Showing papers in "Angiology in 1981"
TL;DR: This discussion will deal with two major aspects where arterial and venous smooth muscle differ in their sensitivity to vasoactive agents; theirensitivity to inhibitors of calcium-influx (Ca2+ antagonists) on the one hand and their reactivity to serotonin (5-hydroxytryptamine) and serotonin antagonists, on the other.
Abstract: There are marked differences in responsiveness to naturally occurring vasoactive substances1-4 between isolated blood vessels of different anatomical origin and in particular between arteries and veins. This discussion will deal with two major aspects where arterial and venous smooth muscle differ in their sensitivity to vasoactive agents; their sensitivity to inhibitors of calcium-influx (Ca2+ antagonists) on the one hand and their reactivity to serotonin (5-hydroxytryptamine) and serotonin antagonists, on the other.
68 citations
TL;DR: Essential hypertension might be causally related to an impair ment of venous function, in which serotonin might be an important pressor factor, and R 41 468 most probably acts by decreasing the venous capacitance bed constriction.
Abstract: In a first experiment, an acute intravenous administration of 10 mg R 41 468, a pure serotonin-receptor blocking agent with high selectivity for blood vessels and thrombocytes and devoid of central effects, dramatically reduced systolic and diastolic blood pressure in 23 elderly hypertensive patients. Heart rate and cardiac output remained virtually unchanged.In a second double-blind placebo-controlled cross-over study a highly significant decrease of systolic and diastolic blood pressure was obtained in 14 elderly hypertensive patients during an 8-day oral treatment with 40 mg t.i.d. of R 41 468. No serious side-effects were observed. An oral maintenance therapy with R 41 468 for 3 weeks showed a further reduction of blood pressure, resulting in a normalization of blood pressure, taking into account the advanced age of the patients.R 41 468 most probably acts by decreasing the venous capacitance bed constriction. Essential hypertension might be causally related to an impair ment of venous function, in wh...
55 citations
TL;DR: A 24-year-old female with venous aneurysm of the persistent left superior vena cava and the left subclavicular vein has been reported, which resulted in a successful outcome with absorption of a large hematoma and building of collateral circulation.
Abstract: A 24-year-old female with venous aneurysm of the persistent left superior vena cava and the left subclavicular vein has been reported Spontaneous closed rupture of the venous aneurysm, secondary to thrombosed obstruction, occurred into the posterior mediastinum and the extrapleural thoracic wall The symptom was aggravated rapidly because of absent communicating vein between the persistent left superior and the right superior venae cavae Surgical intervention was not considered for the reason of difficulty in approach Fortunately an open rupture of the venous aneurysm into the thoracic cavity was not seen A conservative treatment for 4 months resulted in a successful outcome with absorption of a large hematoma and building of collateral circulation
49 citations
TL;DR: The value of infrared thermography in assessing the optimum level of amputation of an ischemic limb is described and a rationale for the inadequacy of the method when attempting to determine the outcome of a partial foot amputation is considered.
Abstract: This report describes the value of infrared thermography in assessing the optimum level of amputation of an ischemic limb. Interpretation of thermograms and the factors that can significantly alter the thermal image of the lower limbs are detailed. Results from 104 patients demonstrate that the thermographic method is a reliable indicator of the level of a major limb amputation. A rationale for the inadequacy of the method when attempting to determine the outcome of a partial foot amputation is considered.
47 citations
43 citations
TL;DR: Red cell filterability in patients with leg ischemia was significantly improved after buflomedil administration versus baseline values with no significant change in filterability versus baseline after placebo administration.
Abstract: This brief communication outlines recent experiments on the effects of buflomedil, a new vasoactive agent, on red cell deformability in patients with leg ischemia. In this randomized, double-blind-cross-over study, 10 patients received 200 mg buflomedil and matching placebo intravenously. Red cell filterabiltiy in these patients was significantly improved after buflomedil administration versus baseline values with no significant change in filterability versus baseline after placebo administration.
37 citations
TL;DR: The protection by flunarizine against endothelial injury may be related to its Ca2+-antagonistic properties and the compound does not affect platelet function, plasma coagulation or generation of PGI2 by vascular tissue and does not impair normal haemostasis at effective doses.
