bluuebunny/crossref_metadata_2025_split huggingface dataset:
Epidemiology of Chronic Venous Insufficiency
Authors: De Backer G. , De Backer G. 
Published: July 2008

In contrast to the knowledge on the frequency and determinants of arterial diseases, little epidemiologic research has been carried out on venous diseases; this may be partly due to methodological problems in defining chronic venous insufficiency and in measuring these conditions with sufficient validity. Epidemiologic studies that were published after 1965 and that are not based on clinical series are reviewed; prevalence and incidence rates are reported. Studies of risk factors for varicose veins have largely resulted in inconsistent results; the sex difference is universal while the large geographical differences suggest strong environmental influ ences. For all other determinants much of the variation between studies is probably related to differences in definition, in population-sampling techniques, and in assess ment methods. Several plausible etiologic theories on the causes and development of chronic venous insufficiency are supported or refuted by the epidemiologic studies. Further research is needed, whenever possible cross-cultural, with particular emphasis on clear definitions, valid methods, and a prospective study design.
The Socioeconomic Profile of Patients Treated by Phlebotropic Drugs in Germany
Authors: Uber Andrea , Uber Andrea 
Published: July 2008

Conservative treatment of venous disease is difficult. There is much skepticism concerning the efficacy of drugs in venous diseases. Nevertheless, in Germany, these drugs have obtained a substantial market share with a tendency to increase. The objective of this empirical study is to evaluate the socioeconomic characteristics of consumers of venous medications and to explore the demand elasticity with respect to health insurance coverage. In a first set of inquiries 12,500 households were asked from July to September 1993 if they had purchased prescribed venous medication during the past 12 months. About 10,000 households with 19,750 persons aged fifteen years and older responded; 2,080 (11%) of those persons had consumed prescribed medications against venous disease over the past twelve months. In the second part of the study a detailed questionnaire was sent to the 2,080 purchasers and to 3,000 randomly selected nonpurchasers; 1,930 (92.8%) purchasers and 2,291 (76.4%) nonpurchasers returned their questionnaire. The key findings can be summarized as follows: The percentage of women is much higher in the group of purchasers (80%) than in the group of nonpurchasers. Most of the purchasers are over fifty years old. Only one quarter of the purchasers are under fifty. One third of the purchasers are retired, and only 29% are working. In the group of nonpurchasers 56% are working and only 17% are retired. A comparison of the distribution of purchasers and nonpurchasers over income classes and education levels shows that higher income and higher education are less prevalent in the group of consumers of venous medica tions. Varicose veins (58%) and various leg complications (30%) and pain in the legs (30%) play a dominant role for applying venous medications. The analysis shows that pregnancy and chronic diseases are risk factors for venous diseases and are more prevalent in the purchasers group. We did not, however, discover a significant difference in the share of smokers, and it is quite low in the group of purchasers (14%). Only 45% of the purchasers feel that their venous disease has a negative influence on their spare- time activities, their family life, or their work. Purchasers consult a physician on the average 3.7 times a year; 40% of the managers, merchants, and self-employed craftsmen have no physician consultation at all. Owing to the pain and trouble of some complications of venous disease, only a rela tively low percentage of purchasers would react to a reduction of health insurance coverage of venous medications; 5% would stop buying these drugs and 22% would reduce consumption if they would have to pay the cost out-of-pocket.
Color Doppler Echocardiographic Evaluation of Tricuspid Regurgitation and Systolic Pulmonary Artery Pressure in the Full-Term and Preterm Newborn
Authors: Schmitz A.J. , Weinzheimer H.R. , Fahnenstich H. , Lê T.P. , Redel D.A. , Kowalewski S. , Schmitz Achim J. 
Published: July 2008

