[A system for non-invasive measurement of arterial pulse velocity in different vascular territories]. / Sistema para la medición no invasiva de la velocidad del pulso arterial en diferentes territorios vasculares.

Blood pulse wave velocity (PWV) is a known index of arterial rigidity and its measurement has proved its usefulness in the study of some cardiovascular pathologies. In this study we describe the design and implementation of a system for noninvasive PWV determination in the aorto-braqui-humero-radial (A-->h), aorto-ileo-femoro-pedial (A-->f) and aorto-carotid (A-->c) regions. This system was examined with 36 normotensives (NT) and 34 hypertensives (HT) patients with (LVH, n = 20) and without (WLVH, n = 14) left ventricular hypertrofy. The equipment consist of a personal computer with an analog to digital converter and hardware and software items adapted to take simultaneously the electrocardiogram (ECG), two photopletismographic pulses and one oscilometric pulse. The Q-pP interval (time between a Q ECG wave and distal blood pulse) and the distance to the register sites are taken into account to calculate the beginning of cardiac prexpulsive period (time zero of pulse trip) which allow the determination of the PWV (in meters/second) from the aortic root to the distal point of the via. PWV was significant higher (p < 0.001) in HT vs. NT (A-->h: 9.3 +/- 2.6 vs. 7.2 +/- 0.8, A-->c: 9.5 +/- 2.8 vs. 6.0 +/- 1.9 and A-->f: 9.5 +/- 1.8 vs. 7.2 +/- 0.9) in each evaluated arterial region. Same thing occurred in cases with LVH vs. WLVH (A-->h: 10.5 +/- 1.6 vs. 8.0 +/- 1.9, A-->c: 10.2 +/- 1.9 vs. 8.0 +/- 1.9 and A-->f: 10.5 +/- 2.0 vs. 8.6 +/- 1.2) (p < 0.025). This is consistent with the relationship more pressure [symbol: see text] more rigidity and with other reports. This method may have clinical application.

[Provocation and measurement of retrograde pulsatile wave velocity in normal subjects and patients with systemic hypertension]. / Provocación y medición de la velocidad de la onda pulsátil retrógrada en sujetos normales e hipertensos sistémicos.

UNLABELLED: There are not published incruent methods of provocation and/or measurement of the velocity of the reflexive arterial pulse wave. This phenomenon is implicated in the pathogenesis of arterial hypertension. We describe that during compressive sphygmomanometry (CS) done in the forearm, reflexive waves are provoked that are register in the arm with an equipment developed by us, which measures the velocity of the antegrade (APWV) and the provoked retrograde (RPWV) pulse waves. The procedure consist in: 1) detection, capture and digitalization by pneumatic cuffs of oscillopulses of the arm and the forearm, 2) detection of finger photopulse to control the efficacy of CS, 3) measurement of APWV and RPWV by taking the conduction time travel distance of pulse wave between detectors arm-forearm and forearm-arm respectively. Thirty normal case (group A, GA) and 37 essential systemic hypertensive patients (group B, GB) were studied. Sixteen cases of GB had left ventricular hypertrophy (LVH). RESULTS: A reflexive wave was provoked in 99% of cases. The APWV (m/s) was 6.0 +/- 0.9 vs 7.5 +/- 1.3, p < 0.001 for GA and GB respectively. The RPWV (m/s) of the same groups were 1.8 +/- 0.3 vs 2.5 +/- 0.7, p < 0.001. The hypertensive cases with LVH had more RPWV than the cases without it (2.7 +/- 0.6 vs 2.3 +/- 0.6, p = 0.07). CONCLUSION: Hypertensive cases vs normals had higher antegrade and retrograde pulse wave velocities possible due to the major degree of arterial rigidity of the former. The method may be used in study of chronic arteriopathy.

[The importance of radiology in the localization of pheochromocytoma]. / Importancia de la radiologia en el estudio de localizacion del feocromocitoma.