Abstract: Flunarizine in vivo protects against endothelial cell damage induced by intravenous injection of citrate, CaCl2, or lactate in rats. Its effect is optimal at the low oral dose of 0.1 mg/kg, corresponding to the clinically used one. It lasts for at least 8 hours. Edema formation, platelet activation, and venostatic thrombosis subsequent to endothelial cell injury consequently are also in hibited by flunarizine. The compound does not affect platelet function, plasma coagulation or generation of PGI2 by vascular tissue and does not impair normal haemostasis at effective doses. As for its vascular and hemor rheological effects, the protection by flunarizine against endothelial injury may be related to its Ca2+-antagonistic properties.
36 citations
TL;DR: Examination of the effect of PF and hence deformability changes on microvascular hemodynamics and the rheological mechanisms underlying such an effect found a significant increase in capillary blood flow brought about by PF administration.
Abstract: Pentoxifylline (PF), known to increase red blood cell (RBC) deformability, has recently attracted much attention because of its possible effect of reducing capillary resistance. There has been practically no reliable demonstration of an increase in capillary blood flow by this drug. This study was intended to examine the effect of PF and hence deformability changes on microvascular hemodynamics and the rheological mechanisms underlying such an effect. Mesentery microvessels of 15 rats were subjected to intravital microscopic observation under transillumination. Capillary blood flow was measured using a newly developed 2-channel sample-hold scanner incorporated into a video display system. Changes in whole blood viscosity were also measured in order to investigate hemorheological changes. It was found that a significant increase in capillary blood flow (as much as 140%) was brought about by PF administration. The increase in blood flow was particularly remarkable in capillaries of about 13 microns in diameter, while whole blood viscosity measured in vitro showed a reduction of 40% at most. In view of these results and the reported effect of PF on increasing the RBC deformability, increased capillary blood flow can be attributed to the increased RBC deformability.
34 citations
TL;DR: Physically, buflomedil in creases perfusion to impaired vascular beds of the microcirculation, increases arterial perfusion with minimal effects on central hemodynamics, exhibits apparent oxygen "sparing" effects in animal experiments, demonstrates inhibitory effects on platelet aggregation, and, in preliminary experi ments, appears to improve deformability of erythrocytes with abnormal fluidity.
Abstract: A brief review of the pharmacology, pharmacokinetics, and metabolism of buf lomedil-HCl is presented providing a phar macologic basis for buflomedil therapy of ischemia associated with peripheral vascu lar disease. Buflomedil is readily absorbed in the gastrointestinal tract and has a plasma half-life of approximately 2-3 hours. The para-desmethyl derivative of buflo medil has been identified as a urinary me tabolite. Pharmacologically, buflomedil in creases perfusion to impaired vascular beds of the microcirculation, increases arterial perfusion with minimal effects on central hemodynamics, exhibits apparent oxygen "sparing" effects in animal experiments, demonstrates inhibitory effects on platelet aggregation, and, in preliminary experi ments, appears to improve deformability of erythrocytes with abnormal fluidity. A non specific α-receptor blocking activity ap pears to be involved, at least in part, in these pharmacologic effects. The relative importance of these mechanisms/effects in the treatment of ...
33 citations
TL;DR: It is concluded that transcutaneous measurements of oxygen tension at the pretibial region are useful in evaluating the ischemic leg quantitatively.
Abstract: We tried to apply transcutaneous oxygen tension (tcPo2) in evaluating the ischemic leg quantitatively from the standpoint of the skin circulation. The tcPo2 measurement was performed on the pretibial and dorsal skin at rest, on exercise loading, and during oxygen inhalation; tcPo2 on the chest wall was measured as a standard value. The subjects consisted of 47 patients with ischemic legs and 20 normal healthy males without ischemic legs.tcPo2 in the pretibial skin had a tendency to decrease with aging. There was a correlation between pretibial tcPo2 and ankle pressure (r = 0.51, p < 0.02). In the affected leg, each mean pretibial tcPo2 under 3 different conditions was much lower than that of control. Pretibial tcPo2 of patients also correlated well with the Fontaine classification of clinical severity of ischemic legs.We concluded that transcutaneous measurements of oxygen tension at the pretibial region are useful in evaluating the ischemic leg quantitatively.