Color Doppler echocardiography of tricuspid valve regurgitation (TR) is a valid, nonin vasive method of determining systolic pulmonary artery pressure (SPAP). In a prospec tive study the authors examined 56 healthy full-term newborns (group I), 36 healthy preterm newborns (group II), and 10 preterm newborns with severe respiratory distress syndrome requiring surfactant replacement therapy (group III). Doppler studies were repeated until the transtricuspid gradient was <20 mm Hg. In 83.3% of children a reproducible spectral curve was recorded at least once. The authors estimated the transtricuspid gradient Δp(RV-RA) by using the modified Bernoulli equation. Within the first twenty-four hours p(RV-RA) was <20 mm Hg in 72.7%, 50%, and 25% of children with measurable TR in groups I, II, and III, respectively, increasing to 91.1%, 78.6%, and 55.6% within forty-eight hours. There was no significant correla tion between SPAP and gestational age, birth weight, mode of delivery, and ductal closing time. Continuous holosystolic envelope tracing of TR was recorded in 16.6%. In these patients Δp(RV-RA) was measured markedly higher (mean of 30.1 mm Hg) than in the others (mean 17.3 mm Hg). The authors conclude that there is a high prevalence of TR in neonates, which allows estimation of SPAP in >80% of newborns without considerable impairment. Normalization of SPAP takes place within four days in most patients, but there is a delay in preterm infants with severe respiratory distress syndrome.
Decreasing Common Carotid Artery Intimal Thickness During Hypolipidemic Therapy
Authors: Spáčil Jiří , Ceška Richard , Sobra Josef , Petrášek Jan , Spáčil Jiří 
Published: July 2008

It has been demonstrated in recent years that ultrasound can be used to measure common carotid artery intimal thickness; an increase in intimal thickness is regarded as an early stage of atherosclerosis. This study was designed to establish whether or not intimal thickness can be modulated by therapy. Twenty-nine patients with familial hyperlipoproteinemias had follow-up ultrasound of the common carotid artery after twenty-nine months of comprehensive therapy. In 21 patients with familial hypercholesterolemia, intimal thickness decreased from 0.83 to 0.68 mm (P<0.01), in 9 with familial combined hyperlipoproteinemia, the decrease was from 0.77 to 0.74 mm (a decrease was seen in only 50% of patients). With the group taken as a whole, the larger decrease was observed in patients treated with statins while the reduction was less marked in those administered fibrates. The authors found a decrease in common carotid artery intimal thickness following hypolipidemic therapy in patients with hyperlipoproteinemias. Their impression is that this was a manifestation of atherosclerosis regression.
Plasma Endothelin-1 Release in Normal and Varicose Saphenous Veins
Authors: Mangiafico Roberto Antonio , Malatino Lorenzo Salvatore , Santonocito Maurizio , Spada Rosario Sebastiano , Benedetto Francesco Antonio , Mangiafico R.A. 
Published: July 2008

The aim of the study was to investigate the release of endothelin-1 (ET-1) in normal and varicose saphenous veins at baseline and after venous stasis test. Ten patients (eight women and two men, mean age 43 ±4) with primarily varicose great saphenous veins and ten controls (eight women and two men, mean age 42 ±6) were recruited. After 30 minutes of resting in supine position, venous occlusion in a leg was performed with a sphygmomanometer provided to keep the pressure in the cuff intermediate between systolic and diastolic blood pressure for 10 minutes. Blood samples were taken from the great saphenous vein just above the medial malleolus at baseline and 10 minutes after venous stasis was begun. Plasma ET-1 was determined by a radioimmunoassay system. Results are expressed as mean ±SD. Plasma ET-1 concentration was higher in varicose than in normal saphenous veins (4 ±0.1 pmol/L vs 2.6 ±0.1 pmol/L, P<0.001), and it significantly increased (P<0.001) in both groups after venous stasis when compared with baseline (6.8 ±0.9 pmol/L and 3.6 ±0.1 pmol/L in varicose and normal saphenous veins, respectively). Absolute increase in plasma ET-1 was significantly greater in varicose than in normal saphenous veins (2.8 ±0.9 pmol/L vs 1.0 ±0.2 pmol/L, P<0.01). In conclusion, increased local ET-1 release in varicose saphenous veins could be a marker for venous endothelial activation/damage and/or contribute to promote the morphologic alterations of the varicose vein wall by stimulating smooth muscle cell prolif eration. On the other hand, increased ET-1 release could contribute to counterbalancing the varicose venous relaxation and to increasing preload in varicose patients via ET-1- induced venoconstriction.
Evaluation of Successful PTCA by Transstenotic Flow Velocity Ratios
Authors: Altstidl Robert , Regenfus Matthias , Lehmkuhl Hans , Dill Harald , Bachmann Kurt , Altstidl Robert 
Published: July 2008

