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Biomedical subjects

A Takarada

Publications and source records attributed to A Takarada.

At least 19 recordsLinked to original sources
PubMed1992

Congestive heart failure in the elderly--echocardiographic insights.

One hundred and seventy-two patients (110 were greater than or equal to 65 years and 62 were less than 65 years) with congestive heart failure (CHF) were prospectively evaluated to determine various pathophysiologic mechanisms of CHF. The incidence of CHF with normal left ventricular (LV) systolic function was higher in elderly (30% vs 12%, p less than 0.05). Of the 110 elderly patients, LV systolic function was impaired in 77. Fifty-five patients had LV dilatation without increased wall thickness, and the clinical diagnosis was "dilated cardiomyopathy in the elderly". Twenty-two patients had hypertrophied LV and a high incidence of hypertension, and they were diagnosed as "hypertensive heart failure" due to contractile dysfunction. On the contrary, the remaining 33 patients did not have impaired LV contractile function. Thirteen patients lacking LV hypertrophy had enlarged atria. CHF was induced by reduced chamber compliance called "the stiff heart syndrome". Twenty patients had hypertrophied LV and a high incidence of hypertension. They were diagnosed as having "hypertensive hypertrophic cardiomyopathy of the elderly" and abnormalities of diastolic function accounted for the CHF. Since echocardiography can easily and accurately diagnose the pathophysiologic mechanism of CHF, an increased awareness of its occurrence in the elderly and use of echocardiography would reduce diagnostic and therapeutic errors.

Aged↗
PubMed1992

Short- and mid-term follow-up results after percutaneous transvenous mitral commissurotomy.

This study reports the clinical follow-up for 6 months of 52 patients who underwent percutaneous transvenous mitral commissurotomy (PTMC). PTMC resulted in an increase in mitral valve area from 1.1 +/- 0.3 to 1.7 +/- 0.4 cm2 (p < 0.0001), a decrease in mean left atrial pressure from 16 +/- 7 to 13 +/- 5 mmHg (p < 0.0001), and an increase in exercise time from 4.6 +/- 2.1 to 6.3 +/- 2.3 min (p < 0.0001). At 6 months follow-up, mitral valve area was unchanged (1.7 +/- 0.4 cm2). Of 52 patients, 33 showed clinical improvement and 19 had no clinical improvement after PTMC. Univariate analysis showed (1) younger age, (2) echocardiographic score of 8 or less, (3) existence of mitral regurgitation of less than grade 2 after PTMC, and (4) amelioration in left atrial dimension, mean pulmonary artery pressure and exercise time after PTMC as correlative factors for clinical improvement. In conclusion, PTMC was an effective procedure for mitral stenosis, especially in younger patients with an echocardiographic score of 8 or less. Change in left atrial dimension was a good indicator of the effectiveness of PTMC.

Adult↗
PubMed1992

[Clinical features of latent dilated cardiomyopathy].

To identify the evidence of presymptomatic manifestations of dilated cardiomyopathy (DCM), we studied 30 patients with latent DCM (mean 37 +/- 14 years) who satisfied the following criteria: 1) left ventricular (LV) systolic function was slightly reduced; 2) LV end-diastolic dimension (< 54 mm) and coronary arteries were normal. The incidence of ECG abnormalities was relatively high; nonspecific ST-T changes were the most common (90%). The incidence of grade 3 or 4 ventricular premature contractions according to Lown's classification on 24 hour ambulatory ECGs was 50%. Perfusion defects were observed in 83% on the thallium-201 images. Right ventricular biopsy showed that the interstitial fibrosis was milder (9 +/- 9%) in the study subjects than in 32 patients with DCM (17 +/- 8%) who were treated in our hospital, but there were no significant differences in the diameters of the myofibers (15 +/- 4 vs 17 +/- 4 microns) between the 2 groups. During the follow-up study, deterioration of LV dysfunction was observed in 3 patients. One patient died suddenly. These findings proved the importance of the early detection and characterization of latent state of DCM.

