Angiology

Published by SAGE Publications
Online ISSN: 1940-1574
Print ISSN: 0003-3197
Publications
The 0.014 inch magnum Meier wire was used as the primary tool for recanalization of chronic total coronary artery occlusions in 230 consecutive patients treated by a single operator over a 3-year period. Exclusive use of the magnum wire resulted in an acute success rate of 80.9% in all occlusions and 64.7% in occlusions with a duration of >6 months. The complication rate of this procedure was extremely low with only one nontransmural myocardial infarction occurring. There were no vessel perforations, no in-hospital deaths, and no need for acute surgery. After failure to recanalize with the magnum wire, various other devices (conventional stiff guidewires, jagwire, crosswire) were used resulting in only six additional successful recanalizations but also in two vessel perforations with spontaneous closure of the perforation hole. Therefore, the 0.014-inch magnum Meier recanalization wire is highly effective for recanalization of chronic coronary artery occlusions, if used as the primary tool by an experienced operator, and is associated with an extremely low complication rate.
 
The correlations between percentage changes in ADMA levels and total cholesterol and LDL-C in the whole study population (n 1⁄4 83). ADMA indicates asymmetric dimethylarginine; LDL-C, low-density lipoprotein cholesterol. 
Baseline Characteristics of the Study Population.
Changes in Lipid Parameters and ADMA Levels After Treatment With Rosuvastatin or Atorvastatin.
Correlations Between Percentage Changes in ADMA Levels and Lipid Parameters in the Study Groups.
Elevated plasma levels of asymmetric dimethylarginine (ADMA) are prevalent in patients with hypercholesterolemia and coronary artery disease. A total of 83 patients with hypercholesterolemia and angiographically documented mild coronary artery stenosis were randomized to rosuvastatin treatment (20 mg) or atorvastatin treatment (40 mg) once daily for 6 weeks after a 4-week dietary lead-in phase. Both statins decreased total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), and triglyceride levels effectively. Only rosuvastatin increased high-density lipoprotein cholesterol (HDL-C) levels. Both rosuvastatin and atorvastatin decreased plasma ADMA levels; rosuvastatin had a significantly greater effect. The reduction in ADMA levels were correlated with the reduction in TC and LDL-C levels as well as LDL-C-HDL-C ratio. Treatment with rosuvastatin or atorvastatin in patients with hyperlipidemia with mild coronary artery stenosis may lead to a decrease in ADMA levels, which may contribute to improved endothelial function.
 
Comparison of neutrophil to lymphocyte ratio and platelet to lymphocyte ratio in patients with saphenous vein graft disease and patients with patent saphenous vein grafts. 
The receiver–operating characteristic (ROC) curve analysis of platelet to lymphocyte ratio for the prediction of saphenous vein graft disease. 
Correlation analysis between the platelet to lymphocyte ratio (PLR) and age of saphenous vein graft. 
Univariate and Multivariate Logistic Regression Analysis for Assessment of Independent Predictors of Saphenous Vein Graft Disease.
Atherosclerosis plays an important role in saphenous vein graft disease (SVGD). Previous trials showed that inflammatory blood cells play a role in this process. The platelet to lymphocyte ratio (PLR) has been proposed as a novel predictor for cardiovascular risk and indicator of atherosclerosis. The aim of this study was to assess the relationship between SVGD and PLR. A total of 220 patients with SVG were enrolled (n = 87 with SVGD and n = 133 with patent SVG). A ≥50% stenosis within the SVG was defined as clinically significant. Median PLR (P < .001) and mean platelet volume (MPV; P = .043) were significantly higher in patients with SVGD. Also, PLR showed significantly positive correlation with age of SVG (P < .05). Median age of SVGs was also higher in the SVGD group (P = .025). In multivariate logistic regression analyses, the PLR and MPV were independent predictors of SVGD. Using a cutoff level of 106.3, the PLR predicted SVGD with a sensitivity of 87.4% and a specificity of 80.3%. To the best of our knowledge, this study showed, for the first time, that PLR was independently associated with SVGD. Both PLR and MPV might predict SVGD. © The Author(s) 2015.
 
It is unclear whether carvedilol and nebivolol will produce different effects on platelet function and prothrombotic state in heart failure (HF). Thus, we compared their effects on these functions in patients with nonischemic HF. We included 61 patients with symptomatic nonischemic HF having ejection fraction ≤40%. The patients were randomized to carvedilol (n = 31) or nebivolol (n = 30). Analyses were made at baseline, 3, and 6 months. At 6 months, mean platelet volume (MPV) was significantly lowered by both carvedilol and nebivolol therapy. However, MPV tended to be lower in the carvedilol group (7.7 ± 1.0 vs 8.0 ± 0.7 fL, P = .05). Fibrinogen and d-dimer levels were significantly decreased in but comparable in both the groups. Carvedilol and nebivolol have similar beneficial effects on platelet function and prothrombotic state in patients with nonischemic HF.
 
