Japanese Heart Journal
Online ISSN : 1348-673X
Print ISSN : 0021-4868
ISSN-L : 0021-4868
Volume 17, Issue 5
Displaying 1-15 of 15 articles from this issue
  • Masahiko OKUNI, Satoshi FUJIKAWA
    1976 Volume 17 Issue 5 Pages 545-549
    Published: 1976
    Released on J-STAGE: December 09, 2008
    JOURNAL FREE ACCESS
    One hundred and eleven patients with rheumatic carditis of the first attack were treated with steroid hormone. In the cases, in which the steroid hormone therapy started within 2 weeks from the onset of the disease, all except one did not reveal a residual valvular heart disease after 2 years from the treatment.
    It was suggested that early diagnosis and the earliest start of steroid hormone therapy with large dose on rheumatic carditis is necessary for the prevention against development of rheumatic heart disease.
    A therapeutic schedule for rheumatic fever is recommended.
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  • Hung-Chi LUE, Chiung-Lin CHEN, Huoyao WEI
    1976 Volume 17 Issue 5 Pages 550-559
    Published: 1976
    Released on J-STAGE: December 09, 2008
    JOURNAL FREE ACCESS
    In Taiwan, rheumatic fever (RF) and rheumatic heart disease (RHD) remain widespread and constituting a health problem. The long-term prevention of streptococcal infections among rheumatic chil dren has also failed to prevail, and yet has seldom been emphasized. Therefore, recurrence of RF remained prevalent.
    For an appraisal of the difficulties in the administration of long-term medication prophylaxis, a prospective study was started in 1967. One hundred and five consecutive cases of RF and RHD were followed up for more than 1 year to 6 years with an average of 4.4 years. One hundred and two cases received monthly injections of benzathine penicillin G for 6 months to 6 years, of whom 10 were switched to daily sulfa drugs; 1 case had oral penicillin daily for 6 years; in 12 cases, sulfa drugs were given for 6 months to 5 years.
    Fifty-one cases (48.6%) stayed well in the program; 22 (21.0%) stayed but were not compliant; 32 (30.4%) dropped out soon or after staying in for more than 1 year. Major risk factors leading to non-compliance are; 1) apparent recovery from the illness or resumption of the normal activity; 2) cram session at school; 3) lack of easy medical care system; and 4) shortage of active participation by the health workers and general practitioners.
    The present study confirmed that the long-term prevention of streptococcal infection was effective and contributed to the decline of RF recurrence rate from more than 30% down to 6%. Our study implicates that this important preventive program can not be achieved just only by the hospital staff, but should be approached jointly by all doctors, health and social workers, school teachers and the parents.
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  • Hung-Chi LUE, Chiung-Lin CHEN, Huoyao WEI
    1976 Volume 17 Issue 5 Pages 560-569
    Published: 1976
    Released on J-STAGE: December 09, 2008
    JOURNAL FREE ACCESS
    The Jones criteria proposed in 1944 for the diagnosis of rheumatic fever (RF) underwent a modification in 1955, and then a revision in 1965. The importance of establishing antecedent streptococcal infection was stressed, and the criteria became more difficult to meet with.
    Thirty-two children, whose clinical and laboratory manifestations met the modified but not the revised Jones criteria were encountered at the National Taiwan University Hospital during 1967-1971. They were labeled as probable RF, and were treated and followed for 1 month to 6 years (average 3.7 years). The diagnosis in each case was evaluated in the light of their outcomes.
    The diagnosis of RF was justified in 27 cases based upon the following observation: Favorable responses to anti-rheumatic treatment (27 cases); normalization of the enlarged heart with disappearance of the murmurs (3 cases); normalization of the enlarged heart with persistence of the murmurs (5 cases); significant reduction of the enlarged heart (12 cases); typical RF recurrence (8 cases); development of pure mitral stenosis (1 case); valvular pathology verified at surgery or autopsy (4 cases).
    The diagnosis in the rest of 5 cases remained not confirmed or negated because that: the enlarged heart stayed unchanged (1 case); the child remained uneventful and free of cardiac involvement (2 cases); and the patient died and no postmortem study obtained (2 cases).
    The risk factors leading to underdiagnosis in these patients are: 1) late coming under observation; 2) no response in ASO titers; 3) limited studies for the evidence of streptococcal infection; and 4) drug induced modification of the clinical manifestations.
