bluuebunny/crossref_metadata_2025_split huggingface dataset:
Potential Use of a Low-Molecular-Weight Heparin to Prevent Restenosis in Patients with Extensive Wall Damage Following Peripheral Angioplasty
Authors: Schweizer Johannes , Müller Axel , Forkmann Lutz , Hellner Grit , Kirch Wilhelm 
Published: July 2008

The long-term outcome of primary successful percutaneous transluminal angioplasty (PTA) for patients with peripheral occlusive arterial disease (POAD) is frequently compromised by the development of restenosis, especially when extensive dissections result from the angioplastic procedure. Unfortunately, prevention of the occlusive process by means of drugs such as antithrombotics, anticoagulants, thrombolytics, corticosteroids, lipid reducers, or cytostatics has not been demonstrated convincingly. The authors sought to clarify whether such patients could benefit from the postsurgical administration of low-molecular-weight heparin. A total of 172 POAD patients with extensive dissections after PTA in the pelvic or upper leg regions were randomized for 7-day post-PTA intravenous treatment with either full heparinization or nadroparin calcium followed by adjunctive oral aspirin for 6 months. The primary outcome measure was the degree of stenosis (normal findings; stenosis <50%, > 50%, >80%, occlusion) before and after angioplasty, as well as 3 weeks and 3 and 6 months after dilation; secondary efficacy criteria included changes in the Fontaine stage and in the cruro brachial ratio. No significant treatment-related differences were found at the 3 post-PTA follow-up exam inations with regard to the degree of stenosis. This was also the case for the subgroup of patients (n = 62) who had undergone angioplasty in the pelvic region. By contrast, when angio plasty was performed in the superficial femoral artery (n = 110), the degree of restenosis was significantly lower (p<0.01) among patients receiving nadroparin calcium compared to those given heparin at week 3, month 3, and month 6. No intergroup differences emerged for secondary outcome measures in the long term or for safety parameters. These preliminary results indicate that patients with extensive dissections after PTA treatment for POAD in the upper leg region might benefit from a reduction in the rate of restenosis by administration of 7-day weight-adjusted nadroparin calcium.
Importance of Left Anterior Hemiblock Development in Inferior Wall Acute Myocardial Infarction
Authors: Özdemir Kurtuluş , Uluca Yavuz , Daniş Gülizar , Tokaç Mehmet , Altunkeser Bülent Behlül , Telli Hasan Hüseyin , Gök Hasan 
Published: July 2008

The aim of this study was to investigate the clinical and angiographic importance of left anterior hemiblock (LAHB) during acute inferior myocardial infarction (AIMI) by comparing patient groups with and without LAHB after AIMI.One hundred seventy-two patients (141 men and 31 women) between 28 and 84 years of age (mean 55 ± 10 years) with AIMI were included in the study. Patients were divided into 2 groups according to electrocardiogram (ECG) criteria: group I comprised 25 patients in whom ECG pattern characteristic of LAHB developed, group II comprised 147 patients without this pattern. According to the electrocardiogram, patients were placed in group I if the mean QRS axis was deviated to the left <30° in the frontal plane with the following pattern: increased S- wave voltage and decreased R-wave voltage in leads II, the appearance of a deep S-wave in lead II, and a terminal positive R-wave in lead aVR. Coronary angiography was performed within 2 weeks. A coronary stenosis was considered if the vessel diameter was narrowed by > 50%. The dominant coronary artery was classified as right or left or balanced. The left ventricular ejection fraction (LVEF) was calculated from left ventriculography.The mean age of the patients in group I was significantly higher (58 vs 54 years, p = 0.007), while the risk factors were similar in both groups. Left anterior descending (LAD) and multi vessel coronary artery disease (CAD) were found to be significantly higher in group I compared with group II (80% vs 38%, p = 0.0001; 84% vs 52%, p = 0.001, respectively). The mean LVEF was found to be lower in group I (51% vs 56%, p = 0.04). Peak creatine phosphokinase MB (CKMB) values were not different (216 vs 162 IU/L, p = 0.09). The frequency of left dominant or balanced coronary artery was determined to be higher in group I (44% vs 17%, p = 0.018).LAHB development during AIMI can be an indicator of LAD lesions, multivessel coronary artery disease, and impaired left ventricular systolic function.
Value of Echocardiographic Findings in Predicting Cardiovascular Complications in Infective Endocarditis
Authors: Mathew James , Anand Aswini , Addai Theodore , Freels Sally 
Published: July 2008

