bluuebunny/crossref_metadata_2025_split huggingface dataset:
Amplified Amplitudes of Circadian Rhythms and Nighttime Hypotension in Patients with Chronic Fatigue Syndrome: Improvement by Inopamil But Not by Melatonin
Authors: van de Luit Leonie , van der Meulen Jan , Cleophas Ton J. M. , Zwinderman Aeilko H. 
Published: July 2008

Fatigue is an important symptom of a disturbed circadian rhythm. To date, no studies of circadian rhythms in patients with chronic fatigue syndrome (CFS) have been published. The objectives of the study were to study rhythms of heart rate and systolic and diastolic blood pressure in patients with chronic fatigue syndrome compared with age-matched normotensive controls and to study the effects of melatonin and inopamil on such rhythms. Ambulatory blood pressure (ABP) measurements (Space Lab, Inc, validated) of 18 patients with CFS were made according to the 1987 U.S. Center for Disease Control Criteria, and measurements of 12 age-matched normotensive controls were used in a cosinor analysis of the two groups. The effects of melatonin and inopamil on ABP were studied subsequently in four patients in an 8-week open-label evaluation. One patient was hypertensive (diastolic blood pressure > 90 mm Hg at least once every 4 hours), and was, therefore, excluded. The data of the remaining 17 patients (15 women, 2 men) revealed a significant 12-hour rhythm in heart rate and 24-hour rhythm in systolic and diastolic blood pressure with 95% confidence intervals not significantly different from sinusoidal patterns. Although these rhythms were synchronous with the control group rhythms, their amplitudes were not and showed, respectively, 2.8, 2.8, and 9.0 times the size of the control group rhythms (p < 0.001, p < 0.001, and p < 0.0001, respectively). Systolic blood pressures in the patients with CFS were consistently below 100 mm Hg during the nighttime. In a subsequent pilot study of four patients from the study population treated with melatonin 4 mg daily and inopamil 200 mg daily for 4 weeks, inopamil reduced nighttime hypotension (p<0.05), whereas melatonin increased nighttime hypotension (p < 0.02). Patients with CFS have increased amplitudes of circadian rhythms and systolic blood pressures consistently below 100 mm Hg during the nighttime. Positive inotropic compounds may be beneficial in such patients, but melatonin may not be.
Usefulness of Cardiopulmonary Bypass in Reconstruction of Inferior Vena Cava Occupied by Renal Cell Carcinoma Tumor Thrombus
Authors: Yamashita Chojiro , Azami Takasi , Okada Morihito , Toyoda Yoshiya , Wakiyama Hidetaka , Yoshida Masato , Ataka Keiji , Okada Masayosi 
Published: July 2008

Aggressive surgical treatment in renal cell carcinoma is still controversial. The aim of this paper is to assess inferior vena caval (IVC) reconstruction for suprahepatic vena caval renal cell carcinoma (RCC) tumor thrombus. Twelve patients with suprahepatic vena caval thrombus from renal cell carcinoma who underwent surgical repair with cardiopulmonary bypass were evaluated. The vena caval defect was reconstructed by direct suture, patch repair, or graft replacement. Of 12 patients undergoing partial cardiopulmonary bypass, tumor thrombus extended to the junction of the hepatic vein in three patients and to the right atrium in one. Tumor thrombus was removed manually or with balloon catheter. Tumor thrombus in the right atrium was removed during electrical ventricular fibrillation. Repair of the IVC was performed by direct suture of the IVC wall in two patients, patch repair with expanded polytetrafluoroethylene (EPTFE) graft in seven, and graft replacement with an EPTFE graft in three. There were no operative deaths and the only postoperative complication was one patient death from pulmonary emboli. The four patients with nonlocalized disease died within 2 years, but four patients lived for more than 3 years postoperatively. Survival was 37.5% at 3 years and 18.8% at 5 years by the Kaplan-Meier's method. Conclusions: (1) Partial cardiopulmonary bypass is useful for the control of bleeding when tumor thrombus in the IVC extends to the junction of the hepatic vein. (2) Nephrectomy with tumor thrombectomy of the IVC is valuable, and long-term survival is possible in patients without distant metastases or regional lymph node metastases.
Immunoscintigraphy of Venous Thrombi: Clinical Effectiveness of a New Antifibrin D-Dimer Monoclonal Antibody
Authors: Ciavolella Massimo , Tavolaro Rosanna , Di Loreto Mario , La Torre Filippo , Nicolai Alessia , Schillaci Orazio , Ierardi Maria , Scopinaro Francesco , Ciavolella Massimo 
Published: July 2008

