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Biomedical subjects

R Ajisaka

Publications and source records attributed to R Ajisaka.

At least 19 recordsLinked to original sources
PubMed1999

Phase changes caused by hyperventilation stress in spastic angina pectoris analyzed by first-pass radionuclide ventriculography.

To understand the effect of hyperventilation (HV) stress in patients with spastic angina, left ventricular (LV) contraction was analyzed by quantitative phase analysis. The study was performed on 36 patients with spastic angina pectoris, including vasospastic angina pectoris (VspAP: 16 patients) and variant angina pectoris (VAP: 20 patients). First-pass radionuclide ventriculography (first-pass RNV) was performed at rest and after HV stress, and standard deviation of the LV phase distribution (SD) was analyzed. The SD was lower in patients with VspAP than in VAP (12.8+/-1.4 degrees vs. 14.6+/-2.2 degrees, p < 0.005) at rest. After HV stress, the SD (HVSD) tended to increase in VspAP patients (62.5%), whereas the SD decreased in VAP patients (70%). Due to HV stress, the percentage change in SD (%SD) in VspAP patients was 8.9+/-23.7% whereas that in VAP patients was -9.1+/-17.3% (p < 0.01). Moreover, phase histograms were divided into HVSD increase and HVSD decrease groups. The HVSD increase group had a decrease of HVEF, but the HVSD decrease group tended to have more decreased HVEF than the HVSD increase group. These results indicate that spastic angina pectoris patients show various responses to HV stress. The HVSD increase group might have additional myocardial ischemia due to regional coronary spasm. In contrast, in the HVSD decrease group severe LV dysfunction or diffuse wall motion abnormality might have been generated, and this caused a reduction in the SD value. Phase analysis would therefore add new information regarding electrocardiographically silent myocardial ischemia due to coronary spasm, and HV stress might increase sensitivity for the detection of abnormalities in quantitative phase analysis, especially in VspAP patients.

Adult↗
PubMed1998

Relationship between normalization of negative T waves on exercise ECG and residual myocardial viability in patients with previous myocardial infarction and no post-infarction angina.

The usefulness of normalization of negative T waves in exercise ECG was investigated as an index of myocardial viability in patients with previous myocardial infarction with no symptoms or ischemic ST-segment change during exercise test. A total of 39 patients, 20 with T-wave normalization (POS group) and 19 without T-wave normalization (NEG group) on exercise ECG. were studied. Myocardial viability was evaluated by thallium-201 single-photon emission computed tomography (SPECT) during exercise or at rest. We also assessed left ventricular ejection fraction (LVEF) by contrast ventriculography before (n=39) and after percutaneous transluminal coronary angioplasty (PTCA) (n=17). SPECT detected myocardial viability in 16 (80%) of the 20 patients in the POS group and in 4 (21%) of the 19 patients in the NEG group (p<0.01). LVEF increased after successful PTCA in the POS group (from 53+/-13% to 63+/-8%, p<0.025), but fell in the NEG group (from 57+/-10% to 51+/-8%). It is concluded that normalization of negative T waves on exercise ECG is a useful, simple index of myocardial viability in patients with previous myocardial infarction with no symptoms or ischemic ST-segment change during exercise testing.

Adult↗
PubMed1998

[Transition in home care service in our hospital].

Progress of medical team ability, including analgesic treatment and nursing care, and a building closer connections with welfare services including visiting nurse station, is necessary for home medical care for the terminal cancer patient.

Costs and Cost Analysis↗
PubMed1997

Relation of a decrease in arterial compliance to ST segment depression on exercise electrocardiograms in patients with hypertension.

Decreased arterial compliance (ACo) and increased arterial resistance are the major alterations of arterial function in patients with hypertension. The influence of decreased ACo on the heart was investigated in patients with hypertension. Patients with a systolic blood pressure of > 140 mmHg, a diastolic blood pressure of > 90 mmHg, or both, who had normal coronary arteriograms were enrolled. These patients were divided into two groups according to the value of ACo: Group I, patients with ACo > or = 0.9 ml/mmHg (n = 15); and Group II, patients with ACo < 0.9 ml/mmHg (n = 13). There were no significant differences in arterial resistance, age, gender, and body surface area between the groups. Echocardiographic, hemodynamic, and exercise stress test variables were compared between the groups. There were no differences between the groups in left ventricular (LV) wall thickness and volume, cardiac output, LV end-diastolic pressure, and LV ejection fraction. However, pulse pressure was higher in Group II than in Group I. Ergometer exercise stress testing revealed that, although exercise duration and the peak rate-pressure product were similar in the two groups, ST segment depression of > or = 1.0 mm on the exercise electrocardiograms was induced more frequently in Group II than in Group I (92% vs. 27%, p < 0.001). Thus, the decrease in ACo in patients with hypertension may not significantly affect LV wall thickness, volume, or ejection fraction; however, it may increase pulse pressure and may adversely affect coronary circulation, as suggested by the ST segment depression on exercise electrocardiograms.

