bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effects of Progressive Vascular Occlusion on Slope and Intercept of the Pulmonary Artery Pressure-Flow Relationship
Authors: Shian Gu  , Prewitt Richard M. , Schick Usha , Ducas John 
Published: July 2008

Pulmonary hemodynamics may be described by mean pulmonary arterial pressure (PAP)-cardiac output (CO) plots. The slope of the PAP-CO relationship may define the incremental resistance (IR), and the extrapolated pressure intercept (PI), the effective outflow pressure. The authors investigated the effects of progressive pulmonary vascular occlusion on the IR and PI of the PAP-CO plot. Nine experimental and nine time control dogs were studied. In the former group, PAP-CO plots were obtained in three conditions: (1) Baseline, (2) following occlusion of the right pulmonary artery, and (3) following occlusion of the right pulmonary artery and blood flow to the left upper lobe. Following progressive occlusion, there was a corresponding increase in the IR of the PAP-CO plot, from 1.95 to 3.62 to 5.16 mmHg.1-1.min (all P < 0.05). In contrast to the increase in IR, PI remained constant. Over the same interval, there were no changes in IR or PI in the time control group. These findings indicate that changes in the slope of the PAP-CO plot correspond to changes in the number of parallel vascular units.
Sudden Cardiac Death Rate in an Area Characterized by High Incidence of Coronary Artery Disease and Low Hardness of Drinking Water
Authors: Bernardi Daniele , Dini Frank Lloyd , Azzarelli Andrea , Giaconi Antonella , Volterrani Cesare , Lunardi Maurizio 
Published: July 2008

From January 1992 to January 1993 the incidence of sudden cardiac death among the population of the Media Valle del Serchio area (Tuscany, Italy), composed of a popula tion of 35,000, was found to be twice that of the European average; 32 cases have been reported over this period in that area (9 per 10,000 in the examined year), with a male/female (M/F) ratio of 2.5:1 (23 M, 9 F). In Italy the mean incidence of sudden death was calculated as 6/10,000 and in Europe 5/10,000. In the examined population hypertension was the coronary risk factor present most frequently (87%). A previous diagnosis of coronary artery disease was documented in 21 cases (66%); 5 of these exhibited previous myocardial infarction and 3 previous myocar dial infarction associated with left ventricular heart failure. In 7 subjects no previous cardiovascular disorders were discovered. Prodromal symptoms had been reported in 20 cases (62%), which included chest pain in 8 and dyspnea in 8. In the examined geographic area a high prevalence of coronary artery disease was verified through the records of the Public Health Service, which documents the main causes of mortality in Tuscany, and through the hospitalization data and the services provided for ischemic heart disease at the local coronary care unit compared with the national average. Moreover, research was accomplished on physical and chemical prop erties of drinking water in the same area, and this revealed a very low total hardness due to the paucity of calcium and magnesium salts. In conclusion, this research demonstrated a close relationship between the incidence of sudden death and the incidence of ischemic heart disease in a mountain area with low-hardness drinking water.
Classification of Congenital Arterial and Venous Vascular Malformations
Authors: Bartels Claus , Horsch Svante 
Published: July 2008

Arterial and venous vascular malformations due to congenital abnormalities rarely occur in the daily practice of vascular surgeons. These malformations represent a heteroge neous group of isolated or multiple congenital abnormalities, sometimes associated with complex congenital syndromes. Correct recognition and classification of these rare abnor malities may sometimes be difficult. No systematic classification of arterial and/or venous vascular malformations due to congenital abnormalities is currently available. On the basis of embryologic and pathophysiologic considerations, a rational and simple classifi cation of arterial and venous vascular malformations due to congenital abnormalities can be performed. This contribution presents an appropiate classification of clinically important arterial and venous vascular malformations due to congenital abnormalities.
Direct In Vivo Visualization of Right Cardiac Anatomy by Fiberoptic Endoscopy Hemodynamic Effects and Image Validation
Authors: Fujimura Osamu , Lawton Mark A. , Koch Cheryl A. 
Published: July 2008

