BACKGROUND AND OBJECTIVES: Flow-mediated brachial artery vasoactivity has been proposed as a noninvasive means for assessing endothelial function. The present study is designed to assess the influence of aging on endothelial function and when vasoactivity developed initially, peaked. MATERIALS AND METHOD: We measured brachial artery diameter for 60 seconds continuously using 7.5 MHz ultrasound following 5 minutes of lower arm occlusion in 22 normal volun-teers (young group: 10 volunteers, 26.5+/-1.9 years; old group: 12 volunteers, 55.9+/-3.3 years). After sublingual administration of 0.6 mg nitroglycerine, 240 seconds continuously. And then we measure vasoactivity every 3 seconds. RESULTS: Flow-mediated vasodilation (FMD) was started earlier in young group (24.3+/-2.8 sec; old group 28.8+/-3.6 sec, p=0.017). After release of occlusion, peak vasoacitivity time was at 35.5+/-4.7 seconds and peak vasoactivity was 8.4+/-1.7% in young group (old group 6.9+/-1.5%, p=0.099). Endothelial independent vasodilation (EID) was started at 80.7+/-13.3 seconds after sublingual nitroglycerine in young group (vs 80.0+/-19.0 sec), peaked at 177.5+/-16.9 seconds (vs 171.3+/-13.8 sec). Peak vasoactivity was higher in young group (19.1+/-3.1%; old group 15.9+/-2.5%, p=0.033). CONCLUSION: We conclude that 1) Aging has influence on endothelial function about initiating time of vasoactivity as well as peak vaso- activity. 2) FMD can be measured around 50 seconds after release of brachial artery occlusion and EID at 180 seconds after application of sublingual nitroglycerine. 3) The initiating time of vasoactivity (under 30 seconds) can be used for evaluation of endothelial function.
Administration, Sublingual ; Aging* ; Arm ; Brachial Artery ; Nitroglycerin ; Ultrasonography* ; Vasodilation ; Volunteers

Ketamine produces an increase in the heart rate and blood pressure, but the precise mechanism is controversial. In order to obtain inslight into the mechanism by observing the influence of nitroglycerin (NTG) on the ketamine effect, ketamine was administered intravenously following sublingual administration of nitroglycerin in conscious patients. The results were as follows: 1) In the ketamine(2mg/kg) group(n=15), the heart rate and blood pressure increased significantly by as much as 25%. 2) In the nitroglycerin(1.2mg) group(n=12), the heart rate increased, but blood pressure decreased from 5 minutes after administration. 3) In the group which received ketamine(2mg/kg) 5min. after NTG(1.2mg)(N=15), the heart rate did not change, but the blood pressure increased significantly without attenuation by nitroglycerin. From the above results, it is suggested that in the ketamine effect control mechanism may also be participated in addition ot the peripheral mechanism involving norepinephrine release.
Administration, Sublingual ; Blood Pressure* ; Heart Rate* ; Heart* ; Humans ; Ketamine* ; Nitroglycerin* ; Norepinephrine

PURPOSE: We wanted to investigate the effect of sublingual nitroglycerin (NTG) on improving the image quality and diagnostic accuracy of coronary computed tomographic angiography (CTA) for detecting atherosclerosis and significant stenosis. MATERIALS AND METHODS: We retrospectively assessed the data of 81 patients who underwent coronary CTA. Forty three patients underwent coronary CTA without medication (the non-administrated group), while 38 patients were given 0.6 mg NTG sublingually before coronary CTA (the administrated group). Image quality was assessed using a five-point grading scale. We evaluated the diagnostic performance of coronary CTA for assessing atherosclerosis and significant stenosis (> or = 50%) in the 42 patients who underwent invasive coronary angiography. RESULTS: The mean image-quality grades were 4.09+/-0.72 and 4.50+/-0.60 in the non-administrated and administrated groups, respectively (p=0.008). On the per-artery analysis, the accuracy percentages for detecting coronary CTA were 65 and 88% for atherosclerosis and 82 and 80% for significant stenosis in the non-administrated and administrated groups, respectively. On the per-patient analysis, the positive predictive values for coronary CTA were 80% and 100% for atherosclerosis and 77% and 88% for significant stenosis in the non-administrated and administrated groups, respectively. CONCLUSION: Coronary CTA with NTG administration improved the image quality. The accuracy of coronary CTA for detecting atherosclerosis was higher in the administrated group than in the non-administrated group.
Administration, Sublingual* ; Angiography* ; Atherosclerosis ; Constriction, Pathologic ; Coronary Angiography ; Humans ; Nitroglycerin* ; Retrospective Studies

OBJECTIVESyncope is one of the common problems in clinical pediatrics. In recent years, vasovagal reflex was identified as the most common reason for unexplained syncope. Head-up tilt test (HUT) was regarded as one of the important diagnostic criteria. But the sensitivity of baseline head-up tilt test (BHUT) is low. To improve the sensitivity of HUT, we evaluated the diagnostic value of head-up tilt testing potentiated with sublingual nitroglycerin (SNHUT) in children with unexplained syncope.