    This study implicates that patients who are very suspicious of RF on the clinical grounds, yet fail to meet the revised Jones criteria, especially those with established valvular heart disease, should be labeled as cases of probable RF, and be treated, followed, and placed on prolonged chemoprophylaxis until proved otherwise. Recurrence of RF may thus by prevented, and the regression or even natural healing of the rheumatic heart disease will become a possibility.
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  • Stanley JOHN, Susil MUNSI, I. P. SUKUMAR, George CHERIAN
    1976 Volume 17 Issue 5 Pages 570-579
    Published: 1976
    Released on J-STAGE: December 09, 2008
    JOURNAL FREE ACCESS
    To our knowledge, no documented hemodynamic studies in larger series of young patients undergoing valve replacement for rheumatic valvular disease have been reported previously. It seems to us that the natural history of rheumatic heart disease in India often follows a rapid and fulminant course which makes an aggressive surgical approach mandatory.
    An operative mortality of 22% was seen in this series. Pronounced cardiac disability together with the poor general condition and the low nutritional status contributed in no small measure to this figure. Patients have been followed for periods ranging from 6 months to 6 years following corrective surgery.
    A remarkable absence of thrombo-embolic phenomena was a striking feature in the follow-up. There has been no evidence of rheumatic reactivation in any of these patients.
    This communication reinforces the beneficial results of valve replacement even at this young age when severe mitral incompetence exists refractory to medical treatment.
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  • Nobuo WATANABE
    1976 Volume 17 Issue 5 Pages 580-591
    Published: 1976
    Released on J-STAGE: December 09, 2008
    JOURNAL FREE ACCESS
    1) The serum ASO and AH assays were performed and compared in a series of 90 healthy children and 7 pediatric patients with rheumatic fever and other disorders related to hemolytic streptococcus infection.
    2) The upper physiological limit of serum AH titer was estimated to be 256×for children.
    3) In rheumatic fever, sometimes the serum AH level rises earlier than elevation of serum ASO and remains to be high over a long period even after the serum ASO has returned to normal level.
    4) The results suggest importance of the serum AH determination in the serologic diagnosis of rheumatic fever and other conditions of hemolytic streptococcus infection.
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  • Seiichi KAWAKITA, Tsune TAKEUCHI, Yoshio UEMURA, Toyohiko ONISHI, Koic ...
    1976 Volume 17 Issue 5 Pages 592-598
    Published: 1976
    Released on J-STAGE: December 09, 2008
    JOURNAL FREE ACCESS
    Beta-hemolytic streptococci were recovered frequently, particularly from the throats of children, and the same type of group A strains was isolated from both throats and tonsils. A significant antibody response to streptolysin O was observed in 44.8 to 43.5% of children whom group A streptococci were recovered. It is considered that these children had the definite evidence of acute streptococcal infections, and administration of josamycin, penicillin G, and benzyl penicillin V benzathine decreases the frequency of recovery of beta-hemolytic streptococci and prevents rheumatic fever.
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  • A Study Using Ultrasonic Analogue Conversion System
    Yasumi UCHIDA
    1976 Volume 17 Issue 5 Pages 599-610
    Published: 1976
    Released on J-STAGE: December 09, 2008
    JOURNAL FREE ACCESS
    The effect of diltiazem hydrochloride on left ventricular function has been examined in patients with and without angina pectoris. Left ventricular volume and function were measured by ultrasonic analogue conversion system. In 12 patients without angina pectoris, a fall in systemic blood pressure, a decrease in heart rate, no change in EDVI, an increase in ESVI, decreases in CI, EF, endocardial mean Vcf, normalized mean systolic ejection rate, SWI, and W/min while no change in systemic vascular resistance were observed following the intravenous injections of 40μg/Kg of the agent. In 10 patients with angina pectoris, decreases in EDVI and ESVI, no change in CI, a tendency of increases in EF, endocardial mean Vcf, and normalized mean systolic ejection rate were observed following the administrations of the same dose. Changes in systemic blood pressure, heart rate, SWI, W/min, and systemic vascular resistance were the same as those in patients without angina pectoris. The results indicate diltiazem-induced reduction in left ventricular function in patients without angina pectoris whereas improvement in left ventricular function in patients with angina pectoris.
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  • Echocardiographic and Ultrasono-cardiotomographic Study
    Tsuguya SAKAMOTO, Chuwa TEI, Masahiro MURAYAMA, Hirofumi ICHIYASU, Yos ...
