JAPANESE CIRCULATION JOURNAL
Online ISSN : 1347-4839
Print ISSN : 0047-1828
ISSN-L : 0047-1828
58 巻, 6 号
選択された号の論文の9件中1~9を表示しています
  • KAZUYUKI SAKATA, HIROSHI YOSHIDA, HIROSHI SUGINO, MASARU IIMURO, YOUIC ...
    1994 年 58 巻 6 号 p. 379-388
    発行日: 1994/05/20
    公開日: 2008/04/14
    ジャーナル フリー
    This study was performed to assess the value of washout rate analysis of quantitative exercise thallium-201 emission computed tomography in vasospastic angina patients without significant coronary stenosis. Quantitative analysis of both thallium-201 perfusion and washout rate before and after drug treatment was performed in 48 patients with vasospastic angina and no significant coronary artery stenosis. All of the patients attained more than 90% of their agepredicted heart rate during each exercise test. Before drug treatment, 26 patients exhibited exercise-induced ischemia (perfusion defects on stress polar map), 17 did not exhibit exercise-induced ischemia (normal stress and washout rate polar maps), and the remaining 5 patients showed no perfusion defects, but did show extensive abnormal washout rates. On coronary angiography, multivessel coronary spasm was documented in 12 of the 26 patients with exercise-induced ischemia, in 7 of the 17 patients without exercise-induced ischemia and in 4 patients with an extensive abnormal washout rate and a normal stress polar map. In the 17 patients without exercise-induced ischemia, the mean washout rate was significantly decreased (p<0.05) in association with a significant decrease in the double product (p<0.05) after drug treatment. Of the 26 patients with exercise-induced ischemia, 18 (group 1) showed an increase in the mean washout rate with improved perfusion defect after drug treatment. The remaining 8 patients (group 2) showed a decrease in the mean washout rate with improved perfusion defect after drug treatment, which increased significantly on repeat exercise test performed after additional increased doses of antianginal drugs were administered (p<0.01). The number of patients with multivessel coronary spasm was significantly high in group 2 (p<0.01). Thirteen patients showed an extensive abnormal washout rate before drug treatment, including 8 patients with exercise-induced ischemia and 5 patients with no perfusion defects, who showed an increased mean washout rate after drug treatment (p<0.05). These findings indicate that washout rate analysis aids in the diagnosis in vasospastic angina patients with exercise-induced ischemia. Some patients with exercise-induced ischemia can not be detected by thallium-201 perfusion analysis alone, especially those with multivessel coronary spasm and when this procedure is performed after drug treatment. In addition, a high frequency of abnormal washout rate in vasospastic angina may result not only from exercise-induced ischemia due to main epicardial coronary artery spasm, but also from microspasm, or impariment of microcirculation or myocyte.
  • HIROYOSHI OKI, SHIN INOUE, NOBUYUKI MAKISHIMA, YOUICHI TAKEYAMA, AKIRA ...
    1994 年 58 巻 6 号 p. 389-394
    発行日: 1994/05/20
    公開日: 2008/04/14
    ジャーナル フリー
    Depletion of norepinephrine in the left ventricular myocardium in cases of dilated cardiomyopathy (DCM) has been suggested. However, there have been few histological studies of the sympathetic nerves, in which myocardial norepinephrine is believed to exist. We performed an immunohistological study of the density of tyrosine hydroxylase (TH, a marker of sympathetic nerves)-positive nerve fiber in endomyocardial biopsy specimens in cases of DCM using antibody against TH. TH-positive nerves were stained brown along with the myocardium, and they were more dense in the right ventricle than in the left ventricle in both the DCM and control groups. The density of TH-positive nerves in cases of DCM was significantly less than that in the control group in the subendocardial myocardium of the right and left ventricles, but especially in the left ventricle. A correlation was observed in the DCM group between the density of TH-positive nerves and the ejection fraction in the right ventricle, but not in the left ventricle. In the failing human heart, a decrease in subendocardial sympathetic nerve density may be one of the causes of myocardial norepinephrine depletion.
  • MASATSUGU HORI, YUKIHIRO KORETSUNE, KAORU TAKEMURA, JUNICHI AZUMA, HIR ...