The authors tested the ability of a balloon-tipped fiberoptic endoscope to accurately visualize and identify right-heart anatomy in 7 anesthetized dogs. A 3.6-mm-diameter fiberoptic endoscope with a latex balloon covering the distal tip was inserted into the right atrium, where the balloon was inflated with air in 5 mL increments. Heart rate did not show changes. Mean arterial pressure and cardiac output started to show signifi cant decreases with a balloon volume at 25 and 20 mL, respectively (n = 7). Visual image quality was excellent with a balloon volume of 10 mL or greater. With a balloon volume of 7-10 mL, the visual field was 15-20 mm in diameter. Right-heart anatomy including the right free wall, ostium of the coronary sinus, atrioventricular node area, tricuspid valve, right ventricular structures, and pulmonary arteries was clearly and accurately identified. Additionally, spatial relationships among these structures could be estab lished. Furthermore, there was an excellent concordance between endoscopically observed images and postmortem findings. In conclusion, balloon-tipped fiberoptic endoscopy can accurately visualize normal intracardiac structures with no or minimal hemodynamic compromise.
Noninvasive Physiological Assessment of Vascular Wall Sclerosis Using Carotid Pulse Tracing and Cine Magnetic Resonance
Authors: Honda Toshio , Hamada Mareomi , Matsumoto Yuji , Matsuoka Hiroshi , Hiwada Kunio 
Published: July 2008

In order to evaluate vascular wall sclerosis, the authors compared parameters of carotid pulse tracing with ascending aortic wall distensibility by using cine magnetic resonance (MR). Cine MR and carotid pulse tracing were performed in 20 healthy volunteers (mean age fifty-six years). They measured the interval from aortic second heart sound (A2) to the dicrotic notch (DN) (A2-DN interval), 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. There were significant positive correlations (r=0.70) between the A2-DN interval and ascending aortic distensibility and between b/a ratio and ascending aortic distensibility (r=0.63). The measurement of A2-DN interval and b/a ratio using carotid pulse tracing is a useful method for assessing ascending aortic wall sclerosis.
Intrathrombus Administration of Tissue Plasminogen Activator in Acute Cerebrovascular Occlusion
Authors: Frey James L. , Greene Karl A. , Khayata Mazen H. , Dean Bruce L. , Hodak John A. , Spetzler Robert F. 
Published: July 2008

Intraarterial thrombolysis for acute cerebrovascular occlusion has achieved recanalization at a 50-90% rate. Clinical outcome has been unpredictable. The authors sought to test the hypothesis that intrathrombus administration of recombinant tissue plasminogen activator (rt-PA) would improve recanalization rate and to assess the possibility that clinical outcome would be predicted by the extent of collateral flow. Seven patients with acute cerebrovascular occlusion (less than six hours in 6, twenty-four hours in 1) were treated with intrathrombus rt-PA at 1 mg/minute. Examinations were scored on a five- point motor scale. Collateral flow was assessed angiographically. Vessels recanalized in 5 patients, 3 of whom had good outcomes. Vessels failed to recanalize in 2 patients, 1 of whom had good outcome. Good collateral flow was evident in all 4 patients with good outcome and in none of those with poor outcome. Intrathrombus administration of rt-PA is technically feasible. Favorable clinical outcome is more likely in the presence of good collateral flow. In the absence of good collateral flow, ultra-early intervention may be necessary.
Does Increased Lipoprotein (a) Impair the Effectiveness of Thrombolysis With Streptokinase?
Authors: Tokgözoğlu S. Lale , Ozmen Ferhan , Kabukçu Mehmet , Karanfil Aydin , Aytemir Kudret , Ozkuyumcu Cumhur , Ugurlu Şevket 
Published: July 2008

Although lipoprotein (a) [Lp(a)] has been shown to interfere with thrombolysis in vitro, its effects on thrombolytic therapy in patients with acute myocardial infarction (MI) are not clear. The authors evaluated 32 male patients ages thirty-five to seventy-five (mean fifty-two ±ten) with the diagnosis of acute MI who underwent thrombolytic therapy with 1,500,000 units of intravenous streptokinase. All patients underwent coronary angio graphy within seven days of the infarction from which the thrombolysis in myocardial infarction (TIMI) flow grades of the infarct-related artery, coronary scores, and ejection fraction were determined. Anterior MI was found in 19 patients (59.4%), inferior MI in 12 (37.5%), and posterolateral MI in 1 patient (3.1%). They found that 6 patients (18.8%) had TIMI flow 0 to 1, and 26 patients (81.2%) had TIMI flow grade 2 or 3. The Lp(a) levels ranged from 0.1 to 60 mg/dL with a mean of 8.6 ±17 mg/dL. Eight (25%) of the patients had Lp(a) levels above 30 mg/dL. The TIMI flow rates were not found to be lower in patients with high Lp(a) levels (P > 0.05), and there was no significant corre lation between the TIMI flow rates and the Lp(a) levels (r=0.28). There was a good correlation between coronary scores and Lp(a) levels ( r=0.87). They conclude that although there is a good correlation between the extent of coronary atherosclerosis and Lp(a) levels, Lp(a) is not a strong predictor of the outcome of thrombolytic therapy.
Comparative Study of Left Ventricular Function in Patients with Unstable Angina, Non-Q Wave Myocardial Infarction and Stable Angina Pectoris: Assessment with Atrial Pacing and Digital Ventriculography
Authors: Hussain K.M.A. , Gould L. , Pomerantsev E.V. , Angirekula M. , Bharathan T. 
Published: July 2008