Adult↗
PubMed1991

Orbital fractures: surface coil MR imaging.

Twenty-six patients with orbital fractures diagnosed with plain radiography and computed tomography were examined with surface coil magnetic resonance (MR) imaging. Fifteen patients had blow-out fractures, and 11 had maxillofacial complex fractures. In all patients with blow-out fractures, the location of the fracture was precisely indicated by the presence of prolapsed orbital fat. Incarceration of the extraocular muscle or orbital fat was correctly diagnosed with MR imaging, which was less sensitive in depicting maxillofacial fractures but was useful in assessment of soft-tissue involvement. Postoperative follow-up MR studies provided valuable information about the cause of motility impairment. While T1-weighted images are useful for the detection of the fracture site, both T1- and T2-weighted images are usually necessary for evaluating soft-tissue lesions. The results of this study indicate that surface coil MR imaging is an important adjunct procedure in the diagnosis and treatment of orbital fractures.

Adolescent↗
PubMed1991

Effects of long-term beta-blockade (metoprolol) therapy in patients with dilated cardiomyopathy.

Twenty-two patients with dilated cardiomyopathy (DCM) were treated with metoprolol and their clinical courses were compared with those of 26 patients untreated with beta-blocking agents (non beta group). Of the 22 patients treated with metoprolol, 19 (beta group) were treated for a long period, 3 patients left the study within its first 6 months. Using the NYHA classification, 4 patients of the beta group were evaluated as having clinically improved, while none was aggravated, excluding 2 cases of death which occurred during the follow up period. In the non-beta group, clinical improvement was found for 2 patients and aggravation in functional class for 10. The left ventricular diameter was significantly decreased and parameters of systolic function and exercise tolerance were significantly improved in patients of the beta group, while no such improvements occurred in patients of the non-beta group. Twenty-four-hour ECG monitoring demonstrated a significant reduction in incidences of ventricular extrasystole in the beta group but not in those of the non-beta group. Improvement of arrhythmias, evaluated using Lown's grading system, was also identified more frequently in the beta group than in the non-beta group. During the follow-up period, 2 patients of the beta group and 10 patients of the non-beta group died. The survival curve for patients of the beta group prepared using the Caplan Meier Method was better than that for patients of the non-beta group. Metoprolol was therefore found to be useful for treatment of DCM.

Arrhythmias, Cardiac↗
PubMed1991

The role of myocarditis and myocardial fibrosis in dilated cardiomyopathy. Analysis of 28 necropsy cases.

The hearts of 28 necropsy cases with DCM and 10 control cases were analysed to elucidate the role of myocarditis and fibrosis in dilated cardiomyopathy (DCM). The extent of fibrosis and myocyte diameter were measured in the transverse sections of the left ventricle. The degree and pattern of fibrosis varied widely from case to case. The DCM cases were then classified into 3 groups: 1) Group Ia, 8 cases with mild diffuse fibrosis; 2) Group Ib, 9 cases with severe diffuse fibrosis and 3) Group II, 11 cases with segmental fibrosis. Myocardial fibrosis and hypertrophy were significantly more prominent in Groups Ib and II than in the control group (p less than 0.01), but no differences were observed between Group Ia and the control group. Thus, it is reasonable to attribute the chronic CHF and LV dilatation in Groups Ib and II to the extensive myocardial fibrosis. In contrast, it is not reasonable to attribute the chronic CHF and LV dilatation in Group Ia to myocardial fibrosis. Focal lymphoid cell infiltration was graded to assess inflammatory changes. Group II showed more prominent inflammatory changes than the other 2 groups (p less than 0.05). Thus, it is possible that myocarditis is an etiologic factor for DCM with a segmental pattern of fibrosis.

Adolescent↗
PubMed1991

Evaluation of biventricular interaction in various cardiac diseases by pulsed Doppler echocardiography.

