Using intermittent pneumatic compression therapy to improve quality of life for symptomatic patients with infrapopliteal diffuse peripheral obstructive disease.

BACKGROUND: Although the acute effect of intermittent pneumatic compression (IPC) therapy had been documented for patients with symptomatic peripheral arterial obstructive disease (PAOD), its efficacy in improving quality of life (QOL), especially for those with infrapopliteal diffuse lesions, remains unclear. METHODS AND RESULTS: Thirty-one patients with infrapopliteal diffuse or multiple segmental lesions were enrolled in the study. Based on receipt of IPC therapy (3 h daily for 3 months), patients were allocated to a study (n=23) or control (n=8) group. The 6-min walking test, transcutaneous oxygen tension (TcPO2), and QOL evaluated with the Short-Form 36 questionnaire were measured at the beginning and end of the study. In the QOL analysis, scores for physical functioning, physical and emotional role functioning, bodily pain, and general and mental health showed significant changes after IPC therapy. In the 6-min walking test, duration, and the initial and absolute claudication distances were significantly increased in the study group. The TcPO2 also significantly increased in the distal end of the target limb after IPC therapy. CONCLUSIONS: Patients at high risk for amputation with infrapopliteal diffuse or multiple segmental lesions can improve their walking ability, TcPO2 of the target limb and QOL after IPC therapy.

Different degrees of overweight: anthropometric indices in patients with coronary heart disease.

OBJECTIVES: Obesity is a risk factor for all-cause mortality. The obesity incidence depends on different definitions. Among patients with high-risk coronary heart disease (HRCA), we have studied differences in obesity incidence, according to different anthropometric indices. METHODS AND RESULTS: Based on the definitions of the International Guidelines Committees for body mass index (BMI), waist circumference (WCF), and waist-hip ratio (WHR), we have classified 487 CAD patients into 3 groups: normal (group 1), overweight (group 2), and obese patients (group 3). Among men, obesity criteria BMI, WCF and WHR were positive in 17.5%, 14.2%, and 66.4% of the subjects. Among male subjects < 65 years, the incidence of HRCA (%), for the 3 groups (normal, overweight, obese) were for BMI (2.4, 21.5, 28.9, P = 0.005); WCF (17.9, 12.1, 37.9, P = 0.012); WHR (0, 15.4, 30.4, P = 0.024). In male subjects > 65 years, for the HRCA incidence (%), only WHR showed a significant difference between the 3 groups (0, 15.4, 30.4, P = 0.024). Among women, 30.6%, 63.6%, and 87.6% were obese by the BMI, WCF, and WHR criteria, respectively. We did not find any significant differences in the HRCA distribution between age groups and degrees of obesity. CONCLUSIONS: HRCA distribution varied among obese male patients. According to the different methods of measurement, obesity percentages varied from 4- to 5-fold among men and 3-fold among women. In our view,WHR measurement is the method of choice for the determination of obesity among patients with CAD.

Feasibility of trans-radial approach in percutaneous intervention for upper arm dialysis access.

BACKGROUND: This retrospective study evaluated the feasibility and efficacy of trans-radial intervention for upper arm dialysis access. METHODS: This study retrospectively reviewed 165 trans-radial interventions performed for upper arm dialysis access in 101 patients. Sixty-nine patients had arteriovenous graft (AVG), and 32 had arteriovenous fistula (AVF). Balloon angioplasty was performed in 66 stenotic dialysis accesses and 99 thrombosed dialysis accesses. Thrombosed dialysis access was further managed by additional balloon thrombectomy with or without urokinase injection. RESULTS: Procedural time was 46.7 +/- 25.5 minutes. Anatomic and clinical success rates were 89.7% and 84.2%, respectively. The rate of complications, most of which involved lesion rupture with contrast-media extravasation and distal embolism, was 9.7%. Pretreatment stenosis was more severe (p = 0.01) and the prevalence of total occlusion was higher (p < 0.01) in the AVG group than the AVF group. The success rate and complication rate did not statistically differ (p = 0.59). Additionally, the thrombosed group had a lower success rate (p = 0.02), a higher complication rate (p < 0.01) and a longer procedural time (p < 0.01) than the stenotic group. CONCLUSIONS: Comparison with previous studies employing the traditional approach reveals that trans-radial intervention has a comparable success rate, procedural time and complication rate for upper arm dialysis access. Therefore, trans-radial intervention is a safe and feasible technique for upper arm dialysis access.

Pheochromocytoma underlying hypertension, stroke, and dilated cardiomyopathy.

