bluuebunny/crossref_metadata_2025_split huggingface dataset:
Estimation of Aortic Wall Sclerosis in Hypertension by Use of Carotid Pulse Tracing and Cine Magnetic Resonance
Authors: Honda Toshio , Hamada Mareomi , Matsumoto Yuji , Matsuoka Hiroshi , Shigematsu Yuji , Hiwada Kunio 
Published: July 2008

In order to evaluate aortic wall sclerosis in hypertension, the authors studied the following two parameters of carotid pulse tracing and ascending aortic wall distensibility by using cine magnetic resonance (MR) in 15 age- and sex-matched normal volunteers (NC) (mean age, fifty-four years old) and 15 hypertensive patients (HT) (mean age, fifty-four years old). As the parameters of carotid pulse tracing, they measured the interval from aortic second heart sound to dicrotic notch (A2-DN), and the height from dicrotic notch to top/total height of carotid pulse tracing (b/a ratio). Ascending aortic distensibility was calculated from the following formula: (max area - min area) / (min area x pulse pressure) A2-DN interval was lower in HT than in NC (18.4 ± 7.9 vs 31.5 ± 9.2 ms, P < 0.01). The b/a ratio was lower in HT than in NC (0.34 ± 0.07 vs 0.44 ±0.09, P < 0.01). Ascending aortic distensibility was lower in HT than in NC (2.08 ± 1.37 vs 7.26 ± 2.51 × 10-3 mmHg-1, P < 0.01). In conclusion, ascending aortic wall sclerosis is advanced in hypertension. A2-DN interval and b/a ratio measured by carotid pulse tracing are useful indicators in evaluating the ascending aortic wall distensibility in hypertension.
Plasma Viscosity Increase with Progression of Peripheral Arterial Atherosclerotic Disease
Authors: Poredoš Pavel , Žižek Bogomir 
Published: July 2008

Increased blood and plasma viscosity has been described in patients with coronary and peripheral arterial disease. However, the relation of viscosity to the extent of arterial wall deterioration—the most important determinant of clinical manifestation and prognosis of the disease—is not well known. Therefore, the authors studied plasma viscosity as one of the major determinants of blood viscosity in patients with different stages of arterial disease of lower limbs (according to Fontaine) and its relation to the presence of some risk factors of atherosclerosis. The study encompassed four groups of subjects: 19 healthy volunteers (group A), 18 patients with intermittent claudication up to 200 m (stage II; group B), 15 patients with critical ischemia of lower limbs (stage III and IV; group C), and 16 patients with recanalization procedures on peripheral arteries. Venous blood samples were collected from an antecubital vein without stasis for the determination of plasma viscosity (with a rotational capillary microviscometer, PAAR), fibrinogen, total cholesterol, alpha-2-macroglobulin, and glucose concentrations. In patients with recanalization procedure local plasma viscosity was also determined from blood samples taken from a vein on the dorsum of the foot. (continued on next page) (Abstract continued) Plasma viscosity was most significantly elevated in the patients with critical ischemia (1.78 mPa.sec) and was significantly higher than in the claudicants (1.68 mPa.sec), and the claudicants also had significantly higher viscosity than the controls (1.58 mPa.sec). In patients in whom a recanalization procedure was performed, no differences in systemic and local plasma viscosity were detected, neither before nor after recanalization of the diseased artery. In all groups plasma viscosity was correlated with fibrinogen concentration (r=0.70, P < 0.01) and total cholesterol concentration (r=0.24, P < 0.05), but in group C (critical ischemia) plasma viscosity was most closely linked to the concentration of alpha-2-macroglobulin (r=0.78, P < 0.01). These results indicate that in patients with peripheral arterial disease plasma viscosity increases with the progression of the atherosclerotic process and is correlated with the clinical stages of the disease. Pavel Poredoš, M.D., Ph.D. University Clinical Center Trnovo Hospital of Internal Medicine Riharjeva 24
A Simple, Noninvasive Method to Investigate Vascular Characteristics in Children
Authors: Hsieh Kai-Sheng , Chen Pao-Lan , Fu Shi-En 
Published: July 2008

