Juntendo Medical Journal
Online ISSN : 2188-2134
Print ISSN : 0022-6769
ISSN-L : 0022-6769
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Volume 50, Issue 3
Displaying 1-16 of 16 articles from this issue
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Contents
  • Management of hypertensive renal injuries
    SATOSHI HORIKOSHI, YASUHIKO TOMINO
    2004 Volume 50 Issue 3 Pages 204-213
    Published: September 29, 2004
    Released on J-STAGE: November 12, 2014
    DOIhttps://doi.org/10.14789/pjmj.50.204
    JOURNAL FREE ACCESS
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    It seemed that the risk of renal failure associated with essential hypertension was relatively low. However, hypertension was recently judged to be the underlying cause of end stage renal failure, which is increasing in the number of arteriosclerosis cases in the general population. Life style modification intervention such as weight loss and dietary salt reduction improve hypertension and reduce the risk of renal injury. Since angiotensin converting enzyme (ACE) inhibitor and/or angiotensin II receptor blocker (ARB) are effective not only in lowering blood pressure but in slowing progression of kidney disease, the regimen in combination with diuretics, preferred agents for the treatment of hypertension in kidney diseases with proteinuria. In addition, treatment, examination of renal function and urinalysis are needed to make an early diagnosis of complication with reno-vascular hypertension.
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  • Medical treatment of hypertension as a important preventive strategy for heart desease
    YOSHIRO WATANABE, HIROYUKI DAIDA
    2004 Volume 50 Issue 3 Pages 214-222
    Published: September 29, 2004
    Released on J-STAGE: November 12, 2014
    DOIhttps://doi.org/10.14789/pjmj.50.214
    JOURNAL FREE ACCESS
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    Hypertension is considered one of the risk factors for coronary heart disease and causes cardiac hypertrophy (left ventricular remodeling). Moreover, increasing cardiac afterload develops aggravation of heart failure. Therefore, in the primary and secondary prevention of heart disease, the medical treatment of hypertension is critical and adequate medical treatment is required for it. There is a possibility of a J curve phenomenon on account of the peculiarity of coronary circulation. The fall of diastolic blood pressure will worsen the prognosis of ischemic heart disease, and we therefore need careful management of hypertension in the treatment of ischemic heart disease. In this paper, we review the medical treatment of hypertension focusing on heart disease.
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  • Recent advances in arrhythmia treatment
    YUJI NAKAZATO
    2004 Volume 50 Issue 3 Pages 223-235
    Published: September 29, 2004
    Released on J-STAGE: November 12, 2014
    DOIhttps://doi.org/10.14789/pjmj.50.223
    JOURNAL FREE ACCESS
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    Treatment of atrial fibrillation (AF) and fatal ventricular arrhythmias such as ventricular tachycardia/ventricular fibrillation (VT/VF) is currently a major topic. Recently, atrial remodeling has been considered an important mechanism for the development of persistent AF; therefore, any pharmacological approach should be implemented by taking into account the suppression of remodeling. In symptomatic patients with drug-refractory AF, catheter ablation of the pulmonary vein is performed, because the majority of atrial extrasystole events that trigger AF originate in that area. According to the results of a multicenter randomized trial in a Western country, the long-term prognosis was not significantly different between the rhythm control and rate control groups. However, several methodological problems, including the evaluation of quality of life, were recognized. Moreover, accumulation of original evidence in Japan is required for further evaluation. As for fatal ventricular arrhythmias, their treatment is directly related to the prevention of sudden cardiac death. Many randomized trials for primary and secondary prevention have revealed the superiority of implantable cardioverter-defibrillator (ICD) therapy to pharmacological therapy in the prognosis of depressed left ventricular function. Automated external defibrillators (AEDs) are increasingly deployed in public places as an emergency treatment option for the prevention of sudden death. An improvement in the survival rate is expected when public-access defibrillation is made available to the common citizen.
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  • Coronary Angiography by Retrospectively ECG-gated Multislice Helical Computed Tomography
    KEIGO SHIMOJI, AKIHIKO SHIRAISHI, YUO IIZUKA, YOSHIHISA KUROSAKI, TADA ...
    2004 Volume 50 Issue 3 Pages 236-242
    Published: September 29, 2004
    Released on J-STAGE: November 12, 2014
    DOIhttps://doi.org/10.14789/pjmj.50.236
    JOURNAL FREE ACCESS
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    Objective : Multislice helical computed tomography (MSCT) with retrospectively ECG-gated image reconstruction permits a whole cardiac image to be obtained without motion artifact. We investigated the potential value of MSCT angiography in patients with coronary artery disease. Materials and Methods : We studied 10 patients with suspected coronary artery disease using both MSCT (4×2mm cross-sections, 500-ms rotation, intravenous non-ionic contrast medium, retrospectively ECG-gated image reconstruction) and conventional coronary angiography. Two independent radiologists analyzed the volume-rendering images that were generated from the obtained data sets by MSCT, and the MSCT results were compared with those of conventional coronary angiography. Results : In all 10 patients, 55 (79%) of the 70 proximal and middle coronary artery segments could be evaluated. Overall, 16 (67%) of the 24 high-grade stenoses and occlusions were correctly diagnosed by MSCT. Six of the 11 lesions in the right coronary artery (RCA), 8 of the 10 lesions in the left anterior descending artery (LAD) and 2 of the 3 lesions in the left circumflex artery (LCX) were correctly detected by MSCT. The sensitivity, specificity, positive predictive values and negative predictive values of MSCT were 67%, 37%, 57% and 78%, respectively. Conclusions : These data suggest that MSCT provides clinically useful information in patients with significant stenosis or occlusion of the coronary arteries.
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