METHODSTwenty-five patients (11 male and 14 female, mean age 11.8 +/- 2.1 years, ranged from 8 to 15) with unexplained syncope and 10 healthy children in control group (5 male and 5 female, mean age 11.4 +/- 2.1 years, ranged from 9 to 15) were studied. The patients and healthy children were tilted upright to 60 degrees for 45 minutes at BHUT. If syncope did not occur, sublingual nitroglycerin (4 - 6 microg/kg, maximum dose 300 microg) was administered, and continued at same degree for 20 minutes.

RESULTSCompared with controls, there was no significant difference in sex, age, supine blood pressure and supine heart rate of syncopal group (P > 0.05). During BHUT, 12 patients (48%) and none of the controls had positive response, whereas another 8 patients and 2 controls had positive response during SNHUT. In syncopal group, total positive rate was 80%. The sensitivity, specificity, and diagnostic value of SNHUT were all 80%. During SNHUT, the mean time to positive response was 5.9 +/- 2.9 minutes (from 4 to 11 minutes), and only 1 patient had mild headache.

CONCLUSIONHead - up tilt testing potentiated with sublingual nitroglycerin (4 - 6 microg/kg, maximum dose 300 microg) as pharmacological provocation test was a useful and an objective diagnostic tool for evaluating vasovagal syncope in children.

Adolescent ; Child ; Diagnostic Techniques and Procedures ; Female ; Humans ; Male ; Nitroglycerin ; administration & dosage ; Posture ; Sensitivity and Specificity ; Syncope, Vasovagal ; diagnosis ; Vasodilator Agents ; administration & dosage

Administration, Inhalation ; Endothelium-Dependent Relaxing Factors ; pharmacology ; Humans ; Hypertension, Pulmonary ; drug therapy ; Nitric Oxide Donors ; administration & dosage ; therapeutic use ; Nitroglycerin ; administration & dosage ; therapeutic use ; Nitroprusside ; administration & dosage ; therapeutic use ; Phosphodiesterase Inhibitors ; administration & dosage ; therapeutic use

BACKGROUND: Smoking is one of well known environmental factors causing endothelial dysfunction and plays important role in the atherosclerosis. We investigated the effect of cilostazol could improve the endothelial dysfunction in smokers with the measurement of flow-mediated dilatation (FMD). METHODS: We enrolled 10 normal healthy male persons and 20 male smokers without any known cardiovascular diseases. After measurement of baseline FMD, the participants were medicated with oral cilostazol 100 mg bid for two weeks. We checked the follow up FMD after two weeks and compared these values between two groups. RESULTS: There was no statistical difference of baseline characteristics including age, body mass index, serum cholesterol profiles, serum glucose and high sensitive C-reactive protein between two groups. However, the control group showed significantly higher baseline endothelium-dependent dilatation (EDD) after reactive hyperemia (12.0 +/- 4.5% in the control group vs. 8.0 +/- 2.1% in the smoker group, p = 0.001). However, endothelium-independent dilatation (EID) after sublingual administration of nitroglycerin was similar between the two groups (13.6 +/- 4.5% in the control group vs. 11.9 +/- 4.9% in the smoker group, p = 0.681). Two of the smoker group were dropped out due to severe headache. After two weeks of cilostazol therapy, follow-up EDD were significantly increased in two groups (12.0 +/- 4.5% to 16.1 +/- 3.7%, p = 0.034 in the control group and 8.0 +/- 2.1% to 12.2 +/- 5.1%, p = 0.003 in the smoker group, respectively). However, follow up EID value was not significantly increased compared with baseline value in both groups (13.6 +/- 4.5% to 16.1 +/- 3.7%, p = 0.182 in the control group and 11.9 +/- 4.9% to 13.7 +/- 4.3%, p = 0.430 in the smoker group, respectively). CONCLUSION: Oral cilostazol treatment significantly increased the vasodilatory response to reactive hyperemia in two groups. It can be used to improve endothelial function in the patients with endothelial dysfunction caused by cigarette smoking.
Administration, Sublingual ; Atherosclerosis ; Body Mass Index ; C-Reactive Protein ; Cardiovascular Diseases ; Cholesterol ; Dilatation ; Follow-Up Studies ; Glucose ; Headache ; Humans ; Hyperemia ; Male ; Nitroglycerin ; Smoke ; Smoking ; Tetrazoles