Palpation of pulses is an ancient clinical technique. In modern medical terms, arterial pulse analysis permits the evaluation of vascular characteristics, the important parameters for study of the properties of vessels. However, the various parameters used to describe the vascular characteristics have been conventionally deriving from expensive, invasive, and complicated methods and involving complex computations. The authors designed, therefore, a simple, noninvasive system to evaluate vascular characteristics. The system consisted of two units of pressure transducer for simultaneous recording of two peripheral arterial pulses, an analog signal processor, an A/D converter, and a personal computer. The vascular characteristics were analyzed by use of the Windkessel model and cross-correlation function. The analysis program was designed by members of this team. Through this system, systemic arterial compliance and pulse wave velocity can be obtained. Thirty-five children (11 normal children and 24 children with various stable, mild congenital heart diseases) were enrolled for data analysis. For these 35 children without hypertension or other clinically apparent arterial disease, the pulse wave velocity in the upper limb was between 3.7 and 16.8 m × sec-1, with a mean ± standard deviation of 9.3 ± 3.3 m × sec-1. The arterial compliance among the 11 normal children was between 0.72 and 1.72 mL x mmHg -1 × m-2 with a mean of 1.15 mL x mmHg-1× m-2; both were consistent with the previously reported values obtained from complex methods. This system provides data comparable with those obtained from invasive methods. In the past, the arterial characteristics could not be extensively studied owing to the invasive nature of the conventional methods. This new, simple, convenient noninvasive system will thus provide a convenient method for clinical use in evaluating the vascular characteristics of patients, especially of children.
Outcome Predictors of Ultrafiltration in Patients with Refractory Congestive Heart Failure and Renal Failure
Authors: Ramos Roque , Salem Bakr I. , DePawlikowski Maria P. , Tariq Manzoor , Haikal Maged , Pohlman Thomas , Mennes Paul 
Published: July 2008

This study is an attempt to identify predictors of outcome from the use of ultrafiltration (UF) in patients with refractory congestive heart failure (CHF) and renal failure. The authors studied 30 patients in NYHA functional class IV in whom UF was utilized in the management of refractory CHF. Patients were retrospectively divided into two groups according to their outcome. Group A included 12 patients who improved and survived hospital admission, and group B included 18 patients who did not respond and died shortly after UF. Clinical, hemodynamic, and laboratory data before UF were fairly comparable between both groups. Renal function and hemodynamic parameters were compared and analyzed within the same group and between both groups before and after UF. The mean age in group A was sixty-three ±thirteen years while in group B it was seventy ±eleven years (P < 0.005). A mean of 9.6 liters of fluid were removed from group A and 3.2 liters from group B (P < 0.001). Group A showed greater reduction in the mean values of right atrial pressure (P < 0.005) and pulmonary capillary wedge pressure (P < 0.05) after UF. Additionally, group A showed a significant decrease in their blood urea nitrogen (P < 0.05) and serum creatinine values (P < 0.05), in contradistinction to group B patients who showed a major increase in those values after UF. There was no significant change in the mean values of cardiac index, systemic vascular resistance, and pulmonary vascular resistance after UF. (continued on next page) These findings suggest that younger age groups, greater fluid removal, as well as significant decreases in blood urea nitrogen, serum creatinine, and right atrial and pulmonary wedge pressures after UF, are associated with favorable outcome. Conversely, older age groups, less fluid removal, and rising blood urea nitrogen and serum creatinine levels after UF were associated with poor outcome.
Noninvasive Evaluation Of Right Ventricle Systolic Pressure During Dynamic Exercise by Saline-Enhanced Doppler Echocardiography in Progressive Systemic Sclerosis
Authors: Mininni Simone , Diricatti Gaetano , Vono Maria Concetta , Giglioli Cristina , Margheri Massimo , Olivo Giuseppe , Gensini Gianfranco , Galanti Giorgio 
Published: July 2008