Doppler probes mounted on the tip of a guidewire allow the measurement of coronary blood flow velocities, not only proximal but also distal to stenoses eligible for percuta neous transluminal coronary angioplasty (PTCA). The objective of this study was to determine the improvement of transstenotic Doppler flow velocity ratios following PTCA and to investigate the possible impact on restenosis during follow-up control angiog raphy three months later. Doppler flow velocity measurements were performed in 29 patients with 29 stenoses eligible for PTCA. Results of PTCA were morphologically evaluated by computer-assisted quantitative coronary angiography (QCA) and measured hemodynamically by deter mining transstenotic Doppler flow velocity ratios. Successful PTCA according to QCA was present in all cases with a reduction of mean diameter stenosis from 66 ±8% to 35 ±7%. Resting spectral peak velocities and velocity integrals were markedly reduced distal to lesions (all P<0.001), resulting in mean transstenotic flow velocity and velocity integral ratios of less than 0.60 prior to PTCA. Owing to endoluminal enlargement, significant improvement of transstenotic Doppler ratios was observed in mean ratios greater than 0.90 (all P < 0.0001 ) . In patients with restenosis, transstenotic ratios following PTCA demonstrated a tendency to be smaller than in patients without restenosis. Transstenotic Doppler flow velocity ratios are diminished in severe coronary stenoses. Improvement of these ratios provides information on hemodynamic success of interven tional procedures. Thus, the determination of intracoronary Doppler flow velocity ratios contributes, in additon to angiographic estimation, to the evaluation of stenoses severity and success of interventional procedures.
A Review of Erythromycin-Induced Malignant Tachyarrhythmia— Torsade de Pointes
Authors: Katapadi K. , Kostandy G. , Katapadi M. , Hussain K.M.A. , Schifter D. , Kostandy G. 
Published: July 2008

The term torsade de pointes refers to a ventricular tachycardia characterized by QRS complexes of changing amplitude that appears to twist around the isoelectric line and occurs at rates of 200-250/minute. Most cases of torsade de pointes are iatrogenically induced by drugs or electrolyte abnormalities. The most important feature is QT interval prolongation. Torsade de pointes was first described in 1966 in France by Dessertenne. The authors report a case of a fifty-year-old woman with medical history of corrective surgery for tetralogy of Fallot who was admitted to the hospital with pneumonia and atrial fibrillation and later developed recurrent episodes of polymorphic ventricular tachy cardia with QT interval prolongation after IV administration of erythromycin. The episodes did not recur after discontinuation of erythromycin, and the QT interval returned to normal. The association of erythromycin with torsade de pointes has been reported in 18 cases to date. Erythromycin has been shown to produce electrophysio logic effects similar to those of class Ia and class III antiarrhythmic drugs on the cardiac muscle. This potentially fatal complication of a commonly used antibiotic is rare, but increased physician awareness is important, especially in patients with predisposing factors like electrolytes abnormalities, use of class Ia and Class III antiarrhythmic drugs, and presence of prolonged QT interval (congenital prolonged QT syndromes). This is the second case reported in a patient with previous cardiac surgery and erythromycin administration.
Left Ventricular Diastolic Filling Dynamics During Isometric Exertion in Syndrome X Assessed with Doppler Flowmetry
Authors: Mizushige Katsufumi , Masugata Hisashi , Morita Hisaki , Senda Shoichi , Matsuo Hirohide , Mizushige Katsufumi 
Published: July 2008