    1994 年 58 巻 6 号 p. 395-402
    発行日: 1994/05/20
    公開日: 2008/04/14
    ジャーナル フリー
    In any program for cardiac transplantation, appropriate recipient selection is critically important. The purpose of this study is to evaluate the prognosis of 42 patients with severe cardiac dysfunction who were referred to the Patient Referral Committee of the Osaka University Cardiac Transplant Program from August 1990 to July 1993. All of the patient profiles and clinical data were presented and discussed in the Committee Conference. The Committee classified the patients into three groups according to the following criteria: Class A; 14 patients judged to have a medical indication for heart transplantation. Class B; 7 patients with possible indications which required reevaluation for a definite indication after further intensive medical treatments, and Class C; 21 patients who did not have indications for heart transplantation or who required further clinical examinations and/or medical treatments before a final judgment. Twelve of the 14 Class A patients had a history of NYHA functional class IV and ejection fractions were 25% or less in all of the patients but one (18.5±1.7%). Six patients in Class A had a history of ventricular tachycardia. The one-year survival rate of Class A patients was 60%, and only 28% survived for 28 months. One patient underwent successful heart transplantation in the United States. If we assume that this patient would have died within a year without heart transplantation, the estimated one-year survival rate would fall to 48%, which is comparable to the survival rate of patients who have been accepted for transplant, but are being treated medically, in Western countries. This indicates that our criteria for recipient selection are comparable to those currently used in the Western countries, and therefore may be appropriate for future heart transplantation in Japan.
  • YUTAKA TAKATA, TAKAYUKI YOSHIZUMI, YASUO ITO, YASUO HIROTA, MASATOSHI ...
    1994 年 58 巻 6 号 p. 403-408
    発行日: 1994/05/20
    公開日: 2008/04/14
    ジャーナル フリー
    The effect of long-term doxazosin treatment on normotensive subjects was evaluated by 48-hour ambulatory blood pressure (BP) monitoring (ABPM). Eight normotensive volunteers were given 1 mg of doxazosin per day, and the dose was titrated every week up to 8 mg/day. The 48-hour ABPM, using a noninvasive device, was performed before treatment and during the 4th week of treatment. Doxazosin did not decrease the average 48-hour systolic BP, but diastolic BP decreased slightly (3 mmHg). This slight decrease in 48-hour diastolic BP was observed during the daytime. The 48-hour pulse rate (PR) was clearly elevated by doxazosin, which was attributed to tachycardia at night. Thus, the present study using 48-hour ABPM indicated that long-term doxazosin treatment may result in only slight daytime hypotension with apparent nighttime tachycardia in normotensive subjects.
  • OSAMU UYAMA, YUKIKO MATSUI, SOUICHIRO SHIMIZU, HISAMASA MICHISHITA, MI ...
    1994 年 58 巻 6 号 p. 409-415
    発行日: 1994/05/20
    公開日: 2008/04/14
    ジャーナル フリー
    Thromboxane A2 biosynthesis was studied in healthy subjects, in patients in whom the extent of carotid atherosclerosis was determined, and in patients receiving chronic aspirin treatment, to determine what factors activate platelets to develop carotid atherosclerosis. Urinary 11-dehydrothromboxane B2, a major metabolite of thromboxane A2, was measured by radioimmunoassay after purification by reverse-phase HPLC. The extent of carotid atherosclerosis was determined by real-time B-mode ultra-sonography. The severity of carotid atherosclerosis in each subject was evaluated by plaque score, which was computed by summing the maximum thickness of plaque measured in millimeters. Urinary excretion of 11-dehydrothromboxane B2 in healthy subjects was higher (P<0.01) in cigarette smokers (1063±244 ng/g creatinine) than in non-smokers (815±183 ng/g creatinine). Aspirin significantly suppressed 11-dehydrothrom-boxane B2 excretion (266±114 ng/g creatinine). In the 24 patients in whom the plaque score was measured, multivariate analysis indicated a significant positive correlation between urinary excretion of 11-dehydrothromboxane B2 and plaque score, age, smoking and hypercholesteremia. Our results indicate that risk factors such as age, hypercholesteremia, atherosclerosis and smoking activate platelets in vivo to develop carotid atherosclerosis.