Echocardiography allows the detection of vegetations and estimation of valvular dysfunction in patients with infective endocarditis. The value of echocardiographic findings in predicting cardiac and other vascular complications in infective endocarditis is not well understood. Identification of high-risk patients and early surgery may improve their prognosis. The authors reviewed echocardiographic findings and related them to the development of congestive heart failure, systemic embolism, and the need for surgery or the risk of death without surgery in patients with infective endocarditis. There were 125 episodes of endocarditis in 114 patients (84 episodes [67%] in men) with a mean age ± standard deviation of 37 ±7 years. Vegetations were detected by echocardiog raphy on at least 1 valve in 87 episodes (70%); on the mitral valve in 36 episodes (29%); on the aortic valve in 21 episodes (17%); and on the tricuspid valve in 45 episodes (36%). Severe aortic regurgitation was present in 9 episodes (7%) and severe mitral regurgitation in 4 instances (3%). In 12 of 21 episodes (57%) of vegetations on the aortic valve compared with 15 of 104 patients (14%) without vegetations on the aortic valve (p < 0.00 1), and in 8 of 9 instances (89%) of severe aortic regurgitation compared with 19 of 116 episodes (16%) without severe aortic regurgitation (p < 0.00001), the patients developed congestive heart failure. In 18 of 55 episodes (33%) of vegetations on the aortic/mitral valve compared with 17 of 70 episodes (25%) without vegetations on the aortic valve/mitral valve (p=NS), the patients developed systemic embolism. In 13 of 21 episodes (62%) of vegetations on the aortic valve compared with 19 of 104 episodes (19%) without vegetations on the aortic valve (p < 0.001 ), and in 8 of 9 episodes (89%) of severe aortic regurgitation compared with 24 of 116 episodes (21%) without severe aortic regurgitation (p < 0.00001), the patients either had surgery or died without surgery. Echocardiographic findings do not reliably predict the risk of systemic embolism in patients with infective endocarditis. Vegetations on the aortic valve and severe aortic regurgitation detected by echocardiography predict a high risk of developing congestive heart failure, and for the combined outcome of requiring surgery, or dying without surgery in infective endocarditis. Early surgery may improve the outlook for survival of these patients.
The Impact of Different Spectral Doppler Criteria on the Proportion of High-Grade Internal Carotid Artery Stenosis in Patients Undergoing Duplex Scanning
Authors: Logason Karl , Karacagil Sadettin , Tulga Ulus A. , Hardemark Hans-Göran 
Published: July 2008

Aim: To investigate the impact of different spectral Doppler criteria on the proportion of high- grade ICA stenosis in patients undergoing carotid artery duplex scanning. Material and methods: Duplex scans of 4,548 internal carotid arteries (ICA) in 2,349 patients were retrospectively analyzed. The following different criteria were applied for each scan for definition of ICA stenosis ≥ 70%: Criteria I = ICA peak systolic velocity (PSV) > 130 cm/sec and ICA end-diastolic (EDV) > 100 cm/sec, Criteria II = PSV ICA/common carotid artery (CCA) ratio > 4, Criteria III = ICA PSV ≥ 230 cm/sec, Criteria IV = ICA PSV > 230 cm/sec and/or ICA EDV ≥ 100 cm/sec and/or PSV ICA/CCA ratio ≥ 3.2. Results: The frequency of detecting a ≥ 70% ICA stenosis with criteria I, II, III, and IV were 5.5%, 6.8%, 8.4%, and 9.6%, respectively (p < 0.05). Conclusion: The use of various duplex criteria significantly affected the number of scans receiving a diagnosis of ICA stenosis of ≥ 70%.
Electrocardiologic and Echocardiographic Features of Patients Exposed to Scorpion Bite
Authors: Alan Sait , Ulgen Mehmet S. , Soker Murat , Geyik Faruk , Karabulut Aziz , Toprak Nizamettin 
Published: July 2008