To study left ventricular diastolic properties in syndrome X, we analyzed transmitral filling dynamics during handgrip exertion. In 14 normal subjects (N), 17 with syndrome X (Syn X), 16 with single-vessel disease (SVD), and 8 with multiple-vessel disease (MVD), transmitral inflow was recorded at baseline and during handgrip (50% of maximal effort for one minute) using pulsed Doppler echocardiography. We measured early diastolic (E) and late atrial (A) inflow velocities, A/E ratio and percent change of A/E from baseline (%A/E). Blood pressure and heart rate increased to the same degree in each group during handgrip. In normal subjects, E did not change with handgrip; A (51 ± 10 vs 54 ±11 cm/sec, P<0.05) and A/E (1.16 ±0.22 vs 1.25 ±0.33, P<0.05) increased minimally. In Syn X subjects, E decreased (51 ± 10 vs 38 ± 10 cm/sec, P<0.0001), A increased (52 ±11 vs 60 ±14 cm/sec, P<0.005), and A/E increased markedly (1.07 ±0.31 vs 1.68 ±0.51, P< 0.0001). The %A/E in Syn X and MVD were significantly larger than that in SVD and N (Syn X: 58 ±29%; MVD: 45 ±25%; SVD: 22 ±21%; N: 8 ±13%). Handgrip-induced changes in diastolic filling in syndrome X and are similar to those in MVD and more marked than in SVD. These changes are consistent with impaired ventricular relaxation and support a generalized left ventricular (LV) abnormality in syndrome X.
Aortic Dissection Decades Following Internal Carotid Artery Dissection
Authors: Schievink Wouter I. , Mokri Bahram , Schievink Wouter I. 
Published: July 2008

Recurrent dissections involving carotid, vertebral, or renal arteries have been described in patients with spontaneous cervical artery dissections, with a maximal interval between dissections of fourteen years. The authors describe 2 patients in whom aortic dissections developed twenty-five and forty years, respectively, following carotid artery dissections. These 2 patients constituted 8% of the total number of patients from Rochester, Minnesota, who were diagnosed with aortic dissection between 1987 and 1992. The first patient, a forty-five-year-old woman, presented in 1948 with right neck pain and headache, associated with several episodes of transient numbness of the right face and numbness and clumsiness of the left upper and lower extremities. Examination showed right miosis. Angiography showed a stenosis of the extracranial right internal carotid artery beginning several centimeters from the bifurcation. She died at age eighty- five from an aortic dissection. The second patient, a thirty-eight-year-old man, noted left orbital and frontotemporal headaches and drooping of the left eyelid in 1962. Examination showed left oculosympathetic palsy. Angiography showed stenosis and an aneurysm in the midportion of the extracranial left internal carotid artery. He died at age sixty-three from an aortic dissection. These cases suggest that following a carotid artery dissection the risk of a recurrent arterial dissection may remain elevated for a prolonged period of time and the recurrent dissection may involve the aorta.
Differentiating Syndrome X from Coronary Artery Disease by Treadmill Exercise Test in Patients with Chest Pain and Exercise-Induced Myocardial Ischemia
Authors: Hsu Nai-Wei , Chen Jaw-Wen , Jen Shu-Long , Kuo Benjamin Ing-Tiau , Lee Wen-Lieng , Mar Guang-Yuan , Lin Shing-Jong , Wang Shih-Pu , Chang Mau-Song , Chen Jaw-Wen 
Published: July 2008

Even though the underlying mechanisms of myocardial ischemia may be different, it is difficult to differentiate syndrome X from coronary artery disease (CAD) by means of the treadmill exercise test in elderly patients with chest pain and exercise-induced myocar dial ischemia. One hundred sex- and age-matched patients—42 with syndrome X and 58 with CAD—were studied. Another 10 subjects with atypical chest pain, negative treadmill exercise test, and normal-appearing coronary angiograms served as controls. We evaluated the difference in exercise performance between patients with syndrome X and CAD, and the treadmill exercise test was undertaken with modified Bruce protocol within 2 weeks before coronary angiography. Parameters including time to 1 mm ST segment depression (STD), exercise duration (ED), heart rate (HR), systolic blood pressure, rate- pressure product (RPP), and percentage of age-predicted maximum HR (% HR) at different stages of the test were measured and then compared among the three groups of patients. Compared with CAD patients, syndrome X patients had significantly higher HR, % HR, and RPP at the time of 1 mm STD and at peak exercise. The time to 1 mm STD and ED were longer in syndrome X than in CAD patients. However, ED was shorter and HR, % HR, and RPP at peak exercise were similar in syndrome X patients as compared with control subjects. The new criterion of combined ED (≥315 seconds) and RPP at peak exercise (≥24,000 beats x mmHg/min) was found to be highly specific (86%) and moder ately sensitive (64%) in differentiating syndrome X from CAD patients. The positive like lihood ratio for this criterion was 4.57 and negative likelihood ratio was 0.42. In conclusion, syndrome X patients had better exercise performance than CAD patients, but less ED and similar workload when compared with control subjects. The new criterion proposed in this study may provide a quick and simple way to differentiate syndrome X from CAD in a group of aged and predominantly male patients with chest pain and positive treadmill exercise test.
A Placebo-Controlled Study of the Effects of Intravenous Buflomedil on Foot Skin Microcirculation in Patients with Severe Intermittent Claudication
Authors: Van den Brande P. , Maurel A. 
Published: July 2008