The usefulness of different radiologic studies in localizing the tumor was evaluated in 26 patients with a firmly established diagnosis of pheochromocytoma. The site of the lesion was correctly identified in 8% of the cases by the plain abdominal x-ray films: in 11% by the plain thoracic films; in 34% by uronephrotomography; in 88% by angiography and in 6 patients (100%) in whom computed tomography scans (CT) were performed. The tumors were intra-adrenal in 19 patients and extra-adrenal in the remaining 7 cases. Of the latter, two were found in the organ of Zuckerkandl, two were abdominal para-aortic, two others in the para-aortic region of thorax, and one with intra an extra-adrenal tumors. It is concluded that CT scans are quite successful in preoperative localization of pheochromocytoma. The non-invasive nature of the technique makes it the method of choice in the anatomical localization of this type of tumors.

[Takayasu arteritis: usefulness of radiologic and angiographic studies]. / Arteritis de Takayasu: utilidad de los estudios radiológicos y angiográficos.

With the purpose of learning the usefulness of radiologic and angiographic procedures for the evaluation of Takayasu's arteritis (TA), we studied 64 patients (ratio women: 8.1, average age: 23.5 years, range: 13-52 years) in which we performed arteriographic studies in the clinically affected area. All cases had chest films: 53 had thoracic aortogram, 60 abdominal aortogram, 16 pulmonary arteriography. According to the topography of the lesions we found 8% of the cases with damage exclusive to the supra-aortic trunk, 6% with isolated alteration of the intermediate thoraco-abdominal aorta, 62% with mixed pathology of the two categories above, and 21% with lesions in the pulmonary artery besides systemic arteriopathy. The results were as follows: 1) radiology of the chest: cardiomegaly (48%), irregularities in the ascending aorta (31%), calcification in the aortic wall (29%), calcified granulomas (25%) and signs of pulmonary venous hypertension (21%); 2) thoracic aortogram: irregularities in the descending aorta (56.6%), thickening of the wall of descending aorta (39.6%), dilatation of the ascending aorta (26.4%), of the descending aorta (26.4%); occlusions: of the left subclavian (24 cases), left mammary (16 cases), left carotid (8 cases) and left vertebral (8 cases); 3) abdominal aortogram: irregularities of the outline, stenosis, prominent "supplementary" arteries and aneurysms in 53%, 43.3%, 38% and 13.3 of the studies performed. The arteries most commonly affected were: renal (74.7%), both (31.6%), right (28.2%) and left (14.9%), superior mesenteric (26.6%) and hepatic (21.6%); 4) pulmonary arteriography: arterial occlusions: right superior lobar branch (37.5%), right medial (6.2%), right inferior (12.5%), without predilection by any lobe; 5) coronary arteriography: one case with occlusion of anterior descending artery and circumflex coronary artery (the other 8 cases without significant lesions). We concluded that TA affects independently the arteries of different areas, hence it is necessary to perform multiple angiographic studies for adequate evaluation of the extension of vascular damage.

Immunologic studies in patients with Takayasu's arteritis. III. Immunoregulatory changes.

Study of cellular immune function in 14 patients with Takayasu's arteritis (TKA) revealed markedly decreased active E rosettes and CD4+ cells and slightly diminished CD8 + and autologous rosette-forming T cells. They were also found to have decreased production of interleukin-2 and decreased response to interleukin-1. Patients with active disease were also found to have decreased response to IL-2. Conversely, patients with inactive disease were found to have a normal response to interleukin-2. Patients with TKA, whether active or inactive, had normal production of interleukin-1, normal concanavalin-A-induced and spontaneously expanded suppression, normal NK cell function and normal enhancement of NK cell function by interleukin 2. The findings indicate that the immunoregulatory disturbance of TKA is different from that occurring in connective tissue disorders.

[Left aortic arch without a circumflex segment and a right descending aorta: a hypothetical case and a real example]. / Arco aórtico izquierdo sin segmento circunflejo y aorta descendente derecha: de un caso hipotético a un ejemplo real.