Arteries↗
PubMed1997

[Typical normal cases and normal cases with abnormal image pattern in every myocardial SPECT radiopharmaceutical].

Working group of cardiac nuclear medicine was made as a Japanese part of society of international cardiac nuclear medicine under the cooperation between Japanese society of nuclear medicine and Japanese society of cardiology. We investigated typical normal cases and normal cases with abnormal image pattern in every myocardial SPECT radiopharmaceutical as one of the research activity of working group. From 11 faculties, 16 T1 cases, 14 BMIPP cases, 8 MIBG cases, 8 MIBI cases and 14 tetrofosmin cases were submitted as typical normal cases, and 12 T1 cases, 5 BMIPP cases, 12 MIBG cases, 10 MIBI cases and 5 tetrofosmin cases were submitted as normal cases with abnormal image pattern. We summarized the condition of SPECT data acquisition of each faculties. And we added the discussion from literature about how to discriminate normal cases with abnormal image pattern from abnormal cases. In MIBG, patterns of typical normal cases and normal cases with abnormal image pattern were slightly different from other 4 pharmaceuticals. In other 4 pharmaceuticals, diaphragmatic attenuation, breast attenuation, apical thinning and others were presented as normal cases with abnormal image pattern.

3-Iodobenzylguanidine↗
PubMed1997

[Transition in nutritional management and the home care service system in our hospital].

During the past two years, Kaname-cho Hospital has been diligent in meeting the health care needs of its patients through its home care service. In nutritional management, considering the activity of daily living (ADL) and the burden of the family, gastrostomy and intravenous hyperalimentation (IVH) have been increased. Although we started with services provided by physicians, nurses, and medical social workers (MSW), recently clinical pharmacists and dieticians have entered our home care services. Due to the strong support of our staff, it is now possible for Kaname-cho Hospital to provide a very fine, efficient home care service.

Community Health Nursing↗
PubMed1997

[Drug consultation and at home care--the present situation and the point at issue in our hospital].

We began drug consultation in our hospital and at home care about one year ago, because of progress in the quality of medical care. As the method for drug consultation, we tried to educate patients using our own pamphlets. It was assumed that the education was important not only for the patients but also for their family. Again, it was assumed that the usefulness of a conference with doctors, nurses, MSW and us made for better compliance in taking drugs, assured early detection of side effects and better management of the disease. With home care, it is supposed that the drug consultation will be carried out by clinical pharmacists will make for progress in the quality of medical care.

Home Care Services, Hospital-Based↗
PubMed1996

Effect of percutaneous transluminal coronary angioplasty on exercise ventilation in patients with coronary artery disease and normal left ventricular function.

We evaluated the ventilatory response to exercise before and after percutaneous transluminal coronary angioplasty (PTCA) in 22 patients with coronary artery disease (CAD) and normal left ventricular systolic function to determine the effect of exercise-induced myocardial ischemia on the ventilatory response. Subjects performed a symptom-limited maximal ergometer exercise test in the sitting position. The ventilatory response was evaluated in terms of the slopes of minute ventilation (VE) and carbon dioxide production (VCO2) during exercise (slope 1 and slope 2, defined as below and above the respiratory compensation threshold, respectively). Slope 1 of the correlation between (VE) and (VCO2) was significantly greater in patients with CAD (27.3 +/- 2.6) than in the age-matched control group (23.7 +/- 2.6; p < 0.01). Slope 2 was also significantly greater in patients (41.0 +/- 4.8) than in the control group (29.7 +/- 2.9; p < 0.01). Slope 1 of the correlation between (VE) and (VCO2) decreased significantly in the 14 patients in whom PTCA was successful but did not decrease in the 8 patients in whom PTCA failed. Our results suggest that myocardial ischemia increases exercise ventilation in patients with CAD and normal left ventricular systolic function and that its effect is reversible.

Adult↗
PubMed1996

Alterations in left ventricular wall stress and coronary circulation in patients with isolated systolic hypertension.