To compare left ventricular global and segmental function at rest and during right atrial pacing in patients with unstable angina, non-Q wave myocardial infarction, and stable angina (class III angina), low-dose digital subtraction ventriculography was performed at rest and after abrupt cessation of pacing in 42 patients with unstable angina, 8 patients with non-Q wave myocardial infarction and 15 patients with stable angina during selective coronary arteriography. Left ventricular ejection fraction was significantly lower at rest in patients with unstable angina (P < 0.01) and non-Q wave myocardial infarction (P < 0.05) and during pacing (P < 0.01). These two groups of patients had significantly higher values of left ventricular end-diastolic and end-systolic volumes at rest and during pacing as compared with stable angina group. In comparing various clinical patterns of unstable angina, ejection fraction was significantly (P < 0.05) lower during pacing in patients with crescendo angina than in new-onset angina. However, ejection fraction was significantly (P < 0.01) lower in crescendo angina only at rest as compared with rest angina. The length of zone of severe hypokinesia was greater in unstable angina (P < 0.01) as well as in non-Q wave myocardial infarction (P < 0.05) both at rest and during pacing as compared with stable angina. Contractility of region of hypokinesia during pacing was higher (P < 0.01) in stable angina than in unstable angina and non-Q wave myocardial infarction. In analyzing segmental function in various subgroups of unstable angina, the authors found that the length of total hypokinesia was significantly higher (P < 0.05) (Abstract continued) during pacing in crescendo angina than in new-onset angina. Contractility of region of hypokinesia was lowest at rest and during pacing in patients with crescendo angina. This study demonstrates that patients with unstable angina as well as non-Q wave myocardial infarction were characterized by more pronounced global and segmental left ventricular dysfunction at rest and during pacing as compared with patients with stable angina, which may explain the poorer prognosis in the former two groups. This study also shows that patients with crescendo angina have more profound left ventricular global and regional dysfunction as compared with patients with new-onset as well as rest angina.
Diagnostic Value of the Arithmetic Sum of the ST Segment of Inferior and V2 Leads, II + V2, III + V2 and aVF + V2 in Identifying the Artery Responsible for Inferior Acute Myocardial Infarction
Authors: Prieto-Solis J.A. 
Published: July 2008

In order to evaluate electrocardiographic changes in the diagnosis of the artery respon sible for inferior myocardial infarction, a prospective study was performed on inferior and V2 ST segment deviation and its correlation using the arithmetic sum: II+V2, III+V2, and aVF+V2. A group of 66 patients with inferior acute myocardial infarction (AMI) was studied. A standard 12-leads electrocardiogram was performed within six hours of the onset of chest pain. Coronary arteriography was performed on each of the patients between one and twelve weeks after infarction. Right coronary artery (RCA) lesion was found in 46 patients, 27 at a proximal level and 19 at a distal level; in 20 patients the left circumflex coronary artery was affected. The isolated value of the magnitude of the inferior ST segment is not an efficient parameter for identifying the artery responsible for inferior AMI. In lead V2 all the patients with a lesion of the left circumflex artery showed ST segment depression ≥ 1 mm (P < 0.001) and all those presenting ST segment elevation had stenosis of the proximal RCA. The most useful parameters for identifying the artery responsible for inferior AMI, with 100% specificity are: (1) for occlusion of the RCA, the arithmetic sum of ST segments: aVF+V2 > 0, with 86.9% sensitivity (P < 0.001); (2) for occlusion of the left circumflex artery III+V2 < 0, with 90% sensitivity (P < 0.001); and (3) for proximal occlusion of the RCA: aVF+V2 ≥ 1, with 96.2% sensitivity (P < 0.001). No specific marker was observed for distal occlusion of the RCA. The value of the arithmetic sum of the ST segment: III+V2 between 0 and 0.9 was the most significant, with 94.7% sensitivity and 95.7% specificity (P <0.001).
Deep Venous Thrombosis in Assir Region of Saudi Arabia Case-Control Study
Authors: Igbinovia A. , Malik G.M. , Adetayo Grillo I. , Seidi O.A. , Egere J.U. , Mazen Hachem M. , Al-Shehri Mohammad Y. 
Published: July 2008

