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Biomedical subjects

H Hishida

Publications and source records attributed to H Hishida.

At least 73 records · Page 4Linked to original sources
PubMed1986

[The effects of intravenous urokinase administration in patients with acute myocardial infarction].

The effects of intravenous urokinase administration were assessed in patients with acute myocardial infarction (AMI). Of 146 patients with AMI, 101 were admitted within 12 hours of onset of chest pain, and classified in four groups according to the method of administering urokinase. PTCR group (15 cases); PTCR was performed within six hours of onset, using less than 960,000 I.U.; Group A (20 cases); 1.5 million I.U. administered in one hour or 960,000 I.U. in 30 min; Group B (48 cases); 240,000 I.U. in two hours; and 4) Group C (18 cases); 240,000 I.U. in 12 hours. In groups A, B and C, urokinase was administered intravenously. The remaining 45 patients did not receive urokinase, and served as a control group. In the chronic stage, infarction-related coronary arteries were patent at rates of 93% in the PTCR group, 82% in group A, 76% in group B, 62% in group C, and 46% in the control group. In the PTCR group and in group A, alpha 2-plasmin inhibitor showed a steep decline to the lowest level on the day after urokinase administration, as did the summation of elevation of ST segments in conventional twelve-lead electrocardiograms. Peak CK times, which represent the duration (hours) from onset to the peak serum CK value increased in the following order: 13.3 +/- 4.8 in the PTCR group, 17.3 +/- 4.9 in group A, 17.3 +/- 6.9 in group B, 20.7 +/- 6.7 in group C and 22.5 +/- 6.4 in the control group. These data suggest early recanalization of occluded coronary arteries in the group A, and intravenous administration of high doses of urokinase in the early phase of AMI seemed to contribute to salvage the ischemic myocardium. However, assessment of ventricular wall motion by two-dimensional echocardiography failed to confirm appreciable improvement in the PTCR group and group A in comparison with the other groups.

Adult↗
PubMed1986

[Left ventricular early diastolic filling and atrial contribution assessed by ECG-gated cardiac blood pool scintigraphy].

This study evaluated early diastolic left ventricular (LV) filling and the atrial contribution to ventricular filling in patients (pts) with various heart diseases using ECG-gated cardiac blood pool scintigraphy. Conventional equilibrium list mode ECG-gated cardiac blood pool scintigraphy was performed for 19 normal subjects (N) as controls, 104 pts with old myocardial infarction (OMI), 19 pts with essential hypertension (HT), seven pts with idiopathic hypertrophic subaortic stenosis (IHSS), three pts with non-obstructive hypertrophic cardiomyopathy (HCM), 19 pts with pure mitral stenosis (MS) and one pt with both MS and aortic regurgitation to evaluate early diastolic LV filling. The LV stroke counts corresponding to stroke volume and the early diastolic LV peak filling rate (DdV/dt) were obtained from the LV time-activity curve and its first derivative. Then the DdV/dt was normalized by stroke counts. The DdV/dt was significantly lower in pts with OMI (4.34 +/- 1.02/sec, p less than 0.001), HT (3.93 +/- 0.70/sec, p less than 0.001), IHSS (4.23 +/- 1.59/sec, p less than 0.01) and MS (4.56 +/- 1.05/sec, p less than 0.01) than in N (5.93 +/- 1.26/sec). Then, in OMI, the DdV/dt correlated significantly (r = -0.45, p less than 0.05) with infarct size (% abnormal contracting segment = %ACS) obtained by contrast left ventriculography. Furthermore, in pts with HT, the DdV/dt correlated significantly (r = -0.59, p less than 0.02) with the left ventricular mean wall thickness obtained by M-mode echocardiography. In pts with MS, the DdV/dt also correlated significantly (r = 0.73, p less than 0.001) with the mitral orifice area obtained by two-dimensional echocardiography. However, it has been difficult to assess the atrial contribution to ventricular filling by conventional ECG-gated cardiac blood pool scintigraphy, because the LV time-activity curve in the late diastolic phase was distorted and unreliable, whenever a minimal variation of the R-R interval occurred. Therefore, to produce a more reliable late diastolic LV volume curve, a "two-beat LV volume curve" was constructed using a new method; namely, each cardiac cycle was divided into 20 msec segments in two different ways, i.e., backward and forward of the R wave, and the backward LV volume curve and forward LV volume curve (conventional method) were connected at the R wave. Then, to estimate the atrial contribution, an increment of counts after the beginning of the P wave divided by counts corresponding to the stroke volume (A(P)/SV) was calculated.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗
PubMed1986

[Left axis deviation investigated by body surface mapping and phase image analysis].