The authors have tested four Greenfield filters for deflection in a 1.5 Tesla magnetic field and found large variations in the amount of deflection among filters. They also placed two filters in dogs and checked the filter for migration by taking radiographs before and after magnetic resonance imaging (MRI) scans. They found no evidence of migration. They conclude that, while most Greenfield filters respond to a magnetic field, the chance of migration of a filter because of an MRI scan is small. Therefore, MRI scanning of patients with Greenfield filters has little risk.
 
Serum levels of S-100B and neurone-specific enolase (NSE) reflect cerebral injury in a variety of neurological conditions such as stroke, traumatic brain injury, and cardiac arrest. There are limited data on the release of S-100B and NSE following carotid artery stenting (CAS). In 22 patients undergoing CAS, serial blood samples for S-100B and NSE were collected before and 2, 4, and 6 to 8 hours after the procedure. A group of 20 patients with significant CAS undergoing purely diagnostic angiography served as controls. A significant increase in S-100B levels was observed 2 hours after the procedure in patients with CAS (P = .001) with a gradual decline over the next hours. In contrast, patients who underwent purely diagnostic angiography did not show significant changes in S-100B levels up to 8 hours after the procedure. Neither patients with CAS nor those undergoing diagnostic angiography displayed any significant changes in serial NSE levels.
 
The objective of this study was to evaluate the efficacy of Daflon® 500 mg (Dios)* in venous ulcers. A multicenter, double-blind, randomized, controlled versus placebo (Plac) trial was conducted, with stratification according to the size of ulcer (≤ 10 cm and > 10 cm). The protocol called for a two-month treatment with Dios (one tablet = 450 mg micronized purified Diosmin) or a placebo, two tablets/day, in addition to compression therapy. Evaluations were performed every fifteen days, from DO to D60. The primary endpoint, in accordance with Alexander House group requirements were: percentage of patients with complete ulcer healing, ie, comparison between Dios and Plac group at D60, and comparison of survival curves in each group between DO and D60 (log rank test). Secondary endpoints included ulcer surface area assessed by computerized plani metric measurements, qualitative evaluation of ulcers, and symptoms. The patients were 105 men and women ranging in age from eighteen to eighty-five years, with standard compression stocking, who were undergoing standardized local care of ulcer and had no significant arterial disease (ankle/arm systolic pressure index > 0.8). Fifty-three patients received Dios, and 52 received Plac. The 2 groups were well matched for age (m ±1 SD = seventy-one ±eleven years), gender, ulcer size, and associated disorders. Among patients with ulcer size ≤ 10 cm (Dios = 44, Plac = 47) a significantly larger number of patients had a complete ulcer healing at two months in the Dios group (n = 14) in comparison with the Plac group (n = 6) (32% vs 13%, P = 0.028) with a signifi cantly shorter time duration of healing (P = 0.037). No difference was shown for the secondary criteria, except for sensation of heavy legs (P = 0.039) and a less atonic aspect of ulcer (P = 0.030) in favor of Dios. Among the 14 patients with ulcer size > 10 cm (Dios = 9, Plac = 5), subjected to a descriptive analysis only, no ulcer healed. This study showed that a two-month course of Daflon 500 mg at a daily dose of two tablets, in addition to conventional treatment, is of benefit in patients with venous ulcer ≤ 10 cm by accelerating complete healing.
 
The authors describe a seventy-six-year-old man with aortic graft, which became the focus of chronic disseminated intravascular coagulation (DIC). The patient had abdominal aortic aneurysm (AAA) and the size had increased up to 38 mm in diameter. The AAA was excised and replaced by Dacron graft. Ten months later, the DIC became chronic with renal dysfunction. Indium 111-labeled platelets scintigraphy showed increased accumulation of radioactivity over the graft. In the treatment of chronic DIC, low-dose subcutaneous heparin injection (5,000-10,000/day) was effective, and he was discharged. In this case there was also suspicion of lung cancer and recurrent aortic aneurysm, which were a more reasonable cause of chronic DIC. This case suggests that an aortic graft prosthesis may be a cause of localized chronic DIC and that indium 111-labeled platelets scintigraphy is useful for the detection of localized chronic DIC. Moreover, subcutaneous heparin administration may be effective for chronic DIC in patients with an abdominal aortic graft prosthesis.
 