    1976 Volume 17 Issue 5 Pages 611-629
    Published: 1976
    Released on J-STAGE: December 09, 2008
    JOURNAL FREE ACCESS
    Left ventricular scanning by echocardiography and ultrasono-cardiotomography was performed to search the possible muscular abnormality in 9 cases with giant T wave inversion without documented cause. The deeply inverted T wave was more than 1.2mV (average was 1.63mV) in the left precordial leads. All the cases had electrocardiographic left ventricular hypertrophy of obscure origin and ischemic episode was absent. Conventional echo beam direction to measure the short axis of the left ventricle disclosed almost normal thickness and movement of both interventricular septum (IVS) and the posterior wall (PW), so that the report of these cases is frequently within normal limits. However, ultrasono-cardiotomography (sector B scan) disclosed the fairly localized hypertrophy near the left ventricular apex, and conventional echocardiography also revealed the same area of either IVS or PW or both below the insertion of the papillary muscles, when the scanning towards the apex was performed (asymmetrical apical hypertrophy: AAH).
    Control study of 9 cases with IHSS showed asymmetrical septal hypertrophy (ASH) with almost equally hypertrophied IVS from base to apex. All cases had inverted T waves, but these were of lesser degree. Three cases had relatively deep T wave compatible with those of AAH, and these cases also had the apical hypertrophy of considerable degree (unusual type of IHSS, i.e., intermediate type between AAH and ASH).
    The close relationship between the depth of the inverted T waves and the Apex/Mid wall thickness ratios suggests that the altered recovery process of the hypertrophied apical musculature is responsible for the giant T wave inversion of heretofore unsolved origin. Until the connective link of AAH to the other forms of hypertrophic cardiomyopathy is disclosed, the cases with such a T wave and the apical hypertrophy may be designated as asymmetrical apical hypertrophy (AAH).
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  • Junichi FUJII, Hiroshi WATANABE, Kazuzo KATO
    1976 Volume 17 Issue 5 Pages 630-648
    Published: 1976
    Released on J-STAGE: December 09, 2008
    JOURNAL FREE ACCESS
    The left ventricular wall motions in 53 patients with myocardial infarction and 14 normal subjects were studied by echocardiography and B-scan imaging (ultrasono-cardiokymography, ultrasono-cardiotomography).
    (1) Abnormal left ventricular wall motions corresponding to the electrocardiographic sites of infarction were seen in the echocardiograms in 80% of total patients and 100% of acute cases. Exaggerated wall motion in opposing noninfarcted areas was seen in 50% of acute cases and 10% of old cases. Quantitative analysis of asynergy could be made by comparing PWE, SE and those ratios to EDD-ESD of infarcted hearts with those of normal hearts.
    (2) In acute myocardial infarction, abnormal motions of left ventricular wall are marked in acute phase and diminished in extent gradually in recovery phase. But in some cases, echo-demonstrated segmental dyskinesis did not disappear in recovery phase, possibly due to the presence of irreversible myocardial damage.
    (3) Echographic thickness of the infarcted wall was less increased than normals or was not increased during systole and decreased when bulged out in some cases, indicating the existence of necrotized muscle. Moreover, multiple echoes sometimes seen between endocardial and epicardial echoes of infarcted myocardium were considered to display the fibrosis of the infarcted myocardium.
    (4) Abnormal echocardiographic motions of septum and posterior wall were observed in some cases who had no electrocardiographic abnormalities which suggest septal or posterior wall involvement. Echocardiography could detect another affected area of the left ventricle which could not be detected by electrocardiography.
    (5) Echocardiography in combination with B-scan imaging (UCKG, UCTG) can detect not only the location, but also the size and extent of myocardial infarction.
    (6) The results of this study indicate that echocardiography and B-scan imaging (UCKG, UCTG) are sensitive methods in detecting the size and location of asynergy and making a precise diagnosis of myocardial infarction. But it is necessary to distinguish abnormal septal and posterior wall motions observed in right ventricular volume overload, complete LBBB or PMD(COCM) from those of myocardial infarction.
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  • Kaoru ONOYAMA, Hideo ONIKI, Tanenao ETO, Teruo OMAE
    1976 Volume 17 Issue 5 Pages 649-655
    Published: 1976
    Released on J-STAGE: December 09, 2008
    JOURNAL FREE ACCESS
    In order to determine the role of fibrinolytic system in the production of fibrinoid necrosis, blood fibrinolytic activities were measured in the rats nephrectomized and administered with the subcellular fractions (lysosomal or microsomal fraction) of the rat kidney cortical extract.
