Juntendo Medical Journal
Online ISSN : 2188-2134
Print ISSN : 0022-6769
ISSN-L : 0022-6769
Search
Advanced search
OR
Browse
Search
Volume 45, Issue 4
Displaying 1-24 of 24 articles from this issue
Show all abstracts
    • |<
    • <
    • 1
    • >
    • >|
Contents
  • Precision of electrocardiographic diagnosis of myocardial infarction in the ventricular septal area
    -comparison with 201-TICI scintigraphy and coronary angiography-
    SHOKO MIYANO, HARUTO FUJIOKA, MASATAKA SUMIYOSHI
    2000 Volume 45 Issue 4 Pages 554-562
    Published: March 22, 2000
    Released on J-STAGE: November 12, 2014
    DOIhttps://doi.org/10.14789/pjmj.45.554
    JOURNAL FREE ACCESS
    Show abstractHide abstract
    Objective : The purpose of this study was to clarify the diagnostic accuracy of 3 electrocardiographic (ECG) indexes including Q waves in V1 [QV1 (+)], Q waves in V1 and V2 [QV1V2 (+)], and absence of septal q waves in V6 [qV6 (-)] for prediction of myocardial infarction (MI) in the interventricular septal area (IVS) using 201-T1C1 myocardial scintigraphy. In addition, we also evaluated the relationship between these ECG indexes and the site of the culprit lesions in the left anterior descending artery (LAD). Patients : This study consisted of 115 patients (100 males; mean age, 60 years) with anteroseptal MI who underwent 201-T1C1 myocardial scintigraphy in our hospital between January 1994 and December 1997. One hundred six of them also underwent coronary angiography (CAG). Methods : On extent maps obtained from SPECT images of 201-T1C1 scintigraphy, the area of MI occupying the IVS area, using the proportion of the defect area in the IVS, was expressed as % defect area (%DA). Three patterns of %DA were defined as follows. A : 50%≤%DA≤100%; B : 70%≤%DA≤100%; and C : 90%≤%DA≤100%. Results : On scintigraphic evaluations, %DA in patients with each of the 3 ECG indexes was significantly larger than %DA in patients without them (p=0.0002, p=0.0008, and p=0.0008, respectively). QV1 (+) and qV6 (-) showed good sensitivities only for pattern C (79% and 75%, respectively), but all ECG indexes showed low sensitivities for patterns A and B. Regarding specificity, QV1V2 (+) showed the best values (76% for pattern A, 68% for pattern B, and 68% for pattern C) among the 3 ECG indexes. For prediction of the culprit lesion located proximal to the origin of the first septal branch, qV6 (-) showed a relatively good sensitivity (67%) and specificity (67%) Conclusions : For prediction of MI in the IVS area, QV1 (+) and qV6 (-) showed good sensitivities when the MI was sufficiently large in size. QV1V2 (+) showed relatively good specificities irrespective of the MI size. qV6 (-) was the best predictive index for the culprit lesions located in the proximal site of the LAD.
    View full abstract
    Download PDF (1278K)
  • New pharmacological stress echocardiography using combined olprinone with low-dose dobutamine to detect myocardial viability
    MAYUMI KINOSHITA, SHIGEO NAKAJIMA, AKIKO SUGO, TOUKO SHIMAMOTO, HIROSH ...