A new monoclonal antibody spe cific for the beta-chain of human fi brin (C22A) and labeled with ¹¹¹ In has been obtained and successfully used in rabbits and dogs for the in vivo de tection of venous thrombosis. Studies in humans are currently ongoing. In order to assess the diagnostic value of ¹¹¹ In-antifibrin for the detection of ve nous thrombosis of the lower extrem ities, the authors investigated 25 consecutive patients. Ten patients had clinical and instrumental (con trast phlebography and duplex scan ning) evidence of acute deep venous thrombosis (DVT), 3 had a long standing DVT with relapsing epi sodes of swelling and pain, 5 had superficial venous thrombosis, and the remaining 7 had no signs of thrombosis at all. Twenty patients were being treated with heparin. All patients received ¹¹¹ In-antifibrin at the dose of 74 MBq IV and were scanned with a large field of view gamma camera coupled with a high- energy, parallel-hole collimator at 30 minutes and three, six, and twenty- four hours postinjection. Only the persistence of an abnormal uptake at twenty-four hours confirmed by two observers at visual inspection was considered as positive. A positive result was obtained in 9 of 10 DVT patients (90% sensitivity) and in all SVT patients. The single DVT patient with a negative ¹¹¹ In- antifibrin test had the longest inter val between scintigraphy and onset of symptoms (fifty-five days). Thus, the age of thrombi represented a sub stantial limitation for the test. A false-positive result was obtained in a single SVT patient, in whom also a deep involvement, unconfirmed by phlebography, was suspected (91.6% specificity). The authors conclude that ¹¹¹ In- antifibrin is a new diagnostic tool for studying deep venous thrombosis, which allows direct imaging of thrombi during their relatively early phase, with a high degree of sensitiv ity and specificity.
 
The authors used nailfold capillary microscopy (NCM) to evaluate 112 pa tients with systemic sclerosis spectrum disorders (SSc). Patients were classified as S1 if they had skin involvement proximal to the metacarpo-phalangeal joints. S2 if they had at least two minor SSc American Rheumatism Association criteria, and S3 if they had at least two CREST criteria (calcinosis, Raynaud's, esophageal motility disorder, sclerodactyly, telangiectases), without S1 or S2 criteria. Dis ease duration from the first symptom was similar in all groups (7.17 ± 8.98 years). Disease severity was determined by a total score of seven target organ involve ments. S1 patients had a greater degree of skin and pulmonary involvement, with a mean score of 26.2 ± 17.3. S2 patients had a mean score of 13.8 ± 12.4, and had mostly vascular and digestive involvement, in comparison with S3 patients (7.2 ± 7.2; p<0.001 and p<0.01 respectively). NCM sensitivity for S1 and S2 was 93.6%. NCM correlated with the degree of target organ involvement (p < 0.01). Three NCM profiles established were: "mild," normal or borderline capillaries; "moderate," other abnormalities with no capillary telangiectases; and "severe," abnormalities other than those of the mild profile, with capillary telangiectases. The positive correlation observed between the degree of skin and vascular abnormalities and the severity of digestive, renal, musculoskeletal, and pulmo nary involvement permits rapid prediction of target organ involvement by SSc at the first visit.
 
This study presents the results of transcutaneous oxygen pressure (TcPO 2 ) monitoring during a treadmill test walk performed in the early stages of peripheral obliterative vascular disease. The study population consisted of a first group of 50 known arteriopathic patients presenting, on questioning, with intermittent claudication; a second group of 50 known arteriopathic patients void of any symptoms of intermittent claudication; and a third group, which was a control cohort of 20 nonarteriopathic, nonclaudicating patients. Though resting TcPO 2 cannot be used to aid the clinical diagnosis of exercise ischemia it may be useful in revealing asymptomatic chronic resting ischemia (9% of cases in this series). On the other hand, a posteffort (recovery phase) fall in TcPO 2 had a predictive positive diagnostic accuracy for ischemia on exercise in 99% of the cases reported here versus 87% for clinical appraisal. In the light of these results, TcPO 2 measurements coupled to a treadmill test walk perfectly ascertain exercise ischemia in arteriopathic patients, whether asymptomatic or not, and avoid the false-positive results obtained by clinical evaluation.
 