Relationship between left axis deviation and left anterior fascicular block (LAFB) was investigated by estimating the ventricular excitation and contraction sequence using body surface potential mapping and phase image analysis by radionuclide ventriculography. This study included seven normal persons, eight patients with complete right bundle branch block (RBBB) without left axis deviation (LAD), twelve with RBBB and unblocked axis (determined by the first half of the QRS complex) of 0 degrees or farther deviated to the left (RBBB with LAD), and three with isolated LAD. The isochrone ventricular activation maps (VAT maps) were obtained by body surface mapping technique. Planar phase images in the left anterior oblique projection and short-axis ventricular tomographic phase images using a seven-pinhole collimator were constructed by ECG-gated equilibrium blood pool scintigrams. On the VAT maps of RBBB, there was a markedly delayed conduction to the right ventricle, however, in the left ventricle, the excitation was initiated in the anterior paraseptal region, and it proceeded rapidly toward the lateral and posterior walls, and in the same direction as normal. The VAT maps of RBBB with LAD were categorized in three types according to the activation sequence in the left ventricle. Type I, the same as maps of RBBB, consisted of three cases. Type II, four cases, showed excitation starting from the apex and ascending in the anterior wall. There were five cases of type III, which showed the earliest excitation in the basal posteroparaseptal region, proceeding toward the apex and ascending in the anterior wall. Type II was considered compatible with block of the left anterosuperior fascicle, and type III was that of left anterosuperior and midseptal fascicles. In types II and III, the phase delay in the left anterior wall was recognized in tomographic phase images, and the difference between right and left ventricular mean phase angles in planar phase images was significantly smaller than in cases of isolated RBBB, These were thought to support the existence of LAFB. The range of the unblocked axis of RBBB with LAD was -3 degrees approximately 13 degrees (-7.7 +/- 5.0 degrees) in type I, -8 degrees approximately -30 degrees (-19.8 +/- 9.1 degrees) in type II, and -33 degrees approximately -60 degrees (-51.0 +/- 10.9 degrees) in type III. All cases with left axis deviation beyond -30 degrees were of type III, and suspected to have extensive damage, including the midseptal fascicle.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗
PubMed1985

[Quantitative evaluation and color display of echo intensity by two-dimensional echocardiography].

To assess myocardial tissue changes by two-dimensional echocardiography, quantitative evaluation and color display of the echo intensity were attempted using computerized image processing. The materials consisted of 11 patients with old anteroseptal myocardial infarction one year or more after the onset (OMI), and 12 normal subjects. Two-dimensional echocardiograms in the parasternal long-axis view were obtained using a commercially-available phased-array sector scanner. Scanner receiver settings including sensitivity-time control were maintained constant in all subjects. Images were recorded on the U-matic tape using a video tape recorder, then stop-frame end-diastolic images were converted to digital images. To measure echo intensity, regions of interest (ROI) were placed in the interventricular septum (IVS), the left ventricular posterior wall (LVPW), the left ventricular cavity, and the pericardium. The mean value of the echo intensities was determined for each ROI. Then, the relative echo intensity of the IVS or LVPW was calculated using the mean value of the pericardium as the maximum echo intensity, and the mean value of the left ventricular cavity as the minimum echo intensity. In normal subjects, the relative echo intensity of the IVS was 0.40 +/- 0.05 (mean +/- SE) and that of the LVPW was 0.31 +/- 0.02. By contrast, in patients with OMI, there was a significant increase (p less than 0.001) in the relative echo intensity of the IVS (0.71 +/- 0.06). The relative echo intensity of the LVPW was less than normal, but the difference was not statistically significant.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1984

Measurement of lung density in congestive heart failure by computed tomography.