We evaluated the biventricular interaction in various cardiac diseases by pulsed Doppler echocardiography. A/R (atrial peak filling velocity/rapid peak filling velocity) from inflow wave and PEP/ET (pre-ejection period/ejection time) from outflow wave were measured as parameters of both ventricular function. In 20 normal cases, A/R and PEP/ET correlated well between the right and left ventricles, respectively. In 6 cases with pulmonary hypertension, both values of A/R and PEP/ET were higher than those in normal cases in the right ventricle, but not in the left ventricle. In 15 cases with left ventricular infarction, these values were higher than those in normal cases. Not only in the left ventricle but also in the right ventricle, and good correlation between both ventricles was observed in each parameter. In 15 cases with hypertrophic nonobstructive cardiomyopathy and 15 cases with dilated cardiomyopathy, both values of A/R and PEP/ET in the both ventricles were also higher than those in normal cases, respectively, however, both parameters did not correlate with the both ventricles. It is suggested that the right ventricular function is influenced not only by the afterload or interventricular septal function, but also by the myocardial property of the right ventricle itself, in cases with cardiomyopathies.

Cardiomyopathy, Dilated↗
PubMed1991

[Progression from latent cardiomyopathy to dilated cardiomyopathy: a review of five cases].

We report 5 patients, who had no cardiac abnormalities at their initial evaluation but progressed to dilated cardiomyopathy (DCM) during a mean follow-up period of 8.2 years. Their echocardiograms revealed increases in left ventricular (LV) end-diastolic dimensions, deterioration of LV contractions, and reduction in the LV wall thickness. Electrocardiographic changes were developed of rhythm disturbances, intensified ST-segment and T-wave changes, and the prolonged QRS durations. These findings, especially those of electrocardiography, seemed to be important for an early detection and characterization of DCM.

Adolescent↗
PubMed1991

[Pericardial effusion in acute myocardial infarction: clinical feature and significance].

To determine the incidence and clinical significance of pericardial effusion after acute myocardial infarction, two-dimensional echocardiography was serially performed in 137 consecutive patients. Pericardial effusion was observed in 45 patients (33%), of whom 22 were followed until they recovered and were discharged. Pericardial effusion was more frequent in patients with anterior acute infarction than those with inferior acute infarction, and so it was in non-recanalized patients than in recanalized ones. Patients with pericardial effusion had higher peak levels of creatine kinase, higher wall motion score indices, and higher defect scores of thallium imagings. The improvement of regional wall motion at an infarct zone in patients with pericardial effusion was less regardless of the successful early recanalization. These results show that pericardial effusion is a common event in patients with acute myocardial infarction and observation of transition of pericardial effusion is important for predicting prognosis.

Aged↗
PubMed1990

Analysis of ventricular arrhythmias in patients with dilated cardiomyopathy--relationship between the effects of antiarrhythmic agents and severity of myocardial lesions.

In order to investigate the usefulness of antiarrhythmic drugs in patients with dilated cardiomyopathy (DCM), 42 patients with DCM were studied using 24 h ambulatory ECG monitoring, echocardiography and right ventricular endomyocardial biopsy. All 42 patients had ventricular arrhythmias with a Lown's classification of grade II or greater (grade IVb, 25; IVa, 7; III, 7; II, 3). The patients with grade IV arrhythmias tended to have greater dilating of the left ventricle and more pronounced interstitial myocardial fibrosis than patients with lower grades. Following procainamide and/or disopyramide treatment the severity of the ventricular arrhythmias improved in 12 (29%) of the 42 patients, did not change in 27 patients (64%), and deteriorated in 3 patients (7%). Treatment with aprindine or mexiletine was effective in 7 (50%) of the 14 patients who did not respond to procainamide and/or disopyramide. Although there were no significant differences in left ventricular dimension and contractility between patients in each group who did and did not respond to antiarrhythmic treatment, those who did respond had less interstitial myocardial fibrosis. Thus, in the procainamide and/or disopyramide treated group the percent interstitial fibrosis in responding vs nonresponding patients was 10.3 +/- 4.1% vs 18.7 +/- 8.3% (p less than 0.05) respectively, while in the group treated with aprindine or mexiletine these figures were 13.0 +/- 3.2% vs 26.1 +/- 7.9% (p less than 0.02), respectively. In conclusion, the effect of antiarrhythmic drugs in DCM was dependent on the severity of the pathological changes in the myocardium, and antiarrhythmic drugs should be appropriately used for the management of ventricular arrhythmias in DCM.