Nitrates, although important for the management of anginal symptoms, produce significant side effects. Little is known about their net effects on health-related, quality-of-life indices. In a self-controlled, 6-month study, the effects on symptoms and quality of life of multiple-dose and once-daily nitrate therapy were evaluated in 1212 patients with stable angina pectoris. Quality of life was assessed by a test battery based on the exercise-tolerance index of Wiklund, the psychological well-being index of Dupuy, and the Short Form 36 questionnaire of Stewart. The internal consistency and reliability of the multi-item scales were estimated by Cronbach's alpha coefficients. The effects of the two treatment regimens on pain index and number of additional sublingual nitrate tablets required were not different. However, based on the New York Heart Association (NYHA) angina classification, patients improved better on the once-daily than on the multiple-dose regimen: by > 1 category in 281 vs 62 of the patients (P < 0.0001); mobility and psychological distress indices also improved (P = 0.006, and P = 0.007). Once-daily nitrate therapy not only provides a better NYHA angina classification than multiple-dose therapy does, but also provides a better quality of life as estimated by improvement of mobility and distress indices, the most important indicators of quality of life in this category of patients.
 
The 2,6-dimethylanilide of quinuclidine-3-carboxylic acid hydrochloride (EO-122), a new structural analog of lidocaine, has been shown to possess po tent antiarrhythmic activity in experimentally induced arrhythmias in animals. Restoration of normal sinus rhythm and suppression of ouabain-induced ar rhythmia in cats and dogs, and of coronary occlusion-induced arrhythmia in dogs, followed a single IV injection of 1-3 mg/kg, with an onset of 2 minutes and a duration of 20-240 minutes. Occlusion-induced arrhythmia was likewise suppressed after an oral dose of 10-20 mg/kg, with an onset of 11-65 minutes and a duration of 25-120 minutes. Under similar conditions, lidocaine was ei ther totally ineffective or of ultra-short duration. The bioavailability of EO-122 by the oral route exceeded 80% of the oral dose. Therapeutic blood concentrations were in the range 0.5-7 μg/ml. At about 5μg/ml there was a slight depression of cardiac function in the anesthe tized cat, but not in the conscious dog. In cats, complete A-V block occurred at concentrations of 60-70 μg/ml. The IV LDso in mice was 22 mg/kg, and in rabbits 8.5 mg/kg. No overt signs of neurotoxicity could be observed at any dose of EO-122. The pharmacokinetic profile of the drug fits a two-com partment open model, with t ½ ≃ 150 min and V d (ss) ≃ 1.5 1/kg.
 
Iodine 123 beta-methyl iodophenyl pentadecanoic acid (123I-BMIPP), a beta-methyl-branched fatty acid analogue, has been proven by experimental studies to reveal abnormalities in fatty-acid-related metabolism. This study was undertaken to validate the accuracy and limitations of 123I-BMIPP imaging at rest in detecting myocardial metabolic abnormalities and predicting coronary lesions in unstable angina (UA). One hundred UA patients without prior myocardial infarction were studied. 123I-BMIPP and thallium 201 chloride (201TlCl) imaging with single photon emission computed tomography (SPECT) and coronary and left ventricular cineangiography (LVC) were performed 1 week after the last episode of angina. There was reduced uptake of 123I-BMIPP imaging in 70 patients, reduced uptake of 201TlCl in 41, and abnormal LVC contraction in 49 patients. There were significant increases in severity scores of 123I-BMIPP imaging along with increases in the number of stenosed coronary arteries and the severity of stenosis in individual coronary arteries. There was a significant reduction in 123I-BMIPP severity scores 1 month after percutaneous transluminal coronary angioplasty (p < 0.01) and a significant correlation between the severity scores of 123I-BMIPP and LVC (r=0. 579, p<0.001). Overall rates of sensitivity and specificity in detecting significant coronary stenosis by 123I-BMIPP imaging were 74% and 86%, respectively, whereas rates of sensitivity and specificity in detecting significant coronary stenosis by 201TlCl were 31% and 91%, respectively. 123I-BMIPP sensitivity increases to 86% if only advanced coronary stenosis of >90% is included. In conclusion, 123I-BMIPP myocardial imaging is an effective method of predicting coronary artery lesions of UA patients without provocative test.
 