We studied a case of a patent left ductus arteriosus, with a left aortic arch connected to a right descending aorta without an aortic circumflex (retroesophageal) segment. We believe this is the first world-published example of this--so far--hypothetical anomaly, included in Kirkling and Edwards classification of vascular rings. The case was a 27-year-old deaf-mute female patient with a patent left ductus arteriosus, with important left to right shunt and moderate pulmonary arterial hypertension who underwent a successful closing surgical procedure. In the aortographic study a left (normal) aortic arch was seen, which after giving off a large left ductus arteriosus, crossed to the right and connected to a right descending aorta. In the upper part of the thorax the esophagus and trachea were displaced to the right by the left aortic arch. The esophagus in the middle and the upper inferior parts of the thorax was also displaced to the right by the descending right aortic segment. Complete vascular ring was not evident. The case--although without clinical importance--reinforces the pathogenic concept of the Rathke diagram of a complete double aortic primitive arch originating the pulmonary and supraaortic vascular structures which are formed by the obliteration or disappearance of particular segments of the structure. This knowledge explains the embryogenesis of these complex anomalies. Our case is believed to be formed by the very early disappearance of a frontal portion of the primitive left dorsal aorta.

[The P wave in systemic arterial hypertension. Comparison with the echocardiogram and apexcardiogram]. / La onda P en la hipertensión arterial sistémica. Correlación con el ecocardiograma y el apexcardiograma.

The cause of an abnormal electrocardiographic P wave (AEPW) in systemic arterial hypertension (SAH) has not been delucidated. In order to demonstrate if this sign is related to volume overload of the left atrial cavity -previously we found no correlation between pressure overload of the cavity and the presence of an AEPW- 34 patients with SAH were studied; population were divided in two groups: group A (GA, n = 13), formed by 13 cases with a P wave more than 0.10 s duration (D2 standard lead) and group B integrated by 21 cases with a P wave at 0.10 s or less duration. In each cases phonocardiographic and echocardiographic (Mode M) studies were performed and the following data were obtained: "A" index (AI), left atrial dimension (LAD) and, septal (SD) and left posterior wall dimension (LPWD); besides: Sokolow electrocardiographic index (SI) and systolic (SBP) and diastolic (DBP) blood pressure. Results are shown in the following table: (Table: see text). There were not statistical differences between groups (data of SBP and DBP not shown). Correlation between LAD and AI and duration of P wave were not statistical different (data not shown). An AEPW in SAH does not seem to be cause by a volume left atrial overload. Possible it is related to an interatrial conduction defect.

[Effects of a calcium antagonist (nifedipine) in hypertensive and normotensive subjects]. / Estudio de algunos efectos de un antagonista de calcio (nifedipina) en sujetos hipertensos y normotensos.

We investigated the effect of the calcium antagonist nifedipine upon the following parameters: systolic and diastolic blood pressure (SBP and DBP) heart rate (HR), electrocardiogram (ECG) and the relative rate of calcium uptake in platelets. The possible correlation between this rate and blood pressure was one of the main points we tried to establish. The subjects studied were 1) 26 patients with uncomplicated essential hypertension and 2) 13 healthy normotensive subjects. SBP and DBP were measured with the subject both in a recumbent and a sitting position. 10 mg of nifedipine were given orally. In the hypertensive patients SBP and DBP decreased significantly in both positions after receiving the drug, as expected, while HR increased significantly (P less than 0.001), also in both positions. In the normotensive subjects BP decreased too, after taking the drug, but was only significantly modified in some instances i.e. SBP recumbent, DBP recumbent and sitting. HR increased significantly in the sitting position but not in the recumbent position. The ECG post-nifedipine showed a negative depression of the ST segment in four patients from the hypertensive group. The relative rate of calcium uptake in platelets measured before the subjects had taken the drug decreased after it was administered. The difference was significant (P less than 0.05) in the hypertensive group, but not in the normotensive group. Some correlation was found between DBP and the rate of calcium uptake.

Systemic arterial hypertension and coronary atherosclerosis. Observations in survivors of a first myocardial infarction.

