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Biomedical subjects

M Suwa

Publications and source records attributed to M Suwa.

At least 91 records · Page 5Linked to original sources
PubMed1989

Prognostic significance of conduction disturbance and reduction of left precordial voltage of electrocardiogram in hypertrophic cardiomyopathy.

To clarify the prognostic significance of electrocardiographic changes in hypertrophic cardiomyopathy, we retrospectively evaluated serial electrocardiograms in 77 patients with hypertrophic cardiomyopathy who were followed for more than 1 year. The electrocardiographic features analyzed were conduction disturbance and left precordial QRS voltage. There were 4 sudden deaths. Various conduction disturbances appeared in 32 (44%) of the remaining 73 patients. Intraventricular conduction delay was the most common (47%). The left precordial voltage decreased in 19 (26%), increased in 3, and did not change in 51. The left ventricular end-diastolic pressure at the initial investigation was significantly higher and clinical deterioration was more frequently seen in patients with a conduction disturbance or reduction of QRS voltage than in those without these electrocardiographic changes. Also, echocardiographic analysis showed that left ventricular dimensions increased significantly (from 4.4 +/- 0.6 to 4.8 +/- 0.7 cm in end-diastole and from 2.6 +/- 0.6 to 3.1 +/- 0.8 cm in end-systole; p less than 0.01, respectively) and left ventricular fractional shortening was reduced (from 41 +/- 8 to 36 +/- 11%; p less than 0.01) in the 32 patients with conduction disturbance during the follow-up period although absolute cavity size remained normal in 26 of these patients. These parameters did not change in those without conduction disturbance. Histopathological analysis of endomyocardial biopsies showed that myocardial fibrosis in the left ventricle was frequently associated with these electrocardiographic changes. However, such changes were not present in the sudden death patients. It is concluded that conduction disturbance and the reduction of QRS voltage are significant parameters which suggest a poor prognosis in patients with hypertrophic cardiomyopathy, but are not predictors of sudden death.

Adolescent↗
PubMed1989

[Study on the plasma plasminogen activators in patients with malignant gynecologic tumors].

Increased plasminogen activator (PA) secretion has been observed in malignant cells and tissue and PA is thought to be involved in the processes of tumorigenesis, cancer invasion and metastasis. Recently two types of plasminogen activator--tissue type PA(tPA) and urokinase type PA(uPA)--have been detected in human plasma. In this study, to investigate the relationship between circulating PA and the malignant state, we measured the plasma PA concentrations (PA activity, tPA and uPA antigen) in 69 women with gynecologic malignancies (cervical cancer 50, ovarian cancer 19). These concentrations were compared to those in control groups of 33 women with benign gynecologic tumors (uterine tumor 8, ovarian tumor 25). An enzyme-linked immunoassay for tPA and uPA antigens was performed by the modified method described by Takada et al. (1986). PA activity was measured by the sensitive spectrophotometric assay of Verheijen et al. (1982). The blood samples were taken from an arm vein with a minimum of venous occlusion before treatment. There was no correlation between PA activity or uPA antigen levels and the malignant state. However, in the case of uterine tumors, a significantly higher concentration of tPA antigen (10.5 +/- 5.1 ng/ml) was found in patients with cervical cancer, in stage IV, than in those in the benign group (5.2 +/- 2.0 ng/ml). Moreover the tPA antigen concentration in cervical cancer, stage IV, was higher than in stages 0-III.(ABSTRACT TRUNCATED AT 250 WORDS)

Antigens↗
PubMed1989

[Prognostic significance of histopathological classification in patients with carcinoma of the uterine cervix].