Safety and thrombus imaging capabilities of the 99mTc-labeled form of a new F(ab')2 monoclonal antibody (MoAb) against fragment D dimers from cross-linked human fibrin, previously shown to be effective labeled to 131I in detecting venous thrombi in the rabbit, were investigated. Sixteen patients (seven men, mean age: 60 ± 7 years) with deep (n = three) and superficial (n= 13) venous thromboses of the lower limbs documented at echo-Doppler study underwent, 24 hours before saphenous vein stripping, a scintigraphic study after IV injection of the 99mTc-MoAb (1,129 ± 275 MBq/mL), acquiring dynamic images, as well as early and delayed static images of lower limbs. Tracer activity was compared in normal and pathologic areas. At the operation, vessel wall including the thrombotic lesion was isolated, weighed, and counted. Blood radioactivity and MoAb concentra tion were also measured. No adverse reaction was observed after MoAb administration. Thrombus site appeared as a focal area (hot spot) of asymmetrically increased tracer uptake, already detectable at early images in all patients. All thrombi detected at echo-Doppler study (n=25) were confirmed at scintigraphic study, which showed four additional hot spots subsequently confirmed to represent thrombi at operation. Average percent ratio between pathologic and normal regions was 1.51 ± 1.34 (p < 0.05) at time-activity curves, 2.27 ± 1.1 (p < 0.05) at early static images, and 2.15 ± 1.2 (p < 0.05) at delayed images, respectively. Thrombus-to-blood uptake ratio was 4.3 ± 0.9 (p < 0.01). The F(ab')2 MoAb proved to be safe, and low levels of antimouse antibodies were detected in response, although further studies are needed to assess tolerance and effec tiveness in case of a second administration in the same patient. The 99mTc-labeled MoAb was very effective in identifying venous thromboses both at deep and superficial local izations, although its sensitivity and specificity need be evaluated in a more numerous group, including also patients with different and clinically more relevant localizations, such as caval thromboses. However, the possibility of obtaining high-quality images within 4 hours of MoAb administration is clinically relevant, and carries also therapeutic implications, especially in pulmonary thromboembolism.
Randomized Reliability Study Evaluating Constant-load and Graded-exercise Treadmill Test for Intermittent Claudication
Authors: Cachovan Milan , Rogatti Waltraud , Woltering Franz , Creutzig Andreas , Diehm Curt , Heidrich Heinz , Scheffler Peter , Cachovan M. 
Published: July 2008

The aim of this randomized study was to compare the reliability of the treadmill test at constant-load (C-test, 3 km/hr; fixed grade of 12%) recommended in Germany with that of the graded-exercise test (G-test, 3 km/hr; increase in grade of 3.5% every 3 minutes) propagated in the United States. In 50 patients with an absolute claudication distance (ACD) in the C-test of between 50 and 400 m, the two treadmill tests were carried out in randomized order on one and the same day, and repeated on 3 days within 1 week. For the initial claudication distance (ICD), the intraclass correlation was 0.88 in the C-test and 0.87 in the G-test. For the ACD the coefficients were identical at 0.91. The within-subject variation (CVwithin) in the C-test and G-test was 25% and 27% for the ICD and for the ACD 24% and 21%, respectively. The between-subject variation was very similar with 72% and 73% (ICD) and with 78% and 68% (ACD). However, in ACDs below 100 m and between 100 to 150 m, the C-test showed significantly smaller coefficients of variation than the G-test: 13% vs 81% and 14% vs 50%, respectively. In conclusion, the results showed that both C-test and G-test are equally well reproducible.
Smoking is Associated with Dose-Related Increase of Intima-Media Thickness and Endothelial Dysfunction
Authors: Poredoš Pavel , Orehek Marta , Tratnik Erika , Poredoš Pavel 
Published: July 2008