OBJECTIVES: To study the alterations in cardiac function and coronary circulation in patients with isolated systolic hypertension (ISH). PATIENTS: Ten patients with a history of ISH were studied and findings were compared with those of seven normotensive subjects. All of the patients had angiographically normal coronary arteries. They underwent cardiac catheterization, and haemodynamic variables and coronary flow velocity were measured. All of the patients also underwent treadmill exercise testing. MAIN OUTCOME MEASURES: Left ventricular mass was evaluated by echocardiography. The coronary flow velocity data were obtained by using the intracoronary Doppler catheter technique. ST-segment depression was observed on the exercise electrocardiogram. RESULTS: Systemic vascular resistance did not differ, whereas total arterial compliance was decreased in the ISH patients versus the controls (P < 0.001). The left ventricular mass of the ISH patients was increased slightly, but their left ventricular systolic wall stress was greater than that of the controls (P < 0.01). The coronary flow reserve ratio and the ratio of diastolic to total coronary flow were decreased in the ISH patients versus the controls (P < 0.01). ST-segment depression on the exercise electrocardiogram was frequently observed in the hypertensive patients (80 versus 0% in control subjects, P < 0.01). CONCLUSIONS: Patients with ISH were characterized haemodynamically by a decrease in arterial compliance. They showed an increase in left ventricular systolic wall stress and also showed decreases in coronary flow reserve ratio and in the relative diastolic coronary flow. Such alterations observed in patients with ISH are detrimental to the heart and may contribute to a reduced exercise capacity and the induction of subendocardial ischaemia during exercise.

Adult↗
PubMed1996

Effect of warming of exercising legs on exercise capacity in patients with impaired exercise tolerance.

OBJECTIVE: The purpose of this study was to determine whether warming of exercising legs improves exercise capacity in patients with cardiac disease and low exercise tolerance. BACKGROUND: Exercising muscle temperature reflects both muscle metabolic rate and muscle blood flow. Increase in muscle temperature in exercising legs is impaired in patients with chronic heart failure. We hypothesized that the mechanisms responsible for impairment of temperature increase in exercising muscle might be related to those responsible for low exercise tolerance. METHODS: We studied 17 patients with cardiac disease whose anaerobic threshold (AT) ranged from 6.6 to 14.8 ml/kg/min (mean 11.2 +/- 1.9 SD). Subjects performed symptom-limited sitting cycle ergometer exercise with or without warming of the thighs. Both thighs were warmed by use of hot packs fixed by supporters. To determine the effect of the supporters themselves on AT and peak VO2, the same ergometer exercise was performed by 7 patients with or without supporters. Peak VO2 and AT were determined by concomitant respiratory gas monitoring. RESULTS: 1) Warming of the thighs increased deep temperature in the thighs (1.0 approximately 2.8 degrees C). 2) AT and peak VO2 were significantly improved in the warming exercise compared with the non-warming exercise (p < 0.01, p < 0.01). 3) There was no significant difference in AT or peak VO2 between the exercise with and without supporters. CONCLUSION: The findings of this study indicate that warming of exercising legs improves exercise capacity in patients with cardiac disease and low exercise tolerance.

Aged↗
PubMed1996

[What terminal cancer patients seek from nurses in treatment at home].

We have provided care at home for 29 patients who were terminally ill, and from the fact that 3 of them needed excretion care, we learned something important for successful nursing care. The first necessity is the technical skill and knowledge of nursing care for the terminal cancer patients. We need to be able to provide guidance for the patient or family. The second is prompt consultation anytime when the patient or family needs it. The key to success is to create a medical network system for terminal cancer patients. The third is to provide support for the patient and family so that they pass the time without pain and meaningfully.

Caregivers↗
PubMed1995

Effects of L- and DL-carnitine on patients with impaired exercise tolerance.

We designed this study to determine whether orally administered L- and DL-carnitine can improve exercise tolerance in a group of patients with exercise intolerance. Nineteen patients with cardiac disease were randomly divided into 2 groups, an L-carnitine treatment group (n = 9) and a DL-carnitine treatment group (n = 10). Eight additional age-matched patients served as an untreated control group. Subjects in both carnitine treatment groups underwent cardiopulmonary exercise testing on a cycle ergometer in order to determine peak exercise time, peak oxygen uptake (VO2), lactate threshold (LT) and ventilatory threshold (VT) before and after the oral administration of 900 mg/day of L- or DL-carnitine for 2 weeks. Basal values of peak exercise time, peak VO2, LT and VT did not differ significantly among the 3 groups. Peak exercise time and peak VO2 tended to be increased in the L-carnitine treatment group, and tended to be decreased in the DL-carnitine treatment group. Both LT and VT (ml/kg/min) were significantly improved (LT: from 9.7 +/- 0.6 to 10.8 +/- 1.0, p < 0.05; VT: from 9.8 +/- 0.8 to 11.8 +/- 1.9, p < 0.02) by the administration of L-carnitine, while LT was significantly decreased (from 11.0 +/- 2.0 to 9.6 +/- 1.2, p < 0.05) and VT tended to be decreased by the administration of DL-carnitine (from 11.6 +/- 2.0 to 10.8 +/- 2.4). In the untreated control group, no significant changes were observed in the values of exercise tolerance between the 2 series of exercise testings. In neither group did carnitine modify hemodynamic parameters at rest or during exercise. In conclusion, this study demonstrated that L-carnitine increases and DL-carnitine decreases exercise tolerance in patients with impaired exercise tolerance.