In a five-year case-control study (1988 to 1993) at Assir Central Hospital (ACH), Abha (8,000 feet above sea level), Saudi Arabia, 92 of 129 patients suspected of deep venous thrombosis (DVT) were studied with ascending contrast venography (CV) (74 patients, 80.4%) or Doppler ultrasonography (DUS) (18 patients, 19.6%). Female-to-male ratio was 2.3 to 1. Age range of patients was twelve to ninety years; mean age was 44.45 yrs ±17.38 years. DVT hospital incidence was 18 per 10,000 admissions. The most common associated factors included immobilization due to chronic diseases (21.7%), trauma and surgery (19.6%), and pregnancy and oral contraceptives usage (16.3%). The most common symptom and sign were limb pain and tenderness (95.6%). Limb swelling was noted in 93.5% of patients. The left lower limb was more commonly affected than the right. There was a definite increase of DVT during the winter months. Altitude was not a contributory factor. Pulmonary embolism was the greatest complication.
Deep Vein Thrombosis as a Predictor of Cancer
Authors: Ahmed Zahoor , Mohyuddin Zahoor 
Published: July 2008

An association between cancer and venous thrombosis has long been recognized. In an attempt to find whether venous thrombosis can serve as a reliable predictor of subsequent cancer, 196 cases of confirmed venous thrombosis treated over a seven-year period were reviewed. Of a total of 196 cases, 113 were found to suffer from primary type deep venous thrombosis (DVT), whereas 83 were allocated to secondary type DVT. Of 113 cases with primary DVT, 23 had suffered from recurrent episodes, whereas 90 had only a single episode. From the secondary DVT group of 83 patients, 14 suffered from recurrent episodes and 69 had a single episode. Of the patients in the primary DVT group, 2.65% (3/113) developed cancer subsequently, whereas none was detected among the group of 83 patients who had secondary DVT. In the group of 113 patients with primary DVT, the incidence was higher among those who had recurrent episodes (4.34%, 1/23) than among those who had a single episode (2.22%, 2/90). The overall incidence of cancer among 196 cases of DVT was found to be 1.53% (3/196). The findings do not support the routine screening of all DVT patients by expensive diagnostic modalities. These patients should rather be assessed by careful clinical examinations and baseline investigations. The detailed investigations should be resorted to if there is any suggestion of presence of occult malignancy by these simpler means. One should be more vigilant in case of patients suffering from primary type DVT, for the incidence in this group is significantly higher.
A Serious Complication of Percutaneous Mitral Valvuloplasty: Systemic Embolism. How Can We Decrease It? Case History
Authors: Demirtaç M. , Usal A. , Birand A. , Şan M. , Batyraliev T. , Niyazova Z. 
Published: July 2008

Systemic embolism is a potential and severe complication of percutaneous balloon mitral valvuloplasty (PBMV). The incidence of systemic embolism during PBMV has been reported to be less than 5% and only 0.6% with the Inoue technique. This is less than that reported in closed commissurotomy series and about the same as in open commissurotomy. In the authors' series of 50 cases, the incidence of systemic embolism was 2% (1 case). The patient had mitral restenosis (after closed commissurotomy) with mild to moderate valvular and subvalvular calcification, and cerebral embolism occurred during the procedure. To prevent systemic embolism, the authors' standard policy was to perform transesophageal echocardiography (TEE), computed tomography, and magnetic resonance imaging before the procedure and to give heparin during the procedure and two months preceding it in cases with atrial fibrillation or with a history of previous embolism and to limit manipulation of the catheter in the left atrium. The authors believe that a close scrutiny in the selection of patients, improved technology of the dilating system, good experience with PBMV, and adequate heparinization are also of great importance in the prevention of thromboembolic complications.
The Quantitation of Blood Flow/Metabolism Coupling at Rest and After Exercise in Peripheral Arterial Insufficiency, Using PET and 15-0 Labeled Tracers
Authors: Depairon Michèle , Zicot Michel 
Published: July 2008