The computed tomography (CT) number within the region of interest (ROI) was used as a parameter to assess lung density in patients with congestive heart failure. Thirty-eight patients with valvular heart disease (VHD) and 34 patients with ischemic heart disease (IHD) were studied. Based on the New York Heart Association (NYHA) classification, 24 VHD patients were in class I or II (VHD I-II) and the other 14 were in NYHA class III or IV (VHD III-IV). Eighteen patients with IHD were in NYHA class I or II (IHD I-II) and 16 were in class III or IV (IHD III-IV). The CT number was measured bilaterally at the upper, middle and lower levels of the chest and compared with the corresponding values in 21 normal subjects (Group N). In a preliminary study on Group N, the CT numbers were insensitive to the size of the ROI, but were closely related to its location. In clinical applications, the mean values of the CT numbers in all six lung fields increased in the order of IHD I-II, to VHD I-II, IHD III-IV and VHD III-IV. Except for patients in IHD I-II, they were significantly larger than in Group N. The relationship between the CT number and the systolic and mean pulmonary arterial pressures and the pulmonary capillary wedge pressure were evaluated in 36 patients. Significant correlations were obtained in all six lung fields (r = 0.65-0.78, p less than 0.001). The results suggest that measurement of lung density by CT is useful for the quantitative evaluation of the severity of disease in patients with congestive heart failure.

Adult↗
PubMed1984

[Estimation of the infarct size by two-dimensional echocardiography in cases with acute myocardial infarction].

We evaluated clinically the infarct size in addition to left ventricular end-diastolic and end-systolic volumes (EDV, ESV) and ejection fraction (EF) using two-dimensional echocardiography (2-D) and algorithms based on the modified Simpson's rule. EDV, ESV and EF obtained by 2-D and three algorithms were compared with those obtained by left ventriculography in 23 patients with various heart diseases. Correlation coefficients obtained by our and other two algorithms were 0.88, 0.88 and 0.90, respectively, for EDV and ESV (p less than 0.01), and 0.71, 0.60 and 0.84 for EF (p less than 0.01). Myocardial mass of the region showing asynergy (asynergic size) was calculated by the above-mentioned three methods and compared with peak serum CK values in 14 patients with acute myocardial infarction. The correlation coefficient between both values was 0.76 (p less than 0.01) by our algorithm and it was higher than by other two algorithms (0.37 and 0.70). The time course of changes in asynergic size in acute myocardial infarction was studied by the use of 2-D and our algorithm. Asynergic size was significantly larger on the day of the onset (24.9 +/- 2.9 ml, mean +/- SE) than the third (21.5 +/- 2.7 ml) and seventh day (20.7 +/- 3.0 ml) after the onset (p less than 0.01). These results suggest that one can make a quantitative and serial estimation of infarct size as well as left ventricular volume by 2-D and our modified model, and that our algorithm is suitable for the purpose.

Cardiac Volume↗
PubMed1984

[Estimation of ventricular activation by scintigraphic phase image analysis].