Adult↗
PubMed1990

Intraocular lesions in patients with systemic disease: findings on MR imaging.

Twenty-one intraocular lesions associated with various systemic diseases in 15 patients were studied by MR imaging. The disorders included diabetes mellitus, cardiovascular disease, Behçet disease, sarcoidosis, and ankylosing spondylitis. MR was performed on a 0.5-T system using a surface-coil technique. Ophthalmoscopic visualization of the fundus was precluded by the presence of opaque media in all cases. MR was found to be effective in demonstrating intraocular bleeding, vitreous opacity, detached lesions of the posterior pole, and eyeball deformity. Surface-coil MR is a useful adjunct in the evaluation of the eyes affected by systemic diseases, especially in patients with opaque media.

Adult↗
PubMed1990

[Mitral valve prolapse as an initial clinical feature of dilated cardiomyopathy: report of two cases].

Two cases with mitral valve prolapse (MVP), without any other cardiac abnormalities at the initial evaluation, developed the clinical features mimic to dilated cardiomyopathy (DCM) during follow-up period. Case 1. A 40-year-old man visited our hospital in May 1982 to evaluate a heart murmur. A standard 12-lead electrocardiogram (ECG) showed an abnormal Q wave in lead III. Echocardiography revealed MVP, but neither dilatation nor wall motion abnormality of the left ventricle (LV) were observed. Thallium-201 scintigraphy revealed an abnormal thallium uptake at the apex and inferior wall. He had no episode of acute myocardial infarction or myocarditis, but complete right bundle branch block developed, thus, he was hospitalized in October 1984. He had no coronary artery lesions, and had only mild mitral regurgitation on left ventriculography. The motion of the interventricular septum and apex was reduced on echocardiogram and a persistent perfusion defect was observed at the inferior wall and the interventricular septum on Tl-201 scintigrams. In December 1985, he experienced an Adams-Stokes attack due to complete atrioventricular block. Echocardiographically, the left ventricle enlarged, and the wall motion abnormalities and a perfusion defect on Tl-201 scintigrams were relatively severe. Case 2. A 46-year-old woman occasionally experienced palpitation of short duration and chest oppression since 1977. She was admitted to our hospital because of cardiac symptoms in 1982. A heart murmur of Levine II was heard and a standard 12-lead ECG showed single supraventricular extrasystole and T wave inversion in lead III and aVF. Echocardiography revealed MVP and mild mitral regurgitation, but neither dilatation nor wall motion abnormality of the LV was observed. During 6-year follow-up period, permanent atrial fibrillation developed and LV developed dilatation and wall motion abnormalities progressed. Thus, during follow-up periods, DCM-like features developed in two cases who had had MVP as a sole echocardiographic abnormality with systolic murmur and non-specific ECG changes. We consider that these two may be important cases who may show a relation between cardiomyopathic process and MVP.

Adult↗
PubMed1989

Mechanism of development of asymmetric septal hypertrophy in patients with essential systemic hypertension.