30 citations
TL;DR: It is concluded that acute myocardial infarction in this patient was probably caused by coronary arterial spasm induced by ergotamine tartrate.
Abstract: A 45-year-old woman with almost normal coronary arteries suffered from acute inferior myocardial infarction after taking 2 tablets (2.0 mg) of ergotamine tartrate for headache. She had had attacks of variant angina and spasm of the right coronary artery had been demonstrated during the attack. After the recovery from myocardial infarction the intravenous injection of ergonovine maleate 0.05 mg induced spasm of the right coronary artery again. We conclude that acute myocardial infarction in this patient was probably caused by coronary arterial spasm induced by ergotamine tartrate.
TL;DR: It is documented that history, clinical examination, and single-plane angiography are often unsatisfactory for assessing the hemodynamic significance of an aorto-iliac lesion, and the use of oblique angiographic views, certain noninvasive methods, and direct pressure measurements will be of benefit in difficult cases and lead to a more accurate diagnosis.
Abstract: Accurate hemodynamic assessment of the severity of aorto-iliac disease has important implications in the management of patients with symptomatic peripheral arterial occlusive disease. This study has documented that history, clinical examination, and single-plane angiography are often unsatisfactory for assessing the hemodynamic significance of an aorto-iliac lesion. The use of oblique angiographic views, certain noninvasive methods, such as quantitative Doppler waveform analysis, and direct pressure measurements will be of benefit in difficult cases and lead to a more accurate diagnosis.
TL;DR: The fourth case of focal (isolated) arteritis of the breast is reported, which presents as a painful or tender mass and has been confused clinically with carcinoma.
Abstract: The fourth case of focal (isolated) arteritis of the breast is reported. The lesion, which may be unilateral or bilateral, presents as a painful or tender mass and has been confused clinically with carcinoma. Arteritis, either necrotizing or granulomatous, may occur as an isolated phenomenon re stricted to a solitary organ; it does not necessarily imply concurrent or subsequent systemic vasculitis.
TL;DR: It is concluded that both tissue p02 and tcpO2 measurements are able to provide unique information about local changes of the microcirculation in occlusive vessel dis ease.
Abstract: Tissue pO2 measurements on skeletal muscle surface both in patients and in ani mals in a model of occlusive disease re vealed local tissue hypoxia that, until now, had not been detected with any other method. This kind of local tissue hypoxia is interpreted as a disturbance of local micro- flow distribution in the presence of un changed regional blood flow rate.In response to buflomedil infusion, tissue p02 histograms improved without any change in regional blood flow or distal blood pressure.In comparison to healthy volunteers, transcutaneous pO2 measurements in pa tients allowed establishment of tcpO2 pro files along the lower extremity which were in agreement with angiographic localization of vessel occlusion. In a preliminary study, buflomedil infusion (3 mg/kg) over 30 min utes caused a significant increase in tcpO2 in 5 patients in the absence of any signifi cant change of segmental blood pressure.It is concluded that both tissue p02 and tcpO2 measurements are able to provide unique information abou...
TL;DR: Lack of associated structural defects or functional deficits makes it difficult to assess the frequency of occurrence in the general population of bilateral superior venae cavae in association with a persistent left hepatic vein draining into the coronary sinus.
Abstract: Potentially significant associations are presented between anomalous systemic venous return (including both left superior vena cava and left hepatic venous drainage to the coronary sinus), a history of atrial fibrillation and a forme fruste of cor triatriatum in an elderly woman. Lack of associated structural defects or functional deficits makes it difficult to assess the frequency of occurrence in the general population of bilateral superior venae cavae in association with a persistent left hepatic vein draining into the coronary sinus. However, the potential for these systemic venous anomalies needs to be considered when unexplained arrhythmias are encountered. More specifically, the size of the coronary sinus needs to be assessed in patients with arrhythmia.
TL;DR: Evidence is provided that, in sustained essential hypertension, the reduced arterial compliance cannot be related exclusively to the level of blood pressure, but also requires some abnormality of the volume of large arteries, and the reservoir role of the large arteries is maintained.