    2000 Volume 45 Issue 4 Pages 563-574
    Published: March 22, 2000
    Released on J-STAGE: November 12, 2014
    DOIhttps://doi.org/10.14789/pjmj.45.563
    JOURNAL FREE ACCESS
    Show abstractHide abstract
    Objectives : Dobutamine stress echocardiography has been proposed as a useful method to identify myocardial viability. However, increasing the dose of dobutamine leads to the increase of the left ventricular (LV) work, and its sensitivity for detecting myocardial viability is subsequently reduced. Olprinone is one of the phosphodiesterase III inhibitors that has both actions of positive inotropy and afterload reduction. To improve the sensitivity of stress echocardiography, we evaluated the effects of olprinone combined with dobutamine for assessment of myocardial viability, compared with dobutamine alone. Materials and methods : In 33 patients (ischemic heart disease : n=29; healthy : n=4), regional wall motion of the LV was examined with 2-dimensional echocardiography at the baseline, during the loading of low-dose dobutamine (2, 5, 10μg/kg/min=γ) and a combination of 2γ olprinone with 10γ dobutamine. Wall motion of the LV in 30 segments was evaluated visually by using a 4-grade scoring system (normokinesis-4, hypokinesis-3, severe hypokinesis-2, akinesis-1). LV work was calculated from end-systolic pressure and stroke volume. Results : Average wall motion score (WMS) per person in 22 asynergic patients significantly increased when given the combination of dobutamine and olprinone, compared to 10γ dobutamine alone (2.09±0.16 vs 1.9±0.15, p=0.003).Average WMS per segment in 232 asynergic segments also significantly increased at each stage of the dobutamine loading and combination with olprinone (p<0.0001). WMS per segment in the severe hypokinesis segments (2.64±0.11 to 2.81±0.1, p=0.003) and the akinesis segments (1.32±0.05 to 1.53±0.07, p<0.0001) was especially significantly increased by combination with olprinone. LV work was significantly increased from baseline to the stage of 10γ dobutamine (0.6±0.04J to O.78±0.04J, P<0.01). However, the combination with olprinone significantly reduced LV work, compared with the stage of 10γ dobutamine (0.57±0.06J, P<0.01). Conclusion : Olprinone combined with dobutamine for stress echocardiography improved the sensitivity for detecting myocardial viability by its additional effects of positive inotropic action and afterload reduction. This combination may be a more useful method for clinical examination than dobutamine alone.
    View full abstract
    Download PDF (2063K)
  • Functional reconstitution of FcαR on murine mesangial cell line
    TOSHINAO TSUGE
    2000 Volume 45 Issue 4 Pages 575-583
    Published: March 22, 2000
    Released on J-STAGE: November 12, 2014
    DOIhttps://doi.org/10.14789/pjmj.45.575
    JOURNAL FREE ACCESS
    Show abstractHide abstract
    Background : One of the most critical findings in patients with IgA nephropathy is glomerular mesangial deposition of IgA (IgAl). It is still unknown whether the activation of mesangial cells is directly triggered by IgA. Fc alpha receptor (FcαR) is the major receptor for binding of IgA in various cells, and displays various immunological responses on binding. There is controversy as to whether FcαR is expressed on mesangial cells. However, it is important to analyze the mesangial functions via FcαR in the pathogenesis of IgA nephropathy. To assess biological functions of FcαR on the mesangial cells, the author established mesangial transfectants which expressed FcαR and FcRγ chain. Methods : Murine mesangial cell lines (SV40 MES 13) were transfected with cDNA of human FcαR. Furthermore, I co-transfected some of the FcαR transfectants with cDNA of the human FcRγ chain which is known as a common signaling molecule of FcRs. The tyrosine phosphorylation of the intra-mesangial proteins in FcαR cross-linking was examined by immunoprecipitation. Amounts of monocyte chemoattractant protein (MCP-1) from each transfectant stimulated with heat aggregated IgA was determined by sandwich ELISA. Results : The author generated two kinds of mesangial transfectants which stably expressed human FcαR with or without FcRγ chain (F/Fγ cells). Tyrosine phosphorylation of FcRγ chain and syk kinase was detected in F and Fγ cells, but not in untransfected cells. The secretion of MCP-1 was elicited by stimulation with aggregated IgA in F and Fγ cells in a dose-dependent manner. Moreover, MCP-1 secretion in Fγ cells was significantly higher than that in F cells. Interestingly, more MCP-1 was produced from F cells under stimulation than from untransfected cells. Conclusion : The author confirmed that mesangial cells had the potential for cell-activation with FcαR cross-linking. Furthermore, these transfectants displayed functional output with aggregated IgA. It appears that the activation mechanisms were efficiently controlled by association of the FcRγ chain, and that FcαR with the FcRγ chain may contribute to the mesangial response to IgA deposition.