Regional blood flow and oxygen uptake of the lower limbs were studied in 11 patients with arterial insufficiency (10 with severe unilateral, 1 with bilateral intermittent clau dication). Regional muscle blood flow (F), oxygen consumption rate (R), and oxygen extraction fraction (E) were evaluated by positron emission tomography (PET) and bolus inhalation of C15O2 and 15O2 by the patient. Tomograms were recorded at the greatest diameter of legs, at rest and ten minutes after a treadmill walk test leading to the devel opment of ischemic pain in the affected leg. In 5 patients, F and E were correlated with the results of occlusive venous strain gauge plethysmography and with the measure ments of blood gases in one brachial artery and in the femoral vein of the affected limb. Blood flow values measured at rest and after exercise by PET were poorly correlated with the plethysmographic findings. This may be because PET does not interfere with flow as venous occlusion plethysmography does in low peripheral pressure conditions. The results show that F, R, and E were not significantly different in normal and patho logic legs at rest. The values of F and R were significantly higher in pathologic than in normal lower limbs, ten minutes after exercise, whereas E was not significantly altered by exercise at any side. This suggests that, during the recovery from a walk test, the delayed increase in oxygen uptake is proportional to the delayed hyperemia in the ischemic muscles ("oxygen debt") and probably not linked to a luxury perfusion.
Cardiac Status in Typhoid Fever Cardiac Status in Typhoid Fever
Authors: Nand N. , Sharma M. , Bhutani M. , Singh G.P. , Sharma V.K. 
Published: July 2008

Fifty adult patients with culture-proved typhoid fever were subjected to daily clinical, electrocardiographic (ECG), and electrolyte assessment to evaluate and correlate their cardiac status. Transaminases and creatine kinase (CCK-MB) were estimated on alternate days and echocardiographic assessment was done once during hospitalization. The patients were distributed into groups: I (21) who did not have any ECG or enzymes changes, IIa (17) who had both ECG as well as enzymes changes, IIb (5) who had ECG changes only, and IIc (7) who had elevated enzymes only. Various types of ECG abnormalities were observed in 22 patients. Transaminases were significantly raised (P < 0.001) in group IIa and IIc patients (24). However, CK-MB was significantly raised (P < 0.001) only in the 5 patients of group IIa. There was no relationship among the elevated enzyme levels, severity of disease, and ECG changes. Further, ECG changes were observed during the convalescence stage also, but transaminases were found to be elevated only during the acute stage. It is concluded that definite injury to the heart occurs during typhoid fever. However, it is difficult to ascertain the exact time and extent of the injury. Further, CK-MB was not found to be superior to transaminases for assessment.
Pericarbon Pericardial Valve Prosthesis: Midterm Results of the Aortic Valve Replacement
Authors: Borowiec Jan W. , Dubiel Thomas W. , Hansson Hans-Erik , Landelius Johan , Nyström Sven-Olov , Borowiec Jan W. 
Published: July 2008

This clinical study was undertaken to verify the encouraging results of experimental studies regarding a new pericardial bioprosthesis. From May 1989 to November 1993, 204 patients underwent an aortic valve replacement with the Pericarbon® (Sorin Biomedica Cardio S.p.A., Saluggia, Italy) prosthesis. A follow-up was 100% complete and extended to 65 months (total 408 patient-years, average 2.0 ±1.4 years). Mean age at the operation was 75.1 ± 5.5 years and 96% were in NYHA clinical stage III or IV. There were 86 men and 118 women; 73 patients had an isolated aortic valve disease, 131 had a concomitant cardiosurgical procedure (coronary artery bypass grafting in 106 patients). The operative mortality (30-day mortality) rate was 11.8% (24/204). There were 24 late deaths (5.9 ±1.2% patient-year). The actuarial probability of survival was 68 ±5% at 5 years. Four patients died of valve-related causes (one thromboembolic complica tion, two endocarditis, one anticoagulant-related hemorrhage). Actuarial rate of freedom from valve-related death was 95 ±3% at 5 years. Valve-related morbidity included seven thromboembolic episodes (1.7% patient-year), four anticoagulant-related complications (0.9% patient-year), three endocarditis (0.7% patient-year) and one reoperation (0.2% patient-year). After 5 years freedom from thromboembolic events was 83 ±7%, from anticoagulant-related hemorrhage 96 ±2%, from endocarditis 97 ±2%, and from reop eration 99 ± 1 %. Echocardiographic study performed in 30 patients showed a paraprosthetic leak in four patients, a central leak in two, and cusp thickening in another three. The clinical data showed that the Pericarbon prosthesis has valve-related morbidity. The echocardio graphic results suggest that the prosthesis can undergo a pathologic process during the first 5 years after implantation. This makes it necessary to continue the follow-up and include the larger number of patients in the echocardiographic investigation.