Biomedical subjects
Publications and source records attributed to M Okuni.
For the determination of streptococcal infection, it is necessary to test 3 antibodies, i.e., ASO, ASK and ADN-B at a time, and if 2 of the 3 titers are positive one can make diagnosis of fairly recent streptococcal infection, but if only one of the 3 titers are positive, previous or non-specific causes should be considered.
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Total cholesterol level was measured in 8,303 children and youth in Tokyo. Age ranged from 6 to 18 years. The change of total cholesterol level relates to sex and age, and girls showed higher level than boys. Not a small number of children revealed elevated total cholesterol level but some children showed very low level. HDL-cholesterol was determined and prevalence of ischemic coronary heart disease risk factors was studied. The elevation of total cholesterol level in senior high school students was caused by either increase of HDL-cholesterol or increased total minus HDL-cholesterol fraction. High school boys with obesity were found to have higher serum total cholesterol level accompanied by low HDL-cholesterol level. High school boys of parents with myocardial infarction were found to have higher total cholesterol level. Majority of Japanese senior high school students were found to have one or more coronary heart disease risk factors. The necessity of prevention for ischemic coronary heart disease starting from childhood in Japan is emphasized.
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A 7-year-old boy presented with intermittent systolic murmur and syncope. Chest roentgenogram revealed mild cardiomegaly. Electrocardiogram showed right bundle branch block and abnormal T-waves. Right ventricular angiography demonstrated a filling defect at the anterior portion of the right ventricular cavity and histological examination of biopsy specimen revealed lipoma. At operation, the tumor could not be totally resected. Histological examination of surgical specimen showed marked proliferation of mature fat cells between cardiac muscle fibers. Postoperatively he has been remained asymptomatic. Postoperative standard M-mode and two-dimensional echocardiogram demonstrated a mass from right ventricular wall, abnormal motion of the interventricular septum and small left atrial cavity. The patient has been followed by serial echocardiography.
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Studies published in the past 10 years suggest that group A streptococcal infections are frequent in the Orient and lead to a high incidence of rheumatic fever (RF) and rheumatic heart disease (RHD). In the present study, streptococcal infections were found to be more prevalent in Japan and Taiwan, whereas RF and RHD were more common and severe in the Philippines, Thailand, and Indonesia, particularly among the socioeconomically less privileged populations. The pattern of childhood RF varied: Carditis was the most common manifestation, occurring in 57% to 94% of the patients; polyarthritis was generally atypical and less common in the tropics; chorea minor and erythema marginatum were much more common in Japan, less common in Taiwan and rare in the tropics. RF recurrences were quite common and led to the development of new carditis, and deterioration or persistence of the pre-existing heart disease. The 5 year mortality rates differed greatly, ranging from zero to 42%. There was disappearance of the heart murmur in 16.5% to 37.5% of patients. Such apparent recovery was related to adherence to chemoprophylaxis. The major risk factors adversely affecting survival were the severity of carditis, inadequacy of medical service, non-compliance to chemoprophylaxis, RF recurrence, poor socioeconomic status, and high prevalence of group A streptococci. It is concluded that there is no uniform "Oriental-type" of natural history of RF and RHD. The natural history varies greatly among countries as is true in other parts of the world.
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A portable system for heart screening in school children is deviced and the results of a trial of this machine were reported. This computerized system analyses electrocardiogram and phonocardiogram of school children within two minutes, print out the abnormal codes and simultaneously record the electrocardiogram and phonocardiogram by the visicoder. This system was tried for the primary heart screening in 1,618 pupils and for the secondary heart screening in 372 students. The results were considered to be satisfactory as a primary as well as a secondary heart screening system from the view points of the reliability, the economical condition and the time-saving of the pediatric cardiologist.
Two cases of (1-year-old and 13-year-old) of constrictive pericarditis (CP) associated with atrial septal defect (ASD) are presented. The correct diagnosis was made preoperatively in both cases. Both patients underwent surgery (pericardiectomy and ASD closure). One patient died soon after the surgery because of low cardiac output. The other patient was associated with protein-losing enteropathy and it improved dramatically after the operation. Cardiac catheterization is necessary for the diagnosis of this unusual combination. The cause of this unusual combination is obscure.
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