In a retrospective study of 724 patients with histologically proven carcinoma of the uterine cervix from 1980 through 1986, the histological classification and clinical stage (FIGO) were investigated for their prognostic value. The clinical stage was very important in relation to prognosis. The histological type of the squamous cell carcinoma (keratinizing, large cell non-keratinizing, small cell non-keratinizing) did not have any value in predicting survival, but small cell non-keratinizing tumor showed a less favorable prognosis than other tumors when surgery was employed. As to survival, there was no difference between adenocarcinoma and squamous cell carcinoma when compared in all patients, but adenocarcinoma had a worse prognosis than squamous cell carcinoma when surgery was employed. The pelvic lymphnode status at operation was correlated with the clinical stage. Adenocarcinoma had more positive nodes than squamous cell carcinoma. There was no significant difference in the frequency of pelvic node involvement among cell types of squamous cell carcinoma. The present histopathological classification of the uterine cervical carcinoma was of little prognostic value in predicting patient outcome.

Adenocarcinoma↗
PubMed1989

[Prevalence and clinical significance of development of conduction disturbances in patients with hypertrophic cardiomyopathy].

To clarify the prognostic significance of electrocardiographic changes in hypertrophic cardiomyopathy, we retrospectively evaluated serial electrocardiograms of 77 patients with hypertrophic cardiomyopathy who were followed more than one year. Conduction disturbance was analyzed as an electrocardiographic feature. Excluding four cases of sudden death, various conduction disturbances developed in 32 of the 73 patients. Intraventricular conduction delay was the most frequent among them (47%). Left ventricular end-diastolic pressure at the initial investigation was significantly higher, and clinical deterioration developed more frequently in patients with conduction disturbances, as compared with those without conduction disturbances. Histopathological analyses showed that proliferation of collagen fibers in the left ventricle was frequently associated with conduction disturbances. However, the electrocardiographic changes did not develop in the four patients who died suddenly. It was concluded that conduction disturbances comprise a significant parameter suggestive of poor prognoses in patients with hypertrophic cardiomyopathy, but that they are not predictors of sudden death.

Adolescent↗
PubMed1988

Augmentation of coronary bypass graft flow induced by dipyridamole and its relation to bypass graft patency.

To evaluate the effect of dipyridamole on coronary bypass graft flow, 10 mg of dipyridamole was injected intravenously, during the measurement of graft flow, at the time of surgery. Its concentration in serum was measured and compared with that after oral administration. In 50 individual vein grafts performed on 35 patients, graft flow increased from 65 +/- 37 to 96 +/- 55 ml/min (p less than 0.001) after the dipyridamole injection and the arterial pressure decreased slightly. In 40 grafts whose graft flow was increased by more than 10 ml/min by dipyridamole, the patency rate (at 5 weeks) was 98 per cent, whereas that of the 10 other grafts, which responded poorly, was only 50 per cent (p less than 0.01). The serum concentration of dipyridamole, 3 minutes after intravenous injection, was 1.46 +/- 0.68 micrograms/ml, while the level of orally administered dipyridamole, in 3 groups of patients who were given 50 mg, 75 mg and 100 mg, three times a day, respectively, was steady, being 0.68 +/- 0.20 micrograms/ml, 1.43 +/- 0.41 micrograms/ml and 1.73 +/- 0.50 micrograms/ml, 2 hours following ingestion. We concluded that intravenous dipyridamole increases the graft flow and that a better patency is obtained in those grafts in which the graft flow is increased by more than 10 ml/min. It is also expected that routine doses of oral dipyridamole possibly increase the graft flow after coronary bypass surgery.

Administration, Oral↗
PubMed1988

Denaturation of bacteriorhodopsin by organic solvents.

The denaturation of bacteriorhodopsin by various organic solvents was studied using absorption, circular dichroism (CD) and fluorescence measurements. Organic solvents with a hydrogen-bonding group caused the release of retinal. The CD measurements showed that the helical structure was maintained even in the denatured state, whereas its tertiary structure was destroyed. The change in fluorescence intensity of tryptophan and fluorescent retinal also confirmed that the tertiary structure was destroyed. Comparison of the denaturation efficiency of various organic solvents showed that the concentration at denaturation was inversely proportional to the partition coefficient of the denaturant. This inverse proportionality clearly indicated that denaturation was determined by the concentration of denaturants which partitioned into the hydrophobic region of the membrane. It was discussed from the experimental results that the tertiary structure of bacteriorhodopsin was stabilized by the hydrogen-bonding networks between side chains of the helices. The results obtained from analysis of the amino acid sequence were also consistent with the hydrogen-bonding mechanism for the formation of the tertiary structure.