OBJECTIVE: To evaluate the applicability of carotid Doppler echography for the assessment of changes of peripheral hemodynamics in the hypertensives. SUBJECTS: 28 hypertensives (17 males, 11 females), mean age of 64 yrs and 40 normal controls (24 males, 16 females) mean age of 49 yrs. METHODS: We recorded the right common carotid arterial Doppler flow velocity (BFV) pattern and measured the peak velocities of the percussion wave (P) and late rising tidal wave (T), the ratio of the two (P/T), the time interval between the two peaks corrected by heart rate (P-Tc), systolic flow velocity integral (FVI) and carotid artery diameter (CAD) before and after 0.4 mg dose of subligual nitroglycerin (NTG). RESULTS: 1) In hypertensives, the P wave velocity showed lower and P-Tc interval shorter than those of the normal controls at baseline. 2) After NTG, the P-Tc and P/T increased, but the T and FVI decreased significantly in both groups of subjects. 3) The P/T ratio was less significantly increased after NTG in the hypertensives than in the controls. These results suggest that NTG might have been involved in concomitant reduction and delay of the wave reflection from the peripheral vessels, preferentially in the normal subjects than in hypertensives. CONCLUSIONS: The carotid Doppler echography can be useful for the evaluation of the changes of hemodynamics in the peripheral vessel such as carotid artery in hypertensive subjects.
Administration, Sublingual ; Blood Flow Velocity/drug effects ; Carotid Arteries/ultrasonography ; Carotid Arteries/drug effects ; Case-Control Studies ; Female ; Human ; Hypertension/ultrasonography ; Hypertension/physiopathology* ; Hypertension/drug therapy* ; Male ; Middle Age ; Nitroglycerin/administration & dosage* ; Ultrasonography, Doppler, Color ; Vasodilator Agents/administration & dosage*

OBJECTIVETo observe the differences of therapeutic effect of acupoint pressing, Nitroglycerin and Suxiaojiuxin pill on angina pectoris (AP) due to coronary heart disease (CHD).

METHODSOne hundred and six ty-eight patients with AP due to CHD were randomly divided into an acupoint pressing group (n = 58), a Nitro glycerin group (n = 56) and a Suxiaojiuxin pill group (n = 54) and were treated with acupoint pressing at Danzhong (CV 17) for 5-10 minutes, sublingual administration of Nitroglycerin and sublingual administration of Suxiaojiuxin pill, respectively. Symptoms, improvements in ECG, the time of producing effectiveness and adverse effects in all the groups were observed.

RESULTSThe total effective rate and the effective rate of ECG were 93.1% (54/58) and 86.2% (50/58) in the acupoint pressing group respectively, 92.9% (52/56) and 85.7% (48/56) in the Nitroglycerin group, and 87.0% (47/54) and 75.9% (41/54) in the Suxiaojiuxin pill group, with no significant differences among the three groups (all P > 0.05). The average time of producing effectiveness was (1.67 +/- 2.45) min in the acupoint pressing group which was shorter than (2.89 +/- 2.64) min in the Nitroglycerin group and (3.75 +/- 2.99) min in the Suxiaojiuxin pill group (P < 0.05, P < 0.001). During the treatment, there were no adverse effects in the acupoint pressing group, which less than 19 cases in the Nitroglycerin group and 12 cases in the Suxiaojiuxin pill group (both P < 0.05).

CONCLUSIONAcupoint pressing can significantly improve symptoms of AP patients with a similar therapeutic effect to Nitroglycerin and Suxiaojiuxin pill, but it has more rapid therapeutic effect without adverse effects.