In order to understand the mechanism of development of asymmetric septal hypertrophy (ASH) in hypertension, 290 patients with essential hypertension (HT) were examined echocardiographically. Out of them 84 cases of advanced left ventricular hypertrophy (LVH) [37 cases of symmetric hypertrophy (HT-SH group) and 47 cases of ASH (HT-ASH group)] were compared in their clinical and echocardiographic findings with hypertrophic cardiomyopathy (HCM). In the 290 HT cases, the highest systolic pressure in each patient's history was found to correlate with left ventricular (LV) posterior wall thickness (PWT), but not with the septal wall thickness (IVST). There were no differences in LV thickness (IVST + PWT) among patients in the HT-ASH, HT-SH and HCM groups. While the HCM group patients showed no significant differences in IVST and PWT from those in the HT-ASH group, they did have greater IVST and smaller PWT than HT-SH group patients. The rapid filling rate (RFR) was also not much different in the HCM and HT-ASH groups, but was significantly lower in the HCM group than in the HT-SH group. Furthermore, HT-ASH group patients has a milder degree of hypertension and a higher incidence of familial occurrence of HCM than did those in the HT-SH group. After treatment for HT, the HT-SH group showed a significant decrease in wall thickness during long-term observation, while the HT-ASH and HCM groups, failed to exhibit such changes. Moreover, the degree of myocardial disarrangement in the HT-ASH group did not differ significantly from that in the HCM group. These results suggested that LVH in HT is related not only to pressure load but also to genetic factors similar to that in HCM.

Adult↗
PubMed1989

Cardiac thrombus in dilated cardiomyopathy. Relationship between left ventricular pathophysiology and left ventricular thrombus.

The relationship between left ventricular thrombus and left ventricular dynamics in dilated cardiomyopathy (DCM) was studied by echocardiography and postmortem examination. The subjects were 57 patients with DCM, 40 were survival patients examined by echocardiography and 17 were autopsy patients. Systemic or pulmonary embolism occurred in 10 of 57 patients, 4 of 40 survival patients and 6 of 17 autopsy patients. Intracardiac thrombus was detected in 11 of 40 survival patients and was found in 8 of 17 autopsy patients. Left ventricular segmental wall motion abnormalities were observed in all 40 patients examined by two-dimensional echocardiography and apical dyskinesis or akinesis was observed more frequently in patients with left ventricular thrombus than in patients without left ventricular thrombus. Of 33 patients examined by pulsed Doppler echocardiography, Doppler ejection flow signals in the apical long axis view were recorded in 9% at the apex, in 17% at the middle portion and in 57% at the portion near the interventricular septal center. The signals at the portion near the interventricular septal center were recorded in only 2 patients with left ventricular thrombus but in 66% of patients without left ventricular thrombus. Systemic or pulmonary embolism and intracardiac thrombus occurred less frequently in patients treated with warfarin than in patients without warfarin. These results indicate that endomyocardial and blood flow disorders of the left ventricle play important roles in the occurrence of left ventricular thrombus and that anticoagulant therapy is useful for the prevention of systemic or pulmonary embolism and cardiac thrombus.

Adult↗
PubMed1989

[Magnetic resonance imaging of diseased cervical and lumbar intervertebral discs].

Magnetic resonance images (MRI) of diseased cervical and lumbar intervertebral discs involving both intrinsic and extrinsic cord lesions were examined using either a 0.15 T resistive or a 0.5 T superconductive magnetic imaging system. High resolution images were obtained by means of a surface coil in most cases. The vertebrae, intervertebral discs, and spinal cord were delineated in greatest detail on spin-echo (SE) images with a long repetition time (TR) and a short echo time (proton density-weighted image), on which the spinal cord was appreciated without overshadowing by the cerebrospinal fluid-filled subarachnoid space. Protrusion of degenerated intervertebral discs into the spinal canal was clearly demonstrated not only on sagittal but also on parasagittal and transverse views. The location of protruded discs and compression of the spinal cord, caudal sac, and nerve roots were well visualized three-dimensionally. Pathological features of intervertebral discs were better appreciated on T2-weighted images with long TR and SE pulse sequences. Degeneration of intervertebral discs resulted in decreased signal intensity in cases involving lumbar disc lesions but not those involving cervical disc lesions. In a case of suspected myelomalacia, the intrinsic cord lesion resulting from traumatic disc protrusion appeared as focal low signal intensity on T1-weighted images and as somewhat high intensity on T2-weighted images. The inversion recovery sequence with median inversion time displayed an inferior image of low contrast and was judged uninformative in comparison to SE images. The authors' observations demonstrate that MRI is an essential diagnostic technique for spinal cord disorders.(ABSTRACT TRUNCATED AT 250 WORDS)