The purpose of this study is to examine clinical progress and hemodynamic and electrocardi ologic features (QT depression and heart rate variability [HRV]) of patients exposed to a scorpion bite. Seventeen patients bitten by scorpions, and, as a control group, 15 healthy subjects were included in the study. Standard electrocardiograph (ECG) records, 24-hour Holter-ECG, and Doppler echocardiographic examinations were performed. Holter ECG indicated sinus tachycardia, sinus bradycardia, paroxysmal supraventricular tachycardia, atrial fibrillation, first-degree and second-degree atrioventricular block not requiring treatment, early atrial beats, and early ventricular beats in the patients at frequen cies of 82%, 12%, 35%, 12%, 8%, 70%, and 47%, respectively. HRV parameters that reflected parasympathetic activity (SD 35 ±13-43 ±16, RMS-SD: 20 ±9-30 ± 12, high frequency: 7.8 ±2-4.3 ±3, p<0.05) were significantly lower (p<0.05). Low frequency, which especially showed sympathetic activity (LF: 11 ± 13-11 ±23, p>0.05), was similar in both groups. In addition, the LF/HF ratio, which reflected sympathovagal balance, was significantly increased in the patient group (1.5 ±1-3.0 ±2, p = 0.005). Corrected QT and QT dispersion values were not significantly different with respect to the control (p>0.05). In the patient group compared to the control, a significant decrease was determined in the proportion of mitral E velocity to mitral A velocity (mEv/mAv), diastolic filling period (DFP), and left ventricular ejection fraction (LVEF), while a significant increase was noticed in pulmonary artery pressure (PAP) (mEv/mAv: 0.9 ±0.4-1.7 ±0.6, DFP: 362 ±8.5-425 ±89, LVEF: 53.1 ±6.7-68.6 ±5.8, PAP: 38.1 ±13-27.2 ±6, p<0.05). Scorpion bite leads to serious cardiovascular disorders, associated with decreased HRV, decreased systolic and diastolic functions, increased arrhythmic events, and hemodynamic disturbance with sympathetic and parasympathetic balance disturbance.
Plethysmographic Confirmation of the Beneficial Effect of Calcium Dobesilate in Primary Varicose Veins
Authors: Androulakis G. , Panoysis P.A. 
Published: July 2008

Sixty patients with varicose veins, in the age range 25 to 52 years, entered the trial and were divided by random allocation into 2 equal groups. The first group received calcium dobesilate orally in dosage of 750 mg daily while the second remained untreated. Out of 25 patients who completed the 3-month treatment course, clinical improvement occurred in 19 (76%). Mercury strain gauge plethysmography in those 19 patients showed a statistically significant mean fall in the venous distensibility index, in maximum venous outflow and in the capillary filtration coefficient after the course of calcium dobesilate. The mean erythrocyte sedimentation rate in the 25 patients fell from 40 mm in 1 hour (Westergren) before treatment to 10 mm at the end of the course. In 42% of the patients there was a fall in serum globulin concentration and correction of the albumin/globulin ratio and in 35% there was a slight fall in serum fibrinogen concentration. Possibly calcium dobesilate's known action in lowering blood viscosity contributes to its beneficial effect in varicose veins.
What Do Medical Students Know About In-Hospital Radiation Hazards?
Authors: Janssen Johan H.A. , Wellens Hein J. J. 
Published: July 2008

A questionnaire (eight multiple-choice questions) administered to 49 fourth-year medical students from the Limburg State University in the Netherlands shows that several misunderstandings, misconceptions, and erroneous beliefs exist in regard to in-hospital radiation hazards. The authors conclude that it is unlikely that ignorance about this subject is restricted to Dutch medical students.
Augmented Fragmentation of Atrial Activity Upon Premature Electrical Stimuli by Verapamil
Authors: Aizawa Y. , Miyajima S. , Niwano S. , Tamura M. , Shibata A. 
Published: July 2008

The significance of fragmented activity obtained from the atrium during electrophysiologic study (EP study) was confirmed since it was al ways observed just at the onset of fi brillation. It was preceded by extra stimuli or atrial flutter, and the initial site of fragmentation varied from case to case. The premature-stimu lus-induced widening of the atrial wave was observed in some cases who had normal size of atrium and no heart failure. The widening was aug mented by administration of vera pamil but not by procainamide, suggesting that for such widening or fragmented activity, slow-fiber-medi ated conduction seems to be responsi ble. One case with intraatrial reen trant tachycardia developed fragmentation lasting for 1.0 second after verapamil. Therefore, some apparently nor mal atria may have a subclinical elec trophysiologic abnormality that can be disclosed by premature stimula tions or verapamil.
Is Increased Plasma Viscosity A Risk Factor for High Blood Pressure?
Authors: Koenig Wolfgang , Sund Malte , Ernst Edzard , Matrai Arpad , Keil Ulrich , Rosenthal Julian 
Published: July 2008