Cigarette smoking is firmly established as a risk factor for atherosclerosis. However, the exact mechanism causing smoking-related damage to the arterial wall and its relation to the atherosclerotic process is not known. Also unknown is the time delay between the start of smoking and the sequence of functional and morphologic changes occurring in the arterial wall caused by smoking and their interrelationship. Therefore, the aim of this study was to evaluate the acute and chronic effects of smoking on endothelium- dependent (flow-mediated) dilation (FMD) of the peripheral arteries, the effects of dose and duration of chronic smoking on intima-media thickness (IMT) of the carotid arteries, and their interrelationship. The study encompassed two groups of smokers. In group A there were 40 subjects of both sexes, who smoked on average 17.6 ±6.5 cigarettes per day, for 5 to 15 years (mean 8.95 ±4.0 years), mean age 28.1 years. Group B consisted of 42 smokers of both sexes who smoked 21.15 ±8.2 cigarettes/day for more than 15 years (mean 21.15 ±3.4 years), mean age 39.5 years. The control group consisted of 40 healthy subjects without major risk factors of atherosclerosis, mean age 29.1 years. By means of high-resolution ultrasound the brachial artery diameter was measured at rest and during reactive hyperemia (after release of a forearm tourniquet) and the flow- mediated, endothelium-dependent dilation was calculated. ( continued on next page) The IMT of the carotid arteries was determined in all subjects by use of B-mode ultra sonography. Resting blood flow in the brachial arteries was significantly less in the smokers' groups than in controls (78.8 ±31.9 vs 134.9 ±45.0 mL/min, p<0.0001) . This decrease was much more evident in female than in male smokers. Female smokers also had significantly smaller brachial artery diameter at rest. In smokers the FMD of the brachial artery was reduced (11 ±4% vs 7 ±4%, p<0.004) and the mean IMT was signif icantly greater than in controls (0.68 ±0.13 vs 0.59 ± 0.04 mm, p<0.001). Impairments of FMD and IMT increase were related to the duration and to the number of cigarettes smoked. In all subjects IMT was significantly correlated with total and LDL cholesterol, fibrinogen, lipoprotein(a) concentration, body mass index, and age of the subjects, but multivariate analysis showed that only total dose smoked and fibrinogen concentration were independently related to IMT. The results of this study show that smoking is associated with dose-related impair ment of FMD and increased IMT of the carotid arteries. Impairment of FMD occurs in smokers very early and is the earliest detectable event, preceding morphologic changes of the vessel wall. Some harmful effects of smoking on the vessel wall are gender related.
QT Dispersion and Early Arrhythmic Risk During Acute Myocardial Infarction
Authors: Paventi Saverio , Bevilacqua Umberto , Parafati Maria A. , Di Luzio Enza , Rossi Francesco , Pelliccioni Patrizia R. , Paventi Saverio 
Published: July 2008

It has been suggested that QT dispersion (maximal minus minimal QT interval calcu lated on a standard 12-lead electrocardiogram) could reflect regional variations of ventricular repolarization and could provide a substrate for reentry ventricular arrhyth mias. The present study evaluates QT dispersion in patients with acute myocardial infarc tion, assessing its relation with early severe ventricular arrhythmias and some clinical features. Three hundred three patients with acute myocardial infarction and a control group of 297 healthy subjects were studied. QT and QTc dispersion were determined on the electrocardiogram taken after 12 hours and on days 3 and 10 after symptoms onset and on the electrocardiogram taken in the control group. The average values of QT and QTc dispersions (ms) were as follows: 70.5 ±42.5-87 ±45.6 (12th hour), 66.7 ±37.6-76.8 ±43.6 (day 3), 68.8 ±42.7-76.8 ±42.8 (day 10), versus 43 ±13.2- 53.9 ±16.2 (control group). There were statistically significant differences between QT and QTc dispersion recorded in normal subjects and in each of the three electrocardio grams taken in patients with infarction. A greater QT dispersion was recorded in patients with anterior infarction (78.9 ±38.5 vs 64.9 ±42.8 in inferior/lateral infarction). In the first 3 days QT dispersion was not different in patients treated and untreated with throm bolysis, whereas on day 10 it was greater in untreated patients (74.9 ±45.3 vs 60.5 ±37.2). Creatine kinase peak level did not influence QT dispersion. In the first 72 hours of infarction, 37 patients developed ventricular fibrillation or sustained ventricular tachy cardia. Higher early values of QT and QTc dispersion were found in patients who developed severe ventricular arrhythmias (107.8 ±62 and 124.8 ±67.5 ms) than in patients without serious arrhythmias (62.9 ±32.2 and 80.1 ±37.9 ms). These data suggest that: (1) QT dispersion increased during acute myocardial infarc tion. (2) The values were higher in the early hours and fell late after infarction with throm bolysis. (3) Greater QT dispersion is associated with severe ventricular arrhythmias.
Prolongation of Left Atrial Augmentation After Handgrip Stress in Coronary Artery Disease: Observation Using Pulsed Doppler Flowmetry
Authors: Tanaka Tetsuya , Mizushige Katsufumi , Masugata Hisashi , Matsuo Hirohide , Mizushige Katsufumi 
Published: July 2008

