useful for objectively monitoring the response to prophylactic treatment in migraine patients or for testing new potentially antimigraine drugs.
Comparative Effects of Volume Loading on Pulmonary Venous Flow in Dogs with Normal Heart and with Myocardial Ischemia
Authors: Akita Sachie , Ohte Nobuyuki , Hashimoto Takeshi , Narita Hitomi , Kobayashi Kenji , Fujinami Takao 
Published: July 2008

The influences of cardiac loading conditions and left ventricular performance on pulmonary venous flow are poorly understood. The authors studied the effects of volume loading on the pattern of pulmonary venous flow in normal and ischemic hearts. Thirteen anesthetized dogs were equipped with a transit-time ultrasonic flow probe around the left upper pulmonary vein. In 6 of the dogs, the left anterior descending artery was ligated to induce myocardial ischemia. The remaining 7 dogs had normal hearts. Heart rate was fixed at 110 beats/minute by right atrial pacing. Dextran was infused from the femoral vein until mean left atrial pressure increased 3 mm Hg above the baseline value in both groups. In normal heart, systolic pulmonary venous flow volume (SI) increased significantly, but early diastolic flow volume (DI) did not show a significant change during volume loading. The ratio of SI/DI increased significantly (1.12 ±0.34 vs 2.11 ±0.49, P<0.05). After ligation of the left anterior descending artery, the SI and DI decreased significantly. The ratio of SI/DI did not show a significant change (0.88 ±0.32 vs 0.87 ±0.30, ns). In dogs with myocardial ischemia, volume loading caused increases in the SI and DI. However, no significant change was observed in the ratio of SI/DI (0.87 ±0.30 vs 0.97 ±0.36, ns). These findings demonstrate that left ventricular performance influences the alter ation in pulmonary venous flow pattern that is caused by systemic volume loading.
Experimental Model of Short-Time Exercise-Induced Preconditioning in POAD Patients
Authors: Capecchi Pier Leopoldo , Pasini Franco Laghi , Cati Graziella , Colafati Marcella , Acciavatti Angela , Ceccatelli Linda , Petri Silvia , de Lalla Arianna , Di Perri Tullio , Capecchi Pier Leopoldo 
Published: July 2008

Regular physical exercise improves walking performance in patients affected with periph eral obliterative arterial disease (POAD). The mechanisms underlying the phenomenon are still controversial. In order to verify the hypothesis that physical conditioning of lower limbs on a treadmill and ischemic preconditioning of the heart could share some biolog ical aspects, 14 POAD subjects underwent a training program on the treadmill consisting of five repeated submaximal exercises at five-minute and two-hour intervals preceding the maximal tolerance test. Moreover, a protocol with two daily submaximal walking exercises over one week was also performed. Pain-free and total walking distance were measured before and after they performed the program. Moreover, plasma levels of adenosine and adenosine triphosphate (ATP) were measured and polymorphonuclear (PMN) leukocyte activity was studied together with rheologic parameters.Pain-free distance was prolonged by 15.4% and 14.3%, and total distance was prolonged by 23.1% and 26.9%, in the exercises with five-minute and two-hour intervals, respectively. After one week of daily exercises, the onset of pain and the end of the test were delayed by 24% and 43.7%, respectively. An improvement in blood rheology and a reduced PMN reactivity were also observed with the three protocols, associated with an increase in plasma levels of adenosine and ATP.Similarly to ischemic preconditioning in the heart, the possibility is suggested that an adenosine-mediated mechanism may contribute to the development of physical condi tioning in treadmill-trained POAD patients.