Journal Article↗
PubMed1988

Prevalence of the coexistence of left ventricular false tendons and premature ventricular complexes in apparently healthy subjects: a prospective study in the general population.

The prevalence of left ventricular false tendons, premature ventricular complexes and their coexistence was evaluated prospectively in 187 healthy company workers aged 21 to 50 (mean 36) years. False tendons were demonstrated echocardiographically in 133 (71%). Eight subjects were withdrawn from the study because of silent mitral valve prolapse. In these 179 healthy subjects, false tendons were detected in 127 (71%) and premature ventricular complexes in 48 (27%). Their coexistence was observed in 40, which showed a significant correlation (p less than 0.05) of false tendons and premature ventricular complexes. In seven of the eight subjects without false tendons, premature ventricular complexes were uniform and infrequent (mean 3 beats/24 h). In the 40 subjects with false tendons, premature ventricular complexes were uniform in 29, multiform in 6 and repetitive in 5, and the mean frequency was 96 beats/24 h. Correlation of premature ventricular complexes with the type of false tendons showed that premature ventricular complexes were significantly associated with thick (greater than or equal to 2 mm) and longitudinal tendons (p less than 0.005). Although it is not certain that left ventricular false tendons are arrhythmogenic, the prevalence of the coexistence of left ventricular false tendons and premature ventricular complexes in the general population, and the special relation between the frequency and the form of premature ventricular complexes and the type of false tendons, suggests that false tendons may play an etiologic role in the genesis of premature ventricular complexes in apparently healthy subjects.

Adult↗
PubMed1988

An autopsy case of histiocytic medullary reticulosis presenting with marked hepatosplenomegaly for 13 years before the onset.

A 32-year-old male was hospitalized with high fever, pancytopenia and hepatosplenomegaly. No atypical cells were found in the peripheral blood. Bone marrow aspiration resulted in dry taps. Superficial lymph node swelling was not observed. He had been treated twice for high fever, hepatosplenomegaly and leukopenia that were very similar to the present illness, 13 and 3 years before the onset and hepatosplenomegaly had been noted by the patient for 13 years. The patient died after a rapid course of 20 days. Histiocytic medullary reticulosis (HMR) was diagnosed at the autopsy, which revealed atypical histiocytic infiltration showing erythrophagocytosis in the liver, spleen, left adrenal, and mesenterial and pulmonary hilar lymph nodes. This patient had shown the same clinical signs and hepatosplenomegaly 13 years before the onset of HMR, which suggest a possible latent stage and acute exacerbation of HMR.

Adult↗
PubMed1988

Optimal timing for valve replacement in chronic aortic regurgitation: analysis based on the myocardial contractility and postoperative prognosis.

Left ventricular (LV) function was evaluated considering force-velocity and stress-shortening relationships in 14 asymptomatic (Group 1), 18 symptomatic patients (Group 2), and 53 normal subjects (Group 3) to determine the optimal time for valve replacement in patients with chronic aortic regurgitation (AR). Valve replacement was recommended for all Group 2 patients and for one patient in Group 1, who had sustained ventricular tachycardia. There was one operative death and five deaths remote from surgery; one patient in Group 1 died suddenly of undetermined cause, and four patients in Group 2 died of congestive heart failure (CHF). The LV end-systolic volume index (ESVI) was greater than 100 ml/m2 in the five patients whose death was unrelated to surgery (remote deaths). ESVI was less than 50 ml/m2 in all but two patients in Group 1, and more than 40 ml/m2 in all cases in Group 2. The index of preload, end-diastolic stress (sigma ed), was increased in Groups 1 and 2 as compared with Group 3. A significant positive correlation was observed between end-systolic stress (sigma es) and ESVI (r = 0.71, p less than 0.001) in patients with AR, and this linear line was not as steep as that of Group 3. Afterload (sigma es) and ejection fraction (EF) in Group 1 were within normal range, afterload was normal but EF was reduced in mildly symptomatic patients in Group 2, and severely symptomatic patients had markedly reduced EF and elevated afterload. There was a close correlation between ESVI and end-diastolic volume index (EDVI), and this was expressed as an exponential curve (Y = 21.69e0.006x, r = 0.88, p less than 0.001). This indicates that the rate of shortening of the muscle fiber deteriorates exponentially with enlargement of the ventricle. These observations suggest that in AR patients: 1) afterload and contractility of the ventricle remain normal in the majority of asymptomatic patients by means of compensatory hypertrophy and preload elevation (preload reserve), 2) deterioration of contractility seems to be the factor initiating CHF, and 3) progression of CHF is due to further deterioration of contractility in addition to elevation of afterload (afterload mismatch). It is concluded that careful observations are necessary when ESVI exceeds 50 ml/m2 in asymptomatic patients. Valve replacement is recommended when such patients develop symptoms of CHF, or either when EF falls to less than 50% or ESVI exceeds 100 ml/m2, even if patients remain asymptomatic.