Although positron emission tomography (PET) assesses myocardial viability (V) accu rately, a rapid, inexpensive substitute is needed. Therefore, the authors developed a low- dose (1 mCi) Iodine-123-Iodophenylpentadecanoic Acid (IPPA) myocardial viability scan requiring analysis of only the first three minutes of data acquired at rest with a standard multicrystal gamma camera. Twenty-one patients > 2 weeks after myocardial infarction (MI) (24 MIs, 10 anterior, 14 inferoposterior, 21 akinetic or dyskinetic) had cardiac catheterization and resting IPPA imaging. V was determined by either transmural myocar dial biopsy during coronary bypass surgery (12 patients, 14 MIs) or reinjection tomo graphic thallium scan (9 patients, 10 MIs), and 50% of MIs were viable. The IPPA variables analyzed were: time to initial left ventricular (LV) uptake in the region of interest (ROI), the ratio of three-minute uptake in the ROI to three-minute LV uptake, three-minute clearing (counts/pixel) in the ROI (decrease in IPPA after initial uptake), and three-minute accumulation (increase in IPPA after initial uptake) in the ROI. Rules for detecting V were generated and applied to 10 healthy volunteers to determine normalcy. While three-minute uptake in nonviable MIs was only 67% of volunteers (P < 0.0001) and 75% of viable MIs, uptake alone identified only 50% of viable MIs and 75% of nonviable MIs. IPPA clearing, however, was ≥ 13.5 counts/pixel in 10/12 (83%) of viable MIs, and IPPA accumulation ≥ 6.75 counts/pixel identified one more viable MI, for a sensitivity for V of 11/12 (92%), with a specificity of 11/12 (92%), and a 100% normalcy rate.
 
Advanced experiences show an extremely high diagnostic potential in im munoscintigraphy of infections using monoclonal antigranulocytes antibodies (Mab). There was no hampering of the biological properties of the granulocytes after in vivo labeling with ¹²³ I or 99m Tc-tagged Mabs. There were mostly identi cal findings and an equal functional behavior of the granulocytes observed with the use of different agents. Diagnosis of infections was made mostly within four to six hours p.i. 99m Tc labeling is more advantageous than ¹²³ I because of better image quality, constant availability, and lower costs. ¹²³ I Mab 47 seems to be recommended in some cases of chronic osteomyelitis and spondylitis. No rele vant antigenicity was observed in follow-up studies of testing HAMA serum levels. Only a few short-time reactions were seen after repeated administration of 99m Tc Mab. There were no side effects and no allergic or adverse reactions. Despite these methodical advantages of the immunoscintigraphic detection of infectious and inflammatory lesions, this method should be further restricted to severe cases or patients in whom other methods would not be practicable or have failed. HAMA controls are continued in all our patients undergoing im munoscintigraphy.
 
To evaluate the thrombolytic effects of the native tissue-type plasminogen activator (t-PA), the authors used a thrombus model simulating clinical situations. The native t-PA (AK-124) was obtained from human-derived normal cells. Experimental canine coronary thrombosis was produced by partial constriction and endothelial denudation of the vessel. In 19 dogs, coronary occlusive thrombus was produced. Three hours after total occlusion of the coronary artery with thrombus, the authors attempted the thrombolytic therapy in 16 dogs. Histologically, three-hour thrombus was composed of a mixture of platelet aggregates, fibrin, and blood cells. They infused 0.375 mg/kg t-PA intravenously in 7 dogs and 20,000 IU/kg urokinase (UK) in 9. Coronary recanalization was achieved in 5 (71%) with t-PA infusion and 6 (67%) with UK infusion. Plasma fibrinogen levels decreased to 76% of preinfusion value in the dogs with t-PA infusion and to 34% in those with UK infusion. Coronary reocclusion occurred in 2 dogs with t-PA and 3 with UK. Thus, the native t-PA (AK-124) can provide coronary thrombolysis without severe depletion of plasma fibrinogen levels.
 
125I fibrinogen test was performed in 20 selected patients who presented with symptoms suggestive of deep venous thrombosis. The incidence of a false positive study was found to be very high: 90%. An increased accumulation of fibrinogen was noted over recent, well-healed surgical incisions, diffuse or focal inflammatory sites, hematoma and also, following a venogram or arthrogram test. The large number of coincidental circumstances that result in an abnormal accumulation of 125I fibrinogen lead us to believe that venogram is the procedure of choice in patients with symptoms simulating thrombophlebitis.
 
To evaluate the prevalence of significant coronary artery disease (CAD) and nondiagnostic studies in patients referred for clinically indicated coronary angiography performed by 128 multidetector computed tomography (MDCT). We examined patients referred for coronary computed tomography (CT) angiography for the presence of CAD. The analysis included 438 studies classified as normal, with nonsignificant CAD, with significant CAD, or nondiagnostic. Of the 438 cases evaluated, 121 (27.6%) cases were reported as normal, 184 (42%) were classified as nonsignificant CAD, 92 (21%) as significant CAD, and 41 (9.3%) were inconclusive. Therefore, 69.7% of the study population most probably did not require conventional coronary angiography. Among patients referred for computed tomography angiography (CTA) for appropriate indications, 69.6% had either normal coronary arteries or nonobstructive disease. Given the high negative predictive value of coronary CTA, these patients most likely would not require invasive coronary angiography. Selective cardiac CTA may substantially decrease unnecessary diagnostic cardiac catheterizations.
 