Abstract: Systemic arterial compliance was estimated in 31 men, including 15 patients with sustained essential hypertension and 16 normal subjects of the same age. Values were derived from analysis of the monoexponential blood pressure-time curve during diastole, according to a simple viscoelastic model. In normal subjects, baseline arterial compliance was 2.56 +/- 0.18 ml/mm Hg. A significant decrease (1.88 +/- 0.13 ml/mm Hg; P less than 0.001) was observed in hypertensives. Administration of vasoactive substances (angiotensin and sodium nitroprusside) showed that, for the same blood pressure levels, normal subjects and hypertensives had similar values for compliance. However, the correlation between the basal values of diastolic pressure and compliance was significant in normal subjects (r = --0.76) but not in hypertensives (r = --0.33); these results suggested differences between acute and long-term conditions in patients and controls. Calculated diastolic runoff was similar in both groups, approximating 58 and 55% of the stroke volume respectively. This study provides evidence that, in sustained essential hypertension, (1) the reduced arterial compliance cannot be related exclusively to the level of blood pressure, but also requires some abnormality of the volume of large arteries, and (2) the reservoir role of the large arteries is maintained.
TL;DR: The correlations between hyperviscosity and heart disease and among diabetes, cancer, and chronic anxiety are dealt with and the predic tive value of hyperViscosity with respect to ischemic episodes and cancer metastases is discussed.
Abstract: Over the last two decades concepts of hemorheology became established and required methods and techniques developed. Progress was made in the formation of a field of clinical hemorheology. The role of viscosity factors in various disorders has been established, especially in heart disease and diabetes. It has been recognized that hyperviscosity can be present if any one of the blood viscosity factors is increased, even if the viscosity of whole blood appears normal or even subnormal. While hyperviscosity may result in ischemic and thromboembolic episodes, the causes of hyperviscosity may include cancer, genetic abnormality, infection, metabolic disorders, and many others. The basic causes can be, in their turn, affected and reinforced by hyperviscosity. Superimposition of an added hyperviscosity factor onto already elevated blood viscosity might lead to precipitation of ischemic episodes. This review deals with the correlations between hyperviscosity and heat disease and among diabetes, cancer, and chronic anxiety. The predictive value of hyperviscosity with respect to ischemic episodes and cancer metastases is discussed.
TL;DR: It is the opinion that S.U.S.H. is an earlier and quite useful sign of arte rial involvement as seen in the following cases observed in the vascular disease section.
Abstract: Subungueal splinter hemorrhage (S.U.S.H.) has been reported in various conditions and may herald a serious systemic disease. It has been related to miscellaneous conditions such as: subacute bacterial endocarditis, severe rheumatoid arthritis, uninfected mitral stenosis, trichinosis, peptic ulcer, hypertension, neoplasm, trauma, and in some cases, is considered idiopathic. Some dermatologic conditions such as psoriasis, dermatitis, and fungal infections may also produce S.U.S.H. It consists of "a homogeneous mass of blood in a layer of squamous cells, adherent to the under surface of the nail, considered to be of embolic origin." In a brief review of pertinent medical literature on thromboangiitis obliterans, we were unable to find a description of its occurrence in this disease. The earliest lesions described in this condition are "painful vesicles on the pulp of digits with intense hyperemia and hypersensitivity of the surrounding skin." It is our opinion that S.U.S.H. is an earlier and quite useful sign of arterial involvement as seen in the following cases observed in our vascular disease section.
TL;DR: Congenital absence of a pulmonary artery is a rare condition that usually presents with an abnormal chest roentgenogram, few symptoms, and a variety of diagnostic possibilities.
Abstract: Presented in part before the Western Regional Scientific Conference of the American College of Angiology and International College of Angiology, February, 1980. From the Departments of Pulmonary Disease (J.R.Y., J.F.T.), Respiratory Therapy (E.M.C.), Internal Medicine (C.M.G.), and Nuclear Radiology (S.A.C.), The Cleveland Clinic Foundation, Cleveland, Ohio. Congenital absence of a pulmonary artery is a rare condition. The patient who survives to adulthood usually presents with an abnormal chest roentgenogram, few symptoms, and a variety of diagnostic possibilities. 1
TL;DR: Bflomedil is more effective and safe than naftidrofuryl in the treatment of patients with intermittent claudication and has vasoactive properties evaluated through walking capacity and time of hyperemia.