Although alterations in left ventricular diastolic filling dynamics have been observed during myocardial ischemia, few data exist regarding temporal changes in left ventricular filling during recovery. Therefore, the authors evaluated transmitral inflow pattern during and after handgrip exertion in coronary artery disease (CAD) by using Doppler echocar diography. The study population consisted of 18 normal (N) subjects and 47 patients with CAD. Of the CAD patients, 17 had coronary lesions associated with a limited area of underperfused myocardium (seven with good collateral circulation and 10 with distal lesions) (MILD), 15 patients exhibited a proximal lesion in a single vessel (SVD), and 15 patients had significant multivessel disease (MVD). Transmitral inflow velocities were continuously recorded at baseline, during handgrip exercise (50% of maximal for 1 minute), and for 5 minutes of recovery. Mean blood pressure, heart rate, early diastolic (E) and late atrial (A) inflow velocities, A/E ratio, and percent changes in E, A, and A/E from baseline were measured. In N and MILD, respectively, left ventricular inflow pattern returned to baseline at 3 minutes after handgrip (%E: 0.7 ± 7.6%, 6.4 ± 13.7%; %A: -0.2 ± 7.9%, 3.1 ±6.5%; %A/E: -0.1 ±9.7%, -1.7 ±12.9%). In SVD and MVD, respectively, change in left ventric ular inflow pattern was continued at 3 minutes after handgrip (%E: 7.2 ±9.4%, -4.3 ± 17.2%, %A: 15.4 ± 11.7%, 20.4 ± 14.6%, %A/E: 7.9 ± 10.0%, 29.2 ±25.6%). Increases in A and A/E in SVD and MVD were significantly higher than in N and MILD. Impaired left ventricular inflow pattern was observed at 3 minutes after handgrip in CAD, which may be reflected from prolonged impairment of diastolic function produced by ischemia. Therefore, temporal observation of left ventricular inflow pattern using the handgrip stress Doppler method may be useful for detection or follow-up of CAD.
Atherosclerotic Lesions Are More Frequent in Femoral Arteries than in Carotid Arteries Independent of Increasing Number of Risk Factors
Authors: Kröger K. , Kucharczik A. , Hirche H. , Rudofsky G. 
Published: July 2008

The authors investigated the prevalence of atherosclerotic lesions in carotid and femoral arteries in people with varying risk factors. They searched for differences in the region of manifestation of atherosclerosis due to different risk factors. Over 5 years they investi gated 4,200 people (2,600 men, 1,600 women aged 20 to 70 years) who reported feeling healthy. They did a B-mode sonography of the internal, external, and common carotid artery; and the common, the proximal superficial, and profundal femoral artery. They questioned the people regarding hypertension, hypercholesterolemia, diabetes mellitus, and smoking habits. Isolated carotid artery atherosclerosis was found in 2.8% of the men and 1.6% of the women; 10.9% of the men and 4.4% of the women had isolated femoral artery lesions. A combination of atherosclerotic lesions in both arteries was present in 8.3% of the men and 4.0% of the women. When only one risk factor was present atherosclerotic lesions of the femoral arteries were predominant. Diffuse atherosclerosis dominated with increasing number of risk factors. The rate of people with isolated carotid atheroscle rosis was highest when no risk factor was present and decreased to a fixed rate of 12% to 17% independent of the number of risk factors. An increasing number of risk factors can be associated with a diffuse manifestation of atherosclerotic lesions. However, there are a certain number of people who demonstrate only carotid artery or femoral artery atherosclerosis independent of the number of risk factors.
Hyperhomocyst(e)inemia Is Associated with Carotid Atherosclerosis
Authors: Lupattelli Graziana , Rufini Stefano , Locati Emanuela H. , Lombardini Rita , Ciuffetti Giovanni , Siepi Donatella , Mannarino Elmo , Lupattelli Graziana 
Published: July 2008