We examined the capabilities of scintigraphic phase imaging in detecting the site of the onset of ventricular activation and the pattern of ventricular activation sequence. ECG-gated equilibrium cardiac blood pool scintigraphy was obtained in the left anterior oblique (LAO) and right anterior oblique (RAO) projections. The standard 12-lead electrocardiograms (ECG) were recorded in 29 cases with various conditions. These included seven normal subjects as controls, eight patients (pts) with complete right bundle branch block (CRBBB), one with CRBBB and left axis deviation (LAD), two with complete left bundle branch block (CLBBB), one with the Wolff-Parkinson-White (WPW) syndrome (B-type), six with right ventricular apical endocardial pacemakers, one with a right ventricular anterior wall myocardial pacemaker, and three with left ventricular apical myocardial pacemakers. Phase image analysis was performed using the first harmonic of the Fourier transform to fit a cosine curve to the time-activity curve of each pixel in the cardiac blood pool study. The results were as follows: In pts with WPW syndrome (B-type) and artificial pacemakers, the site of the earliest phase angle corresponded to the site of the onset of ventricular activation as predicted by ECG and chest radiographs, respectively. However, in normal subjects and in pts with CRBBB, the site of the earliest phase angle was observed at the basal (upper) interventricular septum, which was different from the site of the onset of ventricular activation previously reported by Sodi-Pallares et al and Durrer et al. This discrepancy may have been caused by the paradoxical motion of the basal (upper) interventricular septum in those cases. A similar discrepancy was also observed in pts with CLBBB. Although the site of onset of ventricular activation was predicted to be near the insertion of the anterior papillary muscle of the right ventricle by ECG and electrophysiology, the pixels showing early phase angle were distributed widely along the interventricular septum in those pts with CLBBB. This error in the phase image may have been caused by the extensive paradoxical motion of the interventricular septum. Thus, caution should be exercised in estimating the site of the onset of ventricular activation by phase images. The main direction of phase changes corresponded well to the ventricular activation sequence estimated using ECG in all subjects.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗
PubMed1984

[Ventricular activation process and interventricular septal motion].

The mechanism of abnormal motion of the interventricular septum (IVS) in the altered ventricular activation process was investigated using M-mode echocardiograms (ECHO). Subjects consisted of 37 patients in whom artificial pacemakers was implanted because of sick sinus syndrome in 14 and atrioventricular block in 23. Standard 12-lead electrocardiograms (ECGs) were classified in three groups based on the polarity of the main deflections of the QRS complexes in leads V1 and V6; the pattern was designated as the LBBB type if the main QRS deflections were negative in V1 and positive in V6; as the S type if they were negative in both V1 and V6; and as the RBBB type if positive in V1 and negative in V6. In the LBBB type the excitation was assumed to begin in the RV and to propagate across the IVS to the LV. The S type was considered an expression of activation process which starts in the apex and is propagated radially toward the base with nearly simultaneous activation of the RV and the LV. These assumptions were confirmed by the study of contraction sequences using phase image analysis of cardiac blood pool scintigrams. The RBBB type was thought to reflect delayed activation of the RV. ECHO showed two characteristic patterns of IVS motion in the patients studied. During preejection the IVS moved rapidly posteriorly, then anteriorly, forming a hump. During ejection, anterior displacement or akinesis of the IVS (paradox) was observed. A hump was frequently observed in any types of ECG.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1982

Effects of ajmaline on right precordial Q waves simulating myocardial infarction.

Seven patients with right precordial Q waves (RPQs) simulating anterior myocardial infarction (MI), but without a previous history of either MI or other underlying diseases showing RPQ, were injected intravenously with ajmaline. The RPQs were abolished in 5 patients. Two patients displayed a transient, spontaneous abolition of RPQ, and 2 patients had false positive ST responses to the exercise test. Ajmaline injection in patients with documented MI and in patients with normal electrocardiograms did not produce any notable changes in the initial part of QRS complex. The RPQs abolished by ajmaline were probably a result of a mild pre-excitation, induced by Mahaim fiber conduction, because the PR and QRS intervals were normal and low amplitude delta waves were found in some patients. It is important to note that altered intraventricular conduction, probably a mild preexcitation, can markedly deform electrocardiograms and mimic myocardial infarction.

Adult↗
PubMed1981

Exercise stress body surface isopotential map in patients with coronary artery disease: comparison with coronary angiographic and stress myocardial perfusion scintigraphic findings.

to locate the ischemic area in 22 patients with angina pectoris, exercise stress body surface isopotential maps (MAPs) were assessed and compared with coronary angiography and myocardial stress scintigraphy. Taking coronary angiographic findings into consideration, 4 types of ischemic MAP responses, i.e., septum and anterior, lateral, inferior, and posterior wall ischemia were postulated. Sensitivity of stress MAP was 71% for the average and more than stress imaging. Specificity of stress MAP was 46% for the average and less than stress imaging.

Angina Pectoris↗