Progressive systemic sclerosis (PSS) is characterized in its first phases by vascular damage. Lungs are involved in two thirds of patients with initial progressive destruction of the capillary bed and consequent reduction of the functional reserve, which may lead to hypertension of the pulmonary circulation. For these reasons it is of great interest to have early information about the pressure of the pulmonary circulation, both at rest and during exercise, to follow the progression and the evolution of the illness independently from subjective symptoms. The aim of the study was to evaluate by a noninvasive method, saline-enhanced Doppler echocardiography, the behavior of the right ventricular systolic pressure in patients with PSS, at rest and during exercise, without clear instrumental or clinical signs of pulmonary involvement at rest. Nine patients (7 women and 2 men) with PSS, aged 55.7 ±8.7 years, and 9 control subjects were evaluated. All patients had normal pulmonary pressure at rest and negative history for effort dyspnea. Subjects underwent Doppler echocardiographic examination at rest and during exercise. Right ventricular systolic pressure was evaluated by saline- enhanced Doppler technique, at rest and throughout exercise. (continued on next page) At rest the right ventricular systolic pressure was normal in all patients and controls. At the end of exercise, in 4 patients, values were still normal (40.7 ±2.2 mmHg); in the others pathologic values were recorded (59.8 ±3.9 mmHg). In the control group values were always normal (35.6 ±4.6 mmHg). In our study the saline-enhanced Doppler echocardiography has been demonstrated to be an important diagnostic tool for the noninvasive evaluation of right ventricular systolic pressure, both at rest and during exercise; it could be useful in monitoring the pulmonary vascular damage in patients with PSS.
Evaluation of the Coagulation and Fibrinolytic Systems in Men with Intermittent Claudication
Authors: Handa Koichi , Takao Makiko , Nomoto Junko , Oku Keiko , Shirai Kazuyuki , Saku Keijiro , Arakawa Kikuo 
Published: July 2008

The authors evaluated elements of the coagulation and fibrinolytic systems in 18 male patients with intermittent claudication vs 19 men matched for risk factors who served as controls. Prothrombin time and activated partial thromboplastin time did not significantly differ in the patients and the controls. The plasminogen level in the two groups was not significantly different. The level of lipoprotein(a) was significantly higher in the patients than in the controls. The levels of antigen and the activity of protein C did not differ significantly between the two groups. The thrombomodulin level was significantly higher in the patients than in the controls. There were no significant differences between the two groups in the levels of α2-macroglobulin, C1-inactivator, or antithrombin III. The levels of fibrinogen and α-antitrypsin were significantly higher in the patients vs the controls. Significantly lower levels of α2-plasmin inhibitor and higher levels of α2-plasmin inhibitor/plasmin complex and thrombin/antithrombin III complex were found in the patients vs the controls. These findings suggest that the levels of thrombin/antithrombin III complex, α2- plasmin inhibitor/plasmin complex, and thrombomodulin may perhaps serve as indica tors for injury to the peripheral endothelium and that the coagulation and fibrinolytic systems may be activated in patients with intermittent claudication.
Leukocyte Flow Properties, Polymorphonuclear Membrane Fluidity, and Cytosolic Ca 2+ Content in Subjects with Vascular Atherosclerotic Disease with and Without Noninsulin-Dependent Diabetes Mellitus
Authors: Caimi Gregorio , Canino Baldassare , Ferrara Filippo , Montana Maria , Meli Francesco , Catania Anna , Lo Presti Rosalia 
Published: July 2008

The aim of this research was the evaluation of white blood cell (WBC) filtration, reflecting WBC flow properties, polymorphonuclear cell membrane fluidity, and cytosolic Ca 2+ content in subjects with vascular atherosclerotic disease (VAD) and in VAD subjects with noninsulin-dependent diabetes mellitus (NIDDM), in good hemodynamic balance. The authors examined WBC filtration (unfractionated, mononuclear [MN], polymorphonu clear [PMN] cells), using the St. George Filtrometer and considering, respectively, the initial relative flow rate (IRFR) and the clogging rate (CR); the PMN membrane fluidity, employing the fluorescent probe TMA-DPH and calculating the fluorescence polarization degree; and the PMN cytosolic Ca2+ content, adopting the fluorescent probe Fura 2-AM and considering the ratio between the Fura 2-Ca2+ complex and the unchelated Fura 2 fluorescence intensity. The obtained data showed that only the filtration parameters (IRFR, CR) of unfrac tionated WBCs discriminated normal subjects from VAD groups, whereas the filtration parameters of MN and PMN cells did not demonstrate any distinction. PMN membrane fluidity did not distinguish normal subjects from VAD groups, whereas PMN cytosolic Ca2+ content was significantly increased in VAD groups in comparison with normal subjects. No relationship was evident between WBC filtration and plasma metabolic para meters ; the correlations obtained between PMN filtration and other PMN parameters need further investigation.
Effects of Right Ventricular Pacing on Ventriculoatrial Conduction and Systemic Venous Responses in Sick Sinus Patients
Authors: Chi Woon Kong  , Wen Lieng Lee  , Hsu Tsui-Lieh , Wan Leong Chan  , Jiann Jong Wang  , Liou Jer-Young , Wang Shih-Pu , Chang Mau-Song 
Published: July 2008

