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Biomedical subjects

I Sotobata

Publications and source records attributed to I Sotobata.

At least 37 records · Page 2Linked to original sources
PubMed1988

Diagnostic value of Q waves outside standard precordial lead points in left anterior myocardial infarction undetectable by standard 12-lead electrocardiogram.

Body surface potential maps were recorded for 52 patients with solitary anterior myocardial infarction and 57 normal subjects. All patients had pure anterior wall asynergy on a left ventriculogram but no diagnostic Q wave on the standard 12-lead electrocardiogram. Q wave (greater than 30 msec) distributions on the body surface of the patients and normals were compared. The frequency of Q waves in the area above V1-V2 and in the right middle chest was significantly higher in patients than in normals. The sensitivity of Q waves for asynergy in leads from both these areas was 19-60%. The positive predictive value was 67-94%. The frequency of Q waves was significantly higher in severe asynergy than in mild asynergy. A combination of two selected unipolar leads from these areas yielded a sensitivity and specificity of 33% and 95%, respectively. With a combination of three leads, these values were 42% and 93% and with four leads 48% and 88%, respectively. The results indicate that several unipolar leads from the area above V1-V2 and from the right middle chest in addition to the standard 12-lead electrocardiogram may improve the electrocardiographic diagnostic accuracy of myocardial infarction.

Electrocardiography↗
PubMed1988

New diagnostic evidence on the T wave map indicating involved coronary artery in patients with angina pectoris.

To define the clinical significance of T wave map changes in patients with angina at rest, body surface isopotential T distributions were obtained in 48 patients with single-vessel disease (left anterior descending artery, 34; right coronary artery, eight; left circumflex artery, six) documented angiographically and were compared with those in 120 healthy subjects and those in 19 patients with left ventricular overload whose electrocardiograms showed negative T waves accompanied by an increase in R wave amplitude in left precordial leads. The T wave map abnormalities were observed in 24 of 48 patients (50%) with angina and were classified into three types: (1) type I (18 patients, 37.5%) was characterized by a segmental negative potential in the positive area located at the left thorax and the minimum at the peak of T wave positioned in the upper portion of the left anterior chest, (2) type II (three patients, 6.3%) was characterized by a negative potential with a minimum in the inferior thorax and an indentation of negative potential at the lower margin of the positive potential located over the upper thorax, and (3) type III (three patients, 6.3%) was characterized by a negative potential with a minimum at the back throughout the period of T wave. All patients showing T wave map abnormalities of type I had a significant stenosis of the left anterior descending artery. Likewise, all patients with type II or III had single-vessel disease of the right coronary or left circumflex artery, respectively. All types of T wave map changes observed in patients with angina were different from those in patients with left ventricular overload, whose maps showed the generalized negative potential at the inferior thorax and the left back and the minima clustered at the precordium. In seven patients with lesions of the left anterior descending artery, T wave map abnormalities of type I recovered to normal after successful percutaneous transluminal coronary angioplasty. The behavior of the negative potential and its extrema on the T wave map, which was not available from routine electrocardiography, was indicative of the involved coronary artery and probably of its associated ischemic area in one-half of our patients with angina pectoris.

Adult↗
PubMed1988

[Echocardiographic findings in a case of Fabry's disease with aortic regurgitation and complete AV block, and in his family members].

A 46-year-old man with Fabry's disease having aortic regurgitation and complete atrioventricular (AV) block was presented. In spite of severe aortic regurgitation (Seller's grade 3/4), his two-dimensional (2-D) echocardiogram revealed increased thickness of the left ventricular wall with mild dilatation. The myocardial echo showed a fine granular sparkling texture suggesting phospholipid deposition in the myocardial tissue. The membranous portion of the interventricular septum was thickened, and the aortic valve was thickened and had imperfect coaptation. Endomyocardial biopsy of the right side of the interventricular septum revealed intramyocardial vacuolization by light microscopy. Electron microscopy confirmed the presence of myelinoid lamellar inclusion. Electrophysiologic examination revealed an intra-Hissian AV block. A DDD pacemaker was implanted and the patient's symptoms were improved. Valvular replacement was not attempted due to the danger of suture failure. The patient's brother (41-year-old) also had increased thickness of his left ventricular wall on echocardiography, and a complete AV block by ECG, but no valvular abnormalities. His sister (45-year-old) had increased thickness of the left ventricular wall on echocardiography, and negative T waves by ECG, but she had no cardiac symptoms. The possibility of cardiac involvement in this heterozygous woman with Fabry's disease should also be considered. The patient's 38-year-old sister and all the children of all family members had normal left ventricular wall thicknesses and normal ECG. These findings may correspond to the age-related disease severity. The possibility of cardiac abnormalities should be considered in heterozygous women with Fabry's disease.

Adult↗
PubMed1987

Congenital central alveolar hypoventilation (Ondine's curse): a case report and review of the literature.