To determine the importance of systemic arterial hypertension (SAH) in the pathogenesis of coronary atherosclerosis (CA), the coronary stenosis (CSI), coronary diffuse atheromatous (CDAI) and coronary tortuosity (CTI) indices were assessed by selective coronary angiography (SCA) in 132 survivors of a definite first myocardial infarction (MI). Patients were divided into 2 groups according to the absence (group A, n = 60) or presence (group B, n = 72) of SAH. Group B was further subdivided into 2 subgroups: group B1, consisting of 62 patients receiving no antihypertensive treatment before admission, and group B2, consisting of 20 patients treated continuously for at least 2 years with a diuretic or diuretic + beta-blocker. There were no differences in age, topography of MI, serum total cholesterol and triglyceride concentrations, prevalence of diabetes mellitus or smoking habits, CSI and CTI among the groups or subgroups of patients. Group B had a higher CTI (7.2 +/- 2.8) than Group A (2.7 +/- 2.3, p less than or equal to 0.001). None of the above indices were statistically different between subgroups B1 and B2. Surprisingly, the degree and extent of CA assessed by CSI and CDAI were similar in this population, regardless of the presence or absence of SAH and whether or not patients were treated with a diuretic. Although hypertension was related to tortuosity of the coronary arteries, which does not have a strong role in the development of CA, it is possible that the hypertensive process is relevant to the installation of atheromatous disease but not to its progression. Further studies are needed to clarify this point.

Two factors associated with increased uptake of calcium in platelets from essential hypertensive patients.

The relative rate of calcium transport into platelets from essential hypertensive patients and healthy normotensive donors was measured using the metallochromic indicator arsenazo III and recording net decrease in optical density per 5 minutes (O.D.U./5 min). When platelets from essential hypertensive patients were suspended in the patient's own serum, calcium was transported more rapidly than when suspended in normal sera (0.0166 vs 0.0113 O.D.U./5 min, P less than 0.01) indicating that the difference is due to a circulating factor. When platelets from healthy normotensive volunteers were suspended in the donor's own serum or in a pool of normal sera, the relative rate of transport was lower than in the case of platelets from hypertensives suspended in the pool of normal sera (0.005 vs 0.0113 O.D.U./5 min, P less than 0.01) which suggests a membrane alteration rendering the platelets from hypertensives more permeable to calcium. It was observed that the increase of calcium entry was inhibited by verapamil. The nature of these circulating and membrane-associated factors is at present unknown, but the circulating factor was capable of increasing the membrane permeability to calcium in normal human platelets (from 0.0057 to 0.011 O.D.U./5 min, P less than 0.01) and even in rat liver mitochondria, an effect that was inhibited by ruthenium red.

[The P-wave in systemic arterial hypertension]. / La onda P en la hipertensión arterial sistémica.

An abnormal electrocardiographic P wave (AEPW) has been interpreted as indicative of heart failure, hypertrophy or dilatation of left atrium, or diminished left ventricular compliance. In order to determine the significance of this electrocardiographic sign we studied 47 cases of systemic arterial hypertension (SAH) without heart failure or coronary obstruction. Patients were assigned at 2 groups: group A (22 cases with P wave duration greater than 0.11 seg. (LEAD D2); and group B 25 cases with P wave duration less than this. The following data were studied in all cases: left ventricular ejection fraction (LVEF), left ventricular presystolic filling fraction (LVPFF), Sokoloff electrocardiographic index (SEI), final diastolic pressure of LV (FDPLV), and systolic arterial pressure (SAP). Results were: (Table: see text). There were not statistical differences in these values between groups A and B (including the FDPLV value not shown in the table). Correlation coefficient between duration of P wave and the other parameters studied were also no significant. AEPW in SAH is not related to an specifically degree of left ventricular hypertrophy or disfunction; therefore, hypertensive heart disease should not be classified taking in account this electrocardiographic sign.

[Myocardial infarct secondary to a non-penetrating chest injury. Presentation of a case and review of the literature]. / Infarto miocárdico secundario a traumatismo no penetrante del tórax. Presentación de un caso y revisión de la literatura.

We describe a 21 year old male who had a myocardial infarction as a result of a horse kick in the chest. EKG Showed changes compatible with anterolateral infarction. Thallium scan demonstrated diffuse decreased uptake. Angiographic studied showed normal coronary arteries and abnormal movements of the posterior wall.

[Evaluation of sympathetic tone in essential hypertension by the clonidine suppression test]. / Valoración del tono simpático en la hipertensión esencial mediante la prueba de supresión por clonidina.

