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Biomedical subjects

K Haze

Publications and source records attributed to K Haze.

At least 109 records · Page 6Linked to original sources
PubMed1989

[Comparison of thallium perfusion and electrocardiographic findings at exercise thallium-201 scintigraphy with coronary arteriographic findings].

Findings of thallium-201 perfusion (Tl) and exercise electrocardiography (ECG) at exercise thallium-201 scintigraphy was compared with coronary arteriographic findings (CAG) in 283 patients. We classified these cases into four groups by Tl and ECG; [A] Tl(+).ECG(+), [B] Tl(+).ECG(-), [C] Tl(-).ECG(+), [D] Tl(-).ECG(-). Redistribution of thallium-201 was evaluated by qualitative (visual) analysis. Three percent of group A consisted of the patients with normal coronary artery, and thirty-eight percent of group D consisted of the patients with coronary artery disease. On exercise thallium-201 scintigraphic imagings, most of patients with normal coronary artery showed redistribution of inferior (24%) and septum (45%). On exercise electrocardiographic findings, most of patients with normal coronary artery showed ST-segment depression in II, III, aVF, V5 and V6. In patients with coronary artery disease, single vessel disease in group B was larger than that in group C (62% vs. 33%, p less than 0.05), and triple vessel disease and left main truncus disease in group C was larger than that in group B (37% vs. 10%, p less than 0.05). On exercise thallium-201 scintigraphic imagings, most of false negative in patients with coronary artery disease changed to true positive by quantitative analysis. The patients with less than 90% coronary stenosis in group C was larger than that in group B (65% vs. 100%).

Aged↗
PubMed1989

[Usefulness of coronary angioplasty (PTCA) of the infarct-related artery in patients with prior myocardial infarction--follow up of infarct zone pre- and post-angioplasty by stress thallium scan].

We studied the efficacy of coronary angioplasty (PTCA) of the infarct-related artery in 29 patients with prior myocardial infarction by stress thallium scan. Twenty-seven patients had anterior myocardial infarction (single LAD disease), one had inferior (single RCA disease) and one had posterior (single LCX disease). According to the stress-redistribution thallium scintigraphic finding before PTCA, the patients were classified in 4 groups; (A): three patients with complete redistribution. (B): fourteen patients with incomplete redistribution. (C): seven patients with partial redistribution. (D): five patients with no redistribution. After PTCA, the parameters of residual ischemia in the infarct area (% RD and Thallium ischemic score = TIS) were improved significantly but those of infarct size (RD% uptake and Defect Score = DS) were improved slightly in group A. In group B and C, % RD, TIS, RD% uptake and DS were all improved significantly. In group D, TIS was improved slightly and DS was improved slowly 3 months after PTCA. Group A had high probability of viable muscle and group D had high probability of scar at the infarct zone. Group B and C showed intermediate type between group A and D. The change of infarct area after PTCA was variable in 4 groups but both residual ischemia and infarct size decreased in all groups. Thus, PTCA of infarct-related coronary artery is useful even in the patients with prior myocardial infarction.

Adult↗
PubMed1989

[Assessment of myocardial necrosis by 111In-antimyosin F ab scintigraphy].

111In-antimyosin F ab (AM) myocardial scintigraphy was carried out in (A) 13 patients with acute myocardial infarction (9.9 +/- 2.2 days from the onset) and (B) 9 with myocarditis and/or dilated cardiomyopathy. Forty eight hours after injection of AM, the patients were injected with 74 MBq (2 mCi) of thallium-201 (TL). The two sets of Planar and SPECT image were obtained simultaneously using dual energy window sets. In group A, positive focal AM uptake was demonstrated in 12 (92%) patients. Higher AM uptake was observed in patients who had PTCR/PTCA. By combination with TL, it is useful to detect inferior infarction and to differentiate old from acute infarction. Dual SPECT images gave precise information about the infarcted area. In group B, positive diffuse AM uptake was demonstrated in 7 (77%) patients. In conclusion, AM myocardial scintigraphy was proven to be useful for the assessment of acute necrosis after myocardial infarction but also on-going necrosis of myocarditis and/or myopathy.

Adult↗
PubMed1988

Visualization of isolated conus artery as a major collateral pathway in patients with total left anterior descending artery occlusion.