Aortic Valve↗
PubMed1988

[Advanced sequelae of apical hypertrophic cardiomyopathy: report of two cases with wall motion abnormalities].

In view of the paucity of reports describing symptoms of increased degree, and deterioration of left ventricular systolic function in patients with apical hypertrophic cardiomyopathy (apical HCM), two cases with congestive heart failure and progressive thinning of previously hypertrophied apical portions of the left ventricle are reported. These were among 13 patients observed from eight to 10 years. Case 1: A 56-year-old man was diagnosed as having apical HCM at the age of 49 years. Severe left ventricular hypertrophy and prominent ST-T changes were observed on ECG during his first admission. His left ventricular end-diastolic pressure (LVEDP) was 24 mmHg and a left ventriculo-gram revealed a decrease in the left ventricular cavity in the apex and marked hypertrophy of the apical wall. Moderate interstitial fibrosis without hypertrophy or disarray of myocytes was observed in a left ventricular endomyocardial biopsy specimen. In two episodes of cardiac arrest he was successfully resuscitated at the age of 50 years. At the age of 55 years, two-dimensional echocardiography revealed thinning and abnormal motion in the apical wall, and a defect in 201T1 accumulation was observed in the same region by perfusion scintigraphy. This patient was readmitted with a diagnosis of cerebral embolism at the age of 56 years. Cardiac catheterization revealed normal LVEDP (8 mmHg), and a left ventriculogram revealed an aneurysm in the left ventricular apex with normal major epicardial coronary arteries. He has been under treatment with antiarrhythmic medications, calcium antagonists and anticoagulants, and has become relatively asymptomatic. Case 2: A 69-year-old-man was diagnosed as having apical HCM after a complete evaluation, including cardiac catheterization, at the age of 59 years. His LVEDP was elevated (17 mmHg), and a left ventricular angiogram revealed marked hypertrophy localized to the apex. Ejection fraction was 64%. A left ventricular endomyocardial biopsy revealed interstitial fibrosis without hypertrophy of myocytes. Thereafter, he has been followed as a New York Heart Association functional class III to IV with occasional elevation of cardiac enzymes but without chest pain or acute changes in his ECGs. However, atrial fibrillation with complete right bundle branch block developed at the age of 60 years. Apical wall thinning and dyskinesis were diagnosed by 2D echocardiography and a defect in the 201T1 accumulation was observed at about 65 years of age. He was readmitted in severe cardiac failure at the age of 69 years, and he was diagnosed as having cardiac asthma with pulmonary capillary wedge pressure of 35 mmHg.(ABSTRACT TRUNCATED AT 400 WORDS)

Aged↗
PubMed1987

Multifactorial evaluation of blood pressure fall upon hospitalization in essential hypertensive patients.