This study was designed to assess the ventriculoatrial (VA) conduction and systemic venous responses to right ventricular pacing at different pacing rates and the feasibility of identifying patients prone to pacemaker syndrome by means of a Doppler and two- dimensional echocardiographic technique. Twenty-two sick sinus patients who received ventricular-demand permanent pace makers constituted the study group. The proximal inferior vena cava (IVC) diameters were measured by two-dimensional echocardiography. Fourteen patients had VA conduc tion by preimplant electrophysiologic study or paced electrocardiogram (Group II), while the other 8 patients presented no VA conduction (Group I). Abnormal systolic retrograde flow in the hepatic vein following each paced beat could be demonstrated in those patients with VA conduction in the basal state. In the 8 patients without VA conduction, the IVC diameters were significantly increased during rapid right ventricular pacing in those with left ventricular dysfunction (n=4) as compared with those with normal left ventricular function (n=4) (% increment at 120 beats per minute [bpm] pacing rate, 9% ±6% vs 2% ±3%, P = 0.03). Seven of 14 patients with retrograde conduction showed a 1:1 or 2:1 ratio of paced beat to retrograde flow, at 120 bpm pace rate (Group IIA). Their IVC diameter significantly increased at higher pacing rates than those presenting a higher ratio (group IIB) (% increment at 120 bpm paced rate, 7% ±6% vs -4% ±5%, P < 0.005). Four of 7 patients in group IIA developed symptoms of pacemaker syndrome. However, there were no significant changes in the severity of tricuspid regurgitation at different pacing rates. These data suggest that detection of abnormal systolic retrograde flow in the hepatic vein and measurement of percent changes in IVC diameters during high pacing rates could be helpful in identifying possible pacemaker syndrome in patients receiving ventric ular-demand pacemakers.
Microvascular Changes in Venous Disease: An Update
Authors: Bollinger A. , Leu A.J. , Hoffmann U. , Franzeck U.K. 
Published: July 2008

In an overview the microvascular involvement in chronic venous insufficiency (CVI) is described. Microangiopathy in the lower leg areas is characterized by the presence of typical enlarged and ramified blood capillaries, reduced capillary number, microvascular thrombosis and obliterations, and/or increased permeability of microlymphatics. Transcutaneous oxygen tension (tcPO2) is decreased and directly correlated to the number of perfused capillaries, whereas laser Doppler flux is enhanced. This apparent paradox may be explained by hyperperfusion in the deeper skin layers (mainly shunt vessels) and hypoperfusion in the superficial nutritive vessels. Microvascular changes are of patchy distribution. Trophic changes up to overt venous ulceration are mainly caused by microvascular ischemia and edema formation due to increased capillary permeability and deficient lymphatic drainage.
Therapy Approaches for Lymphedema
Authors: Mortimer P.S. 
Published: July 2008

Lymphedema, regardless of etiology, is essentially incurable but different therapy approaches exist which serve to contain swelling. The objectives of treatment are to reduce swelling, restore shape, and prevent inflammatory episodes, eg, recurrent cellulitis. There are essentially three main approaches to lymphedema treatment: physical therapy, drug therapy, and surgery. Any edema arises from an imbalance between capillary filtration and lymph drainage. The principle of physical therapy is to a) reduce excessive capillary filtration and b) improve drainage of interstitial fluid and macromolecules from congested regions to normally draining lymph node sites. This is achieved through a combination of compres sion, exercise, and if possible, massage. Control of recurrent inflammatory episodes can only be achieved through diabetic type skin care, a reduction in swelling, and if necessary, prophylactic antibiotics. Drug therapy comprises diuretics or the coumarin/flavonoid group of drugs. The use of diuretics for pure lymphedema is physiologically unsound but may be of use in edema of mixed origin and in palliative (cancer) circumstances. Coumarin/flavonoids have been shown to reduce swelling in all types of lymphedema. Surgery is indicated at an early stage for facial swelling, where vision is compro mised, or genital lymphedema, where genitourinary function is affected. Otherwise, reducing operations should only be performed when alternative therapy has failed. Microsurgery for certain forms of lymphedema continues to be evaluated.
Noninvasive Detection of Iliac Artery Disease and Prediction of Its Severity from Doppler Spectral Analysis in Common Femoral Artery
Authors: Makita Shinji , Ohira Atsushi , Murakami Hirofumi , Itoh Shigehiro , Hiramori Katsuhiko , Makita Shinji 
Published: July 2008