To examine the existence of isolated conus artery (ICA) as a source of collateral circulation, we selectively visualized the ICA in patients with left anterior descending coronary artery (LAD) occlusion using a no. 5 French catheter. One hundred and fifty patients with a total LAD occlusion were selected from 639 consecutive patients who had diagnostic coronary angiography during an 18-month period; the ICA was found in 45 patients. Among these patients, 30 showed the ICA as a collateral vessel supplying the distal LAD. In nine of these patients, conventional left and right coronary angiography did not reveal any other significant collateral vessels, and the distal LAD was perfused mainly by the collaterals from the ICA. No serious complications such as ventricular fibrillation or myocardial infarction occurred during these procedures. These results indicate that the selective ICA visualization is clinically important when conventional left and right angiography does not demonstrate collaterals to the obstructed LAD.

Angiocardiography↗
PubMed1988

[Surgical indications of ischemic heart disease: a physician's viewpoint].

Surgical indications for patients with ischemic heart disease are discussed from a physician's viewpoint. Among the subsets of this disease, surgical treatment is undoubtedly recommended for patients with serious complications following acute myocardial infarction (MI) such as cardiac rupture, interventricular septal perforation, acute severe mitral regurgitation and left ventricular mural thrombi complicated by systemic emboli, because these subsets have little or no response to medical treatment. Patients with left ventricular aneurysm are also surgical candidates, if they have refractory left heart failure or ventricular arrhythmias. Indications for coronary artery bypass surgery (CABS) for patients with angina pectoris are as yet controversial in Japan among physicians and surgeons, because the Japanese comply well with medications, and medically-treated patients have favorable prognoses. Indication standards for CABS may consist of three components; the first, an essential condition of the institution where CABS is performed. It includes the physician's ability to precisely diagnose angina pectoris, availability of skilled surgeons and anesthesiologists for heart surgery, a well-organized system for patient management during and after CABS and an acceptable success rate. The second includes a clinical indication. It is considered valid that candidates for CABS should be basically patients unresponsive to medical treatment, in so far as there would be a risk such as perioperative MI or operative death. Angina pectoris is judged to be medically-resistant when chest pain at rest does not resolve, or an exercise capacity necessary for patients' social rehabilitation is not achievable, after the appropriate administration of antianginal agents including a combination of nitrates, calcium antagonists and beta-blockers. The last problem is an anatomical indication. Recent advances in percutaneous transluminal coronary angioplasty (PTCA), an effective therapeutic procedure for coronary revascularization, has greatly influenced indications for CABS, and it makes it difficult to strictly distinguish medical from surgical treatment. The purpose, clinical indications, and efficacy of PTCA are similar to those of CABS. However, patients' physical, emotional and socioeconomic burdens relative to PTCA are remarkably less than those of CABS. Thus, it seems reasonable that CABS should be recommended to patients who have contraindications to or high risks with PTCA, such as left main trunk lesions; whereas in general, there are no anatomical contraindications to CABS.

Angina Pectoris↗
PubMed1987

Maladaptation after successful revascularization in anginal patients without transmural infarction.

In order to elucidate how peripheral or cardiac function maladaptations play a role in deconditioning after coronary bypass surgery, we have evaluated effects of successful coronary artery bypass grafting (CABG) and percutaneous transluminal angioplasty (PTCA) on exercise capacity in anginal patients without myocardial infarction. Symptom-limited treadmill exercise tests were performed in 46 patients before and after CABG and in 28 patients before and after PTCA. None of the patients carried out a cardiac rehabilitation program after their discharge. PTCA patients showed significant improvement of exercise capacity, from 6.4 +/- 1.6 to 10.5 +/- 2.5 METs in 4 weeks after PTCA, and even elderly PTCA patients showed improvement from 6.0 +/- 1.1 to 10.3 +/- 2.5 METs. However, the exercise capacity of CABG patients improved only from 5.9 +/- 1.4 to 8.5 +/- 3.1 METs in the first 6 months after CABG, and from 5.9 +/- 1.7 to 10.0 +/- 3.6 METs thereafter. The 15 elderly CABG patients showed only slight increase of physical activity, from 6.0 +/- 1.7 to 6.9 +/- 1.9 METs in the first 6 months after CABG and from 6.3 +/- 1.9 to 8.7 +/- 2.9 METs thereafter. Furthermore, 6 of 15 elderly CABG patients showed no improved exercise capacity after CABG. There was no correlation between the duration of anginal symptoms before CABG and exercise capacity before or after CABG. These findings suggest that CABG itself and/or physical restriction during admission produces peripheral function maladaptation and may be the main contributors to deconditioning after CABG, especially in elderly patients. This deconditioning can be treated by a rehabilitation program after the discharge.

Aged↗
PubMed1987

A case of variant angina exacerbated by administration of rifampicin.