1. Studies were prospectively performed on 72 hospitalized patients with essential hypertension. Blood pressure was normalized within 1 week of admission in 33 patients (group I), but did not decrease in 39 patients (group II). To determine the factors that differentiate group I from group II, cardio-renal haemodynamic and endocrinological indices were evaluated using multivariate analysis. 2. Systolic, diastolic and mean blood pressures on admission were higher in group II (P less than 0.001), whose optic fundi showed more severe changes (P less than 0.001). Although group II had greater left ventricular posterior wall thickness (P less than 0.02), left ventricular mass index (P less than 0.05) and systemic vascular resistance (P less than 0.01) on echocardiography, their cardiac index and ejection fraction were comparable with those of group I. 3. Renal blood flow (P less than 0.05) and glomerular filtration rate (P less than 0.01) were lower in group II than in group I. Renal vascular resistance was more elevated (P less than 0.01) in group II than in group I. 4. After severe sodium depletion and ambulation, group I showed a greater increase in plasma noradrenaline and adrenaline (P less than 0.05). On multivariate analysis, those with lower systolic blood pressure, better renal function and more reactive sympathetic nervous system were discriminated as group I. 5. These data suggest that group I patients have lower systolic blood pressure on admission, greater sympathetic reactivity and better renal function, all of which contribute to their spontaneous blood pressure fall after admission.

Adult↗
PubMed1987

[Natural course of hypertrophic cardiomyopathy: clinical, hemodynamic and echocardiographic features in the end stage].

We investigated the natural course of 59 patients with hypertrophic cardiomyopathy (HCM) in follow-up periods of one to 13 years and analyzed the clinical, hemodynamic and echocardiographic parameters to determine the factors influencing the prognosis. Among these patients, 44 (75%) remained stable in a compensated condition with or without medications. Five patients died suddenly and two died of congestive heart failure. Heart failure developed in another eight. At the initial evaluation, these 15 patients had high left ventricular end-diastolic pressure (mean: 22 +/- 8 mmHg) significantly higher than that of 44 compensated patients (mean: 13 +/- 6 mmHg, p less than 0.001). There were no differences in age at the initial evaluation between compensated and end stage groups. Atrial fibrillation occurred persistently in three and transiently in two among ten patients with heart failure during follow-up periods. Ventricular dimensions and systolic function did not statistically differ between the two groups. However, six patients with heart failure had cavity dilatation and deteriolated ventricular contractile function at the initial evaluation. Four of them did not show any change in left ventricular hypertrophy, but the regional thinning of the wall was observed in the remaining two. There were no characteristic features to predict sudden death in the clinical, hemodynamic or echocardiographic parameters. Thus, increased left ventricular end-diastolic pressure, atrial fibrillation, left ventricular dilatation and the regional thinning of the left ventricular wall are useful predictive markers for poor prognosis in HCM.

Adolescent↗
PubMed1987

[Noninvasive estimation of left ventricular end-systolic pressure].

A method for noninvasively determining left ventricular (LV) end-systolic pressure (ESP) using carotid pulse tracings and cuff-measured blood pressure was re-evaluated. It was validated during diagnostic cardiac catheterization in 60 patients with cardiovascular diseases. LVESP calculated by this method and systolic blood pressure measured by the cuff were compared with aortic dicrotic notch pressures obtained by a catheter-tip manometer system as true LVESP. The calculated ESP was measured by the following formula; [the ratio of the excursion of dicrotic notch (b) to the peak (a) in carotid pulse tracings: (b/a) x pulse pressure] + diastolic blood pressure. This calculated ESP had a high correlation coefficient with true ESP invasively measured (r = 0.96), but was estimated to be 5.3 +/- 5.0 mmHg less than true ESP. Systolic blood pressure, used as a noninvasive index of ESP, accurately estimated ESP, but it was higher by 14.8 +/- 11.2 mmHg (r = 0.84). Calculated ESP measured by the present method was not affected by age or systemic vascular resistance. This is a reliable noninvasive means of estimating LV end-systolic pressure. Compared with the peak arterial pressure, this is a better parameter for the analysis of LV contractility, such as stress-shortening, and end-systolic pressure-volume relations.

Adolescent↗