Recent evidences suggest that the sympathetic nervous system plays a major role in the pathogenesis and maintenance of several clinical forms of hypertensive disease. The clonidine suppression test allows us to uncover the subtle changes in neuronal noradrenaline release in essential hypertension. To prove this possibility, we selected 16 patients: 7 borderline hypertensives (BH) (4 males and 3 females), mean age: 24 years; and 9 established hypertensives (EH) (6 males and 3 females), mean age: 25 years. In both groups, the heart rate (HR) and blood pressure (BP) were registered every 30 min and by intravenous catheter plasma catecholamines (PCA) and plasma renin activity (PRA) were measured before and after (180 and 240 min) one oral dosis of clonidine (300 mcg) had been administered. Patients remained in clinostatism for 180 and and orthostatism for 60 min. HR and BP diminished in BH and EH after clonidine during clinostatism in comparison to preclonidine period. PCA also showed reduction in 180 min with respect to the basaline period. PRA did not present change in 180 min in either groups in relation to time O. During orthostatism, HR increased in both groups with respect to the baseline period. BP remained low in relation to baseline time. PCA were increased with respect to preclonidine period. PRA showed a slight tendency to increase in relation to time O in both groups. CAP baseline level are not reliable indexes of the role of the sympathetic tone in maintenance of high BP values in hypertensive disease.(ABSTRACT TRUNCATED AT 250 WORDS)

[Takayasu arteritis with calcified giant ventricular aneurysm. Presentation of a case]. / Arteritis de Takayasu con aneurisma ventricular gigante calcificado. Presentación de un caso.

Takayasu Arteritis (TA) was thought to only involve the aortic arch and its main branches, but subsequent studies demonstrated that the arteritis in not confined to these areas. The process can involve, among others, the coronary arterial tree and is capable to produce myocardial infarction. Many authors thought that when patients with TA presented with heart failure, it was generally a consequence of extramyocardial factors such as systemic or pulmonary hypertension and/or aortic regurgitation. We present the case of a young female with TA and calcified giant ventricular aneurysm. We discuss the probabilities of its origin and emphasize the relationship between the pathologic findings and the possibility of direct myocardial damage by TA, but our impression is that it is due to coronary involvement because we found a lesion in the anterior descending artery.

[Hemodynamic study in hypertensive cardiopathy under ischemia induced by atrial stimulation in the absence of fixed coronary obstructions]. / Estudio hemodinámico en la cardiopatía hipertensiva bajo isquemia inducida por estimulación auricular en ausencia de obstrucciones coronarias fijas.

With the purpose to study the haemodynamic changes that occur with myocardial ischaemia induced by atrial pacing (AP) in hypertensive heart disease, we studied 7 patients with such condition, all of them with a long time history of systemic hypertension, electrocardiographic signs at rest of left ventricular hypertrophy and ST-segment depression, at least of 0.5 mm. All the patients showed normal coronary arteries in angiocardiogram. AP was started 10 beats above the basal heart rate with increments of 10 beats every 2 minutes until a ST-segment depression at least of 2 mm was obtained which occurred in all the cases studied. After every 2 minutes of AP a simultaneous 12-leads electrocardiogram recording and left ventricular and aortic pull-back pressure were obtained. At the desired end point the AP was abruptly stopped and the same parameters were registered at 3, 5, 10 and 15 minutes until recovery. During AP the left ventricular systolic pressure (LVSP) did not show any significant change, with the exception of a patient who experienced angor pectoris during the proceeding. The left ventricular end-diastolic pressure (LVEDP) increased in 3.4 +/- 1.7 mmHg, change that was statistically significant (p less than or equal to 0.01) but not hemodynamically important since only in one patient it increased above the normal levels (from 13 mmHg basal to 17 mmHg during AP). In contrast, LVEDP markedly rose above normal when AP was stopped. It is concluded that neither LVEDP nor LVSP play an important role in the genesis of the ST segment depression seen in these patients. It is showed that, similar as in patients with obstructive coronariopathy, these cases work on a depressed Starling curve during AP and its recovery for what is thought that the functional meaning of ischaemia for both entities is similar no matter that their pathogenetic mechanisms are different.