Administration, Oral↗
PubMed1995

Exercise-induced rise in arterial potassium is enhanced in patients with impaired exercise tolerance.

We assessed the changes in arterial potassium concentration during exercise and recovery in relation to exercise tolerance in patients with impaired exercise tolerance. Sixteen patients with cardiac disease were subjected to a cardiopulmonary exercise test on a cycle ergometer. Arterial potassium and lactate concentrations were measured every minute during and after exercise, and ventilatory threshold (VT) and lactate threshold (LT) were identified. Before exercise, arterial potassium concentration was 3.8 +/- 0.3 mEq/l. It increased to 4.1 +/- 0.3 mEq/l at LT (p < 0.002 versus at rest), to 4.2 +/- 0.3 mEq/l at VT, and to 4.8 +/- 0.5 mEq/l at peak exercise (p < 0.001 versus at LT, p < 0.001 versus at VT). At an exercise intensity equivalent to 30, 40, 50 or 60% of predicted maximum oxygen uptake, the increase in arterial potassium showed a negative and significant correlation with %LT (r = -0.62 approximately -0.72, p < 0.01 approximately 0.05) and %VT (r = -0.62 approximately -0.75, p < 0.001 approximately 0.05), where %LT and %VT represent the ratios of LT and VT to the predicted maximum oxygen uptake, respectively. There was a good correlation between the rate of fall in potassium concentration during recovery and its increase during exercise. It was concluded that in patients with impaired exercise tolerance, the greater the degree of exercise intolerance, the greater the increase in arterial potassium concentration during exercise, and the steeper the fall in potassium concentration during recovery. Because the rise in potassium concentration during exercise and its fall during recovery were greater when the exercise level exceeded the anaerobic threshold, exercise levels below the anaerobic threshold are recommended for patients with cardiac diseases.

Aged↗
PubMed1995

Usefulness of hyperventilation thallium-201 single photon emission computed tomography for the diagnosis of vasospastic angina.

To establish a safe and sensitive diagnostic procedure for detecting coronary vasospasm, we utilized 201-thallium myocardial SPECT combined with hyperventilation (HV-SPECT) in 29 patients with vasospastic angina (VAP) and 11 controls. Twenty-five of 29 patients with VAP and 5 of 11 controls developed transient perfusion defects on HV-SPECT, resulting in a sensitivity and specificity calculated at 86% and 55%, respectively. Overall accuracy in identifying corresponding vessels with coronary vasospasm, respectively. Coronary vasospasm tended to be identified more accurately in the left anterior descending branch and the right coronary artery than in the circumflex branch (75%, 71% and 50%, respectively). The hyperventilation test induced ischemic ECG changes in 11 of 29 patients with VAP, yielding a sensitivity of 38%. Analyzing the washout rate of HV-SPECT in patients with VAP, both the extent and severity scores of patients with ischemic ECG changes were larger than those of patients without. No serious complications occurred during HV-SPECT. In conclusion, HV-SPECT was a safe and sensitive procedure as a primary diagnostic approach for VAP. From the results of washout analysis, HV-SPECT could detect more mild myocardial ischemia than could the ECG, and seemed quite useful especially for detecting coronary vasospasm accompanied by minimal ischemic ECG changes.

Adult↗
PubMed1995

Resting asynchronous left ventricular contraction abnormality analyzed by a phase method in spastic angina pectoris.

UNLABELLED: Quantitative phase analysis of equilibrium ventriculography was performed to study the character of left ventricular (LV) wall motion abnormalities in patients with spastic angina pectoris, who may have clinically and electrocardiographically silent ischemia combined with myocardial stunning, during rest and hyperventilation stress testing. METHODS: Phase analysis of the left ventricle at rest was performed by equilibrium radionuclide ventriculography in 13 control subjects and 36 patients with spastic angina pectoris. First-pass methodology along with hyperventilation stress testing was performed to assess spasm occurrences. Phase analysis of equilibrium multigated blood-pool scintigrams was performed to evaluate LV asynchrony at rest. RESULTS: The mean s.d. of LV phase distribution in the patients with variant and vasospastic angina was greater than that in the healthy control subjects (11.28 +/- 1.79 and 10.02 +/- 1.57 degrees versus 6.16 +/- 1.07 degrees). In addition, the mean s.d. of LV phase distribution in the variant angina group was greater than that in the vasospastic angina group. Furthermore, a linear correlation was found between the s.d. of LV phase distribution at rest and the percent decrease in ejection fraction during hyperventilation stress. CONCLUSION: Asynchronous LV contraction without significant hypokinesis was detected at rest in spastic angina pectoris. The severity of this asynchronous contraction corresponded well with decreases in ejection fraction during hyperventilation stress testing. Thus, analysis of the s.d. of LV phase distribution at rest is expected to provide useful information regarding LV asynchrony in spastic angina pectoris.

Adult↗