Rifampicin, an antituberculosis agent, is known to be a potent inducer of microsomal drug-metabolizing enzymes in the liver. Elimination or clearance of many drugs has been reported to be enhanced, and their effectiveness reduced; however, no report in the literature has dealt with the interaction between rifampicin and dihydropiridine calcium entry-blocking drugs such as nifedipine. We present here evidence for the possible interaction between rifampicin and nifedipine in a patient with angina pectoris, which was exacerbated during coadministration or rechallenge with rifampicin. The peak plasma level and area under the curve were reduced and the apparent oral clearance of nifedipine was increased by rifampicin, suggesting that rifampicin enhanced the elimination of nifedipine via induction of a hepatic microsomal drug-metabolizing enzyme, as has been reported on other drugs widely metabolized in the liver.

Aged↗
PubMed1987

Long-term prognosis of patients with acute myocardial infarction: is mortality and morbidity as low as the incidence of ischemic heart disease in Japan.

Long-term prognosis of hospital survivors with myocardial infarction (MI) was investigated to assess the validity of previous reports on the low incidence of ischemic heart disease in Japan. Among 686 patients with acute MI, 115 (16.8%) died during hospitalization and eight were lost to follow-up. The cumulative mortality rate of the 563 hospital survivors was 6.2% in the first year, 12.0% in the third year, and 19.1% in the fifth year, with cardiac death accounting for 63% of the deaths. Cumulative rates for recurrent MI were 4.4% in the first year, 11.0% in the third year, and 13.2% in the fifth year. Parameters influencing long-term mortality rates obtained by stepwise discriminant analysis were arteriosclerosis-related factors, presence of congestive heart failure at admission, age, and presence of previous MI, while parameters influencing the recurrence of MI were congestive heart failure, arteriosclerosis-related factors, and ischemic findings at discharge. Our findings indicate that the prognosis for patients with MI is far better in Japan than in Western countries and support the previous reports on the low incidence of ischemic heart disease in Japan, while factors influencing the prognosis are similar to those previously reported.

Adult↗
PubMed1987

Differentiation of myocardial ischemia and left ventricular aneurysm in the genesis of exercise-induced ST-T changes in previous anterior myocardial infarction.

We attempted to differentiate between myocardial ischemia and left ventricular asynergy as the underlying mechanisms of exercise-induced ST-segment elevation in patients with previous myocardial infarction (MI). Sixty patients with previous anterior MI, who underwent stress myocardial scintigraphy (SMS) and coronary angiography (CAG), which revealed a single vessel disease of the left anterior descending artery, were entered in this study. SMS and CAG were performed within 3 months of MI onset, and SMS and ECG were quantitatively analyzed. T wave changes to a complete upright position with concomitant ST-segment elevation (T-dominant ST-elevation) was seen in 56% of the patients with post-MI angina pectoris (N = 16) and in 50% of those with significant redistribution in SMS (n = 20). On the other hand, ST-segment elevation without T wave reversion (ST-dominant ST-elevation) was seen in 43% of patients with severe LV asynergy (akinesis and dyskinesis, n = 39) and in 50% of those with severe scintigraphic defect in delayed images (relative thallium uptake less than or equal to 40%, n = 10). When these findings were combined, T-dominant ST-elevation had sensitivity and specificity of 54% and 78%, respectively, for the diagnosis of myocardial ischemia, while the corresponding values for ST-dominant ST-elevation were 44% and 100%, for the diagnosis of severe ventricular asynergy. We conclude that the two underlying mechanisms, ischemia and asynergy, may produce different changes in ST-T shape in patients with previous myocardial infarction.

Adult↗
PubMed1986

Comparison of clinical features of non-Q wave and Q wave myocardial infarction.

The clinical spectrum and outcome of 119 patients with acute non-Q wave myocardial infarction (NQMI) were studied, in comparison with those of 354 patients with acute Q wave myocardial infarction (QMI). The patients with NQMI had a significantly higher incidence of preinfarction angina (73% vs 63%), previous myocardial infarction (43% vs 22%), multivessel disease (73% vs 51%), postinfarction angina (55% vs 21%), and recurrent myocardial infarction during follow-up for an average of 25 months (17% vs 8%). NQMI patients also had a lower rate of complication of pump failure and smaller infarct size estimated by peak creating phosphokinase (CPK) levels (1361 +/- 1243 vs 2711 +/- 1684 IU/L) than those with QMI. There was no difference in in-hospital mortality between the two groups (17% vs 17%). However, death due to cardiac rupture was exclusively noted in the QMI group. The present study suggests that NQMI is more unstable than QMI in the clinical course.

Aged↗