  • HIDEYUKI HONDA, YOSHIRO KOIWA, TAMOTSU TAKISHIMA
    1994 年 58 巻 6 号 p. 416-425
    発行日: 1994/05/20
    公開日: 2008/04/14
    ジャーナル フリー
    We previously reported that the application of an external mechanical vibration to the epicardial surface caused a vibration-induced-depression (VID) of left ventricular (LV) function. The magnitude of the VID of peak LV pressure increased as either the amplitude or the frequency of the vibration increased. When LV contractility was altered by the administration of propranolol or by continuous infusion of dobutamine, the magnitude of the VID of peak LV pressure was inversely correlated with LV contractility. These characteristics were observed in open-chest and isolated canine preparations. In the present study, we constructed a muscle model to obtain a theoretical explanation for these effects. This model was first proposed by Gray, Gonda and Cheung, and has been extended in this report to explain twitch tension. This new, improved model is able to explain twitch tension and the effects of external vibration on twitch contraction semi-quantitatively. The successful predictions of the this model support the idea that external vibration directly affects contractile protein and modulates crossbridge kinetics.
  • SHOU-HSIEN HOU, HUNG-CHI LUE, SHU-HSUN CHU
    1994 年 58 巻 6 号 p. 426-432
    発行日: 1994/05/20
    公開日: 2008/04/14
    ジャーナル フリー
    To determine the mechanism of cardiac output and hemodynamic changes during cardiopulmonary resuscitation (CPR), we performed 60 min of CPR using a mechanical resuscitator ("Thumper", MII USA) in 20 piglets (13.7±1.2 kg) following cardiac arrest induced by intravenous injection of KCl. Conventional CPR (C-CPR), i.e., 60 external chest compressions (60 psi force, 3 cm deep, and 50% duration) and 12 ventilations (following every 5th compression, with peak airway pressure of 30 cmH2O) per minute, was performed in 10 piglets; and simultaneous compression and ventilation CPR (SCV-CPR), i.e., 60 external chest compressions of the same magnitude, simultaneously with 60 ventilations (with peak airway pressure of 60 cmH2O) per minute, was performed in the 10 other piglets. Cardiac output in C-CPR and SCV-CPR was maintained near 70% or more of baseline throughout the CPR. Systemic vascular resistance dropped to below 50% of baseline. Systolic, mean and diastolic arterial pressures were maintained above 70, 40, and around 20 mmHg, respectively, during the first 30 min of CPR. Central venous pressure rose after arrest and subsequent CPR to above 25 mmHg, and remained high in SCV-CPR, but declined thereafter in C-CPR. Aortic diastolic minus right atrial diastolic pressure was around 15 mmHg early in CPR and dropped to almost zero thereafter. Serial arterial blood gas analyses showed a significant deterioration after 20 min of SCV-CPR. All but one piglet in the SCV-CPR group died after 60 min of CPR. Postmortem examination revealed that pulmonary barotrauma was more extensive and severe in SCV-CPR than in C-CPR. These results suggest that cardiac pumping is the primary mechanism of cardiac output during CPR in piglets. The mechanical resuscitator consistently achieved adequate cardiac output and systolic arterial pressure. Pulmonary barotrauma may have a negative impact on CPR results.
  • ITSURO MORISHIMA, HIROMI SASSA, TAKAHITO SONE, HIDEYUKI TSUBOI, JUNICH ...
    1994 年 58 巻 6 号 p. 433-438
    発行日: 1994/05/20
    公開日: 2008/04/14
    ジャーナル フリー
    We report the case of a 41-year-old man with acute fulminant myocarditis. The patient went into cardiac standstill immediately after admission and was placed on a percutaneous cardiopulmonary support system. The system remained in place for 302 h, after which the patient recovered from cardiogenic shock without complications and has returned to normal life.
  • TAKAHIDE ITO, HIRONOBU ANDO
    1994 年 58 巻 6 号 p. 439-442
    発行日: 1994/05/20
    公開日: 2008/04/14
    ジャーナル フリー
    Gastrointestinal bleeding is not rare in patients with calcific aortic stenosis (AS) in Western countries, which has suggested an association between the two conditions. However, there has been no previous report of this association in Japan. In this report we describe a patient with AS who had recurrent gastrointestinal bleeding. An 84-year-old female who had been followed for severe AS presented with recurrent rectal bleeding, but the site of bleeding could not be detected despite various examinations, including endoscopy. She died of progressive heart failure during hospitalization. Postmortem examination disclosed severe left ventricular hypertrophy with calcific aortic stenosis. Microscopically, angiodysplastic lesions were observed in the submucosa throughout the gastrointestinal tract.
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