The direct interrogation of iliac artery disease (IAD) with color-coded duplex scanning is limited by the presence of intestinal gas or obesity. The purposes of this study were to examine the diagnostic accuracy of duplex ultrasound (DUS) analysis of spectral waves in common femoral artery (CFA) for detection of IAD and to predict its severity. DUS and arteriography were performed in 107 lower extremities in this study. The following were calculated from the CFA spectral waves obtained by DUS: peak systolic velocity (PSV), acceleration (PSV/pulse rise time), and deceleration (PSV/pulse decay time). In patients with isolated IAD, the treadmill exercise test was also performed to evaluate the ischemic severity expressed as recovery rate of ankle pressure index five minutes after exercise (RR-API). Forty-six lower extremities with IAD and 61 without IAD were diagnosed by arteriography. PSV was significantly reduced in lower extremities with IAD (109.5 ±32.7 vs 59.8 ±32.9 cm/s, P<0.05). The deceleration detected IAD with a greater specificity and sensitivity vs acceleration (100.0 vs 82.0% and 97.8 vs 82.6%, respectively). Moreover, the acceleration and deceleration significantly corre lated with the RR-API (r=0.589, P<0.05 and r=0.779, P < 0.01, n=14, respectively). The present evaluation is a simple and accurate technique to augment other exami nations for detection of IAD and to assess its ischemic severity.
Leriche Syndrome
Authors: Sugimoto Takaki , Ogawa Kyoichi , Asada Tatsuro , Mukohara Nobuhiko , Higami Tetsuya , Obo Hidefumi , Gan Kunio , Kitano Ikuo , Izumi Yuko , Sugimoto Takaki 
Published: July 2008

During the past thirteen years, 29 patients underwent surgical intervention for Leriche syndrome. Fifteen patients (aged forty-two to seventy-two years, average 60.7 years) underwent anatomical bypass, and 9 of them whose thrombus was confined to the infrarenal aorta received a routine graft insertion. In the other 6 whose thrombus extended to the level of the renal arteries, an open thrombectomy of the juxtarenal aorta was first performed through a transection of the infrarenal aorta under renal ischemia (4-14 minutes, average 7). Twelve elderly or high-risk patients (aged sixty-eight to eighty-four years, average 75.3 years) underwent an axillobifemoral bypass, and another (continued on next page) 2 (fifty-eight and sixty years old, respectively) who had been operated on at an earlier time received an ascending aortobifemoral bypass. In cases of anatomical bypass, no graft has occluded and all patients but 1, who died of cerebral infarction, have an active life now. In cases of extraanatomical bypass, 5 of the 28 grafts occluded and only 6 patients have survived. The other 8 patients died of malignancy, atherosclerotic complications, or unknown causes. The 10-year survival rate was 92.9% and 29.5% in the anatomical bypass and extraanatomical bypass group, respectively. In Leriche syndrome, anatomical bypass is preferred to extraanatomical bypass if conditions permit. In the juxtarenal type, an open thrombectomy under renal ischemia is mandatory for anatomical bypass, and a transection of the infrarenal aorta facilitates this procedure. Because the patients with Leriche syndrome are elderly and harbor arte riosclerotic lesions, a careful follow-up is mandatory.
Sulodexide Versus Calcium Heparin in the Medium-Term Treatment of Deep Vein Thrombosis of the Lower Limbs
Authors: Pinto Antonio , Corrao Salvatore , Galati Domenico , Arnone Sabrina , Licata Anna , Parrinello Gaspare , Maniscalchi Tiziana , Licata Giuseppe , Pinto Antonio 
Published: July 2008

Thirty adult patients with distal, monolateral deep vein thrombosis of the lower limbs were randomly treated for sixty days either with subcutaneous Ca-Heparin or with Sulodexide, administered IM for ten days and orally for fifty days. The thrombus accretion above the knee, the venous pressures of the affected leg, the clinical sympto matology, and some laboratory coagulative tests were monitored throughout the admin istration period. Local tolerability of the two treatments was also evaluated. The two applied treatments evidenced a net antithrombotic activity, preventing thrombus accretion above the knee, improving with the same efficacy the venous pressures in the affected legs, and similarly reducing clinical symptoms, with a quick and statistically significant trend toward normalization. Blood fibrinogen was significantly lowered by both drugs, while only Ca-heparin yielded a prolongation of activated partial thromboplastin time. Local tolerability of treatments was better for the mainly oral Sulodexide administrations, while subcutaneous Ca-heparin often induced small, though transient, hematomas.