Congenital central alveolar hypoventilation (C-CAH), so called Ondine's curse, is known to be quite a rare neuropathology that has been reported in only 23 cases to date. C-CAH was diagnosed in a 2-year-5-month-old infant. In the treatment of C-CAH, we implanted a right unilateral diaphragm pacemaker in the infant and his respiratory status was remarkably improved after diaphragm pacing. Twenty-three reported cases of this disorder are reviewed in the literature.

Child, Preschool↗
PubMed1987

Complete evaluation of the cardiovascular lesions in 24 patients with Takayasu's aortitis using four-image, intravenous digital subtraction angiography.

We studied the entire distribution of cardiovascular lesions with the use of intravenous digital subtraction angiography (DSA) in 24 patients having Takayasu's aortitis. The aorta, its branches, pulmonary vessels, and left ventricle were assessed by neck (anteroposterior), abdominal (anteroposterior), and chest (right and left anterior oblique) images. DSA showed multiple arterial lesions (n = 24) including proximal renal artery stenoses (n = 4), pulmonary arterial stenoses (n = 4), inferior-superior mesenteric arterial anastomoses (n = 3), brachiocephalic arterial aneurysms (n = 2), aortic root aneurysm (n = 1), diffuse left ventricular hypokinesis (n = 1), subclavian steal phenomenon (n = 1), and right aortic arch (n = 1). The incidence of total occlusion was highest in the right subclavian artery (n = 12). Average percent luminal stenosis (mean +/- S.D.) over the aorta and its branches tended to be smaller in patients with prior corticosteroid therapy (17.3 +/- 14.6%) than in those without (22.0 +/- 9.8%), but the difference was not significant. DSA (four-series) was useful in assessing the whole disease spectrum and often revealed subclinical lesions in this disease.

Adolescent↗
PubMed1987

Effects of a new second generation calcium channel blocker, nilvadipine (FR34235), on exercise-induced hemodynamic changes in stable angina pectoris.

The mechanism of the antianginal actions of nilvadipine was investigated in 11 patients with effort angina pectoris. Hemodynamic data were obtained by angina-limited supine multistage bicycle ergometer exercise testing before and after a single 6 mg dose of nilvadipine. Compared with chest pain during control exercise testing, pain at peak exercise disappeared or abated and the ST segment at peak exercise also showed less significant depression after administration of nilvadipine. At rest and at peak exercise, mean blood pressure, pulmonary artery wedge pressure and systemic vascular resistance decreased significantly, whereas heart rate and cardiac index increased significantly after nilvadipine. Rate-pressure product and stroke volume index did not change significantly. Coronary sinus flow at peak exercise increased significantly and total coronary vascular resistance at rest and at peak exercise decreased significantly after nilvadipine. The plasma concentrations of nilvadipine 1.5 hours after administration ranged from 1.15 to 8.23 ng/ml. These data suggest that the principal factors in the antianginal actions of nilvadipine are an increase in myocardial oxygen supply due to increased coronary blood flow and a reduction in myocardial oxygen demand mainly by a decrease in afterload and additionally by a decrease in preload.

Adult↗
PubMed1987

Effects of diltiazem on left ventricular diastolic behavior in patients with hypertrophic cardiomyopathy: evaluation with exercise pulsed Doppler echocardiography.

To estimate the effects of diltiazem on the left ventricular diastolic abnormalities in patients with hypertrophic cardiomyopathy, transmitral flow velocity during diastole was studied before and immediately after dynamic leg exercise with the pulsed Doppler technique combined with two-dimensional echocardiography. Seventeen patients with hypertrophic cardiomyopathy and 24 apparently healthy men performed bicycle ergometer exercise in the supine position with the target heart rate set at 120 beats/min. The patients with cardiomyopathy were directed to perform the exercise at the same intensity after receiving 30 to 60 mg of diltiazem, three times daily, for 1 or 2 weeks. The pattern of transmitral flow velocity in diastole had two components, one corresponding to the rapid filling phase in early diastole and the other to the atrial contraction phase in late diastole. To assess left ventricular diastolic behavior, the following variables were analyzed: peak velocity in the rapid filling and atrial contraction phases, the ratio of peak velocity in the atrial contraction phase to that in the rapid filling phase, and pressure half-time. The changes in peak velocity in the atrial contraction phase, pressure half-time and the ratio of peak velocity in the atrial contraction phase to that in the rapid filling phase with exercise differed significantly between patients with hypertrophic cardiomyopathy with no medication and control subjects. After diltiazem, the response of these variables to exercise was almost identical in the two groups. These results suggest that diltiazem can lessen the left ventricular diastolic abnormality in patients with hypertrophic cardiomyopathy on dynamic exercise of mild intensity.

Adult↗
PubMed1987

Effects of treadmill exercise on platelet function, blood coagulability and fibrinolytic activity in patients with atrial fibrillation.