Data from several epidemiologic studies have suggested that, among other variables, hematocrit and fibrinogen may constitute risk factors for high blood pressure. As part of a population survey for cardiovascular risk factors, plasma viscosity and hemoglobin were measured. Blood pressure was determined under standardized conditions according to the recommendations of the AHA. A two- stage age-sex-stratified cluster sample of 5,312 persons, aged twenty-five to sixty-four years, was selected from a mixed urban/rural target population of 282,279 (total population approximately 533,000). A net response of 79.3% was achieved. Multiple logistic regression analyses including plasma viscosity, hemoglobin, body mass index, alcohol consumption, smoking behavior, and total serum cho lesterol as independent variables were run controlling for both age and sex. Plasma viscosity appeared as a significant main effect in all analyses and dem onstrated the strongest association with high blood pressure next to body mass index. Whether this association implies a causal relationship cannot be an swered from cross-sectional data. However, even if plasma hyperviscosity rep resents a secondary phenomenon in hypertension, it might be of prognostic relevance. There is evidence that increased plasma viscosity may contribute to myocardial hypertrophy. Therefore hypertensives with impaired blood fluidity might constitute a subgroup at particular risk for cardiovascular complications. When antihypertensive drugs are selected, their influence on blood viscosity should be taken into account.
Late Cardiac Deaths After Isolated Valve Replacement for Aortic Stenosis. Relation to Impaired Left Ventricular Diastolic Performance
Authors: Lund Ole , Jensen Finn Taagehøj 
Published: July 2008

Sixty-three patients took part in a follow-up study ten to seventeen years after valve replacement for aortic stenosis. Data obtained were used to predict cardiac deaths (n = 14) occurring in the following three-year period. The degree of residual left ventricular (LV) hypertrophy correl ated inversely with indices for LV sys tolic and diastolic performance (radionuclide cardiography). A logis tic regression (LR) model had a posi tive predictive value for cardiac deaths of 100% (10/10) with 8% (4/53) false negatives. Evaluating LV performance indices exclusively, LR analysis showed that only peak filling rate had independent predictive value. Subnormal and normal LV ejection fractions were associated with equal three-year cardiac death rates (29%). Depressed LV function was re lated to residual hypertrophy. Im paired diastolic performance was the prime predictor of cardiac deaths.
Influence of Local and Environmental Temperatures on Cutaneous Circulation with Use of Laser Doppler Flowmetry
Authors: Winsor Travis , Haumschild Daniel J. , Winsor David , Mikail Amani 
Published: July 2008

The purpose of this study was to determine a standard set of conditions for detecting peripheral arteriosclerosis with ischemia. One series of studies was done to determine the influence of room tempera ture on peripheral flow in healthy subjects and patients with peripheral vascu lar disease. The room temperature was varied from 30° to 35°C. The temperature from 24° to 30°C had only minor effects on the circulation. Thus, it seemed appropriate to use a room temperature in the lower range, usually 23°C. Another series of studies showed the effect of changing skin temperatures locally at the finger tip or toe tip on the plantar and volar surfaces in healthy subjects and in patients with peripheral vascular disease. Results showed that as temperature was increased from 10° to 45°, there was a marked increase in the finger and toe circulations, which was considerably greater in the normal sub jects as compared with those with digital disease. The ideal temperature at which to work as a routine is 40 ° C as opposed to the lower temperatures, which did not separate healthy subjects from patients with peripheral vascular dis ease. A third experiment was done to study normal subjects and patients by using the finger circulation as control against the toe circulation when the conditions were a local skin temperature of 40 ° C and a room temperature of 23°C. A toe- finger index was established to detect abnormalities in the circulation. An index using a part of the body as its reference has been used in many other physical measurements such as the ankle/wrist pulsation ratio or Doppler pulse ratio. Use of the index excludes the cardiac output from the ratio measurements. The index narrows the range of normal subjects as compared with single measure ments made on various individuals.
Gated Intracoronary Thallium201 Scintigraphy: Feasibility and Potential Clinical Advantages
Authors: Siegel Michael E. , Chen David C. P. , Lee Kai , Rasmussen Deanna , Colletti Patrick , Thom Peter , Rahimtoola S.H. 
Published: July 2008