Abstract: In a group of 58 patients with peripheral arteriopathies, we have studied efficacy and safety of buflomedil hydrochloride and naftidrofuryl Both drugs have been shown to have vasoactive properties evaluated through walking capacity and time of hyperemia According to our results, buflomedil is more effective and safe than naftidrofuryl in the treatment of patients with intermittent claudication
TL;DR: Angiography was found to be a low-risk technique of use for diagnosis and followup studies on vasculitis and two patients showed regression of microaneurysms after immunosuppressive therapy.
Abstract: Angiographic studies were carried out on 21 patients with systemic necrotizing vasculitis. Four basic arterial anomalies were found: (1) saccular microaneurysms appeared in 62% of the patients (2) arterial thrombosis was seen in 81% of patients; (3) arterial stenosis occurred in 81%; and (4) lumen irregularities occurred in 90%. Alterations in the renal vascular flow were also observed in accordance with changes in the cortical medullary differentiation, heterogeneous nephrogram, and prolonged washout. Two patients showed regression of microaneurysms after immunosuppressive therapy. We found angiography to be a low-risk technique of use for diagnosis and followup studies on vasculitis.
TL;DR: In clinical applications, it was observed by this method that the autonomic imbalance in patients with vibration disease, angina pectoris, or hypertension was recovered by the treatment, and the abnormal types of the response recovered to N type.
Abstract: Further observations of the digital plethysmography with auditory stimuli and its clinical applications were performed in patients with vibration disease and heart diseases. The responsive pattern to the auditory stimuli in the digital plethysmogram could be faithfully reproducible if it elapses more than 5 minutes apart between the first stimulus and the second one. The responsive patterns were divided into four types: normal (N), hyperreactive (I and D) types and hyporeactive (P) type. The values of urinary catecholamine increased in parallel to the activity level of the autonomic nerve. The hyperreactive type (D) had the highest value of urinary catecholamine, and vice versa. With regard to the age, the elderly was prone to show hyporeactive (P) type, and the young tended to be hyperreactive (D) type. Psychologic factors were examined by Cornell medical index. Neurosis was not necessarily related to the hyperreactive type. In clinical applications, it was observed by this method that the autonomic imbalance in patients with vibration disease, angina pectoris, or hypertension was recovered by the treatment, and the abnormal types of the response recovered to N type. In conclusion, the digital plethysmography with auditory stimuli as one of the autonomic nerve function tests would be much useful and non-invasive method for observation of clinical course and decision of the severity.
TL;DR: A fixed procedure of strain gauge plethysmography in a control population aged between 20-30 years allows normal values for venous parameters (venous distensibility, emptying, and resistance) and capillary filtration coefficient, to be determined.
Abstract: A fixed procedure of strain gauge plethysmography in a control population aged between 20-30 years allows normal values for venous parameters (venous distensibility, emptying, and resistance) and capillary filtration coefficient, to be determined. High speed recording reveals two phases in venous emptying, one passive, purely elastic, and a second active phase, resulting from venous constriction.
TL;DR: The electrocardiographic manifestations of hyperkalemia are peaking of the T waves, widening of the QRS complexes, slowed atrial conduction with a decreased P wave amplitude, and increased P wave duration.
Abstract: From the Department of Medicine, Wayne State University, Detroit, and St. Joseph Hospital, Mt. Clemens, Michigan. The electrocardiographic manifestations of hyperkalemia are peaking of the T waves, widening of the QRS complexes, slowed atrial conduction with a decreased P wave amplitude, and increased P wave duration. As serum potassium levels rise, prolongation of the PR interval and atrioventricular con-
TL;DR: A new diagnostic test of the qualitative and quantitative evaluation of vasospastic disorders is described, which entails measurement of systolic digital artery pressure during successive cooling from 35-5 degrees C.
Abstract: A new diagnostic test of the qualitative and quantitative evaluation of vasospastic disorders is described. It entails measurement of systolic digital artery pressure during successive cooling from 35-5 degrees C. In cases with vasospastic disorders with Raynaud phenomena a significant reduction of systolic blood pressure below 78% of control level is observed and in the most pronounced cases total cessation of flow occurs (critical closing). The test is also a quantitative measure of the degree of vasospasm since the pressure reduction correlates to the clinical degree of vasoconstriction.