Acupressure ; Acupuncture Points ; Adult ; Aged ; Angina Pectoris ; drug therapy ; etiology ; therapy ; Coronary Disease ; complications ; Drug Therapy, Combination ; Drugs, Chinese Herbal ; administration & dosage ; Female ; Humans ; Male ; Middle Aged ; Nitroglycerin ; administration & dosage ; Vasodilator Agents ; administration & dosage

BACKGROUNDBirth asphyxia may result in multiple organ dysfunction such as lung injury. Inhalation of nebulized nitric oxide precursor can selectively reduce pulmonary hypertension. However, it is unknown whether such precursors can alleviate lung injury induced by hypoxia. We evaluated the effect of inhalation of nebulized nitroglycerine and sodium nitroprusside on acute hypoxic lung injury in newborn piglets.

METHODSAcute hypoxic lung injury was induced by inspiring 10% O2 for 1 hour. Twenty-four anaesthetized and mechanically ventilated piglets (5-7 days old) were randomly divided into four groups: (1) group S, not hypoxic; (2) group C, nebulized saline after hypoxia; (3) group NTG, nebulized nitroglycerine after hypoxia; (4) group SNP, nebulized sodium nitroprusside after hypoxia. Respiratory dynamic compliance and resistance of respiratory system were recorded at baseline, 0.5 hour and 1 hour of hypoxia; then 0.5 hour, 1 hour, 3 hours and 5 hours following hypoxia. After nebulization, arterial blood was collected for measuring methaemoglobin and nitrate/nitrite levels. Right lung tissue, wet-dry ratio and myeloperoxidase level were determined. White blood cell count (WBC), total surfactant phospholipids (TPL) and disaturated phosphatidyl choline (DSPC) of the bronchoalveolar lavage fluid (BALF) were calculated. Left lungs were used for examining pathological changes.

RESULTSNo significant difference was observed in respiratory dynamic compliance, resistance of respiratory system, wet-dry ratio, levels of methaemoglobin and nitrate/nitrite after nebulization, TPL or DSPC/TPL among four groups. WBC in BALF in groups NTG and SNP significantly decreased as compared with group C: similarly for myeloperoxidase level in lung tissue. Lung histological findings showed infiltration of neutrophils in groups NTG and SNP decreased significantly as compared with group C.

CONCLUSIONInhalation of nebulized nitroglycerine or sodium nitroprusside can alleviate the infiltration of neutrophils, while it affects neither the metabolism of phospholipids nor water content in the lungs.

Acute Lung Injury ; drug therapy ; metabolism ; pathology ; Animals ; Animals, Newborn ; Bronchoalveolar Lavage Fluid ; chemistry ; cytology ; Hypoxia ; complications ; Leukocyte Count ; Lung ; enzymology ; pathology ; Methemoglobin ; analysis ; Nebulizers and Vaporizers ; Nitric Oxide Donors ; administration & dosage ; Nitroglycerin ; administration & dosage ; Nitroprusside ; administration & dosage ; Peroxidase ; metabolism ; Swine

Cardiotoxicity associated with 5-fluorouracil (FU) is an uncommon, but potentially lethal, condition. The case of an 83-year-old man with colon cancer who developed chest pain during 5-FU infusion is presented. The electrocardiogram (ECG) showed pronounced ST elevation in the lateral leads, and the chest pain was resolved after infusion of nitroglycerin. A coronary angiogram (CAG) revealed that the patient had significant atherosclerosis in the proximal left circumflex artery. Coronary artery spasm with fixed stenosis was considered, and a drug-eluting stent was implanted. After 8 hours, the patient complained of recurring chest pain, paralleled by ST elevation on the ECG. The chest pain subsided after administration of intravenous nitroglycerin followed by sublingual nifedipine. Repeated CAG showed patency of the previous stent. This case supports the vasospastic hypothesis of 5-FU cardiac toxicity, indicating that a calcium channel blocker may be effective in the prevention or treatment of 5-FU cardiotoxicity.
Aged, 80 and over ; Angina Pectoris/chemically induced ; Antineoplastic Combined Chemotherapy Protocols/administration & dosage/*adverse effects ; Calcium Channel Blockers/administration & dosage ; Colonic Neoplasms/*drug therapy ; Coronary Angiography ; Coronary Vasospasm/*chemically induced/diagnosis/therapy ; Drug-Eluting Stents ; Electrocardiography ; Fluorouracil/administration & dosage/*adverse effects ; Humans ; Leucovorin/administration & dosage/adverse effects ; Male ; Nifedipine/administration & dosage ; Nitroglycerin/administration & dosage ; Organoplatinum Compounds/administration & dosage/adverse effects ; Percutaneous Coronary Intervention/instrumentation ; Recurrence ; Severity of Illness Index ; Treatment Outcome ; Vasodilator Agents/administration & dosage