The atherogenicity of homocyst(e)ine—H(e) —emerged from many studies showing an association between moderately elevated levels and vascular occlusive disease. The aim of this study was to evaluate whether high homocyst(e)ine levels were associated with carotid atherosclerosis. Carotid atherosclerosis was defined as an intimal media thickness of internal and carotid bifurcation of at least 2 mm on the near and far walls as deter mined by B-mode ultrasonography. The study population included 91 patients: group 1 (61% males, mean age 64 ± 10 years, 57% with history of hypertension) with ultrasound evidence of carotid atherosclerosis and 100 with normal carotid walls—group 2 (36% males, mean age 52 ± 15 years, 27% with history of hypertension). Homocyst(e)ine levels (μmol/L) were determined by high-performance liquid chromatography with a fluorescent detector. Body mass index, dyslipidemia, smoking, diabetes, serum creatinine, plasma folic acid and vitamin B12 were not significantly different in the two groups. Homocyst(e)ine levels (μmol/L) were significantly higher in patients with carotid ather- osclerosis than in those with normal arteries (11.7 ± 6.5 μmol/L, 95% CI 10.4-13.1 vs 8.07 ±4.4 μmol/L, 95% CI 7.2-8.9, p < 0.0001). By multiple regression analysis H(e) levels were positively correlated with male gender (p < 0.02), age (p < 0.001), and nega tively with folic acid (p < 0.0001). By logistic regression the independent predictors of carotid atherosclerosis were male gender (OR 2.65), hypertension (OR 2.55), age (x 10 years, OR 2.15) and H(e) levels (x 1 μmol/L, OR 1.11). This study confirmed homocyst(e)ine is associated with carotid atherosclerosis. Consequently the authors recommend H(e) levels be screened in all patients at risk for atherosclerosis.
Ocular Manifestations of the Fetal Hydantoin Syndrome
Authors: Hampton G. Robert , Krepostman Jaime I. 
Published: July 2008

Eleven per cent of infants exposed to hydantoins in utero have a recogniz able pattern of abnormalities with serious clinical consequences. This report of a child born to a mother taking diphenylhydantoin emphasizes the ocular find ings. At birth and subsequent 8-month exam, a girl was noted to have microph thalmus, prominent iris vessels, and an inferior iris and choroidal colobma. Relation of these anomalies to teratogenic properties of diphenylhydantoin is discussed.
The value of reality orientation in 1987
Authors: Holden Una 
Published: July 2008

When considering the value of Reality Orientation (RO) it is extremely difficult to avoid reference to the many and various meanings, misinterpre tations and misunderstandings which have formed the basis of some criticisms. However, these should be covered in the other part of this critique. Here, RO will be taken to imply an approach (or philosophy) which is continuous and focuses on regaining and maintaining, as far as possible, normal living patterns relevant to each particular individual with impairments of social or intel lectual functions. This includes group sessions, or intensive individual sessions, where the focus could be on relearning verbal or spatial in formation, daily living activities, social behaviour or solving problem behaviours. Research and evaluation have required a break down of RO into specific aspects in order to assess their relative values. In practice, RO is multi faceted, and carers will use whatever facet or facets that are relevant to the needs of the in dividual.
Facilities for rehabilitation of adults after head injury
Authors: Cockburn JM , Gatherer A. 
Published: July 2008

Little information has been published about facilities that exist for rehabilitation after head injury. In 1985 a questionnaire was sent to 27 centres throughout the UK known to make some provision for rehabilitation of adults after head injury. Information was sought on five broad areas of provision: location and size of centre; patient population; facilities and services provided; communications; teaching and research interests. Replies were received from 23 centres, all but three of which were funded by the National Health Service. In total 112 beds (14%) were occupied by head-injured patients. One centre took only head injuries and a furtherthree concentrated on neurological rehabilitation. Six excluded referrals with behavioural problems. All the NHS funded centres gave preference to referrals from their own district or region. Length of stay for head-injured patients ranged from one day to three years. Active therapy was provided by all centres and occupied between three and six hours per day. Although this survey was not exhaustive, it indicates wide regional differences in the availability of rehabilitation and provides a framework for further investigations, especially in regions where no facilities were identified.