Visualization of ventricular walls with true global motion and myocardial thickening is not possible with use of present scintigraphic techniques. When thallium 201 (201TI) is injected intravenously (IV), only about 5% reaches the myocardium. However, if201TI is injected intracoronarily, 100% reaches, and approximately 88% localizes in, the myocardium, which results in higher count rates than when given IV, permitting acceptable acquisition times for gated true wall motion studies. The authors describe a new technique using intracoronary (IC)201TI to acquire high count rate, high contrast, and short acquisition time in gated true wall motion studies.Thirteen patients were studied at rest with gated IC thallium. Six of these patients also had resting IV201TI myocardial studies. After routine coronary angiography, 0.75 mCi of201TI was injected into each coronary artery. Multiple sequential one-minute gated studies were obtained in LAO and RAO projec tions, followed by sequential five-minute images for two hours to determine201TI redistribution kinetics. Regions of interest over segments of left and right ven tricles and background permitted definition of temporal and spatial distribu tions. Three one-minute gated studies were summed with a total count of 2,100 K for a three-minute acquisition.Myocardium-to-background ratios were as high as 13:1 with a mean of 11.4:1 in the IC study compared with 2.3:1 in the IV studies. Washout half-time in normal myocardium was 95 ± 5 min. The detectability and size of perfusion defects were different on gated diastolic and systolic, nongated, and IV studies. Questionable defects seen on nongated studies or after IV administration were easily noted on gated diastolic images. Apparent alterations in wall thickness during the cardiac cycle were visualized.Short-acquisition and high-resolution myocardial perfusion images demon strating the wall motion obtained by this new technique may be a useful adjunct to the blood pool and coronary anatomy detail acquired during cardiac cathe terization. The apparent advantages of the gated perfusion study are being ap plied to experimental99mTc-labeled myocardial perfusion agents presently being evaluated.
Importance of Blood Viscoelasticity in Arteriosclerosis
Authors: Hell K.M.D. , Balzereit A. , Diebold U. , Bruhn H.D. 
Published: July 2008

Corpuscular and biochemical components of blood create the vis coelastic nature of blood flow, which varies because of changes in flow ve locity. The flow properties of blood are of special interest in arterioscle rotic diseases for vasoregulatory mechanisms are often disturbed in these states. The authors compared the rheologic properties of blood in patients with arteriosclerotic lesions (coronary heart disease: n=56; cere brovascular disease: n=37; periph eral arterial occlusive disease: n=29 and healthy controls: n=42). With a new oscillating capillary rheometer imitating the physiologic pulsations of blood flow in an un branched artery, the viscosity (η') and elasticity (η") of whole blood and plasma were measured (diameter of the capillary: 0.9928 mm; pulse rate: 2/s; shear rate: γ=0.03-200/s; tem perature : 37°C). In arteriosclerotic patients a sta tistically significant elevation of the viscoelasticity of whole blood and plasma was found. In addition, plasma fibrinogen levels were aug mented in the patients' groups. Clot ting parameters (Quick, partial thromboplastin time, platelet count) and total serum protein levels were in the normal range in all patients inves tigated. In conclusion the question arises whether the increase of blood vis coelasticity is an additional risk fac tor for patients with arteriosclerotic disease or if it is just a consequence of the underlying disease. The authors' observations concerning blood vis coelasticity support the clinical im portance of improving blood rheology by appropriate therapeutic measures.
Noninvasive Surveillance of Allografted Kidneys by Ultrasonic Duplex Scanning
Authors: de Gaetano Anna Maria , Boldrini Giuseppe , Nanni Giuseppe , Serino Francesco , Giovannini Ivo , Castagneto Marco 
Published: July 2008

Over a one-year period 1,000 duplex Doppler evaluations were performed in 70 patients submitted to kidney transplantation for end-stage renal failure. Duplex monitoring was performed to evaluate transplant status from hemodynamic patterns of the graft arteries. A duplex scanner with a 3.75 MHz sector transducer was used; pulsed Doppler was utilized to detect blood flow velocities in the main renal, segmental, interlobar and arcuate arteries. Arterial signals were quantified through a pulsatility index (PI). Three cases of acute rejection (AR), 9 cases of chronic rejection (CR), 2 cases of cyclosporine nephrotoxicity (Csa Tox), and 4 cases of acute tubular necrosis (ATN) were recognized and biopsy proved. At each arterial site PI values of normally functioning allografts were lower than 1.5; AR patients showed PI values ranging from 1.7 to 3.1, promptly lowered by immunosuppressive treatment. CR patients had a spectrum of PI from 0.5 to 3.1. Patients with Csa Tox and ATN showed in all the explored sites normal arterial signals and thus normal PI values. PI variations reflect even slight blood flow reductions due to immunologically mediated increases in intrarenal arterial resistances. Duplex sonography of allografted kidneys shows great diagnostic attitudes in the noninvasive characterization of transplant malfunction.