We investigated whether serum concentrations of apolipoprotein (apo) B and apoA-I and the apoB/apoA-I ratio provided predictive information on myocardial infarction (MI) and ischemic stroke during 13 years of follow-up in a group of initially clinically healthy 58-year-old men, free from previous cardiovascular disease, diabetes, other established disease, or treatment with cardiovascular drugs. Multivariate logistic regression analysis showed that the apoB/apoA-I ratio and apoB were significant and independent determinants of MI (exponentiation of the B coefficient [Exp(β)] 3.1, 95% confidence interval [CI] 1.6-6.3, P = .001, Exp(β) 2.8, 95% CI 1.1-7.7, P = .045, respectively). The area under the receiver-operating characteristics curve as a relative measure of test efficiency was highest and significant for both apoB/apoA-I ratio and apoB (area under the curve = 0.75, P < .001). In conclusion, the apoB/apoA-I ratio and apoB are independent risk factors for MI and has the highest efficiencies for predicting MI in initially healthy middle-aged men.
 
In total, 13 patients, from April 1992 to November 2002 at this institution, had embolization caused by central venous catheter fragments including 4 peripherally-inserted central catheters (PICCs), 1 Hickman catheter, 1 Swan-Ganz catheter, and 7 port-A catheters. These dislodged fragments were percutaneously retrieved successfully in 12 patients. As each type of the central venous catheter has its distinct properties, the locations of embolization, detection, and retrieval methods differed.
 
The recent literature concerning Raynaud's syndrome is reviewed. Ray naud's syndrome is as common as hypertension and diabetes. In spite of its generally benign character, it causes a lot of discomfort to individuals and sick ness absenteeism to society, especially in the colder regions of the world. The etiology remains an enigma 130 years after its first description, perhaps even more so than ever before, the many new theories proposed in the litera ture. Clearly, in a condition where seventy different etiologic theories are advo cated, the culprit lesion is obviously missing, or there is not a culprit lesion but an accumulation of conditions having nothing in common but a few symptoms. Moreover a Raynaud attack may result, not from a single event, but from a cascade of events, just as, for example, hemostasis does. Controversy about diagnosis exists all over. For example, how does one make a diagnosis? Patient history has been considered unreliable. A standardized cold test, though highly reproducible in the authors' hands, is far from common property. Raynaud's syndrome is a condition for which thirty-eight therapies have been advocated in the last three years, but the curative answer is still to come.
 
The radioisotope test using I-131 labelled serum albumin, performed during a period of reactive hyperemia, provides quantitative data which express the rate at which radioactive blood flowing from the leg replaces the non-radioactive blood present in the foot. It has been applied in normal subjects and in patients with arterial occlusions in the lower limbs. High washout rates, i.e. small M/2 index values, were found in the former, whereas low washout rates with higher M/2 indices were observed in the latter. Surprisingly, patients with a very low washout rate could be without subjective symptoms. The usefulness of the test in clinical practice is explained.
 
A radioisotope test using ¹³¹ I-labelled serum albumin and venous occlusion plethysmography were performed simultaneously on the feet of normal individuals and patients with peripheral arterial disease during a period of reactive hyperemia. The radioisotope test includes a circulation time and a build-up curve reflecting a local clearance process which is characterized by the parameter M/2 — delay. Between the parameter M/2 — delay of the radioisotope test and the blood flow measured by the plethysmograph, the power relationship was found to be: M/2 — delay = 74.01 F -0.74 with r = 0.69. The experimental data show that the plethysmographic blood flow mea surement is an accurate method for the assessment of the peripheral circu lation in normal individuals but is less suitable in patients with peripheral arterial disease. The radioisotope test appears to be more valuable than the plethysmographic blood flow measurement for the differentiation of normal individuals from patients with peripheral arterial disease and for the evalu ation of the grade of ischemia.
 
The renal and intrarenal haemodynamic pattern in 17 patients with essential hypertension of different severity and duration was studied by means of the 133-Xenon washout technique and the selective renal angiography. The mean and the cortical renal blood flows were on average significantly decreased as compared to the controls. A good agreement was found between the reduction in renal perfusion and the degree of vascular abnormalities as shown by angiography; on the contrary no correlation was found between the impairment in renal blood flow and the degree and/or duration of hypertension.
 