    View full abstract
    Download PDF (1280K)
  • A study for diagnostic specificity and reproducibility of signal-averaged electrocardiogram by spectral turbulence analysis
    KAORU NAKAZATO
    2000 Volume 45 Issue 4 Pages 584-595
    Published: March 22, 2000
    Released on J-STAGE: November 12, 2014
    DOIhttps://doi.org/10.14789/pjmj.45.584
    JOURNAL FREE ACCESS
    Show abstractHide abstract
    Objective : To evaluate the reliability of spectral turbulence (ST) analysis of signalaveraged electrocardiograms (SAE), the specificity and the reproducibility of the diagnoses were studied and compared to time domain (TD) analysis. Materials : Two hundred healthy subjects consisting of 100 males and 100 females, with an average age of 29 years, were involved in this study. Methods : We recorded SAE in all subjects. In 65 of 200 subjects, two recordings were performed within 15 minutes, and in 24 of the 65 subjects, SAE was also recorded 1 week later in order to evaluate short-term and long-term reproducibility. The obtained signals were analyzed by ST and TD methods. The normal values for the parameters, the gender differences, and the correlation with physical characteristics were evaluated. The reproducibility of measurement values in each parameter and the diagnostic concordance were compared by applying previously proposed criteria and the criteria set by 95% confidence interval of measurements. Results : The measurement values of TD analysis were influenced by gender and physical characteristics, whereas those of ST analysis were not. Applying the previously proposed criteria, diagnostic specificity was 93% in TD analysis and it was 99% using the new criteria. The values were 98% and 99.5% in ST analysis, respectively. A significant correlation of the measurement value in each parameter was observed in the two recordings separated by a 15 minute interval. The diagnostic concordance with the short-term or long-term intervals was 89-100% in TD analysis and 96-100% in ST analysis by applying each criterion. Conclusions : ST analysis of SAE is not influenced by gender or physical characteristics and it is highly specific and reproducible. Therefore, the clinical usefulness including a screening test is suggested.
    View full abstract
    Download PDF (1543K)
  • Long-term follow-up study of ventricular endocardial pacing function : evaluation of the changes in stimulation threshold
    MASAYUKI YASUDA
    2000 Volume 45 Issue 4 Pages 596-603
    Published: March 22, 2000
    Released on J-STAGE: November 12, 2014
    DOIhttps://doi.org/10.14789/pjmj.45.596
    JOURNAL FREE ACCESS
    Show abstractHide abstract
    The performance of endocardial ventricular pacing was evaluated in 453 patients. The mean follow-up period was 59.8 months (ranging from 1 to 305 months). Acute pacing parameters such as stimulation threshold, lead impedance, and R wave amplitude were satisfactory in all patients except one with an extremely high pacing threshold. No significant differences were noted between steroid-eluting electrodes and non-eluting ones in their acute pacing parameters. Pulse width thresholds at 3.5 volts in the subacute phase (1 week after implantation) were also acceptable. These thresholds were statistically lower in steroid-eluting electrodes than in non-eluting ones. Strength-duration curves (S-D curves) were measured at the times of both lead implantation and replacement of the pulse generator in 104 patients. Although chronic S-D curves were shifted upward and to the right, chronaxie did not change. Some complications in pacing leads were recognized during the follow-up periods. Lead conductor fracture occurred in 15 leads, but the fracture sites were various. Lead tip dislodgement occurred in 4 leads (all de-tined type), 3 of which occurred within 24 hours, and in the remaining case, it occurred on the 24th postoperative day. Early battery depletion was recognized in 6 patients, 4 of whom showed marked elevation of stimulation threshold. The overall performance in endocardial ventricular pacing including lead system was almost satisfactory, and measurement of the S-D curve seems to be useful to set the appropriate output with safety margin in both the acute and chronic period.
    View full abstract
    Download PDF (993K)
    • |<
    • <
    • 1
    • >
    • >|
feedback
 Top