    Tissue plasminogen activator was present in both fractions and blood fibrinolytic activity was increased in the rats so treated. But fibrinoid necrosis in pancreatic and mesenteric small arteries was observed only in those administered lysosomal fraction.
    Direct relationship between the increase of blood fibrinolytic activity and the aggravation of the vascular degeneration could not be observed in this experiment.
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  • Shigetoshi CHIBA, Tony W. SIMMONS, Matthew N. LEVY
    1976 Volume 17 Issue 5 Pages 656-662
    Published: 1976
    Released on J-STAGE: December 09, 2008
    JOURNAL FREE ACCESS
    Using an isolated, blood-perfused atrium preparation, the effects of temperature on SA nodal pacemaker activity were investigated in 9 preparations. The PP interval decreased as temperature was raised. Regular sinus rhythm and atrial contraction were maintained above approximately 26°C. Below 26°C, sinus depolarization still showed a regular rate, although atrial contractions had ceased. At about 24°C, atrial rhythm became irregular. Below 20°C, atrial depolarization disappeared.
    Chronotropic responses to norepinephrine were suppressed at decreased temperatures, not only with respect to maximum PP shortening but also to the threshold dose for inducing sinus acceleration.
    Overdrive suppression was not influenced significantly by decreasing temperature.
    These results indicate that a temperature decrease causes suppression of SA nodal pacemaker activity, although the SA node continues to function regularly until about 25°C.
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  • A Theoretical Approach
    Hiroyuki SUGA
    1976 Volume 17 Issue 5 Pages 663-668
    Published: 1976
    Released on J-STAGE: December 09, 2008
    JOURNAL FREE ACCESS
    A hypothesis of a principle of the adaptation of heart size to volume load was generalized from some experimental findings in literature on hearts of a few mammalian species. The hypothesis was that the heart adapts its size and weight so that both myocardial force per unit cross sectional area and extent of shortening per unit length be kept constant. From these 2 conditions, mathematical relationships of heart weight and enddiastolic volume to stroke volume were derived by the aid of a thick wall sphere model of the left ventricle. The calculated result was in good agreement with comparative physiology data in literature on normal hearts from rats to cows. The present hypothesis was therefore suggested to be a basic principle of heart adaptation to the natural volume load in a wide variety of mammalian species.
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  • Hakaru TASAKI, Junichiro FUKUSHIGE, Sunao HONDA, Ikuho JINNAI, Tasuo T ...
    1976 Volume 17 Issue 5 Pages 669-675
    Published: 1976
    Released on J-STAGE: December 09, 2008
    JOURNAL FREE ACCESS
    A case of cardiac rhabdomyoma was presented. She was diagnosed as intraatrial tumor by cardiac catheterization and angiocardiography at 7 months of age.
    Two months later, she was undergone open heart surgery, which revealed large rhabdomyoma in the left atrium obstructing the mitral valve.
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  • A Case of Successful Repair with Review of Literature Since 1943
    Isao SAKASHITA, Tadao YOKOSAWA, Chikara SUZUKI, Masahiko WASHIO, Ken-i ...
    1976 Volume 17 Issue 5 Pages 676-684
    Published: 1976
    Released on J-STAGE: December 09, 2008
    JOURNAL FREE ACCESS
    A case of aorticopulmonary fistula secondary to thoracic aortic aneurysm of syphilitic origin has been presented. Aneurysm involved the first portion of the ascending aorta and ruptured into the main pulmonary artery a few cm above the pulmonic valve. Two weeks after onset, the patient successfully operated upon under profound hypothermia with perfusion.
    Thirteen cases of this disease since 1943 were reviewed and we discussed briefly profound hypothermia as a useful technic for surgical correction of this condition.
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  • Nobuharu AKATSUKA, Toshiko MAEKAWA, Masayasu HIRAOKA
    1976 Volume 17 Issue 5 Pages 685-689
    Published: 1976
    Released on J-STAGE: December 09, 2008
    JOURNAL FREE ACCESS
    Atrial dissociation was recorded in a patient with malignant hypertension and microangiopathic hemolytic anemia. Digitalis intoxication was considered the cause of atrial dissociation.
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