The increase in skin blood flow produced by both reactive hyperemia and histamine was examined in 8 normal, 8 diabetic and 3 cancer patients using the epicutaneous Xenon-133 clearance method. The histamine flare response in both diabetic and cancer groups was reduced compared to that in the normal group. There was no significant difference in the reactive hyperemia responses. It is concluded that the reduction in the histamine flare response is due to a defect in the sensory nerves mediating the axon reflex and not due to a change in the vascular response.
 
Cerebral venous thrombosis occurring in puerperium is about 10 to 12 times more frequent in India than in Western countries. A clinical study of 135 patients with cerebrovascular accidents in early puerperium is reported. Cortical vein thrombosis is common and arterial thrombosis rare (6/135). The illness usually occurs within the first two weeks, after normal delivery at full term, in a multiparous woman, with multi-focal seizures, stupor or coma, regressing focal signs or at times as pseudotumour cerebri. Deep leg vein thrombosis and pelvic sepsis are rare. Mortality has been high reaching 28 to 33 percent in both Indian and Western countries. With the use of anticoagulants in some selected patients and earlier; energetic, supportive and symptomatic measures in others the mortality could be reduced to less than 20 percent. The quality of survival is good since those who survive have only minimal physical disability.
 
The authors studied 136 Chinese patients with verified cerebral arteriovenous malformations (AVMs) in Taiwan. Intracranial hemorrhage (ICH) was the leading problem at presentation (83.8%), followed by epileptic seizures (21.3%) and vascular headache alone (9.6%). Patients less than forty years old and/or with small AVMs (less than 20 ml) had a statistically significantly higher risk of bleeding (P less than 0.01 and P less than 0.05 respectively). The risk of rebleeding remained unchanged in both small (less than 20 ml) and large (greater than or equal to 20 ml) AVMs once ICH had occurred. The average annual bleeding rate of a nonbleed AVM with seizure alone was 1.7%. Seizures with a partial component could be identified in less than half of the epileptic patients, and EEG abnormalities were found in 85.7% of 45 studied cases. The difference in mortality between medically and surgically treated patients was not of statistical significance. The numbers for both morbidity and good recovery were higher in the surgical group. The rationale for selection of surgical cases is discussed.
 
A beneficial effect of thiazolidinediones includes the reduction of intermediate markers, suggesting a potential for reducing atherosclerosis and restenosis. The objective of this study was to determine if rosiglitazone (RSG) reduced the odds of restenosis and if RSG improved the odds of clinical outcomes after percutaneous coronary intervention (PCI) in type 2 diabetes mellitus (DM) patients. A total of 609 patients with 734 lesions were selected from the period between January 1, 2001 and January 31, 2004. These patients were divided into 2 groups: a "control" group representing patients seen between January 1, 2001 and September 2002 when RSG was not available in our hospital and a "RSG treatment" group representing patients seen between September 2002 and January 31, 2004 when RSG was available in our hospital. Thus, 213 patients with 253 lesions (1.19 L/P) were placed in the RSG group and 396 patients with 481 lesions (1.21 L/P) were placed in the control group. Subgroup analysis based on the PCI received had 88 patients in the RSG arm receiving balloon angioplasty and 125 patients receiving coronary stenting; the control group had 187 and 209 patients, respectively, in the subgroups. Primary endpoint was angiographic restenosis at 6 months, and secondary endpoints were death, myocardial infarction, and target lesion revascularization. More patients in the control group were insulin-requiring, had poorer left ventricular function, but had a larger preprocedural minimal lumen diameter (pre-MLD). At 6 months, restenosis and reocclusion rates were lower in the RSG group (P = .014 and P = .006, respectively). Twenty-nine patients died in the control group versus 1 in the RSG group (P <or= .001). RSG (P = .019), stenting (P = .005), preprocedural reference vessel diameter (P = .017), metformin (P = .022), pre-MLD (P < .001), hyperlipidemia (P = .016), and combined RSG and metformin (P = .020) were predictors of restenosis, while RSG (P = .016) and metformin (P = .029) were predictors of survival. In conclusion, RSG was found safe and well tolerated and was associated with reduced odds of restenosis, reocclusion, and mortality rates in type 2 DM patients independent of glycemic control and PCI performed.
 
Noninvasive characterization of coronary plaques is challenging for cardiologists. The authors' goal was to explore the clinical feasibility of newly developed 16-slice computed tomography (CT) in tissue characterization of coronary arterial plaques in patients with acute coronary syndrome. Sixteen patients with acute coronary syndrome underwent 16-slice CT (Aquillion, Toshiba) and coronary arteriography with intravascular ultrasound (IVUS) within 7 days. Twenty-three plaques were classified by IVUS according to plaque echogenicity: 6 soft plaques, 11 intermediate plaques, and 6 calcified plaques. Mean (+/- SD) CT numbers (Hounsfield units [HU]) of these 3 types of plaques were 50.6 +/-14.8 HU, 131 +/-21.0 HU, and 721 +/-231 HU, respectively. Sixteen-slice CT facilitates noninvasive tissue characterization of coronary arterial plaques.
 