We report the case of a 65-year-old man with a 6-year history of hypertension who presented with dilated cardiomyopathy, a transient cerebrovascular event, paroxysmal sweating, and intractable hypertension. Coronary angiography revealed no abnormality, but diagnostic testing was pursued because of the severe sweating and hypertension. Two-dimensional echocardiography showed 4-chamber dilatation with decreased left ventricular contractility. Further investigation, including a computed tomographic scan of the abdomen, led to a diagnosis of pheochromocytoma. Surgical resection of a left adrenal pheochromocytoma quickly resolved the patient's hypertension and resulted in substantially improved cardiac function after 4 months. Although pheochromocytoma has rarely been reported in the presence of both dilated cardiomyopathy and cerebrovascular events, it should be included in the differential diagnosis when patients present with dilated cardiomyopathy and a cerebrovascular event that have no obvious cause.

Thrombus aspiration complicated by systemic embolization in patients with acute myocardial infarction.

Percutaneous coronary intervention (PCI) is the preferred treatment modality for patients with acute coronary syndrome, but the "no-reflow" phenomenon, primarily caused by distal embolism, has hampered the effectiveness of PCI as regards reperfusion of the myocardium. Thrombus aspiration is sometimes used to reduce the incidence of distal embolism, but potentially the procedure may be complicated by upstream thrombus migration and systemic embolism. Two cases of systemic embolism during thrombus aspiration are presented. One patient had embolism of the cerebral artery and the other embolism of the left radial artery. It is suggested that a large-lumen guiding catheter with a deep-seated position and gentle injection of contrast medium should be used for thrombus aspiration.

Misdiagnosis: cardiac metastasis presented as a pseudo-infarction on electrocardiography.

Most tumor invasion into the heart is nonspecific and clinically silent. Myocardium metastasis rarely mimics a myocardial infarction. In this case, a cardiac metastasis from a squamous cell carcinoma presented with both persistent ST elevation and paroxysmal supraventricular tachycardia. The secondary lesion was located in the anterior wall and lateral wall of the left ventricle and induced electrocardiographic changes imitating an acute myocardial infarction.

Prognostic value of arterial/alveolar oxygen tension ratio (a/APO2) in acute pulmonary embolism.

BACKGROUND: Because the arterial/alveolar oxygen tension ratio (a/APO2) is relatively constant throughout the entire range of fractional inspired oxygen concentration (FiO2), its use in determining the prognosis of acute pulmonary embolism (APE) was investigated. METHODS AND RESULTS: This study retrospectively assessed 202 consecutive patients with APE confirmed by computed tomography or high probability lung scintigraphy. All patients underwent initial arterial blood gas analysis during the first 24 h of admission. Receiver-operating characteristic analyses were performed to determine the a/APO2 cut-off value for predicting 30-day death or 30-day composite events. Cut-off values for a/APO2 were used to determine stability in all patients and 2 subgroups (0.49 for all patients; 0.49 for FiO2 =0.21; 0.46 for FiO2 >0.21). Using the cut-off value of a/APO2 <0.49 for predicting 30-day death, the negative predictive value (NPV) was 90%, and the positive predictive value (PPV) was 30.3%. For the 30-day composite end point, the NPV was 81.3%, and the PPV was 40.9%. Excluding massive APE, the a/APO2 also had high NPV and moderate PPV in predicting short-term prognosis. This study additionally demonstrated a linear relationship between platelet count and a/APO2. CONCLUSIONS: The cut-off value of a/APO2 <0.49 exhibits stability at variable FiO2 values and is a useful prognostic predictor in APE.

Ankle-arm index is a useful test for clinical practice in outpatients with suspected coronary artery disease.

BACKGROUND: Although a low ankle-arm index (AAI) has been reported to be associated with increased risk of cardiovascular mortality in several populations, no data exist concerning the impact of AAI for outpatients with suspected coronary artery disease (CAD) in the clinical setting. METHODS AND RESULTS: The present study enrolled 840 outpatients (age range 35-87 years, mean age 63.9+/-10.2) with suspected CAD. All patients underwent AAI measurements and coronary angiography, and based on the AAI values, they were divided into group A (AAI <0.9; n=191; CAD positive, 181) and group B (AAI >or=0.9; n=649; CAD positive, 509). Metabolic syndrome (MS), obesity, and level of the inflammatory biomarker high sensitive C-reactive protein (hsCRP) were compared between the 2 groups. The sensitivity, specificity, positive and negative predictive values in predicting CAD with an AAI value <0.9 in all patients were 26.2%, 93.3%, 94.8% and 21.6%, respectively. The patients in group A was significantly older and there was a higher female-to-male ratio than in group B. The presence of hypertension and diabetes mellitus, current smoking status, and levels of low density lipoprotein (LDL)-cholesterol level, uric acid and hsCRP differed significantly between the 2 groups. Group A had a higher percentage of high LDL-cholesterol level, high waist-to-hip ratio and more positive cases of MS than group B. Multivariate logistical regression analysis showed that AAI was related to MS, high levels of hsCRP (>3 mg/L) and uric acid (>7 mg/dl) with odds ratios of 1.769, 3.907 and 2.580, respectively. CONCLUSIONS: The AAI test is an effective tool in predicting CAD in outpatients in clinical practise.