TL;DR: Therapeutically decreasing the blood viscosity improves the ischemia by increasing flow through the narrowed vessels and may as such offer a valuable alternative to surgery.
Abstract: Peripheral ischemia is mostly due to narrowing of the vessels, although blood supply is also influenced by the hemorheologic properties of the blood. Recent research has revealed that abnormally high blood viscosity can be a contributing cause in ischemia. Therapeutically decreasing the blood viscosity improves the ischemia by increasing flow through the narrowed vessels and may as such offer a valuable alternative to surgery. Different possible therapeutic approaches for decreasing blood viscosity and the related clinical evidence are discussed.
TL;DR: A double-blind study was performed on 40 physically trained patients with stage II peripheral arterial insufficiency and significant increases were achieved in walking distances during these tests, but the increase was not significant.
Abstract: A double-blind study was performed on 40 physically trained patients with stage II peripheral arterial insufficiency. Daily doses of 450 mg buflomedil were administered for 90 days and eventual improvements were compared to the effects of pentoxifylline given in daily doses of 300 mg. After treatment with buflomedil and also with pentoxifylline, significant increases were achieved in walking distances during these tests, the increase was not significant. Nor uniform findings were noted in oscillograms and in ultrasonic Doppler investigations.
TL;DR: In 34 instances of total internal carotid obstruction, flow went to zero in diastole in 33 cases and also demonstrated flow reversal in 22, and there was a significant reduction in peak systolic velocity when the low-resistance internalCarotid was obstructed.
Abstract: Flow in the common carotid artery is normally quasisteady with flow never approaching zero during diastole. With total occlusion of the internal carotid artery, flow in the common carotid assumes the pattern observed in the external carotid, which supplies a relatively high-resistance vascular bed. In 34 instances of total internal carotid obstruction, flow went to zero in diastole in 33 cases and also demonstrated flow reversal in 22. In addition, there was a significant reduction in peak systolic velocity when the low-resistance internal carotid was obstructed. These observations, which are simple to determine using an ultrasonic duplex scanner, are of value in suspecting total occlusion of the internal carotid artery, thus obviating the need for arteriography in some cases.
TL;DR: The phlebologist's decision to carry out high ligation and stripping of the saphena magna in patients with varicose veins should be considered only for those cases where the extent of incompetence has been established beyond doubt.
Abstract: SFV competence was investigated in 100 patients (189 legs) suffering from varicose veins. The incidence was found to depend on the method used. The simpler clinical methods such as the cough test, percussion test, Trendelenburg test, revealed SFV insufficiency to be between 15.4-21.6%. Using the Doppler ultrasound the incidence increased to 47.6%; by using the MABP, SFV insufficiency was found to be increased 20%. The SFV competence was indicated as playing an important role in the pathogenesis of varicose veins. The phlebologist's decision to carry out high ligation and stripping of the saphena magna in patients with varicose veins should be considered only for those cases where the extent of incompetence has been established beyond doubt.
TL;DR: A new nerve conduction procedure was described here in which nerve conductions over the ulnar nerves were obtained in the thoracic outlet stress position and found to show a reduction in amplitude of the evoked potential obtained at the hypothenar eminence.
Abstract: Twenty patients with a clinically documented thoracic outlet syndrome were studied with regard to their clinical and electromyographic findings. Certain vascular as well as neurologic signs were noted to be prominent, particularly the presence of a supraclavicular bruit as well as reproduction of the patient's symptomatology while doing the thoracic outlet stress test. Other findings such as interossei weakness, ulnar nerve hypalgesia, supraclavicular tenderness to deep palpation, and reproduction of the patient's symptomatology via bilateral shoulder opposition were noted to be present. Classical maneuvers used to diagnose the thoracic outlet syndrome were compared and the thoracic outlet stress test was shown to be the best clinical test available at the present time. In addition, electromyographic studies were done showed abnormalities in only 55% of the cases when using multiple parameters that have been described in the literature recently. A new nerve conduction procedure was described here in which a conductions over the ulnar nerves were obtained in the thoracic outlet stress position and found, in a few cases, to show a reduction in amplitude of the evoked potential obtained at the hypothenar eminence. In addition, some findings suggestive of cervical radiculopathy were noted in the cases studied and several possible explanations for this were discussed.