Acute myocardial infarction in the teenage years of life is a rare phenomenon. It is more rare in patients who have no risk factors or comorbid conditions and normal coronary arteries. Evaluation requires extensive investigation into the various risk factors that may be involved as well as the performance of invasive and noninvasive cardiovascular studies. A case of acute myocardial infarction in a teenage boy without familial, inherent, or extraneous risk factors is presented.
 
Cyclosporin A (CyA) is intensively metabolized by the hepatic cytochrome p450 III monooxygenase A system in the human liver, the most important metabolites being M1, M17, and M21. Because CyA and its metabolites have nephrotoxic, hepatotoxic, and neurotoxic side effects, CyA dosage must be calculated to avoid the risk of organ rejection through underdosage and toxic organ damage through overdosage or accumulation of metabolites. In this study, we determined the whole-blood concentrations of cyclosporin and metabolite M17 by high-pressure liquid chromatography (HPLC) and by monoclonal specific and polyclonal nonspecific fluorescence polarization immunoassay (Abbott) in patients after immunosuppressive treatment. Patients with different resorption and metabolization rates showed high individual variations. CyA concentrations in patients with good liver function and low concentra tions of CyA metabolites showed a good correlation between the HPLC and the FPIA (TDx-monoclonal assay) methods in ranges between 25 and 180 ng/mL. TDx-mono clonal was not always as precise as HPLC. In cases of metabolic disorders, we found false high CyA concentrations assayed with the immunologic method, caused by a cross- reaction of the elevated metabolite concentration. We found that HPLC rendered more information about the extent of immunosuppressive activity and the metabolization rate and showed a good correlation with the concentration of metabolite M17 and total metabolites measured with the Abbott CyA polyclonal kit.
 
Venous leg ulcers are common, chronic, debilitating, and expensive. Evidence supports use of compression bandaging, with superficial venous surgery in selected cases, but these interventions frequently fail to achieve healing. We describe a series of 152 consecutive referrals from a nurse-led specialist dermatology clinic to a vascular surgical service; a group posing particularly challenging problems. This observational study, with median follow-up of 18 months, describes outcomes in a number of important clinically identifiable subgroups. Its findings may assist service planning and discussion of the surgical role within multidisciplinary ulcer management.
 
Vascular graft infection is associated with a high morbidity and mortality rate. Diagnosis is difficult, as there is no single diagnostic criterion that has a 100% accuracy. A combination of physical examination, laboratory tests, and several imaging techniques is mandatory. Beside a wide range of indications in the oncological field, positron emission tomography with (18)F-fluorodeoxyglucose (FDG-PET) has a well-known role in the diagnosis of bone and soft-tissue infections. Some authors have recently reported on the potential use of FDG-PET in the diagnosis of vascular graft infections. The aim of this study is to review personal experience. Five consecutive patients with a suspected prosthetic infection (1 aortobifemoral bypass, 3 femoropopliteal bypasses, and 1 femorofemoral bypass) underwent FDG-PET. All prostheses showed a moderate or intense FDG tracer uptake. All 3 patients with an intense FDG uptake proved to have a prosthetic infection (based on microbiologic examination). These preliminary results suggest that FDG-PET might be an interesting tool to confirm vascular graft infection.
 
In order to assess the impact of thrombolytic therapy on return to work eighteen months after a first myocardial infarction, 32 patients treated with streptokinase were compared with 30 patients not treated with streptokinase. The study was designed as a historical cohort study. The patients in both groups had continuous chest pain of less than six hours prior to admission and electrocardiographic changes consistent with acute myocardial infarction (MI). The two groups were comparable with respect to medical variables related to their myocardial infarction and to educational level. A total of 17 patients (53%) in the streptokinase group and 16 (53%) among controls had stopped working eighteen months after their MI. An association between the treatment and the working status could not be found (relative risk = 1.0) nor could it be found if the figures were corrected for deaths and retirements because of age. In conclusion, this study could not demonstrate any beneficial effect of thrombolytic therapy on the return to work eighteen months after an initial myocardial infarction.
 
Top-cited authors
Sevket Balta
  • Malatya Hayat Hastanesi
Turgay Celik
  • Wake Forest University
Mustafa Duran
  • Gediz University
Mahmut Akpek
  • Kayseri Education and Research Hospital
Maciej Banach
  • Medical University of Łódź