The effects of treadmill exercise on platelet function, blood coagulability and fibrinolytic activity were evaluated in 20 patients with lone atrial fibrillation (AF) and 15 age-matched normal controls (normals). Multistage treadmill exercise up to 85% of the predicted maximal heart rate was performed, and blood for measurements was obtained pre-exercise, and immediately and 6 min post-exercise. There was an increase in the platelet sensitivity to ADP-aggregation after exercise in both groups. Pre-exercise plasma beta-thromboglobulin (beta-TG) levels were higher in AF than in normals. Beta-TG increased after exercise in both groups (immediate post-exercise; 35.1 ng/ml for normals and 62.8 ng/ml for AF), and the increase was greater in AF than in normals. PT and APTT shortened, and plasma fibrinogen levels increased after exercise in both groups. Pre-exercise levels of plasma ATIII and protein C were lower in AF than in normals. These two proteins increased after exercise in both groups. However, the increase was greater in normals. Plasma alpha 2-PI increased after exercise in both groups; the level was lower in AF than in normals at each exercise stage. In conclusion, enhanced platelet activity, and lower levels of anticoagulant and antifibrinolytic activity were observed in AF not only at rest but also after treadmill exercise. These changes might reflect the hypercoagulable state in patients with AF. It is speculated that the risk of thromboembolic complications may be enhanced with exercise in AF patients.

Adenosine Diphosphate↗
PubMed1987

Non-linear pharmacokinetics of aprindine hydrochloride in oral administration.

The pharmacokinetics of oral aprindine hydrochloride (in the following briefly called aprindine; Aspenon) were studied in 38 patients with ventricular premature contractions following single or multiple administration. Oral administration of aprindine in a single dose of 100-150 mg resulted in a mean maximal plasma concentration of 0.77 microgram/ml and a mean elimination half-life of 26.5 h. With multiple oral administration in 10 mg and 20 mg doses at intervals of 8 h, plasma concentration reached a steady state in 1-2 weeks with either dosage rate. Stable plasma concentrations were maintained with little diurnal or day-to-day fluctuation. The mean steady-state minimal plasma concentration with a 10 mg dosage was 0.28 microgram/ml. With a 20 mg dosage, however, this was more than tripled to 0.89 microgram/ml. The elimination process after the final administration of the drug was slower than with single dosage, and deviated from the first-order kinetics to produce a convex curve on a semilogarithmic graph paper. From these results it was apparent that aprindine shows non-linear pharmacokinetic behavior within the therapeutic dosage range.

Administration, Oral↗
PubMed1987

[Eigenvector analysis in body surface potential maps for evaluating right ventricular hypertrophy in primary pulmonary hypertension].

This study related the eigenvectors derived from the QRS complex in body surface isopotential maps of normal subjects to regional myocardial excitation, with special emphasis on the right ventricle. The subjects consisted of 120 normal healthy adults and eight patients with primary pulmonary hypertension and right ventricular hypertrophy (PPH). According to the Karhunen-Loève theory, eigenvectors were derived from the normal group and the eigenvector coefficient of each subject was obtained against time for the first three components. The cumulative proportion of the first three eigenvectors was 90.3% in normals and 80.2% in PPH. The first eigenvector had a peak of eigenvector coefficients early in the QRS and had a bottom late in the QRS. The peak of the second was in the middle of the QRS. The coefficients of the third eigenvector were low compared to the former two eigenvectors, and had no characteristic time pattern. PPH had a similar time pattern of coefficients in the first eigenvector, reduced coefficients in the second, and a definite peak in the mid-QRS in the third. The average eigenvector coefficient of the third eigenvector in PPH was significantly higher than those in normal subjects (p less than 0.01). We conclude that the third eignevector derived from normal subjects strongly reflects right ventricular excitation.

Adult↗
PubMed1987

[Cardiovascular involvement in the aortitis syndrome: a study using digital subtraction angiography].

Cardiovascular involvement in 22 cases with clinically confirmed aortitis syndrome was assessed using digital subtraction angiography (DSA) with an ADAC DPS-4100 system added to Siemens Angioskop A. The aorta and its branches, and the pulmonary vessels were examined for the extent, severity, and type of involvement. Left ventriculography was also performed for all patients. Digital subtraction angiograms of diagnostic quality were obtained in all the patients. Significant arterial narrowing was demonstrated by DSA in at least one vascular segment of each patient. DSA showed 32 total and 43 subtotal occlusions in 484 segments. DSA also imaged aneurysmal dilatation of the aortic root in one patient; an aneurysm of the innominate artery in two; a large anastomotic vessel connecting the superior and inferior mesenteric arteries in three; diffuse hypokinesis of the left ventricular wall in one; and stenosis of the pulmonary arterial branches in four patients. Clinical symptoms and signs did not correlate closely with the findings of DSA. It is concluded that the radiographic imaging of DSA is adequate and can be used to replace that of conventional angiography in evaluating the aortitis syndrome.

Adolescent↗