Cervical Vertebrae↗
PubMed1989

[Myocardial perfusion assessed by dynamic computed tomography, with respect to viable muscle in the infarcted region].

To clarify the significance of regional myocardial perfusion, 31 patients of old myocardial infarction including 11 cases undergoing PTCA with a left anterior descending artery lesion were studied using dynamic transmission computed tomography with excellent time resolution. Serial one-second dynamic scans with an electrocardiographic triggering system were performed at the middle level of the left ventricle using a bolus injection of contrast medium via the inferior vena cava. The F/V (F = flow, V = volume) ratio, a parameter of perfusion per unit of myocardium, was calculated from gamma-variate fitted time density curves obtained in the myocardium and in the left ventricular cavity. The F/V ratio was significantly lower in patients not only with severe but also mild and no coronary artery stenosis (post PTCA: 185 +/- 54, 50-75% stenosis: 193 +/- 47, 90% stenosis: 181 +/- 51, 99% stenosis: 140 +/- 34, 100% stenosis: 142 +/- 27 ml/min/100 g, control value: 243 +/- 51 ml/min/100 g, post PTCA, 50-75% stenosis, 90% stenosis vs control p less than 0.05, 99%, 100% stenosis vs control p less than 0.005). The functional images depicting myocardial perfusion frequently revealed abnormal perfusion findings in patients not only with severe but also mild and no coronary stenosis. In the patients with mild or insignificant coronary stenosis, the F/V ratio was dependent on the severity of left ventricular wall motion abnormalities (hypokinesis: 192 +/- 51, akinesis or dyskinesis: 141 +/- 32 ml/min/100 g; p less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Angioplasty, Balloon, Coronary↗
PubMed1989

[Effects of PTCR and PTCA on serial changes in left and right ventricular wall motion in acute myocardial infarction].

To evaluate the effects of early recanalization on left and right ventricular wall motion in acute myocardial infarction (AMI), we serially observed their degrees in 66 patients with AMI. The patients were categorized as Group 1:17 with spontaneous recanalization within 6 hours of onset of the chest pain; Group 2:34 with effective recanalization within 6 hours (10 by PTCR, 10 by PTCR+ PTCA, and 14 by direct PTCA), and Group 3:21 without effective recanalization. The Group 2 patients were classified in 3 subgroups according to the time intervals from onset of symptoms to recanalization; 11 patients with recanalization within 2 hours (Group 2a), 10 between 2 and 4 hours (Group 2b), and 13 between 4 and 6 hours (Group 2c). The left and right ventricular wall motion abnormality indexes (WMAI) were defined as the means of point scores for the degrees of regional wall motion abnormality at 11 segments of the left ventricle and seven segments of the right ventricle on serial two-dimensional echocardiograms. Results were as follows: 1. The LV-WMAI of Group 1 was smaller on day 1, and improved on day 28 as compared to those of the other groups (0.63 +/- 0.35 to 0.18 +/- 0.18, p less than 0.001). 2. The improvements of the LV-WMAI from days 1 to 28 in Group 2a (WMAI: 1.01 +/- 0.57 to 0.26 +/- 0.26, delta WMAI: 82 +/- 14%) and Group 2b (1.03 +/- 0.38 to 0.52 +/- 0.48, 54 +/- 36%) were greater than that in Group 2c (1.01 +/- 0.46 to 0.64 +/- 0.52, 38 +/- 47%).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