Buflomedil hydrochloride (Buflomedil), a vasoactive drug, has been proven to improve pain-free walking distance in patients with peripheral arterial occlusive disease stage II of the lower extremities. In the present double-blind, randomized study, resting skin flux motion activity and skin flux response to a local heat stress at the hallux were assessed by laser Doppler fluxmetry (LDF) in claudicants. Twenty of 39 enrolled patients with severe intermittent claudication received a daily intravenous dose of 400 mg Buflomedil, and the other 19 patients received 0.9% NaCl as placebo over a 5-day period. Before treatment mean LDF skin resting flux, flux frequency, and flux amplitude were 2 ±0.8 Arbitrary Units (AU), 8.4 ±0.5 cycles per minute (c/min), and 0.12 ±0.01 AU, respectively in the Buflomedil group, and 2.3 ±0.3 AU, 8.7 ±0.7 c/min, and 0.13 ±0.02 AU in the placebo group (NS). Also the response to heat stress was identical in both groups: a slow initial increase of skin flux, followed by a reflex reduction, with a maximal initial flux increase to 138 ± 12% of the resting value in the Buflomedil group, and 155 ± 16% in the placebo group (NS). (continued on next page) After 5 days of treatment the mean LDF skin resting flux, flux frequency, and flux amplitude were unchanged in both patient groups. The response to heating on the contrary was dramatically enhanced in the Buflomedil group (226 ±33%), against that in the placebo group, which remained unchanged (144 ±13%) after 3 minutes (P<0.05), while after reflex reduction the flux in the Buflomedil group remained stable at 200% of resting value during further heating and was only approximately 140% in the placebo group (P<0.05). It is concluded that Buflomedil, administered in a daily intravenous dose of 400 mg, does not alter the mean LDF skin flux and flux motion at the hallux in claudicants in resting conditions. Local skin heating on the contrary provokes a significant LDF monitored skin flux increase, suggesting an improved capacity of cutaneous microvessel perfusion in stressed conditions.
Arterial Calcifications in β-Thalassemia
Authors: Aessopos Athanassios , Samarkos Michael , Voskaridou Ersi , Papaioannou Dimitris , Tsironi Maria , Kavouklis Emmanuel , Vaiopoulos George , Stamatelos George , Loukopoulos Dimitris 
Published: July 2008

The purpose of this study was to define the incidence of arterial calcifications in patients with β-Thalassemia. β-thalassemia patients have been shown to present a high preva lence of angioid streaks and skin lesions characteristic of pseudoxanthoma elasticum (PXE). Given the fact that vascular involvement in the form of arterial calcifications is also a common manifestation of PXE, the authors investigated radiographically the presence of arterial calcifications in β-thalassemia patients. They studied 40 patients with β-thalassemia over 30 years of age. Forty healthy, age- and sex-matched subjects were chosen as a control group. Radiographs of the tibias were performed in order to disclose arterial calcifications. The occurrence of PXE skin lesions and of angioid streaks (AS) was also investigated. Arterial calcifications were detected in the posterior tibial artery in 22 (55%) β-thalassemia patients and in six (15%) controls (P<0.01 for the comparison). PXE skin lesions and AS were found in eight (20%) and 21 (52%) patients respectively. A total of 34 patients (85%) had at least one of the three lesions, namely, arterial calcifications, angioid streaks, and/or PXE-like skin lesions. Stepwise logistic regression analysis did not reveal prognostic value in independent variables such as transfusions, chelation therapy, pseudoxanthoma elasticum skin lesions and/or angioid streaks, diabetes, hemoglobin, serum ferritin, and uric acid. It was concluded that arterial calcifications are common in older β-thalassemia patients. This finding could be a manifestation of an acquired PXE syndrome associated with β-thalassemia, and consequently, vascular events complicating PXE should be expected in these patients.